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The Bone & Joint Journal Feb 2015Revision knee arthroplasty presents a number of challenges, not least of which is obtaining solid primary fixation of implants into host bone. Three anatomical zones...
Revision knee arthroplasty presents a number of challenges, not least of which is obtaining solid primary fixation of implants into host bone. Three anatomical zones exist within both femur and tibia which can be used to support revision implants. These consist of the joint surface or epiphysis, the metaphysis and the diaphysis. The methods by which fixation in each zone can be obtained are discussed. The authors suggest that solid fixation should be obtained in at least two of the three zones and emphasise the importance of pre-operative planning and implant selection.
Topics: Arthroplasty, Replacement, Knee; Diaphyses; Epiphyses; Femur; Humans; Reoperation; Tibia
PubMed: 25628273
DOI: 10.1302/0301-620X.97B2.34144 -
Atencion Primaria 2019
Topics: Adult; Chondroma; Diaphyses; Female; Humans; Humerus; Shoulder Pain
PubMed: 30686678
DOI: 10.1016/j.aprim.2018.12.003 -
Orthopaedics & Traumatology, Surgery &... Feb 2018The Monteggia injury is defined as radial head dislocation with a fracture of the ulnar shaft. This combination should be sought routinely in patients with ulnar... (Review)
Review
The Monteggia injury is defined as radial head dislocation with a fracture of the ulnar shaft. This combination should be sought routinely in patients with ulnar fractures, even when the displacement is small. The emergent management is simple, as reducing the ulnar fracture is usually sufficient to stabilise the radial head. Internal fixation of the ulna deserves to be widely used to fully stabilise the radial head. Irreducibility of the radial head at the acute stage may indicate an interposition, which requires open surgery on the joint. Radial head dislocation may occur even with minimal displacement of the ulnar fragment. Chronic Monteggia fractures are more challenging to treat and their outcomes are more variable. The radial head becomes irreducible after 2 to 3 weeks. When a simple surgical approach fails to ensure stable reduction, the most widely used method at present is open reduction of the radial head and proximal osteotomy of the ulnar shaft. Stability must be obtained intra-operatively. Without treatment, radial head dislocation may be well tolerated for several months or even years. In the long term, however, osteoarticular remodelling results in loss of joint congruence, pain and, eventually, osteoarthritis. Radiographs must therefore be obtained on an emergency basis and analysed with great care to avoid missing a Monteggia fracture.
Topics: Diagnosis, Differential; Diaphyses; Elbow Joint; Fracture Fixation, Internal; Humans; Monteggia's Fracture; Osteotomy; Radiography; Treatment Outcome; Ulna
PubMed: 29174872
DOI: 10.1016/j.otsr.2017.04.014 -
Journal of Feline Medicine and Surgery Jul 2022Cats frequently present with diaphyseal fractures, which require treatment in order to achieve a good return to function. These fractures often occur due to significant... (Review)
Review
PRACTICAL RELEVANCE
Cats frequently present with diaphyseal fractures, which require treatment in order to achieve a good return to function. These fractures often occur due to significant trauma; for example, as a result of road traffic accidents, high-rise syndrome and dog bite wounds. The first priority is to ensure the patient is systemically well before embarking on any specific surgical treatment of a fracture.
CLINICAL CHALLENGES
Surgical management of diaphyseal fractures can be challenging due to the surgical approach for some bones being technically demanding, for example because of the presence of important neurovascular structures, and the small size of feline bones, which limits the choice of implant size and strength. Further, it may be difficult to visualise fracture alignment when using minimally invasive techniques, although the use of intraoperative fluoroscopy can aid with this, and malalignment can be common for some fracture repairs, particularly in cases where anatomical reconstruction is not possible.
AIMS
This review focuses on diaphyseal long bone fractures and aims to assist decision-making, with an overview of the management and treatment options available.
