A Transpatellar Approach to Treat Distal Femoral Type C3 Fractures Combined with Patellar Fractures

AbstractWe report our surgical method used to treat type C distal femur fractures accompanied by patella fractures whereby we approach the articular surface of the femur through the already-fractured patella. We treated 10 patients with type C3 distal femur and patella fractures between May 2013 and April 2015. Because the patella was fractured in all cases, we could approach the articular surface of the distal femur through the transverse gap between the retracted patellar fracture fragments, “transpatellar approach.” Any surgical complications were recorded. Knee function was evaluated using the Böstman system. The average age of the 10 patients (8 males) was 42.9 years (range, 22.0–58.0 years). All distal femur fractures were type C3, combined with patella fractures. Bony union of the distal femur and patella was achieved in all but one patient, who required an additional bone graft (without any change in the implant). Overall, three patients (30%) reported excellent results and seven (70%) reported good results, based on the Böstman system. A midline anterior approach through a patella fracture adequately exposes the entire joint surface of the distal femur, except the posterior surface. This approach is useful when treating a type C distal femur fracture accompanied by a patella fracture. The level of evidence is IV.

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Modified Capanna’s Technique (Vascularized Free Fibula Combined with Allograft) as a Single-Stage Procedure in Post-traumatic Long-Segment Defects of the Lower End of the Femur: Outcome Analysis of a Series of 19 Patients with an Average Gap of 14 cm

Indian Journal of Plastic Surgery ◽

10.1055/s-0039-3400672 ◽

2019 ◽

Vol 52 (03) ◽

pp. 296-303

Author(s):

Dheenadhayalan Jayaramaraju ◽

Hari Venkataramani ◽

Raja Bhaskara Rajasekaran ◽

Devendra Agraharam ◽

Shanmuganathan Raja Sabapathy ◽

...

Keyword(s):

Distal Femur ◽

Clinical Care ◽

Single Stage ◽

Long Bone ◽

Outcome Analysis ◽

Functional Score ◽

Bony Union ◽

Fibular Graft ◽

Level Of Evidence ◽

Vascularized Fibula

Abstract Objectives Salvage and reconstruction of posttraumatic defects of the long bone are complex due to the multiple procedures involved and increased chances of poor outcomes. We present the outcomes of the modified Capanna’s technique—a reliable single-stage procedure of combining allograft and free vascularized fibular graft—in treating large posttraumatic bone defects in the distal third of the femur. Study Design This is a retrospective analysis. Materials and Methods Between April 2012 and September 2016, 19 patients with an average age of 33.8 years (range: 18–49 years) and an average defect of 14.5 cm (range: 9.5–20 cm) in the distal femur were managed by the modified Capanna’s technique. Bone union time and functional outcome using lower extremity functional score (LEFS) after union were noted. Outcomes and Results Eighteen grafts went onto achieve bony union at an average of 6.6 months (range: 5–9), with an average knee flexion of 80 degrees (range: 45–110 degrees) and an average LEFS of 63 (range: 46–72). One patient had a nonunion with graft resorption at 8 months following persistent infection and was revised with debridement and augmenting the vascularized fibula from the other leg which went on to achieve union. Three patients had superficial infection, and three patients had delayed union. Conclusion The modified Capanna’s technique provided increased biology and enhanced structural stability and therefore is a good single-stage procedure in the reconstruction of posttraumatic long-segment defects of the distal femur. Level of Evidence Level 4. Level of Clinical Care Level I tertiary trauma center.

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Management of intra-articular fracture of distal femur with LCP and Lag screws in adults

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20171241 ◽

2017 ◽

Vol 5 (4) ◽

pp. 1434 ◽

Cited By ~ 1

Author(s):

Manjit S. Daroch ◽

Deepak Vashisht ◽

Sanjeev Sreen

Keyword(s):

