Reconstruction of composite bone and soft tissue defect of the hand or foot with the chimeric medial femoral condyle osteofascial free flap / 中华显微外科杂志

Objective:To explore the clinical application of free chimeric medial femoral condyle osteofascial free flap (CMFCOF) in the treatment of traumatic composite bone and soft tissue defect of hand and foot.Methods:Between January, 2015 and March, 2020, 8 patients with traumatic composite bone and soft tissue defect in hand and foot were treated with CMFCOF. Of the 8 patients, there were 6 males and 2 females, with an average age of 41 (range, 24 to 56) years. The causes of injury included 3 of traffic accident, 3 of machine crush and 2 of crush. Two cases had proximal phalanx defect, 3 with metacarpal bone and 3 with metatarsal bone. The time between injury to the flap repair were 2 to 120 (mean, 84) days. The size of bone defect ranged from 2.0 cm×1.2 cm×1.2 cm to 4.4 cm× 3.0 cm×2.3 cm. The soft tissue defect ranged from 2.0 cm×1.4 cm to 5.6 cm×4.5 cm. All bone defects were on the diaphysis, without involvement of joints. Two cases had tendon defect. According to the defect of bone and soft tissue, the CMFCOF was prepared and skin graft was performed on the surface of its fascial flap.Results:The average time of flap harvesting was 53(52-96) minutes. All donor sites were directly closed. All flaps and skin grafts achieved stage I survival. All patients entered 9-16 months of follow-up, with an average of 14.5 months. The average healing time of bone was 7.5 (range, 6-10) weeks. At the last follow-up review, all flaps were not thinned. The function of donor site was restored well, without weight bearing disorder and paraesthesia in the anterior patella area. According to the trial standard of Digit Function Evaluation of the Hand Surgery Society of Chinese Medical Association, 3 patients were rated as excellent, 1 was good and 1 was fair. According to the Maryland foot evaluation criteria, 3 patients were rated as excellent for recovered with normal weight-bearing walking.Conclusion:CMFCOF can achieve satisfactory results in repairing composite bone and soft tissue defect of hand or foot. The flap has the advantages in simple operation, high quality of bone and concealed donor site.

Transfer of vascular pedicled free medial femoral condyle bone flap in treatment of scaphoid nonunion / 中华显微外科杂志

Objective:To investigate the clinical effect of the free medial femoral condylar bone flap in treatment of scaphoid nonunion.Methods:From May, 2012 to May, 2016, 15 patients, which were 10 males and 5 females and aged from 18 to 63 (mean 43.5±15.5) years, with scaphoid nonunion were treated with transfer of free medial femoral condyle bone flaps. After debridement of the fractural segment in surgery, the bone flap was transferred to scaphoid and had the bone defect filled. The artery of the bone flap was end-to-side or end-to-end anastomosed to the radial artery. The concomitant vein of the bone flap was end-to-end anastomosed to the concomitant vein of the radial artery. Thirteen patients were treated with the free osteoperiosteal medial femoral condylar graft, and 2 were treated with the free osteochondral medial femoral condylar graft. Fracture healing was evaluated based on X-ray evidence. The clinical effect was evaluated by visual analogue scale (VAS), strength of grip and modified Mayo wrist score. The t-test was used to compare the function between before and after surgery. Results:All patients were entered into a followed-up for an average of 32.5 (8-60) months, 11 of them took the follow-up reviews at the outpatient clinic and 4 via WeChat distanced interviews. All fractures of the 15 patients healed with an average healing time at 12.5 (10-16) weeks. The VAS score decreased from (3.5±1.5) before the surgery to (1.0±1.0) after the surgery. The strength of grip increased from (16.5±4.3) kg before the surgery to (31.5±3.5) kg at the last follow-up review. The modified Mayo wrist score increased from (46.2 ±11.4) before the surgery to (68.5 ±10.8) at the last follow-up review. The wrist function was excellent in 8 patients, good in 6 and fair in 1. There was significant difference in functional evaluation ( P<0.05). Conclusion:The transfer of free medial femoral condylar bone flap is effective in the treatment of scaphoid nonunion. This technique provides both of sufficient blood supply and a structural support for defected scaphoid bone and promotes the healing of fracture. Osteochondral flap transfer may be used as an alternative measure to prevent wrist osteoarthritis and collapse, in the case that there is an avascular necrosis of the proximal pole of the scaphoid. It has an advantage in the treatment of refractory scaphoid nonunion.

