Proximal tibiofibular joint dislocation treated using flexible and permanent syndesmosis fixation

We present the case of a 40-year-old man who suffered an isolated proximal tibiofibular dislocation of the left knee after a trauma during a soccer game. Physical examination and radiographic imaging revealed an anterolateral dislocation of the proximal fibula. The diagnosis was confirmed by MRI. The treatment choice was open reduction and internal fixation under direct visualisation using flexible and permanent internal fixation. Postoperative treatment includes knee immobilisation during the first week, and partial weight was allowed for 2 weeks progressing to full weight bearing over 4 weeks. The patient started a gradual and progressive physical therapy programme with range of motion exercises, muscle strengthening and gait training. Full knee range of motion was achieved after 4 weeks. No complaint of pain or hardware discomfort was reported, and the patient is back to daily life and sports activities after 6 months of surgical treatment.

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Differences in femoral component subsidence rate after THA using an uncemented collarless femoral stem: full weight-bearing with an enhanced recovery rehabilitation versus partial weight-bearing

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-021-03913-0 ◽

2021 ◽

Author(s):

Franziska Leiss ◽

Julia Sabrina Götz ◽

Matthias Meyer ◽

Günther Maderbacher ◽

Jan Reinhard ◽

...

Keyword(s):

Risk Factors ◽

Enhanced Recovery ◽

Weight Bearing ◽

Femoral Stem ◽

Full Weight Bearing ◽

Partial Weight Bearing ◽

Fill Ratio ◽

Stem Subsidence ◽

Partial Weight

Abstract Background Femoral component subsidence is a known risk factor for early failure of total hip arthroplasty (THA) using cementless stems. The aim of the study was to compare an enhanced recovery concept with early full weight-bearing rehabilitation and partial weight-bearing on stem subsidence. In addition, the influence of patient-related and anatomical risk factors on subsidence shall be assessed. Methods One hundred and fourteen patients underwent primary cementless THA and were retrospectively analyzed. Sixty-three patients had an enhanced recovery rehabilitation with early full weight-bearing and 51 patients had rehabilitation with partial weight-bearing (20 kg) for 6 weeks. Postoperative subsidence was analyzed on standing pelvic anterior–posterior radiographs after 4 weeks and 1 year. Subsidence was measured in mm. Anatomical and prosthetic risk factors (stem size, canal flare index, canal fill ratio as well as BMI and demographic data) were correlated. Results Femoral stem subsidence rate was significantly higher for the group with an enhanced recovery concept compared to the group with partial weight-bearing at the first radiological follow up after 4 weeks [2.54 mm (SD ± 1.86) vs. 1.55 mm (SD ± 1.80)] and the second radiological follow up after 1 year [3.43 mm (SD ± 2.24) vs. 1.94 (SD ± 2.16)] (p < 0.001, respectively). Stem angulation > 3° had a significant influence on subsidence. Canal flare index and canal fill ratio showed no significant correlation with subsidence as well as BMI and age. Conclusion In the present study, cementless stem subsidence was significantly higher in the group with enhanced recovery rehabilitation compared to partial weight-bearing. Small absolute values and differences were demonstrated and therefore possibly below clinical relevance. Anatomical radiological parameters and anthropometric data did not appear to be risk factors for stem subsidence.

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Early full weight-bearing versus 6-week partial weight-bearing after open wedge high tibial osteotomy leads to earlier improvement of the clinical results: a prospective, randomised evaluation

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-015-3592-x ◽

2015 ◽

Vol 25 (1) ◽

pp. 325-332 ◽

Cited By ~ 29

Author(s):

S. Schröter ◽

A. Ateschrang ◽

W. Löwe ◽

H. Nakayama ◽

U. Stöckle ◽

...

