Percutaneous cerclage wiring for the surgical treatment of displaced patella fractures

The patella plays an important role in the knee joint extension, and a patella fracture requires surgical treatment when it is accompanied by displacement of bone fragments and a joint surface gap. In patella fractures, there is disruption of the soft tissue structures that support the knee extension mechanism. We use a method of percutaneous cerclage wiring to fix the patella and include the peripatellar soft tissues in five patients. All cases were closed fractures, and the AO classification was type A in 1 and type C in 4. At a mean follow-up of 11.2 months, union was achieved in four cases with failure in one inferior pole fracture avulsion. There was no extensor lag noted in any patient, with mean flexion at 141° (120–160). As this percutaneous cerclage wiring method includes soft tissue approximation in the wiring, it may be especially suitable for comminuted fractures for which classic tension band wiring techniques cannot be used. We employed this procedure to atraumatically manipulate peripatellar soft tissues together with the fracture fragments in order to obtain optimal restoration of continuity of the extensor mechanism

Safe and Effective Reduction Technique for Intertrochanteric Fracture with Ipsilateral Below-Knee Amputated Limb

The positioning of the patient on the fracture table is critical for the successful reduction and operative fixation of intertrochanteric hip fractures. However, this manipulation is challenging with patients who have undergone amputations of their legs. A 97-year-old man presented to the emergency department with symptom of right hip pain following a mechanical fall. He had a below-knee amputation on his right leg following a traffic accident as a 19-year-old and had a below-knee patellar tendon bearing prosthesis fitted to his lower limb for mobility. Radiographs of his pelvis revealed a displaced intertrochanteric fracture of the right side femur. The patient was positioned on a fracture table, as in the standard procedure. The method of inverting the traction boot to accommodate the flexed knee and stump described by Al-Harthy could be used to provide traction and rotational control. Internal fixation was performed using a short femoral nail. Postoperatively, the patient could walk with full weight bearing using a prosthesis on his affected limb. The method of inverting the traction boot to accommodate the flexed knee and stump can be used safely and effectively to achieve and maintain fracture reduction during fixation of intertrochanteric fractures for patients with a below-knee amputated limb

Therapeutic strategies for periprosthetic femoral fractures based on three classification systems

Purpose: The standardization of treatment strategies for periprosthetic femoral fractures is a critical objective for orthopedic surgeons. This review outlines detailed therapeutic approaches based on three classification systems: the Baba, AO/OTA, and Vancouver classifications. Methods: This review examined implant stability assessment, internal fixation techniques, and revision strategies for hip function restoration in periprosthetic femoral fractures. Results: The Baba classification objectively determines implant stability, guiding treatment selection. The AO/OTA classification assists in identifying the most appropriate internal fixation technique. The Vancouver classification informs the choice of reconstruction methods for revision surgery. Conclusions: Management of periprosthetic femoral fractures necessitates specialized expertise in joint reconstruction while adhering to the fundamental principles of osteosynthesis to promote bony union

Evaluation of the effect of oxidative stress on articular cartilage in spontaneously osteoarthritic STR/OrtCrlj mice by measuring the biomarkers for oxidative stress and type II collagen degradation/synthesis

To investigate the involvement of oxidative stress in the pathogenesis of osteoarthritis (OA), we evaluated the relationship between oxidative stress and articular cartilage degradation by measuring the serum levels of malondialdehyde (MDA, an oxidative stress marker), CTX-II (a type II collagen degradation marker) and CPII (a type II collagen synthesis marker) in obese and hyperlipidemic STR/Ort (STR) and control CBA mice. Seven-week-old osteoarthritic STR male mice (n=10) and control CBA male mice (n=10) were fed standard laboratory food ad libitum. At 35 weeks of age, the mice were sacrificed, and the serum levels of MDA, CTX-II and CPII were determined. Furthermore, histopathological changes were evaluated in the knee joints. Most of the STR mice spontaneously developed OA (18 of the 20 knees). By contrast, the CBA mice developed OA in only 4 of the 20 knees. Importantly, the serum levels of MDA, CTX-II and CPII were elevated to a greater extent in the STR mice compared to levels in the CBA mice. Notably, the level of MDA was correlated with that of CTX-II, but not of CPII. Moreover, the MDA levels were significantly correlated with the serum lipid (total cholesterol and triglyceride) levels as well as body weight. Together these observations suggest that oxidative stress is likely involved in the degradation of type II collagen in articular cartilage, thereby possibly contributing to the development of OA in obese and hyperlipidemic STR mice

Pulmonary thrombosis associated with antidiuretic hormone replacement therapy due to secondary diabetes insipidus after traumatic brain injury: A case report

AbstractINTRODUCTIONDiabetes insipidus is a well-recognized complication of traumatic brain injury. The majority of patients with post-traumatic diabetes insipidus will require antidiuretic hormone (ADH) replacement therapy and tend to show dehydration. On the other hand, some negative effects of ADH on blood coagulation, such as increased platelet cohesion and the promotion of von Willebrand factor release, have also been reported. However, the incidence of thrombosis during antidiuretic hormone replacement therapy is disputed.PRESENTATION OF CASEA case of pulmonary thrombosis associated with ADH replacement therapy due to secondary diabetes insipidus after traumatic brain injury is presented here.DISCUSSIONIn our case, there were three factors that may have contributed to the observed thrombosis (dehydration, bed rest for a long period and ADH replacement therapy).CONCLUSIONWe believe that controlling urinary output and monitoring urinary and serum osmotic pressure are necessary for the management for diabetes insipidus patients after traumatic brain injury. In particular, we must carefully monitor the management of such patients during antidiuretic hormone replacement therapy

Posterior versus direct anterior approach in revision hip arthroplasty using Kerboull-type plate

Introduction: The purpose of this study was to investigate revision with a Kerboull-type plate through the posterior approach (PA) and direct anterior approach (DAA) and compare the clinical outcome. Subjects and methods: Fifty-four patients (56 hip joints) underwent revision surgery in which acetabular reconstruction was performed concomitantly using the Kerboull-type plate and allogeneic bone. Revision surgery through DAA was performed in 21 hip joints and these were compared with 34 hip joints treated through PA. There was no significant difference in the patient demographics between the DAA and PA. Results: There was no significant difference between the operative times in the DAA and PA groups (203.2 ± 43.5 and 211.7 ± 41.8 min). There was a significant difference between the intraoperative blood loss in the DAA and PA groups (503.9 ± 223.7 mL and 703.8 ± 329.6 mL, respectively, p &lt; 0.05). There was no significant difference between the modified Harris Hip Score in the DAA and the PA groups. The loosening of the acetabular component was observed in four cases (11.8%) in the PA group. In the DAA and PA groups, the 5-year survival rates were 100 and 85.7%, respectively. Recurrent dislocation of the hip was observed in six cases (one case in the DAA group (4.8%) and five cases in the PA group (14.7%)). Conclusions: It was verified that the difference in the surgical approach of acetabular reconstruction concomitantly using the Kerboull-type plate and allogeneic bone graft influenced the postoperative outcome.</jats:p