Using the semitendinosus tendon to stabilize sternoclavicular joints in a patient with Ehlers-Danlos syndrome: a case report.

Symptomatic recurrent anterior dislocation of the sternoclavicular joint is a rare but sometimes painful condition. A novel technique of extrathoracic reconstruction using tendon autograft is presented in this case report. When spontaneous ankylosis of an anterior dislocation of the sternoclavicular joint does not occur, and the patient remains symptomatic, surgical reconstruction using this procedure may be a viable alternative.

Long-term results of total joint arthroplasty in elderly patients who are frail.

Many studies of joint replacement in the aged population include a wide spectrum of geriatric patients ranging from relative healthy and otherwise vigorous younger-elderly to small numbers of much older patients with many comorbid problems. To clarify the latter patient subset we assessed the results of total hip and knee arthroplasties done on a group of frail elderly patients. We retrospectively reviewed the preoperative and postoperative charts and radiographs of 130 patients who were at least 80 years when they had a total joint arthroplasty. One hundred arthroplasties (70 hips, 30 knees) were done. On a subjective grading scale, 95% of the patients were very satisfied, 5% reported satisfactory outcomes and no patients considered their results poor. After surgery, 90% of the patients became community walkers without assistance. The level of independent living was maintained in 97% of patients at long-term followup. Causes of morbidity included two infections, one dislocation, and one leg-length discrepancy. This study specifically addresses the outcomes of total joint replacement in elderly patients who are frail. We show that satisfactory and cost-effective health outcomes can be anticipated after total joint arthroplasties in this age group.

Algorithms for the treatment of femoral neck fractures.

Worldwide prevalence of femoral neck fractures is increasing, doubling for patients older than 50 years. Age of the patient, prefracture activity level, and associated comorbidities must be considered when determining treatment. It seems that hemiarthroplasty is best suited for an elderly patient who is a household ambulator with low demands on the prosthesis. Younger patients, and those with minimally displaced fractures, should be treated with internal fixation in an attempt to preserve the natural hip. Proximal femur fractures in the pediatric population are associated with high complication rates. Because of vascular vulnerability, avascular necrosis of the femoral head continues to be the most frequent and serious complication after hip trauma in children. Femoral neck fractures in children also differ from those in adults because a child can tolerate immobilization much more readily than can an adult. As healthcare resources become more limited and their use becomes scrutinized more closely, cost-effective treatment algorithms for femoral neck fractures will dictate orthopaedic treatment. For some fractures, closed treatment is evolving toward interventional approaches to minimize late sequelae. With the availability of viable treatment options, the potential risks and benefits of individual treatment modalities as related to each fracture pattern must be reviewed.