One-stage total knee arthroplasty combined with open reduction and internal fixation for knee osteoarthritis complicated with tibial stress fracture北大核心CSCD

Objective To explore one-stage total knee arthroplasty (TKA) combined with open reduction and internal fixation (ORIF) for knee osteoarthritis complicated with tibial stress fracture. Methods The 3 patients were retrospectively analyzed who had been treated for knee osteoarthritis complicated with tibial stress fracture at Department of Orthopedics, Ganzhou District People's Hospital from March 2018 to March 2020. They were all female, aged from 54 to 76 years (average, 66 years). There were 2 transverse fractures and one short oblique fracture; all of them had knee varus deformity. The Hospital for Special Surgery (HSS) scores averaged 37.6 (from 28 to 50) for the left knee and 28.3 (from 22 to 39) for the right knee. One-stage TKA was performed for the articular surface while ORIF for the right tibial stress fracture for all patients. Recorded were fracture union time, HSS knee score and range of articular motion. Results The 3 patients were followed up for 25 to 44 months (average, 32 months).The fracture union time ranged from 4 to 7 months (average, 5 months). The last follow-ups revealed no such complications as prosthesis loosening, peri-prosthesis osteolysis or joint instability. Knee varus deformity was corrected in all patients. The HSS knee scores at the last follow-up averaged 89.6 (from 88 to 91) for the left knee and 88.3 (from 85 to 90) for the right knee. Conclusion In the treatment of knee osteoarthritis complicated with tibial stress fracture, one-stage TKA combined with ORIF can restore the function of knee joint, leading to fine curative effects. © 2022 Authors. All rights reserved.     

锁定钛板及半肩关节置换治疗肱骨近端骨折的疗效分析

目的 探讨锁定钛板及半肩关节置换术治疗肱骨近端骨折的疗效与适应证。方法 2005年1月至2008年12月共收治51例肱骨近端骨折患者,其中39例获得随方,男12例,女27例;平均年龄65.1岁（17 ～ 80岁）。骨折按Neer分型：二部分骨折23例,三部分骨折10例,四部分骨折6例。受伤至手术时间平均为5.5d(1～9d)。手术方式选择：二部分骨折及年龄＜60岁的患者使用锁定钛板内固定治疗,四部分骨折及年龄＞ 60岁的患者使用半肩关节置换术。本组使用肱骨近端内固定系统(PHILOS)钛板切开复位内固定32例（PHILOS钛板组）,其中二部分骨折23例,三部分骨折9例;采用肱骨头置换术治疗7例（关节置换组）,其中三部分骨折1例,四部分骨折6例。结果 PHILOS钛板组患者手术时间平均为84 min(60 ～ 140 min),失血量平均为155 mL( 100 ～400 mL);关节置换组患者手术时间平均为125 min( 100 ～ 170 min),失血量平均为220 mL(150～450) mL。39例患者术后获平均23个月（16～46个月）随访,无一例出现并发症。PHILOS钛板组28例术后3个月复查X线片示骨折愈合,另4例术后6个月骨折愈合,肩臂手功能丧失量表(DASH)评分平均为20.7分,患者对手术主观满意率为87.5％。关节置换组7例患者DASH评分平均为36.0分,患者对手术主观满意率为71.4％。结论 对于年龄＜60岁的患者及大部分Neer 二、三部分骨折的老年患者,可以选择PHILOS钛板内固定治疗,而年龄＞60岁的四部分骨折患者选择半肩关节置换术可以获得较满意的疗效。     

Short-term outcomes of total hip arthroplasty after complications of open reduction internal fixation for hip fracture

Failed open reduction internal fixation (ORIF) of the proximal femur can render patients severely disabled. This study analyzed the short-term functional results and complications of total hip arthroplasty (THA) for complications of ORIF after hip fracture. A retrospective arthroplasty database review identified 36 patients treated with a THA for complications of ORIF of the hip. These patients were matched to a cohort of 36 patients who underwent primary unilateral THA for osteoarthritis. Study results indicate that THA for failed ORIF of the hip is a successful procedure despite concerns of increased intraoperative difficulty and risk of fracture.     

Prophylactic intramedullary femoral rodding during total knee arthroplasty with simultaneous femoral plate removal

Removal of a plate from the distal femur creates a risk of fracture through the screw holes. This is a particular concern when a total knee arthroplasty is present because supracondylar fracture may occur with minimal trauma. A patient who presents after prior plating of a distal femur fracture with osteoporosis, retained hardware associated with pain, and gonarthrosis severe enough to warrant total knee arthroplasty is often difficult to manage. Prophylactic intramedullary rodding is a well-accepted method of treating pathologic stress risers in the femur. An intramedullary rod can be inserted into the femur at the time of total knee arthroplasty. This method permits simultaneous plate removal and total knee arthroplasty while protecting the femur from postoperative fracture.     

