Immediate Weight Bearing as Tolerated Is Safe Following Intramedullary Fixation of Extra-articular Metaphyseal Proximal Tibia Fractures (OTA/AO 41-A).

OBJECTIVES: To determine whether immediate weight bearing after intramedullary fixation of extra-articular proximal tibia fractures (OTA/AO 41A) results in change of alignment before union. DESIGN: Retrospective Review. SETTING: Level I and Level II Trauma Center. PATIENTS/PARTICIPANTS: Thirty-seven patients with 37 proximal tibial fractures, all whom could bear weight as tolerated postoperatively. Eighteen fractures were OTA/AO 41-A2, and 19 were OTA/AO 41-A3. INTERVENTION: Intramedullary nailing of extra-articular proximal tibia fractures. MAIN OUTCOME MEASUREMENTS: Change in fracture alignment or loss of reduction. RESULTS: The average change in coronal alignment at the final follow-up was 1.22 ± 1.28 degrees of valgus and 1.03 ± 1.05 degrees of extension in the sagittal plane. Twenty-five patients demonstrated excellent initial alignment, 10 patients demonstrated acceptable initial alignment, and 2 patients demonstrated poor initial alignment. Five patients demonstrated a change in alignment from excellent to acceptable at the final follow-up. No patient went from excellent or acceptable initial alignment to poor final alignment. Five patients required unplanned secondary surgical procedures. Two patients required return to the operating room for soft-tissue coverage procedures, 2 patients required surgical debridement of a postoperative infection, and 1 patient underwent debridement and exchange nailing of an infected nonunion. No patient underwent revision for implant failure or loss of reduction. CONCLUSION: Immediate weight bearing after intramedullary fixation of extra-articular proximal tibia fractures (OTA/AO 41A) led to minimal change in alignment at final postoperative radiographs. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Peripheral Nerve Blocks for Surgery About the Knee.

Peripheral nerve blocks are an often-utilized and efficacious method of analgesia for orthopaedic surgery about the knee. Benefits include decreased pain and narcotic use, increased participation in postoperative physical therapy, and decreased length of hospital stay. Adductor canal blocks have the advantage of preserving quadriceps function for early postoperative range of motion and walking. The risk of serious complications resulting from a peripheral nerve block is relatively low, ranging from 0% to 3%.