Osteonecrosis of the lateral femoral condyle following anterior cruciate ligament reconstruction: is bone bruising a risk factor?

Osteonecrosis of the knee is extremely rare following anterior cruciate ligament (ACL) reconstruction surgery. We report a case of osteonecrosis of the lateral femoral condyle in a patient after ACL reconstruction. The osteonecrotic lesion occurred in the same area as a large bone bruise, which was sustained at the time of the initial injury. We hypothesize that the combination of bone bruising and femoral tunnel drilling for ACL reconstruction may have compromised the overall vascularity of the articular cartilage and the subchondral bone, thereby resulting in osteonecrosis.     

Salter–Harris type III fracture of the lateral femoral condyle with a ruptured posterior cruciate ligament: an uncommon injury pattern

We report a case of an obscure injury to the distal femoral epiphysis with an uncommon pattern in a 12-year-old boy following a road traffic accident. Initial plain radiographs of the knee were inconclusive. Further investigation with magnetic resonance imaging revealed Salter–Harris type III fracture of the lateral femoral condyle with a gap at the fracture site associated with avulsion of the posterior cruciate ligament. This potentially serious injury can be underestimated on plain radiographs and therefore any suspected injury to the distal femoral epiphysis should be thoroughly assessed and investigated to institute appropriate treatment and minimise the risk of long-term complications.     

An unusual anterior dislocation of fractured mandibular condyle leading to psuedo-ankylosis in a 8 yr old child—A distinct case report

IntroductionLiterature reviews are replete with discussions focusing on the incidence, types, and patterns of disruption in TM joint function, besides enumerating and classifying its causes. However, atypical situations do present, such situations warranting a detailed, methodical assessment before therapeutic institution.Presentation of caseDescribed here is management of a unique case of post-traumatic pseudo-ankylosis in a 8 year old child that had an old fractured condyle, displaced and dislocated anteriorly into the sigmoid notch, with eventual fusion to the ipsilateral zygomatic arch on its medial side.DiscussionAlthough conventional imaging tools still have relevance, but the significance of multi detector CT scan with multiplanar reformation and three dimensional images have a become unequivocally a standard part of assessment of such complex facial injuries regardless of therapeutic setting. The probable explanation for the condylar fracture and unusual anterior dislocation of the condylar segment is also hypothesized.ConclusionAlthough Post traumatic ankylosis is common in developing countries like India, distinct cases do present rarely which requires a disciplined approach in the management of such cases.     

Is lateral ankle sprain of the child and adolescent a myth or a reality? A systematic review of the literature

BackgroundAnkle trauma in children and adolescents is the most common orthopedic injury encountered in pediatric trauma. It has long been recognized that a lateral ankle injury in this population is often a Salter and Harris type I fracture of the distal fibula (SH1). The purpose of this study is to confirm the existence of a lateral ankle sprain and to report the incidence of each pathology of the lateral ankle compartment: SH1 fracture, ATFL injury, and osteochondral avulsions.MethodsA systematic review of the literature is done using the database provided by PubMed and Embase. All articles reporting the incidence of imaging modality-confirmed lateral ankle injury (SH1, ATFL injury, osteochondral avulsion) in children and adolescents were included. Exclusion criteria were the following: case reports or articles with less than ten subjects, unspecified imaging modality and articles unrelated to lateral ankle lesions. Thus, 237 titles and abstracts were selected, 25 were analyzed thoroughly, and 11 articles were included for final analysis.ResultsSH1 fractures were found in 0–57.5% of the cases in all series and 0–3% in the most recent series. A diagnosis of an ATFL injury was found in 3.2–80% and an osteochondral avulsion of the distal fibula in 6–28.1%. The most recent series report 76–80% and 62% for ATFL injury and osteochondral avulsion respectively.ConclusionsThere is a non-negligible incidence of ATFL sprains and fibular tip avulsions in patients with a suspected SH1 fracture of the distal fibula. According to recent evidence and MRI examinations, the most common injuries of the pediatric ankle are ATFL sprain and osteochondral avulsions. This should be taken into consideration in daily practice when ordering radiological examination and deciding on treatment modalities     

Spatial clustering of remodeling osteons in the femoral neck cortex: a cause of weakness in hip fracture?

