Fixation of periprosthetic femur fractures above total knee arthroplasty with the less invasive stabilization system: a midterm follow-up study.

BACKGROUND: The complication rate of periprosthetic femoral fractures above well-fixed total knee arthroplasties is high. The Less Invasive Stabilization System (LISS) was introduced to reduce surgical dissections at the fracture site. The purpose of this retrospective study was to evaluate the midterm functional outcome of a group of patients with periprosthetic fractures above well-fixed total knee arthroplasties treated with the LISS. METHODS: Between January 1999 and June 2004, 23 consecutive patients (all women) with periprosthetic fractures above well-fixed total knee arthroplasties were treated with the LISS. The mean age was 77 years (range, 61-90 years). RESULTS: Nineteen of the patients (83%) were seen after a midterm follow-up of 46 months (range, 26-67 months). Three patients (13%) died, and one patient (4%) was lost to follow-up. A proximal screw pull-out of the internal fixator occurred in one patient (4%). All fractures healed within a mean of 14 weeks (range, 9-21 weeks). No bone graft was required. There were two delayed unions, no nonunions or infections. One patient (4%) had a malalignment with 7° varus. The mean range of motion was 102° (range, 65-120°). The mean knee score of the Knee Society was 81 points (range, 65-90 points), and the mean function score of the Knee Society was 56 points (range, 35-90 points). CONCLUSIONS: We found that a minimally invasive, locked plating system permitted stable fixation, early knee motion with good midterm results, and minimal complications. These techniques should be used in place of less stable and more invasive methods.

Opening-wedge high tibial osteotomy with a locked low-profile plate: surgical technique.

BACKGROUND: High tibial osteotomy has been recognized as a beneficial treatment for osteoarthritis of the medial compartment of the knee. The purpose of this prospective study was to assess the short-term results of opening-wedge high tibial osteotomies with locked plate fixation. METHODS: From September 2002 to November 2005, fifty-one consecutive medial opening-wedge high tibial osteotomies were performed. The mean age of the patients at the time of the index operation was forty-nine years. The preoperative and postoperative factors analyzed included the grade of arthritis of the tibiofemoral compartment (the Ahlbäck radiographic grade), the anatomic tibiofemoral angle, patellar height, the Hospital for Special Surgery rating system score, and the Lysholm and Gillquist knee score. RESULTS: Postoperatively, one superficial wound infection occurred. Fifty of the fifty-one osteotomies healed after an average period of 12.9 weeks (range, eight to sixteen weeks) without bone grafts. A nonunion developed in a sixty-two-year-old patient who was a cigarette smoker. The average postoperative tibiofemoral angle was 9° of valgus. Forty-nine patients were followed for a mean of fifty-two months. The average score on the Hospital for Special Surgery rating system was 86 points at the time of the most recent follow-up. The rating was excellent in twenty-eight patients (57%), good in twelve (24%), fair in four (8%), and poor in five (10%). The average score on the Lysholm and Gillquist knee-scoring scale was 83 points. According to these scores, the outcome was excellent in nine patients (18%), good in thirty-one (63%), fair in three (6%), and poor in six (12%). Four knees failed after an average of thirty-six months. CONCLUSIONS: Our results suggest that an opening-wedge high tibial osteotomy with locked plate fixation allows a correct valgus angle to be achieved with good short-term results.

Opening-wedge high tibial osteotomy with a locked low-profile plate.

BACKGROUND: High tibial osteotomy has been recognized as a beneficial treatment for osteoarthritis of the medial compartment of the knee. The purpose of this prospective study was to assess the short-term results of opening-wedge high tibial osteotomies with locked plate fixation. METHODS: From September 2002 to November 2005, fifty-one consecutive medial opening-wedge high tibial osteotomies were performed. The mean age of the patients at the time of the index operation was forty-nine years. The preoperative and postoperative factors analyzed included the grade of arthritis of the tibiofemoral compartment (the Ahlbäck radiographic grade), the anatomic tibiofemoral angle, patellar height, the Hospital for Special Surgery rating system score, and the Lysholm and Gillquist knee score. RESULTS: Postoperatively, one superficial wound infection occurred. Fifty of the fifty-one osteotomies healed after an average period of 12.9 weeks (range, eight to sixteen weeks) without bone grafts. A nonunion developed in a sixty-two-year-old patient who was a cigarette smoker. The average postoperative tibiofemoral angle was 9 degrees of valgus. Forty-nine patients were followed for a mean of fifty-two months. The average score on the Hospital for Special Surgery rating system was 86 points at the time of the most recent follow-up. The rating was excellent in twenty-eight patients (57%), good in twelve (24%), fair in four (8%), and poor in five (10%). The average score on the Lysholm and Gillquist knee-scoring scale was 83 points. According to these scores, the outcome was excellent in nine patients (18%), good in thirty-one (63%), fair in three (6%), and poor in six (12%). Four knees failed after an average of thirty-six months. CONCLUSIONS: Our results suggest that an opening-wedge high tibial osteotomy with locked plate fixation allows a correct valgus angle to be achieved with good short-term results.

