Intraoperative Periprosthetic Fractures during primary Total knee arthroplasty: Experience from an Asian high-volume arthroplasty centre.

BACKGROUND: Intraoperative periprosthetic fracture (IF) is an under-reported complication in primary total knee arthroplasty (TKA). This study aimed to audit the outcomes and complication rates in patients encountering IF during primary TKA and propose a new classification for its management. METHODS: A nested case-control study was performed at a tertiary referral hospital where 50 patients encountering IF during primary TKA operated by a single surgeon team between January 2016 to May 2021, were compared with 150 (3:1) age-, gender- and implant-matched patients not encountering IF. Demographic data, risk factors, outcomes and complications of both groups were compared at a minimum follow up of 1 year. RESULTS: The incidence of IF was 0.45%, with 44 fractures in the femur (88%), six (12%) in the tibia and none in the patella. Medial collateral ligament avulsion fracture (54.54%) in the femur and medial plateau fracture (66.66%) in the tibia were the most common fracture types. At final follow up, the fracture group had higher rates of 90-day re-admissions (8% vs. 2.66%, P = 0.095), deep infection (4% vs. 0.66%, P = 0.15) and revisions (6% vs. 1.33%, P = 0.06). The mean Knee Society Score was not significantly different between the two groups (152.22 ± 9.25 vs. 161.68 ± 11.22, P = 0.642) with union being achieved in all but one patient at a mean duration of 9.6 weeks. CONCLUSIONS: Patients with severe and fixed deformities have a higher risk for IF. The occurrence of fracture and the complexity of surgery equally contribute to the higher complication rates. Appropriately managed fractures have comparable functional outcomes.

Surgical Management of Hip Dislocation in a Patient with SCARF Syndrome: A Case Report with a 6-Year Follow-up.

CASE: We report a six-year-old child with SCARF syndrome (skeletal anomaly, cutis laxa, ambiguous genitalia, mental retardation and distinct facial features) who presented with unilateral teratologic hip dislocation. She underwent an open reduction of her hip with femoral and pelvis osteotomies. At six years follow-up, she was asymptomatic with a mild lurch, a leg length discrepancy of 1.5cms and a good range of motion at the hip. A mild shortening of the femoral neck was noted but the joint was congruous and concentrically reduced at 6 years. CONCLUSION: The management principles must follow an aggressive approach which includes open reduction of the hip, femoral and pelvic osteotomies with a good capsular repair. We may expect good hip development after surgical intervention even in a child with increased elasticity due to this genetic condition.

Bizarre Parosteal Osteochondromatous Proliferation (Nora Lesion) in Upper and Lower Limbs: A Report of Three Cases and Review of Literature.

INTRODUCTION: Bizarre parosteal osteochondromatous proliferation (BPOP) is a rare bone pathology affecting small bones of hand and feet. This benign lesion needs to be distinguished from many malignant bone tumors as it poses a diagnostic dilemma due to its clinical, radiological, and histological picture. We report three cases of BPOP affecting the hand and foot. CASE 1: A 21-year-old gentleman presented with painful swelling in the long finger of the right hand. A plain radiograph showed a radio dense mass which was later excised and diagnosis confirmed in histopathology. There was no recurrence in 2 years of follow-up. CASE 2: A 5-year-old boy presented with painful swelling over the right ankle with no history of antecedent trauma. Following radiological evaluation, the patient was successfully treated with excision. CASE 3: A 35-year-old lady presented with a painful swelling on the dorsal aspect of her hand which was gradually increasing in size. After radiological evaluation, the patient was successfully treated with excision and lesion confirmed to be BPOP on histological examination. She was symptom free without recurrence in up to 2 years of follow-up. CONCLUSION: Nora's lesion is a rare pathology requiring high index of suspicion. Excision is the recommended mode of treatment. All our cases responded well with excision with immediate pain relief following surgery and no recurrence in up to 2 years of follow-up.