scholarly journals Implantation of an attachment tube preserves knee extension after nonunion of Felix IV fracture: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Alena Richter ◽  
Henning Windhagen ◽  
Max Ettinger

Abstract Background While commonly utilized to fix tissue and muscles to megaprostheses to restore function and stability after tumor surgery, an attachment tube was used as a synthetic reconstruction of the knee joint’s extension mechanism after nonunion of Felix IV C fracture. Fixation of the tibial fragment, and therefore its osteointegration, is complicated after total knee arthroplasty, causing tibial tubercle dislocation. Case presentation A 61-year-old German patient presented to our clinic with Felix IV C fracture, persistent knee pain, and reduced knee extension strength. In this special case, mobilization and reattachment of the tibial tubercle was not possible because of necrosis and underlying tibial component. Therefore, we covered the defect with cement and used an polyethylene terephthalate tube for knee extension system augmentation. Follow-up after 10 months demonstrated a good clinical result. Conclusion The management of Felix IV C fractures is complicated by the underlying prosthesis resulting in redislocation of the fragment and persistent symptoms of pain and reduced functionality. We here present a new surgical technique to treat periprosthetic fracture complicated by tibial tubercle dislocation. Good clinical and radiologic results on follow-up after 10 months indicate the use of attachment tubes as a suitable surgical technique to restore knee joint extension and to reduce knee pain after dislocated Felix IV C fracture.

2003 ◽  
Vol 28 (3) ◽  
pp. 228-230 ◽  
Author(s):  
T. KALELI ◽  
C. OZTURK ◽  
S. ERSOZLU

A new surgical technique is described for the treatment of mallet finger deformity which involves the application of a mini external fixator across the distal interphalangeal joint and resection of a portion of the extensor mechanism. We reviewed 19 patients who were treated with this technique, at a mean follow-up period of 36 (range, 24–48) months. The mean extensor lag was 2° (range, −7° to 13°) and the mean flexion range was 70° (range, 20°–90°).


Author(s):  
Shreekantha K. S. ◽  
Mohammed Usman ◽  
Deepak Malik ◽  
Mahammad Aseem ◽  
Mohammad Gous Mulla

<p class="abstract"><span lang="EN-US">The purpose of this study was to present new surgical technique for MPFL reconstruction. We also describe its functional outcome, complications, and the advantages of the procedure. This study is a prospective analysis of collected data during the period of august 2018 to January 2020. Ten cases of patients with recurrent symptomatic patellar instability and who underwent isolated MPFL reconstruction were included in the study. Kujala scoring and lysholm scoring was done to assess the functional outcome at follow-up. Post-operative dislocation and apprehension were recorded in each case along with any complication. Pre-operative Kujala score was 36.80 which improved to 89.80 postoperatively at the time follow-up. Pre-operative lysholm score was 36.80 which improved to 92.70 postoperatively at the time follow-up. The improvement in Kujala score and Lysholm score was found to be highly significant (p&lt;0.01). We have done a simple technique where MPFL is reconstructed anatomically to restore kinematics and stability. Consistent good results with early rehabilitation can be obtained using the described technique.</span></p>


Author(s):  
W Greeff ◽  
RDV Greeff ◽  
CT Frey ◽  
V Singh

ABSTRACT INTRODUCTION: Reports of fatigue failure of the femoral component of a total knee arthroplasty (TKA) is scanty in the literature. As a result, there are no clearly defined risk factors to aid us in predicting fatigue failure of an implant. Furthermore, these patients may present with non-specific knee pain, which may or may not be well tolerated, depending on the stability of the implant. We report a case of fatigue failure of a poorly cemented femoral component of a TKA in a 72-year-old female, approximately seven years after the initial surgery CASE REPORT: A 72-year-old female presented to our tertiary level arthroplasty unit with new-onset knee pain approximately seven years after undergoing a TKA at our unit. She reported hearing a crack six months earlier, while standing up from a seated position. She had initially presented to her local clinic, but the pathology was missed. She received revision surgery at our institution and was doing well at early follow-up. DISCUSSION: We reviewed the literature on fatigue failure of femoral components in TKA in an attempt to define risk factors. We also summarised all cases of femoral component fatigue failure in the English literature. CONCLUSION: Although femoral component fatigue failure in TKA is rare, the majority of cases have attributed the failure to poor surgical technique. Despite this, certain implants have been failing more often than others, and proposed mechanisms for this exist. Orthopaedic surgeons need to be aware of which implant designs are prone to failure, as well as how meticulous surgical technique can reduce the chances of fatigue failure. Level of evidence: Level 5 Keywords: femoral component, total knee arthroplasty, fatigue failure, stress fracture


Author(s):  
Sandeep Kumar Kanugula ◽  
Mallesh Rathod ◽  
Venugopal S. M.

