Open fractures of the patella: long-term functional outcome.

Seventy-nine open patella fractures in 76 patients were treated between 1986 through 1994, with an 80% incidence of multiple injuries. All were treated with irrigation and debridement, open reduction, internal fixation, and reconstruction of the extensor mechanism. In no case was a primary patellectomy performed, even with severe comminution. There were three failures of initial fixation and one asymptomatic nonunion. Average range of motion for all groups was 112 degrees, at an average follow-up of 21 months. Secondary surgical procedures were performed in 65% of knees, the majority for symptomatic hardware. To determine long-term functional outcome, a modified Hospital for Special Surgery knee score was used. At an average of 36 months, good to excellent knee scores were observed in 17 of 22 patients. We conclude that all attempts for preservation of bone substance and precise reconstruction of the extensor should be attempted, reserving total patellectomy as a salvage procedure.

Ganglion cysts about the shoulder girdle in the absence of suprascapular nerve involvement.

Ganglion cysts about the shoulder girdle are being identified with increasing frequency by the magnetic resonance image scanner. These masses rarely become evident clinically unless they cause compression of the suprascapular nerve. In this series a ganglion not causing compression of the suprascapular nerve was identified in each of five patients. Three of these patients had shoulder pain, tenderness over the supraspinotus muscle, and an increase in pain with abduction in the plane of the scapula. Plain radiographs showed erosion of the scapular neck. In the remaining two patients the pain pattern was consistent with an impingement syndrome in one and a rotator cuff tear in the other. Successful operative resection was undertaken on three patients. In two of these patients the magnetic resonance image scan helped determine the need for simultaneous exposure of the suprospinous and infraspinous fossae by means of scapular spine osteotomy. In the two patients not believed to be symptomatic from their ganglia, treatment for the primary shoulder diagnosis resulted in complete relief of symptoms. In the absence of suprascapular nerve involvement, the presence of a ganglion cyst in the shoulder girdle is not an absolute indication for operative resection. In the presence of another common shoulder diagnosis, treatment for that diagnosis should be pursued.

The pullout strength of titanium alloy MRI-compatible and stainless steel MRI-incompatible Gardner-Wells tongs.

The stainless steel Gardner-Wells tongs and pins previously employed to reduce cervical spine fractures are increasingly being replaced by magnetic resonance imaging (MRI)-compatible graphite tongs and titanium pins. Concern regarding the relative pullout strengths of these two systems, however, prompted the performance of a cadaver study in which tongs and pins were placed in 10 cadaver skulls and tested to failure. The MRI-compatible tongs failed due to plastic deformation of the titanium pin tips resulting in tong slippage and loss of fixation, whereas the stainless steel tongs and pins failed when the skull fractured. These results indicated that MRI-compatible systems must be used with extreme caution, particularly when traction exceeds 50 pounds.