Knee Fractures Research Articles

Combined Ipsilateral Fracture and Dislocation of Hip, Knee and Foot Joints - A Case Report -

Combined Ipsilateral Fracture and Dislocation of Hip, Knee and Foot Joints - A Case Report -

Acute primary total knee arthroplasty for peri-articular knee fractures in patients over 65years of age

Acute primary total knee arthroplasty for peri-articular knee fractures in patients over 65years of age

Knee Pain Correlates With Union After Tibial Nailing

The purpose of this study is to evaluate the change in quantitatively scored knee pain during union. This is a retrospective review of prospectively collected data over a 15-year period. Academic medical center. All patients treated with an intramedullary nail were evaluated for knee pain and union. Four hundred twenty-eight patients with 443 tibia fractures were included. All tibia fractures were treated with an intramedullary nail. Patient-based knee pain was scored from 0 to 3. Fracture union was also graded using a modified Hammer score based on cortical bridging and remodeling. We found a significant inverse association between pain and union score (P < 0.01). In contradistinction, there was not a correlation between time from surgery and pain (P = 0.13). Because union score and time were related, a model was created with both parameters. This model demonstrated a statistical correlation with union score (P < 0.01), but not for time from surgery (P = 0.18). We postulated that knee pain may correlate with either union or time from surgery. We found a statistically significant, negative correlation between knee pain and fracture union. There was no such association between pain and time from surgery.

History of knee injuries and knee osteoarthritis: a meta-analysis of observational studies

Although knee injury has been implicated as a risk factor for the development of knee osteoarthritis (OA), there is great disparity in the magnitude of quantifiable risk. Our aim was to systematically review the relationship between history of knee injuries and knee OA. Six electronic databases were searched between August and October 2010. Relative risk estimates or odds ratio (OR) and 95% confidence intervals (95% CI) were extracted or calculated from observational studies meeting the inclusion criteria. Publication bias was determined using funnel plot and the Egger's test. Heterogeneity was examined using Cochran Q test and I(2) statistic. Random effects model was used to pool the heterogeneous results and OR was used to present the results. Subgroup analyses were performed to examine potential causes of heterogeneity. Twenty-four observational studies (20,997 subjects) were included in the meta-analysis of which there were seven cohort, five cross-sectional and 12 case-control studies. The overall pooled OR was 4.20 (95% CI 3.11-5.66, I(2)=81.0%). Association between history of knee injuries and knee OA was significantly different for specified injuries such as ligament or tendon injuries; meniscus damage or meniscectomy; and fracture of femur, knee or lower part of the leg (OR=5.95, 95% 4.57-7.75), compared to unspecified injuries (OR=3.12, 95% 2.17-4.50). History of knee injury is a major risk factor for the development of knee OA irrespective of study design and definition of knee injury. As one of the few modifiable/preventable risk factors, knee injury should be part of the future prevention programme in reducing the risk of knee OA.

Acute primary total knee arthroplasty for peri-articular knee fractures in patients over 65 years of age

Peri-articular knee fractures in osteoporotic or osteoarthritic bone present a challenge to fixation, mobilisation or non-operative management. We present a series of 15 proximal tibial and 11 distal femoral fractures treated with total knee arthroplasty at over mean follow-up period of 38.8 months. The mean age of the patients was 80 years. The choice of the implant and level of constraint was determined as per the nature of injury and preference of the surgeon dealing with the fracture. Patients were allowed rapid mobilisation with immediate full weight-bearing. Good clinical results were achieved with fracture healing, sound fixation and well-aligned flexible knees. Mean Knee Society knee score was 90.2; Knee Society function score was 35.5; Oxford Knee score was 39.5; and Short Form (SF)-36 physical function score was 37.3 and mental score 50.6. Good correlation was noted between Knee society knee score and SF-36 physical function score (Pearson's 0.76, p = 0.001), suggesting that generic health would dictate the final function achieved, whilst high knee scores suggest the satisfactory results of the operation. Analogous to arthroplasty for hip fractures, this technique should be considered as a treatment option in elderly peri-articular knee fractures with osteoporosis and/or osteoarthritis.

Simultaneous ipsilateral hip and knee fracture-dislocations

Simultaneous ipsilateral hip and knee fracture-dislocations are orthopedic emergencies requiring immediate management. Delayed or inadequate treatment usually results in an extremely poor outcome. Reduction of the dislocated hip can be difficult because of the ipsilateral knee dislocation and instability. We report a case involving a 46-year-old man with simultaneous ipsilateral hip and knee fracture-dislocations. He underwent closed reduction for the knee fracture in the emergency department but required open reduction and internal fixation of the unstable hip fracture-dislocation with a distal femur skeletal traction pin under general anesthesia.

