Intra-articular Injuries Research Articles

Clinicoradiological Outcome of Concomitant Fractures of Proximal Femur and Femoral Shaft Treated With Second-Generation Cephalomedullary Nailing

BackgroundThe ideal modality of treatment of concomitant fractures of the hip (intertrochanteric/femoral neck) and the femoral shaft is still evolving. The aim of our retrospective study was to assess the clinicoradiological outcome of such fractures managed by closed second-generation cephalomedullary nailing.MethodologyThe study was conducted among skeletally mature patients presenting within one week of injury who underwent closed second-generation cephalomedullary nailing (proximal femoral nail). Those presenting beyond one week or those who had pathological fractures, incomplete follow-ups, or other modes of fixation were excluded. Functional results were evaluated according to Friedman and Wyman’s clinical assessment system. Time required for fracture healing and the presence of any complications were also noted.ResultsA total of 10 patients with the ipsilateral hip (five intertrochanteric and five femoral neck) and femoral shaft fractures were included in the study. Associated injuries found included fractures of the ipsilateral tibia/fibula at varying levels in three patients; hand and wrist injuries in two patients; and contralateral femoral shaft fracture, ipsilateral patella, bilateral crush injury of the foot, and head and chest injury with brachial plexus injury in one patient each. Four patients were diagnosed with intra-articular knee injuries (ligamentous and meniscal injuries) postoperatively. At the final follow-up, the functional outcome results were good in four, fair in one, and poor in five patients. All femoral neck fractures united at a mean of 15.2 weeks (range: 12.0-18.0 weeks) and intertrochanteric fractures at a mean of 14.0 weeks (range: 12.0-22.0 weeks). However, there was residual varus malunion in two intertrochanteric fractures. Eight femoral shaft fractures were infra-isthmic; of these, four resulted in nonunion (two of hypertrophic and two of atrophic type) and two were found to be in the delayed union, which eventually united by 24 weeks.ConclusionsSecond-generation cephalomedullary nail is an acceptable, cost-effective, and minimally invasive alternative for the management of concomitant ipsilateral fractures of the hip and supra-isthmic or isthmic femoral shaft fractures. For infra-isthmic fractures, retrograde femoral nail or distal femoral plate along with a separate implant for addressing the hip fracture (either cannulated cancellous screw or dynamic hip screw, preferably in a rendezvous/overlapping manner) are better options.

Does an 8-week exercise intervention impact knee-related symptoms 3-15-years following intra-articular knee injury? a pilot randomized controlled trial

Purpose: Knee injury has been established as a risk factor for developing osteoarthritis. It is not known if post-traumatic osteoarthritis can be prevented or delayed following a knee injury. It has been established that symptoms (e.g., knee-related pain, stiffness, locking etc.) and functional deficits (i.e., quadriceps weakness, balance, hopping performance) can persist for years following an intra-articular knee injury. We hypothesized that a neuromuscular training program that targets quadriceps strength and frontal plane knee control could improve knee-related symptoms in young adults 3 to 15 years after an injury.

Using the patient acceptable symptom state (pass) to evaluate KOOS outcomes 3-12 years following a youth sport-related knee injury

Purpose: Anterior cruciate ligament (ACL) and other traumatic intra-articular knee injuries are associated with an increased likelihood of developing knee joint osteoarthritis (OA). Research has elucidated the negative consequences on health outcomes that are present in this population in the short-term (1-2 years) and medium-term (3-15 years) interval post injury. The Knee Injury and Osteoarthritis Outcome Score (KOOS) is a common patient-reported outcome measure (PROM) used to track the most prevalent clinical features across the timeline from knee injury to OA.

Ankle Arthroscopy as an Adjunct to the Management of Ankle Fractures.

