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Lara-Taranchenko Y, Nomdedéu JF, Barro VM, Peiró JVA, Guerra-Farfán E, Selga J, Tomás-Hernández J, Teixidor Serra J, Molero V, Collado D, Mimendia I, Hernández A, Porcel-Vázquez JA. Vancouver B2 periprosthetic hip fractures treatment: fix or replace? A retrospective study comparing both techniques. Eur J Orthop Surg Traumatol 2024; 34:2055-2063. [PMID: 38528273 DOI: 10.1007/s00590-024-03881-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 02/18/2024] [Indexed: 03/27/2024]
Abstract
INTRODUCTION Vancouver B2 periprosthetic hip fractures involve stem stability and they have been classically treated with revision surgery. Crucial factors such as age, clinical comorbidities and functional status are often neglected. The current study aims to compare clinical outcomes between patients treated with open reduction and internal fixation (ORIF) or femoral stem exchange. METHODS This is a retrospective study that includes all Vancouver B2 periprosthetic hip fractures in a tertiary referral hospital from 2016 to 2020. Patients were divided into two groups: Group 1. Patients treated with an ORIF and Group 2. Patients treated with stem replacement. The outcomes that were compared between groups included demographic data, functional capacity, complications and mortality. RESULTS 29 periprosthetic Vancouver B2 fractures were finally analyzed. 11 (37.9%) were treated with ORIF (Group 1) and 18 (62.1%) by stem replacement (Group 2). Surgery time (143 vs. 160 min), hemoglobin drop (1.8 vs. 2.5 g/dL) and hospital stance (25.5 vs. 29.6 days) were shorter in Group 1. According to complications, 18.2% of patients in the ORIF group had orthopedic complications compared with 44.4% in the revision group. In the revision group, 3 cases needed a two-stage revision and one of these revisions ended up with a resection arthroplasty (Girdlestone). The first-year mortality rate was 27% in Group 1 and 11% in Group 2. DISCUSSION ORIF treatment seems to be a less aggressive and complex procedure which can lead to a faster general recovery. Revision surgery can imply a higher risk of orthopedic complications which can be severe and may require further aggressive solutions. The ORIF group mortality was similar to the proximal femur fracture rate (20-30%). In conclusion, ORIF treatment seems to be a good option especially in fragile patients with low functional demand when anatomical reduction is possible.
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Affiliation(s)
- Yuri Lara-Taranchenko
- Orthopedic Surgery Resident, Hospital Universitari Vall d'Hebron, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain.
| | - Josep F Nomdedéu
- Orthopedic Surgery Resident, Hospital Universitari Vall d'Hebron, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Víctor M Barro
- Orthopedic Surgery Resident, Hospital Universitari Vall d'Hebron, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - José V Andrés Peiró
- Orthopedic Surgery Resident, Hospital Universitari Vall d'Hebron, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Ernesto Guerra-Farfán
- Orthopedic Surgery Resident, Hospital Universitari Vall d'Hebron, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Jordi Selga
- Orthopedic Surgery Resident, Hospital Universitari Vall d'Hebron, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Jordi Tomás-Hernández
- Orthopedic Surgery Resident, Hospital Universitari Vall d'Hebron, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Jordi Teixidor Serra
- Orthopedic Surgery Resident, Hospital Universitari Vall d'Hebron, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Vicente Molero
- Orthopedic Surgery Resident, Hospital Universitari Vall d'Hebron, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Diego Collado
- Orthopedic Surgery Resident, Hospital Universitari Vall d'Hebron, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Iñaki Mimendia
- Orthopedic Surgery Resident, Hospital Universitari Vall d'Hebron, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Alejandro Hernández
- Orthopedic Surgery Resident, Hospital Universitari Vall d'Hebron, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Juan A Porcel-Vázquez
- Hospital Universitari Son Espases, Illes Balears, Carretera de Valldemossa, 79, 07120, Palma, Spain
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Teixidor-Serra J, Andrés-Peiró JV, García-Sanchez Y, Selga-Marsa J, Garcia-Martínez MC, Carbonell-Rosell C, García-Albó E, Tomás-Hernández J. Outcomes and their predictors in suprapatellar nailing for tibia fractures. Multivariable analysis of 293 consecutive cases. Eur J Trauma Emerg Surg 2024:10.1007/s00068-024-02476-0. [PMID: 38472386 DOI: 10.1007/s00068-024-02476-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 02/19/2024] [Indexed: 03/14/2024]
