RESUMO
The management of bone loss in revision replacement of the knee remains a challenge despite an array of options available to the surgeon. Bone loss may occur as a result of the original disease, the design of the prosthesis, the mechanism of failure or technical error at initial surgery. The aim of revision surgery is to relieve pain and improve function while addressing the mechanism of failure in order to reconstruct a stable platform with transfer of load to the host bone. Methods of reconstruction include the use of cement, modular metal augmentation of prostheses, custom-made, tumour-type or hinged implants and bone grafting. The published results of the surgical techniques are summarised and a guide for the management of bone defects in revision surgery of the knee is presented.
Assuntos
Artroplastia do Joelho/métodos , Reabsorção Óssea/cirurgia , Prótese do Joelho/normas , Joelho/cirurgia , Artroplastia do Joelho/normas , Cimentação/métodos , Humanos , Articulação do Joelho/diagnóstico por imagem , Desenho de Prótese , Falha de Prótese , Radiografia , ReoperaçãoRESUMO
Proximal tibial fractures are rare in children, and most are treated conservatively. We report a case of a minimally displaced proximal tibial epiphyseal injury (Salter-Harris type III) in an 11-year-old child. We initially thought to treat this fracture conservatively, but the presence of massive haemarthrosis and considerable pain made us choose arthroscopy under general anaesthetic. During examination under anesthesia no instability could be detected, but the knee was locked in 5 degrees of flexion. On screening the fracture was not reducible anatomically. At arthroscopy the medial meniscus was not visualised as it was displaced into the fracture site. A small medial arthrotomy showed the meniscus trapped in the fracture site without any avulsion in the anterior or posterior horns. The fracture easily reduced once the meniscus was levered out. The importance of this injury is the fact that it could have been easily missed and would have led to serious functional deficit of the knee joint. We present radiographs and intra-operative pictures of this interesting injury.