A Retrospective Review Over 1999 to 2007 of Head, Shoulder and Knee Soft Tissue and Fracture Dislocation Injuries and Associated Costs for Rugby League in New Zealand

King et al. reported that of 5 941 moderate to serious claims resulting in medical treatment for rugby league injuries, the knee, shoulder, and head and neck body sites and soft tissue and fracture-dislocation injuries were most frequent and costly in the New Zealand national no-fault injury compensation corporation database during 1999 to 2007. However, additional analyses of knee, shoulder and head and neck body sites by soft tissue and fracture-dislocation injury types was required to enable a greater understanding of the nature of injuries most likely to be seen by sports medical personnel dealing with rugby league players. From 1999 to 2007 the injury claims and costs for head and neck soft tissue, fracture-dislocations, shoulders soft tissue significantly increased. Knee soft tissue injury claims and costs significantly decreased from 1999 to 2007. There was no significant difference in knee fracture-dislocation injury claims but there was a significant increase in knee fracture-dislocation injury costs from 1999 to 2007. Changes in the nature of injuries may be related to changes in defensive techniques employed in rugby league during this time. Sports medical personnel dealing with rugby league players should focus their injury prevention strategies on reducing musculoskeletal injuries to the head and shoulder. There should be a focus on increasing awareness of correct tackling technique, head injury awareness and management of suspected cervical spine injuries.

Algorithms can be used to identify fragility fracture cases in physician-claims databases

Physician-billing claims databases can be used to determine the incidence of fractures in the community. This study tested three algorithms designed to accurately and reliably identify fractures from a physician-billing claims database and concluded that they were useful for identifying all types of fractures, except vertebral, sacral, and coccyx fractures. To develop and validate algorithms that identify fracture events from a physician-billing claims database (PCDs). Three algorithms were developed using physician's specialty, diagnostic, and medical service codes used in a PCD from the province of Quebec. Algorithm validity was assessed via calculation of positive predictive values (PPV; via verification of a sample of algorithm-identified cases with hospitalization files) and sensitivities (via cross-referencing respective algorithm-identified fracture cases with a well-characterized fracture cohort). PPV and sensitivity varied across fracture sites. For most fracture sites, the PPV with algorithm 3 was higher than with algorithms 1 or 2. Except for knee fracture, the PPVs ranged from 0.81 to 0.96. Sensitivities were low at the vertebral, sacral, and coccyx sites (0.40-0.50), but high at all other fracture sites. For 95% of fractures, the fracture site identified by algorithm agreed with the fracture site from patients' medical records. Fracture dates identified by algorithm were within 2 days of the actual fracture date in 88% of fracture cases. Among cases identified by algorithm 3 to have had an open reduction (N = 461), 95% underwent surgery according to their respective medical charts. Algorithms using PCDs are accurate and reliable for identifying incident fractures associated with osteoporosis-related fracture sites. The identification of these fractures in the community is important for helping to estimate the burden associated with osteoporosis and the utility of programs designed to reduce the rates of fragility fracture.

Bilateral symmetrical periprosthetic (mirror) fractures of knee fixed with dual plating technique

IntroductionPeriprosthetic fracture following total knee arthroplasty is a potentially serious condition. Here we report a case of bilaterally symmetrical (mirror) fracture of supracondylar area following trivial trauma. Presentation of caseBoth fractures were OTA 33A2 and according to Rorabeck classification they were type II. Both fractures were fixed by dual plating technique using non locking plates. Intra operative fracture site biopsy revealed marked osteopenia and hence the patient was treated for osteoporosis. DiscussionBoth fractures united well at 14 weeks. At final follow up of 6 years there were no radiological signs of implant loosening and the patient was able to walk without any aids and had a range of 80° and 60° flexion in the right and left knees respectively. ConclusionWe conclude that in the pre locking plate's era such difficult case has been successfully managed by dual plating technique.

Treatment advice for periarticular fractures of the knee

股骨远端骨折 一、流行病学概述 股骨远端骨折通常指股骨远侧15 cm内的骨折,包括干骺端及关节面骨折,约占股骨骨折的4%～6%[1-2].骨折在不同人群中呈双峰状分布,15～50岁的年轻患者中,以高能量创伤(交通伤、坠落伤和体育运动损伤等)多见,男性为主;而50岁以上的患者,多为低能量创伤(跌倒摔伤等)所致,常合并严重的骨质疏松症,以女性为主[2],股骨远端骨折中年龄50岁以上者占85%以上[1]。

Bilateral floating knee: An exceptional injury

Presentation, in the samepatient, of bilateral floating knee is exceptional, and in principle,has never been published. We report the case of a patient withmultiple fractures whose four diaphyseal fractures were treatedsurgically with intramedullary nailing in the same operativesession.2. Case reportThe patient, a 20-year-old bricklayer, was the victim of a roadtraffic accident involving collision of his motorbike with a lightvehicle on 23 February 2008 at 5 p.m. He was transferred byhelicopter by the emergency services to our hospital at 7.40 p.m.Assessment of his injuries found head injury without loss ofconsciousness, and bilateral closed diaphyseal fractures of thefemur and both leg bones, without associated neurovascularlesions [Fig. 1A and B]. He also presented articular fracture of theright knee, and abdominal contusion. The full-body CT scanconfirmedfractureoftheleftkidneywithoutassociatedvisceralorbone lesions. The Injury Severity Score of 48 confirmed poly-trauma.