EVIDENCE BASE
Many textbooks and original articles have been published on aspects of managing fractures in small animals. The authors also provide recommendations based upon their own clinical experience.
Topics: Animals; Bone Plates; Cat Diseases; Cats; Diaphyses; Dog Diseases; Dogs; Fluoroscopy; Fractures, Bone
PubMed: 35775308
DOI: 10.1177/1098612X221106354 -
Cureus Dec 2022Osteosarcoma is a tumour that can originate in any bone and is the most frequent malignant tumour of the skeleton. It typically develops close to the metaphyseal growth...
Osteosarcoma is a tumour that can originate in any bone and is the most frequent malignant tumour of the skeleton. It typically develops close to the metaphyseal growth plates in the limbs' long bones. The three most prevalent places are the femur, tibia, and humerus. Additional locations include the pelvis, skull, and jaw. Diaphyseal osteosarcoma involves a smaller population and is highly uncommon. Conventional kinds of osteosarcoma, such as osteoblastic, chondroblastic, and fibroblastic types, as well as telangiectatic, multifocal, parosteal, and periosteal types, are some of the variations of the disease. The primary bone tumour (cancerous) is generated by the formation of immature bone and primarily affects adolescents. We present a case of a 45-year-old menopausal female with left tibial osteosarcoma of the proximal 1/3 diaphysis infected with maggots and complaints of left knee pain and tingling.
PubMed: 36686136
DOI: 10.7759/cureus.32718 -
Medicine and Science in Sports and... Dec 2022Female runners have high rates of bone stress injuries (BSIs), including stress reactions and fractures. The current study explored multidirectional sports (MDS) played...
PURPOSE
Female runners have high rates of bone stress injuries (BSIs), including stress reactions and fractures. The current study explored multidirectional sports (MDS) played when younger as a potential means of building stronger bones to reduce BSI risk in these athletes.
METHODS
Female collegiate-level cross-country runners were recruited into groups: 1) RUN, history of training and/or competing in cross-country, recreational running/jogging, swimming, and/or cycling only, and 2) RUN + MDS, additional history of training and/or competing in soccer or basketball. High-resolution peripheral quantitative computed tomography was used to assess the distal tibia, common BSI sites (diaphysis of the tibia, fibula, and second metatarsal), and high-risk BSI sites (base of the second metatarsal, navicular, and proximal diaphysis of the fifth metatarsal). Scans of the radius were used as control sites.
RESULTS
At the distal tibia, RUN + MDS ( n = 18) had enhanced cortical area (+17.1%) and thickness (+15.8%), and greater trabecular bone volume fraction (+14.6%) and thickness (+8.3%) compared with RUN ( n = 14; all P < 0.005). Failure load was 19.5% higher in RUN + MDS ( P < 0.001). The fibula diaphysis in RUN + MDS had an 11.6% greater total area and a 11.1% greater failure load (all P ≤ 0.03). At the second metatarsal diaphysis, total area in RUN + MDS was 10.4% larger with greater cortical area and thickness and 18.6% greater failure load (all P < 0.05). RUN + MDS had greater trabecular thickness at the base of the second metatarsal and navicular and greater cortical area and thickness at the proximal diaphysis of the fifth metatarsal (all P ≤ 0.02). No differences were observed at the tibial diaphysis or radius.
CONCLUSIONS
These findings support recommendations that athletes delay specialization in running and play MDS when younger to build a more robust skeleton and potentially prevent BSIs.