Keyword(s):

High Tibial Osteotomy ◽

Weight Bearing ◽

Clinical Results ◽

Full Weight Bearing ◽

Tibial Osteotomy ◽

Open Wedge ◽

Partial Weight Bearing ◽

Wedge High Tibial Osteotomy ◽

Partial Weight

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Femoral neck stress fracture in a young female recruit: case report

SICOT-J ◽

10.1051/sicotj/2018011 ◽

2018 ◽

Vol 4 ◽

pp. 16 ◽

Cited By ~ 2

Author(s):

Hélder Fonte ◽

Ricardo Rodrigues-Pinto

Keyword(s):

Femoral Neck ◽

Stress Fracture ◽

Early Recognition ◽

Weight Bearing ◽

Full Weight Bearing ◽

Imaging Studies ◽

Partial Weight Bearing ◽

Military Recruit ◽

Femoral Neck Stress Fracture ◽

Partial Weight

Introduction: Femoral neck stress fractures are uncommon and depending on their location, can be at high risk for non-union and significant morbidity. Their prevalence is higher among runners and military recruits, and women seem to be at higher risk. Methods: A 27-year-old female, who was enrolled in military recruit, reported left side groin pain after a strenuous running exercise. Due to persistent pain an X-Ray was ordered, which revealed no signs of acute lesions. Further imaging studies with CT scan and MRI identified a compression-type femoral neck stress fracture. Results: The patient was submitted to conservative treatment consisting of restricting from full weight-bearing. Six weeks after she initiated partial weight-bearing, becoming asymptomatic at seven months. Follow-up imaging studies revealed union of the fracture. Discussion: This diagnosis should be considered when evaluating military and athlete populations. Early recognition of these injuries is crucial because complication and morbidity rates are high.

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Iliac intramedullary stabilization for Type IIIA fragility fractures of the pelvis

Scientific Reports ◽

10.1038/s41598-020-77560-7 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Shingo Okazaki ◽

Masahiro Shirahama ◽

Ryuki Hashida ◽

Mitsuhiro Matsuura ◽

Shiro Yoshida ◽

...

Keyword(s):

Internal Fixation ◽

Weight Bearing ◽

Fragility Fractures ◽

Full Weight Bearing ◽

Walking Ability ◽

Less Invasive ◽

Type Iiia ◽

Iliac Screws ◽

Intramedullary Stabilization ◽

The Mean

AbstractThere have been few reports on fixation of Rommens classification Type IIIA fragility fractures of the pelvis (FFPs). Here, we present our less invasive surgical technique, called iliac intramedullary stabilization (ILIS), for the internal fixation of Type IIIA FFPs. The technique involves a closed reduction, termed the femur internal rotation reduction method (FIRM), whereby the fracture fragments are repositioned using lateral rotators by internally rotating the femur while the patient is in the prone position. Two iliac screws are inserted on the ilium bilaterally via the supra-acetabular bone canal during FIRM and connected with two transverse rods and two cross connectors. We refer to this internal fixation procedure as ILIS. We retrospectively recruited patients with Type IIIA fractures, treated using this procedure, at our institute between October 2017 and October 2019. We evaluated operative and post-operative outcomes. We enrolled 10 patients (9 women and 1 man; mean age, 85.2 years) who were followed up for over 6 months. All patients suffered FFPs after falling from a standing position. The mean operative time was 145.1 (range, 94–217) minutes, and the mean blood loss was 258.5 (range, 100–684) ml. All patients were allowed full weight bearing from post-operative day 1. All patients achieved bone union and regained their pre-injury walking ability at 6 months after surgery without evident secondary displacement. In conclusion, our ILIS technique allows less invasive internal fixation of Type IIIA FFPs with adequate stability for full weight bearing from post-operative day 1.

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Synovial Lipomatosis (Lipoma Arborescens) of the Knee

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967114s00263 ◽

2014 ◽

Vol 2 (11_suppl3) ◽

pp. 2325967114S0026

Author(s):

Melih Malkoç ◽

Ozgur Korkmaz ◽

Ali Seker ◽

Mehmet Isyar ◽

Ismail Oltulu ◽

...

