Total knee arthroplasty for post-traumatic arthrosis.

The outcomes of total knee arthroplasty for post-traumatic arthrosis were studied in 31 knees. The average age at arthroplasty was 60 years old (range, 36-78 years). The interval from fracture to total knee arthroplasty averaged 13 years. Simultaneous corrective osteotomy was necessary in 4 patients to correct axial alignment and preserve ligamentous integrity. Follow-up averaged 46 months. Mean arc of motion increased significantly, from 94 degrees to 100 degrees (P = .027). Average function score improved from 44 to 72 points. This change was statistically significant (P<.0001). Knee Society knee scores also improved significantly, from 36 to 78 points (P<.0001). At most recent follow-up, the functional scores were considered excellent or good in 58%; knee scores were considered excellent or good in 71% of cases. All periarticular osteotomies and tibial tubercle osteotomies healed uneventfully within 16 weeks. Complications occurred in 57% of cases, including aseptic failure (26%), septic failure (10%), patellar tendon rupture (3%), patellar subluxation (6%), thromboembolism (6%), and wound breakdown requiring debridement and muscle flap coverage (6%). Despite significant improvements in motion and function, patients with post-traumatic arthrosis are susceptible to high rates of complications. Adverse outcomes can be minimized by restoring limb alignment, soft tissue balance, and component alignment and by preserving vascularity of the skin and subcutaneous tissues.

Traumatic open anterior lumbosacral fracture dislocation. A report of two cases.

STUDY DESIGN: Case presentation. OBJECTIVES: To review the diagnosis and treatment of rare anterior lumbosacral fracture dislocations. SUMMARY OF BACKGROUND DATA: The severity of closed anterior and open and closed posterior lumbosacral dislocations has been documented; however, there have been no reports of open anterior lumbosacral dislocations in the literature. Two patients are reported who experienced acute open anterior lumbosacral fracture dislocations. METHODS: Review of the patient history and physical examination, radiologic review, operative techniques, and a review of the literature. RESULTS: Fractures healed in both patients, with no major infections. Both patients had persistent neurologic deficits at last follow-up. CONCLUSIONS: Open lumbosacral fracture dislocations are complex injuries that require diligence on the part of the surgeons involved the recognize the severity of the injury, to prevent or resolve any infectious process, to prevent further neurologic injury, and then to obtain and maintain alignment of the spine on the pelvis.

Fractures below the end of locking humeral nails: a report of three cases.

We report three cases of fracture of the humerus that occurred at the tip of interlocking humeral nails inserted previously for humeral shaft fractures. The fractures occurred at 8, 10, and 26 weeks postoperatively, and all occurred through the distal interlocking screws after the patient sustained a rotational force to the arm. All three patients had further surgery, two subsequently healed their fractures, and one is still in active treatment. Orthopaedists should be aware of this complication when choosing interlocking humeral nails for the treatment of humeral shaft fractures.