Orthop Traumatol Sur
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Orthop Traumatol Sur · Feb 2010
Multicenter StudyCommon peroneal nerve palsy complicating knee dislocation and bicruciate ligaments tears.
The occurrence rate of common peroneal nerve (CPN) palsy associated with knee dislocation or bicruciate ligament injury ranges from 10 to 40%. The present study sought first to describe the anatomic lesions encountered and their associated prognoses and second to recommend adequate treatment strategy based on a prospective multicenter observational series of knee ligament trauma cases. ⋯ Level IV, prospective study.
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Orthop Traumatol Sur · Feb 2010
Type C periprosthetic fractures treated with locking plate fixation with a mean follow up of 2.5 years.
Type C periprosthetic femoral fractures present fixation problems related to the extent of the fracture and the quality of the bone stock. ⋯ Level IV, prospective therapeutic study.
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Orthop Traumatol Sur · Feb 2010
Importance of screw position in intertrochanteric femoral fractures treated by dynamic hip screw.
Tip-apex distance greater than 25 mm is accepted as a strong predictor of screw cut-out in patients with intertrochanteric femoral fracture treated by dynamic hip screw. The aim of this retrospective study was to evaluate the position of the screw in the femoral head and its effect on cut-out failure especially in patients with inconvenient tip-apex distance. ⋯ IV, retrospective series.
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The decrease of patellar height following opening-wedge proximal tibial osteotomy can affect function, and subsequent total knee arthroplasty may be more difficult and give poorer results. ⋯ Retrospective, level IV.
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Orthop Traumatol Sur · Dec 2009
Multicenter StudyVascular lesions associated with bicruciate and knee dislocation ligamentous injury.
The incidence of associated vascular lesions in biligamentous cruciate injuries of the knee ranges from 16 to 64%, with a mean rate of 30%. Treatment of ischemic vascular lesions associated with ligaments injury is well established, comprising emergency arterial vascular repair, most of the times combined to external fixation. In the absence of clinical symptoms of vascular lesion, some authors recommend systematically performing arteriography, while others advocate selectively prescribing this examination in doubtful clinical situations. The present study analyzed data extracted from the prospective series of the 2008 SOFCOT Symposium (dedicated to management of bicruciate knee lesions) and from an analysis of the literature, with emphasis on developing a diagnostic strategy for vascular lesions associated with bicruciate lesions. ⋯ At initial examination, it is essential to look for the peripheral pulse. In case of ischemic syndrome, the priority is a revascularization procedure associated to intraoperative arteriography. In case of abnormal pulse without obvious ischemia, emergency imaging (usually arteriogram or angioscan) is essential. Where there is no initial clinical vascular abnormality, good practice is less clearly cut. Initially, present pulses are found in a mean 30% (17-55%) of cases of popliteal artery lesion, according to the series. Different authors draw diverging conclusions from this fact. For some, the absence of frank abnormality on clinical examination is sufficient to exclude not any possible anatomic vascular lesion but any vascular lesion requiring surgery. However, even without pulse abnormality, we consider systematic imaging to be justified, partly by the difficulty of ensuring strict monitoring, and partly by the decompensation risk of clinically asymptomatic intimal lesions during the ligament surgery under consideration in most cases. Although many authors cling to the dogma of late emergency arteriography, recent reports argue against this attitude. Angio-MRI has good diagnostic value, but in practice is difficult to obtain in emergency. We would rather advocate angioscanning, which is easily available in emergency and does not incur the risk of local complication associated with arteriography.