Keyword(s):

Range Of Motion ◽

Knee Society Score ◽

Weight Bearing ◽

Full Range ◽

Daily Activities ◽

Full Weight Bearing ◽

Female Group ◽

Arthroscopic Synovectomy ◽

Significant Difference ◽

Synovial Lipomatosis

Objectives: The goals of this retrospective study are to emphasize that the patients who have non surgical treatments for several times due to the massive swelling in their knees should be considered the SL and this pathology is treatable by arthroscopic synovectomy Methods: Seventeen patients (four female and thirteen male), were evaluated retrospectively from May 2009 and April 2013. Mean age for female group was 34,75 (range between 32 to 41) and for male group was 34,23 (range between 26 to 46). Mean follow-up period was 14,76 months (range between 6 months and 38 months). Mean duration of compliance was 26,23 months (range between 9 to 96) months. All patients rated by Knee Society Score preoperatively and postoperatively arthroscopic synovectomy, performed by using radiofrequency ablation and arthroscopic shaver for treatment procedure. Patients were discharged at the end of the one day hospitalization. Postoperatively all patients were allowed to full range of motion and full weight-bearing within one day after surgery. Results: Patients were evaluated preoperatively and postoperatively using the Knee Society Score. The mean Knee Society Score was 67,82 preoperatively and 88,23 was postoperatively. There is significant difference between preoperative and postoperative Knee Society scores.(p <0.05) At the end of the three months, MRI studied and there was no clue of recurrence except two patients. All patients returned to their daily activities with full of range of motion and without swelling of the affected knee joints. At the microscopic histological studies were reported as synovial lipomatosis for all patients Conclusion: Arthroscopic synovectomy is the safe and dramatically effective method of treatment in synovial lipomatosis with less complication, curability and retrieving patients full range of motion with no limitation in their daily activities

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Comparison of two reinforcement rings for primary total hip arthroplasty addressing displaced acetabular fractures: a biomechanical analysis

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-020-03433-3 ◽

2020 ◽

Vol 140 (12) ◽

pp. 1947-1954

Author(s):

Johannes Becker ◽

M. Winkler ◽

C. von Rüden ◽

E. Bliven ◽

P. Augat ◽

...

Keyword(s):

Acetabular Fracture ◽

Weight Bearing ◽

Biomechanical Analysis ◽

Acetabular Fractures ◽

Full Weight Bearing ◽

Acetabular Cup ◽

Partial Weight Bearing ◽

Quadrilateral Plate ◽

Stable Conditions ◽

Partial Weight

Abstract Introduction Aim of this study was to biomechanically compare two different acetabular cup fixation constructs in terms of fracture fixation for displaced acetabular fractures involving the anterior column with hemitransverse fracture under partial and full weight-bearing conditions. Methods Two different reinforcement rings designed as cages for primary THA were biomechanically tested in terms of managing a complex acetabular fracture. Single-leg stance cyclic loading was performed to assess fracture gap movement and fragment rotation. Twelve hemi pelvis Sawbones were divided into two groups: primary THA with acetabulum roof reinforcement plate (ARRP) (n = 6) and primary THA with Burch–Schneider reinforcement cage (BSRC) (n = 6). Results During loading under partial weight-bearing (250 N) fracture gap movement tended to be larger in the BSRC group as compared to the ARRP group. Under full weight-bearing conditions, the ARRP showed 60% significantly less motion (p = 0.035) of the os ilium to os ischii gap compared to BSRC. Fracture gap movements between the os ilium and spina iliaca fragments were significantly reduced by 76% (p = 0.048) for ARRP in contrast to BSRC. The ARRP group also demonstrated significantly less movement in the fracture gaps os ischii to quadrilateral plate (62% reduction, p = 0.009) and quadrilateral plate to spina iliaca (87% reduction, p < 0.001). Significantly less rotational movement of the quadrilateral plate to the os ilium was exhibited by the ARRP group (p = 0.015). Conclusions The presented acetabulum roof-reinforcement plate (ARRP) provides stable conditions at the acetabular component with adequate stabilization of a displaced acetabular fracture.

