Jason R. Ferrel

Short-term Outcomes of Femoral Neck Fractures Treated With Hemiarthroplasty Using the Anterior Approach

The direct anterior approach has recently gained popularity for patients undergoing elective total hip arthroplasty. It is unknown whether the reported benefits of the direct anterior approach to elective total hip arthroplasty can be extrapolated to patients undergoing hemiarthroplasty after femoral neck fracture. A retrospective review of 101 patients was performed to compare the outcomes of patients treated with hemiarthroplasty using the direct anterior approach (group 1) with those of patients undergoing the procedure with the posterior, anterolateral, or lateral approach (group 2). No differences in age, American Society of Anesthesiologists classification, and preinjury ambulatory status were identified between treatment groups. No difference in operative time was found between those undergoing the anterior approach (98.7 minutes) and those undergoing other surgical approaches (96.5 minutes) (P=.76). No difference in either the need for transfusion or the number of blood products transfused was seen (P=.21) postoperatively. Patients undergoing the direct anterior approach were more likely to be discharged by postoperative day 3 (P=.004) despite no difference in the recorded number of feet ambulated in the hospital. At a mean clinical follow-up of 16 weeks, there was no difference in the rate of return to baseline ambulatory status between groups (P=.07). The overall rates of major and minor complications for all patients were 23% and 26%, respectively, with no statistically significant differences between groups. The overall dislocation rate of all patients was found to be 3%. All dislocations were observed in group 2. Larger prospective studies are needed to further define the benefits of the direct anterior approach in this patient population.

The Anatomy of the Medial Patellofemoral Ligament

Recurrent patellar dislocation is observed in many patients treated nonoperatively following primary dislocation. Injury to the medial patellofemoral ligament (MPFL) is reported in the majority of patients following dislocation. There is an increased interest in repair or reconstruction of the MPFL for patients experiencing recurrent instability. The femoral attachment of the MPFL is critical in determining graft behavior following reconstruction. The femoral attachment can be determined by referencing local anatomy, fluoroscopic imaging or on the basis of desired graft-length changes. This article reviews the anatomy of the MPFL, with a focus on its femoral insertion site as it pertains to anatomic, isometric, and anisometric reconstruction. [Orthopedics. 2017; 40(4):e583-e588.].

Anterior Tibial Artery Injury Following Tibiotalocalcaneal Retrograde Intramedullary Nailing

Case: We report the case of a patient who sustained injury to the anterior tibial artery during tibiotalocalcaneal retrograde nailing and developed an acutely ischemic foot. Conclusion: Vascular injury during tibiotalocalcaneal arthrodesis with retrograde nailing is a rare but serious complication. While retrograde tibiotalocalcaneal arthrodesis nailing for end‐stage ankle and subtalar arthritis has shown encouraging results, a high index of suspicion for postoperative complications is necessary in patients with risk factors for poor posterior collateral circulation.

Late Abnormal Skin Changes Overlying Total Knee Arthroplasty: A Case Report

More than 600,000 total knee arthroplasties are performed in the United States every year1. Superficial wound complications occur infrequently, and the overall appearance of the incision is important to judge appropriate healing. Ecchymosis about the knee is common postoperatively and typically resolves within the first few weeks. Persistent skin changes around the incision and knee are rare, and they prompt additional investigation regarding the etiology. We report on a seventy-four-year-old woman who had undergone an uncomplicated right total knee arthroplasty and, almost three and one-half years later, developed an atraumatic ecchymotic-appearing lesion involving the superior aspect of the incision. She was diagnosed with biopsy-proven pigmented purpuric dermatosis (PPD). To our knowledge, this is the first such case reported in the orthopaedic literature. The patient was informed that data concerning the case would be submitted for publication, and she provided consent. A seventy-four-year-old woman with a past medical history of hypertension, hypothyroidism, and a prior left total knee arthroplasty presented for a right total knee arthroplasty. She underwent femoral and sciatic nerve blocks followed by general anesthesia. A posterior cruciate ligament-retaining total knee prosthesis (Vanguard; Biomet, Warsaw, Indiana) was implanted uneventfully. The patella was resurfaced, and a lateral release was performed. She did well in the postoperative period with regard to …

Ischemic Optic Neuropathy Following Surgical Fixation of Multiple Ipsilateral Upper-Extremity Fractures

Postoperative vision loss is a rare but devastating surgical complication. Ischemic optic neuropathy (ION) is one such form of vision loss, most commonly recognized with prone positioning in spinal surgery. It is also documented as a complication of multiple surgical specialties, including general orthopaedics1, otolaryngology2, obstetrics and gynecology3, cardiothoracic surgery4,5, and general trauma surgery6. ION is an acute ischemic disorder that causes blindness, with reported postoperative incidence ranging from 0.013% to 1.3%5,7-9. Blood flow to the optic nerve is autoregulated and is dependent on ocular perfusion pressure (OPP). OPP can decrease to a level beyond which autoregulation mechanisms can compensate10, leading to ischemic injury. The most common associated risk factors for this complication are often encountered in orthopaedic trauma, namely length of surgery11 and intraoperative arterial hypotension6,8. To our knowledge, ION has not previously been reported in the orthopaedic trauma literature. We present the case of a fifty-year-old man who developed ION after internal fixation of ipsilateral fractures of the proximal part of the humerus and olecranon. The patient was informed that data concerning the case would be submitted for publication, and he provided consent. A fifty-year-old healthy man sustained an eight-foot fall from a ladder, landing directly on the right elbow. He was hemodynamically stable with isolated closed injuries to the right upper extremity; there were no neurovascular deficits. The general surgery trauma team evaluated the patient, and no additional injuries were found. Radiographs and computed tomography (CT) of the right shoulder showed a comminuted fracture of the proximal part of the humerus, described as an Orthopaedic Trauma Association (OTA) classification type 11-B1.212, as well as a Neer two-part fracture involving the …