ABSTRACT
Minimally invasive total knee arthroplasty (TKA) has evolved over the last 5 years to a viable alternative to the traditional open technique. In this paper a new classification system is proposed to help organize the various approaches. The surgical technique for quadriceps-sparing minimally invasive TKA, the anaesthesia and the rehabilitation programme are described. Medium-term results of a pilot study of 58 knees in 54 patients are presented, which suggest excellent early outcomes. Technical factors, quality control, and training remain the main issues of concern for surgeons new to these demanding techniques.
Subject(s)
Knee Prosthesis , Minimally Invasive Surgical Procedures/classification , Minimally Invasive Surgical Procedures/instrumentation , Osteoarthritis, Knee/surgery , Aged , Anesthesia, Local , Anesthesia, Spinal , Early Ambulation , Female , Follow-Up Studies , Humans , Male , Motion Therapy, Continuous Passive , Pain, Postoperative/prevention & control , Postoperative Care , Prosthesis Design , Surgical InstrumentsABSTRACT
A 35-year-old man sustained multiple injuries including a fractured pelvis, a ruptured urethra, and a femur fractured at the neck, the shaft, and the supracondylar region. The fractured femur was grade IIIB open. Urethrography showed a ruptured urethra with extravasation of the dye into the upper thigh. Internal fixation of all femur fractures and the pelvis fracture was successful. A suprapubic cystostomy tube was inserted to manage the urethral tear. The tube became infected, and the infection extended from the pelvis into the thigh region, infecting the femoral fracture. The femur infection was thought to be a postoperative one that had originated locally. Computerized tomography (CT) scan was helpful in localizing the infection and its origin from the pelvis. Treatment included incision and drainage, with aggressive serial débridement of both abscesses. In addition, bone grafting of the femur was performed. The infection was controlled completely, and the patient returned to work 18 months after injury. The authors alert the orthopaedic surgeon to the possibility of this serious lesion, particularly when the initial urethrogram shows extension of the dye below the inguinal ligament.
Subject(s)
Abscess/etiology , Femoral Fractures/surgery , Femur , Fractures, Open/surgery , Multiple Trauma/complications , Multiple Trauma/surgery , Pelvis/injuries , Surgical Wound Infection/diagnosis , Urethra/injuries , Abscess/diagnosis , Abscess/surgery , Adult , Anti-Bacterial Agents/therapeutic use , Bone Diseases/diagnosis , Bone Diseases/etiology , Bone Diseases/surgery , Bone Transplantation , Debridement , Drainage , Femoral Fractures/diagnostic imaging , Fracture Fixation, Internal , Fractures, Open/diagnostic imaging , Humans , Male , Pelvis/diagnostic imaging , Pelvis/surgery , Surgical Wound Infection/physiopathology , Tomography, X-Ray Computed , Urethra/diagnostic imaging , Urethra/surgeryABSTRACT
We studied 300 wrists from cadavera and the wrists of forty patients with de Quervain disease to determine the variation in the pattern of the tendons and septa in the first extensor compartment. In 75 per cent of the wrists from cadavera, we found that the number of tendons within the compartment differed from what is considered standard; there was complete or partial septation in 40 per cent. In about a third of the specimens from cadavera, the first extensor compartment was divided by a septum and two tendons or more were present within the major subcompartment. These features might readily result in inadequate decompression of the compartment in the treatment of de Quervain disease. In our prospective study of forty patients with de Quervain disease, septation was found in twenty-seven. There was no significant difference between the number of patients and the number of specimens from cadavera that had no, one, or two accessory abductor tendons.