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Isolated PCL and ACL Avulsion Fractures of the Knee

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967114s00185 ◽

2014 ◽

Vol 2 (11_suppl3) ◽

pp. 2325967114S0018

Author(s):

Özgur Baysal ◽

Engin Ecevız ◽

Fevzi Saglam ◽

Nurzat Elmalı

Keyword(s):

Range Of Motion ◽

Avulsion Fracture ◽

Weight Bearing ◽

Full Range ◽

Imaging Modalities ◽

Advanced Imaging ◽

Avulsion Fractures ◽

Pull Out ◽

Partial Weight ◽

Acl Avulsion

Objectives: Isolated combined PCL and ACL avulsion fractures is a rare condition. A 40 year old woman had both PCL and ACL avulsion fracture due to a car accident. These fractures often have a subtle appearance at conventional radiography. Advanced imaging modalities, particularly CT and MRI are helpful to diagnose correctly and define the extent of damage. The aim of the study was point out this rare injury. We diagnosed this patient who had both PCL and ACL avulsion fractures. In the literature only a few case have been reported. We think that these fractures may be missed in the Emergency Department. If a patient is brought to the ED with high-velocity trauma, careful evaluation of bone and soft tissues followed by advanced imaging modalities should be performed. Methods: The PCL avulsion fracture was fixed with a cancellous screw via posterior approach and ACL avulsion fracture was fixed with arthroscopically assisted pull-out sutures 10 days after the traumatic event. The knee was immobilized in 20° flexion. Isometric knee, hip and ankle exercises were started immediately. Six weeks later after the operation active range of motion exercises and partial weight-bearing were allowed. In the third month full weight bearing was allowed and full range of motion was achieved. Results: Both PCL and ACL avulsion fractures healed uneventfully. Conclusion: Although knee injuries are frequent, simultaneous PCL and ACL avulsion fractures are rare . The clinician should have a high index of suspicion for these injuries. Careful physical examination and radiological imaging, especially magnetic resonance imagination is helpful in the diagnosis. Early surgical repair and appropriate rehabilitation are the keys to a good outcome in these injuries.

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Displaced Femoral Neck Stress Fracture in a 7-year-old Child: A Case Report

International Journal of Clinical Research ◽

10.38179/ijcr.v1i1.21 ◽

2020 ◽

Vol 1 (1) ◽

pp. 68-72

Author(s):

Raymond Massaad ◽

Said El Orra ◽

Mohammed Dabbous ◽

Ali Ibrahim ◽

Antonella Massaad

Keyword(s):

Case Report ◽

Femoral Neck ◽

Stress Fracture ◽

Weight Bearing ◽

Full Weight Bearing ◽

Partial Weight Bearing ◽

Radiographic Images ◽

Femoral Neck Stress Fracture ◽

Displaced Fracture ◽

Partial Weight

Background: Stress fracture of the femoral neck is rare in children. Its differential diagnosis includes muscle strain, synovitis, infection, dysplasia, etc. Since physicians rarely see this type of fracture in children, they often overlook it or misdiagnose it. Case Report: A seven-year-old girl presented to our service with right groin pain following a fall on her right hip 15 days ago. Pelvic and knee radiographs of her right limb showed a fracture line with sclerosis at the femoral neck. Magnetic-resonance imaging (MRI) confirmed the diagnosis of a stress fracture of the femoral neck. We opted for conservative management and gave the patient analgesics and limited weight-bearing with the help of crutches for eight weeks. Three weeks after her first visit, the patient presented with severe limping and inability to bear weight on her right leg. Right hip radiographic imaging showed a varus displaced fracture of the femoral neck, which we managed surgically with an open reduction and internal fixation using plate and screws, followed by immobilization of the right hip with a hip spica cast. Six weeks following the surgery, the patient had no complaints, and the radiographic images showed an appropriate reduction and signs of union. The patient was allowed to start partial weight-bearing for a further six weeks before proceeding to full weight-bearing. Conclusion: Our case emphasizes the importance of considering femoral neck stress fracture in children, through a thorough clinical evaluation and imaging analysis, especially for those carrying classical risk factors. Failure to do so can complicate the disease course and may lead to a displaced fracture requiring more invasive and timely management.