Enhanced osseointegration of porous titanium scaffold implanted with preload: an experiment study in rabbits / Osteointegración mejorada de malla de titanio poroso implantada con precarga: un estudio experimental en conejos

Porous titanium alloy scaffold was widely used in treating bone defect caused by traumatic injury and osteomyelitis, which was incapable of self-healing. The implantation of scaffold produced stress shielding thereby forming osteolysis. The objective of this study was to analysis trabecular morphological features of osseointegrated bone. 14 New Zealand rabbits were divided into two groups, surgery group and healthy control group. 7 rabbits in surgery group were selected to perform 3D printed porous titanium alloy scaffold implantation surgery with preload at the defect of femoral condyle for osseointegration. The other 7 rabbits in control group were feed free. After 90 days healing, femoral condyles were extracted to perform micro-CT scanning with hydroxyapatite calibration phantom. Mean bone mineral density (BMD), bone volume fraction (BV/TV), BS/TV (bone surface area ratio), Tb.Th (thickness of trabeculae), Tb.N (number of trabeculae), Tb.Sp (trabecular separation) and DA (degree of anisotropy) were calculated from micro-CT images. The results revealed that osseointegration inside and at the surface of scaffolds worked well from grey values of micro-CT images. After 12 weeks healing, mean bone mineral densities (BMD) in surgery group and healthy control group were calculated as 800±20mg/cm3 and 980±90mg/cm3, respectively. This revealed that the strength of trabeculae in surgery group might lower than that in the healthy group. Trabecular morphological parameters test showed that trabecular morphological parameters at the surface of scaffolds in the surgery group deteriorated significantly. It was found from micro-CT images that ingrowth bone was filled with pores of scaffold. Overall, the effect of osseointegration was promoted through the change of mechanical micro-environment in the scaffold region. Overall, preload could improve osseointegration effect in the long-term after surgery. However, the trabecular morphology in the surgery group was deteriorated, which might bring secondary fracture risk again.

La malla de aleación de titanio poroso se usó ampliamente en el tratamiento de defectos óseos causados por lesiones traumáticas y osteomielitis. El implante de la malla generó una protección contra el estrés, formando así osteolisis. El objetivo de este estudio fue analizar las características morfológicas trabeculares del hueso osteointegrado. Se dividieron 14 conejos (Neozelandeses) en dos grupos, grupo cirugía y grupo control saludable. Se seleccionaron 7 conejos en el grupo de cirugía para realizar una implantación de mallas de aleación de titanio poroso, impresas en 3D con precarga en el defecto del cóndilo femoral para la osteointegración. Los 7 conejos restantes del grupo control se mantuvieron sin alimentación. Después de 90 días de curación, se extrajeron los cóndilos femorales para realizar una exploración por micro-CT con un espectro de calibración de hidroxiapatita. Se calcularon a partir de imágenes de micro-CTDensidad mineral ósea media (DMO), fracción de volumen óseo (BV / TV), BS / TV (relación de área de superficie ósea), Tb.Th (espesor de trabéculas), Tb.N (número de trabéculas), Tb.Sp (trabecular separación) y DA (grado de anisotropía). Los resultados revelaron que la osteointegración dentro y en la superficie de los andamios funcionó bien a partir de los valores grises de las imágenes de micro-CT. Después de 12 semanas de curación, las densidades medias de minerales óseos (DMO) en el grupo cirugía y en el grupo control sano se calcularon como 800 ± 20 mg/cm3 y 980 ± 90 mg/cm3, respectivamente. Esto reveló que la fuerza de las trabéculas en el grupo de cirugía podría ser menor que la del grupo sano. La prueba de parámetros morfológicos trabeculares mostró que en el grupo de cirugía, la superficie de las mallas, se deterioraron significativamente. Se descubrió a partir de imágenes de microCT que el hueso en crecimiento estaba lleno de poros de andamio. En general, el efecto de la osteointegración se promovió mediante el cambio del microambiente mecánico en la región de la malla. En general, la precarga podría mejorar el efecto de osteointegración a largo plazo después de la cirugía. Sin embargo, la morfología trabecular en el grupo de cirugía se deterioró, lo que podría traer un nuevo riesgo de fractura secundaria.