<p class="abstract"><strong>Background:</strong> Anterior knee pain (AKP) following total knee arthroplasty (TKA) ­­­­­­is one of the complication which cause dissatisfaction in patients. Incidence estimated to be 4-49%. The aim of our study is to know the efficacy of patelloplasty with circumpatellar denervation with diathermy in reducing AKP in primary TKA.</p><p class="abstract"><strong>Methods:</strong> A total of 130 unilateral TKAs’ are divided into 2 groups. Group I (control) includes 65 patients in which only patelloplasty was done. Group II (intervention) includes 65 patients in which both patelloplasty and circumpatellar denervation with diathermy was done and analysed. Mean follow up period was 18 months. Patients were assessed both preoperatively and postoperatively at final follow up.<strong></strong></p><p class="abstract"><strong>Results:</strong> The overall incidence of AKP at follow up (18 months) was 16.9%, with 7.7% in the intervention group and 26.1% in the control group (p&lt;0.05).  Western Ontario and McMaster Universities osteoarthritis index scores were significantly  better in intervention group when compared to control group (28.71±3.948 vs 31.40±3.860). Better results were also found in knee society scores for intervention group compared to control group (166.57±7.941 vs 161.23±11.219); Feller patellar score of  intervention group was significantly better when compared to control group (23.28±2.546 vs 20.69±3.729); the range of knee flexion was similar in both the groups (94.62±12.6 vs 93.54±10.7). In terms of pain referred by the patient at 72 hrs postoperatively, there was statistically significant difference observed according to visual analogue scale.</p><p class="abstract"><strong>Conclusions:</strong> There is statistically significant difference with respect to AKP in patients who have undergone patelloplasty with circumpatellar denervation using diathermy compared with patelloplasty alone.</p><p> </p>


2019 ◽  
Author(s):  
Cameron J Hicks ◽  
Pazit Levinger ◽  
Jasmine C Menant ◽  
Stephen R Lord ◽  
Perminder S Sachdev ◽  
...  

Abstract Aims Pain is an independent risk factor for falling. One in two older community-dwelling people with musculoskeletal pain fall each year. This study examined physical, psychological and medical factors as potential mediators to explain the relationship between knee pain and falls.Methods Three hundred and thirty-three community-dwelling people aged 70+ years (52% women) participated in this cohort study with a 1-year follow-up for falls. Participants completed questionnaires (medical history, general health and concern about falls) and underwent physical performance tests. Participants were classified into ‘pain’ and ‘no pain’ groups based on self-reported knee pain. Poisson Regression models were computed to determine the Relative Risk (RR) of having multiple falls and potential mediators for increased fall risk.Results One hundred and eighteen (35.5%) participants were categorised as having knee pain. This group took more medications and had more medical conditions (P <0.01) compared to the no pain group. The pain group had poorer balance, physical function and strength and reported increased concern about falls. Sixty one participants (19.5%) reported ≥ 2 falls, with the pain group twice as likely to experience multiple falls over the 12 month follow up (RR = 2.0, 95% confidence interval (CI) = 1.27 – 3.13). Concern about falls, knee extension torque and postural sway with eyes closed were identified as significant and independent mediators of fall risk, and when combined explained 23% of the relationship between knee pain and falls.Conclusion This study has identified several medical, medication, psychological, sensorimotor, balance and mobility factors to be associated with knee pain, and found the presence of knee pain doubles the risk of multiple falls in older community living people. Alleviating knee pain, as well as addressing associated risk factors may assist in preventing falls in older people with knee pain.