Fixation of distal femoral fractures with the Less Invasive Stabilization System: a minimally invasive treatment with locked fixed-angle screws.

BACKGROUND: The Less Invasive Stabilization System (LISS) is an internal fixator, which combines closed reduction of the diaphysis or metaphysis of distal femur fractures with locked unicortical screw fixation. METHODS: In a retrospective consecutive study, 50 patients with Association for the Study of the Problems of Internal Fixation/Orthopaedic Trauma Association (AO/OTA) type 33-A1 to 33-C3 fractures were treated with the LISS between January 1999 and December 2003. Final results were assessed using the functional score of Neer after a median follow-up of 29 months (15-48 months). RESULTS: Fifteen male and 16 female patients were followed up. The mean age was 49 years (17-90 years). Deep wound infection was seen in one patient (3%) and malpositioning with cutting-out of the proximal screws was in two patients (6%). All other fractures healed uneventfully without bone graft requirements after a mean of 12 weeks (7-20 weeks). A revised osteosynthesis was performed for correction of a valgus deformity of 20 degrees after 4 months. There was no difference in leg length exceeding 2 cm. One patient had a valgus deformity of 10 degrees combined with a rotational deformity of 10 degrees. Range of motion of the knee joint was >120 degrees in 15 patients (48%); 12 (39%) had a range of motion between 90 degrees and 120 degrees and 4 (13%) between 70 degrees and 90 degrees. The function according to the Neer score was excellent in 15 (48%), good in 10 patients (32%), and fair in 6 patients (20%). The mean Neer score was 80 (60-100). CONCLUSIONS: The LISS promotes early mobilization and rapid rates of bony and clinical healing without bone grafting with low rates of infection.

A hinged external fixator for the elbow.

OBJECTIVE: Stabilization of the ulnohumeral joint against rotation and shear forces, preserving flexion and extension movements, in order to safeguard the healing of the collateral ligaments. INDICATIONS: Persistent instability of the elbow joint in 90 degrees flexion following elbow dislocation, particularly in the anteroposterior direction; dislocation fractures; arthrolysis and graft arthroplasties; closed distraction arthrolysis. CONTRAINDICATIONS: Local infection in the area of the planned Schanz pins, uncertain position of the neurovascular structures, and lack of experience with the external fixator. SURGICAL TECHNIQUE: Determination of the joint axis through the capitulum of the humerus and the trochlea. Insertion of a 3-mm Kirschner wire (reference pin) in the center of rotation. Insertion of the humeral and ulnar Schanz pins under direct vision from the lateral or medial aspect. The lateral humeral Schanz pins are inserted in the distal humerus dorsal to the radial nerve. Removal of the reference pin. Symmetrical distraction of the ulna 2-3 mm from the joint surface of the humerus with the aid of the distractor. POSTOPERATIVE MANAGEMENT: No immobilization, immediate start on active and passive physiotherapy under plexus anesthesia, depending on the soft-tissue situation, individual pain, and the extent of the surgical procedure. RESULTS: The case histories of ten patients treated for persistent instability of the elbow at 90 degrees flexion or for an old dislocation of the elbow between April 2001 and March 2003 were studied retrospectively. The average age was 51 years (40-62 years). In seven patients internal fixation of the elbow had to be performed, six of which were treated initially with an AO fixator. After an average of 8 days the management was changed to hinged fixation. The median Mayo Elbow Function Score was 78 points with two very good, three good, and five satisfactory results. Subjective satisfaction on the DASH Score (Disabilities of Arm, Shoulder and Hand) revealed a slight reduction by an average of 18 points.