Effectiveness of arthroscopic microfracture combined with osteochondral autologous transplantation for large area cartilage injury of femoral condyle of knee / 中国修复重建外科杂志

Objective: To explore the effectiveness of arthroscopic microfracture combined with osteochondral autologous transplantation (OAT) in treatment of large area (4-6 cm 2) cartilage injury of the femoral condyle of knee. Methods: Between March 2016 and June 2017, 22 patients of large area cartilage injury of the femoral condyle of knee were treated with arthroscopic microfracture combined with OAT. There were 16 males and 6 females with an average age of 22-60 years (mean, 38.6 years). The cause of injury was traffic accident in 8 cases and sports injuries in 14 cases. The disease duration was 1-6 months (mean, 3.4 months). There were 15 cases of medial femoral condyle injuries and 7 cases of lateral condyle injuries. The area of cartilage defect was 4-6 cm 2 (mean, 4.98 cm 2). According to the International Cartilage Repair Society (ICRS) classification, 9 cases were rated as grade Ⅲ and 13 cases as grade Ⅳ. Eighteen cases were combined with meniscus injuries. Preoperative visual analogue scale (VAS) score was 6.36±1.25 and Lysholm score was 36.00±7.77. Results: All incisions healed by first intention. All patients were followed up 2-3 years with an average of 2.3 years. At 2 years after operation, the VAS score was 1.27±0.94 and the Lysholm score was 77.82±6.21, which were significantly improved when compared with those before operation ( t=16.595, P=0.000; t=21.895, P=0.000). At 2 years after operation, MRI showed that the cartilage defect was repaired well. Conclusion: Arthroscopic microfracture combined with OAT can be used to treat large area cartilage injury of the femoral condyle of knee, and the good early effectiveness can be obtained.

Preparing an animal model of critical femoral defect in rabbit femoral condyle and the critical bone defect size / 中国组织工程研究

BACKGROUND: Rabbit model of distal femoral bone defect has been widely used to test bone tissue engineering materials for bone defects. However, there is no uniform standard for the size of the cylindrical bone defect model of the rabbit femoral condyle, which ranges 5-9 mm in diameter and 8-12 mm in depth. OBJECTIVE: To establish the bone defect model of adult rabbit femoral condyle with different sizes and to determine the critical bone defect size of the femoral condyle METHODS: Eighteen male New Zealand White rabbits aged 6 months were randomly divided into three groups according to the diameter of bone defect: 5 mm diameter group, 6 mm diameter group, and 7 mm diameter group. The defect depth was 10 mm. These rabbits underwent bilateral radial surgery, a total of 12 sides. Computed Tomography (CT) scan and three-dimensional reconstruction were performed at 1 day, 4, 8, 12 weeks after surgery. The CT-Hedberg score was used to evaluate the healing of bone defects. The rabbits were sacrificed at 12 weeks after surgery, and the femoral condyle specimens were taken out. Healing of the defect was analyzed by gross observation and hematoxylin-eosin staining. The study protocol was approved by the Animal Ethics Committee of Xuzhou Medical University. RESULTS AND CONCLUSION: All rabbits survived after surgery. The gross observation showed that the defect of 5 mm diameter group was filled with new bone tissue, the femoral condyle was well shaped, and the bone defect was completely repaired. In 6 mm and 7 mm diameter groups, depressed deformation was obviously observed in the defect area, with less new bone tissue, and the defect was was not repaired. The CT images showed that the defect area of 5 mm diameter group gradually decreased, and the broken ends of the defect were bridged. In the defect area of 6 mm and 7 mm diameter groups, only a small amount of new bone tissue was implanted, and the defect area was slightly reduced. At the 12th week after surgery, the cortical bone structure of 5 mm diameter group was intact and continuous, the femoral condyle was well shaped, and the bone defect was completely repaired. The defects of 6 mm and 7 mm diameter groups were partially or not repaired, and the defect cavity was still visible in the 7 mm diameter group. The CT-Hedberg scores of 6 mm diameter group were significantly lower than those of 5 mm diameter group at different time points (P 0.05). Histological results showed that there were irregular trabecular structures in the defect area of 5 mm diameter group, with a large amount of new bone tissue. In the other two groups, there were some new bone trabeculae around the bone defect, but the defect area was less filled with new bone tissue. During the 12-week observation period, the femoral condyle defect with a diameter of > 6 mm and a depth of 10 mm could not heal spontaneously, while the defect with a diameter of < 6 mm could be completely repaired, which met the criteria of critical bone defect. Therefore, the diameter of < 6 mm could be used as the critical bone defect size of rabbit femoral condyle.

Intraoral anastomosis for maxillary reconstruction with medial femoral condyle periosteal flap: a case report / 华西口腔医学杂志

Maxillary defects result in esthetic and functional defects in patients. Several techniques are available for ma-xillary reconstruction. Herein, we present a case of maxillary reconstruction with medial femoral condyle periosteal flap by intraoral anastomosis. The characteristics of medial femoral condyle periosteal flap and the advantages of intraoral anasto-mosis are introduced.

