A Crossed Screw Patellar Reconstruction Technique for the Treatment of the Severely Deficient Scaphoid Shaped Patella in Total Knee Arthroplasty.

One of the contraindications to patella resurfacing in total knee arthroplasty is a thin and severely eroded 'deficient' patella. However, such patients often present with severe patellofemoral joint arthritis, patellar lateral subluxation, and patella maltracking, which can only be treated effectively with resurfacing. While various treatments have been proposed, options remain limited. Here we introduce a method of patella reconstruction using four 2.7-mm titanium cortical screws crossing each other into the inner shell of the patella. This provides a scaffold onto which bone cement and any standard polyethylene patellar component can be fixed. Postoperatively, the patient had no anterior knee pain, no patella maltracking, and no component loosening. Advantages of this technique include minimization of extensor disruption, low costs, easy accessibility, reproducibility, and improved mechanical strength.

A Modified Surgical Technique of Patellar Tendon Reconstruction in Total Knee Arthroplasty Using Achilles Tendon Allograft.

Patellar tendon disruption is one of the most dreaded complications after total knee arthroplasty (TKA) impacting joint function and implant longevity. Management of this condition remains controversial, and no one treatment has provided consistent clinical success. Here we propose a modified technique from the standard Achilles allograft procedure to reconstruct a ruptured patellar tendon after TKA. A fresh-frozen Achilles tendon allograft with attached calcaneal bone graft was used. Our technique offers the advantage of a more stable graft fixation by relying on both quadriceps tendon and transosseous patellar fixation and bone-to-bone allograft fixation to the tibial tuberosity. The patient regained full extension and discontinued walking aids postoperatively. Careful attention to graft preparation, tensioning, stable graft fixation, and postoperative rehabilitation led to encouraging results in this complex problem.

Paget-Schroetter syndrome as a result of 1st rib stress fracture due to gym activity presenting with Urschel's sign - A case report and review of literature.

BACKGROUND: Paget-Schrotter Syndrome (PSS) also known as "effort thrombosis" is a form of primary thrombosis in the subclavian vein at the costoclavicular junction is usually seen in younger patients after repeated strenuous activity of the shoulders and arms. When occurring in younger patients, PSS presents itself with predisposing factors such as unilateral dull, aching pain in the shoulder or axilla and swelling of the arm and hand. CASE PRESENTATION: We report a rare case of unusual left axillo-subclavian vein thrombosis following narrowing of thoracic outlet due to stress injury of rib fracture likely during gym activity in absence of other clear risk factors and a negative hypercoagulable workup in a 27-year-old man who was admitted as left deltoid rupture 5 days after his usual gym. Subsequently he was transferred under vascular surgery for thrombectomy. CONCLUSION: In addition to the unusual location in the left upper extremity in our case, the absence of common etiologic factors makes our case of Paget-Schroetter Syndrome a very unique one. This case report aims to discuss the common causes of PSS in order to raise a high index of suspicion in certain groups of patients. This will allow early identification and avoidance of catastrophic outcomes such as pulmonary embolism and stroke.

Combined Rotational Alignment Change after Total Knee Arthroplasty in Different Tibial Component Designs: Implications for Optimal Tibial Component Rotational Alignment.

PURPOSE: The rotational alignment of the femoral and tibial components is closely related to the results after total knee arthroplasty (TKA). In this study, we measured the combined rotational alignment change (ΔCR) after TKA and compared the different influence of symmetric and asymmetric tibial component designs on the combined rotational alignment. MATERIALS AND METHODS: Eighty-four patients (mean age, 67.9 years) were included. A symmetric tibial component was used in 51 knees (group I), whereas an asymmetric tibial component was used in 50 knees (group II). We measured the angles of four anatomical landmarks by using preoperative and postoperative computed tomography images. The combined rotational alignment and the amount of change were calculated. The correlation between the isolated tibial component rotation (ITR) and ΔCR was analyzed by using the Spearman correlation coefficient. RESULTS: The mean ΔCR was -0.1°±6.3° in group I and -4.8°±5.7° in group II after TKA. Excluding the intercomponent rotation, the change was -1.0°±7.3° and -6.7°±6.7° in group I and group II, respectively. A correlation analysis between the ITR and tibial component rotation relative to the tibial tuberosity showed a statistically significant correlation. CONCLUSIONS: The combined lower limb rotational alignment was internally rotated in both symmetric and asymmetric tibial component designs after TKA. The asymmetric tibial component was better than the symmetric tibial component in achieving internally rotated combined lower limb rotational alignment. The internal rotation of the symmetric tibial component relative to the tibial tuberosity tip should fall within 20° to correct the externally deformed lower limb.

Entrapment of the deep peroneal nerve and anterior tibial vessels by a spiral tibial fracture causing partial non-union: a case report.

We report a case of entrapment of the deep peroneal nerve as well as the anterior tibial artery and vein by a spiral distal tibial shaft fracture, causing partial non-union. The authors describe the utility of MRI in making the diagnosis of this post-traumatic complication, which may potentially result in a permanent neurovascular deficit and adverse functional outcome if left undetected. The importance of recognizing the distinct possibility of entrapment and injury to the deep peroneal nerve as well as the anterior tibial vessels, when managing a fracture involving the distal third of the tibial shaft is emphasized. Absence of clinical symptoms or signs of neurovascular entrapment should not deter one from performing the relevant investigations to exclude this complication, in particular when surgical fixation is being contemplated, or in the presence of a non-healing fracture.

Transpositional adipofascial flaps for complicated acute finger injries.

Seven patients who presented with complicated acute finger injuries were treated successfully with local transpositional adipofascial flaps. This is a one-stage procedure with advantages of simplicity and rapidity. This flap is thin with good pliability and provides a very versatile and reliable covering for soft-tissue defects of the fingers. Full-thickness skin grafts were applied to the raw surface of the adipofascial flaps in all patients. All cases had excellent wound healing and restored full range of motion. This procedure facilitates early wound healing and early range of motion for finger joints; it also reduces wound pain, minimizes scar formation, and eliminates the need for second-stage surgery.

Impact of national health insurance on the survival rate of patients with osteosarcoma in Taiwan: review of 74 patients.

The 2-year survival rate for high-grade osteosarcoma was 46.9% before the introduction of National Health Insurance (NHI) in Taiwan on March 1, 1995, but increased to 73.8% after the implementation of NHI. The 5-year survival rate also increased, from 37.5% to 63.6%. Between May 1990 and May 2001, 74 patients with high-grade osteosarcoma were treated at our hospital. Median age was 17 years (range, 7-63 years). Inadequate surgical margins, poor histologic response to chemotherapy, advanced stage of disease, and incomplete treatment were strongly associated with poor prognosis. Before NHI, 10 patients had incomplete treatment, mainly because of unaffordable medical fees. After NHI, only three patients had incomplete treatment, due to personal reasons. Patient survival improved dramatically with advances in multiagent chemotherapy, but it was the NHI that enabled patients to complete expensive treatment courses, including preoperative neoadjuvant chemotherapy, limb-salvage surgery, and postoperative adjuvant chemotherapy. The NHI also improved the accessibility of medical care, with more patients presenting in the early stages of disease and, as a result, it not only improved survival rate but also increased the number of patients undergoing limb-salvage surgery. We concluded that the NHI significantly improved the survival rate for patients with osteosarcoma in Taiwan.