Intracapsular femoral neck fractures are associated with decreased cortical width and increased proportions of Haversian canals with diameters greater than the normal mean plus 3 SD (i.e., >385 microm). Such canals might be formed if closely associated resorbing osteons merge; a cortical event analogous with the loss of cancellous connectivity. To test this, we investigated the pattern of osteon distribution in the aging femoral neck to determine if remodeling osteons were distributed in anatomical clusters. Femoral neck biopsies from female patients with intracapsular hip fractures (n = 13) were compared with age/gender-matched cadaveric controls (n = 13). Solochrome-stained sections were analyzed for Haversian canal location, canal diameter, and the presence of an osteoid surface. Clustering was investigated using statistical software with a cluster defined as two or more osteoid-bearing osteon centers within 0.75 mm of each other. Clusters occurred more frequently than would be expected by chance (p < 0.001). Fracture cases had more clusters per unit area (3.14 +/- 0.31 clusters/25 mm2 of cortical bone) than controls (1.89 +/- 0.22) (p = 0.002). In fracture cases, the antero-inferior, antero-superior, and infero-anterior regions had more clusters per 25 mm2 than comparable control regions (ant/inf: 4.12 +/- 0.79, 1.70 +/- 0.60,p = 0.025; ant/sup: 5.31 +/- 1.1, 1.80 +/- 0.59,p = 0.013; inf/ant: 3.15 +/- 0.49, 1.27 +/-0.29, p = 0.004). The mean number of clusters per 25 mm2 per region correlated with the mean porosity per region (adjusted r2 = 0.60;p = 0.014), and the total number of giant canals per region correlated with the total number of clusters per region (adjusted r2 = 0.58; p = 0.011). In conclusion, remodeling osteons are clustered or grouped anatomically, and fracture cases have more clusters than controls. Our data suggest that merging of adjacent, clustered osteons during resorption could lead to the rapid development of canals with excessive diameters and focal weakness. Clustering is greatest in those regions that we have previously shown to have the largest relative reductions in bone strength compared with controls and known to be maximally loaded during a sideways fall. This implicates the remodeling process underlying clustering of remodeling osteons in the aetiology of hip fracture.     

Could this unusual scaphoid fracture occurring in a badminton player be a stress fracture?

An unusual fracture of the scaphoid occurred in an otherwise healthy young badminton player, caused by a violent movement of extension/flexion of the wrist while performing a smash. There was no direct blow or fall on the wrist, nor history of wrist pain prior to the fracture. No underlying pathology was identified. Conservative treatment failed and surgical stabilization was required to achieve bone union. The diagnosis of stress fracture was suggested. The characteristics of these uncommon fractures are reviewed.     

The transfer of the posterior femoral condyle – first results of a salvage operation

In this study large osteochondral defects on the weight-bearing surface of the medial and lateral femoral condyle were treated by transplantation of the autologous posterior condyle in 20 patients. The cartilage defects, type Outerbridge IV, ranged in size from 2 x 1.5 cm to 5 x 3.5 cm. 8 condyle transfers were done from 1984-1996 at the orthopaedic clinic of the university of Balgrist, Zürich. 12 condyle transfers at the department of orthopedic sports medicine at the technical university of Munich from 1996-1998. Patients were operated before the condyle transfer, 2 times on average. In 9 patients a high tibial osteotomy was performed simultaneously. Clinical evaluation was done according to the Lysholm score. The Lysholm score improved in the patient serie from 1996 from preoperatively 62 (54-81) points to postoperatively 85 (74-95) points. The follow-up was on average 9.8 (2-26) months. 18 patients reported about pain relief, 2 patients didn't improve. We describe the operative technique. Despite the lack of long-term results the transfer of the autologous posterior condyle seems to be an effective alternative for the knee prosthesis, especially for young patients with a great cartilage damage in the weight bearing area.     

