Risk of total knee replacement after proximal tibia fracture: a register-based study of 7,841 patients

Background and purpose — Post-traumatic knee osteoarthritis following proximal tibia fracture (PTF) is a common complication that may lead to total knee replacement as secondary treatment (TKRS). We determined the risk of TKRS following PTF, whether treated nonoperatively or operatively, and compared the results with a 38-fold control group without prior PTF. Patients and methods — We identified all patients over 18 years of age in Finland with PTF treated during the period 2009–2018 from the Finnish Hospital Discharge Register (FHDR) and Finnish Arthroplasty Register (FAR). Age, sex, treatment method, follow-up time, and possible TKRS were recorded. Results — 7,701 patients were treated for PTF during the period 2009–2018. Over the 5.1-year (SD 3.1) follow-up, TKRS was performed in 340 (4.3%) patients with a prior PTF after a mean of 2.1 (SD 2.0) years post-fracture. TKRS was needed in 138 (3.7%, HR 1.8) patients in the nonoperatively treated group and in 202 (5.0%, HR 3.2) patients in the operatively treated group. Operative treatment, female sex, and high age were identified as risk factors for TKRS. The incidence of TKRS was highest during the first 2 years after fracture and remained elevated throughout the follow-up. Interpretation — Patients with a prior PTF had a 1.8- to 3.2-fold higher risk of TKRS compared with controls during the first 5 years post-fracture. Risk of TKRS was associated with an operatively treated PTF, female sex, and high age. The patients in the operative group likely sustained more complex fractures, while female sex and age may be explained by more osteoporotic bone quality.

A COMPARATIVE STUDY OF FUNCTIONAL AND RADIOLOGICAL OUTCOME OF HIGH ENERGY PROXIMAL TIBIA FRACTURE USING ILLIZAROV EXTERNAL FIXATOR VS HYBRID EXTERNAL FIXATOR

Background: In High energy proximal tibia fracture aim is to achieve adequate reduction and stability without signicantly compromising the soft tissue integrity and vascularity . External xator minimizes soft tissue dissection and minimize other complications. Method: 60 patients' high energy proximal tibia fracture with cases were considered in the study. 30 patients were treated with Ilizarov external xator and 30 patients were treated with hybrid external xator. Results were analyzed both clinically and radiologically using Johner and Wruh's criteria. Results: Mean time of union was 22 week in ilizarov xator group and 34 week in hybrid xator group. Pin tract infection occured in 6 patient (20%) in ilizarov xator group and 4 patient in hybrid xator group. Joint stiffness occured in 3 Patient (10 %) in ilizarov group and 10 patient in hybrid xator group.Shortning occured in 2 patient (6.6 %) in ilizarov xator group and 2 patient in hybrid xator group. Overal results in ilizarov group were excellent in 23 patient (76.7%), good in 5 patient (16.67%) , fair in 2 patient (6.67%) while in hybrid group excellent in 16 patient( 53.33%),good in 10 patient(33.33%),fair in 4(13.33%)patient. Conclusion: External xators are excellent modalities in treatment of high energy proximal tibia fracture with ilizarov method has advantage of early mobilization and early union but require long operative time and bulky framework on other hand hybrid xator has simpler construct ,lesser operative time but has lesser stability , longer union time and longer immobilization time.