Background:Ankle fractures are one of the most common injuries managed by orthopedic surgeons. Although the etiology of posttraumatic osteoarthritis in anatomically reduced ankle fractures is not completely known, several studies suggest that undetected intra-articular pathology at the time of injury may play a role. The purpose of this study is to report the operative findings of ankle arthroscopy as an adjunct to ankle fracture open reduction and internal fixation.Methods:A retrospective review was performed of all ankle fractures treated consecutively at our institution by a single surgeon from August 2010 to October 2019, which were found using Current Procedural Terminology codes. A total of 84 patients met our inclusion criteria for whom patient demographics and clinical history were collected. Pre- and postoperative diagnoses from every operative report were noted as well as intra-articular intervention made during the time of arthroscopy.Results:The study included 49 men (58.3%) and 35 women (41.7%), with a mean age of 39.0 (range, 12-69; SD = 15.0) years. Sixty-three patients (75%) had new diagnoses detected by the addition of ankle arthroscopy. The most common new pathology seen arthroscopically were osteochondral lesions (n = 36, 41.9%) and posterior malleolus fractures (n = 28, 32.6%). Thirty-four patients had a total of 40 additional arthroscopic procedures in conjunction with their fracture management. Complications were noted in 13 patients, with hardware removal (n = 8) being the most common (62%).Conclusion:Ankle arthroscopy can act as a significant diagnostic and prognostic tool and can help address intra-articular injuries without adding considerable cost or serious adverse events.Level of Evidence:Level IV, retrospective case series.

Multi-Ligament Knee Injury with Concomitant Tibial Tubercle Fracture: A Challenging Case Report and Review of the Pertinent Literature

Background: Multi-ligament knee injury (MLKI) combined with a comminuted tibial tubercle avulsion fracture in the literature has been reported as a very rare condition. To the best of our knowledge, there was no case report of this condition associated with open proximal tibia fractures. Case Report: A 32-year-old man was referred to our center, with a comminuted tibial tubercle fracture, patella alta, fracture of the tibia at the proximal meta-diaphyseal junction, a Segond fracture, and proximal tibiofibular dislocation on X-ray images. Further assessment of intra-articular pathologies was performed during the operation and complete tear of anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) tear were identified. Radial tear of the body and anterior root avulsion of medial meniscus were also noted. All of the extra-articular and intra-articular injuries were addressed surgically, except ACL and PCL tear, which were postponed to a second stage. Proximal tibiofibular dislocation was not approached surgically. The rehabilitation protocol included 6 weeks of non-weight-bearing followed by 6 weeks of crutch-assisted partial weight-bearing ambulation, and forbidden active knee extension during the first 6 weeks and allowing the patient to perform passive flexion of the knee to 90 degrees starting from the second week. Following the rehabilitation program, the patient achieved near-full range of motion (ROM) by the end of 6 months of clinical follow-up. Conclusion: By means of our specific surgical technique and post-operative rehabilitation protocol, we led the patient with this specific condition to have fracture union and near-normal ROM by the end of 6 months.

Knee Injury and Osteoarthritis Outcome Score (KOOS) Responder Criteria and Minimal Detectable Change 3-12 Years Following a Youth Sport-Related Knee Injury.

The applicability of thresholds that constitute an acceptable score or meaningful change on the Knee injury and Osteoarthritis Outcome Score (KOOS) in cohorts ≥ 5 years following knee injury is not well understood. The primary objective of this study was to evaluate the association between intra-articular knee injury type and two different KOOS pain thresholds (patient acceptable symptom state (PASS) and Englund symptomatic knee criteria) in the Alberta Youth Prevention of Osteoarthritis (PrE-OA) cohort, which includes participants 3–12 years following a youth sport-related knee injury and uninjured controls with similar age, sex and sport characteristics. Analyses accounted for sex, time since injury and the interaction between time since injury and injury type. Secondary objectives were to report proportions meeting thresholds for KOOS outcomes and minimal detectable change (MDC) from published test–retest reliability data, over a 1–4-year follow-up. Two hundred and fifty-three (253) participants (124 injured, 129 controls) were included in analyses, of which 153 (77 injured, 76 controls) had follow-up data. Similar odds were observed for presence of pain (below PASS threshold) in participants with anterior cruciate ligament (ACL)/meniscus injury (odds ratio (OR) 4.2 (97.5% confidence interval (CI): 1.8, 9.9)) and other knee injuries (OR 4.9 (97.5% CI: 1.2, 21.0)), while there were higher odds for presence of Englund “symptomatic knee” criteria in participants with ACL/meniscus injury (OR 13.6 (97.5% CI: 2.9, 63.4)) than other knee injuries (OR 7.3 (97.5% CI: 0.8, 63.7)) compared to controls. After a median 23.4 (8 to 42) month follow-up, 35% of previously injured participants had at least one KOOS sub-scale score that worsened by more than the MDC published threshold. Despite limited research, this study shows that individuals with youth sport knee injuries other than ACL or meniscus injury may also experience significant pain and symptoms 3–12 years following injury. Replication and further follow-up are needed to identify a possible clinical trajectory towards osteoarthritis.

