Part 1: Outcome of Posterior Pelvic Ring Injuries and Associated Prognostic Factors - A Five-Year Retrospective Study of One Hundred and Sixty Five Operated Cases with Closed Reduction and Percutaneous Fixation.

PURPOSES: The aim of this study was to evaluate: 1. the outcome of pelvic ring fractures treated by closed reduction and percutaneous fixation, 2. the prognostic factors associated with a poor quality reduction, 3. the prognostic factors associated with ilio-sacral screws misplacement and 4. the prognostic factors associated with nonunion. METHODS: Data from medical charts for all patients admitted with unstable posterior pelvic ring injuries from 2009 to 2013 were extracted. A total of 165 patients with a mean age of 40 years were included. One hundred and five patients were reviewed at a mean of 32 months of follow-up. The prognostic factors analyzed were clinical and radiological factors. Tile B and Tile C pelvic ring fractures were compared and analyzed separately. Then specific statistical analysis was performed using a logistic regression model to eliminate confusion factors. RESULTS: An excellent or good clinical result was achieved for 94 patients (90%). An excellent or good reduction was achieved for 141 patients (85%). Nonunion rate, smoking patients, bad reductions, age of patients and ISS score were significantly higher in Tile C group. To eliminate confusion factors we used a multivariate analysis logistic regression model. Only unstable vertical bilateral posterior injuries (Tile C2 and C3) were independent prognostic factors for unsatisfactory reduction (p = 0.001; OR = 4.72; CI 95% [2.08-16.72]). Screw misplacement was recorded for 30 patients (16%) and sacral dysmorphia was an associated prognostic factor (p = 0.0001; OR = 15.6; CI95% [3.41-98.11]). Nonunion was recorded for ten patients (6%) and smoking was an associated prognostic factor (p = 0.01, OR = 5.12; CI95% [1.1-24.1]). CONCLUSIONS: Posterior pelvic ring fractures treated by closed reduction and percutaneous fixation are associated with excellent/good clinical results if excellent/good reduction and bone healing are achieved without screw misplacement. Bilateral unstable vertical posterior pelvic ring injuries, and sacral dysmorphia are risk factors for bad quality reduction and screw misplacement respectively.

Acute traumatic patellar tendon rupture: Early and late results of surgical treatment of 38 cases.

INTRODUCTION: Acute patellar tendon rupture is easy to diagnose but is still often overlooked. The aim of this study was to assess early and late results of surgical treatment of acute patellar tendon rupture. Our hypothesis was that functional outcome is satisfactory. METHODS: A retrospective study included 38 knees in 37 patients (4 female, 33 male). Mean age was 42.6 ± 9.9 years (range, 23-81 years). Lesions comprised 15 tendon body ruptures, 20 avulsions from the tip of the patella and 3 avulsions from the anterior tibial tuberosity. Tendon repair was protected in more than 95% of cases by a reinforcement frame: hamstring (21 cases), synthetic ligament (12 cases) or metallic wire (3 cases). Results were evaluated in 2 steps: on patient files at a mean follow-up of 7.1 months (range, 3-24 months) to assess complications and early functional and radiological results; and by phone at a mean follow-up of 9.3 years (range, 19-229 months) in order to assess long-term functional outcome on Lysholm score and patient satisfaction. RESULTS: Thirty-one knees were assessed at a mean 7.1 months. Mean knee flexion was 128.5° ± 7.5° (range, 85°-150°), extension -1° (range, -15° to 0°) and Caton-Deschamps index 0.96 (range, 0.57-1.29). Twenty-three knees were further assessed at a mean 9.3 years. Mean Lysholm score was 93.7 points (range, 61-100). Ninety-six percent of patients were satisfied or very satisfied with the result. All had returned to their previous job, and 20 had returned to sports activities, including 8 at pretrauma level. CONCLUSION: Patellar tendon rupture has good prognosis if diagnosis and surgical treatment is early.

Acute quadriceps tendon ruptures: a series of 50 knees with an average follow-up of more than 6 years.

INTRODUCTION: Quadriceps tendon ruptures are rare and mainly affect patients over 40 years of age who have a systemic disease. The aim of this study was to evaluate the functional and radiological outcomes following surgical repair of acute quadriceps tendon ruptures. METHODS: This retrospective study included 68 knees in 65 patients (three women, 62 men), having an average age of 55.2 ± 13.9 years. The Lysholm and Tegner scores, patient satisfaction, range of motion and X-rays were evaluated. RESULTS: Fifty knees were evaluated with a mean follow-up of 76±67 months (12-253 months). The average Lysholm score was 93.7±10 (range 56-100, median 99) and 49 of 50 knees (98%) had good or very good subjective results. The average Tegner score was 3.4±1.6 (range 1-9, median 4). At the last follow-up, the average active flexion was 133°±10.8° (range 110°-150°, median 130°). Minor or moderate patellofemoral osteoarthritis was found in 24% of knees, but this was attributed to the surgery or initial injury in only 8% of cases. For 97% of active patients, the surgical repair allowed them to return to work in their pre-injury occupations. CONCLUSION: Quadriceps tendon ruptures have a good prognosis if they are diagnosed quickly. Treatment consists of surgery and postoperative immobilization for at least 6 weeks. An intensive rehabilitation protocol is also needed to recover good knee function. LEVEL OF EVIDENCE: Level IV. Retrospective study.