Pelvic injuries have an incidence of 1: 100 000 children per year in the UK, of which 10% are unstable. A literature review was conducted. Clinical examination alone in a stable patient precludes the need for imaging. Imaging options in the acute pelvic injury are critically reviewed. Where appropriate Judet views or limited exposure computed tomography scan remain of diagnostic benefit. Displacement greater than 1 cm should be reduced and held with an appropriate method. Closed reduction and external fixation for rotationally unstable fractures, and closed or open reduction with internal fixation of two columns should be considered for rotationally and vertically unstable fractures.
A 51-year-old woman with rheumatoid arthritis presented to clinic with an increasingly painful knee. The patient had undergone patellectomy for patellofemoral arthritis 10 years previously. The patient achieved some relief with this procedure but, in the intervening time, her symptoms had deteriorated. In the last 8 months, she had increasing pain and was unable to sleep. After knee arthroscopy showing extensive arthritic changes, the decision was taken to offer her primary arthroplasty of her knee with patellar reconstruction using posterior lateral femoral condyle graft taken at the time of arthroplasty.The patient underwent a standard total knee arthroplasty with patellar reconstruction as described below. Tracking of the new patella was satisfactory intraoperatively and arthroplasty was completed. Postoperative care was as per standard protocol for primary total knee arthroplasty with straight leg raises, flexion exercises and full-weight bearing the next day.The patient was seen at 6 weeks, 1 year, 2 years and 4 years from knee arthroplasty. The patient remains symptom free, with no anterior knee pain and no symptoms of instability.On examination, the knee was pain free to palpation with a full range of motion of 0-100º flexion as standard with the implant used. There was no extensor lag and the
On the basis of this study in the context of animal model and observational evidence, the area of physeal injury using drill tunnels for anterior cruciate ligament reconstruction would not appear to contribute to potential growth disturbances.
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