Erno Peltola

Femoral Avulsion of the Medial Patellofemoral Ligament after Primary Traumatic Patellar Dislocation Predicts Subsequent Instability in Men: A Mean 7-Year Nonoperative Follow-Up Study

Background The clinical relevance of medial patellofemoral ligament (MPFL) injury location in primary patellar dislocation has not been studied. Hypothesis Prognosis after primary traumatic patellar dislocation may vary by MPFL injury location. Study Design Cohort study; Level of evidence, 3. Methods The initial magnetic resonance imaging (MRI) findings in 53 patients with identical nonoperative management were retrospectively analyzed for medial restraint injuries. The MPFL injury sites were classified as follows: femoral, midsubstance, and patellar. Magnetic resonance imaging was used to assess initial and control articular cartilage lesions in the patellofemoral joint. After a mean follow-up of 7 years, 42 patients were evaluated for redislocations, subjective symptoms, and functional limitations. Results Based on the initial MRIs, MPFL rupture was classified as femoral in 35 patients, midsubstance in 11, and patellar in 7. At follow-up, 15 patients reported an unstable patella (13 femoral, 1 patellar, 1 midsubstance; P =. 01) and 9 reported patellar redislocations (8 femoral, 1 midsubstance; P =. 05). The proportion of patients who regained their preinjury activity level was significantly smaller among those with femoral MPFL injury than among those with midsubstance or patellar MPFL injury (P =. 05). The median Kujala score was as follows: 90 for femoral, 91 for patellar, and 96 for midsubstance (P =. 76). Control MRI showed full-thickness patellofemoral cartilage lesions in 50% of the patients, unrelated to MPFL injury location. Conclusion An MPFL avulsion at the femoral attachment in primary traumatic patellar dislocations predicts subsequent patellar instability. The authors suggest that MPFL injury location be taken into account when planning treatment of primary traumatic patellar dislocation.

Segond fracture combined with tibial plateau fracture.

OBJECTIVE The objective of our study was to examine the coexistence of Segond fracture in tibial plateau fractures and to assess the prevalence of anterior cruciate ligament (ACL) rupture and meniscal tear when those fractures coexist. MATERIALS AND METHODS This retrospective study was conducted at a level 1 trauma center. A total of 1203 emergency department knee trauma MDCT examinations were evaluated. Surgical findings served as the reference standard for intraarticular injuries. RESULTS A total of 33 patients with a Segond fracture were found. Of these patients, 10 had isolated Segond fractures (surgery, n = 7) and 23 patients (surgery, n = 20) had a Segond fracture associated with a tibial plateau fracture. Patients with both fractures had significantly fewer anterior cruciate ligament (ACL) ruptures (20% vs 71%, p = 0.023) and more avulsion fractures of the ACL (50% vs 0%, p = 0.026) than patients with isolated Segond fractures. For meniscal injuries, the corresponding numbers were 25% and 57% (p = 0.175), respectively. In approximately one of every 32 tibial plateau fractures, a Segond fracture also coexists. CONCLUSION Patients with a Segond fracture combined with a tibial plateau fracture have a high risk of avulsion fracture of the ACL.

Peripheral Vascular Restenosis: A Retrospective Study on the Use of Drug-Eluting Balloons in Native Arteries, Vein Grafts and Dialysis Accesses