Abstract
PURPOSE Intramedullary nailing of tibial fractures is one of the most common procedures in orthopedic surgery. It can be technically demanding in proximal or distal fractures, which may be facilitated using semi-extended approaches. The aim of this study is to identify outcomes and their predictors using a semi-extended suprapatellar approach for tibial fracture nailing. METHODS This is a retrospective cohort of 293 patients who underwent intramedullary nail fixation of a tibial fracture through a suprapatellar approach, considering a postoperative follow-up of 1 year. Data on patient's baseline characteristics, injuries, treatments, and outcomes regarding alignment, fracture union, and complications were recorded. For multivariable analysis, hierarchical binary (logistic) regression analysis was performed. RESULTS The mean patient age was 47.7 years (SD 18.9), with 42A1 the most frequent fracture pattern (n = 98, 33.5%). Correct or anatomical alignment (≤ 5º in both planes) was achieved in 272 (92.8%) of the patients. On multivariate analysis, surgical delay ≥ 7 days (OR = 1.3, 95% CI = 1.3-8.1) and age over 50 years (OR = 3.2, 95% CI = 1.2-8.3) were found as predictors of fracture malalignment. Fracture healing was achieved in 97.6%, and reoperation rate was 6.14%. Overall complication's predictors were proximal fracture (OR = 2.8, 95% CI = 1.1-7.2), temporary external fixation (OR = 2.4, 95% CI = 1.2-4.9), and fracture malalignment (OR = 2.9, 95% CI = 1.1-7.9). CONCLUSION The suprapatellar approach is a safe and useful technique for treating tibial fractures, leading to no less than correct reduction in almost all patients and achieving a high fracture healing rate, at very low rates of complications. Pre- and postoperative predictors identified must be taken into account to improve outcomes while treating these fractures.
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Affiliation(s)
- Jordi Teixidor-Serra
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department of Orthopaedic Surgery and Traumatology, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - José Vicente Andrés-Peiró
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
- Department of Orthopaedic Surgery and Traumatology, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.
| | - Yaiza García-Sanchez
- Department of Orthopaedic Surgery and Traumatology, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Jordi Selga-Marsa
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department of Orthopaedic Surgery and Traumatology, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | | | - Carla Carbonell-Rosell
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department of Orthopaedic Surgery and Traumatology, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Enrique García-Albó
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Jordi Tomás-Hernández
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department of Orthopaedic Surgery and Traumatology, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
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Aguado HJ, Castillón-Bernal P, Teixidor-Serra J, García-Sánchez Y, Muñoz-Vives JM, Camacho-Carrasco P, Jornet-Gibert M, Ojeda-Thies C, García-Portabella P, Pereda-Manso A, Mateos-Álvarez E, Manzano-Mozo J, Carrillo-Gómez R, País-Ortega S, García-Virto V, Noriega-González D, Álvarez-Ramos BA, Ganso-Pérez A, Cervera-Díaz C, Plata-García M, Ortega-Briones A, Berrocal-Cuadrado J, Criado del Rey-Machimbarrena D, Salvador J, Rey L, Tomás-Hernández J, Selga-Marsà J, Andrés-Peiró JV, Querolt-Coll J, Triana G, Vives-Barquiel M, Renau-Cerrillo M, Campuzano-Bitterling B, Hernández JM, Ostilla R, Carreras-Castañer A, Torner P, Díaz-Suárez R, Fernández EA, Olaya-González C, Fernández-Villán M, García de Cortázar U, Arrieta M, Escobar D, Castrillo E, Balvis P, Rodríguez-Arenas M, García-Pérez Á, Moreta J, Bidea I, Jiménez-Urrutia X, Olías-López B, Boluda-Mengod J, González-Martín D, Bárcena-Goitiandia L, López-Dorado D, Borrás-Cebrián JC, García-Aguilera D, Freile-Pazmiño PA, Suárez-Suárez MÁ, Lanuza-Lagunilla L, García-Arias A, Sánchez-Saz J, García-Coiradas J, Valle-Cruz J, Mora-Fernández J, Cano-Leira MÁ, Rieiro G, Benjumea-Carrasco A, Priego-Sánchez RJ, Sánchez-Pérez C, Guadilla-Arsuaga J, Fernández-Juan A, Sánchez P, Ricón J, Fuentes-Díaz A, García-García EM, Cuadrado-Abajo F, García-Portal G, del PozoManrique P, Castillo del Pozo V, Garcia-Navas FM, García-Paredero E, Beteta-Robles T, Guijarro-Valtueña