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1.
Knee Surg Sports Traumatol Arthrosc ; 28(2): 568-575, 2020 Feb.
Article in English | MEDLINE | ID: mdl-31559462

ABSTRACT

PURPOSE: Knee dislocations (KDs) are potentially devastating injuries, leading to loss of function or limb in often young patients. This retrospective database review aims to determine the relative incidence and risk factors for KDs presenting to North American Level I and II trauma centers. METHODS: The National Trauma Data Bank (NTDB) was retrospectively interrogated using ICD-9-CM codes to identify KDs between 2010 and 2014 to derive KD incidence. KDs were stratified by age, sex, Injury Severity Score (ISS), Glasgow Coma Scale (GCS), drug and alcohol use, injury mechanism, open vs. closed KD, vascular injury and fracture. Each co-variate was tested against different mechanisms of injury, using Chi-squared tests and risk adjusted analyses to derive risk factors for KD. The same calculations were done for secondary outcomes (vascular and neurological injuries, compartment syndrome, amputation, and mortality). RESULTS: A total of 6454 KDs met the inclusion criteria (18/10,000 admissions). KDs occurred most commonly amongst men, aged 20-39, with an ISS score 1-14 and following motor vehicle collision (MVC). A vascular investigation was performed in 29%, with injury documented in 15% of KDs and 10.8% receiving a vascular procedure. Associated fractures were observed in 41.4% of KDs. Open injuries in 13.6%. Neurological injury documented in 6.2%, compartment syndrome in 2.7%, amputation in 3.8% (> 50% had vascular injury) and 2.8% died. MVC was the most common mechanism of injury (p < 0.001), significantly more common in young, male patients, associated with higher ISS and lower GCS, especially when drugs or alcohol were involved (p < 0.0001). Being male, having a vascular injury or open KD were all risk factors for compartment syndrome, amputation and neurological injuries. CONCLUSIONS: KDs are rare injuries, but their relative incidence may be increasing. Young, male patients involved in MVCs are risk factors for KDs and their associated injuries, such as neurological injuries, amputations and compartment syndrome. Vascular injury occurs at a frequency of around 15%. The findings of the current study may guide future research and help to inform clinicians on the expected rates of associated injuries in patients identified to have KD in a trauma center population. It informs regarding risk factors for KD, which may improve diagnosis rates of spontaneously reduced knee dislocations by increasing index of suspicion in high-risk patients and identifies specific links with impaired driving. LEVEL OF EVIDENCE: IV.


Subject(s)
Knee Dislocation/epidemiology , Trauma Centers/statistics & numerical data , Accidents, Traffic/statistics & numerical data , Adolescent , Adult , Child , Child, Preschool , Databases, Factual/statistics & numerical data , Female , Humans , Incidence , Infant , Infant, Newborn , Knee Dislocation/complications , Knee Dislocation/diagnosis , Knee Dislocation/therapy , Male , Middle Aged , Retrospective Studies , Risk Factors , United States/epidemiology , Young Adult
2.
BMJ Case Rep ; 20182018 May 18.
Article in English | MEDLINE | ID: mdl-29776938

ABSTRACT

The incidence of acetabular fractures has increased markedly in patients over 60 in the last quarter of a century, with open reduction and internal fixation being regarded to be the treatment of choice in most patients with displaced acetabular fractures. Lower limb ischaemia following acetabular fixation or arthroplasty is rare. However, such complications can be limb or life threatening, and therefore, it is important to recognise them as early as possible. We present the case of a 70-year-old man with no significant medical history who underwent acetabular fixation with simultaneous arthroplasty complicated with bilateral lower limb ischaemia. We highlight the importance of having a high degree of suspicion which allows early diagnosis and corrective measures to be implemented which can ultimately lead to excellent outcome.


