Standing on shoulder of giants: the incredible legacy of the Judet family in orthopaedic surgery.

In orthopaedic surgery, as well as other areas in medicine, it is common for a surgical technique to carry the original authors' name describing the procedure. The Judet family represents a unique history, since several orthopaedic procedures are known as "Judet's technique". The aim of this historic review is to outline the genealogy of the orthopaedic arm of the Judet family, while crediting each surgical procedure to the specific family member that described the technique.

What Do We Need to Know About Musculoskeletal Manifestations of COVID-19?: A Systematic Review.

¼: COVID-19 is a disease that is challenging science, health-care systems, and humanity. An astonishingly wide spectrum of manifestations of multi-organ damage, including musculoskeletal, can be associated with SARS-CoV-2. ¼: In the acute phase of COVID-19, fatigue, myalgia, and arthralgia are the most common musculoskeletal symptoms. ¼: Post-COVID-19 syndrome is a group of signs and symptoms that are present for >12 weeks. The associated musculoskeletal manifestations are fatigue, arthralgia, myalgia, new-onset back pain, muscle weakness, and poor physical performance. ¼: Data on COVID-19 complications are growing due to large absolute numbers of cases and survivors in these 2 years of the pandemic. Additional musculoskeletal manifestations encountered are falls by the elderly, increased mortality after hip fracture, reduced bone mineral density and osteoporosis, acute sarcopenia, rhabdomyolysis, Guillain-Barré syndrome, muscle denervation atrophy, fibromyalgia, rheumatological disease triggering, septic arthritis, adhesive capsulitis, myositis, critical illness myopathy, onset of latent muscular dystrophy, osteonecrosis, soft-tissue abscess, urticarial vasculitis with musculoskeletal manifestations, and necrotizing autoimmune myositis. ¼: A wide range of signs and symptoms involving the musculoskeletal system that affect quality of life and can result in a decrease in disability-adjusted life years. This powerful and unpredictable disease highlights the importance of multimodality imaging, continuing education, and multidisciplinary team care to support preventive measures, diagnosis, and treatment.

Comparing Intramedullary Nailing Versus Locked Plating in the Treatment of Native Distal Femur Fractures: Is One Superior to the Other?

INTRODUCTION: Distal femur fractures make up < 1% of all fractures and 3-6% of all femur fractures. In the literature, both intramedullary nailing (IMN) and locked plating (LP) have shown favorable results, but there is no consensus on a gold standard. The purpose of this systematic review is to compare outcomes of native distal femur fractures treated via IMN versus LP in an effort to determine if one is superior to the other. METHODS: Systematic review of MEDLINE, EMBASE, and Cochrane Library databases was conducted according to PRISMA guidelines. Only articles published within the last ten years were included. Evidence and study quality were evaluated with the MQOE and Oxford Criteria. RESULTS: Forty-six articles were included in the review. Fractures treated with IMN were found to have a 93.9% union rate, an average time to union of 19.2 weeks, an average arc of motion of 105.1 degrees, with an average of 14.4 degrees of malalignment. Fractures treated with LP were found to have a 90.2% union rate, an average time to union of 20.5 weeks, an average arc of motion of 104 degrees, with an average of 12.6 degrees of malalignment. CONCLUSION: Compiled data comparisons revealed no differences in union rate, malalignment, time to union, average arc of motion, or complication rates requiring a return to the operating room. Until higher level randomized data is available, either IMN or LP are acceptable methods of treatment for native distal femur fractures.

Subchondral Rafting Plate for the Treatment of Fragmented Articular Central Depression Tibial Plateau Fracture Patterns: Case Series and Technical Illustration.

Articular depression is a significant component of lateral tibial plateau fracture patterns. Current literature supports the use of subchondral rafting screws, either placed through a plate or not. However, articular comminution has been associated with increased articular subsidence despite an adequate screw-joint distance. We report four cases that underwent the subchondral rafting plate technique for fragmented articular central depression lateral tibial plateau fractures. Clinical and radiographic evaluations were performed at the last follow-up. The mean follow-up was 18 months. All patients healed the fracture without any significant articular subsidence or loss of reduction. This case study hints that this novel technique is a potentially safe and cost-effective strategy to be incorporated in the daily practice of the orthopedic trauma surgeon, especially in certain challenging circumstances when a salvage procedure is required due to lateral tibial plateau fracture malreduction and the unavailability of anatomically designed locking plates.