In Situ Fixation of Symptomatic Fibrous Non-union Hoffa Fracture: A Case Report

@#Femoral condyle fracture in coronal plane, also known as Hoffa fracture, is a rare fracture. Non-union of Hoffa fracture is even rarer. We present a case of fibrous nonunion of a Hoffa fracture in which the fractured fragment, though not freely movable, led to painful walking. Since the fragment was un-displaced and non-movable we fixed the fractured fragment in situ. Patient regained full range of motion of the knee and was asymptomatic on follow-up.

Internal fixation of in situ femoral condyle fractures assisted by CT scanning for 3D reconstruction and 3D printing / 中华创伤骨科杂志

Objective To investigate the efficacy of CT scanning for 3D reconstruction and 3D printing in the internal fixation for in situ femoral condyle fractures.Methods A retrospective study was conducted of the 111 patients with in situ femoral condyle fracture who had been treated by internal fixation at Department of Traumatic Orthopaedics,The First People's Hospital of Hefei from June 2013 to January 2018.They were 59 males and 52 females,aged from 20 to 59 years(average,47 years).In 74 of them (observation group),the internal fixation was assisted by 3D printing using 3D images.There were 38 males and 36 females with an age of 44.5 ±4.7 years;there were 20 cases of type C1,40 cases of type C2 and 14 cases of type C3 according to the AO classification.In the other 37 patients (control group),the operation was assisted only by 3 D scanning.There were 21 males and 16 females with an age of 43.1 ±4.6 year;there were 8 cases of type C1,19 cases of type C2 and 10 cases of type C3 according to the AO classification.The 2 groups were compared in terms of operation time,clinical fracture healing time,intraoperative blood loss,hospital stay,number of fluoroscopy,knee joint score of Hospital for Special Surgery (HSS),fixation modes and postoperative complications.Results There were no significant differences in the preoperative general data between the 2 groups,showing comparability (P ＞ 0.05).All the patients were followed up for 8 to 12 months (average,10.6 months).The observation group had significantly shorter operation time (62.3 ± 4.7 minutes),fracture healing time (21.2 ± 3.4 weeks) and hospital stay (14.9 ± 3.3 days) than the control group (89.5 ± 6.0 minutes,25.1 ± 3.5 weeks,23.5 ± 3.5 days) (P ＜ 0.05).In the observation group,the intraoperative blood loss (84.1 ± 11.1 mL),fluoroscopy number (2.1 ±0.3 times) and HSS score (94.1 ± 4.2 points) were significantly less than those in the control group (129.6 ± 14.7 mL,4.7 ± 0.4 times and 86.5 ± 4.6 points) (P ＜ 0.05).There were no significant differences between the 2 groups in the use of L type iliac plate,dynamic iliac screws,retrograde interlocking intramedullary nail or minimally invasive internal fixation system (P ＞ 0.05).There were no significant differences in abnormal healing,joint adhesion,fixation fracture or incision infection between the 2 groups either (P ＞ 0.05).Conclusions CT scanning for 3D reconstruction can be used for multi-angle observation of the bone fragments in patients with femoral condyle fracture and 3D printing based on 3D reconstruction for manufacture of physical model of individualized fracture to assist the internal fixation.Combination of the two can help choose an appropriate fixation mode to facilitate fracture reduction.

Clinics in diagnostic imaging (185)

A 20-year-old National Serviceman presented with left knee pain and swelling after training for his physical fitness test. Lateral knee radiography and magnetic resonance (MR) imaging showed patellar tendon-lateral femoral condyle friction syndrome (PT-LFCFS), on a background of patella alta and patellar malalignment. The patient was treated non-operatively with a course of physiotherapy and given advice on rest and activity modification. PT-LFCFS is a less well-recognised but important cause of anterior knee pain and represents an entity in a spectrum of disorders related to patellofemoral instability. We herein discuss the MR imaging findings specific to and associated with this condition, as well as briefly describing treatment options. In addition, we showcase a range of commonly encountered abnormalities that affect the infrapatellar fat pad and briefly discuss their specific MR imaging findings.

