BackgroundThe purpose of this study is to analyze the clinical results and related complications of the femur plate system (FP) and the retrograde-inserted supracondylar nail (RISN).Materials and methodsThe study included 42 cases of periprosthetic supracondylar femoral fractures (PSF) proximal to posterior stabilized total knee arthroplasty between 2005 and 2009. Twenty-four cases of PSF were treated with the FP, and the other 18 cases were treated with the RISN. This study cohort was divided into subgroups according to the AO classification. We retrospectively compared the clinical results between the FP and RISN group.ResultsThere were no significant differences between the two groups in terms of time of clinical union (p = 0.649). In the subgroup analysis, the mean operation time was significantly different only in subgroup A1 (p = 0.03). Complications were seen in 29.2 % (7/24) of patients in the FP group and 27.8 % (5/18) in the RISN group. The age during the index TKA and fracture fixation was a significant risk (p = 0.008) factor for complications between the two groups. No significant differences were found in the other factors between the two groups. The p value for operative time (p = 0.223), immobilization period (p = 0.129), ROM (p = 0.573), KSS (p = 0.379), KSS functional scores (p = 0.310) and time to union (p = 0.649).ConclusionClinical results did not differ according to the treatment methods used. Fixation method and fracture type did not cause an increase in the complication rate, but there was a trend toward higher non-union rates with the FP method and higher re-fracture rate with the RISN method. Noting the fact that only increasing age correlated with an increased complication rate, more careful attention should be paid to elderly patients in terms of both prevention and surgical care.Level of evidence Level III, therapeutic study.
Background: There are several studies that have focused on functional outcome and rate of recurrent infection for patients undergoing two-stage revision total knee arthroplasty (TKA) for the treatment of periprosthetic joint infection (PJI). However, there are very few studies assessing the mental health status of these patients, which is why we conducted a study to assess and compare the mental health status between patients who underwent first-stage revision with a static spacer and those who had an articulating spacer. Our hypothesis was that the patients with articulating spacers have a lesser degree of mental stress than those with static spacers. Methods: From 2011 to 2013, a total of 40 knees with a diagnosis of PJI were treated with a standard two-stage revision TKA. Hospital anxiety and depression scale (HADS)-A and D, Visual Analogue Scale (VAS), Short-form-36 mental health (SF-36) scores were compared between groups preoperatively and 4 weeks postoperatively. Results: There were no significant differences between the two groups. Similarly, P value did not show any significant differences between the groups for both VAS and SF-36 score even though it was significant within the groups for VAS score preoperatively and postoperatively (P<0.0001). Conclusions: Both articulating and static spacers significantly reduced the psychological stress on the patients undergoing two-stage revision for PJI. Based on our results, we concluded that improvement in mental health status of both articulating and static spacer groups were comparable with no statistically significant differences.
BACKGROUND: Open tibia diaphysis fractures are complex injuries associated with a high incidence of soft tissue complications and union. Management of it varies with soft tissue and its outcome requires an aggressive approach towards patient along with revision surgery, so study was conducted to assess the outcome of closed proximal tibia fracture management. AIM AND OBJECTIVES: The study was conducted to assess the outcome of compound fractures of tibia managed by interlocking Intra-medullary nailing or External Fixator, to evaluate the incidence of complications and need for secondary procedures in these open fractures and to assess various factors/variables that may affect the outcome of such fractures when treated by these implants. STUDY DESIGN: Prospective type, MATERIALS AND METHODS: 50 consecutive closed tibial plateau fractures were included in this study. All fractures were classified according to Gustilo Anderson classification.There were 42 men and 8 women The study was conducted between June 2009 and October 2011 at the Department of Orthopaedics, New Civil hospital, Surat after the Ethical committee approval. The final outcome was assessed using the Modified Ketenjian's Criteria. The results were analysed using different parameters; male vs. female, age distribution, mode of trauma, functional outcomes and complications etc. RESULTS AND CONCLUSION: The average age was 35.6 years with the fracture being more common in the 2 nd to 5th decades. 90 % sustained fracture due to road traffic accident. The most common location of fracture was middle 3rd shaft of tibia (50%) and most common type was Open Grade 2 (52%) fracture according to Gustilo-Anderson classification. Patients treated by Interlocking nailing(n=33) group had high (90.9%) chances of union at final follow up, while only 70.58% of patients had union treated by external fixator group(n=17). Functional evaluation were assessed by modified Ketenjian's criteria, with results 28(56%) excellent, 10(20%) good, 5(10%) fair and 7(14%) poor results. Complication being infection(12), nonunion(6), ant knee pain(6), delayed andmal union(4) and osteomylitis(1).
BackgroundWe hypothesized that not all persons with end-stage lateral osteoarthritis (OA) have valgus malalignment and that full extension radiographs may underreport radiographic disease severity. The purpose of this study was to examine the demographic and radiographic features of end-stage lateral compartment knee OA.Materials and methodsWe retrospectively studied 133 knees in 113 patients who had undergone total knee arthroplasty between June 2008 and August 2010. All patients had predominantly lateral idiopathic compartment OA according to the compartment-specific Kellgren–Lawrence grade (KLG). The mechanical axis angle (MAA), compartment-specific KLG and joint space narrowing (JSN) of the tibiofemoral joint at extension and 30° of knee flexion, tibia vara angle, tibial slope angle, body mass index, age, and sex were surveyed.ResultsEnd-stage lateral compartment knee OA has varus (37.6 %), neutral (22.6 %), and valgus (39.8 %) MAA on both-leg standing hip-knee-ankle radiographs. KLGs at 30° of knee flexion (fKLG) were grades 3 and 4 in all patients. However, for KLGs at full extension (eKLG), 54 % of all patients had grades 3 and 4. The others (46 %) showed grades 1 and 2. We observed significant differences in lateral compartment eKLG/eJSN (2.3/2.3 mm in varus, 2.5/1.9 mm in neutral, 2.9/1.6 mm in valgus, p = 0.01 and 0.03, respectively), tibia vara angle (4.9° in varus, 4.1° in neutral, 3.0° in valgus, p < 0.01), and medial compartment eKLG/eJSN (2.1/3.1 mm in varus, 2.0/3.4 mm in neutral, 1.8/4.3 mm in valgus, p < 0.01 and 0.01, respectively) between MAA groups, except for the tibial slope angle (9.7° in varus, 10.1° in neutral, 9.8° in valgus, p = 0.31).ConclusionVarus alignment was paradoxically shown in approximately one-third of those with end-stage lateral knee OA on both-leg standing hip-knee-ankle radiographs. Films taken in full extension underreported the degree of OA radiographic severity.Level of evidenceLevel IV, observational study.
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