Fix it or discard it? A retrospective analysis of functional outcomes after surgically treated patella fractures comparing ORIF with partial patellectomy.

OBJECTIVES: The goal of this study was to compare functional outcomes of patients with patella fractures treated with open reduction and internal fixation (ORIF) with those treated with partial patellectomy (PP). DESIGN: Retrospective cohort study. SETTING: Urban Level I Trauma Center. PATIENTS: Seventy-three patients with isolated displaced patella fractures underwent operative treatment between January 1, 2002, and December 31, 2009, at our institution. Of these, 52 (71%) patients with isolated patella fractures with minimum 1-year follow-up agreed to participate and were enrolled in the study. INTERVENTION: PP or ORIF. MAIN OUTCOME MEASUREMENTS: Patients completed outcome questionnaires and participated in a physical examination. Outcome instruments included the Knee Outcome Survey-Activities of Daily Living Scale, Short Form (SF)-36 Health Survey, and SF Musculoskeletal Function Assessment Survey. RESULTS: Twenty-six patients underwent PP and 26 underwent ORIF. There were no significant differences in any of the functional outcome instruments, including Knee Outcome Survey-Activities of Daily Living Scale (ORIF: 64.1 ± 11, PP: 62.1 ± 7.9, P = 0.76), SF-36 physical component score (ORIF: 40.8 ± 5.4, PP: 41.1 ± 5.2, P = 0.94), SF-36 mental component (ORIF: 47.7 ± 5.1, PP: 51.8 ± 4.9, P = 0.19), Short Musculoskeletal Function Assessment (SMFA) Function Index (ORIF: 28.6 ± 9.1, PP: 27.7 ± 6.7, P = 0.78), or SMFA Bother Index (ORIF: 26.0 ± 9.7, PP: 23.6 ± 8.8, P = 0.72). Complication rates did not differ significantly between the 2 groups. CONCLUSIONS: This study demonstrates that functional impairment persists after operative treatment of patella fractures. Both ORIF and PP demonstrated similar final range of motion, functional scores, and complication rates. Despite its purported benefits, in this study, ORIF did not result in superior outcomes compared with PP. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Accuracy and reliability of the Mayo Elbow Performance Score.

PURPOSE: To test the reliability of the Mayo Elbow Performance Score (MEPS) and compare it with a validated outcomes instrument, the American Shoulder and Elbow Surgeons (ASES) score. METHODS: A total of 42 patients with the chief problem of elbow dysfunction formed the study cohort. Patients with an immediate surgical indication or treatment at the index visit were excluded. The others completed an MEPS questionnaire; at a second visit 2 to 3 weeks later, they completed another MEPS questionnaire and were evaluated with the ASES elbow assessment. Reliability and accuracy were calculated using 2-tailed Pearson correlation coefficients with 95% confidence intervals. Pearson coefficients greater than 0.8 indicated strong agreement. RESULTS: The average MEPS score at the initial visit was 58. At the second visit, the average MEPS score was 69 and the average ASES score was 78. The Pearson coefficient for MEPS scores at the 2 time points averaged 0.82, and between the MEPS and ASES scores averaged 0.83. Both coefficients indicated strong agreement. CONCLUSIONS: The MEPS has strong reliability when assessed at different times and when compared with a validated elbow outcomes instrument. Differences in compared scores of approximately 10 points indicate some patient improvement between time points; however, 95% confidence intervals, standard deviations, and ranges were essentially equivalent between and among tests, indicating similar accuracy. CLINICAL RELEVANCE: The MEPS is a reliable outcomes instrument for clinical studies of elbow function that is used to assess nonsurgical treatment.

Posterior knee dislocation following septic arthritis of the knee.

This is a report of a case of nontraumatic posterior knee dislocation following septic arthritis in a 59-year-old male with leucopenia secondary to sarcoidosis. After confirmation of the diagnosis with synovial fluid analysis, the patient was taken emergently to the operating room for arthroscopic-assisted irrigation and debridement. Arthroscopy demonstrated intact cruciate ligaments but confirmed the diagnosis of septic arthritis demonstrating purulent synovial fluid. He was discharged after multiple repeat irrigation and debridement procedures and intravenous antibiotics improved his symptoms. The infection appeared to resolve as his laboratory values normalized following treatment. Three months later, however, x-rays revealed a nontraumatic posterior knee dislocation. We hypothesize that the soft tissues including the cruciate and collateral ligaments were made incompetent by enzymatic digestion and stretching with mobilization which allowed the knee to dislocate without a traumatic event.

Total hip arthroplasty with ceramic-on-ceramic bearing failure from third-body wear.

This article describes a new mechanism of failure of a ceramic-on-ceramic total hip arthroplasty (THA) due to fretting corrosion and failure of the Morse taper. A 46-year-old man with hip osteonecrosis underwent THA in 2006. A ceramic-on-ceramic, un-cemented THA with a titanium femoral component and metal-on-ceramic Morse taper was implanted. Two years postoperatively, he presented with swelling in his groin and a painless medial thigh mass. The thigh mass was diagnosed as an abscess. Incision and drainage was performed and resulted in a sinus tract that continuously drained copious amounts of seropurulent fluid. Two months later, the patient underwent irrigation, debridement, and explantation of his hip. Frozen sections showed no signs of infection. There was dramatic visible wear of the Morse taper and pieces of metal embedded in the ceramic. Permanent sections showed chronic inflammation and foreign body reaction. He subsequently underwent an uneventful re-implantation with a metal-on-highly-cross-linked-polyethylene THA. In this case, failure of the morse taper led to metal debris, which reacted with the ceramic and caused dramatic third-body wear. The thigh mass, which appeared to be an infection, proved to be a massive foreign body granuloma. Malfunction of the morse taper as reported in this case represents a possible failure mechanism of a ceramic-on-ceramic THA.