Synovial Fluid Biomarkers Used to Predict the Degree of Articular Cartilage Injury in the Knee

Injury-driven changes to the intra-articular microenvironment are thought to initiate the development of post-traumatic osteoarthritis. The purpose of this study was to evaluate the accuracy with which synovial fluid and clinical data can predict the presence of high-grade cartilage lesions following intra-articular injury. Synovial fluid aspirate, collected immediately prior to surgical incision from prospectively enrolled patients, was processed using a multiplex magnetic bead immunoassay to determine the concentration of 10 pre-determined cytokines and chemokines. The degree of cartilage injury was assessed intraoperatively using ICRS grading. Logistic regression models were built to predict the presence of high-grade cartilage lesions based on clinical and biomarker data. The models were validated using repeated k-fold cross-validation, and accuracy and quality were assessed using likelihood-ratio tests. 249 patients (mean age: 41.42+/-14.02 years) were enrolled. These patients either had isolated ACL injuries (N=37), isolated meniscus injuries (N=118), combined ACL-meniscus injuries (N=76), or focal chondral lesions (N=18). Four logistic regression models were compared (Table 1). The full model, with 10 synovial fluid biomarker concentrations, age, BMI, and duration of time between injury and surgery, was found to predict high-grade ICRS cartilage damage with 85.71% accuracy. The isolated-biomarker model, consisting of all 10 biomarker concentrations, was found to have a 71.43% prediction accuracy. The isolated-clinical model was found to have a 71.43% prediction accuracy. The stepwise model, consisting of 6 biomarkers and the clinical variables, was found to predict high-grade ICRS cartilage damage with 83.67% accuracy. Through likelihood ratio testing, the stepwise model was confirmed to be superior to the other models. This study demonstrates that the combination of clinical variables and 6 synovial fluid biomarkers can be used to accurately predict high-grade cartilage lesions following intra-articular injury. This suggests that there are distinct inflammatory phenotypes among different degrees of cartilage damage with potential prognostic benefit.

Die pediatrische vordere Kreuzbandläsion – Eminetia intercondylaris-Fraktur

Ligamentous structures are more robust than bone. Therefore, avulsion fractures are more common in children. This principle is seen in bony avulsion fractures of the anterior cruciate ligament in children. Diagnostics include conventional radiographs as well as an MRI to evaluate further intra-articular injuries. The fracture rarely occurs; however, it usually requires arthroscopically assisted reduction and fixation. The indication is given if at least a grade II fracture is evident radiologically. The injury, as well as the surgical procedure, carries the risk of growth damage and arthrofibrosis.

Arthroscopically Assisted Internal Fixation of Foot and Ankle Fractures: A Systematic Review.

