Yu-Ping Su

Periprosthetic Femoral Supracondylar Fracture After Total Knee Arthroplasty With Navigation System

We report 1 patient with a supracondylar periprosthetic fracture 1 month after computer-assisted total knee arthroplasty. The fracture line extended from previous anchoring pinholes into the supracondyle area. Intramedullary nailing of the left femur was performed under close reduction. The possible complication of pinhole fracture to total knee arthroplasty with navigation system should be kept in mind.

A facile technique to make articulating spacers for infected total knee arthroplasty.

Background: To treat total knee arthroplasty, 2‐stage revision, including removal and reimplantation, remains the standard treatment for the infected arthroplasty. Articulating cement spacer has been shown to provide better functional results after reimplantation. However, its cost as a manufactured product is not always easily affordable and the choice of antibiotics is not flexible either. The authors have developed a method for surgeons to make cement‐on‐cement articulating spacers themselves by using an impression‐taking technique with polydimethyl siloxane. The current study was conducted to test their clinical efficacy. Methods: Fifteen patients with infected total knee arthroplasties were prospectively treated with 2‐stage revision using articulating spacers made by this technique. The clinical assessment included intraoperative finding, surgical records, radiographic and laboratory examination and final functional scores. All the patients were regularly followed‐up. Results: Fourteen of the 15 patients (93.3%) had infection eradicated, of which 13 patients received revision arthroplasty successfully. The average interval between the resection arthroplasty and the final procedure was 3.5 months. During this period, most of the patients could sit comfortably with bent knees and walk with partial weight‐bearing. No patients had secondary bone loss. The range of motion after revision surgery achieved an average of 110 degrees. The average Hospital for Special Surgery score was 90.5 points, and none had recurrent infection after an average of 47.5 months of follow‐up. Conclusion: Treating infected total knee arthroplasty with these self‐made articulating spacers eradicates infection effectively, improves the life quality before reimplantation and provides good final results without significant complications.

Patient controlled epidural analgesia for bilateral versus unilateral total knee arthroplasty: A retrospective study of pain control

Background: Patient controlled epidural analgesia (PCEA) has been used commonly for postoperative pain management following total knee arthroplasty (TKA). The purpose of this study was to compare a single standardized PCEA protocol in patients who received unilateral TKA with patients who received simultaneous bilateral TKA. Methods: From October 2003 to October 2008, 912 patients were enrolled. Patient‐machine interaction data were retrieved from PCA machines and stratified into 12 hour intervals. The data were analyzed according to the side of surgery, gender and methods of anesthesia. Patient demographic data, pain scores and side effect scores were compared to evaluate clinical efficacy. Results: There was no significant difference between the unilateral and bilateral TKA groups for pain scores, severity of side effects, and total drug use. However, there was a paradoxical increase in demand, delivery, and demand/delivery ratio of analgesics for unilateral rather than bilateral TKA. This was only noted in the first 12 hours. Both genders demanded more bolus doses than set by the standard protocol. Women with unilateral TKA received more delivery doses. All of the patients who received general anesthesia had a higher demand/delivery ratio while spinal anesthesia patients had no significant ratio difference. Conclusion: PCEA provided equal analgesia for patients with unilateral or bilateral TKA. However, the paradoxical increase in demand suggested that psychological factors may play a role in pain perception. A comprehensive pain management program that addresses gender and anesthesia methods in the first 12 hours will improve clinical efficacy and patient satisfaction of PCEA.