Reconstruction of Acetabular Defects With Impaction Grafting in Primary Cemented Total Hip Arthroplasty Produces Favorable Results: Clinical and Radiographic Outcomes Over 6.4 Years on Average.

BACKGROUND: Cemented primary total hip arthroplasty (THA) associated with acetabular reconstruction (AR) involving impacted bone grafting has been employed successfully in the revision of cavitary defects but the results are reportedly less predictable for segmental defects. The objective of the study is to evaluate the clinical and radiographic results of patients who had presented cavitary, segmental, and combined acetabular defects and received THA/AR involving impacted morselized cancellous bone autografts followed by rigorous postoperative management. METHODS: Clinical outcomes were assessed retrospectively of 154 patients who had been submitted to 169 THA/AR procedures performed by a single surgeon over a 15-year period. The Harris Hip Score system was applied to 103 patients, and the degree of acetabular migration was determined from radiograph images of 91 AR procedures, of which 40 were segmental/combined and 51 were cavitary reconstructions. RESULTS: The frequency of aseptic acetabular loosening was 3% while that of thromboembolic events was 4.1%. According to Harris Hip Score, 87.4% of outcomes were classified as excellent/good after an average follow-up period of 6.4 years irrespective of the type of acetabular defect. Horizontal and/or vertical acetabular migrations and changes in angular tilt were observed in all ARs, although the minor movements detected did not undermine the structural stability of the reconstructions or the functional capacity of patients. CONCLUSION: The described THA/AR technique can be used effectively in the reconstruction of segmental/combined and cavitary acetabular defects. The success of the technique as applied to segmental/combined defects was attributed in part to the rigorous rehabilitation protocol with temporary postoperative weight-bearing restriction.

Safety and efficacy of the modified Judet quadricepsplasty in patients with post-traumatic knee stiffness.

BACKGROUND: Knee stiffness is a challenging complication following complex fractures around the knee. Several treatment strategies have been described in the last decades, but clinical results and complication rates still remain as potential drawbacks. The aim of this study was to access the clinical outcomes and complications of the modified Judet quadricepsplasty following knee stiffness secondary to complex fractures around the knee. METHODS: A total of 11 patients presenting post-traumatic knee stiffness underwent modified Judet quadricepsplasty from 2014 to 2017. All procedures were performed by the same surgical team, and all patients followed the same postoperative pain control and rehabilitation protocols. No patients underwent medial approach for medial release. When necessary, medial release was performed through the lateral approach. Patients were evaluated using the Judet criteria for final range of motion after 1-year minimum follow-up. RESULTS: According to the Judet criteria, 4 patients (36.4%) presented excellent, 6 (54.5%) good, and 1 (9.1%) poor clinical outcomes. Blood transfusion was required in 5 patients (45.4%). No patients presented infection or wound dehiscence. CONCLUSIONS: Although quadricepsplasty is considered a high morbidity surgical procedure, our favorable functional outcomes with very low complication rates using this modified Judet quadricepsplasty confirmed safety and efficacy of this helpful surgical procedure for the challenge of post-traumatic knee stiffness. LEVEL OF EVIDENCE: Level 4 retrospective case series.

Expanding the indications for calcaneal plates beyond foot fractures: a technical trick and case series.

Although non-locking calcaneal plates are designed to treat calcaneal fractures, they present some interesting characteristics that justify using them beyond their current application in fractures of the foot. Calcaneal plates are malleable, have an increased footprint area for fracture containment or buttressing, and present several hole options for screw placement in different trajectories, thereby providing proper fixation even in comminuted fracture patterns. The aim of this study is to describe the unconventional use of calcaneal plates in the orthopaedic trauma scenario.

Expanding the horizons of clinical applications of proximal humerus locking plates in the lower extremities: A technical note.

Pre-contoured anatomical locking plates were designed to address the clinical need of fixing small epiphyseal segments with a larger number of screws. Those plates match the contour and shape of a variety of bones allowing for optimal buttress properties. The aim of this manuscript is to highlight the benefits of applying proximal humerus locking plates in the fixation of lower extremity bones. Although designed for the proximal humerus, the low-profile plate shape and anatomic contour also provides versatile use in certain areas of the lower extremity. This technical narrative highlights the versatile and reliable use of this plate for other anatomical areas than the one to which it has been originally conceived.