Background:Patients undergoing fixation for foot and ankle fractures may experience poor outcomes despite achieving apparent anatomic reduction. Adjunct arthroscopy to identify missed concomitant injuries and subtle displacements has been proposed as a vehicle to enhance functional results for these patients. The purpose of this review is to provide an overview of the literature regarding arthroscopically assisted open reduction and internal fixation (AAORIF) methods for commonly encountered foot and ankle injuries including pilon, ankle, and calcaneus fractures published to date.Methods:A systematic review of the literature was performed using the PubMed database to access all studies reporting on arthroscopically assisted internal fixation methods for pilon, ankle, and calcaneus fractures. Relevant publications were analyzed for details on their respective study designs, the operative technique used, clinical outcomes, outcome instruments used, and reported complications.Results:A total of 32 studies were included in this review. Two studies on pilon fractures, a randomized controlled trial (RCT) and case series with a total of 243 patients, met inclusion criteria. Postoperative articular reductions, bone union, and Mazur scores were found to be significantly better for those using adjunct arthroscopy when compared to those with no arthroscopy use. Patient-reported outcomes were overall reported as excellent for most patients, with no difference in patient-reported outcomes reported in the RCT. For ankle fractures, a total of 17 studies comprising of 2 systematic reviews, 1 meta-analysis, 2 RCTs, 5 retrospective comparative studies, 6 case series, and 1 case-control study met inclusion criteria for this review. Results were mixed, though the overall consensus was that arthroscopy use may help to better visualize concomitant intra-articular injuries and is generally considered safe with at least comparable outcomes to conventional methods. For the calcaneus, 13 studies met the criteria. Two studies were review papers, 8 were case series, and 3 were retrospective comparative studies. A total of 308 patients with 316 fractures formed the basis of analysis. In general, the studies found comparable functional outcomes between with or without arthroscopy use, but found that anatomical reductions were significantly improved with the use of arthroscopy.Conclusions:Arthroscopy shows promise as a valuable adjunct tool for internal fixation of foot and ankle fractures, though definitive conclusions as to its clinical significance have yet to be drawn because of limited evidence. Potential advantages related to the direct visualization of the fracture site and minimally invasive nature of arthroscopy were suggested throughout studies examined in this review. The presence of intra-articular pathology may lead to unexpectedly poor outcomes seen in some patients who undergo surgical fixation of ankle fractures with an otherwise anatomic reduction on postoperative radiographs; the ability to diagnose and address these lesions with arthroscopy, therefore, has the potential to improve patient outcomes. To date, however, available literature has not shown that significant improvements in anatomical reductions and treatment of these intra-articular injuries provide any improvement in outcomes over standard fixation methods. Few prospective randomized controlled studies have been performed comparing these 2 operative techniques, rendering any suggestion that AAORIF improves clinical outcomes over traditional open fixation difficult to justify. Further research is indicated for what may be a potentially promising surgical adjunct prior to advocating for its routine use in patients.

Artroskopski asistirana osteosinteza preloma platoa tibije Šacker III tipa - prikaz slučaja

Introduction. Tibial plateau fractures are complex injuries that, in most cases, require surgical treatment in order to prevent far-reaching consequences for the functionality and quality of life of the patient. While numerous surgical techniques have been described, it is evident that the technique of arthroscopically assisted repositioning (reduction) and internal fixation has the potential to take the lead in the management of these types of injuries. Case report. We present the case of a 36-year-old patient injured in a traffic accident with a fracture of the left tibial plateau, type III by Schatzker classification. After the diagnostic procedures and preparation, the patient was operated on using arthroscopically assisted repositioning (reduction) and internal fixation, with the filling of the bone defect with a combination of allogenic and synthetic bone graft. No other intra-articular injuries were diagnosed intraoperatively. The postoperative recovery went without complications, and after a period of 10 weeks of non-weight bearing and functional rehabilitation, the fracture healed completely, while the patient regained full range of motion in the knee. Conclusion. Although this type of injury has traditionally been treated with open surgery, we believe that minimally invasive surgery is the future, when it comes to tibial plateau fractures Schatzker types I-III. There is still not enough data in the literature regarding the long-term outcomes of this type of treatment, but the early postoperative results are extremely encouraging since this surgical technique enables faster recovery and fewer postoperative complications.

The Dose-Response Effect of the Mast Cell Stabilizer Ketotifen Fumarate on Posttraumatic Joint Contracture: An in Vivo Study in a Rabbit Model.