Changes in hip fracture rate before and after total knee replacement due to osteoarthritis: a population-based cohort study

ObjectivesPatients with knee osteoarthritis have an increase in bone mass but no corresponding decrease in risk of fracture. This study describes the rates of hip fracture in subjects with knee...

Extensor malalignment arising from femoral component malrotation in knee arthroplasty: Effect of rotating–bearing

Background Many patellofemoral complications such as anterior knee pain, subluxation, fracture, wear, and aseptic loosening after total knee arthroplasty are attributed to malrotation of the femoral component. Rotating-platform mobile bearings can reduce malrotation between the tibial and femoral components and may also improve patellofemoral maltracking. Methods A computer model (LifeMOD/KneeSIM) of a weight-bearing deep knee bend was validated using cadaver knees tested in an Oxford-type knee rig. Changes in knee kinematics and patellofemoral forces were measured after femoral component malrotation of ± 3°. The effect of a rotating–bearing on these kinematics and forces was determined. Findings In a fixed-bearing arthroplasty femoral component internal malrotation increased tibiofemoral internal rotation by 3.4°, and external malrotation increased tibiofemoral external rotation by 4°. Femoral component malrotation affected patellofemoral lateral shift by up to 2.5 mm, and patellofemoral lateral shear by up to 19 N. When the malrotated femoral component was tested against a rotating–bearing the change in tibiofemoral rotation and patellofemoral lateral shift was less than 1° and 1 mm respectively. The rotating–bearing reduced peak lateral shear by 7 N and peak medial shear by 17 N. Increasing the conformity of the rotating–bearing reduced changes in tibiofemoral rotation due to femoral malrotation and increased the net rotation of the bearing (by approximately 5°) during flexion. Interpretation Our results are consistent with one randomized clinical outcome study and emphasize the value of computational modeling for preclinical design evaluation. It is important to continue to improve existing methodologies for accurate femoral component alignment especially in rotation.

Pyoderma gangrenosum following trauma of the knee: A case of pathergy and review of orthopaedic cases

Pyoderma gangrenosum (PG) is a rare noninfectious neutrophilic dermatosis. Its course can be mild or malignant, chronic or relapsing with remarkable morbidity. We describe a case of PG, which presented with severe wound breakdown following a closed tibial plateau fracture of the left knee. Two weeks after the trauma, the patient developed ulcers in both lower legs. Sepsis was suspected and concomitant treatment was begun. No causal agent was found. A suspicion of PG arose and a treatment with corticosteroids was started. The patient recovered swiftly. The very rare pathology of PG is discussed and a review of the literature of this pathology is given. This diagnosis should always be considered when confronted with an enlarging painful skin lesion, which does not grow organisms when cultured and fails to respond to antibiotic therapy, especially if there are similar lesions in other sites. To our knowledge, this is the first case report of PG following trauma without any skin lesions at initial trauma.

A Modified Thompson Quadricepsplasty for Extension Contracture Resulting From Femoral and Periarticular Knee Fractures

The lack of knee flexion is an increasingly recognized complication of femoral and periarticular knee fractures. This is a significant challenge for both surgeon and patients. This article reports the clinical outcomes of 40 knees in 40 patients who underwent a modified Thompson quadricepsplasty. They were 36 men and 4 women. We performed a modified Thompson quadricepsplasty for all patients without excision of vastus intermedius even in scarred cases. The definitive flexion gain was classified recording to Judet criteria; excellent defined as >100 degrees, good when >80 degrees and <99 degrees, fair when >50 degrees and <79 degrees, and poor when <50 degrees. Patients were operated on average 6.9 months +/- 3.6 months (range, 4-24 months) after first initial surgery. Average follow-up was 17.5 months (range, 12-24 months). According to Judet criteria, 9 patients (22.5%) achieved excellent, 27 patients (67.5%) good, 2 patients (5%) fair, and 2 patients (5%) poor. Final average flexion arc improvement was 65 degrees +/- 25.99 degrees with a range between 5 degrees and 100 degrees. Our complications included two cases (5%) of superficial infection and one case (2.5%) with patellar fracture. In patients who had preoperative extension lag, we did not achieve a significant improvement of the extension lag (p = 0.062). Modified Thompson quadricepsplasty is a promising procedure with satisfactory results. It provides significantly results if it is performed earlier and in more severe extension contracture.