A, Gutiérrez-Baiget G, Alonso-García N, Navas-Pernía I, Ariza-Herrera D, Vilanova J, Videla-Cés M, Serra-Porta T, Vázquez-García C, Carrasco-Becerra C, Pena-Paz S, Otero-Naveiro V, Fernández-Billón-Castrillo I, Martínez-Menduiña A, Hernández-Galera C, Fernández-Dorado F, Madrigal-López M, Murcia-Asensio A, Galián-Muñoz E, Castro-Sauras Á, Espallargas-Doñate T, Royo-Agustín M, Plaza-Salazar N, Gámez-Asunción C, Muñoz-Vicente A, Pareja-Sierra T, Benito-Santamaría J, Cuenca-Copete A, Verdejo-González A, González-Montero B, Giraldo-Vegas LA, Alonso-Viana L, Díez-Pérez EJ, Briso-Montiano R, Andrés AI, Mingo-Robinet J, Naharro-Tobío M, Escudero-Martínez E, Serrano-Sanz J, Peñalver-Matamoros JM, Fernàndez-Poch N, Martínez-Carreres L, Macho-Mier M, Martín-Hernández C, Laclériga-Giménez AF, Saló-Cuenca JC, Salamanca-Ontiveros C, Espona-Roselló J, Altemir-Martínez V, Criado-Albillos G, Cunchillos-Pascual J, Millán-Cid M, Cabello-Benavides HG, Martínez-Íñiguez-Blasco J, Sevilla-Ortega P, Cano JR, Ramírez A, Marqués-López F, Martínez-Díaz S, Carabelli GS, Slullitel PA, Astore I, Boietti BR, Hernández-Pascual C, Marín-Sánchez J, Córdova-Peralta JC, Dot-Pascuet I, Pereira-Mosquera E, Martín-Antúnez J, Pérez JM, Mandía-Martínez A, De Caso J, Martín-Marcuello J, Benito-Mateo M, Murillo-Vizuete AD, Delgado LG, dela Herrán G, Nunes N, Pérez-Coto I, González-Panisello MR, Iglesias-Fernández S, Ruete-Gil GL, Ramos-García S, Villarreal JP. Optimizing periprosthetic fracture management and in-hospital outcome: insights from the PIPPAS multicentric study of 1387 cases in Spain. J Orthop Traumatol 2024; 25:13. [PMID: 38451303 PMCID: PMC10920552 DOI: 10.1186/s10195-024-00746-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 01/01/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND The incidence of all periprosthetic fractures (PPF), which require complex surgical treatment associated with high morbidity and mortality, is predicted to increase. The evolving surgical management has created a knowledge gap regarding its impact on immediate outcomes. This study aimed to describe current management strategies for PPF and their repercussions for in-hospital outcomes as well as to evaluate their implications for the community. METHODS PIPPAS (Peri-Implant PeriProsthetic Survival Analysis) was a prospective multicentre observational study of 1387 PPF performed during 2021. Descriptive statistics summarized the epidemiology, fracture characteristics, management, and immediate outcomes. A mixed-effects logistic regression model was employed to evaluate potential predictors of in-hospital mortality, complications, discharge status, and weight-bearing restrictions. RESULTS The study encompassed 32 (2.3%) shoulder, 4 (0.3%) elbow, 751 (54.1%) hip, 590 (42.5%) knee, and 10 (0.7%) ankle PPF. Patients were older (median 84 years, IQR 77-89), frail [median clinical frailty scale (CFS) 5, IQR 3-6], presented at least one comorbidity [median Charlson comorbidity index (CCI) 5, IQR 4-7], were community dwelling (81.8%), and had outdoor ambulation ability (65.6%). Femoral knee PPF were most frequently associated with uncemented femoral components, while femoral hip PPF occurred equally in cemented and uncemented stems. Patients were managed surgically (82%), with co-management (73.9%), through open approaches (85.9%) after almost 4 days (IQR, 51.9-153.6 h), with prosthesis revision performed in 33.8% of femoral hip PPF and 6.5% of femoral knee PPF. For half of the patients, the discharge instructions mandated weight-bearing restrictions. In-hospital mortality rates were 5.2% for all PPF and 6.2% for femoral hip PPF. Frailty, age > 84 years, mild cognitive impairment, CFS > 3, CCI > 3, and non-geriatric involvement were candidate predictors for in-hospital mortality, medical complications, and discharge to a nursing care facility. Management involving revision arthroplasty by experienced surgeons favoured full weight-bearing, while an open surgical approach favoured weight-bearing restrictions. CONCLUSIONS Current arthroplasty fixation check and revision rates deviate from established guidelines, yet full weight-bearing is favoured. A surgical delay of over 100 h and a lack of geriatric co-management were related to in-hospital mortality and medical complications. This study recommends judicious hypoaggressive approaches. Addressing complications and individualizing the surgical strategy can lead to enhanced functional outcomes, alleviating the economic and social burdens upon hospital discharge. Level of Evidence Level IV case series. TRIAL REGISTRATION registered at ClinicalTrials.gov (NCT04663893), protocol ID: PI 20-2041.