Background:Posttraumatic joint contracture is a debilitating complication following an acute fracture or intra-articular injury that can lead to loss of motion and an inability to complete activities of daily living. In prior studies using an established in vivo model, we found that ketotifen fumarate (KF), a mast cell stabilizer, was associated with a significant reduction in the severity of posttraumatic joint contracture. Our primary research question in the current study was to determine whether a dose-response relationship exists between KF and posttraumatic joint contracture reduction.Methods:A standardized operative method to create posttraumatic joint contracture in a knee was performed on skeletally mature New Zealand White rabbits. The animals were randomly assigned to 1 of 5 groups (n = 10 per group): a nonoperative control group, an operative control group, or 1 of 3 experimental KF groups (0.01 mg/kg [the KF 0.01 group], 0.1 mg/kg [KF 0.1], or 5.0 mg/kg [KF 5.0]). Flexion contractures were measured following 8 weeks of knee immobilization using a hydraulic material-testing machine. The posterior knee joint capsules were then harvested for quantification of myofibroblast and mast cell numbers with immunohistochemistry analysis.Results:Forty-five rabbits were used in the final analysis. Contracture severity was significantly reduced in the KF 0.1 group (p = 0.016) and the KF 5.0 group (p = 0.001) compared with the operative control group. When converted to a percent response, posttraumatic joint contracture reduction was 13%, 45%, and 63% for the KF 0.01, KF 0.1, and KF 5.0 groups, respectively. A half-maximal effective concentration (EC50) for KF of 0.22 mg/kg was established. There was also a decrease in myofibroblasts, mast cells, and substance P-containing nerve fiber counts with increasing doses of KF.Conclusions:Using a preclinical, rabbit in vivo model of posttraumatic joint contracture, increasing doses of KF were associated with decreasing biomechanical estimates of knee posttraumatic joint contracture as well as decreasing numbers of myofibroblasts, mast cells, and substance P-containing nerve fibers.Clinical Relevance:KF has been used safely in humans for more than 40 years and, to our knowledge, is the first and only agent ready to be potentially translated into an effective treatment for posttraumatic joint contracture.

FRACTURAS TRIPLANAS DE TOBILLO. A PROPÓSITO DE UN CASO

Triplan distal tibial fractures are a complex type of bone injury that occurs in adolescence, prior to closure of the distal tibial physis. They correspond to 6 to 10% of adolescent epiphyseal fractures; and 5 to 10% of intra-articular tibial injuries in pediatrics. The objective of this work is to present a case of triplanar fracture of the distal tibial epiphysis treated with cannulated screws.

A comparative study based on surgical and functional outcome of proximal tibia fractures between unicondylar and bicondylar fractures

Background: Tibia plateau fractures constitute 1%of all fractures. Bicondylar fractures account for 10-30%, whereas isolated medial and lateral condyle fractures constitute the remaining injuries. Although only 3% of these fractures are open injuries, many of them have closed degloving, deep abrasions or severe soft tissue injuries which require careful consideration in deciding the timing and the nature of surgery. Proximal tibia fractures may be difficult to treat even in experienced hands due to intraarticular extension, comminution, cartilage damage and soft tissue injuries of the cruciate ligaments and menisci. Aim: To compare the functional and surgical outcomes of operative treatment of unicondylar and bicondylar fractures. Materials and Methods: It was a prospective and comparative study of Surgical and functional outcome of proximal tibial fractures in the department of orthopaedics from July 2019 to December 2019. Clearance was obtained from the hospital ethical committee. Fifty patients were taken into consideration for the study. All patients are selected on the basis of history, clinical examination and radiography. The Schatzker’s classification was used to classify these fractures. The patients were followed up for an average period of 6 to 12 months. The patients were divided into two groups. Twenty-five patients in the unicondylar fracture group 1and 25 patients in the bicondylar fracture group 2. Results: The mean age of group 1 patients was 45.7210.85 years, and that of group 2 patients was 46.408.602 years (p>0.05). In group 1 there were 18 (72%) males and 7 (28%) females, in group 2 there were 21 (84%) males and 4 (16%) females. In group 1, the mean union time was 3.04 0.351 and in group 2 was 3.1 0.433(p>0.05). In group 1, the mean follow-up time was 12.81 2.09 and in group 2 was 13.04 2.28 (p>0.05). The mean functional score of group 1 was 91.212.27, and in group 2, it was 8718.2 (p>0.050). In group1 mean WOMAC score was

Modern concepts of surgical treatment of anterior shoulder instability in military personnel

