Comparison of the pre-shaped anatomical locking plate of 3.5 mm versus 4.5 mm for the treatment of tibial plateau fractures.

PURPOSE: Treatment of tibial plateau fractures is discussed. A retrospective comparative study of fractures treated with an anatomical locking plate of 4.5 mm or 3.5 mm. Our hypothesis is that the 3.5 mm plates give an equivalent hold of fractures with comparable results and better clinical tolerance. METHODS: From May 2010 to October 2011, 18 patients were operated on using a 4.5-mm LCP™ anatomical plate (group A) and 20 patients received a3.5-mm LCP™ anatomical plate (group B). Groups were comparable. One fracture was open. RESULTS: For the Group A, 14 patients had a follow up of 35.3 months and for the Group B, 16 patients had a follow up of 27 months. Mobility was comparable in both groups. The Hospital for Special Surgery (HSS) score was 86.4 versus 80.6, the Lysholm score was 83.6 versus 77 for groups A and B respectively. Consolidation was 3.25 months versus 3.35 months and mean axis was 183.1° versus 181.6° for groups A and B. Mechanical axes during revision were statistically different to the controlateral axes. One secondary displacement was noted in group A and one secondary displacement in group B. Group A had eight patients reporting discomfort with the material versus three in group B (p < 0.05). CONCLUSION: The hypothesis is proven. In regards to the results, there is no significant difference between the two groups but the clinical tolerance was better in group B. More time is needed in the long term to better evaluate these severe fractures.

Has a patient type with peri-prosthetic femoral fractures evolved?

PURPOSE: Peri-prosthetic fractures (PPF) have been showing a constant increase. The typical patient described in the SOFCOT symposium in 2005 with PPF was an elderly 77-year-old woman with hip athroplasty (HA). The purpose of this study was to actualize the characteristics of this population. Our hypothesis is that patient type remains a female, but much older, with an equal distribution between HA and knee arthroplasty (KA). METHODS: All cases of PPF were retrospectively gathered during an 18 month period. Besides regular epidemiologic data, we noted autonomy level (Parker, Devane), residence and dependence (Katz), the type of implant, of fracture, the severity of fracture, the onset and the state of solidity of the prosthesis. RESULTS: The series consisted of 81 patients (58 F, 23 M) (81 fractures), mean age of 82.2 years; 3.5% of them were admits from the emergency admits; and 69.1% lived at home. Parker's mean score was 4.6, Devane's mean score was 1.8 and Katz's mean score was 4.2. There were totals of 46 HA fractures and 39 total knee arthroplasty (TKA) of which four were inter-prosthetic and three were either KA or proximal osteosynthesis. Onset before fracture for HA was 12.1 years, 7.9 years for KA, and 10.2 years for all series. Patients were younger for HA (80.8 years) than for KA (84.1 years). The fracture was mostly noticed in the third proximal (49.4%), spiral segment (44.5%) and around the implant, while 34.8% of loosening was observed for HA versus 7.7% for KA. DISCUSSION-CONCLUSION: The patient type has evolved confirming our hypothesis: they are always a female more than 82 years old with a number of fractures on KA similar to that of HA. The patients lived at home, had some autonomy, were somewhat independent in their daily activities but sedentary. Fractures were mostly on the third proximal femur, spiral segment and around the implant. PPF remains rare and a theoretical increase is yet to be confirmed. LEVEL OF EVIDENCE: prospective study type IV, cohort study.

Minimally invasive surgery with locking plate for periprosthetic femoral fractures: technical note.

PURPOSE: Periprosthetic fractures of the femur are increasing due to the increase of arthroplasties and the aging population. They concern a population that is often elderly and with important comorbidities that complicate managing this already complex pathology. Usual complications of classic osteosynthesis are numerous, including infections and nonunions and the need for delayed weight bearing after surgery. METHODS-RESULTS: The development of locking plates has allowed complication avoidance. When used in minimally invasive surgery, they combine the biological advantages of closed-wound surgery to the mechanical advantages of locking plates, which have better stability in fragile bones. We propose a technical update on handling such fractures by using locking plates under minimally invasive surgery. DISCUSSION-CONCLUSION: In our experience, under certain guidelines, this allows for immediate post-operative full weight bearing, which is beneficial to these often elderly patients.

Tibia valga morphology in osteoarthritic knees: importance of preoperative full limb radiographs in total knee arthroplasty.

Osteoarthritis of the knee is associated with deformities of the lower limb. Tibia valga is a contributing factor to lower limb alignment in valgus knees. We evaluated 97 valgus knees and 100 varus knees. Long-leg films were taken in weight bearing with both knees in full extension. For valgus knees, 52 knees (53%) had a tibia valga deformity. Average tibia valgus deformation was 5.0°. For varus knees, there was only 1 case of tibia valga (1%), with a deformation of 2.5°. The aim of this study was to assess the prevalence of primary tibia valga in valgus and varus knees and understand how it affects our approach to total knee arthroplasty (TKA). We recommend having full-leg length films when planning for TKA in valgus knees.

Whole blood metal ion measurement reproducibility between different laboratories.

Monitoring patients' metal ion blood concentrations can be useful in cases of problematic metal on metal hip implants. Our objective was to evaluate the reproducibility of metal ion level values measured by two different laboratories. Whole blood samples were collected in 46 patients with metal on metal hip arthroplasty. For each patients, two whole blood samples were collected and analyzed by two laboratories. Laboratory 1 had higher results than laboratory 2. There was a clinically significant absolute difference between the two laboratories, above the predetermined threshold, 35% of Cr samples and 38% of Co samples. All laboratories do not use the same technologies for their measurements. Therefore, decision to revise a metal on metal hip arthroplasty should rely on metal ion trends and have to be done in the same laboratory.