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Castellanos-Alonso S, Tomás-Hernández J, Teixidor-Serra J, Selga-Marsà J, Piedra-Calle CA, Andrés-Peiró JV. Non-prosthetic implant-related femur fractures in post-polio patients. Trauma Case Rep 2023; 46:100843. [PMID: 37251433 PMCID: PMC10213328 DOI: 10.1016/j.tcr.2023.100843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2023] [Indexed: 05/31/2023] Open
Abstract
The overall societal impact of poliomyelitis worldwide is decreasing, rendering it almost absent in most developed countries. However, even there, patients are still seen who contracted it in endemic areas or developed polio before vaccinations became widely available. Post-polio syndrome (PPS) causes skeletal and neurological changes that increase affected individuals' likelihood of fractures, including fractures requiring complex surgical treatment. The existence of previous internal fixation creates a particularly difficult challenge. We present here the surgical management of four post-polio patients who suffered non-prosthetic implant-related femoral fractures. Injuries occurred at earlier ages than implant-related fractures in non-polio patients and three of the four fractures occurred around plates, a phenomenon which is usually rare. The treatment of implant-related fractures in patients with post-polio syndrome poses significant technical challenges, often creating problematic functional sequelae for patients and high costs for healthcare systems.
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Affiliation(s)
- Sara Castellanos-Alonso
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Jordi Tomás-Hernández
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department of Orthopaedic Surgery and Traumatology, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Jordi Teixidor-Serra
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department of Orthopaedic Surgery and Traumatology, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Jordi Selga-Marsà
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department of Orthopaedic Surgery and Traumatology, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Carlos Alberto Piedra-Calle
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department of Orthopaedic Surgery and Traumatology, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - José Vicente Andrés-Peiró
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department of Orthopaedic Surgery and Traumatology, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
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Borges FK, Devereaux PJ, Cuerden M, Sontrop JM, Bhandari M, Guerra-Farfán E, Patel A, Sigamani A, Umer M, Neary J, Tiboni M, Tandon V, Ramokgopa MT, Sancheti P, Lawendy AR, Balaguer-Castro M, Jenkinson R, Ślęczka P, Nur AN, Wood GCA, Feibel RJ, McMahon JS, Biccard BM, Ortalda A, Szczeklik W, Wang CY, Tomás-Hernández J, Vincent J, Harvey V, Pettit S, Balasubramanian K, Slobogean G, Garg AX. Accelerated Surgery Versus Standard Care in Hip Fracture (HIP ATTACK-1): A Kidney Substudy of a Randomized Clinical Trial. Am J Kidney Dis 2022; 80:686-689. [PMID: 35346742 DOI: 10.1053/j.ajkd.2022.01.431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 01/14/2022] [Indexed: 02/02/2023]
Affiliation(s)
- Flavia K Borges
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Department of Perioperative Medicine, Population Health Research Institute, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - P J Devereaux
- Department of Perioperative Medicine, Population Health Research Institute, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Meaghan Cuerden
- Division of Nephrology, London Health Sciences Centre, London, Ontario, Canada
| | - Jessica M Sontrop
- Division of Nephrology, London Health Sciences Centre, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Mohit Bhandari
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Ernesto Guerra-Farfán
- Department of Orthopaedic Surgery and Traumatology, University Hospital Vall d'Hebron, Barcelona, Spain
| | - Ameen Patel