The operative management of osteoporotic fractures of the knee: to fix or replace?

This review considers the surgical treatment of displaced fractures involving the knee in elderly, osteoporotic patients. The goals of treatment include pain control, early mobilisation, avoidance of complications and minimising the need for further surgery. Open reduction and internal fixation (ORIF) frequently results in loss of reduction, which can result in post-traumatic arthritis and the occasional conversion to total knee replacement (TKR). TKR after failed internal fixation is challenging, with modest functional outcomes and high complication rates. TKR undertaken as treatment of the initial fracture has better results to late TKR, but does not match the outcome of primary TKR without complications. Given the relatively infrequent need for late TKR following failed fixation, ORIF is the preferred management for most cases. Early TKR can be considered for those patients with pre-existing arthritis, bicondylar femoral fractures, those who would be unable to comply with weight-bearing restrictions, or where a single definitive procedure is required.     

Acetabular Fractures in the Elderly: Treatment Recommendations

Acetabular fractures in the elderly population are marked by a high degree of variability in terms of patient and fracture characteristics. Successful outcomes depend on application of highly individualized management principles by experienced teams. Reviewed are indications and outcomes associated with various management options, including closed treatment, open reduction internal fixation, and acute or staged total hip arthroplasty. Proper initial management choices are critical, as early failures and subsequent salvage surgery can be accompanied by significant morbidity. Clinical results after ORIF closely follow the quality of articular reduction and the ability to maintain a congruent reduction of the hip joint. Fracture characteristics predictive of anatomic articular reduction should be treated with ORIF. Fracture characteristics predictive of early post-traumatic arthritis should be treated with simultaneous ORIF and THA. Presented is one referral institution’s treatment algorithm and management approach.The views expressed in this article are those of the author and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, nor the U.S. Government.     

Patellar fracture after total knee arthroplasty

BACKGROUND: Patellar fracture can occur as a complication following total knee arthroplasty. The purpose of this study was to evaluate a large series of patellar fractures to determine the results of different forms of treatment of specific fracture types. METHODS: A retrospective review identified eighty-five fractures (in seventy-seven patients) following 12,464 consecutive total knee arthroplasties performed between 1985 and 1998. Seventy-eight fractures occurred after primary total knee arthroplasty and seven, after revision total knee arthroplasty. Five fractures were treated elsewhere, and two others were lost to follow-up. The results of treatment of the remaining seventy-eight fractures were reviewed. Fractures were classified according to three main criteria: integrity of the extensor mechanism, fixation status of the patellar implant, and quality of the remaining bone stock. The mean duration of follow-up was 3.6 years. RESULTS: The prevalence of patellar fracture after total knee arthroplasty was 0.68%; fractures were significantly more prevalent among men (1.01%) than among women (0.40%) (p = 0.0004). Thirty-eight fractured patellae had a stable implant and an intact extensor mechanism (Type I). All but one were treated nonoperatively, and there was only one late failure of nonoperative treatment, which required operative intervention. Twelve fractures were associated with disruption of the extensor mechanism (Type II). Eleven were treated operatively; six knees had complications and five had a reoperation. Twenty-eight fractures occurred in association with a loose patellar component (Type III). Twenty were treated operatively; nine knees had complications, and four had a reoperation. CONCLUSIONS: Patellar fractures after total knee arthroplasty are infrequent. Treatment can be guided by three main criteria: integrity of the extensor mechanism, fixation status of the patellar implant, and quality of the remaining bone. Fractures associated with a stable implant and an intact extensor mechanism were usually treated successfully with nonoperative means, with minimal complications. When operative treatment was required, it was associated with a high rate of complications and reoperations.     

Total knee arthroplasty and fractures of the tibial plateau

Tibial plateau fractures are common injuries that occur in a bimodal age distribution. While there are various treatment options for displaced tibial plateau fractures, the standard of care is open reduction and internal fixation(ORIF). In physiologically young patients with higher demand and better bone quality, ORIF is the preferred method of treating these fractures. However, future total knee arthroplasty(TKA) is a consideration in these patients as post-traumatic osteoarthritis is a common long-term complication of tibial plateau fractures. In older, lower demand patients, ORIF is potentially less favorable for a variety of reasons, namely fixation failure and the need for delayed weight bearing. In some of these patients, TKA can be considered as primary mode of treatment. This paper will review the literature surrounding TKA as both primary treatment and as a salvage measure in patients with fractures of the tibial plateau. The outcomes, complications, techniques and surgical challenges are also discussed.     