Concomitant tibial shaft and posterior malleolar fractures can be readily diagnosed from plain radiographs: A retrospective study

Background: Concomitant tibial shaft and posterior malleolar fractures (PMFs) are often encountered in clinical settings. Plain films were reviewed for concomitant PMF, and fracture patterns were analyzed by focusing on the integrity of the fibula and the location of the fibular fracture. Methods: A retrospective review of patients who presented with tibial shaft fractures between January 2005 and January 2010 was performed. Patients were included if they were at least 18 years of age and had a tibial diaphyseal fracture. Exclusion criteria were age less than 18 years, previous surgery on the same leg, and pathological fractures. Medical records were reviewed for information on injury mechanisms. Pre‐ and post‐operative radiographs were analyzed for PMFs, tibial fracture pattern, fibular integrity, fibular fracture pattern, treatment type, and time to fracture union. Descriptive statistical tests were used. Results: Among 240 patients, there were 20 cases (15 male and 5 female) of concomitant PMF, all detected in lateral radiograph views. The incidence of PMF was 8.3%. Most patients had a motorcycle injury (n = 15, 75%). Distal tibia spiral fracture was the most common fracture pattern (85%) and there was no proximal tibia fracture (0%). Combined fibular fractures were found in 17 patients (85%). There were nine proximal fibular fractures (45%). Intact fibulas were found in three patients (15%). Only one PMF was treated with screw fixation. All PMFs showed radiographic evidence of healing within 5 months post‐operatively. Conclusion: We recommend careful radiographic examination to evaluate PMF, especially in patients with distal tibial spiral fractures combined with proximal fibular fractures or intact fibulas.

The role of autologous bone graft in surgical treatment of hypertrophic nonunion of midshaft clavicle fractures.

Background: This study was conducted to evaluate the results of treating hypertrophic nonunion of mid‐shaft clavicle fracture with a limited contact dynamic compression plate (LC‐DCP) without autologous cancellous bone graft. Methods: From 1995 to 2008, 51 cases of hypertrophic nonunion of mid‐shaft clavicle fracture were managed with open reduction and internal fixation by LC‐DCP without bone graft involvement. Of these 51 cases, 30 had nonunion after failure of initial surgical treatment (Group 1), and 21 had nonunion after failure of conservative treatment (Group 2). Preoperative and postoperative case management were the same for both groups, with the average follow‐up period being 20.4 months (range 18–36). Our study evaluated the radiographic results and functional outcomes of these cases according to the quick disability of arm, shoulder, and hand score. Results: All 51 cases resulted in uneventful unions. There was no statistically significant difference between the two groups regarding patient demography, cause of injury, preoperative and postoperative functional scores, length of operation, union time, and duration of hospitalization (p > 0.05). Conclusion: LC‐DCP fixation is an effective method for treating hypertrophic nonunion of mid‐shaft clavicle fracture. Local bone graft is sufficient to achieve necessary union, and autologous bone graft from other sites of the body appears unnecessary.

Concomitant hip and distal radius fractures

Background Concomitant ipsilateral hip and distal radius fractures are uncommon, and little research has been published about these injuries. Our aim was to evaluate the characteristics and results of treatment for these injuries. Methods Between 2006 and 2012, 35 concomitant hip and distal radius fractures were identified, comprising the study group. The characteristics and results of treatment for these injuries were evaluated and analyzed. Another matched control group with isolated hip fractures was collected for comparison of patient characteristics, fall mechanism, fracture pattern, bone density, and functional recovery. Results For the patients with concomitant fractures, the average age was 77.6 years, and the female‐to‐male ratio was 6:1 (30:5). The majority (91.4%) of patients sustained ipsilateral injuries. Among the controlled pairs, 20 (57.1%) patients in the study group sustained a backward fall, and 25 (71.4%) patients in the control group had a sideways fall. With respect to the pattern of hip fracture, 22 (62.9%) patients in the study group had femoral neck fractures and 20 (57.1%) patients in the control group had pertrochanteric fractures. The average hospital stay was 15.3 days in the study group versus 10.2 days in the control group. Twenty‐five (71.4%) patients in the study group and 27 (77.1%) patients in the control group had osteoporosis. The average Barthel index score was 75.1 in the study group and 75.7 in the control group. Conclusion Concomitant hip and distal radius fractures were generally ipsilateral and involved the femoral neck after a backward fall. These patients were younger than and not more osteoporotic than the population with isolated hip fractures; however, the hospital stay was significantly increased. The functional outcome was not influenced by concomitant wrist fracture.