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Department of Perioperative Medicine, Population Health Research Institute, Hamilton, Ontario, Canada
| | - Alben Sigamani
- Clinical Research, Narayana Hrudayalaya Limited, Bangalore, India
| | - Masood Umer
- Department of Orthopaedic Surgery, Aga Khan University, Karachi, Pakistan
| | - John Neary
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Maria Tiboni
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Vikas Tandon
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Mmampapatla Thomas Ramokgopa
- Department of Orthopaedic Surgery, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa; Department of Orthopaedic Surgery, University of the Witwatersrand, Johannesburg, South Africa
| | - Parag Sancheti
- Department of Orthopaedic Surgery, Sancheti Institute for Orthopaedics & Rehabilitation, Pune, India
| | | | - Mariano Balaguer-Castro
- Department of Orthopaedic Surgery and Traumatology, Parc Taulí Hospital Universitari, Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Richard Jenkinson
- Department of Surgery and Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | | | - Aamer Nabi Nur
- Department of Orthopaedic Surgery, Shifa International Hospital, Islamabad, Pakistan
| | - Gavin C A Wood
- Department of Surgery, Queen's University, Kingston, Ontario, Canada
| | - Robert J Feibel
- Division of Orthopaedic Surgery, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Bruce M Biccard
- Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Observatory, South Africa
| | - Alessandro Ortalda
- Department of Anaesthesia and Intensive Care, Vita-Salute San Raffaele University, Milan, Italy
| | - Wojciech Szczeklik
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Chew Yin Wang
- Department of Anaesthesiology, University of Malaya, Faculty of Medicine, Kuala Lumpur, Malaysia
| | - Jordi Tomás-Hernández
- Department of Orthopaedic Surgery and Traumatology, University Hospital Vall d'Hebron, Barcelona, Spain
| | - Jessica Vincent
- Department of Perioperative Medicine, Population Health Research Institute, Hamilton, Ontario, Canada
| | - Valerie Harvey
- Department of Perioperative Medicine, Population Health Research Institute, Hamilton, Ontario, Canada
| | - Shirley Pettit
- Department of Perioperative Medicine, Population Health Research Institute, Hamilton, Ontario, Canada
| | - Kumar Balasubramanian
- Department of Perioperative Medicine, Population Health Research Institute, Hamilton, Ontario, Canada
| | - Gerard Slobogean
- Department of Orthopedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Amit X Garg
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Division of Nephrology, London Health Sciences Centre, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada.
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Lara Y, Aguilera-Sáez J, Tomás-Hernández J, Teixidor-Serra J, Khoudeir-Ávila AS, Andrés-Peiró JV. Treatment of a post-traumatic stiff knee after an open extensor apparatus injury by arthroscopic arthrolysis through a free flap. Trauma Case Rep 2021; 36:100553. [PMID: 34825042 PMCID: PMC8605279 DOI: 10.1016/j.tcr.2021.100553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2021] [Indexed: 12/05/2022] Open
Abstract
Open patella fractures have high complication rates. Post-traumatic joint stiffness is particularly common. The management of this complication is even more difficult if free flap was used to cover a soft tissue defect. Late surgical manipulation of free flaps can lead to their failure, with catastrophic consequences. The use of minimally invasive techniques could reduce the associated risks. We present a case of knee stiffness after the fix and flap treatment of a grade IIIB open patella fracture. We performed an arthroscopic arthrolysis with portals through the flap. The pedicle was preoperatively located and avoided. Joint range of motion remarkably improved without records of flap complications. We consider that the technique is feasible. Its success was based on the multidisciplinary collaboration between orthopaedic and plastic surgeons and rehabilitation medicine specialists.