Subject(s)
Acetabuloplasty/adverse effects , Acetabulum/injuries , Arthroplasty, Replacement, Hip/adverse effects , Fracture Fixation, Internal/adverse effects , Fractures, Bone/surgery , Ischemia/etiology , Lower Extremity/blood supply , Postoperative Complications/etiology , Aged , Arthroplasty, Replacement, Hip/methods , Fracture Fixation, Internal/methods , Humans , Male
3.
BMJ Case Rep ; 20182018 Jan 23.
Article in English | MEDLINE | ID: mdl-29367367

ABSTRACT

A 77-year-old man sustained an acetabular fracture after falling from a staircase and landing on his right side. He fractured the anterior column of his acetabulum and the quadrilateral plate. He underwent a single-stage open reduction and internal fixation of the fracture combined with a dual mobility total hip arthroplasty (THA). He sustained a traumatic hip dislocation 1 month postoperatively. Closed reduction was attempted at another hospital, and the femoral stem was pulled out. We believe this was caused by the polyliner being hitched either to the acetabular cup or in the soft tissues around the ilium. We present this case to caution orthopaedic surgeons that dual mobility THA dislocations are difficult to diagnose as the polyliner is not clearly seen on X-rays, and reduction attempts may lead to worsening of an already difficult situation.


Subject(s)
Arthroplasty, Replacement, Hip/adverse effects , Fracture Fixation, Internal/adverse effects , Hip Dislocation/surgery , Hip Prosthesis/adverse effects , Prosthesis Failure/adverse effects , Accidental Falls , Acetabulum/injuries , Aged , Arthroplasty, Replacement, Hip/methods , Fracture Fixation, Internal/methods , Fractures, Bone/surgery , Hip Dislocation/etiology , Humans , Male , Open Fracture Reduction/adverse effects , Open Fracture Reduction/methods
4.
J Arthroplasty ; 32(4): 1132-1136, 2017 04.
Article in English | MEDLINE | ID: mdl-28110847

ABSTRACT

BACKGROUND: Unicompartmental knee arthroplasty (UKA) is an underutilized implant for medial tibiofemoral arthritis despite proven benefits in performance and reduced complications. This is likely related to registry recorded higher revision rates compared with total knee arthroplasty. It is our feeling that better component alignment resulting from the usage of computer-assisted surgery should improve longer-term functional results and survival of UKAs. METHODS: Between August 2003 and June 2007, 265 medial UKAs were performed in 264 consecutive patients using navigation. RESULTS: Eighty-eight women and 176 men with an average age of 51.7 (±4.63) years were assessed for function and survival over a follow-up period of 92.6 (63-120) months (7.7 years). The final survival rate over 5 years for this cohort was 97.6% at 5 years. CONCLUSION: We conclude that computer-assisted UKA, to treat medial tibiofemoral joint arthritis, produces 5-year survival rates that are comparable with total knee arthroplasty.


Subject(s)
Arthroplasty, Replacement, Knee , Osteoarthritis, Knee/surgery , Surgery, Computer-Assisted , Female , Follow-Up Studies , Humans , Knee Prosthesis , Male , Middle Aged , Prosthesis Failure
5.
J Arthroplasty ; 30(8): 1344-7, 2015 Aug.
Article in English | MEDLINE | ID: mdl-25820119

ABSTRACT

Computer Aided Surgery has consistently shown superior alignment of components when compared to non-navigated jig based techniques. The aim of this study is to assess the mid-term clinical outcome of TKA performed by a consultant orthopedic surgeon, compared to trainee surgeons. Ninety-two patients were matched and randomly allocated to have CAS surgery performed by either a consultant or trainee and followed up prospectively for 5-years. Knee society scores, mechanical axis, tourniquet time and blood loss data were collected. Our study demonstrated that trainees were able to achieve equal coronal alignment (P=0.15), blood loss (P=0.45) and functional scores (P=0.15). The Consultant group had a significantly (P<0.001) shorter tourniquet time. We confirm that CAS can assist less experienced surgeons to reliably achieve good mid-term outcomes in TKA.