Safety and efficacy of surgical fixation of fibula fractures using an intramedullary nail: a retrospective observational cohort study in 30 patients.

BACKGROUND: Open reduction and internal fixation remains the standard treatment for displaced unstable ankle fractures. Plate fixation represents the most frequently used instrumentation option in fibula fractures and favourable outcomes have been reported. Recently, intramedullary nailing techniques have been suggested as a viable alternative resulting in less soft tissue disruption. The objectives of this study are to describe the surgical technique and to evaluate the safety and efficacy of using an intramedullary nail in patients undergoing surgical fixation of their fibula fracture. METHODS: A total of 30 skeletally mature patients with unstable ankle fracture who underwent intramedullary fixation of their fibula fractures from February 2016 to July 2017 were included in this retrospective study. Patients were evaluated using the Short Form-36 (SF-36) and the American Orthopaedic Foot and Ankle Society (AOFAS) at 18 months after surgery. RESULTS: All patients went on to fracture union. Two patients required a secondary surgical procedure. No patient included in this series developed any wound complications. The mean Physical Component Summary (PCS) of the SF-36 was 53.90 ± 13.3 and the mean Mental Component Summary Score (MCS) was 52.63 ± 11.12. The AOFAS subscale scores were 34.67 ± 1.03 for pain, 42.40 ± 0.2997 for function and 9.50 ± 0.2785 for alignment. CONCLUSIONS: Our study demonstrates promising outcomes associated with intramedullary nail fixation of unstable fibula fractures. We recommend intramedullary nail fixation of fibula fractures to be a safe procedure with a low complication rate. LEVEL OF EVIDENCE: Level 4 retrospective case series.

Setting Yourself Up for Success: Locked Plating in Periprosthetic Fractures About Total Knee Arthroplasty.

As the incidence of total knee arthroplasty increases, a concurrent increase in periprosthetic fractures will also occur. This article focuses on the most common fracture types and current strategies adopted to overcome this challenging clinical problem. Our goal is to outline the role of locking plates in the management of knee periprosthetic fractures.

Use of a stainless steel locking calcaneal plate for quadrilateral plate buttress in the treatment of acetabular fractures.

Operative fixation of acetabular fractures involving the quadrilateral surface presents a challenging clinical scenario. Classically, quadrilateral plate buttress was achieved via the use of a "seven" plate. More recently, the use of an anatomic, pre-contoured design has been gaining popularity due to its pre-contoured shape and larger footprint, allowing for a wider quadrilateral plate buttress. The current study presents using a stainless steel locking calcaneal plate to obtain similar surface area coverage as the modern pre-contoured quadrilateral plate, but at a lower cost.Level of evidence IV.

Calf Augmentation Implant Disruption Following a Tibial Plateau Fracture Fixation: An Extremely Rare Complication.

INTRODUCTION: Calf augmentation is a procedure to enhance leg contour, therefore, providing better aesthetic aspect. Patient satisfaction is extremely high, and reported complications following this procedure are rare. CASE REPORT: The aim of this study is to report an as yet described complication related to calf implants: Prosthesis disruption in a 60-year-old female patient who fell downstairs and presented a closed bicondylar tibial plateau fracture on the right knee (Schatzker V). CONCLUSION: We believe this case report can alert orthopaedic surgeons to carefully evaluate leg images in traumatized extremities and look for calf augmentation implants, especially in unconscious patients.

Algorithmic treatment of Busch-Hoffa distal femur fractures: A technical note based on a modified Letenneur classification.

Treatment of distal femur fractures in the coronal plane can be challenging. Depending on fracture line orientation, topography and associated comminution, decision-making regarding approach and fixation is not straightforward and can result in complications. Therefore, treatment of coronal plane distal femur fractures (Busch-Hoffa fractures) should be approached in a systematic manner, leading to efficient planning and operative execution. Here, we offer a proposed treatment algorithm, guiding treatment, approach and fixation based on the modified Letenneur classification of coronal plane distal femur fractures.