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Affiliation(s)
- Yuri Lara
- Orthopaedic Surgery Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Jordi Aguilera-Sáez
- Plastic Surgery Department and Burn Center, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Jordi Tomás-Hernández
- Orthopaedic Trauma Unit, Orthopaedic Surgery Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Jordi Teixidor-Serra
- Orthopaedic Trauma Unit, Orthopaedic Surgery Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | - José-Vicente Andrés-Peiró
- Orthopaedic Trauma Unit, Orthopaedic Surgery Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
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Piedra-Calle CA, García-Sánchez Y, Teixidor-Serra J, Tomás-Hernández J, Selga-Marsá J, Porcel-Vázquez JA, Molero-García V, Andrés-Peiró JV. Challenges and outcomes in the treatment of floating knees. A case series of ipsilateral femur and tibia fractures around the knee. Eur J Orthop Surg Traumatol 2021; 32:325-331. [PMID: 33884493 DOI: 10.1007/s00590-021-02981-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 04/12/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Ipsilateral femur and tibia fractures around the knee (floating knee) are rare injuries that threaten both limb viability and patient life. A correct surgical strategy is essential to reduce complications and sequelae. The aim of this study was to evaluate characteristics and results of treatment in patients with a floating knee treated at a single trauma center. MATERIAL AND METHODS This is a retrospective and non-consecutive case series of 18 floating knees occurred in 17 patients. All patients were operated in a single third-level public and university hospital from December 2010 to December 2018. Data on demographics, injuries, treatment and follow-up were collected. A general health questionnaire (SF-12) and a knee functional questionnaire (KOOS-PS) were used to display results. RESULTS We identified 13 men and 4 women, aged between 16 and 52. Mean follow-up period was 16.49 months. High-energy trauma following a traffic collision was the most frequent mechanism. Mean Injury Severity Score (ISS) was 39.05, and a damage control strategy was used in 15 (83.33%) injuries. Extra-articular fractures (Fraser I) largely predominated, resulting in double intramedullary nailing in 72.22% of cases. Eleven injuries (61.11%) presented with an open fracture. Complications appeared in 6 (33.33%) injuries, being 3 infections. Mean score for the SF-12 was 35.59 for the physical dimension and 50.44 for mental dimension. Mean score for the KOOS-PS was 43.64. CONCLUSION Floating knee injuries usually occur in polytrauma contexts. Visceral involvement and exposed fractures are common, so the most appropriate strategy is usually a staged treatment. Complications and sequelae are frequent.
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Affiliation(s)
| | | | - Jordi Teixidor-Serra
- Orthopaedic Surgery Department, Orthopaedic Trauma Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Jordi Tomás-Hernández
- Orthopaedic Surgery Department, Orthopaedic Trauma Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Jordi Selga-Marsá
- Orthopaedic Surgery Department, Orthopaedic Trauma Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Juan-Antonio Porcel-Vázquez
- Orthopaedic Surgery Department, Orthopaedic Trauma Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Vicente Molero-García
- Orthopaedic Surgery Department, Orthopaedic Trauma Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - José Vicente Andrés-Peiró
- Orthopaedic Surgery Department, Orthopaedic Trauma Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
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Andrés-Peiró JV, Teixidor-Serra J, Tomás-Hernández J, Guerra-Farfán EM, Selga-Marsà J, Porcel-Vázquez JA, Molero-García V. Retrospective study of 16 acetabular fractures with involvement of the quadrilateral plate treated with an anterior intrapelvic modified Rives-Stoppa approach. Rev Esp Cir Ortop Traumatol (Engl Ed) 2019. [DOI: 10.1016/j.recote.2019.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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9
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Andrés-Peiró JV, Teixidor-Serra J, Tomás-Hernández J, Guerra-Farfán EM, Selga-Marsà J, Porcel-Vázquez JA, Molero-García V. Retrospective study of 16 acetabular fractures with involvement of the quadrilateral plate treated with an anterior intrapelvic modified Rives-Stoppa approach. Rev Esp Cir Ortop Traumatol (Engl Ed) 2019; 63:416-423. [PMID: 31521581 DOI: 10.1016/j.recot.2019.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 05/12/2019] [Accepted: 06/25/2019] [Indexed: 12/29/2022] Open
Abstract
GOAL To report our experience with the use of Stoppa approach for fractures of the acetabulum with quadrilateral plate involvement. MATERIAL AND METHOD Retrospective study; level iv. All patients were operated in a third level trauma center. The surgical team was experienced in the management of pelvic fractures. Data about patients, injuries, treatment features and clinical and radiological results were collected. We performed a statistical analysis; both descriptive and analytical. RESULT 16 patients integrated the sample. 15 suffered associated fracture patterns. Anatomical plates were used in 15. Four required extended approaches. Reduction was anatomical in 9. 7 suffered some complication, needing the additional surgical procedures in 4. The surgical site infection rate was particularly high, appearing in 3. DISCUSSION Radiological results were within the previously reported. We had a high complication rate, particularly infection. This outcome may be influenced by the special complexity of our cases and the adaptation process to a new technique. CONCLUSSION Using the Stoppa approach we achieved lots of good or anatomical reductions. However, is an exigent and not without complications technique.
