Simultaneous Clavicle Fracture and Acromioclavicular Joint Dislocation: Novel Surgical Technique: A Case Report.

CASE: A 41-year-old man sustained a midshaft clavicle fracture with associated type IV ipsilateral acromioclavicular joint (ACJ) dislocation. The clavicle was fixed with a locking plate and ACJ stabilized with a novel technique: 2 metal anchors with preloaded suture fixed at the coracoid process, looping the sutures over the clavicle, and passing through the plate holes without clavicle bone drilling. Excellent functional outcomes for range of motion, pain, and functional scores persisted 2 and a half years after surgery. CONCLUSION: The described surgical technique achieved exceptional short-term outcomes, sparing clavicle bone stock and allowing an early return to sports.

Late-Onset Recurrent Femoral Cyst Formation 10 Years after ACL Reconstruction: A Case Report and Literature Review.

Synovial fistula and cyst formation after anterior cruciate ligament (ACL) reconstruction is very unusual and almost always affects the tibia. Only 3 cases originating in the femur have been reported. We present a rare case of late-onset femoral cyst formation related to ACL reconstruction. Ten years after successful ACL reconstruction surgery, effusion and pain at the lateral aspect of the lateral femoral condyle appeared. Symptoms persisted despite initial percutaneous drainage and conservative treatment. Surgery was carried out, with drainage and graft-fixation pin device removal, with recurrent cyst formation after the intervention. Total recovery of the patient was achieved after carrying out revision surgery consisting in bone tunnel filling using autologous bone graft and occlusion of cortical bone defect with local fascial flap. The development of this unusual complication was related to lack of absorption of the fixation device, bone burn due to drilling, and persistent synovial fluid in the femoral bone tunnel, combined with the absence of bone ingrowth.

Two-Stage Anterior Cruciate Ligament Reconstruction Revision Surgery for Severe Bone Defects With Anterolateral Ligament Reconstruction Technique.

Anterior cruciate ligament revision surgery poses a number of specific difficulties. These include the lack of bone mass to enable effective fixation of the reconstruction, morbidity of the donor area when bone autograft is used to fill the tunnels, and absence of the semitendinosus and gracilis homolateral tendons in cases in which they have already been used in the primary surgical procedure. To address all these problems, we describe a 2-stage revision technique that uses bone allograft for tunnel filling and Achilles allograft for ligament reconstruction. In addition, the intervention includes an extra-articular phase in which the anterolateral ligament is reinforced to increase the rotational stability of the knee, thus improving the prognosis of operation.

Association Between Use of Enhanced Recovery After Surgery Protocol and Postoperative Complications in Total Hip and Knee Arthroplasty in the Postoperative Outcomes Within Enhanced Recovery After Surgery Protocol in Elective Total Hip and Knee Arthroplasty Study (POWER2).

Importance: The Enhanced Recovery After Surgery (ERAS) care protocol has been shown to improve outcomes compared with traditional care in certain types of surgery. Objective: To assess the association of use of the ERAS protocols with complications in patients undergoing elective total hip arthroplasty (THA) and total knee arthroplasty (TKA). Design, Setting, and Participants: This multicenter, prospective cohort study included patients recruited from 131 centers in Spain from October 22 through December 22, 2018. All consecutive adults scheduled for elective THA or TKA were eligible for inclusion. Patients were stratified between those treated in a self-designated ERAS center (ERAS group) and those treated in a non-ERAS center (non-ERAS group). Data were analyzed from June 15 through September 15, 2019. Exposures: Total hip or knee arthroplasty and perioperative management. Sixteen individual ERAS items were assessed in all included patients, whether they were treated at a center that was part of an established ERAS protocol or not. Main Outcomes and Measures: The primary outcome was postoperative complications within 30 days after surgery. Secondary outcomes included length of stay and mortality. Results: During the 2-month recruitment period, 6146 patients were included (3580 women [58.2%]; median age, 71 [interquartile range (IQR), 63-76] years). Of these, 680 patients (11.1%) presented with postoperative complications. No differences were found in the number of patients with overall postoperative complications between ERAS and non-ERAS groups (163 [10.2%] vs 517 [11.4%]; odds ratio [OR], 0.89; 95% CI, 0.74-1.07; P = .22). Fewer patients in the ERAS group had moderate to severe complications (73 [4.6%] vs 279 [6.1%]; OR, 0.74; 95% CI, 0.56-0.96; P = .02). The median overall adherence rate with the ERAS protocol was 50.0% (IQR, 43.8%-62.5%), with the rate for ERAS facilities being 68.8% (IQR, 56.2%-81.2%) vs 50.0% (IQR, 37.5%-56.2%) at non-ERAS centers (P < .001). Among the patients with the highest and lowest quartiles of adherence to ERAS components, the patients with the highest adherence had fewer overall postoperative complications (144 [10.6%] vs 270 [13.0%]; OR, 0.80; 95% CI, 0.64-0.99; P < .001) and moderate to severe postoperative complications (59 [4.4%] vs 143 [6.9%]; OR, 0.62; 95% CI, 0.45-0.84; P < .001) and shorter median length of hospital stay (4 [IQR, 3-5] vs 5 [IQR, 4-6] days; OR, 0.97; 95% CI, 0.96-0.99; P < .001). Conclusions and Relevance: An increase in adherence to the ERAS program was associated with a decrease in postoperative complications, although only a few ERAS items were individually associated with improved outcomes.