Elderly Patients ◽

Range Of Motion ◽

Distal Femur ◽

Articular Surface ◽

Poor Quality ◽

Osteoporotic Bone ◽

Bony Union ◽

Articular Fracture ◽

Articular Fractures ◽

Stable Osteosynthesis

Background: Accurate reconstruction of articular surface of distal femur by closed manipulation is not possible. The recent trend for displaced intra-articular fractures of the distal femur is open reduction and stable osteosynthesis with early rehabilitation. The best exposure is achieved through Swashbuckler approach with good results. Purpose of the study was to review the surgical management with LCP and lag screws of complex and most challenging intra-articular fracture of distal femur.Methods: 30 cases of intra-articular fractures of distal femur were treated with LCP and Lag screws in adults. Regular follow-up with all records was carried out for a period of 36 months. Most of patients were treated with Swashbuckler approach. Final outcome was carried based on Neer’s criteria.Results: Union was achieved in all the cases and mean time was 15 weeks. Patients have more range of motion in C1 and C2 types of fracture as compare to C3 Types. Mean range of motion was 1140. Early physiotherapy has big role to achieve good range of motion.Conclusions: LCP is better implant in comminuted I/A fractures of distal end of femur and in elderly patients with osteoporotic bone. In spite of the worst fracture anatomy of the comminuted fracture of distal femur and the poor quality of bone in elderly patients, this can provide better post-operative range of knee motion with overall better Knee score, achieving bony union in all the cases with early physiotherapy.

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Joint Preservation Techniques in Orthopaedic Surgery

Sports Health A Multidisciplinary Approach ◽

10.1177/1941738117712203 ◽

2017 ◽

Vol 9 (6) ◽

pp. 545-554 ◽

Cited By ~ 4

Author(s):

Philip J. York ◽

Frank B. Wydra ◽

Matthew E. Belton ◽

Armando F. Vidal

Keyword(s):

Articular Cartilage ◽

Autologous Chondrocyte Implantation ◽

Hyaline Cartilage ◽

Articular Surface ◽

Joint Surface ◽

Level Of Evidence ◽

Joint Preservation ◽

The Past ◽

Chondrocyte Implantation ◽

Autologous Chondrocyte

Context: With increasing life expectancy, there is growing demand for preservation of native articular cartilage to delay joint arthroplasties, especially in younger, active patients. Damage to the hyaline cartilage of a joint has a limited intrinsic capacity to heal. This can lead to accelerated degeneration of the joint and early-onset osteoarthritis. Treatment in the past was limited, however, and surgical treatment options continue to evolve that may allow restoration of the natural biology of the articular cartilage. This article reviews the most current literature with regard to indications, techniques, and outcomes of these restorative procedures. Evidence Acquisition: MEDLINE and PubMed searches relevant to the topic were performed for articles published between 1995 and 2016. Older articles were used for historical reference. This paper places emphasis on evidence published within the past 5 years. Study Design: Clinical review. Level of Evidence: Level 4. Results: Autologous chondrocyte implantation and osteochondral allografts (OCAs) for the treatment of articular cartilage injury allow restoration of hyaline cartilage to the joint surface, which is advantageous over options such as microfracture, which heal with less favorable fibrocartilage. Studies show that these techniques are useful for larger chondral defects where there is no alternative. Additionally, meniscal transplantation can be a valuable isolated or adjunctive procedure to prolong the health of the articular surface. Conclusion: Newer techniques such as autologous chondrocyte implantation and OCAs may safely produce encouraging outcomes in joint preservation.

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Scaphotrapezoid Assessment during Thumb Carpometacarpal Arthroplasty: A Cadaveric Study

Journal of Wrist Surgery ◽

10.1055/s-0041-1729992 ◽

2021 ◽

Author(s):

Brianna R. Fram ◽

Bryan Hozack ◽

Asif M. Ilyas ◽

Christopher Jones ◽

Michael Rivlin

Keyword(s):

