Background:Distal femur fractures are serious injuries that can be difficult to treat and lead to long term disability and morbidity.Objectives:Evaluate the early results of Minimally Invasive Plate Osteosynthesis (MIPO) in treatment of distal femur fractures using locking plate .Study Design & Methods:The study was a prospective study that included 20 patients suffering from supracondylar fractures of the femur.All patients had fixation of the fracture using distal femur locking plate (Less Invasive Stabilization System,LISS,Synthes) in a minimally invasive technique using antrolateral or direcr lateral approach to the distal femur according to the fracture classification .All patients were followed up and assessed both clinically and radiologically according to the functional evaluation scale developed by Sander's et al.Results:The mean age was 52.80 (19-80 ) years.The mechanism of trauma was road traffic accidents (RTA) in nine patients (45%) and falling at home (FAH) in eleven patients (55%) . Eight patients had type A1 fracture (40%), one patient had type A2 fracture (5%), five patients had type A3 fracture (25%), one patient had type C1 fracture (5%) ,and five patients had C2 fracture (25%).The final results obtained were excellent in four patients(20%), good in nine patients (45%), fair in five patients (25%) and poor in two patients (10%).Complications encountered were knee stiffness (20%), delayed union (10%), infection (10%) and shortening (15%).Conclusions:Minimally Invasive Percutanous Osteosynthesis (MIPO) technique is a safe and worthwhile method of managing supracondylar femur fractures.

Introduction: Interprosthetic femoral fractures (IFF) are rare but increasing with ageing population. Operative management is challenging and there is currently a paucity of outcome data in the literature. Purpose of this study was to evaluate outcomes of IFFs managed with modern distal femoral locking plates, in a larger sample size than previously published. Methods: This retrospective study reviewed 49 closed IFFs at a major trauma center from 2009 to 2019 occurring between previous total hip arthroplasty (n=38), hemi hip arthroplasty (n=3), dynamic hip screw (n=6) or cephalomedullary nail (n=2) and total knee arthroplasty. They were managed with Minimally Invasive Plate Osteosynthesis (MIPO) employing modern biological fixation techniques and stabilised with VA-LCP Condylar (Synthes; n=28) or Peri-Loc (S&N; n=21) plate. Clinical and radiographic outcomes were measured. Results: Majority were female (80%), elderly (average 83 years), and comorbid (55% ASA grade 3 or 4). Most fractures were Pires type IIA and OTA/AO type 33A. Average plate spanning femur was 16 holes, with average working length of 6 holes. 86% had unrestricted weight bearing immediately post operatively. 31 fractures reached radiological (n=25) or clinical (n=6) union. 13 died with 2 lost to follow up, giving union rate of 91% (n=31/34). There were 3 non-unions, with all 3 implants failing before 4 months. Conclusion: IFFs are occurring with increasing frequency in a frail elderly population. In patients with IFFs, MIPO and biological fixation techniques using modern distal femoral locking plates can achieve high rate of union when combined with immediate unrestricted weight bearing postoperatively.

Background

The treatment of periprosthetic femur fractures around a total knee replacement remains a technical challenge for the Orthopaedic surgeon. Numerous management options include plate fixation, intramedullary nailing, revision knee arthroplasty and distal femur replacement (DFR). Optimal treatment often poses a difficult risk-benefit question where few studies compare fixation with DFR. This paper is the first meta-analysis in the literature to directly compare clinical outcomes between fixation and distal femoral replacement in the treatment of supracondylar periprosthetic knee fractures.

Methods

An up-to-date literature search of the Embase and Medline databases was performed. The search was conducted using a predesigned search strategy where all eligible literature was critically appraised for methodological quality via the Cochrane’s collaboration tool. Length of stay (LOS), mortality rate (MR), revision rate (RR) and complication rate (CR) were all considered.

