Floating hip and associated injuries.

AIM: To describe our experience in treating patients diagnosed with floating hip injury and to communicate the outcomes achieved and the rate of complications. A secondary aim is to compare the results of this group in terms of quality of life with those of patients presenting with a fracture either of the pelvis or of the acetabulum, but in which the femoral segment is not involved. PATIENTS AND METHODS: This is a descriptive study of the patients diagnosed with floating hip injury (25 patients) who were treated at our hospital between 2004 and 2007, with a minimum follow-up of seven years. The results are compared with those of a control group of 56 patients diagnosed with an isolated pelvic or acetabular injury. We describe the injuries and the associated lesion. The patients' quality of life was assessed using the EUROQOL tool. RESULTS: Among the floating hip group of patients, three suffered an additional arterial lesion and were later treated with a supracondylar amputation. Seven patients presented heterotopic ossification. No significant difference was observed between the study and control groups, according to the EUROQOL tool, although the scores for every dimension were lower among the floating hip patients. Among the patients in the control group, the quality of life scores were also affected in every dimension of the EUROQOL scale. DISCUSSION AND CONCLUSIONS: The addition of a femoral fracture to a pelvic or acetabular injury, the so-called floating hip, is a devastating injury which has an important impact on patients' quality of life, going beyond that experienced by patients with isolated injuries. Nevertheless, our results did not reflect statistically significant differences in the quality of life among the three groups analyzed: isolated fractures, floating hip and floating hip resulting in amputation.

Outcomes after repair of chronic bucket-handle tears of medial meniscus.

PURPOSE: The purpose of this study was to determine the outcomes after repair of chronic bucket-handle medial meniscal tears by use of magnetic resonance imaging, clinical examination, and patient-reported outcomes. METHODS: A retrospective review of patients with chronic bucket-handle medial meniscal tears that had been repaired with meniscal sutures was undertaken. The following criteria for inclusion were adopted: minimum tear length of 2 cm and chronic medial meniscal tear identified at the time of arthroscopy. The tears were susceptible to dislocation with probing. Data collected included demographic, clinical, radiologic, and surgical data. Postoperative healing was assessed with the clinical criteria of Barrett et al. The International Knee Documentation Committee rating, Lysholm score, and Tegner activity level were determined, and postoperative magnetic resonance imaging was used to evaluate healing in accordance with the criteria of Henning et al. RESULTS: Twenty-four patients fulfilled the inclusion criteria. The mean time from injury to surgery was 10 months (range, 2 to 60 months). Sixteen patients underwent anterior cruciate ligament reconstruction, 1 patient underwent posterior cruciate ligament reconstruction, and 6 patients underwent meniscus repair only. A median of 5 sutures (range, 3 to 6 sutures) were used for repair. Four cases (all of which had undergone meniscus repair only) required revision. Complete healing was achieved in 83% of cases according to the criteria of Barrett et al. The mean follow-up time was 48 months (range, 24 to 112 months). An International Knee Documentation Committee rating of A or B was achieved in the 20 patients who did not require revision. The median Lysholm score was 95 (range, 92 to 100). The median Tegner activity level before injury was 7, and it remained unchanged after surgery in all cases. CONCLUSIONS: This study showed that repair of chronic bucket-handle meniscal tears can lead to good clinical outcomes and a relatively low (17%) failure rate. In addition, repairs of isolated meniscal tears had a significantly higher risk of failure than repairs performed in conjunction with anterior cruciate ligament reconstruction. LEVEL OF EVIDENCE: Level IV, therapeutic case series.