2021 ◽  
Vol 39 ◽  
Author(s):  
Robert Marchand ◽  
◽  
Laura Scholl ◽  
Manoshi Bhowmik-Stoker ◽  
Kelly Taylor ◽  
...  

Introduction: Valgus knee deformities can sometimes be challenging to address during total knee arthroplasties (TKAs). While appropriate surgical technique is often debated, the role of new operative technologies in addressing these complex cases has not been clearly established. The purpose of this study was to analyze the usefulness of computed tomography scan (CT)-based three-dimensional (3D) modeling operative technology in assisting with TKA planning, execution of bone cuts, and alignment. Specifically, we evaluated valgus TKAs performed using this CT-based technology for: (1) intraoperative implant plan, number of releases, and surgeon prediction of component size; (2) survivorship and clinical outcomes at a minimum follow up of one year; and (3) radiographic outcomes. Materials and Methods: A total of 152 patients who had valgus deformities receiving a CT-based TKA performed by a single surgeon were analyzed. Cases were performed using an enhanced preoperative planning and real-time intraoperative feedback and cutting tool. The surgeon predicted and recorded implant sizes preoperatively and all patients received implants with initial and final implant alignment, flexion/extension gaps, and full or partial soft tissue releases recorded. A modified Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS, JR.) scores were collected preoperatively and at approximately six months and one year postoperatively. Preoperative coronal alignment ranged from 1 to 13° valgus. Follow-up radiographs were also evaluated for alignments, loosenings, and/or progressive radiolucencies. Results: A total of 96% of cases were corrected to within 3° of mechanical neutral. For outlier cases, initial deformities ranged from valgus 5 to 13°, with final alignment ranging from 4 to 8° valgus (mean 4° correction). Patients had mean femoral internal rotation of 2° and mean femoral flexion of 4°. The surgeon was within one size on the femur and tibia 94 and 100% of the time, respectively. Only one patient required a lateral soft tissue release and one patient had osteophytes removed, which required a medial soft tissue release. Five patients required manipulations under anesthesia. Aside from these, there were no postoperative medical and/or surgical complications and there was 100% survivorship at final follow up. WOMAC and KOOS, JR. scores improved significantly from a mean of 21 ± 9 and 48 ± 10 points preoperatively to 4 ± 6 (p<0.05) and 82 ± 15 (p<0.05) at final follow up, respectively. None of the cases exhibited progressive radiolucencies by final follow up. Discussion: A limitation of this study was not evaluating dynamic kinematics in these patients to determine if rotation had any effects on kinematics. Future studies will evaluate this concern. Nevertheless, the technology successfully assisted with planning, executing bone cuts, and achieving alignment in TKAs complicated by the deformity. This may allow surgeons to predictably avoid soft tissue releases and accurately know component sizes preoperatively, while consistently achieving desired postoperative alignment. Conclusions: This study demonstrated the utility of CT-based 3D modeling techniques for challenging valgus deformity cases. Use of 3D modeling allowed the TKA components to be positioned according to the patient’s anatomy in the coronal, transverse, and sagittal planes. When making these intraoperative implant adjustments, the surgeon may choose to place components outside the preoperative planning guidelines based on the clinical needs of the patient.


2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
Eduardo Arenas ◽  
Diana Muñoz

Aim. To report a new surgical technique for the treatment of conjunctivochalasis.Methods. A new surgical technique in which specially designed bipolar electrocautery forceps facilitate the complete reduction of the conjunctival folds without creating lesions near the corneoscleral limbus was designed. A retrospective revision of the medical records of patients treated with this technique between the years 2011 and 2013 was made, and eighteen eyes of sixteen patients with conjunctivochalasis treated with this new technique were included.Results.All the eyes treated showed a significant improvement with no evidence of scar lesions after a mean follow-up time of 10 months.Conclusions. The surgical technique presented here could be a good alternative for the management of conjunctivochalasis.


2018 ◽  
Vol 5 (1) ◽  
pp. 29-32
Author(s):  
Sameer Rathore ◽  
Nithin Vadlamudi ◽  
Yellati Lvsnr ◽  
A.H. Ashwin Kumar ◽  
Indukuri Viswanatha Reddy ◽  
...  

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