ABSTRACT
<p><b>Background</b>Patellar dislocation is one of the most common knee injuries in the adolescent population. It is often combined with osteochondral fracture. The purpose of this study was to compare the outcomes between fixation and excision of osteochondral fractures not involving the bearing surface in adolescent patients with patellar dislocations.</p><p><b>Methods</b>Patients who underwent surgery for osteochondral fracture following patellar dislocation in our institution from 2007 to 2014 were retrospectively evaluated. Visual analog scale (VAS) of pain and the International Knee Documentation Committee (IKDC) form were used to assess knee pain and function at follow-up. Patient satisfaction was evaluated. Differences in the values of variables among groups were assessed using t-test if equal variance or Mann-Whitney U-test if not equal variance. The Pearson's Chi-square test was applied for dichotomous variables if expected frequency was >5 or Fisher's exact test was applied if not. A value of P < 0.05 was considered statistically significant.</p><p><b>Results</b>Forty-three patients were included, with the average age of 14.1 ± 2.3 (range, 9.0-17.0) years. Nineteen underwent fixation of osteochondral fractures and 24 did not. The average follow-up time was 28 ± 10 months. There was no significant difference in age, gender, follow-up time, causes of injury, times of dislocation, and location of osteochondral fracture between fixation and excision groups. The fixation group had a significantly longer surgery time (82 ± 14 min) and larger size of osteochondral fracture (2.30 ± 0.70 cm) than the excision group (43 ± 10 min, 1.88 ± 0.62 cm, respectively, t = 10.77, P < 0.01 and t = 0.84, P < 0.05). At the last follow-up, the average IKDC score in the fixation group (82.52 ± 8.71) was significantly lower than that in the excision group (89.51 ± 7.19, t = 2.65, P < 0.01). There was no significant difference in VAS of pain and patients' satisfaction. There were 7 (16%) patients with recurrent dislocation.</p><p><b>Conclusion</b>Excision of osteochondral fractures has equivalent or better outcomes compared to fixation in adolescent patients with patellar dislocations when these fractures do not involve the bearing surface.</p>
Subject(s)
Adolescent , Child , Female , Humans , Male , Femoral Fractures , General Surgery , Knee Injuries , General Surgery , Patellar Dislocation , General Surgery , Retrospective StudiesABSTRACT
<p><b>OBJECTIVE</b>To study the effects of surgical reconstruction of the lateral ligament complex for posterolateral rotatory instability (PLRI) of the elbow joint.</p><p><b>METHODS</b>From January 2013 to January 2015, 20 patients with posterolateral rotatory instability of elbow joint were treated in our department. There were 12 males and 8 females whose age ranged from 30 to 60 years old, with an average age of 45.5 years old. Sixteen patients had injuries on the right side and 4 patients had injuries on the left side. Nine patients were caused by elbow dislocation and 6 cases were caused by elbow fracture. Five patients had no history of trauma. All the patients had closed injuries. According to the patient's history, physical examination and preoperative X-ray and MRI examination, a definite diagnosis was made. All the patients were treated conservatively for more than 2 months without efficacy, and they were treated with reconstruction of the lateral collateral ligament complex using palmaris longus tendon as a reconstruction graft under general anesthesia. Individual rehabilitation exercises were carried out according to the patient's condition.</p><p><b>RESULTS</b>All the patients were followed up, and the duration ranged from 12 to 23 months(mean, 16 months). There were no complications such as infection and obvious limitation of elbow joint. The HSS score of all the patients was improved from preoperative 75.2±8.3 to postoperative 94.1±5.4; and the VAS score was improved from preoperative 6.7±3.2 to postoperative 2.3±1.5.</p><p><b>CONCLUSIONS</b>The lateral cubital ligament complex is the most important limiting structure for the posterolateral rotatory instability of the elbow joint. Reconstruction of the lateral ligament complex is an effective method for the treatment of posterolateral rotatory instability of the elbow joint.</p>