Periprosthetic knee infection with Brucella species - a case report

A 63-year-old female patient presented for infected total knee prosthesis by brucella spp. several years after undergoing knee replacement arthroplasty. She underwent a two-stage revision surgery and was treated wih gentamicin, rifampicin and doxycycline for a total duration of four months

sagittal pattello-femoral type [SPFT] in total knee arthroplasty a new parameter

Patient's satisfaction commonly goes beyond surgeon's satisfaction after total knee arthroplasty [TKA]. The authors aim at evaluating the correlation between patient's satisfaction and a new radiographic parameter, after TKA, the so-called "sagittal patello-femoral type" [SPFT]. The SPFT corresponds to the relationship between two radiographic lines drawn on the strict lateral knee radiograph: the patellar cut line and the posterior femoral cut line. A total of 69 knee replacements were retained for this retrospective study. They all fulfilled a number of inclusion criteria: 6 months of minimal follow-up, strict lateral radiograph of the operated knee in monopodal full weight bearing and full extension, and patient reported outcome using the Oxford Knee Score. Two types of SPFT were identified. In Type A, the patellar cut is parallel to the posterior femoral cut, while in type B the two lines are distally convergent. Oxford Knee Score was 78.34% for Type A and 72.34% for Type B; the difference was statistically significant according to Student t-test. The authors believe that SPFT reflects an important aspect of the patello-femoral relationship in TKA, and seems to be correlated to patient's satisfaction; patients with Type A have a higher rate of satisfaction. Nevertheless, the surgical steps the surgeon has to follow, in order to achieve parallel patellar and posterior femoral cuts, need to be clarified in the future

Intrafocal pinning for dorsally displaced distal radius fractures

Intrafocal pinning of dorsally displaced distal radius fractures, as described by Kapandji in 1976, was very popular during the last two decades of the last century. This method has clear economic advantages over other modern methods of internal fixation such as locking plates. The authors aim at presenting the results of a series of 56 patients operated for distal radius fractures between 1994 and 1999. All patients were clinically reviewed and radiographically assessed at a mean of 16 months follow-up. The authors believe that intrafocal pinning remains a valuable method for the treatment of dorsally displaced extra-articular distal radius fractures; however, it should be used with caution in presence of epiphyseal and dorsal metaphyseal comminution

Guiding principles and pearls in a stepwise surgical technique of revision total knee arthroplasty

The authors aim at reviewing the guiding principles in revision total knee arthroplasty according to a stepwise procedure. Strict preoperative planning is of paramount importance for this surgery. Thorough clinical history and physical exam, the assessment of limb deformity and knee range of motion as well as knee stability in flexion, extension and mid-flexion are crucial. Blood exam, standardized radiographic views, and CT scan are powerful tools for etiologic diagnosis of total knee arthroplasty failure. Templating is unique and mandatory to provide the surgeon with the critical data concerning the valgus position of the femoral component, the AP size of the femoral component, and the optimal position of the joint line; these three parameters are determinant for the final clinical outcome. A stepwise surgical technique with close adherence to the guiding principles of revision knee arthroplasty should be adopted from skin incision to closure. Femoral and tibia components with modular stem are ideally set at their optimal position as predetermined by templating. Any residual implant-bone gap is filled with metallic augment or bone graft. Finally, repositioning of the patella on a symmetrical bone cut presents a great value for a successful procedure

Kapandji technique as a minimally invasive procedure for selected patients with two- and three- part fractures of the proximal humerus

Current algorithms for decision making in proximal humerus fractures consider the fracture pattern along with the patient characteristics and surgeon's experience. Minimally invasive techniques for reduction and internal fixation of many types of these fractures have recently been widely promoted, especially with the use of the newly developed locking plate systems. Intramedullary flexible nailing is one of the oldest techniques using minimally invasive reduction and fixation of proximal humerus fractures. Kapandji technique uses the "Deltoid V" landmark as entry point for intramedullary insertion of the flexible nails into the humeral head. The authors report their experience with this procedure in twenty-six, relatively young patients with good bone quality, presenting with displaced 2- or 3-part extra-articular fracture of the proximal humerus, treated with percutaneous reduction and intramedullary flexible nailing as described by Kapandji. Nineteen medical records were available for this retrospective review, with 9 to 12 months follow-up. There were 15 excellent and 1 good results when patients were assessed for pain, function and range of motion of the shoulder. The authors submit that Kapandji technique is a valuable procedure for management of extra-articular displaced 2- and 3- part proximal humerus fractures in young patients with good bone quality