Lateral cortex blowout during PFNA blade insertion in a subtrochanteric fracture---Should bone quality determine the type of nail used? / 中华创伤杂志(英文版)

Subtrochanteric fractures pose a therapeutic challenge to the surgeons. With the advent of proximal femoral nails, most of the cases are treated with nailing. Newer nails like proximal femoral nail antirotation (PFNA) require the blade to be directly hammered into the bone compared to older nails where the screws are drilled and tapped before insertion. We report one such case in a middle aged female that had intraoperative lateral cortex blowout during PFNA blade insertion in a sclerotic bone. This occurrence to the best of our knowledge is unreported in literature. It is therefore imperative to consider the quality of bone before a decision is made on the implant chosen.

Total hip arthroplasty in patients with chronic autoimmune inflammatory arthroplasties.

OBJECTIVE: Patients with systemic lupus erythematosus (SLE), rheumatoid arthritis (RA) and ankylosing spondylitis (AS) often require total hip arthroplasties. We present a retrospective review of 32 total hip arthroplasties (THA) performed for patients with SLE, RA or AS from 2003 to 2008 in a tertiary hospital in Singapore. MATERIALS AND METHODS: A total of 323 THAs performed between January 2003 to December 2008 were traced and cases of arthroplasties performed for such patients were isolated. Pre- and post-operative range of motion, Harris hip score, limb length discrepancies and complications were studied. RESULTS: Twenty-six patients aged 24-66 years (mean 47 years) were reviewed, with two AS patients (7.7%), 16 RA patients (61.5%), seven SLE patients (26.9%) and one patient (3.8%) with both RA and SLE. Thirty-two THA operations were conducted with six patients requiring bilateral THAs. The average follow-up was 3.3 years. Mean Harris hip score for 25 patients (one excluded due to patient expiry 2 month post-surgery) improved from 41.3 to 86.53 (P < 0.05). Mean pre-operative hip flexion improved from 61.3 degrees (0-120) to 89.7 degrees (30-120) (P < 0.05). Seventeen cases had preoperative limb length discrepancies (median 1 cm) which were all corrected. There were no implants loosening, infective arthritis, dislocations or neurovascular injuries documented. CONCLUSION: Our series demonstrated the excellent outcome of THA for patients with chronic autoimmune arthropathies at the time of follow-up. Careful patient selection remains a priority as long-term outcomes for such patients of a significantly younger population is yet to be determined.

A review of clinical pathway data of 1,663 total knee arthroplasties in a tertiary institution in Singapore.

INTRODUCTION AND OBJECTIVES: A total knee arthroplasty (TKA) clinical pathway database has been used in our institution since the year 2000. The primary aim of this study was to review the patient epidemiology, postoperative complications and factors influencing hospital length of stay following TKA. The clinical outcomes and cost-savings between elective and same day admissions for TKA patients were also reviewed. MATERIALS AND METHODS: The study cohort retrieved from the database comprised 1,371 patients (1,663 knees) who underwent total knee replacement over a 6-year time period. The following variables were reviewed: epidemiological data, admission data (elective admission [EA] versus same day admission [SDA]), hospital length of stay (LOS), and complication rates. RESULTS: The mean age of patients undergoing TKA is 65.2 years (range, 22 to 90). Osteoarthritis was the main surgical indication in 96% of the study cohort. Overall, there was a gradual decline in the hospital length of stay for the study cohort for the 6-year time period. The overall complication rate was 2% and the 3 most common complications were deep vein thrombosis, pulmonary embolism and urinary tract infection. CONCLUSION: With an increasing elderly population there will be an annual increase in the number of TKAs. In our local population TKAs are performed primarily for the Chinese female in the 7th decade. The overall complication rate of TKA remains low with a mortality rate of <1%.

Results of total elbow arthroplasty in the treatment of distal humerus fractures in elderly Asian patients.

BACKGROUND: Distal humerus fractures in elderly patients are difficult to treat as these fractures are often complicated by varying degrees of comminution intra-articular involvement and osteoporosis. We retrospectively reviewed the results of primary total elbow arthroplasty in the treatment of distal humerus fractures in seven patients followed for a minimum of 1 year. METHODS: Between July 2000 and June 2002, seven patients with distal humerus fractures were treated electively with total elbow arthroplasty using the semiconstrained Coonrad-Moorey elbow replacement prostheses. The Mayo Elbow Performance Score was used to assess the outcomes. RESULTS: The mean age of our patients was 72.9 years. The mean duration of postoperative hospitalization stay was 7.6 days. The average length of follow up was 24.9 months. Six of these patients had no pain, and one patient had mild pain. The mean arc of flexion was 88.6 degrees. Six elbows had excellent results, while 1 elbow had good result. The mean Mayo score was 94.3 points. One elbow developed blisters postoperatively but resolved with dressings and antibiotics. CONCLUSIONS: Our review suggests that total elbow arthroplasty can give good to excellent short term results when used in the treatment of distal humerus fractures in elderly Asian patients.