Primary arthrodesis of the injured knee: still a solution in 1995? A case report.

After major trauma of the knee joint, conservation and reconstruction of the different bony, ligamentary and soft tissue structures is usually attempted. The end results of these reconstructive procedures are not always gratifying, and in many cases significant instability remains, combined with severe restriction in motion, pain or infectious problems, leading to severe functional impairment. Many patients need secondary corrective procedures, such as arthrodesis. We present a case of an unusual injury to the knee with massive destruction, loss, and contamination of bony, ligamentary, and soft tissue structures. Because attempts at reconstruction would have led to the above-mentioned problems, including possible life-threatening septic complications necessitating amputation, a primary arthrodesis was performed, followed by simple reconstruction of the soft tissue envelope. Two years after the accident, the patient is doing very well. To our knowledge, no such cases have previously been described. We therefore want to communicate our experience with this procedure, which led to an early, pain free, and good functional recovery.

Treatment of unstable peritrochanteric fractures in elderly patients with a compression hip screw or with the Vandeputte (VDP) endoprosthesis: a prospective randomized study.

A prospective randomized study was set up, comparing a compression hip screw with the Vandeputte (VDP) endoprosthesis treatment for fresh, unstable peritrochanteric fractures, according to the Evans-Jensen and AO systems. Ninety patients, ages > or = 70 years, 47 of whom were treated with a compression hip screw and 43 with a VDP endoprosthesis, were included. All patients were being followed for 3 months. No difference between the two groups was found for operating time, wound complications, and mortality rate, but there was a higher transfusion need in VDP treatment. Severe fracture redisplacement or total collapse of the fracture occurred in 11 (26%) compression hip screw patients, two of whom had revision surgery. Only one patient needed reintervention after VDP treatment. Functional capacity of preoperative independent patients at hospital discharge did not differ for the two groups. In conclusion, the compression hip screw seemed to be an appropriate implant for most of the peritrochanteric fractures, but for very old patients with advanced osteoporosis, with a complex, unstable peritrochanteric fracture, and who are eligible for early mobilization, primary cemented endoprosthesis might be the best treatment.

Primary arthrodesis of the injured knee: still a solution in 1994?--case report.

We describe a case of a major trauma to a knee joint with extensive destruction of soft tissues, ligamentary structures, and bone loss. Although in extensive trauma of the knee, conservation and reconstruction of the joint structures is usually attempted, the massive destruction and gross contamination in this case prompted us to perform a primary arthrodesis in order to avoid life-threatening complications and to obtain early functional recuperation of the involved limb.