Topics: Humans; Female; Bone Density; Bone and Bones; Radius; Tibia; Running
PubMed: 35941520
DOI: 10.1249/MSS.0000000000003016 -
Orthopaedics & Traumatology, Surgery &... Feb 2018Relatively poor results have been reported with open reduction and internal fixation of complex fractures around the knee in elderly osteoporotic patients, and primary... (Review)
Review
Relatively poor results have been reported with open reduction and internal fixation of complex fractures around the knee in elderly osteoporotic patients, and primary total knee arthroplasty (TKA) has been proposed as an alternative solution. While limiting the number of procedures, it meets two prerequisites: (1) to save the patient's life, thanks to early weight-bearing, to limit decubitus complications; and (2) to save knee function and patient autonomy, thanks to early knee mobilization. There are 3 main indications: complex articular fractures in elderly patients with symptomatic osteoarthritis prior to fracture; complex articular fractures of the tibial plateau in elderly patients whose bone quality makes internal fixation hazardous; and major destruction of the distal femur in younger patients. Although admitted in emergency, these patients require adequate preoperative management, including a multidisciplinary approach to manage comorbidities, control of anemia and pain, and assessment and management of vascular and cutaneous conditions. Preoperative planning is crucial, to order appropriate implants and materials that may be needed intraoperatively. Surgical technique is based on the basic principles of revision surgery as regards choice of implant, steps of reconstruction, bone defect management and implant fixation. For complex fractures of the distal femur, primary temporary reduction is a useful "trick", to determine the level of the joint line and femoral rotation. Complementary internal fixation may be required in case of diaphyseal extension of the fracture and to prevent inter-prosthetic fractures. In the literature, the results of primary TKA for fracture are encouraging and better than for secondary TKA after failure of non-operative treatment or internal fixation, with lower rates of revision and complications, earlier full weight-bearing and better functional results. Loss of autonomy is, however, frequent, and 1-year mortality is high, especially following complex femoral fractures in the elderly.
Topics: Arthroplasty, Replacement, Knee; Diaphyses; Early Ambulation; Femoral Fractures; Fracture Fixation, Internal; Humans; Intra-Articular Fractures; Knee Joint; Osteoarthritis, Knee; Patient Care Planning; Tibial Fractures; Weight-Bearing
PubMed: 29199087
DOI: 10.1016/j.otsr.2017.05.029 -
Orthopaedics & Traumatology, Surgery &... Feb 2016The removal of a well-fixed prosthetic stem raises technical challenges. The objective is not only to remove the material, but also to prepare the implantation of a new... (Review)
Review
The removal of a well-fixed prosthetic stem raises technical challenges. The objective is not only to remove the material, but also to prepare the implantation of a new prosthesis. Cemented stems are only very rarely unremovable; extraction of the cement mantle and plug raises the greatest difficulties. The main risk is cortex perforation, and a radiograph should be obtained at the slightest doubt. The removal of cementless stems carries a higher risk of fracture. Difficulties should be anticipated based on thorough familiarity with the implant design and on evaluations of implant fixation and bone stock. The intramedullary approach is usually sufficient to extract a cemented or cementless, well fixed, standard stem. Routine use of a transfemoral approach is warranted only in the following situations: revision surgery for infection, S-shaped stem, long stem, curvature or angulation of the femoral shaft, or unfeasible hip dislocation. However, the possibility that the intramedullary approach may need to be converted to a transfemoral approach should be anticipated. Thus, preoperative planning must include determination of the optimal length of a femoral osteotomy or femoral flap, should one be needed, and the surgeon must have access to all the revision implants and tools that might be needed for re-implantation. Experience with the various techniques is indispensable, as a well-performed extensive approach is associated with less morbidity than a fracture or trajectory error. There are three main techniques, which are described here: intramedullary extraction of a cementless stem, intramedullary extraction of a cemented stem, and transfemoral extraction through an extended trochanterotomy. The patients should receive detailed information on the difficulties of femoral stem removal and on the available solutions.
Topics: Arthroplasty, Replacement, Hip; Bone Cements; Device Removal; Diaphyses; Femur; Fractures, Bone; Hip Prosthesis; Humans; Osteotomy; Postoperative Complications; Prosthesis Failure; Reoperation; Surgical Flaps
PubMed: 26797009
DOI: 10.1016/j.otsr.2015.06.029