Surface Area ◽

Articular Surface ◽

Total Surface Area ◽

High Rate ◽

Joint Surface ◽

Level Of Evidence ◽

Large Variability ◽

Thumb Carpometacarpal ◽

Intraoperative Visualization ◽

Cmc Joint

Abstract Background Due to limited sensitivity of radiographs for scaphotrapeziotrapezoid (STT) arthritis and the high rate of concurrence between thumb carpometacarpal (CMC) and STT arthritis, intraoperative visualization of the STT joint is recommended during CMC arthroplasty. Purpose We quantified the percentage of trapezoid facet of the scaphotrapezoid (ST) joint that could be visualized during this approach, and compared it to the degree of preoperative radiographic STT arthritis. Methods We performed dorsal surgical approach to the thumb CMC joint after obtaining fluoroscopic anteroposterior, lateral, and oblique wrist radiographs of 11 cadaver wrists. After trapeziectomy, the ST joint was inspected and the visualized portion of the trapezoid articulation marked with an electrocautery. The trapezoid was removed, photographed, and the marked articular surface area and total surface area were independently measured by two authors using an image analysis software. The radiographs were analyzed for the presence of STT arthritis. Results The mean visualized trapezoid surface area during standard approach for CMC arthroplasty was 60.3% (standard deviation: 24.6%). The visualized percentage ranged widely from 16.7 to 96.5%. There was no significant correlation between degree of radiographic arthritis and visualized percentage of the joint (p = 0.77). Conclusions: On average, 60% of the trapezoid joint surface was visualized during routine approach to the thumb CMC joint, but with very large variability. Direct visualization of the joint did not correlate with the degree of radiographic STT arthritis. Clinical Relevance A combination of clinical examination, pre- and intraoperative radiographs, and intraoperative visualization should be utilized to assess for STT osteoarthritis and determine the need for surgical treatment. Level of Evidence This is a Cadaveric Research Article.

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Management of Complex Distal Femur Fractures: Comparative Study between Ilizarov External Fixation and Double Plating

QJM ◽

10.1093/qjmed/hcaa059.007 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

M F Thakeb ◽

A H Gooda ◽

T A Fayyad ◽

M A Elkersh ◽

E N Abourisha

Keyword(s):

Knee Society Score ◽

Distal Femur ◽

Weight Bearing ◽

Femoral Fractures ◽

Controlled Study ◽

Level Of Evidence ◽

Femur Fractures ◽

Randomized Clinical Study ◽

Significant Difference ◽

Double Plating

Abstract Background In this prospective randomized clinical study, we report results of management of type C2 and C3 distal femur fractures by Ilizarov external fixator in comparison with double plating through separate medial and lateral approaches with a mean of 42.8 ± 6.84 weeks follow-up. Patients and Methods In this study we managed 30 cases with highly comminuted distal femoral fractures AO classification type C2 or C3. Fifteen cases were surgically managed by Ilizarov technique and the other fifteen cases were surgically managed by double plating technique. We compare between both group as regard clinical, radiological results and rate of complications. Results while using Knee society score, the results are the following: In Ilizarov group: 7 cases (46.67%) are excellent, 4 cases (26.67%) are good, 3 cases (20.00%) had fair results while 1 case (6.67%) had poor results. In internal fixation group, 8 cases (53.33%) had excellent results, 3cases (20%) had good results, 2 cases (13.33%) had fair results while 2 cases (13.33%) had poor results. Conclusion In fixation of complex distal femur fracture, both Ilizarov and double plating methods had no significant difference in clinical outcome by knee society score and in rate of complications. Ilizarov allow earlier weight bearing and less blood loss while double plating gives better ROM of knee joint and rapid radiological healing. Level of Evidence Level I Randomized controlled study.

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Primary ilizarov external fixation in open grade III type C distal femur fractures: Our experience

Journal of Clinical Orthopaedics and Trauma ◽

10.1016/j.jcot.2019.01.026 ◽

2019 ◽

Vol 10 (5) ◽

pp. 928-933 ◽

Cited By ~ 1

Author(s):

Rakesh Kumar ◽

Soumya Shrikanta Mohapatra ◽

Narendra Joshi ◽

S.K. Goyal ◽

Kamlesh Kumar ◽

...

Keyword(s):

External Fixation ◽

Distal Femur ◽

Femur Fractures ◽

Type C ◽

Grade Iii

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Clinical, Histologic, and Radiographic Outcomes of Distal Femoral Resurfacing with Hypothermically Stored Osteoarticular Allografts

The American Journal of Sports Medicine ◽

10.1177/0363546507299529 ◽

2007 ◽

Vol 35 (7) ◽

pp. 1082-1090 ◽

Cited By ~ 58

Author(s):

Philip A. Davidson ◽

Dennis W. Rivenburgh ◽

Patti E. Dawson ◽

Roman Rozin

Keyword(s):

