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PubMed1997

[Particular posteromedial and posterolateral approaches for the treatment of tibial head fractures].

Tibial plateau fractures with depression of posterior aspects of the proximal tibia cause significant therapeutic problems. Posterior fractures on the medial side are mainly highly instable fracture-dislocations (Moore type I). Posterolateral fractures usually cause massive depression and destruction of the chondral surface. Surgical exposure of these fractures from anterior requires major soft tissue dissection and has a significant complication rate. However, incomplete restoration of the joint surface results in chronic postero-inferior joint subluxation, osteoarthritis and pain. We present new specific approaches for posterior fracture types avoiding large skin incisions, but allowing for atraumatic exposure, reduction and fixation. Posteromedial fracture-dislocations are exposed by a direct posteromedial skin incision and a deep incision between medial collateral ligament and posterior oblique ligament. The posteromedial pillar and the posterior flare of the proximal tibia are visualized. The inferior extent of the joint fragment can be reduced by indirect techniques or direct manipulation of the fragment. Fixation is achieved with subchondral lag screws and an anti-glide plate at the tip of the fragment. Posterolateral fractures are exposed by a transfibular approach: the skin is incised laterally, the peroneal nerve is dissected free. The fibula neck is osteotomized, the tibiofibular syndesmosis is divided and the fibula neck is reflected upwards in one layer with the meniscotibial ligament and the iliotibial tract attachment. Reflexion of the fibula head relaxes the lateral collateral ligament, allows for lateral joint opening and internal rotation of the tibia and thus exposes the posterolateral and posterior aspect of the tibial plateau. Fixation and buttressing on the posterolateral side can be achieved easily with this approach. In closure, the fibula head is fixed back with a lag screw or a tension-band system. These two exposures can be combined in bicondylar posterior fracture situations. 168 cases with tibial plateau fractures had ORIF in the authors' institution from 1988 to 1994. 26 of these patients had a total of 29 posterior exposures to treat their fractures (9 posteromedial, 12 posterolateral, 3 combined posteromedial/posterolateral and 2 posterior/anterior exposures). No specific complications occurred related to these exposures, i.e. no skin slough, no infection, no nerve palsy. The mean duration of follow-up was 4 years. Twenty-one cases healed uneventfully: 12 were excellent in Rasmussen's clinical score, 8 were good and 1 was fair. Seven patients were excellent in the radiological score, 13 good and 1 fair. Five of the 26 cases had revision surgery: 3 patients developed valgus or retrocurvatum deformity and were successfully treated by an osteotomy. They obtained a good result at follow-up. Two fractures in elderly patients were revised to an endoprosthesis.

Bone Nails↗
PubMed2000

[Retropatellar autologous cartilage-bone transplantation. A treatment option in severe cartilage damage].

In a 32 years old professional handball layer, the micro-traumata typical of this game led to retropatellar cartilage lesion, which became sympthomatic following an distortion-impact trauma. Since the patient remains symptomatic after initial conservative treatment as well as arthroscopic chondroplastic, osteo-chondral transplantation was performed. There was a good functional result 6 months after surgery.

Adult↗
PubMed2001

[Preoperative computerized tomography diagnosis of fractures of the tibial plateau].

Within the last decade computed tomography has become an important instrument for skeletal diagnosis. In this study the value of helical CT-scan was compared with plan X-rays and conventional tomography in 45 patients having sustained an intraarticular tibia plateau fracture. Between plan roentgenogramms and CT-scan the fracture classification according to the AO-classification was changed in 40% of all patients, in 39 cases the amount of impression or dislocation increased with a mean of 4.2 mm. Especially tiny fragments were better visible and therefore responsible for the shift of many B1 fractures to group B3. The difference between conventional tomography and computed tomography was less impressive, a change of fracture classification could be observed in only 6.7% of all cases.

Adult↗
PubMed2002

Avulsion fractures of both anterior and posterior cruciate ligament tibial insertions.

Ipsilateral femur fracture, patellar fracture, and tibial avulsion fractures of anterior and posterior cruciate ligament injuries are reported. We know of no other report of an injury such as this in the literature. We sutured the tibial avulsion fractures by transtibial suturing technique and internally fixated the femur by intramedullary interlocking nailing 2 weeks after the trauma. After 1 year the results were evaluated as very good. Early surgical repair is valuable in these injuries.

Adolescent↗
PubMed2002

Reconstruction of the lateral patellar retinaculum following lateral release: a case report.

The recognition and treatment of iatrogenic medial subluxation of the patella following lateral retinacular release may be difficult. The diagnosis even by magnetic resonance imaging may be difficult. The use of a medial patellar stabilising brace may be helpful in the diagnosis, alleviating symptoms in the short term and to gain the confidence of the patient. A technique of direct repair that was used successfully is described in a case report.

Adult↗
PubMed1999

Locked lateral patellar dislocation: a rare case of irreducible patellar dislocation requiring open reduction.

