Anatomical fixation of tibial intercondylar eminence fractures in children using a threaded pin with an adjustable lock.

INTRODUCTION: Tibial intercondylar eminence fractures are a rare pathology causing anterior laxity of the knee, which requires anatomical reduction and a stable osteosynthesis. The aim of this study was to present the clinical results of reinsertion in anatomical position of these fractures, in the paediatric population, using a threaded pin with an adjustable lock. HYPOTHESIS: Our hypothesis was that the clinical results would be satisfactory and comparable to the literature. METHOD: This retrospective, monocentric study involved 34 consecutive patients with tibial intercondylar eminence fractures, divided into 55.9% with type 2, 35.2% with type 3, 8.8% with type 4 according to Meyers & McKeever, operated on between March 1999 and March 2018. Assessments were performed at a minimum follow-up of 1-year and included the Lysholm, subjective International Knee Documentation Committee (IKDC) and Tegner activity scores, and the measurement of anterior knee laxity by the KT1000. RESULTS: At the average follow-up of 8.8 years, 7 patients were lost to follow-up, 2 required anterior cruciate ligament reconstruction. Pathological residual laxity was present in 25% of cases and instability in 16%. The average Lysholm score was 93.1±9.8, the average subjective IKDC was 93.8±6.4 and the average Tegner score was 5.6±1.5. The average anterior laxity of the knee was 0.7±2.0mm. CONCLUSION: The anatomical reinsertion using a threaded pin with an adjustable lock for tibial intercondylar eminence fractures in a paediatric population provides good functional results and is comparable to the data in the literature. LEVEL OF EVIDENCE: IV; retrospective.

Influence of femoral morphology and canal fill ratio on early radiological and clinical outcomes of uncemented total hip arthroplasty using a fully coated stem.

AIMS: The diversity of femoral morphology renders femoral component sizing in total hip arthroplasty (THA) challenging. We aimed to determine whether femoral morphology and femoral component filling influence early clinical and radiological outcomes following THA using fully hydroxyapatite (HA)-coated femoral components. METHODS: We retrospectively reviewed records of 183 primary uncemented THAs. Femoral morphology, including Dorr classification, canal bone ratio (CBR), canal flare index (CFI), and canal-calcar ratio (CCR), were calculated on preoperative radiographs. The canal fill ratio (CFR) was calculated at different levels relative to the lesser trochanter (LT) using immediate postoperative radiographs: P1, 2 cm above LT; P2, at LT; P3, 2 cm below LT; and D1, 7 cm below LT. At two years, radiological femoral component osseointegration was evaluated using the Engh score, and hip function using the Postel Merle d'Aubigné (PMA) and Oxford Hip Score (OHS). RESULTS: CFR was moderately correlated with CCR at P1 (r = 0.44; p < 0.001), P2 (r = 0.53; p < 0.001), and CFI at P1 (r = - 0.56; p < 0.001). Absence of spot welds (n = 3, 2%) was associated with lower CCR (p = 0.049), greater CFI (p = 0.017), and lower CFR at P3 (p = 0.015). Migration (n = 9, 7%) was associated with lower CFR at P2 (p = 0.028) and P3 (p = 0.007). Varus malalignment (n = 7, 5%), predominantly in Dorr A femurs (p = 0.028), was associated with lower CFR at all levels (p < 0.05). Absence of spot welds was associated with lower PMA gait (p = 0.012) and migration with worse OHS (p = 0.032). CONCLUSION: This study revealed that femurs with insufficient proximal filling tend to have less favourable radiological outcomes following uncemented THA using a fully HA-coated double-tapered femoral component.Cite this article: Bone Joint Res. 2020;9(4):182-191.

Hinged total knee arthroplasty for fracture cases: Retrospective study of 52 patients with a mean follow-up of 5 years.

INTRODUCTION: Hinged total knee arthroplasty (hTKA) is one of the treatment options available for complex fractures around an intact knee or an existing implant. The primary objective of this multicenter study was to evaluate the medium-term outcomes of hTKA for fractures. The secondary objective was to analyze the complications and risk factors based on fracture type, predisposition and time to surgery. We hypothesized that outcomes would be satisfactory, despite the context, and comparable to published data although impacted by significant mortality and morbidity. MATERIALS AND METHODS: Within the framework of a symposium organized by the French Society of Orthopedic and Traumatology Surgery (SOFCOT), 52 patients from 11 hospitals were included retrospectively. All had undergone hTKA following a fracture event: recent fracture, postoperative course after a complex epiphyseal fracture on an intact knee, or periprosthetic fracture. Clinical outcomes (demographics, IKS score, Parker score, Devane score, time to surgery) and radiographic outcomes, along with complications were analyzed. RESULTS: Of the 52 patients included, 3 were lost to follow-up and 1 died early on. Thus, 48 patients with a mean age of 72 years (range, 31-95) were available for analysis at a mean follow-up of 59 months (range, 3-162). Forty of these patients (78%) had suffered a fracture to an intact knee and 12 (22%) had suffered a periprosthetic fracture. Of the 52 initial patients, 21 (40%) had early complications with 7 patients (19%) requiring surgical revision (5 surgical site infections, 1 extensor mechanism tear, 1 patellar dislocation). Sixteen patients (31%) developed late complications an average of 57 months after the hTKA implantation. All required surgical revision. There were 8 implant infections (15%), 3 cases of stiffness (6%), 2 extensor mechanism tears (4%) and 3 cases of loosening (6%). At a mean follow-up of 59 months, there was a 24-point improvement on the IKS pain scale (p=0.032). The postoperative activity level was unchanged in the patients who did not suffer a complication. The mortality rate was high (7/48; 15%). CONCLUSION: Our hypothesis was confirmed since the outcomes were satisfactory, but mortality and morbidity were high. Performing hTKA remains an option in the post-fracture context, although surgeons must carefully consider the indications. LEVEL OF EVIDENCE: IV, retrospective study.