Conclusion

A total of five studies where included in the meta-analysis (n=347). 221 patients underwent distal femur replacement and 126 patients underwent fixation with an average follow-up time of 47.17 months. The results of this analysis suggest that no significant difference exists in any of the observed outcomes when comparing DFR to fixation for the treatment of periprosthetic supracondylar femur fractures.

Background - Fractures of the plateau affect knee alignment, stability, and motion. As the anatomy of the tibial plateau is complex, careful surgical planning with standard radiographies and computed tomography (CT) is essential. Methods- We did a retrospective analysis of all operated tibial plateau fracture in adults from march 2018-march 2020 presenting to our institution . Results- There were 24 operated tibial plateau fracture patient .We did both radiological and clinical outcome with mean follow up 6 months. There were 3 patients with condylar widening and 3 patients had coronal malalignment . One patient had deep infection . Conclusion- Approach to the fracture based on column classification and articular reduction is the key for tibial plateau fracture . Posterior column has been shown to have a major influence on surgical planning, fracture reduction accuracy and functional outcomes . Luo’s classification addresses this column concept and should be used as a complimentary tool in preoperative planning .

Introduction:The primary aim of this study was to evaluate the functional outcome of patients sustaining a periprosthetic fracture around hip and knee arthroplasty presenting to a Major Trauma Center in the UK. The secondary aim was to evaluate the associated complications.Patients and Methods: We extracted the data of 345 patients presented with periprosthetic fractures over 9 years period. We excluded patients who were non contactable, refused to participate in the telephone survey or those who were mistakenly coded. Baseline demographic data, co-morbidities and treatment methods were recorded. EuroQol 5 Dimension (EQ-5D-5L) score and Oxford hip or knee score were obtained via telephone survey. Results: A total of 269 were available for analysis. The mean follow up was 3.4 years ( range 7 months - 8 years). The mortality rate at the mean follow up was 42.7%, with 30-days and 1-year mortality rates of 6.7 % and 12.6 % respectively. 74% of the patients sustained a fracture around a hip arthroplasty, and 26% around a knee arthroplasty. 60.7% were treated with fixation, and 39.3% were treated with revision. Analysis of the EQ-5D showed significant impact of these injuries on the function and quality of life of the included patients. Conclusions: Despite the advances in surgical techniques and the improved multi-disciplinary care, this study highlights the considerable effect that periprosthetic fractures impose on the quality of life. Further improvements in outcome might be possible by re-directing resources towards high dependency care, nursing, physiotherapy and perioperative medical optimisation.

Background: One of the major limitations of the 2D fracture classification based on Schatzker classification is its failure to adequately assess fracture lines in the frontal plane and fracture displacement in the antero-posterior direction. 3D fracture line mapping which includes steric assessment can thus aid decision making with regards to the surgical approach and fixation scheme. We hypothesized that there are consistent fracture patterns and zones of comminution for proximal tibial fractures. Methods: Radiographic data of One hundred and eighty-seven tibial plateau fractures were retrospectively included in this study. Fracture lines and zones of comminution were graphically superimposed onto a 3D template of an intact tibia after virtual reduction and normalization to identify major patterns of fracture and comminution. Results: Out of 169 male and 18 female patients, 81 had a fracture involving the lateral plateau only, 44 had a fracture involving the medial plateau only and 63 had a high grade fracture involving both the condyles. Fracture lines involving the lateral plateau were oriented largely in the sagittal plane, whereas those involving the medial plateau were mostly in the coronal plane. In bicondylar fractures, lines were usually not seen to pass directly through the posteromedial region. Conclusions: Tibial plateau fractures have consistent fracture patterns and zones of comminution. A clearer understanding of the 3D orientations of fractures based on CT scans can aid in diagnosing and management of the common patterns of fractures and to eventually improve operative outcomes with better plate positioning.

