Treatment of two or more metatarsal fractures.

INTRODUCTION: Metatarsal fractures are the most common type of foot fracture. When surgical treatment is needed, pinning is typically used, either percutaneous or open. However, this fixation method has been criticized by some authors who lament residual malunion and prefer to use plate and/or screws. The primary objective of our study was to compare the outcomes of K-wire versus plate and/or screw fixation for the surgical treatment of two or more metatarsal fractures. The secondary objective was to evaluate the factors that contribute to poor outcomes and complications. We hypothesized that plate and/or screw fixation will produce better functional outcomes than K-wire fixation. MATERIALS AND METHODS: This was a prospective and retrospective multicenter study carried out between 1 January 2010 and 1 June 2018 with a minimum follow-up of 12 months. Three functional scores were determined (AOFAS, FAAM and SF12 physical and mental) preoperatively, postoperatively and at the final assessment. We evaluated the outcomes in the entire study population and in four injury type subgroups, including one with isolated metatarsal fractures to control analysis bias. RESULTS: Our analysis compiled data from 165 patients (123 men, 42 women) who had a mean age of 38 years (16-82). The mean follow-up time was 27.9months (10-120). There were no complications in 130 patients (79%). Skin necrosis occurred in 25 patients (15%). The FAAM score was significantly higher in the plate and/or screw group 70.2 (17-84) versus 60.3 (31-84) in the K-wire group (P=0.033). The 78 (19-100) AOFAS was higher, but not significantly, in the plate and/or screw group versus 70 (12-100) in the K-wire group (P=0.144). CONCLUSION: Trauma to the foot that causes a fracture in two or more metatarsals often occurs due to a crush injury (39%). The frequency of associated bone lesions means that a preoperative CT scan should be done routinely to analyze the injury pattern and determine the best treatment. The fixation method should be adapted to the local conditions; when possible, it is preferable to use rigid fixation with plates and/or screws as it yields better functional outcomes. LEVEL OF EVIDENCE: IV; study with retrospective component.

Return to work after primary total hip or knee arthroplasty. First French study. Retrospective study of 241 cases.

INTRODUCTION: The quality and reliability of the results of primary total hip or knee arthroplasty (THA, TKA) have allowed indications to be extended to younger, working-age patients, raising the issue of return to work. This question has never been specifically addressed in THA and TKA in a French population. We therefore conducted a retrospective study to determine: (1) the rates and intervals of return to work, and (2) factors affecting return to work and reasons for non-return. HYPOTHESIS: Rates and intervals of return to work are comparable to those in Western countries as a whole: 1.1-10.5 weeks in THA and 8-12 weeks in TKA. MATERIAL AND METHOD: A single-center retrospective study included patients aged under 65 at surgery, between 2009 and 2013. A questionnaire collected population and occupational data. The patients' occupational situation was collected at a minimum 1 year postoperatively. During the study period, 289 TKAs or THAs were performed; 241 patients were recontacted, 144 of whom had been working at the time of surgery: 72 THAs and 72 TKAs. The sex-ratio was well balanced: 69 males, 75 females. Mean age was 55.8±8 years (range, 18.6-65.7 years). The mean time from surgery to data collection was 34.5 months (95% CI, 32.2-36.8 months). RESULTS: In all, 86 patients (57.6%) returned to work, at a mean 124 days (range, 15-540 days; 95% CI, 102.8-144.4 days). At 3 months, 55.4% of patients (n=46) had returned to work, and 97.6% (n=81) at 12 months. In most cases, patients returned to the same occupation. CONCLUSION: The study hypothesis was not confirmed. French primary THA or TKA patients returned to work later and less frequently than in other Western countries. LEVEL OF EVIDENCE: IV, retrospective study without control group.

Management and results in periprosthetic tibial fracture after total knee arthroplasty: Two-center 15-case retrospective series at 2 years' follow-up.

INTRODUCTION: Periprosthetic tibial fracture after total knee arthroplasty (TKA) is rare, but jeopardizes implant survival. The main objective of the present study was to assess treatment efficacy, on the hypothesis that surgery provides good long-term results. MATERIAL AND METHODS: A two-center retrospective study included 15 patients (6 male, 9 female: mean age, 71.8±10.2 years), managed between 1997 and 2017 for isolated tibial fracture after TKA. Patients were assessed clinically (IKS, inverted Oxford, Parker and SF-12 scores) and radiologically. Complications and revision surgeries were collated. Fractures were classified on the SoFCOT classification: 9 stable implants (4 type B1, 5 type C1), 4 periprosthetic osteolyses (1 type A3, 2 type B3, 1 type C3), and 2 loosenings (type A2). Treatments comprised: non-operative treatment (1 bed-ridden patient), 11 osteosyntheses for fracture on stable implant (2 standard plates, 7 locking plates, 2 intramedullary nailings), and 3 implant replacements by cemented long stem models for loosening. RESULTS: Mean follow-up was 28 months (range, 12-120 months). Consolidation was achieved in 13 cases, at a mean 15 weeks. Complications comprised: 4 infections, 2 cases of secondary displacement, and 2 of non-union. Surgical revision was required in 8 cases, including 2 secondary implant revision procedures. Functional results were good in 10 cases. At last follow-up, mean Parker score was 7 (range, 4-8.5), Oxford score 32 (range, 16-39), and IKS score 150 (range, 85-167) with knee and function scores respectively 78 (range, 55-86) and 75 (range, 30-85). CONCLUSION: Radiologic and clinical results were encouraging, but with impaired quality of life and a high rate of complications. LEVEL OF EVIDENCE: IV, retrospective cohort study.