Free bone flap of medial femoral condyle for treatment of old scaphoid fracture with bone necrosis / 中华显微外科杂志

Objective To evaluate the outcomes of the free bone flap of medial femoral condyle for treatment of old scaphoid fracture with bone necrosis and review the utility of this procedure.Methods Eleven cases of old scaphoid fracture with bone necrosis were treated with the free medical femoral condyle bone grafting between Feburay,2013 and May,2015(9 males and 2 females).The average age was 34 years ranged from 27 to 55 years.Six cases were in left wrist,and other 5 cases were in right.Six cases were in waist area,and the other 5 cases were proximal pole nonunion.All cases were evaluated with 3D-CT scan,while humpback deformity were occurred in 6 cases,and avascular necrosis at the proximal pole were occurred in 3 cases.After refreshing the fracture,the free medical femoral condyle bone was transferred to the scaphoid,reduct the scaphoid and fix with the Kirschner wire.An endto-side anastomosis was performed with the bone flap artery and the radial artery,accompanied by the end to end anastomosis of the flap vein and the vein with the radial artery.The plaster was used for 8 weeks.Bone healing was evaluated with X-ray and 3D CT scan.A functional review was performed after the operation and a Mayo wrist scoring test was taken 6 months after the treatment.Results The average followed-up period was 13.1 months(ranged from 9 to 24 months).Bone union were demonstrated in all cases at 13.4 weeks after the operation (ranged from 11 to 18 weeks).Mayo wrist scoring testing showed excellent in 5 cases,good in 4 cases,and fair in 2 cases.Conclusion Free bone flap of medial femoral condyle is constant in vascular anatomy,and is easy to perform with plenty bone graft and less morbidity at donor site.Medial femoral condyle bone flap transplantation based on the descending gennicular vessels is an effective method for treatment of old scaphoid fracture with bone necrosis.

The comparison of two different intraarticular injections using a sonographic anterolateral approach in patients with osteoarthritic knee

BACKGROUND: The intraarticular (IA) injection has become popular for the management of the osteoarthritic knee without an effusion. The success rate of IA injection would be better if it was able to be visually confirmed. We hypothesized that an anterolateral approach, which targets the synovial membrane of the lateral condyle using ultrasound, would provide an equivalent alternative to the anterolateral approach, targeting the synovial membrane of the medial condyle for IA injection of the knee. METHODS: A total of 96 knees with osteoarthritis were randomized placed into the two groups, which were group I (anterolateral approach to the medial condyle) and group II (anterolateral approach to the lateral condyle). The primary outcome was to compare the success rate of the two methods of IA injection. The required length of the needle for injection was also measured and compared. Pain intensity was assessed using the Numeric Rating Scale in order to evaluate the success of injection. RESULTS: There were no significant differences in the success rate between both groups. The success rate of group I and group II were 87.8% (95%, CI 78.7–97.0) and 91.5% (95%, CI 83.6–99.5), respectively (P = 0.549). The needle depth was 5.0 ± 0.8 (3.0 to 6.1 cm) in group I, and 3.0 ± 0.8 (1.5 to 5 cm) in group II (P < 0.001). CONCLUSIONS: The anterolateral approach to the lateral femoral condyle, using ultrasound, is an alternative method to the approach targeting the medial femoral condyle, using shorter needle.

Effect of Anteromedial Portal Entrance Drilling Angle during Anterior Cruciate Ligament Reconstruction: A Three-Dimensional Computer Simulation

PURPOSE: The object of this study was to evaluate entrance angle effects on femoral tunnel length and cartilage damage during anteromedial portal drilling using three-dimensional computer simulation. MATERIALS AND METHODS: Data was obtained from an anatomic study performed using 16 cadaveric knees. The anterior cruciate ligament femoral insertion was dissected and the knees were scanned by computer tomography. Tunnels with different of three-dimensional entrance angles were identified using a computer simulation. The effects of different entrance angles on the femoral tunnel length and medial femoral cartilage damage were evaluated. Specifically, tunnel length and distance from the medial femoral condyle to a virtual cylinder of the femoral tunnel were measured. RESULTS: In tunnels drilled at a coronal angle of 45degrees, an axial angle of 45degrees, and a sagittal angle of 45degrees, the mean femoral tunnel length was 39.5+/-3.7 mm and the distance between the virtual cylinder of the femoral tunnel and the medial femoral condyle was 9.4+/-2.6 mm. The tunnel length at a coronal angle of 30degrees, an axial angle of 60degrees, and a sagittal angle of 45degrees, was 34.0+/-2.9 mm and the distance between the virtual cylinder of the tunnel and the medial femoral condyle was 0.7+/-1.3 mm, which was significantly shorter than the standard angle (p<0.001). CONCLUSION: Extremely low and high entrance angles in both of axial plane and coronal plane produced inappropriate tunnel angles, lengths and higher incidence of cartilage damage. We recommend that angles in proximity to standard angles be chosen during femoral tunnel drilling through the anteromedial portal.