Relevance. Shoulder instability covers a wide range of pathology, there is a fairly high level of its prevalence with a tendency to increase in military personnel.Intention. To assess a comprehensive diagnostic and preoperative planning algorithm taking into account the individual characteristics of the patient in order to optimize the choice of effective treatment approach.Methodology. The object of the study was scientific articles indexed in the abstract-bibliographic database of the Russian Science Citation Index (RSCI) and the international database Scopus in 2005-2019.Results and Discussion. The main approaches to assessing intra-articular injuries are analyzed, which are fundamental for choosing the optimal individual treatment approach, including the interpretation of risk factors for unsuccessful clinical outcomes and recurrence. The data on the clinical effectiveness of the main methods of surgical treatment of pathology and the prospects for their development are summarized. The most common types of complications, risk factors for their occurrence are highlighted. The concept of surgical treatment of anterior shoulder instability notes the technological and scientific improvement of diagnostic and planning methods in order to obtain the most complete objective clinical picture and verification of risk factors for selecting optimal and personalized surgical modalities.Conclusion. The development of promising treatment technologies, including additive ones, will allow reaching a qualitatively new level of medical care, increasing efficiency and reducing the risk of complications.

Arthroscopic Reduction and Internal Fixation of Posterior Cruciate Ligament Avulsion Fracture Using an Adjustable-Length Loop Device

A displaced avulsion fracture at the tibial attachment of the posterior cruciate ligament is considered an indication for surgical reduction and internal fixation because nonunion and remaining posterior instability of the knee are common consequences of conservative treatment. The problems with standard open surgical techniques are that they are relatively invasive despite the limited operative field and it is impossible to explore intra-articular lesions by the posterior approach. An arthroscopic procedure has the advantage of being minimally invasive and allowing the surgeon to detect and treat associated intra-articular injuries. We present an arthroscopic reduction–internal fixation technique using an adjustable-length loop device. A trans-septal portal is created to visualize the fracture fragment directly, and the fragment is reduced and penetrated with a cannulated drill under fluoroscopic guidance. An adjustable-length loop device is relayed from the posteromedial portal and pulled out through the fragment in an anterograde fashion, placing a button on top of the fragment. By tightening the loop, downward compression can be applied to the fragment. Overall, this technique provides good reduction and bone union, and excellent clinical outcomes, including posterior knee stability, can be achieved.

A VCP modulator, KUS121, as a promising therapeutic agent for post-traumatic osteoarthritis

Post-traumatic osteoarthritis (PTOA) is a major cause which hinders patients from the recovery after intra-articular injuries or surgeries. Currently, no effective treatment is available. In this study, we showed that inhibition of the acute stage chondrocyte death is a promising strategy to mitigate the development of PTOA. Namely, we examined efficacies of Kyoto University Substance (KUS) 121, a valosin-containing protein modulator, for PTOA as well as its therapeutic mechanisms. In vivo, in a rat PTOA model by cyclic compressive loading, intra-articular treatments of KUS121 significantly improved the modified Mankin scores and reduced damaged-cartilage volumes, as compared to vehicle treatment. Moreover, KUS121 markedly reduced the numbers of TUNEL-, CHOP-, MMP-13-, and ADAMTS-5-positive chondrocytes in the damaged knees. In vitro, KUS121 rescued human articular chondrocytes from tunicamycin-induced cell death, in both monolayer culture and cartilage explants. It also significantly downregulated the protein or gene expression of ER stress markers, proinflammatory cytokines, and extracellular-matrix-degrading enzymes induced by tunicamycin or IL-1β. Collectively, these results demonstrated that KUS121 protected chondrocytes from cell death through the inhibition of excessive ER stress. Therefore, KUS121 would be a new, promising therapeutic agent with a protective effect on the progression of PTOA.

Dutch Guideline on Knee Arthroscopy Part 2: non-meniscus intra-articular knee injury: a multidisciplinary review by the Dutch Orthopaedic Association

Background and purpose — A guideline committee of medical specialists and a physiotherapist was formed on the initiative of the Dutch Orthopedic Association (NOV) to update the Guideline Arthroscopy of the Knee: Indications and Treatment 2010. This next Guideline was developed between June 2017 and December 2019. In part 1 we focused on the meniscus; this part 2 addresses all other aspects of knee arthroscopy. Methods — The guideline was developed in accordance with the criteria of the AGREE instrument (AGREE II: Appraisal of Guidelines for Research and Evaluation II) with support of a professional methodologist from the Dutch Knowledge Institute of Medical Specialists. The scientific literature was searched and systematically analyzed. Conclusions and recommendations were formulated according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method. Recommendations were developed considering the balance of benefits and harms, the type and quality of evidence, the values and preferences of the people involved, and the costs.