Subject(s)
Arthroplasty, Replacement, Knee/standards , Joint Diseases/surgery , Knee Joint/surgery , Surgery, Computer-Assisted/standards , Aged , Aged, 80 and over , Arthroplasty, Replacement, Knee/education , Arthroplasty, Replacement, Knee/methods , Female , Humans , Male , Middle Aged , Orthopedics/education , Orthopedics/standards , Prospective Studies , Recovery of Function , Surgery, Computer-Assisted/education , Surgery, Computer-Assisted/methods
6.
Foot Ankle Surg ; 19(2): 131-4, 2013 Jun.
Article in English | MEDLINE | ID: mdl-23548457

ABSTRACT

BACKGROUND: Barbed sutures provide a novel technique for knotless wound closure. They have mainly been used in plastic and general surgery. There are no reports about its use in the foot. METHODS: We present a case series of 11 feet in 8 patients whose wounds were closed with barbed sutures. Ten had primary hallux valgus correction and one had a revision correction. RESULTS: No problems were noted at 2-weeks follow-up. Four of the 11 cases required open suture excision due to an adverse reaction. Five were followed to delayed wound healing. Histology results from one scar showed a localised histiocytic reaction and superficial dermal abscess formation. CONCLUSIONS: We feel the thin subcutaneous tissue of the foot, the amount of motion and pressure from the shoe causes the barbs to repeatedly irritate the soft tissue. Based on our short case series we cannot recommend the use of a barbed skin closure system in the foot.


Subject(s)
Cicatrix/etiology , Dermatologic Surgical Procedures/instrumentation , Foot/surgery , Sutures/adverse effects , Adult , Humans , Middle Aged , Suture Techniques , Wound Healing
8.
Foot Ankle Int ; 31(2): 131-5, 2010 Feb.
Article in English | MEDLINE | ID: mdl-20132749

ABSTRACT

BACKGROUND: Aneurysmal bone cysts (ABC) mainly occur in the long bones but only rarely in the bones of the feet. This study reviews the 25-year experience of a tertiary orthopaedic oncology referral center treating ABC's in the bones of the feet, using prospectively collected data to document their incidence, treatment and the outcome. MATERIALS AND METHODS: Information on the diagnosis, treatment, complications and outcomes were collected for all eligible patients from our prospectively collected database. Radiologic healing was used as our primary outcome measure. Cases were considered to have failed treatment if there was progression of the lesion that needed further treatment. RESULTS: Of 273 patients with ABC, 16 patients (5.9%) were found to have their lesions in the foot. There were ten female and six male patients, aged from 4 to 52 (mean, 18.2) years. The metatarsals were the most commonly affected site (44%). Curettage of the lesion without additional adjuvant measures (14 of 16 patients) was sufficient for the treatment in 11 of 14 patients (79%). This gave a recurrence rate of 21% (three of 14 patients) in those treated by curettage alone and 19% (three of 16 patients) if the whole cohort is considered. CONCLUSION: Although relatively rare, there is no reason to assume that ABCs of the feet will respond to treatment or recur any differently from ABCs that occur elsewhere in the body. Our experience has been that surgical curettage alone is sufficient to treat most ABCs of the feet.


Subject(s)
Bone Cysts, Aneurysmal/surgery , Curettage/methods , Foot Bones/pathology , Foot Bones/surgery , Adolescent , Adult , Bone Cysts, Aneurysmal/diagnosis , Bone Cysts, Aneurysmal/epidemiology , Child , Child, Preschool , Female , Humans , Incidence , Magnetic Resonance Imaging , Male , Middle Aged , Prospective Studies , Treatment Outcome , United Kingdom/epidemiology
9.
Hip Int ; 19(3): 234-8, 2009.
Article in English | MEDLINE | ID: mdl-19876877

ABSTRACT

The management of osteoarthritis of the hip in young active patients is challenging. We compared the functional outcomes and activity levels following hip resurfacing and uncemented THA in young active patients matched for age, gender and activity levels. Mean follow-up period was five years (4-7 years). Within each group there was a statistically significant improvement in the mean University of California at Los Angeles (UCLA) and Oxford Hip Score (OHS) scores following surgery. This study found no statistically significant difference in the levels of function (p= 0.82) or activity pursued (p= 0.60) after surgery between uncemented THA and hip resurfacing. The potential complications unique to hip resurfacing may be avoided by the use of uncemented THA which in itself has longer follow-up compared to resurfacing.


Subject(s)
Arthroplasty, Replacement, Hip/methods , Arthroplasty, Replacement, Hip/rehabilitation , Osteoarthritis, Hip/surgery , Osteotomy/methods , Prosthesis Design , Recovery of Function , Adult , Age Factors , Aged , Arthroplasty, Replacement, Hip/instrumentation , Female , Follow-Up Studies , Humans , Male , Middle Aged
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