Irreducible patellar dislocations are rare injuries, but those that do occur are mainly directed intra-articularly. In this case, a 53-year-old woman sustained a locked lateral patellar dislocation when falling from a chair. A preoperative CT-scan revealed bony avulsions at the insertion of the vastus medialis muscle, the medical retinaculum, and partial disruption of the ligamentum patellae from the apex patellae. Open reduction was necessary and the torn structures were reattached with anchor systems and sutures. Postoperative management included intensive physiotherapy. At 1 year after surgery, the patient was without swelling or pain and had a normal gait, but flexion was restricted to 120 degrees. All postoperative radiographs showed the patella correctly placed in the femoral groove.

Accidental Falls↗
PubMedDate not supplied

Elongation of the aorta and multiple cardiovascular abnormalities associated with larsen syndrome.

Larsen syndrome is a genetically heterogeneous group of disorders characterized by multiple joint dislocations and a characteristic face. We describe a girl with the typical features of Larsen syndrome. She also had associated multiple cardiovascular anomalies. The anomalies included elongation of the aorta, bicuspid aortic valve, subaortic stenosis, mitral valve prolapse with mitral regurgitation, atrial septal defect of the secundum type, and a patent ductus arteriosus.

Abnormalities, Multiple↗
PubMed2001

The effect of electrostimulation and high load exercises in patients with patellofemoral joint dysfunction. A preliminary report.

Traditional conservative treatment for patellar disorders is successful in about 80 percents of cases. We introduced two new conservative treatment protocols for patellar pathology in order to further improve the success rate. The first protocol consisted of high load/low repetition quadriceps femoris training (10 patients) while the second enclosed selective electrostimulation of vastus medialis muscle (7 patients). Results were evaluated clinically and neurophysiologically. High load/low repetition training resulted in significant increase of maximal voluntary contraction of quadriceps muscle (P < 0.001). Significant gain of Activity (P = 0.017) and Kujala scores (P = 0.07) was observed in group with high load/low repetition quadriceps training compared to patients with electrostimulation. There was no significant change in neurophysiological or clinical status between the beginning and the end of treatment with electrostimulation. Our results indicate that high load/low repetition quadriceps femoris training poses an important alternative to traditional conservative treatment protocol for patellar disorders.

Electric Stimulation↗
PubMedDate not supplied

Injuries in young athletes.

UNLABELLED: Most injuries in children's sports are minor and self-limiting, suggesting that children and youth sports are safe. A child's skeletal system shows pronounced adaptive changes to intensive sports training. Sports injuries affect both growing bone and soft tissues and could result in damage of the growth mechanisms with subsequent life-lasting damage. During growth there are significant changes in the biomechanical properties of bone. In young athletes, as bone stiffness increases and resistance to impact diminishes, sudden overload may cause bones to bow or buckle. Epiphyseal injuries are usually due to shearing and avulsion forces, although compression also plays a significant role. Given the remarkable healing potential of bone in youngsters, fractures that initially united with some deformity can completely remodel and appear totally normal in later life. CONCLUSION: As the risk of injuries sustained by young athletes can be significant, it is essential that training programmes take into account their physical and psychological immaturity, so that growing athletes can adjust to their own body changes.

Athletic Injuries↗
PubMed1999

Factors affecting the rectus femoris-patellar tendon Q-angle, measured using a computed tomographic scan.

We devised a method to measure the Q-angle (the angle between the rectus femoris and the patellar ligament), using computed tomography (CT), in 1993. In this study, I investigated the lateral shift at each point forming the angle as factors affecting the Q-angle. The study group consisted of 83 patients with recurrent patellar dislocation (83 lower limbs) and a control group of 55 healthy people (55 lower limbs). A lateral shift was found in the anterosuperior iliac spine (ASIS) in the dislocation group compared with the control group (P < 0.01). A lateral shift was also found in the anteroinferior iliac spine (AIIS) in the dislocation group compared with the control group (P < 0.05). A medial shift was found in the bottom of the groove of the femoral condyle in the dislocation group compared with the control group (P < 0.001). A lateral shift was also seen in the tibial tubercle of the dislocation group in comparison with the control group (P < 0.0001). Lateral shift of the tibial tubercle may be the main factor influencing the Q-angle, as measured by CT.

Adolescent↗
PubMed1982

Injury to the popliteal artery.

During a 32 year period, 164 patients with 165 popliteal artery injuries were treated. One hundred twenty-five injuries were due to penetrating trauma, and 40 to blunt force. During the first decade reviewed, with ligation the main method of management, the amputation rate was 74 percent. Almost routine attempts at vascular repair over the ensuing 10 years reduced the amputation rate to 28 percent. During the final 12 years, six amputations were required for 81 injuries, thereby producing an amputation rate of only 6 percent. From this experience, the following principles of management have evolved: (1) early diagnosis is best accomplished by a careful history and detailed physical examination, not by arteriography; (2) thrombectomy followed by distal heparinization before repair is the best method for guaranteeing an adequate arterial outflow tract and thus successful revascularization; (3) resection of all injured vessels with reconstitution of continuity by the use of an interposed saphenous vein graft is often warranted to avoid tension; (4) popliteal vein repair should be performed when practical; and (5) subperiosteal fibulectomy-fasciotomy should be done routinely immediately after vascular repair.

Adolescent↗