Patellar resurfacing versus no resurfacing in Scorpio total knee arthroplasty.

This retrospective study compared the results of patellar resurfacing versus no resurfacing in 121 patients (142 knees) who underwent Scorpio total knee arthroplasty (TKA) between January 2002 and September 2004. Mean follow-up was 33 months in the nonresurfaced group and 18 months in the resurfaced group. The 2 groups were similar in age and gender. The incidence of anterior knee pain was 25% in the nonresurfaced group compared to 7% in the resurfaced group (P = 0.05), and the rate of revision was 10% in the nonresurfaced group compared to zero in the resurfaced group (P = 0.013). Mean Euroquol score was 91 in the nonresurfaced group compared to 95 in the resurfaced group (P = 0.26). Euroquol score, Knee Society score, knee instability, return to preoperative functional level, ability to kneel, use of a walking aid, and presence of limp were not significantly different between the 2 groups. The results of this study suggest a more consistent outcome can be achieved with patellar resurfacing in TKA with the Scorpio prosthesis.

Open reduction and internal fixation versus hybrid fixation for bicondylar/severe tibial plateau fractures: a systematic review of the literature.

INTRODUCTION: Bicondylar/Schatzker 6 type tibial plateau fractures are a significant challenge to the trauma and orthopaedic surgeon. These injuries tend to be complex, high energy and are activated with significant morbidity. Two surgical methods are commonly in use: (1) hybrid external fixation or (2) internal fixation. We performed a systematic analysis of papers comparing these two techniques. METHODS: The Medline database was used and the MeSH terms associated with bicondylar/severe tibial plateau fractures were inserted. RESULTS: Forty-nine studies were retrieved but only five papers presented data to directly compare the two techniques as these studies actually compared the implants. Study designs and outcome measures were not consistent in all studies and therefore no direct comparison could be made between the papers. The first two studies were laboratory based and suggested that hybrid external fixation may have a benefit over internal fixation with respect to failure load and its use in compromised bone. Two further papers presented only type 4 evidence. The final paper was a multicentre randomised controlled trial and it demonstrated a marginal non-significant benefit of hybrid external fixation over internal fixation although there was suggestion of beta error [i.e. accepting the hypothesis when it is not true]. CONCLUSION: Bicondylar/Schatzker 6 type fractures are difficult to manage. The treatment of such fractures, need to pay specific attention to the soft tissue envelope around the knee. Hybrid external fixation has theoretical advantages in terms of the soft tissues but the benefit over internal fixation is modest at best and has not demonstrated improved outcome. Newer fixed angle screw and plate systems are increasingly in use and need comparative studies to determine their role in this complex group of fractures.

The reliability and reproducibility of the Neer classification system--digital radiography (PACS) improves agreement.

INTRODUCTION: We investigated if the introduction of digital radiography, with its software permitting enhancement of plain radiographs, improved inter- and intra-observer agreement in the Neer classification. METHODS: Five observers participated in classifying 50 randomly selected radiographs with a confirmed proximal humeral fracture. The observers included a junior registrar, an upper-limb fellow, a lower-limb orthopaedic consultant and two orthopaedic shoulder consultants. Agreement was quantified via kappa values. RESULTS: In general, good (0.61-0.80) results were obtained using kappa value for inter-observer reliability throughout all grades. On further analysis, however, discrepancies persist in the classification between Neer type 1/2 and Neer type 5 categories. The latter was not restricted to more inexperienced surgeons. Intra-observer agreement (> 0.81) was excellent throughout all grades. CONCLUSION: The introduction of digital radiography aids the improvement of Neer classification of proximal humeral fractures across all grades. With superior agreement in displacement and fracture patterns, improved communication and discussion of these injuries and similar treatment plans can be expected. This may help negate one aspect of the variability in outcome of proximal humeral shaft fractures. More complex fracture configurations continue to have difficulty in interpretation and may require further imaging analysis to conclude definitively.

Report of GBM metastasis to the parotid gland.

Glioblastoma Multiforme frequently metastasises from their original location by for example infiltration along white matter tracts [1]. GBM metastasis outside the central nervous system is distinctly rare though there are previous reports of spread to various organs [2-5]. We add an unusual case of a patient with aggressive cerebral GBM metastasis to the parotid gland and the lungs.