Chauffeur fractures or isolated radial styloid fractures (IRSF) are known to be associated with scapholunate ligament (SL) injuries. Diagnosis without arthroscopic confirmation is difficult in acute fractures. Acute management of this injury with early repair may prevent the need for more complex reconstructive procedures for chronic injuries. We investigated if all IRSF should be assessed arthroscopically for concomitant SL injuries.

We performed a prospective cohort study on patients above the age of 16, presenting to the Gold Coast University Hospital with an IRSF, over 2 years. Plain radiographs and computerized tomography (CT) scans were performed. All patients had a diagnostic wrist arthroscopy performed in addition to an internal fixation of the IRSF. Patients were followed up for at least 3 months post operatively. SL repair was performed for all Geissler Grade 3/4 injuries.

10 consecutive patients were included in the study. There was no radiographic evidence of SL injuries in all patients. SL injuries were identified arthroscopically in 60% of patients and one third of these required surgical stabilisation. There were no post operative complications associated with wrist arthroscopy.

We found that SL injuries occurred in 60% of IRSF and 20% of patients require surgical stabilisation. This finding is in line with the literature where SL injuries are reported in up to 40-80% of patients. Radiographic investigations were not reliable in predicting possible SL injuries in IRSF. However, no SL injuries were identified in undisplaced IRSF. In addition to identifying SL injuries, arthroscopy also aids in assisting and confirming the reduction of these intra-articular fractures.

In conclusion, we should have a high index of suspicion of SL injury in IRSF. Arthroscopic assisted fixation should be considered in all displaced IRSF. This is a safe additional procedure which may prevent missed SL injuries and their potential sequelae.

Introduction

Well-balanced soft tissue is essential for achieving a good result when performing total knee arthroplasty. The preoperative planning is critical for ensuring a good operation. This study evaluated the preoperative distractive stress radiographs in order to quantify and predict the extent of medial release according to the degree of varus deformity in primary total knee arthroplasty.

Introduction

The acquisition of proper soft tissue balance is one of the crucial factors for preventing long-term failure and obtaining successful treatment outcomes of total knee arthroplasty (TKA). Medial collateral ligament (MCL) release is essential for encountering severe varus deformity. However, conventional subperiosteal MCL release for severe varus deformity can cause the complete detachment of MCL. This study compared retrospectively the results of complete distal release of the MCL with those of medial epicondylar osteotomy during ligament balancing in varus knee TKA

Introduction

Medial open wedge high tibial osteotomy (HTO) is a generally accepted surgical method for medial unicompartmental osteoarthritis with varus malalignment of the lower extremity. However, several authors have suggested the possibility of unintentional secondary changes during open wedge HTO, which include posterior tibial slope angle (PTS) change, tibial rotation change and medial–lateral slope change of the knee joint line, may influence knee kinematics and produce poor clinical outcomes. We sought to analyze postoperative changes in three-dimensional planes using a virtual wedge osteotomy 3D model. Pre- and post-operative changes in the medial proximal tibial angle (MPTA) in the coronal plane, posterior tibial slope (PTS) in the sagittal plane, and axial tibial rotation were measured as dependent variables. And this study was attempted to determine their mutual relationships and to clarify which independent variables, including hinge axis angle and gap ratio, affect tibial rotation change and PTS change by applying the identified hinge position.

Severely varus deformed knees are common in Asian countries due to lifestyles such as sitting on the floor. MCL release is essential for encountering severe varus deformity. However, conventional subperiosteal MCL release for severe varus deformity can cause the complete detachment of MCL and it can induce mid-flexion instability. We performed medial epicondylar osteotomy when conventional subperiosteal MCL release couldn't resolve tight medial gap of severely varus deformity. The epicondyle is reattached with #5 nonabsorbable sutures or screws (figure 1). This study evaluated the clinical and radiologic results of medial epicondylar osteotomy for severe varus TKA. From 2004 to 2012, 63 cases (of total 909 cases of primary TKA, 6.9%) with a minimum follow-up of 2 years (24 to 116 months) were included in this study. Two cases of 63 cases were excluded due to the loss of follow up. Intraoperative medial and lateral gap difference in flexion and extension was accepted at less than 2 mm. Average follow up was 50.6±29.8 months (24–116 months). Average clinical knee score was 35.5±17.1 preoperatively and 89.1±8.4 postoperatively. Average function score improved from 48.7±16.0 preoperatively to 88.6±8.0 postoperatively. Average flexion contracture was reduced from 8.5±9.8° preoperatively to 1.0±2.3° postoperatively and range of motion improved from 112.0±21.8° preoperatively to 118.9±13.3° postoperatively. Preoperative femorotibial angle was average varus 10.4±5.7° and mechanical axis was average varus 16.7±5.6°. Postoperative femorotibial angle was average valgus 5.5±3.4° and mechanical axis was average varus 1.0±4.1° (figure 2). Valgus stress radiographs showed average 1.6±0.7 mm gap (femoral implant to liner) and varus stress radiographs revealed average 2.7±1.5 mm gap. The difference with medial and lateral gaps was average 1.2±1.1 mm (figure 2). Unions of bony wafer were 39 bony and 22 fibrotic unions (figure 3). According to the difference with medial and lateral gaps, bony union was average 1.2±1.2 mm and fibrotic union was average 1.2±0.9 mm. There were no significant differences between bony and fibrotic union groups. The clinical and radiological results of medial epicondylar osteotomy are satisfactory in severe varus TKA. The stability with bony and fibrotic unions is not different.