Treatment of periprosthetic femoral fractures of the knee.

PURPOSE: We report a continuous series of periprosthetic femoral fractures after knee arthroplasty treated with a locking plate. We hypothesize that minimally invasive surgery and immediate weight-bearing improve functional recovery. METHODS: From June 2002 to December 2008, 15 patients with 16 fractures were treated. Median age was 81 years. The autonomy level according to the mobility score of Parker and Palmer showed a median of 5 (0-9). Osteosynthesis was performed mainly through a minimally invasive approach using a locking compression plate. The rehabilitation protocol consisted of immediate mobilization and, whenever possible, immediate unrestricted weight-bearing. RESULTS: Five patients died during follow-up, more than 1 year after osteosynthesis. Their results were included. Autonomy and mobility were preserved with a median postoperative score of 4 (0-9) according to Parker and Palmer. The consolidation rate was 93.8%, which was obtained within 10 weeks. There were no mechanical or infectious complications. Fourteen cases were treated with minimally invasive surgery without fracture exposition; the remaining 2 required a slightly more extended approach. Full weight-bearing occurred 10 times; 20-kg partial weight-bearing was advised twice; and on 4 occasions, no weight-bearing was allowed for 6 weeks. CONCLUSION: Osteosynthesis with a minimally invasive bridge-plating technique is effective in the treatment of periprosthetic, distal femoral fractures without component loosening. Immediate full weight-bearing is possible if certain rules are respected. The surgical management presented herein is beneficial for these challenging fractures, and it may help reduce the complication rate and improve functional outcome.

Upper limb joint muscle/tendon injury and anthropometric adaptations in French competitive tennis players.

The purpose of this study was to examine the relationship between the upper limb anthropometric dimensions and a history of dominant upper limb injury in tennis players. Dominant and non-dominant wrist, forearm, elbow and arm circumferences, along with a history of dominant upper limb injuries, were assessed in 147 male and female players, assigned to four groups based on location of injury: wrist (n = 9), elbow (n = 25), shoulder (n = 14) and healthy players (n = 99). From anthropometric dimensions, bilateral differences in circumferences and in proportions were calculated. The wrist group presented a significant bilateral difference in arm circumference, and asymmetrical bilateral proportions between wrist and forearm, as well as between elbow and arm, compared to the healthy group (6.6 ± 3.1% vs. 4.9 ± 4.0%, P < 0.01; -3.6 ± 3.0% vs. -0.9 ± 2.9%, P < 0.05; and -2.2 ± 2.2% vs. 0.1 ± 3.4%, P < 0.05, respectively). The elbow group displayed asymmetrical bilateral proportions between forearm and arm compared to the healthy group (-0.4 ± 4.3% vs. 1.5 ± 4.0%, P < 0.01). The shoulder group showed significant bilateral difference in elbow circumference, and asymmetrical bilateral proportions between forearm and elbow when compared to the healthy group (5.8 ± 4.7% vs. 3.1 ± 4.8%, P < 0.05 and -1.7 ± 4.5% vs. 1.4 ± 4.3%, P < 0.01, respectively). These findings suggest that players with a history of injury at the upper limb joint present altered dominant upper limb proportions in comparison with the non-dominant side, and such asymmetrical proportions would appear to be specific to the location of injury. Further studies are needed to confirm the link between location of tennis injury and asymmetry in upper limb proportions using high-tech measurements in symptomatic tennis players.

Rapid chondrolysis of the medial knee compartment after arthroscopic meniscal resection: a case report.

BACKGROUND: Rapidly destructive osteoarthritis of the hip and rapid chondrolysis of the lateral compartment of the knee or the shoulder are rare, but have been previously described in the medical literature. To the best of our knowledge, no case of medial femorotibial compartment chondrolysis after arthroscopy has yet been described. We therefore submit the first case report. CASE PRESENTATION: A 64-year-old white European man presented with right knee pain due to a medial meniscal tear with no other abnormality found on examination or imaging. An arthroscopic partial medial meniscectomy was performed and early evolution was favorable with no signs of infection. He developed knee pain 2 months later. X-rays showed a thinning of the medial compartment which was confirmed by computed tomography arthrogram. There was no articular effusion, mobility was conserved (0/0/125°), there was no laxity, and pain was localized to the medial femorotibial compartment, with no meniscal signs. There was a 8° varus deviation (versus 3° for his uninjured left knee). His blood work was normal. As there were no signs of infection, no aspiration was performed. Viscosupplementation was offered but refused by the patient. He is now waiting for a partial knee replacement. CONCLUSIONS: To the best of our knowledge, this is the first description of such a case. Rapid chondrolysis has been described in the hip, shoulder, and the lateral compartment of the knee. Infiltration of bupivacaine and lateral meniscectomy are the most frequently sited offending procedures. Concerning the medial compartment, cases of avascular necrosis have been reported after meniscectomy or use of radiofrequency devices. This case underlines the necessity of a thorough physical examination and complete radiological work up before any surgery. It must also drive us to use caution regarding meniscectomy, especially in patients over 60 years of age, and reminds us that patients must be informed of this potential complication.