Background and Aims: The objective of this study is to analyze outcomes of the first experiences with drug-eluting balloons in native arteries, vein grafts, and vascular accesses. The study is also a pilot for our future prospective, randomized, and controlled studies regarding the use of drug-eluting balloons in the treatment of the stenosis in bypass vein graft and dialysis access. Materials and Methods: A total of 93 consecutive patients were retrospectively analyzed and in the end 81 were included in the study. Inclusion criteria included at least one previous percutaneous angioplasty to the same lesion. Patients were divided into three groups according to the anatomical site of the lesion: native lower limb artery, vein bypass graft, or vascular access. Time from the previous percutaneous angioplasty to the drug-eluting balloon was compared to the time from the drug-eluting balloon to endpoint in the same patient. Endpoints included any new revascularization of the target lesion, major amputation, or new vascular access. Results: The median time from the drug-eluting balloon to endpoint was significantly longer than the median time from the preceding percutaneous angioplasty to drug-eluting balloon in all three groups. This difference was clearest in native arteries and vein grafts, whereas the difference was smaller from the beginning and disappeared over time in the vascular access group. No significant differences were seen between the groups with regard to smoking, antiplatelet regime, diabetes, Rutherford classification, or sex. Conclusion: Although the setup of this study has several limitations, the results suggest that there could be benefit from drug-eluting balloons in peripheral lesions. Very little data have been published on the use of drug-eluting balloons in vein grafts and vascular accesses, and randomized and controlled prospective studies are needed to further investigate this field.

Bleeding gastric and duodenal ulcers: case-control study comparing angioembolization and surgery

Abstract Objectives: To compare the safety, efficacy and feasibility of transcatheter arterial embolization (TAE) and surgery in the treatment of bleeding gastric and duodenal ulcers (BGDUs). Materials and methods: The study group comprised patients receiving TAE or surgery for BGDUs after failed endoscopic hemostasis in Helsinki University Hospital (HUH) during 2000–2015. Hospital medical records provided study data. 30-d mortality and rebleeding rates were the primary outcomes. Postoperative complications, blood transfusion rate, and the durations of intensive care and hospital admissions were the secondary outcomes. Results: During the study period, BGDUs lead to 1583 hospital admissions. TAE or surgery was necessary on 85 (5.4%) patients, 43 receiving surgery and 42 TAE. Out of 42, 16 received prophylactic TAE. Two underwent angiography and TAE to localize the bleeding. The remaining 24 received TAE for active or recurrent bleeding after endoscopy. The comparison of TAE (n = 24) and surgery (n = 43) included only patients with active or recurrent bleeding. Mortality rate was 12.5% after TAE and 25.6% after surgery (p = 0.347). Rebleeding rate was 25% after TAE and 16.3% after surgery (p = 0.641). Postprocedural complications were less frequent after TAE than surgery (37.5 vs. 67.4%, p = 0.018). Other secondary outcomes did not differ. Out of 85 procedures, 14 (16.5%) took place between midnight and 8 a.m., all nighttime interventions being surgeries. Conclusions: Mortality and rebleeding rates did not differ between TAE and surgery. With less postoperative complications, TAE should be the preferred hemostatic method when endoscopy fails.

Multidetector computed tomography evaluation of bony fragments and donor sites in acute patellar dislocation

Background Patellar dislocation is frequently associated with bony fragments that are difficult to see on radiographs. MRI or MDCT are often used to rule out or characterize these bony fragments. Purpose To assess the use of MDCT for locating bony fragments and donor sites in patients with acute patellar dislocation, and to test whether sizes and quantity of bony fragments differ between first-time dislocations and recurrent dislocations. Material and Methods Retrospective data from two hospitals during a 96-month period were collected, and a total of 46 patients (mean age 27 years, range 9–69 years) that had sustained an acute patellar dislocation (22 first-time, 24 recurrent) were identified. Size, location and donor site of bony fragments were evaluated on MDCT images. Surgical correlation was available for 22 of 46 patients. Results On MDCT images, the likely donor site could be identified in 62 of 71 (87%) bony fragments. Of the bony fragments that were seen on MDCT images, 40 of 68 (59%) were not seen on AP and lateral views of the conventional radiographs. There was no significant difference in size of bony fragments between first-time or recurrent dislocators (p = 0.77). The average number of bony fragments were 2.1 and 1.0 in first-time and recurrent dislocators, respectively. The location and donor site of bony fragments was similar between two patients groups. Conclusion MDCT is a suitable imaging method to locate bony fragments and donor sites. The number of bony fragments seems to be higher in first-time dislocators than recurrent dislocators, otherwise findings between the two patient groups were similar.