Meniscal Entrapment After Tibial Plateau Fracture and Fixation: A Case Report.

CASE: A 40-year-old man presented with limited in range of motion, pain, and tenderness over the medial joint line after an open reduction and internal fixation (ORIF) because of a bicondylar tibial plateau fracture (TPF). The cause of his pain was inconclusive on Magnetic Resonance Image (MRI), so arthroscopy was performed and identified an incarcerated medial meniscus at the fracture site. An osteotomy with medial joint elevation was performed followed by a meniscus release, with excellent results at the 1-year follow-up. CONCLUSION: To our knowledge, this is the first case reporting a trapped/incarcerated meniscus in a healed TPF after ORIF.

Informal (Hallway) medical consultation in orthopedics-is it as common as it seems?

INTRODUCTION: Informal (hallway) medical consultation is an integral part of the physician's work. As musculoskeletal complaints are very common, orthopedic surgeons stand in the frontline of this practice. Many of these consultations are poorly, if at all, documented, thus imposing a potential medical danger to the patient and a medicolegal danger to the surgeon. We conducted this first study to examine whether this practice is common among the orthopedic surgeons in university hospital. METHODS: In this prospective study, a 2-month record of informal consultations was kept. Six orthopedic surgeons-two joint reconstruction surgeons, one spine surgeon, two arthroscopy and sports medicine surgeons, and a shoulder surgeon participated. They recorded the details of the consulter, whether the consultation was for himself or somebody else, the major complaint, and whether it was a second opinion. All patients were advised to go to the formal orthopedic consultation and no advice or treatment was given. At the end of 2 months, each surgeon was asked to evaluate the percentage of cases he had failed to report. RESULTS: During the 2-month period, 158 people asked for informal (hallway) consultations. 11 of them (7%) were physicians, 114 (72%) were other hospital personnel, 26 (17%) were unrelated to hospital, and 6 (4%) were treated patients' relatives. 93 (59%) of consultations were about the consulter himself and the rest were about a relative or a friend. 41 (26%) were requests for a second opinion. The estimated percentage of not reported cases was 10-40%; when the number of consultations was corrected for these figures, it reached 208 consultations in 2 months. DISCUSSION: In this prospective study, six participating surgeons recorded 158 informal consultation requests in 2 months. If a correction is performed, it averages 0.6 consultations a day for a surgeon (or, if only workdays are counted-0.8 consultations a day). Orthopedic surgeons should be aware of this frequent habit and send these patients to a formal consultation.

Fracture-table-mounted versus bone-mounted dynamic reference frame tracking accuracy using computer-assisted orthopaedic surgery--a comparative study.

OBJECTIVE: Fluoroscopy-based computerized navigation systems enable accurate implant placement while reducing radiation exposure. The navigation process normally requires the attachment of a dynamic reference frame (DRF) to a bone, causing additional surgical trauma. The aim of this study was to compare the accuracy of navigation with the DRF either attached to the bone or mounted on the fracture table. METHODS: We conducted a prospective study on 10 consecutive patients who underwent operative fixation of femoral neck fractures with cannulated screws using computerized navigation. After insertion of the three guide wires, the DRF was moved from the patient's bone to the fracture table. For each screw, angular and translational deviations of the navigated images as compared to the conventional fluoroscopic images were analyzed. RESULTS: The accuracy of navigated Kirschner wire placement was similar with both techniques, resulting in an average translational error of less than 2 mm in both groups and around 1 degrees in angulation error--both of these accuracy measurements are acceptable and sufficient for the insertion of cannulated screws into the femoral head. CONCLUSION: Our study suggests that attaching the DRF to a fracture table during navigated femoral neck fixation allows for acceptable accuracy with the possible added benefit of reducing patient morbidity.