Periprosthetic supracondylar femur fractures following total knee arthroplasty

Periprosthetic supracondylar femur fractures following total knee arthroplasty (TKA) are an infrequent, but devastating, complication. From 1998 to 2000, we treated 30 supracondylar femur fractures above TKAs. Eighteen fractures were managed with retrograde intramedullary rod fixation (FIMR) and the other 12 fractures with traditional open reduction with internal fixation (ORIF). Follow-up averaged 3 years, with Knee Society knee scores being 84 and 82, respectively. Complications included 1 above-knee amputation for deep sepsis and 1 nonunion with varus alignment. FIMR appears to be the treatment of choice when it is feasible. However, traditional ORIF also may yield satisfactory results in those designs that cannot accommodate retrograde FIMR fixation.     

Open reduction internal fixation vs. reverse shoulder arthroplasty for the treatment of acute displaced proximal humerus fractures

BackgroundProximal humerus fractures are a frequent fragility fracture in the aging population and represent a challenge to the orthopedic surgeon. Open reduction internal fixation (ORIF) of these fractures is viable but technically challenging and associated with a high complication rate. Recently, reverse shoulder arthroplasty (RTSA) with tuberosity repair has become a popular and successful option for treating these fractures. The purpose of this study is to compare outcomes of ORIF and RTSA for treatment of proximal humerus fractures.MethodsAn age-matched group of 50 patients treated with ORIF (25) and RTSA (25) were assessed at an average follow-up of 4.4 years. American Shoulder and Elbow Surgeons score (ASES) and Simple Shoulder Test (SST), radiographs, range of motion, and complications were evaluated between the two groups.ResultsThe reoperation rate and major complications were higher in the ORIF group compared to RTSA. No major complications were observed in the RTSA group. Forward flexion in the RTSA patients (143.2 ± 23.1) was shown to be significantly greater than ORIF patients (121.4 ± 35.1) (p= 0.0125) but no significant differences were observed for shoulder external rotation or internal rotation. There was no difference in ASES and SST scores between groups.ConclusionThe current study demonstrates good clinical outcomes for both RTSA and ORIF. However, reoperation rate was higher with ORIF with locked plating compared to RTSA for fracture with tuberosity repair in an age matched population. RTSA may be a better treatment option than ORIF for 3- and 4-part fractures in patients older than 65.Level of evidenceLevel III     

Primary prosthetic replacement in per- and intertrochanteric fractures

Purpose

Hip arthroplasty is rarely indicated in the treatment of per- and intertrochanteric femur fractures. Although the majority of fractures are amenable to closed- or open reduction and internal fixation (CRIF/ORIF), in some patients the complexity of the fracture or other patient-related factors may cause the orthopaedic surgeon to consider arthroplasty as the treatment of choice. Decision-making is challenging, and a reliable score has not yet been established.

Results

Reviewing literature, several predictors of inferior outcome after CRIF/ORIF in per- and intertrochanteric fractures such as age, gender, poor bone quality, hip osteoarthritis, operation time and postoperative weight-bearing restrictions have been identified. Based on the literature review, a novel Hamburg Per- and Intertrochanteric Fracture Score (HPIFS) is proposed to support decision-making for per- and intertrochanteric fracture treatment.

Conclusions

CRIF/ORIF remain the workhorses in per- and intertrochanteric fracture management. Arthroplasty offers an advantageous treatment option for a well-defined patient and fracture collective. The HPIFS might support the decision-making process.     

Osteosynthese bei Acetabulumfrakturen im Alter

The aim of this study was to analyze the clinical outcome and incidence of hip arthritis in elderly patients with acetabular fractures. Because of poor bone quality in the elderly, even a low-energy trauma may lead to an acetabular fracture. An anatomical reconstruction of the acetabulum is necessary to achieve sufficient stability also for a potential hip arthroplasty. So far, there is very limited information on the outcome of acetabular fractures in the elderly. During a period of 6 years (2001-2006), 48 patients older than 60 years were admitted to our department with an acetabular fracture. Thirty-nine patients were treated operatively and nine patients non-operatively. Twenty-nine operatively treated patients were followed up. Nineteen of them were assessed using EQ-5D, SF-12 and Merle d'Aubigné questionnaires in addition to their clinical examination. Ten other surgical patients were only examined using the questionnaires. Of the 29 patients that were followed up, 5 underwent total hip arthroplasty due to secondary post-traumatic hip arthritis after open reduction and internal fixation (ORIF). The range of motion of the operated hip was comparable to that of the non-operated contralateral side. However, the internal rotation was found to be slightly decreased at the operated side when compared to the non-operated contralateral side. Merle d'Aubigné score and physical and mental SF-12 score components as well as quality of life were better in patients treated with ORIF compared to those patients that were treated by secondary hip arthroplasty. Regarding the different treatment strategies (ORIF vs primary hip arthroplasty vs non-operative treatment) of acetabular fractures in the elderly, data from the literature are conflicting. Our results indicate that ORIF represents a good treatment option for acetabular fractures in the elderly. In patients that did not develop secondary hip arthritis, a good clinical outcome and quality of life was documented.     