Comparing Outcomes between Arthroscopic-Assisted Reduction and Fluoroscopic Reduction in AO Type C Distal Radius Fracture Treatment.

Background Distal radius fracture is one of the most common injuries. Poor functional result with restricted wrist motion can be developed when there is intra-articular fibrous tissue development arising from articular step-off and gapping. Objectives The aim of this study is to compare the functional and radiological outcome between arthroscopic-assisted reduction and fluoroscopic reduction in treating unstable intra-articular distal radius fracture. Methods We retrospectively analyzed 12 patients with intraarticular AO type C distal radius fracture treated with arthroscopic-assisted fracture reduction and internal fixation and compared them with another group of 12 patients in which fracture reduction is assessed by fluoroscopy alone (15 males and 9 females, mean age 57.3, range 27-73). The two cohorts were analyzed for differences in radiological parameters including articular stepping and gapping, palmar tilt, radial inclination, ulnar variance as well as functional outcome in range of motion, grip strength, modified mayo wrist score, and Quick Disabilities of the Arm, Shoulder, and Hand (DASH) score at an average of 12.5 months (range 5-26) after surgery. Results Arthroscopic-assisted fracture reduction group has statistically better restoration of articular stepping and gapping, volar tilt and ulnar variance. Range of motion, grip strength, modified mayo wrist score and Quick DASH score also had statistically significant improvement in arthroscopic group. Conclusion Our study showed arthroscopic-assisted technique can precisely restore radiological parameters in highly comminuted distal radius fracture with good functional outcome. Also, associated intra-articular soft tissue injury can be detected and treated simultaneously. Level of Evidence This is a level III, retrospective cohort study.

Anterior Cruciate Ligament Reconstruction Using Combined Graft of Hamstring and Fascia Lata With Extra-articular Tenodesis. A Technique in Case of Insufficient Hamstrings

A technique for augmentation of the anterior cruciate ligament (ACL) with hamstring graft and lateral extra-articular tenodesis is presented. The patient is positioned supine with the knee flexed 90°. First, intra-articular injuries are addressed arthroscopically, and then autologous hamstring tendons are harvested and measured; the present technique is a resource for cases with a very small graft diameter (less than 8 mm), due to thin tendons or to tendon breakage, even after tripling the hamstring graft, which is prepared using a facia lata strip long enough to fit the lengths of the femoral tunnel, the anterior cruciate ligament graft, and the tibial tunnel. A single femoral tunnel is performed and only 2 interference screws are needed for fixation.

Arthroscopic Findings During Routine Ankle ORIF: What is Being Missed?

Category:Ankle; Arthroscopy; TraumaIntroduction/Purpose:Ankle fractures are among the most common operatively treated injuries by orthopedic surgeons. However, up to 20% of patients will have continued pain and poor patient reported outcomes despite good/excellent radiographic results. Ankle fractures typically occur with varying degrees of intra-articular and soft tissue injury which can include ligamentous injury, loose bodies, and chondral lesions. The aim of study is to document intra-articular findings with ankle arthroscopy prior to ankle open reduction internal fixation (ORIF) and to contribute to the growing body of literature that shows this to be a safe adjunct to fracture fixation.Methods:IRB approval was obtained prior to chart review. This is a retrospective review of ankle fractures that were treated with arthroscopy and ORIF by a single surgeon. Between August 2016 and July 2018 Operative reports, office notes, and images were reviewed to identify intra-articular pathology and fracture type. Analysis was performed with regard to fracture type, presence and location of osteochondral lesions, presence of loose-body, syndesmotic injury, and deltoid injury.Results:Fifty-seven ankle fractures were identified that met inclusion criteria. 84.2% of the fractures had intra-articular pathology, most commonly a syndesmotic injury followed by loose joint body and osteochondral defect.Conclusion:Arthroscopic evaluation during ankle fracture ORIF, particularly pronation external rotation and supination external rotation patterns give a more detailed examination of associated pathology. Arthroscopy at the time of ankle fracture fixation is a safe adjunct and should be considered a potential compliment to routine ORIF of ankle fractures.