Acute, unstable slipped capital femoral epiphysis with associated congenital coxa vara.

Slipped capital femoral epiphysis in patients younger than 10 years is rare and is often associated with some identifiable metabolic or endocrinologic abnormality. We present a case of a 5-year-old girl with an acute, unstable, severe slipped capital femoral epiphysis associated with congenital coxa vara and its surgical management. This association has not been described in previous literature. Surgical treatment is proposed and described.

The prevalence and combined prevalences of anatomic factors associated with recurrent patellar dislocation: a magnetic resonance imaging study.

BACKGROUND: Anatomic factors, including patella alta, increased tibial tubercle-trochlear groove (TT-TG) distance, rotational deformities, and trochlear dysplasia, are associated with dislocation of the patella. Identifying the presence of these anatomic factors both in isolation and in combination may influence treatment in patients with patellar dislocation. PURPOSE: The aim of this study was to compare the prevalence and combined prevalences of these anatomic factors using magnetic resonance imaging in a group of patients with and without histories of recurrent dislocation of the patella. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: The prevalence and combined prevalences of patella alta, increased TT-TG distance, rotational deformity, and trochlear dysplasia on magnetic resonance imaging were reported and compared in 60 patients (60 knees) with and 120 patients (120 knees) without histories of recurrent patellar dislocation. RESULTS: Patients with recurrent patellar dislocation possessed higher rates of patella alta (60.0% vs. 20.8%), increased TT-TG distance (42.0% vs. 3.2%), rotational deformity (26.7% vs. 2.5%), and trochlear dysplasia (68.3% vs. 5.8%) compared with patients without histories of patellar dislocation. Multiple anatomic factors were identified in 58.3% of patients (35/60) with recurrent dislocation compared with only 1.7% of controls (2/120). CONCLUSION: Recurrent patellar dislocation is associated with an increased prevalence of patella alta, increased TT-TG distance, rotational deformity, and trochlear dysplasia compared with patients with no histories of patellar dislocation. Multiple anatomic factors were identified in the majority of patients with recurrent dislocation. Further research may identify which factors play a greater role in patellar stability and may allow physicians to predict which first-time dislocation patients are more likely to sustain recurrence.

Medial collateral ligament recession for chronic medial knee laxity.

The medial collateral ligament (MCL) is the primary restraint to valgus stress of the knee. Although the MCL has demonstrated an ability to reliably heal with conservative management, chronic medial instability has been well described following an isolated MCL injury or in combination with an anterior cruciate ligament (ACL) tear. When the MCL heals with persistent medial laxity surgical treatment may be necessary to prevent chronic medial instability and valgus overload of a reconstructed cruciate ligament. We present a simple technique for MCL recession that can be used for isolated MCL laxity as well as in chronic ACL/MCL knee injuries. This technique allows for secure fixation with bone-to-bone healing, avoids donor-site morbidity, maintains relative MCL isometry, and can be performed through a modest incision.

Lower extremity bypass graft occlusion after intramedullary fixation of intertrochanteric hip fracture on a fracture table.

This article presents a case of a 90-year-old woman who previously underwent a common femoral to anterior tibial artery bypass grafting with a Gore-Tex graft (Gore Medical, Flagstaff, Arizona). She subsequently sustained an ipsilateral intertrochanteric hip fracture after a mechanical fall and underwent internal fixation with an intramedullary nail using a fracture table. In the immediate postoperative period, she developed limb-threatening ischemia in her leg due to graft thrombosis. The patient underwent a successful thrombectomy and embolectomy. However, she subsequently developed nonhealing ulcers to this extremity over the course of weeks, requiring surgical debridement. Gangrene ensued and she underwent a below-the-knee amputation.Complications from the use of fracture tables have been described for perineal soft tissue injury, leg malrotation or malalignment, neurologic injury, and iatrogenic compartment syndrome of the healthy leg. Arterial complications after intramedullary fixation of femur fractures are rare and may be caused by direct arterial trauma during placement of the locking screws through the intramedullary nail. This article is the first, to our knowledge, to describe an occlusion of a lower extremity bypass graft after intramedullary fixation on a fracture table. Surgeons should be aware of potential limb threatening ischemia in patients with peripheral vascular disease, especially in those with prior lower extremity bypass grafts. Proper preoperative counseling should be given to these patients when using fracture tables during hip fracture surgery.