Validation of the Ottawa Knee Rule in Iran: a prospective study

BackgroundThis study was designed to determine the accuracy of the Ottawa Knee Rule (OKR) when applied to patients with acute knee injury in the Iranian population of the Imam Hospital...

Circular External Fixation in Knee Arthrodesis Following Septic Trauma Sequelae – Preliminary Report

Deep infection is one of the most devastating complications after knee fractures. It may be related to the initial fracture status or, more commonly, the surgical intervention. From 1991 to 2003, 12 patients underwent knee fusion to treat resistant infection after complex knee fractures or arthrodesis fractures using the Ilizarov method and frame. There were 9 men and 3 women (mean age, 39.7 years). Two-thirds of the patients had long-standing infection and 5 patients had undergone earlier attempts at knee arthrodesis. Correction of concurrent malalignment was achieved in 2 patients. Bone transport using the same arthrodesis frame was necessary in 2 patients to overcome large bony defects. Solid fusion was achieved in all patients by the end of treatment. The average duration of external fixation was 22 weeks (range: 11-44 weeks). No patients required secondary bone grafting to achieve union. Complications occurred in 6 (50%) patients. The most common problem seen was pin tract infection, but only 2 patients required surgical intervention for its treatment. The study emphasizes the clinical success of the Ilizarov method in knee arthrodesis after infected fractures.

A Pilot Study of Vitamin D and Balance Characteristics in Middle-Aged, Healthy Individuals

To examine what relationship exists between 25-hydroxyvitamin D (25-OHD) levels and postural competency in the middle-aged, healthy individual. A community convenience sample. Major medical center employees. Thirty-five healthy individuals older than 40 years of age who demonstrated appropriate cognition and physical stability. Specific exclusion criteria included any prior history of hip, knee, or ankle fracture or surgery. Questionnaire regarding exercise and sun exposure, vitamin D blood level, followed by computerized dynamic posturography (CDP) assessment of balance. CDP scores of individuals with normal and subnormal vitamin D levels. Thirteen male and 22 female subjects had a mean age of 56.0 years (standard deviation, 7.6; range, 42-77). Self-reported, retrospective mean weekly sun exposure was 7.36 hours (standard deviation, 6.4 hours). Twenty-six subjects (76.5%) described themselves as regular exercisers. Mean 25-OHD level for the sample was 21.5 ng/mL (standard deviation, 12.1 ng/mL). When subjects were divided into those with low and high 25-OHD levels, there was no significant difference in composite limits of stability reaction time scores (mean, 0.98 seconds and 0.84 seconds; P = .23), composite maximal velocity scores (4.2 degrees /second and 5.5 degrees /second; P = .08), composite end point excursion (70.3% and 70.1%; P = .95), and directional control composite scores (71.0% and 71.4%; P = .93). The two groups also showed no significant differences in rhythmic weight shifting left and right as well as forward and backward. Unlike studies involving elderly subjects, this study of younger, healthy subjects did not demonstrate a relationship between vitamin D and balance.

Factors Associated with the Timed Up and Go Test Score in Elderly Women

[Purpose] The purpose of this study was to determine the relationship between the Timed Up and Go (TUG) test score and the physical performance of women aged 75 years and over according to orthopedic status. [Subjects] The participants were 832 elderly women (mean age, 78.6 ± 2.7 years) who carried out their daily activities independently in their own homes and did not have histories of stroke or osteoarthritis of the hip. [Methods] Maximal voluntary contractions of the knee extensor and ankle plantar flexor muscle groups were measured using a hand-held dynamometer. One-leg standing time and usual walking speed were assessed as balance and walking performances. [Results] The TUG score was more strongly correlated with walking speed (r = -0.776) than the other measures of physical performance (r = -0.228 to -0.399). Correlations between the TUG score and walking speed were strongest for participants with knee osteoarthritis (r = -0.824) and fractures after 60 years of age (r = -0.809). A linear regression model of data from all participants showed that all performance scores and age were determinants of the TUG score (R2 = 0.634). The determinants of the TUG score for participants with osteoarthritis or fractures were walking speed and one-leg standing score, and age (R2 = 0.701) and walking speed, age, and knee strength (R2 = 0.688). Beta estimates of walking speed for all participants and for the subgroups were higher (-0.69 to -0.76) than those for the other determinants (-0.06 to 0.14). [Conclusion] Walking speed is a stronger determinant of the TUG score than muscle strength or balance for elderly women.

Nonunion of a Hoffa fracture in an adult

The coronal fractures of femoral condyles, known as Hoffa fractures, are a rarity. Conservative management often leads to unsatisfactory results and nonunion. In this study, we present a case of a 35-year-old patient with an established nonunion of medial Hoffa fracture of right knee treated with open reduction and internal fixation.