Management of Necrotizing Fasciitis with Proximal Tibia Fracture

Introduction: Necrotizing fasciitis is a rare disease of soft tissue infection with a high mortality. It is characterized by rapidly spreading inflammation and necrosis of fascial planes. It usually follows an injury, though the cause may be a small abrasion or an insect bite or surgical incisions. It is commonly caused by bacteria such as Group A streptococcus. It may be accompanied by septic shock. It causes rapid death unless it is diagnosed quickly and managed aggressively. Prompt surgical debridement must be done to reduce mortality. Rapid diagnosis, antibiotic therapy, fluid resuscitation, and surgical debridement of the infection are all needed in the management of this fatal disease. However, when necrotizing fasciitis is associated with an underlying fracture the treatment becomes even challenging and limb-threatening. Case Report: A 48-year-male patient of South Asian descent came to Emergency Room with history of road traffic accident and sustained injury to the right (RT) leg. He was admitted with pain, swelling and blisters of the RT leg and suspected to have necrotizing fasciitis with proximal tibia fracture of the RT leg. He was treated with thorough surgical debridement, broad-spectrum antibiotics, free flap, and Masquelet’s technique with limb reconstruction system (LRS). At 18 months of follow-up the fracture healed, LRS was removed, pin tracts healed and patient was able to walk without any support. Conclusion: Necrotizing fasciitis is rare, rapidly progressive disease with a high mortality rate which requires prompt diagnosis, early surgical debridement, broad-spectrum antibiotics, careful fluid, and electrolyte management. These patients require a combined multidisciplinary approach for their management. Keywords: Necrotizing fasciitis, proximal tibia fracture, surgical debridement.

Assessment of complications in treating the fracture around knee joint by using locking compression plate

<p><strong>Background:</strong> Aim of the study was to describe complications and problems in treating the fracture around knee joint by using LCP (locking compression plate).</p><p><strong>Methods:</strong> This multicentric prospective functional out-come study has been conducted in the department of orthopedics, Barmer medical college and hospital, Barmer, Rajasthan and department of orthopedics, Pacific institute of medical sciences, Udaipur, Rajasthan. A total of 90 patients were studied, out of which 60 patients were with fracture distal femur and 30 patients were with proximal tibia fractures.</p><p><strong>Results:</strong> Out of 44 patients of distal femur fracture group 10 (22.72%) had infection where as in proximal tibia fracture group 4 (15.38%) out of 26 patients (all were operated by ORIF technique) had infection.<strong> </strong>Varus deformity was found in 3 patients (6.66%) of distal femur fracture patients and 4 patients (15.38%) of proximal tibia fracture patients out of these 3 were operated by ORIF and 1 by MIPO.<strong> </strong>Muscle wasting was found in 20 patients (40.44%) of distal femur fracture patients. Limb shortening was found in 7 patients (15.90%) of distal femur fracture. Limp shortening was present in 17 patients (38.60%) of distal femur fracture and 4 patients (15%) of proximal tibia fracture out of these 4 were operated by ORIF and 1 by MIPO.<strong> </strong>Delayed Union was found in two patients (4.54%) of distal femur fracture patients. Non-union with plate breakage and Non-union with plate loosening each were found in one patient (2.25%). Extension lapse was found in four patients (9.09%) of distal femur fracture and 1 patient (5.88%) of proximal tibia fracture.<strong></strong></p><p><strong>Conclusion:</strong> We concluded that MIPO technique was best.</p>

Evaluation of the functional outcome of locking compression plate for fractures around knee joint distal 1/3rd femur or proximal 1/3rd tibia

<p><strong>Background:</strong> The aim of the study was to evaluate the functional outcome of locking compression plate for fractures around knee joint (Distal 1/3^rd femur or proximal 1/3^rd tibia).</p><p><strong>Methods:</strong> This multicentric prospective functional out-come study has been conducted in the department of orthopedics, Barmer medical college and hospital, Barmer, Rajasthan and department of orthopedics, Pacific institute of medical sciences, Udaipur, Rajasthan. A total of 90 patients were studied, out of which 60 patients were with fracture distal femur and 30 patients were with proximal tibia fractures. At the end of study, 20 patients were lost to the follow-up (16 patients were with distal femur fracture and 04 patients were with proximal tibia fracture).</p><p><strong>Results:</strong> According to modified Mehrotra’s criteria for distal femur fracture excellent (43.18%) and fair (43.18%) and (13.64%) had poor result. All followed-up patients of proximal tibia fracture managed with MIPO technique had excellent (11.11%), good (66.67%) and fair (22.22%) functional outcome and no failure. While 17.65% followed patients of proximal tibia fracture who were managed with ORIF technique had failure.</p><p><strong>Conclusions:</strong> Locking compression plate is the optimal tool for many supracondylar fractures of femur and proximal tibia fractures. It provides rigid fixation, where a widening canal, thin cortices and frequently poor bone stock make fixation difficult.</p>