Distal Femur ◽

Surface Defects ◽

Clinical Success ◽

Short Form ◽

Articular Surface ◽

Case Series ◽

Full Thickness ◽

Level Of Evidence ◽

Second Look ◽

The Mean

Background Fresh osteoarticular allograft transplantation has a long history of clinical success. These grafts have typically been implanted less than 1 week from donor asystole. Hypothesis Osteoarticular allografts stored 4 to 6 weeks represent a viable alternative to treat full-thickness cartilage and osteochondral defects of the distal femur as measured by clinical, histologic, and magnetic resonance imaging (MRI) criteria. Study Design Case series; Level of evidence, 4. Methods Osteoarticular allografts were implanted after a mean graft storage time (at 4°C) of 36 days (range, 28-43). Sixty-seven patients received massive hypothermically stored osteoarticular allografts. Ten knees in 8 of these patients underwent second-look arthroscopic evaluation and biopsy at a mean of 40 months (range, 23-60) after implantation. Clinical assessment was performed using multiple outcome measures and sequential MRI evaluations. Biopsy specimens were obtained from the graft as well as from native articular cartilage at the time of second-look arthroscopy for histologic analysis. Results The mean International Knee Documentation Committee scores were as follows: preoperative, 27 (range, 9-55); postoperative, 79 (range, 56-99); P = .002. The mean Lysholm scores were as follows: preoperative, 37 (range, 12-47); postoperative, 78 (range, 55-90); P = .002. The mean Short Form-36 physical scores were as follows: preoperative, 38 (range, 24-55); postoperative, 51 (range, 39-61); P = .002. The mean Tegner scores were as follows: preoperative, 4.3 (range, 1-9); postoperative, 5.3 (range, 4-7); P = .16. The mean International Cartilage Repair Society score at follow-up was 10 (nearly normal) (range, 7-11). The mean modified Outerbridge scores were as follows preoperative, 4.3 (range, 3-5); postoperative, 0.6 (range, 0-1); P = .002. The mean graft and native cartilage cellular density and viability were not statistically different. Conclusions Fresh-stored osteoarticular grafts for full-thickness articular surface defects of the distal femur appear to offer a viable biological method to restore knee function. Our study suggests that osteoarticular grafts stored in cell culture medium at 4°C for 4 to 6 weeks provide successful short-term clinical outcomes.

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Competency of distal femur locking plate as an answer for fixation of all varieties of distal femur fractures

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20192066 ◽

2019 ◽

Vol 5 (4) ◽

pp. 555

Author(s):

Mriganka Nagen Medhi ◽

Girish Balasaheb Mote

Keyword(s):

Distal Femur ◽

X Rays ◽

Locked Plating ◽

Basic Principles ◽

Ao Classification ◽

Femur Fractures ◽

Satisfactory Outcome ◽

Time Period ◽

Type C ◽

Buttress Plate

Background: Distal femur fractures are common and need to be treated operatively and for optimal functional outcome. Multiple implants are available for fixation e.g. angled blade plate, dynamic condylar screw, buttress plate, antegrade nailing, retrograde nailing, locking distal femoral plates, external fixator etc. We have designed this study to analyse clinico-radiological outcome and competency of locked plating for all varieties of distal femur fractures.Methods: We conducted a prospective interventional study on 79 consecutive patients with fractures of distal femur operated with locking distal femur plate from January 2015 to February 2018. Patients were regularly followed up with x-rays and clinical examination. At the end of clinicoradiological union, patients were evaluated with Neer’s score.Results: Total 79 distal femur fractures were studied based on inclusion and exclusion criteria. There were 63 (79.75%) males and 16 (20.25%) females. As per AO classification fracture of type A were 39 (49.36%), type B were 10 (12.65%) and type C were 30 (37.97%). Average time period from injury to surgery was 8.2 days. In our study, the average period of clinicoradiological union was 16 weeks. 62 (78.48%) patients had excellent to satisfactory outcome, 13 (16.45%) patients had unsatisfactory and 4 (5.06%) patients had poor outcome.Conclusions: Distal femur fractures are common, complex injuries and different implant option are available for fixation. All types of distal femur fractures can be fixed using distal femur locking compression plate. If fixed following basic principles of fracture fixation good results can be obtained.

