Treatment of periprosthetic fractures around hip resurfacings with cephalomedullary nails.

We describe 2 cases of proximal femoral fractures, 1 intertrochanteric and 1 subtrochanteric, distal to hip resurfacing implants that were managed successfully via internal fixation with trochanteric start point cephalomedullary nails. Both patients had pain-free, well-functioning implants with radiographically healed fractures at their 1-year follow-up. This novel approach offers several advantages over previously described techniques for these rare and difficult-to-treat fractures.

Risk factors for peroneal nerve injury and recovery in knee dislocation.

BACKGROUND: Acute knee dislocation is rare but has a high rate of associated neurovascular injuries and potentially limb-threatening complications. These include the substantial morbidity associated with peroneal nerve injury: neuropathic pain, decreased mobility, and considerably reduced function, which not only impairs patient function but complicates treatment. QUESTIONS/PURPOSES: We therefore identified and quantified the risks associated with specific factors for peroneal nerve injury and recovery in patients with knee dislocations. PATIENTS AND METHODS: We retrospectively reviewed the charts of 26 patients, from among a cohort of all 91 knee dislocations, with a peroneal nerve palsy over a 5-year period. We then used univariable and multivariable statistics to identify risk factors predicting peroneal nerve injury and recovery. RESULTS: Gender (odds ratio, 5.47), body mass index (odds ratio, 1.14), and fibular head fracture (odds ratio, 4.77) were associated with peroneal nerve injury. Only younger age was associated with peroneal nerve recovery. CONCLUSIONS: Knowledge of the risk factors for peroneal nerve injury and the predictors of recovery in knee dislocation allows the treating surgeon to have a better understanding of the nature of the neurologic injury and modify management based on the anticipated return of nerve function. LEVEL OF EVIDENCE: Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

Outcomes of operative and nonoperative treatment of multiligament knee injuries: an evidence-based review.

Knee dislocation is an uncommon orthopedic diagnosis with a high rate of neurovascular complications. The goal of definitive management is to provide a pain free and functional knee through restoration of ligamentous stability and range of motion. Operative management has been suggested to be superior to nonoperative management for knee dislocations largely in part owing to a meta-analysis on the topic published a decade ago. The purpose of this study was to summarize the results of operative and nonoperative treatment of knee dislocations over the past 10 year period. There were a total of 855 patients from 31 studies managed operatively and 61 patients from 4 studies managed nonoperatively. The overall methodological quality of the studies was poor as measured by the Newstead-Ottawa scale. Data regarding functional outcome, instability, contracture, and return to activity were all in favor of operative management. Significant differences were found for return to employment (P<0.001) and return to sport (P=0.001). The results of this study provide further evidence for the superiority of operative management, compared with nonoperative management, for knee dislocations across several clinical and functional domains. There is a need for higher level studies to assist the treating surgeon in the management of these challenging injuries.

Diagnosis and management of knee dislocations.

An acute knee dislocation is an uncommon injury, with a high rate of associated vascular and neurologic injuries as well as potentially limb-threatening complications. High-energy trauma is the most common cause of an acute knee dislocation, although lower-energy injuries, such as those sustained during athletic competition, are increasing in incidence. Injuries to the popliteal artery and common peroneal nerve are relatively common, requiring a high index of suspicion and complete neurovascular examination in a timely fashion. All cases of suspected knee dislocation should have an ankle-brachial index performed, reserving arteriography for those with an abnormal finding. Initial management consists of closed reduction, if possible, and application of a hinged brace or external fixator. Definitive management remains an area of controversy, although anatomic surgical repair or reconstruction is favored by most surgeons to help optimize knee function. Most patients treated for a knee dislocation can expect to return to their daily activities, but with less predictable returns to sporting activities.