Osteoarthritis knee with patellar fracture in the elderly: single-stage fixation and total knee arthroplasty

Periarticular fractures that occur in a previously osteoarthritic knee, especially in an elderly patient, will be associated with other comorbidities and is a treatment challenge. Early mobilization is a key treatment principle in the geriatric population. We present a case report of an elderly diabetic patient with osteoarthritis of the knee joint who sustained a patellar fracture and was treated with single-stage primary total knee arthroplasty and fixation of the patellar fracture.     

Increased Revisions in Conversion Total Knee Arthroplasty After Periarticular Open Reduction Internal Fixation Compared With Primary Total Knee Arthroplasty: A Matched Cohort Analysis

BackgroundPrior studies on conversion total knee arthroplasty (cTKA) have reported increased technical challenges and risk of complications compared with primary knee arthroplasty. The purpose of this study was to compare two-year postoperative complication/revision rates between patients undergoing cTKA after prior periarticular open reduction and internal fixation (ORIF) and those undergoing primary TKA.MethodsPatients who underwent cTKA after prior periarticular ORIF of the ipsilateral knee were identified in a national all-payer claims database from 2010 to 2018. This ORIF-cTKA cohort was propensity matched to participants undergoing primary TKA based on age, gender, Charlson comorbidity index, and obesity status. Univariate analysis was performed to analyze differences in two-year complication and revision rates.ResultsAfter propensity matching, 823 patients were included in the ORIF-cTKA cohort and 1640 patients in the primary TKA cohort. No differences in demographics or comorbidities existed between cohorts. Relative to the primary TKA cohort, the ORIF-cTKA cohort had significantly higher incidences of all-cause revision (5.47% vs 2.47%, P = .001), periprosthetic joint infection (PJI; 4.74% vs 1.34%, P < .001), and intraoperative or postoperative periprosthetic fracture (1.58% vs 0.55%, P = .01) at two years postoperatively. There was also a nonsignificant trend toward increased rates of aseptic loosening (1.82% vs 0.91%, P = .052) in the ORIF-cTKA.ConclusionRelative to primary TKA, cTKA after periarticular ORIF is associated with significantly increased rates of all-cause revision, PJI, and periprosthetic fracture at two years postoperatively. Surgeons should counsel these patients about the increased risks of these postoperative complications and consider treating them as high risk for PJI in the perioperative period.     

关节镜辅助微创手术与切开复位内固定术治疗胫骨平台骨折的疗效比较

目的比较关节镜辅助微创手术与切开复位内固定术治疗胫骨平台骨折的临床疗效。方法对我院2006年2月至2009年10月分别采用关节镜辅助微创手术和切开复位内固定术治疗胫骨平台骨折的病例进行回顾性研究,比较两种治疗方法术后并发症、骨折愈合时间、Rasmussen膝关节功能评分情况。结果微创组骨折优良率为88．6％,明显优于手术组的66．7％（P〈0．05）;并发症发生率17．14％,明显少于手术组27．28％;骨折临床愈合时间微创组平均8．5周,明显短于手术组10周（P〈0．05）;Rasmussen膝关节功能评分微创组平均24．78分,高于手术组21．85分（P〈0．05）。结论关节镜辅助微创手术治疗Schatzker分型Ⅰ、Ⅱ、Ⅲ、Ⅳ型胫骨平台骨折较切开复位内固定术能明显缩短骨折愈合时间、改善术后关节功能、减少并发症的发生、提高疗效。     

Is It Worth Discriminating Against Patients Who Smoke? A Systematic Literature Review on the Effects of Tobacco Use in Foot and Ankle Surgery

