Journal of Orthopaedic Trauma最新文献

Objectives: To determine the rate of subsequent ipsilateral proximal femur fractures after fixation of low energy distal femur fractures among patients ≥ 50 years old and to evaluate whether fixation protecting the femoral neck mitigates the risk of subsequent ipsilateral hip fracture.

Methods: Designs: A retrospective comparative study.

Setting: Four academic level I trauma centers.

Patient population: Included were patients aged 50 years or older treated with open reduction internal fixation of a low energy distal femur fracture (AO/OTA 33 A, B, or C) from 2005 to 2024 without prior proximal femur implant.

Outcome measures and comparisons: Patient demographics, comorbidities, injuries, fixation type, and subsequent hip fracture were evaluated and compared based on femoral neck protection.

Results: Femoral neck protection was employed for 103 patients (80 women, 77.7%) with median age 77 years (IQR 70 to 84) and was not employed among 517 patients (424 women, 82.0%) with median age 71 years (IQR 63 to 82). Twenty-six subsequent ipsilateral hip fractures occurred. Two were immediately adjacent to prior fixation, and 24 were distant from prior fixation. Subsequent ipsilateral fractures occurred more often without femoral neck protection (26/517, 5.0%) than when the femoral neck was protected (0/103, 0%), p = 0.013. The cumulative rate of hip fracture in the absence of femoral neck protection at 1, 2, 3, and 4 years postoperatively was 2.4%, 4.0%, 5.6% and 7.2%, respectively, while the cumulative rate remained at 0% throughout follow up in the setting of femoral neck protection (log-rank p = 0.031).

Conclusion: Patients ≥ 50 years old with low energy distal femur fractures had a clinically significant risk of subsequent ipsilateral hip fracture that increased steadily with time. Fixation protecting the femoral neck during distal femur fracture treatment was associated with a significantly reduced risk of subsequent ipsilateral hip fracture.

Level of evidence: Level III, therapeutic study.

Summary: This review describes a modified technique for the surgical management of a displaced medial femoral condyle fracture in a 22-year-old man after a motorcycle accident. This case involved an open reduction and the use of a medial buttress plate to restore joint congruity and reduce the risk of varus failure. The modified transfascial approach through the VMO muscle belly was used to facilitate ample exposure while safely protecting the neurovascular structures behind the robust adductor fascia. This technique highlights the utility and benefits of the modified transfascial approach compared with the traditional medial subvastus approach when used in medial distal femur fracture fixation.

Summary: Percutaneous medial plating of distal femur fractures, particularly comminuted fractures, offers improved biomechanical stability without the soft tissue insult of an open approach. The addition of a medial plate neutralizes the cantilever bending force that arises from the offset between the single lateral locking plate and the femur's anatomical axis. This cantilever bending force has been theorized to be a contributor to the high nonunion rate of distal femur fractures. Although concerns about the proximity of the superficial femoral artery have previously limited widespread adoption of medial plating, there is a considerable medial distal femur safe zone where the superficial femoral artery is not at risk. In cases where supplemental medial fixation would be beneficial and soft tissue or host limitations prevent open instrumentation, percutaneous medial plating is a safe and effective alternative.

Summary: Posterior shoulder dislocations are uncommon but pose diagnostic and treatment challenges, particularly when locked due to humeral head impaction or soft tissue interference. These cases often necessitate surgical intervention, especially when locked or associated with recurrent instability or bony injuries. Preoperative assessment is vital to confirm the diagnosis and guide surgical planning. The surgical procedure begins with patient positioning and anesthesia, followed by a chosen approach, such as the deltopectoral route. In this case, exposure involved identifying and tenodesing the biceps tendon and performing a lesser tuberosity osteotomy. Reduction of the humeral head is achieved under direct visualization and confirmed with fluoroscopy. Stabilization is performed, and any associated lesions are addressed. Postoperative care involved immobilization and gradual rehabilitation. Consideration of patient age, chronicity, and associated bone loss helped dictate the appropriate intervention.

Summary: Patellar tendon ruptures resulting in extensor mechanism disruption are typically treated with surgical repair. This case involved a 53-year-old man with an acute right patellar tendon rupture sustained during a basketball game. This review describes the standard transosseous primary repair using Krackow sutures with a novel box-and-1 suture augmentation technique.

Summary: A single-stage operative repair of terrible triad injuries through a laterally-based approach using arthroscopic instrument-assisted reduction of the coronoid fracture in cases in which the radial head is deemed appropriate for repair rather than arthroplasty is described in this technical trick. Using an arthroscopic suture lasso, adjustable drill guides, cannulated guide-pins with nitinol shuttling wires, and a suspensory cortical button allow for a more precise and facile technique of "lasso" fixation of coronoid fractures and anterior capsular injuries with intact radial heads in terrible triad injuries.

Summary: This procedure demonstrates a 65-year-old man who sustained an injury approximately 2 weeks ago with a displaced multifragmented intra- and extra-articular scapular fracture. It describes the technique of a minimally invasive approach and fixation with the use of mini fragment plating. Indications are a displaced extra-articular scapula body, glenoid neck, and intra-articular fracture of the glenoid. Intraoperative imaging confirms anatomic reduction and stable fixation. Follow-up shows a good functional outcome and return to normal daily life.

Summary: This is a case of a 62-year-old man with significant peripheral vascular disease who presented with chronic nonhealing full-thickness ulcerations along his right lower leg, now progressed to deep infection with systemic involvement. This review describes an above knee amputation with a medial-based myofasciocutaneous flap, which was chosen due to its dependency on the less-diseased vascular supply from the obturator artery. The anatomic dissection and myodesis technique are methodical and reproducible for all surgeons.

Summary: This case presentation describes a technique for reconstruction of an acute posterior sternoclavicular joint dislocation. The patient was a 37 year-old female who sustained a left posterior sternoclavicular dislocation after a fall. A curvilinear incision was made directly over the sternoclavicular joint. After reduction, a semitendinosus allograft was used to reconstruct the sternoclavicular joint in a figure-of-8 fashion through drill holes in the manubrium and the proximal clavicle and secured with suture tape. Sternoclavicular reconstruction with semitendinosis allograft provides a reliable option with good clinical outcomes and low rates of recurrent instability.