Luxación del polietileno en prótesis patelo-femoral con patela móvil. Caso clínico / Dislocation of the polyethylene in a patello-femoral replacement with a movable patella

La artroplastia femoro-patelar continúa siendo una técnica quirúrgica poco utilizada por los discutidos resultados obtenidos. En un intento de mejorar sus resultados se introdujo el diseño con polietileno móvil. Presentamos un caso clínico con una complicación poco frecuente: la luxación del polietileno de la base metálica de la patela; y a propósito realizamos una revisión bibliográfica de esta complicación (AU)

Patellofemoral arthroplasty is an infrequently used surgical technique because of its controversial results. In an attempt to improve the results, a design with a mobile-bearing poliethylene patellar component has been developed. We describe a clinical case with an unusual complication: the dislocation of poliethylene from the metal backing; and accordingly, we carried out a literature review of this complication (AU)

[Dislocation of the polyethylene in a patello-femoral replacement with a movable patella]. / Luxación del polietileno en prótesis patelo-femoral con patela móvil. Caso clínico.

Patellofemoral arthroplasty is an infrequently used surgical technique because of its controversial results. In an attempt to improve the results, a design with a mobile-bearing poliethylene patellar component has been developed. We describe a clinical case with an unusual complication: the dislocation of poliethylene from the metal backing; and accordingly, we carried out a literature review of this complication.

Nonreamed flexible locked intramedullary nailing in tibial open fractures.

Thirty-nine open unstable tibial shaft fractures were treated with a nonreamed flexible locked intramedullary nail between 1992 and 1995. There were 23 Grade I, 12 Grade II, three Grade IIIA, and one Grade IIIB fractures. The average time of followup assessment was 24 months. The average time to fracture union was 24 weeks. Complications were related in most cases to fractures with highly unstable patterns and extensive soft tissue lesions. There were five (12.5%) delayed unions and one (2.5%) nonunion. Deep infections developed in three (7.7%) patients. One patient required an additional procedure to correct a varus malunion. There were no implant failures. It was concluded that nonreamed flexible locked nailing provides effective control of axial and rotational stability in unstable Grades I to IIIA open fractures with acceptable union rates and a low incidence of complications secondary to the fixation system.

Treatment of mallet finger fractures by the extension-block K-wire technique.

We treated 22 patients with mallet finger fractures involving more than one-third of the articular surface by the extension-block K-wire technique. There were 18 men and four women with a mean age of 23 years (range, 14-34). The Wehbé and Schneider method was used to classify the fractures and the results were graded according to Crawford's criteria. All the fractures united, with an average healing time of 5.6 weeks (range, 4-7). At a mean follow-up of 25 months (range, 18-48) 21 mallet finger fractures had an excellent or good result. One patient had a fair result with a lag to extension of 20 degrees. We conclude that the extension-block K-wire technique is an effective method of treatment for displaced mallet finger fractures.

Surgery for fracture of the calcaneus. 5 (2-8) year follow-up of 20 cases.

20 displaced intraarticular fractures of the calcaneus were treated by open reduction and internal fixation. Results were evaluated according to a standardized protocol. With an average follow-up of 5 (2-8) years, results were excellent or good in 15 cases and fair or poor in 5 cases. An accurate radiographic study and CT scanning are essential for understanding these fractures. We feel that restoring calcaneal shape as anatomic as possible, getting an appropriate reduction of the posterior joint surface by a surgical procedure with early mobilization, and delayed weight bearing would be a good option in treatment of these fractures.

Kuntscher nailing of femoral shaft fractures in children and adolescents.

We have reviewed 29 cases of very unstable diaphyseal fractures of the femur in children and adolescents treated by Kuntscher nailing. Follow up was for at least 5 years, and in most cases until after the end of growth. There were no postoperative complications, and the mean overgrowth of the femur was 7.06 mm. There was growth disturbance of the proximal femur in one case, but this did not interfere with function. We believe that Kuntscher nailing is indicated in children and adolescents with unstable high velocity fractures of the femoral shaft.