Bilateral Osteochondritis Dissecans of the Femoral Condyles in Both Knees: A Report of Two Sibling Cases

Osteochondritis dissecans (OCD) of both femoral condyles is very rare, with no previously reported cases of bilateral OCD of both knees in two siblings. We report on a brother and sister with both femoral condyle OCD with a description of surgical technique and clinical results. Fixation using headless compressive screws, osteochondral autologous transplantation and autologous chondrocyte implantation were all successful.

Bone marrow mesenchymal stem cells combined with allogeneic bone for cancellous bone defects / 中国组织工程研究

BACKGROUND: Some studies have shown that bone marrow mesenchymal stem cells and al ograft bone have a certain role for repairing bone defects, but the effectiveness on cancel ous bone defects is seldom reported so far. OBJECTIVE: To observe the effectiveness of bone marrow mesenchymal stem cells combined with al ogeneic bone on cancel ous bone defects. METHODS: The models of cancel ous bone defects (0.6 cm×1.2 cm) were made artificial y in both condylus lateralis femoris of New Zealand white rabbits: one side served as model group implanted with combination of bone marrow mesenchymal stem cells and al ogeneic bone, and the other side was considered as control group implanted with al ogeneic bone. RESULTS AND CONCLUSION: The model group was better than the control group in new bone growth and defect repair at 4, 8, 12 weeks after implantation, which was confirmed by general observation, X-ray examination and hematoxylin-eosin staining. There was a large amount of trabecular bone formation and mature lamel ar bone tissue in bone defects of model group by histological observation at 12 weeks after implantation, and bone defects of the model group were repaired basical y; while there were only abundant woven bones in the control group, and bone defects in the control group were not repaired effectively. Scores on Lane-Sandhu’s X-ray combined with histological observation were higher in the model group than the control group (P < 0.05). Biomechanical test showed that the maximum pressure load of the femoral condyle and load/strain ratio in the model group were significantly higher than those in the control group at 12 weeks after implantation (P < 0.05),while the maximum strain and displacement of the model group was lower than that of the control group (P < 0.05). These findings suggest that the combination of bone marrow mesenchymal stem cells and al ogeneic bone is superior to simple al ogeneic bone implantation in the repair of cancel ous bone defects of the femoral condyle.

Osteocondrite dissecante do côndilo femoral lateral em cão shar-pei: relato de caso / Osteochondritis dissecans in the femoral lateral condylus in the shar-pei dog: case report / Osteocondritis disecante del cóndilo femoral lateral en perro shar-pei: relato de caso

Descreve-se o tratamento cirúrgico de osteocondrite dissecante do côndilo femoral lateral, em um cão macho adulto da raça Shar-Pei, com acesso para-patelar lateral ao joelho. O diagnóstico foi realizado por meio de exame ortopédico e radiográfico. Como tratamento, realizou-se artrotomia e condiloplastia femoral lateral, removendo retalho cartilaginoso e expondo o osso subcondral. Foram perfurados orifícios, com a finalidade de acelerar o processo cicatricial. No período pós-operatório houve restrição de exercícios durante 10 dias, com o retorno gradual às atividades físicas. Indicou-se o uso de tramadol e cetoprofeno durante sete dias, e sulfato de condroitina por 100 dias. Quarenta dias após a cirurgia, o paciente apresentou ausência de dor e claudicação, retornando à ambulação normal.

This paper reports the surgical treatment of osteochondritis dissecans in the femoral lateral condylus in a male adult Shar-Pei dog, with lateral parapatellar access to the knee. Diagnosis was made by physical and radiographic examination. The treatment was arthrotomy and lateral femoral condylar plastia, removing a cartilaginous flap and exposing the subchondral bone, in which there were performed punctures in order to accelerate the healing process. Exercises were restricted during the first 10 days of the post-op period, and then a gradual return to physical activities was recommended. Tramadol and ketoprofen were prescribed for seven days, and chondroitin sulphate for 100 days. Forty days after the surgery the patient showed absence of pain or lameness, returning to normal ambulation.