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Anatomy of the Intermetatarsal Facets of the Fourth and Fifth Metatarsals

Foot & Ankle Orthopaedics ◽

10.1177/2473011420975709 ◽

2021 ◽

Vol 6 (1) ◽

pp. 247301142097570

Author(s):

Mossub Qatu ◽

George Borrelli ◽

Christopher Traynor ◽

Joseph Weistroffer ◽

James Jastifer

Keyword(s):

Articular Cartilage ◽

Digital Imaging ◽

Articular Surface ◽

Implant Design ◽

Joint Surface ◽

Fracture Classification ◽

Articular Damage ◽

Metatarsal Fracture ◽

Metatarsal Fractures ◽

The Mean

Background: The intermetatarsal joint between the fourth and fifth metatarsals (4-5 IM) is important in defining fifth metatarsal fractures. The purpose of the current study was to quantify this joint in order to determine the mean cartilage area, the percentage of the articulation that is cartilage, and to give the clinician data to help understand the joint anatomy as it relates to fifth metatarsal fracture classification. Methods: Twenty cadaver 4-5 IM joints were dissected. Digital images were taken and the articular cartilage was quantified by calibrated digital imaging software. Results: For the lateral fourth proximal intermetatarsal articulation, the mean area of articulation was 188 ± 49 mm2, with 49% of the area composed of articular cartilage. The shape of the articular cartilage had 3 variations: triangular, oval, and square. A triangular variant was the most common (80%, 16 of 20 specimens). For the medial fifth proximal intermetatarsal articulation, the mean area of articulation was 143 ± 30 mm2, with 48% of the joint surface being composed of articular cartilage. The shape of the articular surface was oval or triangular. An oval variant was the most common (75%, 15 of 20 specimens). Conclusion: This study supports the notion that the 4-5 IM joint is not completely articular and has both fibrous and cartilaginous components. Clinical Relevance: The clinical significance of this study is that it quantifies the articular surface area and shape. This information may be useful in understanding fifth metatarsal fracture extension into the articular surface and to inform implant design and also help guide surgeons intraoperatively in order to minimize articular damage.

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Early Outcomes After Surgical Management of Geriatric Patella Fractures

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/2151459320987699 ◽

2021 ◽

Vol 12 ◽

pp. 215145932098769

Author(s):

Jaclyn Kapilow ◽

Junho Ahn ◽

Kathryn Gallaway ◽

Megan Sorich

Keyword(s):

Risk Factors ◽

Postoperative Complications ◽

Length Of Stay ◽

Geriatric Patients ◽

The United States ◽

Unplanned Readmission ◽

Patella Fracture ◽

Factors Associated ◽

Prolonged Hospitalization ◽

Patella Fractures

Objectives: To report the incidence and risk factors for prolonged hospitalization, discharge to a facility, and postoperative complications in geriatric patients who underwent surgery for patella fracture. Design: Retrospective database review. Setting: The American College of Surgeons—National Surgical Quality Improvement Program (NSQIP) collects data from 600 hospitals across the United States. Patients/Participants: NSQIP patients over 65 years of age with patella fractures. Intervention: Surgical fixation of patella fracture including extensor mechanism repair. Main Outcome Measurements: Prolonged hospitalization, discharge to a facility, and 30-day post-operative complications. Results: 1721 patients were included in the study. The average age was 74.9 years. 358 (20.8%) patients were male. 122 (7.1%) patients had a length of stay greater than 7 days. Factors associated with prolonged length of stay include pre-existing renal failure, need for emergent surgery, and time to surgery greater than 24 hours from admission. 640 patients (37.2%) of patients were discharged to a facility after surgery. Discharge to facility was associated with age >77 years, obesity, anemia, thrombocytopenia, pre-operative SIRS, and CCI > 0.5. Admission from home decreased the odds of discharge to a facility. The most common postoperative complications in this population were unplanned readmission (3.4%), unplanned reoperation (2.7%), surgical site infection (1.1%), mortality (1.0%), venous thromboembolism (0.8%), and wound dehiscence (0.2%). Complication rates increased with anemia and ASA class IV-V. Conclusions: Geriatric patients undergoing operative intervention for patella fractures are at high risk for prolonged hospitalization, discharge to facility, unplanned readmission or reoperation, and surgical site complications in the first 30 days following surgery. This study highlights modifiable and non-modifiable risk factors associated with adverse events. Early recognition of these factors can allow for close monitoring and multidisciplinary intervention in the perioperative period to improve outcomes. Level of Evidence: Prognostic level III.

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