No abstract

Die-punch fragments refer to articular cartilage and subchondral bone embedded in cancellous bone as part of an intra-articular fracture. Bartoní cek type IV posterior malleolar fractures with associated die-punch fragments are rare, and the appropriate surgical approach remains unclear. We determined outcomes, and the effect of diepunch fragment size on outcomes, for 32 patients with Bartoní cek type IV posterior malleolar fractures with diepunch fragments between January 2015 and December 2017. Mean follow-up for all patients was 23.8 (range 20.0-30.0) months. At the final follow-up visit, mean ankle dorsal extension was 24.6°and plantar flexion was 40.0°; American Orthopaedic Foot and Ankle Society ankle-hindfoot score was 88.6 § 4.3; visual analog scale weightbearing pain score was 1.5 § 0.6; and Bargon traumatic arthritis score was 0.8 § 0.4. There were no severe complications. We divided patients into a small-fragment (≤3 mm) group (n = 12) and large-fragment (>3 mm) group (n = 20). The Bargon scores at final follow-up were 0.5 and 1, respectively (P=.02). There were no statistically significant differences between the 2 groups for the other outcome scores at various time intervals. The posterolateral approach with distal locking plate internal fixation for Bartoní cek type IV posterior malleolar fractures with die-punch fragments can result in excellent anatomical reduction of the collapsed articular surface and the displaced fragment from the tibial plafond, recovery of articular surface congruity, and maintenance of joint stability. Die-punch fragment size may not impact clinical and functional outcomes but may contribute to post-traumatic arthritis.

Background: Local infiltration analgesia (LIA) has become popular in postoperative pain relief after total hip arthroplasty (THA) or total knee arthroplasty (TKA). The aim of this meta-analysis was to compare the efficacy and safety of LIA with intrathecal morphine and epidural analgesia after THA and TKA. Methods: A systematic article search was performed from PubMed, Embase, and Web of Science databases, up to February 21, 2019. The main outcomes included visual analog scale for assessment of pain, morphine equivalent consumption, length of hospital stay, and adverse events. The data were calculated using weight mean difference (WMD) or risk ratio (RR) with 95% confidence intervals (95% CIs). Results: Eleven studies with a total of 707 patients met the inclusion criteria and were included in this meta-analysis. LIA provided better pain control than other 2 techniques at 24-hour (WMD = 10.61, 95% CI: 3.36–17.87; P = .004), 48-hour (WMD = 16.0, 95% CI: 8.87–23.13; P < .001), and 72-hour (WMD = 11.31, 95% CI: 3.78–18.83; P < .001). Moreover, LIA had similar morphine consumption and duration of hospital stay with intrathecal morphine and epidural analgesia. There was significantly lower incidence of adverse events with LIA than with the other 2 techniques. Conclusion: LIA provided better postoperative pain control and less adverse events than intrathecal morphine and epidural analgesia after THA and TKA.

We herein report the long-term effect of valgus intertrochanteric osteotomy for nonunion after femoral neck fracture. In this report, we describe our experience using valgus intertrochanteric osteotomy to treat nonunion after femoral neck fracture in a 20-year-old woman. The patient was discharged from the hospital 10 days after the operation, the internal fixation device was removed 1 year after the operation, and the patient was then followed up for 18 years. Valgus intertrochanteric osteotomy can effectively treat nonunion after adductive femoral neck fracture.