Objectives

C-reactive protein(CRP) Used as screening test for acute periprosthetic joint infection has high sensitivity and low specificity. So there are many reasons except acute infection after total knee arthroplasty to elevate CRP level but it is unclear what reasons exactly were concerned. We therefore performed this study to determine the Causes of elevated CRP level in the early-postoperative period after primary total knee arthroplasty.

Introduction

The pathophysiology of osteonecrosis of femoral head (ONFH) is uncertain for most cases with speculation of vascular impairment and changes in cell biology due to multi-factorial etiologies including corticosteroid, alcohol, smoking, trauma, radiation or caisson disease and genetic. Extracorporeal shockwave therapy (ESWT) began with an incidental observation of osteoblastic response pattern during animal studies in the mid-1980 that generated an interest in the application of ESWT to musculoskeletal disorders. The mechanism of shockwave therapy is not fully understood but several reports showed better clinical outcomes and promoted bone remodelling and regeneration effect of the femoral head after ESWT in ONFH. Therefore, we compared the clinical results of the use of extracorporeal shock wave therapy (ESWT) on the patients with ONFH in radiographic staging.

Introduction

A large proportion of patients with osteoarthritis of the knee, present with bilateral symptoms at the outpatient department. A simultaneous total knee arthroplasty (TKA) procedure is available for such patients. The first operation in a simultaneous surgery may provide information to the operator to determine component size, soft tissue balancing, and estimate gap size for the second operation, while the second team usually conducts an operation in a confined space on the contralateral side during closure for the first operation, which can disturb cooperation during the second operation and may lead to more intra-operative surgical errors. We hypothesized that the circumstances of the two consecutive operations of a simultaneous bilateral TKA are different, could lead to different outcomes of overlapping bilateral TKAs. We therefore addressed the following research questions to determine whether there would be differences in short-term clinical outcomes, radiographic results, and implanted component size between the two sides

Introduction The importance of soft tissue and bone preservation at total hip replacement is well recognised. This paper reviews the results of a stem designed not to contact the femoral cortex, thus ensuring exclusive metaphyseal loading.

Methodology Eighty-one consecutive metaphyseal bearing cementless stems were followed up for 2 – 6 years (mean 3 years 9 months).

There were 27 male and 46 female patients (8 bilateral). The mean age was 42 (range 18 to 57). Secondary osteoarthritis was the most common presenting pathology. There were no exclusion criteria beyond those applicable to any replacement arthroplasty.

Results One hip was revised for deep infection. Five hips required cerclage wiring of an intra-operative calcar fracture and there was one post-operative dislocation. One patient, who was being treated for an acute psychotic condition, complained of severe pain. Three patients complained of mild to moderate discomfort in the region of the greater trochanter. The remaining patients were asymptomatic and there was no thigh pain.

There was no evidence of stem subsidence. A sclerotic line was frequently observed around the non-coated distal stem. Buttressing of the coated area was almost universally seen in the metaphyseal region. There were no radiolucent lines in any of the zones around the textured area in the metaphyseal region.

Conclusion These findings persuaded the authors that the stem of the femoral component was superfluous. This paper includes a preliminary report of the initial experience with a conservative, bone and soft tissue sparing metaphyseal femoral implant. Early results are encouraging.

Purpose: Using the finite element analysis, the authors analyze the effect of the articulating material properties of the total hip arthroplasty to stress and micro-motion of the proximal femur and the femoral stem.

Material and methods: The head (28mm) and the acetabular component (outer diameter = 54mm, liner thickness = 11.4mm) were considered as ceramic on ceramic, cramic on polyethylene, metal on metal, metal on polyethylene and metal on metal-polyethylene. The femur was modeled with different friction coefficients according to the different contact portion of the femoral stem, which was modeled after Omni fit HA #9(Osteonics, Allendale, NJ). Non-linear contact analysis was proceeded in human with body weight 70Kg at one leg standing and stair climbing.

Result: The maximal yield strength was always higher in hard-hard coupling. In one leg standing, the site of maximal yield strength was represented at the contact point of articulation. In stair climbing, the site of maximal yield strength was represented at the same site in hand on hard coupling but at the lateral aspect of the neck in hard-soft couplings. There were no changes in the patterns of stress distribution but the micro-motions were up to the limit of bone in growth in hard-hard coouplings.

Conclusion: The maximal yield strength and the micro-motions revealed different values according to the articulating materials. These findings were considered valuable information to postoperative management and longavity of the total hip prosthesis but requiring the following experimental and clinical study.