Bilateral Total Knee Arthroplasty for Charcot Arthropathy After Cauda Equine Syndrome: A Case Report.

Charcot arthropathy of the knee is a relatively rare and poorly understood condition. Diagnosis requires detailed history of the patient, radiological investigation and exclusion of other causes of arthropathy. Conservative treatment is sufficient only in early stages. In late stages, either arthrodesis or total knee arthroplasty is the treatment of choice. We report a case of a 65-year-old woman who presented with Charcot arthropathy in both knees, after a spinal fracture 35 years ago, which caused cauda equine syndrome with diminished sensation of both legs. She underwent bilateral total knee arthroplasty using hinged knee prosthesis.

Operative treatment of unilateral bicondylar Hoffa fractures.

A rare case of unilateral bicondylar fractures of the femoral condyles is presented. Internal fixation of the fragments was achieved by three cancellous lag screws, followed by a short period of cast immobilization and intensive physiotherapy. Full weight bearing was allowed 3 months postoperatively. Full range of motion of the knee and no presence of articular defects on femoral condyles were observed 2 years after hardware and heterotopic ossification removal.

Functional evaluation of comminuted intra-articular fractures of the distal humerus (AO type C). Long term results in twenty-six patients.

The authors present the results achieved in 26 patients who presented with intra-articular fractures of the distal humerus (8 AO type C1, 8 C2 and 10 C3) and who were operatively treated between 1999 and 2001; they were retrospectively evaluated after a mean follow-up period of 70.2 months. There were 12 males and 14 females with a mean age of 46.1 years. After a standard posterior approach with olecranon osteotomy, internal fixation was achieved with unilateral or bilateral plates and screws, or isolated screws and/or Kirschner wires. Anterior intramuscular transposition of the ulnar nerve was performed in 14 of the patients. The results were evaluated using the criteria of Morrey. The results were graded as excellent in 6 patients (23.1%), very good in 15 (57.6%) and fair in 5 (19.3%). Complications included postoperative ulnar nerve palsy (1), wire migration (4), heterotopic ossification (3), infection (2) and material failure (2). The overall re-operation rate was 38.4%. The authors conclude that careful preoperative planning, transolecranon approach for good visualisation, routine ulnar nerve exploration and stable internal fixation facilitating early active rehabilitation, remain the gold standard for the treatment of intra-articular fractures of the distal humerus.

Herbert screw fixation and reverse guided drillings, for treatment of types III and IV osteochondritis dissecans.

We evaluated the outcome in 10 young patients, ages ranging from 15 to 26, with types III and IV osteochondritis dissecans of the knee, treated with Herbert screws fixation and reverse guided drillings. The disease involved the medial femoral condyle in eight patients and the lateral in two. Diagnosis and preoperative planning based on plain radiographs (AP, lateral and tunnel view) and MRI (in seven patients). Fixation of the fragment with Herbert screws using a mini-arthrotomy technique and additional reverse drillings behind the crater of the lesion using the ACL aiming devise were performed in all patients. Post-operatively, no weight bearing was recommended for at least three months. The follow-up ranged from 15 months to 38 months (mean 27 months). According to the subjective questionnaire of the International Cartilage Repair Society (ICRS) scale, seven patients had normal knees, two had nearly normal knees and one abnormal. The Lysholm Knee score ranged 65-96 points (mean 88 points). All patients except one returned to their previous activities and they were satisfied with the result. Radiological union of the fragment was found in 9/10 patients (six grade III, three grade IV). Progressive flattening of the injured femoral condyle was noticed in two patients (grade III). Securing the lesion using Herbert screws in combination with reverse guided drillings seems to be an effective treatment choice for detached or displaced osteochondral fragments.

Aplasia of the posterior arc of the atlas with persistent posterior tubercle: a case report.

An unusual case of partial aplasia of the posterior arc of the atlas, with persistent posterior tubercle, is presented in a previously healthy individual who sustained a neck trauma. Both plain X-rays and CT findings specified the lesion. Dynamic X-rays in flexion and extension showed an immobile posterior tubercle. The patient did not develop neurological symptoms at any stage during follow-up (1 year).

Modified extra rotator-cuff entry point in antegrade humeral nailing.

INTRODUCTION: We describe an extra-articular, extra-rotator cuff entry point for antegrade humeral nailing, which preserves the articular surface and rotator cuff integrity. MATERIAL AND METHODS: Thirty-two patients with humeral shaft fractures underwent antegrade intramedullary nailing using a modified insertion point located 1 cm below the crest of the greater tuberosity, in a region outside the articular surface and rotator cuff area. RESULTS: In all cases, nailing was done successfully, without any perforation of the humeral inner cortex by the nail. Extension of the fracture line to the distal metaphysis happened intraoperatively in one case of a distal diaphysis fracture. In the remainder of the patients, postoperative reduction of the fracture was successful, with no sign of an iatrogenic incident of fracture comminution. Excellent active shoulder function and full early functional recovery of the shoulder joint (to 16th week postoperatively) were established in 98% of the patients. All fractures were united in a mean period of 14 weeks. CONCLUSION: We suggest an extra-articular, extra-rotator cuff entry point for antegrade humeral nailing as a possible and safe technique with beneficial results for the shoulder's postoperative function.