There are limited publications describing gunshot injuries to the knee. Consequently, there is debate about what is the preferred timing and treatment of these fractures. We present a complex patella fracture after a close-range shotgun discharge to the knee. A 26-year-old male presented to the emergency department with a 10x6cm anterior wound of the knee with loss of substance and joint exposure. The patient had complaints of severe pain and functional disability, neurovascular examination was intact. Imaging revealed a comminuted patella fracture and impacted pellets. Tetanus prophylaxis and antibiotic treatment were started. After lavage, debridement and removal of the majority of the pellets, a trans-articular external fixator was applied. After 3days of antibiotics and acceptable skin conditions, the patient underwent fracture closed reduction and fixation with tension wiring. After one month the patient presented with signs of infection with material exposure. A new surgical intervention was proposed where osteonecrosis of the rotula was found, without signs of viability. A total patellectomy and extensor reconstruction with autologous tendon were performed. The patient was discharged 1week later and followed a rehabilitation plan. Two years follow-up he is ambulatory working in construction, mobility arc is 0-70º. Shotgun wounds to the knee are rare but can lead to serious complications including neurovascular injuries, infection and non-union. Soft-tissue is an integral part of the treatment and the correct timing for definitive treatment may be difficult to determine. Several treatment options could have been accepted leading to different impacts on the patient’s quality of life.

Patellar tendon ruptures are a rare condition usually occurring in young to middle-aged males. While the treatment of primary tears is fairly standardized, the treatment of recurrent ruptures is a surgical challenge and there are no gold standard protocols. The weakened fibers with the scar tissue from the previous surgery make simple reinsertion insufficient or not even possible. We present three cases of reconstruction of recurrent patellar tendon rupture using the ipsilateral gracilis and semitendinosus autographs. We treated 3 male patients (ages 22, 36 and 64) who presented with pain and inability to perform active straight leg raise. Objectively large hemarthrosis, patella alta and palpable gap. Radiographs and ultrasound confirmed the diagnosis. Surgical treatment consisted of reconstruction using anchors and transosseous sutures with augmentation with ipsilateral gracilis and semitendinosus as a protection band. In the older patient, a partial thickness quadriceps tendon flap was also used. The postoperative was uneventful. An extension brace was kept for 3 weeks until soft tissues healed. By six months all were back to work with a good or excellent Lysholm Knee Score. Just as the inherent patient risk factors, inadequate rehabilitation and insufficient surgical technique of the primary repair may also justify the relapse. Rehabilitation protocols are also not well established leading to surgeons making more conservative variations of their primary repair protocols. The method of augmentation offers a stronger tendon and acts as a protection band for the primary tendon, creating a stable and functional extensor mechanism.

Introduction: Patella fractures comprise 1% of all orthopaedic injuries but yield high patient dissatisfaction rates, complications and removal of metal-work surgery. While the traditional method of tension-band wiring (TBW) has delivered adequate results, other alternatives such as plating could be considered, especially for high-energy comminuted fractures. We conducted a review to investigate the current operative methods used to fix patellar fractures, their advantages, pitfalls and functional outcomes. Methods: A PRISMA literature search was performed to evaluate all studies included in the literature until February 2021. Two independent reviewers read and filtered the articles according to our inclusion and exclusion criteria. Results: Of 67 studies, a total of 19 studies involving 556 patients were included. Patients had a mean age of 51.9 years, 223 (40%) were women and mean follow-up was 17.6 months. Complications were reported in 94 of the 556 cases (16.9%), 40 patients underwent removal of metalwork (7.2%), and 21 (3.8%) required some form of revision surgery. Conclusion: While patellar fractures are typically simple, two-part fractures that can be managed well with TBW, for comminuted multifragmentary complex fractures (AO 34C2/3), plating seems to offer superior outcomes. This systematic review showed that such implants could deliver good clinical outcomes, reducing surgical complications and re-operation. There remains insufficient research to definitively conclude superiority and indeed there remains multiple plating options. An RCT comparing the treatment of comminuted patella fracture management would be recommended.