Short-term follow-up of pertrochanteric fractures treated using the proximal femoral locking plate.

OBJECTIVES: The proximal femoral locking compression plate is a fixed angled anatomically contoured stainless steel plate used to treat pertrochanteric fractures of the proximal femur. Recent reports quote a high failure rate associated with this implant. We aimed to identify the common methods of failure and determine the elements of surgical techniques that could be altered to potentially improve outcomes should this implant be used for the treatment of unstable pertrochanteric fractures. DESIGN: Retrospective chart analysis. SETTING: Three separate centers. PATIENTS: Twenty-nine patients with 29 fractures. INTERVENTION: All patients were treated for pertrochanteric fractures using the proximal femoral locking compression plate. OUTCOME MEASURES: The patient demographics, fracture classification, implant details, and complications. RESULTS: Twelve of 29 fractures (41.4%) suffered a complication associated with the implant, and 83% of these occurred in elderly women. Complications included bending, backing-out, fracture, or cut-out of the proximal screws and plate fracture. Common technical errors included the following: (1) leaving the plate proud proximally, (2) malposition of the proximal screws within the femoral neck/head, (3) inappropriate use of the hook plate, (4) creating too ridged a construct when used as a bridging plate. CONCLUSIONS: Our experience with the use of this implant suggests an unacceptably high failure rate (41.4%). A knowledge of the common pitfalls encountered when using this device is critical in an effort to reduce failure rates. Based on our data, we would urge caution when considering this device for unstable pertrochanteric fractures, especially in the elderly female. LEVEL OF EVIDENCE: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Cell cultured chondrocyte implantation and scaffold techniques for osteochondral talar lesions.

Cell cultured techniques have gained interest and popularity in osteochondral defects because, unlike bone marrow stimulation methods, where fibrocartilage fills the defect, they allow for the regeneration of "hyaline-like cartilage" with better stiffness, resilience, and wear characteristics. Osteochondral defects in the ankle are a rare but challenging problem to treat in young active patients. If left alone, they can cause pain and reduced function and risk progressive degenerative changes in the joint. Clinical results of cell cultured and scaffold technology in the ankle, although still limited by small studies and midterm follow-up, are certainly encouraging.

Good result after surgical treatment of Pellegrini-Stieda syndrome.

Ossification of the femoral attachment of the medial collateral ligament (MCL) of the knee with associated pain and restricted movements is rare and is characteristic of the Pellegrini-Stieda (PS) syndrome. Although in mild cases conservative treatment is often successful, patients with more significant bone formation and persistent symptoms require surgical excision. We describe a case of PS syndrome with a description of the surgical technique consisting of excision of the bony lesion and reconstruction of the MCL by using the adductor magnus tendon.