Orthopedics
-
No data on the results of total knee arthroplasty (TKA) in patients with fibromyalgia have been published. The purposes of this study were to review a cohort of patients with fibromyalgia undergoing TKA to determine the level of postoperative pain and satisfaction with the surgery, the incidence of postoperative surgical complications, and revision rates and their relationship to TKA design. One hundred ten patients with fibromyalgia (141 knees) who underwent primary TKA between 1990 and 2001 were studied. ⋯ Patients with fibromyalgia undergoing primary TKA have a high prevalence of complications and pain. Despite continued pain, the majority of patients were satisfied with the results and reported improvements after TKA. This data should be used to counsel patients with fibromyalgia preoperatively regarding limited goals with respect to pain relief and suggests that a multimodal individualized treatment program may be necessary to achieve optimal outcomes in patients with fibromyalgia.
-
Case Reports
Iatrogenic subclavian arteriovenous fistula: rare complication of plate osteosynthesis of clavicle fracture.
Iatrogenic subclavian arteriovenous fistula is rare and has not been reported as a complication of plate osteosynthesis of clavicle fracture. This article describes the first case of iatrogenic subclavian arteriovenous fistula caused by plate osteosynthesis. A 36-year-old man sustained a right middle clavicle fracture in an injury and underwent open reduction and internal fixation with clavicular compression plate 3 days later in a local hospital. ⋯ The operative manipulation in the process of fracture reduction and hole drilling should be meticulous, and the screw length must be accurate. Orthopedic surgeons should be aware of this uncommon complication with plate osteosynthesis of clavicle fracture. We recommend using an endovascular surgical technique for treatment of this complication.
-
Gonarthrosis in the relatively young and active population causes major daily discomfort and disability. If the arthritic process is mainly limited to the medial compartment, the axis of a varus knee can be realigned laterally with high tibial osteotomy to unload the medial compartment and allow some cartilage regeneration and pain relief. This study describes the outcomes of patients who underwent opening-wedge high tibial osteotomies using Puddu plate (Arthrex, Naples, Florida) fixation. ⋯ All radiographs showed full incorporation of the bone grafts. At the end of the study, 2 patients underwent total knee replacement. Opening-wedge high tibial valgus osteotomy with Puddu plate fixation can be a reliable procedure for the treatment of medial-compartment osteoarthritis of the knee associated with varus deformity.