Se relata el tratamiento quirúrgico de osteocondritis disecante del cóndilo femoral lateral, en un perro Shar-Pei macho adulto, con acceso pararotuliano lateral a la rodilla. El diagnóstico fue realizado por medio de examen ortopédico y radiográfico. Como tratamiento, se realizó artrotomía y condiloplastía femoral lateral, removiéndose colgajo cartilaginoso y exponiendo el hueso subcondral. Se realizaron perforaciones, con objetivo de acelerar el proceso de cicatrización. En el periodo post-operatorio se indicó restricción a los ejercicios por 10 días, y después un retorno gradual a las actividades físicas. Se prescribió tramadol y ketoprofeno durante siete días, y sulfato de condroitina por 100 días. Cuarenta días después de la intervención el paciente no más demostraba dolor y claudicación, retornando a la ambulación normal.

Tratamiento quirúrgico de la fractura posterior del condilo femoral / Femoral condylar posterior fracture: Surgical treatment / Traitement chirurgical de la fracture postérieure du condyle fémoral

Las fracturas distales del fémur representan solamente el 6 por ciento de todas las fracturas femorales. Presentamos el caso de un paciente masculino de 42 años que sufrió accidente del transito, que le provocó fractura unicondilar del extremo distal del fémur en el plano coronal, conocida como fractura de Hoffa. Se muestra el tratamiento quirúrgico realizado mediante estudios radiológicos, donde se utilizó tornillo del sistema AO. Con este tipo de proceder se obtuvo reducción y estabilidad de la fractura. Se concluye que una planificación preoperatorio adecuada es necesaria para obtener resultados satisfactorios.

Femoral distal fractures accounts for only the 6 percent of all femoral ones. Authors present the case of a male patient aged 42 suffered a road accident provoking a unicondylar fracture of femur distal end in coronal plane , known as Hoffa fracture. Surgical treatment by radiological studies is showed, where we used a screw of AO system. Using this procedure we achieved the fracture reduction and stability. We conclude that an appropriate preoperative planning is necessary to get satisfactory results.

Les fractures distales du fémur ne représentent que 6 percent de toutes les fractures fémorales. Dans ce travail, le cas d'un patient âgé de 42 ans, ayant souffert un accident de la route qui lui a provoqué une fracture condylienne de l'extrémité distale du fémur sur le plan coronal, connue par fracture d'Hoffa, est présenté. Un traitement chirurgical basé sur des études radiologiques, et dans lequel une vis du système AO est utilisée, est exposé. On a constaté une réduction et une stabilité de la fracture grâce à cette procédure. On peut conclure qu'une planification préopératoire est nécessaire pour obtenir des résultats satisfaisants dans ces cas.

Autogenous Osteochondral Grafting for Treating Osteochondral Defect of the Femoral Condyle of the Knee Joint / 대한정형외과학회잡지

PURPOSE: We wanted to evaluate the outcomes of an autologous osteochondral graft (Mosaicplasty) for treating chondral defects of the femoral condyle and We assessed the factors affecting the clinical results. MATERIALS AND METHODS: This study enrolled 18 patients (19 cases) who underwent an autogenous osteochondral graft to treat a osteochondral defect in the femoral condyle from July 2000 to June 2006. The average age was 26.2 years old (age range: 16-48 years old). Among the patients, 17 cases were men. In 14 cases, the osteochondral defects were localized in the medial femoral condyle and only 5 cases showed a defect in the lateral femoral condyle. The average size of the osteochondral defects was 4.2 cm2 (1-13 cm2). The Lysholm knee scoring scale and the Tegner's activity score were applied for clinical evaluation. Further, we carried out simple X-ray for all the cases and we performed MRI in 5 cases for the radiological evaluation. Tthe factors affecting the clinical results were also analyzed and the complications were evaluated. RESULTS: The average follow-up period was 22 months (range: 6-55 months). Eighten out of 19 cases (94.7%) were able to return to ordinary life. The Lysholm knee scoring scale and the Tegner's activity score indicated much better clinical results for small lesions and for young patients. For the radiological results, all the cases displayed a decrease in the size of radiolucent zones on the follow up X-ray. Among the 5 cases for which an MRI was performed, graft unions were observed in 3 cases, but 2 cases displayed continuous peri-graft edema. Any other complications involving the donor and recipient site were not observed. CONCLUSION: We conclude that autogenous osteochondral grafting is useful for specific patients depending on the size of the lesion and the patient's age. It is a valuable treatment option for osteochondral defects in the knee joint.

