Is the fracture pattern in periprosthetic fractures around the knee related with the anterior femoral notch?

INTRODUCTION: Periprosthetic fractures around the knee (PPF) are a devastating complication of total knee arthroplasty (TKA). Anterior femoral notching during TKA is considered a risk factor for PPF. The aim of this paper is to determine if an anterior femoral notch after total knee arthroplasty may affect the fracture pattern when a PPF appears postoperatively. MATERIAL AND METHODS: 50 patients diagnosed in our centre of a PPF from January 2010 to December 2013 were retrospectively enrolled. 100 patients who underwent a total knee arthroplasty without fracture were randomly obtained as a control group. Evidence of the notch was searched in both groups in postoperative X-rays. In the PPF group, distance from the shield of the femoral component to the most distal (d) and proximal (D) point of the fracture were measured. RESULTS: Two different groups were obtained: 1) d = 0 (33 out of 50 patients); the fracture is supposed to be related with the notch as it's a theoretically weaker area. 2) d > 0 (17 out of 50 patients); the fracture pattern has no relationship with the notch. Prevalence of patients suffering a fracture in the shield of the prosthesis (d = 0), was similar in both patients with notch (66,7%) and without it (68%). CONCLUSIONS: In conclusion, fracture pattern is not related with the existence of a femoral notch in the clinical setting.

The comparison of measurement accuracy among three different imaging modalities in evaluating elastofibroma dorsi. An analysis of 52 cases.

PURPOSE: Elastofibroma dorsi (ED) is a rare soft-tissue tumour. Diagnosis is made using imaging, mainly magnetic resonance due to its higher sensitivity and specificity in soft tissues. No agreement exists when deciding which imaging test must be used. Often multiple tests are made in the same patient, increasing time and costs. The aim of this paper is to compare the usual imaging exams and evaluate which one is the most accurate when diagnosing and measuring ED. METHODS: A retrospective review was made of those patients who were diagnosed and operated for ED since January 2006 to December 2013. Fifty-two ED were included (19 men, 25 women), and eight of them were bilaterally affected. They were divided into three different groups according to the imaging test used: ultrasound (US) computed tomography (CT) and magnetic resonance (MR). After surgery the pieces were sized and compared with the measurements made by imaging exams. RESULTS: Two hundred fourteen measures were analysed (40 US, 33 CT and 34 MR with their pathological equivalent). When CT group and its corresponding AP were analysed, no significant differences between them were founded (p > 0.05). Moreover, we analysed absolute differences between measures. In the US group a mean difference of 2.23 ± 1.87 cm was obtained. In the CT group, the mean difference was 1.22 ± 0.97 cm. Likewise, the difference of the MR group was 1.62 ± 1.15 cm. CONCLUSIONS: This study demonstrates that the CT obtains a higher correlation than MR when determining the size of ED.

Tratamiento de las fracturas periarticulares de rodilla mediante artroplastia total primaria. Presentación de tres casos / Treatment of the periarticular knee fractures with a primary total knee arthroplasty: Report of three cases

Objetivo: Analizar los resultados obtenidos en pacientes tratados mediante una artroplastia total primaria tras sufrir una fractura periarticular de rodilla, en el Hospital Universitario Reina Sofía de Córdoba. Material y métodos: Estudio de tres casos de pacientes con fracturas periarticulares de la rodilla que fueron tratados mediante una artroplastia total primaria, consecutivamente desde junio de 2009 hasta agosto de 2010: Una mujer de 75 años con fractura de cóndilo femoral externo, un varón de 70 años con fractura-hundimiento de meseta tibial interna, y un varón de 80 años con fractura-hundimiento de meseta tibial externa. El período de seguimiento medio fue de 12 meses. En la evaluación de resultados se utilizaron las siguientes escalas: Knee Society Score (KSS), Escala Visual Analógica y la escala de valoración de la fuerza muscular de Daniels. Resultados: No hubo complicaciones intraoperatorias ni postoperatorias graves. Dos de los tres pacientes necesitaron valoración por Rehabilitación. Al finalizar el seguimiento todos los pacientes se mostraron satisfechos con los resultados, refiriendo un adecuado control del dolor, y el balance articular fue superior a 0-100 grados en dos de los tres casos. Durante el seguimiento no se observaron signos radiográficos de fracaso de la técnica y no huboindicación para cirugía de revisión en ninguno de los casos. Conclusión: Los resultados a corto plazo indican, al igual que otras series de casos publicadas, que la artroplastia primaria total en pacientes ancianos con fracturas periarticulares de la rodilla es una opción válida de tratamiento (AU)

Objective: Analyze the results obtained in patients with primary total arthroplasty after having suffered a periarticular knee fracture, at the Reina Sofia University Hospital in Cordoba (Spain). Material and method: Three cases of patients with periarticular fractures of the knee were studied using primary total arthroplasty, all consecutive from June 2009 until August 2010: a 75 year old woman with external femoral chondral fracture, a 70 year old man with collapsed fracture of the internal tibial plateau and an 80 year old male with a collapsed fracture of the external tibial plateau. Average follow-up was 12 months. Results were assessed using the following scales: Knee Society Score (KSS), CVAS (Cosmetic Visual Analogue Scale) and the Daniels Muscle Testing scale. Results: There were no inter-operative or serious post-operative complications. Two of the three patients needed assessment for rehabilitation. Once follow-up concluded, all patients were satisfied with the results, referring to an adequate control of pain and the articular balance was greater than 0-100 degrees in two of the three cases. Throughout follow-up, no radiographic signs of failure of the technique were observed and there was no indication that the surgery needed revision in any of the cases. Conclusion: The short-term results indicate that as with the other series of cases published, primary total knee arthroplasty in elderly patients with periarticular knee fractures is a valid treatment option (AU)