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Lateral Plantar Arch Reconstruction Using Vascularized Fibula Osteocutaneous Flap

Journal of Surgical Case Reports and Images ◽

10.31579/2690-1897/087 ◽

2021 ◽

Vol 4 (6) ◽

pp. 01-05

Author(s):

Srivatsa M Shet ◽

Subin Joseph ◽

Kader Kalathinga ◽

Hafiz Muhammed Koyappathody ◽

Srikant Aruna Samantaray ◽

...

Keyword(s):

Road Traffic ◽

Weight Bearing ◽

Full Weight Bearing ◽

Partial Weight Bearing ◽

Post Surgery ◽

Vascularized Fibula ◽

One Stage Reconstruction ◽

Arch Reconstruction ◽

Partial Weight ◽

Osteocutaneous Flap

A Sixteen-year-old male had a road traffic accident resulting in crush and loss of lateral two metatarsals of the left foot. The Lateral plantar arch was reconstructed with a vascularized fibula osteocutaneous flap. Flap survived and partial weight-bearing was started by 3 months and full weight-bearing was started 6-months post-surgery. At a 16-month follow-up patient had a normal gait and integrity of the lateral plantar arch was maintained. Vascularized fibula osteocutaneous flap is an excellent option for one-stage reconstruction of the lateral arch of the foot and gives satisfactory results in terms of functions of foot and in avoiding long-term morbidity.

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Treatment of subtrochanteric fracture femur by open reduction and internal fixation by long proximal femoral nailing

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20195811 ◽

2019 ◽

Vol 6 (1) ◽

pp. 164

Author(s):

Prabhu P. Munavalli ◽

Gururaj N. G.

Keyword(s):

Internal Fixation ◽

Open Reduction ◽

Road Traffic ◽

Weight Bearing ◽

Subtrochanteric Fracture ◽

High Rate ◽

Full Weight Bearing ◽

Subtrochanteric Fractures ◽

Fractures In Children ◽

Pathologic Fractures

Background: Subtrochanteric fractures are devasting injuries that most commonly affect the elderly population and also in young.Methods: This is a prospective study of 20 cases of subtrochanteric fracture admitted to KIMS, Huballi between November 2008 to August 2010 treated with left proximal femoral nail (LPFN) by open method. Cases were taken according to inclusion and exclusion criteria, i.e., fresh subtrochanteric fracture in adults. Pathologic fractures, multiple fractures, fractures in children, old neglected fractures were excluded from the study. Objectives of this study were to study subtrochanteric fractures and to determine effectiveness of LPFN in tretment of subtrochanteric fractures by open reduction and internal fixation (ORIF).Results: In our study of 20 cases, there were 16 male and 4 female patients with age ranging from 17 years to 75 years with most patients in between 21-40 years. 65% of the cases admitted were road traffic accidents, 25% due to fall from height and 10% due to trivial fall with right side being more common side affected. Russell and Taylor type IA fracture accounted for 40% of cases. Mean duration of hospital stay was 24 days and mean time of full weight bearing was 14 weeks in our patients. Good to excellent results were seen in 85% of cases in our study.Conclusions: Subtrochanteric fractures of femur can be successfully treated by ORIF by LPFN resulting in proper anatomical reduction and hence alignment and high rate of bone union.

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