Although numerous studies have linked smoking with lower extremity wound and bone healing complications, a comprehensive study on the effects of smoking in foot and ankle surgery has not yet been reported. The purpose of the present study was to report the results of our systemic literature review, identifying the effects of tobacco use on common foot and ankle procedures. The systematic literature review was performed according to guidelines set by the PRIMSA statement (Preferred Reporting Items for Systematic Review and Meta-Analyses). Smoking, as a single risk factor, was analyzed and used to compare adverse outcomes in the postoperative setting of foot and ankle surgery. We reviewed 528 abstracts that met our initial identification criteria. After an extensive review process, 46 of the articles (8.71%) met the eligibility requirements to be included in the present study. Distal bunionectomy with osteotomy, first metatarsophalangeal joint arthrodesis, Lapidus bunionectomy, toe amputation, transmetatarsal amputation, Syme's amputation, open reduction internal fixation (ORIF) of calcaneal fractures, ankle fracture ORIF, pilon fracture ORIF, subtalar arthrodesis, rearfoot arthrodesis, tibiocalcaneal arthrodesis, ankle arthrodesis, total ankle arthroplasty, and plastic surgery procedures and their respective negative association with smoking was identified and described in our review. Our systematic literature review revealed that procedures involving arthrodesis, fracture ORIF, and plastic surgery were associated with negative outcomes in smokers. Procedures that did not involve osseous unions such as total ankle arthroplasty and amputations did not appear to have negative outcomes associated with smoking.     

Proximal interphalangeal joint fracture dislocations

Proximal interphalangeal joint fracture dislocations are complex, potentially disabling injuries for any patient, especially the competitive athlete. Dorsal fracture dislocations are fairly common and volar fracture dislocations are rare. Stable injuries often heal with minimal functional deficit, whereas unstable injuries can result in limitation in range of motion, joint incongruity, and degenerative joint disease. A number of surgical procedures have been described to treat the unstable dorsal fracture dislocation, including ORIF, extension block pinning, external fixation, dynamic traction, and volar plate arthroplasty. Volar fracture dislocations are usually amenable to closed or open reduction and internal fixation. The results of treatment of both volar and dorsal fracture dislocations can be unpredictable.     

Distal Femoral Arthroplasty for the Treatment of Periprosthetic Fractures After Total Knee Arthroplasty

Periprosthetic fractures after total knee arthroplasty present substantial challenge if associated with poor bone stock, fracture comminution, and loose or damaged components. Revision total knee arthroplasty with distal femoral arthroplasty is often necessary in these injuries. We reviewed 20 patients (22 knees) with a mean age of 69.5 years who underwent revision with distal femoral arthroplasty fracture. Patients were followed for an average of 58.6 months. At the latest follow-up, the mean Knee Society knee and functional score were 82.8 and 40, and the Short Form 36 mean physical functioning and mental functioning scores were 55.8 and 65.6, respectively. There were 10 postoperative complications with 5 patients requiring additional surgery. Distal femoral arthroplasty seems to be a viable option for complex periprosthetic femoral fractures after total knee arthroplasty. However, considering the relatively high rate of complications, this procedure should be reserved for patients where alternative treatments are not possible.     

Supracondylar fracture of the femur after total knee arthroplasty

We reviewed the data on thirty-six supracondylar fractures of the femur (in thirty-four patients) that occurred after total knee arthroplasties that were done between April 1974 and December 1981. Patients who had osteoporosis, rheumatoid arthritis, one or more previous arthroplasties of the knee, or inadvertent breeching of the anterior aspect of the femoral cortex at operation appeared to be particularly at risk for a supracondylar femoral fracture. Malalignment of the component could not be implicated as a cause. Twenty-six fractures (in twenty-five patients) were treated by non-operative methods. Seventeen of them (65.4 per cent) healed and required no surgical treatment. Fourteen of the seventeen were followed for more than two years; they had no significant difference in the knee score and lost less than 10 degrees of motion. The nine remaining knees required revision of the arthroplasty because of non-union in four knees, malunion in two, loosening of the component in two, and extension lag in one. At an average of forty months after revision, the nine knees were rated as having one excellent, four good, three satisfactory, and one failed result. In contrast, only three of the five fractures that were treated by early open reduction and internal fixation had a satisfactory result, and one of them required a second bone-grafting procedure. One patient died perioperatively and another required an above-the-knee amputation because of sepsis. Of the three fractures that were initially treated by external fixation, one had an excellent and two had a good result at an average of forty-five months after fracture. We have found that supracondylar fractures that occur after total knee arthroplasty can be managed by either traction or application of a cast, or both, which usually results in healing of the fracture and a satisfactory outcome of the arthroplasty. Patients who have a poor arthroplasty result after non-operative treatment of the fracture usually can undergo a revision arthroplasty with the expectation of a satisfactory outcome. Operative treatment of the fracture should be reserved for patients who do not have osteopenia and in whom stable fixation can be achieved, for those who demand a highly functional arthroplasty, and for those in whom adequate closed reduction cannot be maintained.