Femoral shaft fracture and secondary diagnosis of ipsilateral femoral neck fracture. Typical constellation or a complication of the distal femoral nail (DFN)?

We present a case of two patients with a distal femur shaft fracture due to a high velocity trauma. Both were treated with a distal femur nail (DFN). After mobilisation a fracture of the neck of the femur was diagnosed which was not seen in the x-rays on admission. In this paper we discuss whether this is a typical constellation of ipsilateral fractures of the neck of the femur in femur shaft fractures or a complication of implantation of a DFN. Immediately after operative treatment of a femur shaft fracture specifically after high velocity trauma or in polytraumatized patients an x-ray of the hip in two plains should be made in the same narcosis. A possible fracture of the neck of the femur could be treated at same time. Post-operatively a further diagnostic should be done in case of suspicion, e.g. pain during mobilisation.     

The femoral neck fracture in the elderly patient - cemented or cementless hip arthroplasty?

This is a report on the treatment results of femoral neck fractures with a cemented (group 1) and cementless (group 2) type of hip prosthesis, resp. 72 patients were enrolled. 35 patients were treated with a cemented hip prosthesis (mean age: 78 years), and 37 patients with a cementless modular hip prosthesis (mean age: 77 years). In the cemented group we observed 5 cases of hypotension during insertion of the prosthesis in the femoral shaft. One of these patients required mechanical resuscitation during surgery. In the second group 3 cases of proximal femur fissure and one case of distal femoral fracture were recorded. One year after surgery 43 patients presented for follow up evaluation (cemented group: n = 24; cementless group: n = 19). Both groups revealed comparable results according to the Harris Hip Score (75 versus 78,3 points). No prosthesis loosening was observed in either group. In our view the cemented hip prosthesis is the treatment of choice for femoral neck fractures among the old and very old, if no stabile osteosynthesis can be performed. Patients with cardiopulmonary risk factors, however, may profit from cementless hip arthroplasty to avoid the well known cardiodepression during surgery.     

Role of dual energy X-ray absorptiometry in monitoring fracture healing in a rat femoral fracture model

Earlymobilizationandweightbearingplayimportantrolesinminimizingtheamountofbonelosstoachievegoodhealingafterbonefracture.1Areliableandnoninvasivemethodforevaluatingfracturehealingcannotonlyhelpdecidewhentostarweightbearing, butalsohelpdetecttheimpairedboneunionearlytopreventdelayedunionsornonunions.However, objectivequantitativemethodsforearlyevaluationoffracturehealinghavenotbeendevelopedyet. DualenergyX rayabsorptiometry(DEXA)isoneofthemostaccuratemethodsformeasuringbonemassinvivo. Itismain…     

Analysis of prosthetic replacement in treatment of femoral neck fracture on the hemiplegia side in the elderly

InChinathepopulationofoldpeopleisincreasing ,sotooisstrokeorfemoralneckfracture (FNF) .Thesequelaeofhemiplegiccausedbystrokeisquitecommon ,andfemoralneckfracturesonthehemiplegiasidehappenfrequently .BetweenMay1990andMay 2 0 0 0 ,2 9elderlyhemiplegiapatientswhohadhadstrokewithGardentypeIIIortypeIVfemoralneckfracturesonthehemiplegiasideweretreatedwithprosthesisreplacement .The presentstudyanalyzedthecurativeeffectof prostheticreplacementintreatmentoffemoralneckfracturesonthehemiplegiasidein…     

Hemiarthroplasty for a displaced femoral neck fracture: with or without bone cement?

European Journal of Orthopaedic Surgery & Traumatology -