RESUMEN
The aim of this study was to report the incidence of arthrofibrosis of the knee and identify risk factors for its development following a fracture of the tibial plateau. We carried out a retrospective review of 186 patients (114 male, 72 female) with a fracture of the tibial plateau who underwent open reduction and internal fixation. Their mean age was 46.4 years (19 to 83) and the mean follow-up was16.0 months (6 to 80). A total of 27 patients (14.5%) developed arthrofibrosis requiring a further intervention. Using multivariate regression analysis, the use of a provisional external fixator (odds ratio (OR) 4.63, 95% confidence interval (CI) 1.26 to 17.7, p = 0.021) was significantly associated with the development of arthrofibrosis. Similarly, the use of a continuous passive movement (CPM) machine was associated with significantly less development of arthrofibrosis (OR = 0.32, 95% CI 0.11 to 0.83, p = 0.024). The effect of time in an external fixator was found to be significant, with each extra day of external fixation increasing the odds of requiring manipulation under anaesthesia (MUA) or quadricepsplasty by 10% (OR = 1.10, p = 0.030). High-energy fracture, surgical approach, infection and use of tobacco were not associated with the development of arthrofibrosis. Patients with a successful MUA had significantly less time to MUA (mean 2.9 months; sd 1.25) than those with an unsuccessful MUA (mean 4.86 months; sd 2.61, p = 0.014). For those with limited movement, therefore, performing an MUA within three months of the injury may result in a better range of movement. Based our results, CPM following operative fixation for a fracture of the tibial plateau may reduce the risk of the development of arthrofibrosis, particularly in patients who also undergo prolonged provisional external fixation.
Asunto(s)
Fijación Interna de Fracturas/efectos adversos , Fracturas Intraarticulares/cirugía , Articulación de la Rodilla/patología , Fracturas de la Tibia/cirugía , Adulto , Factores de Edad , Anciano , Estudios de Cohortes , Femenino , Fibrosis/etiología , Fibrosis/fisiopatología , Estudios de Seguimiento , Fijación Interna de Fracturas/métodos , Humanos , Incidencia , Fracturas Intraarticulares/diagnóstico por imagen , Articulación de la Rodilla/cirugía , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Radiografía , Reoperación/métodos , Estudios Retrospectivos , Medición de Riesgo , Factores Sexuales , Fracturas de la Tibia/diagnóstico por imagen , Resultado del Tratamiento , Adulto JovenRESUMEN
The use of impacted morselized cancellous bone grafts in conjunction with cementless hemispherical acetabular cups for treatment of AAOS type II acetabular cavitary deficiencies was evaluated in a retrospective study of 23 primary and 24 revision total hip arthroplasties, at a mean follow-up of 7.9 and 8.1 years, respectively. All primary hips received autografts, while all revision hips received allografts. Modified Harris Hip Scores for primary and revision hip replacements increased from a pre-operative mean of 37 and 47 to a postoperative mean of 90 and 86, respectively. All 23 autografts and 23 out of 24 cancellous allografts were radiographically incorporated without evidence of resorption. There were no instances of infection, component migration, or cases requiring subsequent acetabular revision. We conclude that impacted morselized cancellous bone-graft augmentation of cementless cups is a viable surgical option for AAOS type II cavitary acetabular defects.
Asunto(s)
Acetábulo/patología , Acetábulo/cirugía , Artroplastia de Reemplazo de Cadera/métodos , Trasplante Óseo/métodos , Dispositivos de Fijación Ortopédica , Acetábulo/diagnóstico por imagen , Adulto , Anciano , Anciano de 80 o más Años , Artroplastia de Reemplazo de Cadera/instrumentación , Resorción Ósea , Tornillos Óseos , Trasplante Óseo/instrumentación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Procedimientos Ortopédicos , Radiografía , Estudios RetrospectivosRESUMEN
The use of TNP on infected open wounds with exposed orthopaedic implants has not yet been described in the literature. Here, its application on these wounds accelerated healing and enabled definitive wound closure to be undertaken.