Modified Ollier transtrochanteric approach for the treatment of acetabular fractures.

The purpose of this retrospective clinical study was to evaluate the rates of wound and neurologic complications and clinically significant heterotopic ossification, Brooker stage 3 and 4, with the modified Ollier transtrochanteric approach for the treatment of acetabular fractures. The study group comprised 94 consecutive patients (95 acetabuli) who had unstable acetabular fractures requiring surgical fixation. All patients were treated with open reduction internal fixation via the Ollier approach by a single surgeon (L.E.D.). Demographic and clinical information regarding rates of wound and neurologic complications and remaining articular stepoff at fixation was obtained from a chart review. The degree of heterotopic ossification was graded from standard anteroposterior pelvis radiographs according to the Brooker classification. Six (6%) patients underwent reoperation for infection; however, only 3 (3%) of these patients had deep infections. Three (3%) patients had iatrogenic sciatic nerve injuries; only 1 patient had persistent sensory changes at final follow-up. Thirteen (18%) of the 73 patients with radiographs available for review at a minimum of 3-month follow-up had Brooker grade III heterotopic ossification and 1 (1%) patient had grade IV. Five (5%) patients underwent excision of heterotopic ossification. Fourteen (17%) of 81 patients had no radiographic union of the greater trochanteric osteotomy, but none of these patients required further surgery. The complication rates of the Ollier approach in this study compare favorably with alternative surgical approaches reported in large series. We believe this approach provides excellent exposure without increasing the risk of complications.

Effect of fatigue on knee kinetics and kinematics in stop-jump tasks.

BACKGROUND: Altered motor control strategies in landing and jumping maneuvers are a potential mechanism of noncontact anterior cruciate ligament injury. There are biomechanical differences between male and female athletes in the landing phase of stop-jump tasks. Fatigue is a risk factor in musculoskeletal injuries. HYPOTHESIS: Lower extremity muscle fatigue alters the knee kinetics and kinematics during the landing phase of 3 stop-jump tasks and increases an athlete's risk of anterior cruciate ligament injury. STUDY DESIGN: Controlled laboratory study. METHODS: Three-dimensional videography and force plate data were collected for 20 recreational athletes (10 male and 10 female athletes) performing 3 stop-jump tasks before and after completing a fatigue exercise. Knee joint angles and resultant forces and moments were calculated. RESULTS: Both male and female subjects had significantly increased peak proximal tibial anterior shear forces (P = .01), increased valgus moments (P = .03), and decreased knee flexion angles (P = .03) during landings of all 3 stop-jump tasks when fatigued. Fatigue did not significantly affect the peak knee extension moment for male or female athletes. CONCLUSION: Fatigued recreational athletes demonstrate altered motor control strategies, which may increase anterior tibial shear force, strain on the anterior cruciate ligament, and risk of injury for both female and male subjects. CLINIC RELEVANCE: Fatigued athletes may have an increased risk of noncontact anterior cruciate ligament injury.