Primary Retrograde Tibiotalocalcaneal Nailing in an Elderly Osteoporotic Patient With Ankle Fracture: A Case Report.

Introduction: Ankle fractures are a common orthopedic injury traditionally treated with open reduction and internal fixation or conservative management. One complication introduced with open reduction and internal fixation is the requirement for non or partial weight bearing in the post-operative period. This requirement poses a unique challenge for patients who may not comply with these weight-bearing restrictions. This case is the first known article that specifically illustrates the validity and effectiveness of retrograde tibiotalocalcaneal (TTC) nailing for patients who are unlikely to follow weight-bearing restrictions. Case Report: An 83-year-old Caucasian female with idiopathic mild mental retardation and Alzheimer's presented with a minimally displaced trimalleolar ankle fracture and was treated at a single urban hospital with a retrograde TTC nail secondary to her inability to adhere to weight-bearing restrictions post-operatively. Pertinent demographic, clinical, radiographic, and surgical data were collected. The patient had minimal post-operative pain, was able to bear weight on the day of surgery, and had no post-operative complications. Conclusion: This case report demonstrates that the use of a TTC nail is a safe and effective mode of fixation for ankle fractures in patient populations who may not adhere to weight-bearing restrictions post-operatively. The main benefits of fixation with a TTC nail are the ability to weight bear as tolerated post-operatively and decreased wound complications while having similar functional outcomes to open reduction and internal fixation. We suggest the use of TTC nails for ankle fractures in select patients who may not adhere to weight-bearing restrictions post-operatively.

Mid-term outcomes following primary semi-constrained total knee arthroplasty in patients less than 60 years old, a retrospective review.

INTRODUCTION: Total knee arthroplasty (TKA) is a successful operation for osteoarthrosis. Typically, the knee can be balanced using posterior stabilized or cruciate retaining implants. However, in patients with severe deformity or ligamentous laxity, this cannot be obtained, and more constrained devices are needed. Semi-constrained implants, such as the Total Condylar III (TCIII) provide increased coronal stability. Outcomes in young (<60 years old) patients, following a primary semi-constrained TKA are not well reported in the literature. The purpose of this study was to evaluate patient reported outcomes, functional recovery, and implant survival in this population. METHODS: We performed a retrospective review of 21 patients, under the age of 60 years, that underwent primary semi-constrained TKA. Patient demographics, postoperative outcomes, patient satisfaction scores, and implant loosening were reported. RESULTS: At an average follow-up of 66 months, Knee Society Scores (KSS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were 94.7 and 15.7, respectively. No difference in patient reported outcomes between 1 year and final follow-up were observed. Patient demographics such as age, BMI, and gender had no effect on functional outcomes. No cases of aseptic loosening were observed. Implant survivorship, patient satisfaction, and excellent or good results were reported in 100%, 85.7%, and 92%, respectively. CONCLUSION: In young patients, in which the knee cannot be effectively balanced with standard releases, the use of a semi-constrained TKA as a primary implant lead to positive patient reported outcomes and no evidence of loosening at mid-term follow-up.