Autologous Chondrocyte Implantation for Articular Cartilage Defect of Femoral Condyle / 대한정형외과학회잡지

PURPOSE: To evaluate the midterm clinical and histological results after autologous chondrocyte implantation (ACI) for an articular cartilage defect of the distal femoral condyle. MATERIALS AND METHODS: Twenty four cases with an articular cartilage defect (Outerbridge grade IV) of the femoral condyle that was confirmed by MRI and the arthroscopic findings underwent ACI. Their mean age at the time of surgery was 42.8 years and the mean follow-up period was 53.2 months (range, 20-82 months). At the last follow up, the articular cartilage view (SPGR) of MRI was examined and the clinical results were evaluated using the HSS and Lysholm scores. In 8 cases, second-look arthroscopy and biopsy were performed and evaluated using histological and histochemical methods. RESULTS: All cases except for one showed well-regenerated articular cartilage on MRI. All cases showed significant clinical improvement in the HSS and Lysholm scores (p<0.0001), with the exception of the Lysholm score of an articular cartilage fracture. Histologically, the regenerated tissue appeared to be a hyaline-like cartilage in all specimens. CONCLUSION: ACI for the treatment of articular cartilage defects of the distal femoral condyle showed a good clinical and MRI results. In OA, the clinical results were relatively acceptable after an associated high tibial valgus osteotomy. However, a longer term follow-up study will be needed to reach a final conclusion.

Treatment effect of the coronal fractures of the femoral condyle with open reduction and internal fixation / 中国矫形外科杂志

[Objective] To discuss the method and clinical effects of coronal fractures of the femoral condyle treated with open reduction plus cancellous lag screw internal fixation.[Method]From May 1998 to June 2006,17 cases of coronal fractures of femoral condyle were treated with open reduction 'and cancellous lag screw internal fixation by using anterolateral for typ Ⅰ or typ Ⅲ lateral femoral condylar fracture(LFCF)/anteromedial for type Ⅰ or type Ⅲ medial femoral condylar fracture(MFCF)or posterolateral for type ⅡLFCF/posteromedial approach for type Ⅱ MFCF.There were 15 males and 2 females with the average age 39.5 years,ranging from 19 to 48 years.According to Letenneur classification,there were type Ⅰfracture 7 cases,type Ⅱ 4 cases,and type Ⅲ 6 cases.Among them,14 cases were closed fracture,3 eases were open fracture.Auto ilium transplant or homologous allograft bone transplant(5 cases)were also used.All patients were treated with plaster external fixation after operation.The interval between injury and surgery averaged 3.6 days(2.5 hours to 8 days).[Result]All patients were followed up for 8～26 months with an average of 18.2 months.All fractures got bone union with average union time 3.6 months.Knee joint function was rated based on Letenneur evaluation system and showed excellen and good in 14 cases,fine in 3 cases and no poor.There were no deep infection,implant failure or bone necrosis.[Conclusion]Open reduction plus cancellous lag screw internal fixation is an ideally safe and effective operation to treat coronal fractures of the femoral condyle.Accurate choice of approach,satisfactory reduction and rigid internal fixation have important influence on clinical outcomes.

Treatment of Hoffa facture associated with extensor mechanism injury / 中国矫形外科杂志

[Objective]To investigate the injury characteristics and treatment of the Hoffa facture associated with extensor mechanism injury.[Method]Four patients with Hoffa facture associated with extensor mechanism injury treated in author's hospital in recent 6 years were enrolled in this study.All the patients were multiple-injured,and associated with the ipsilateral limb fracture and retinacular and capsule laceration.The site of the extensor mechanism injury included 1 distal patellar tendon disruption,2 proximal patellar tendon disruption,and 1 distal quadriceps tendon disruption.No cruciate ligament injury was found in 3 ipsilateral bicondylar fractures.One unicondylar fracture was associated with anterior and posterior cruciate ligament and medial collateral ligament injury simultaneously.Emergency operation was performed along with the debridement in the three open fractures.In another patient with closed fracture,operation was performed one week after injury.Fractures were reduced and fixed with lag screws.Extensor apparatus were repaired and strengthened with a tension band wire through both patella and tibia.Ipsilateral limb fractures were reduced and internal fixed with hardware simultaneously. The knees were immobilized in extension with cast after operation,and flexion exercise was commenced four to six weeks later.[Result]Four patients wounds reached the first rate healing.There was no infection and necrosis of skin.All patients were followed-up for six months to three years.All 7 condyles of the 4 patients reached bone union.Healing time was about six to twelve weeks.According to Letenneur’s functional assessment system,excellent and good results were in 1 cases,fine in 3 cases.[Conclusion]Hoffa facture associated with extensor mechanism injury are usually accompanied with injuries in other part of the body.In open fracture,emergency operation is mandatory,and fracture reduction and internal fixation and extensor apparatus repair should be performed along with debridement.Tension band wire may strengthen the stability of the extensor mechanism and facilitated early mobilization.