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Affiliation(s)
- J V Andrés-Peiró
- Unidad de Traumáticos, Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitari Vall d'Hebron, Barcelona, España.
| | - J Teixidor-Serra
- Unidad de Traumáticos, Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - J Tomás-Hernández
- Unidad de Traumáticos, Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - E M Guerra-Farfán
- Unidad de Cirugía de Cadera, Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - J Selga-Marsà
- Unidad de Traumáticos, Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - J A Porcel-Vázquez
- Unidad de Traumáticos, Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - V Molero-García
- Unidad de Traumáticos, Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitari Vall d'Hebron, Barcelona, España
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10
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Tomás-Hernández J, Núñez-Camarena J, Teixidor-Serra J, Guerra-Farfan E, Selga J, Antonio Porcel J, Andrés-Peiró JV, Molero V. Salvage for intramedullary nailing breakage after operative treatment of trochanteric fractures. Injury 2018; 49 Suppl 2:S44-S50. [PMID: 30219147 DOI: 10.1016/j.injury.2018.07.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 07/08/2018] [Accepted: 07/23/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Trochanteric fractures are one of the most common fractures in elderly people. The use of intramedullary nails is an option for their treatment, especially in unstable patterns. Nail breakage is a rarely reported complication. The aim of this study was to determine the prevalence of nail breakage in our center. Secondary objectives are to show the management of this complication in our institution as well as the technical problems, complications and final outcomes of these patients in our hands. MATERIAL AND METHODS In a retrospective case series review between 2010 and 2015, we analyzed 1481 patients with trochanteric and subtrochanteric fractures who had been treated by cephalomedullary nailing in our centre. 13 patients with nail breakage were identified. RESULTS The percentage failure rate in our institution is 0.87%. 9 (69.2%) patients were women and 4 (3.8%) were men, with a mean age of 74.6 years (range 47-90). In all cases the mechanism of injury was a simple fall from standing height. Initial fracture types were: 1 case of AO/OTA 31A1, 6 cases of AO/OTA 31A2 and 6 cases of AO/OTA 31A3. Only 3 cases had a good overall reduction with a correct TAD, an optimal femoral neck-shaft angle and absence of fracture gaps >5 mm after surgery. The average time from the first surgery to the diagnosis of implant breakage was 333 days (range 70-1460), 11 months. Breakage occurred at the nail junction with the lag screw in 11 cases and in the distal nail aperture in 2 cases. CONCLUSIONS An insufficient reduction with varus and fracture gaps >5 mm, the use of short nails in unstable patterns with subtrochanteric involvement and patients with certain comorbidities are facts observed that can contribute to the development of delayed or nonunion with subsequent nail breakage. Different salvage treatments, conversion to hip arthroplasty or revision osteosynthesis, may be considered but we think that prevention has to be the best treatment.
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Affiliation(s)
- Jordi Tomás-Hernández
- Trauma Unit of the Department of Traumatology and Orthopaedic Surgery of Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona (UAB), Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain.
| | - Jorge Núñez-Camarena
- Trauma Unit of the Department of Traumatology and Orthopaedic Surgery of Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona (UAB), Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Jordi Teixidor-Serra
- Trauma Unit of the Department of Traumatology and Orthopaedic Surgery of Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona (UAB), Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Ernesto Guerra-Farfan
- Trauma Unit of the Department of Traumatology and Orthopaedic Surgery of Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona (UAB), Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Jordi Selga
- Trauma Unit of the Department of Traumatology and Orthopaedic Surgery of Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona (UAB), Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Juan Antonio Porcel
- Trauma Unit of the Department of Traumatology and Orthopaedic Surgery of Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona (UAB), Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - José Vicente Andrés-Peiró
- Trauma Unit of the Department of Traumatology and Orthopaedic Surgery of Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona (UAB), Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Vicente Molero
- Trauma Unit of the Department of Traumatology and Orthopaedic Surgery of Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona (UAB), Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
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Abstract
High-energy pilon fractures are challenging injuries. Multiple options are described for the definitive surgical management of these fractures, but there is no level I evidence for optimal management. The current management and recommendations for treatment will be reviewed in this article. Anatomical reduction of the fracture, restoration of joint congruence and reconstruction of the posterior column with a correct limb axis minimising the soft-tissue insult are the key points to a good outcome when treating pilon fractures. Even when these goals are achieved, there is no guarantee that results will be acceptable in the mid-term due to the frequent progression to post-traumatic arthritis. In high-energy fractures with soft-tissue compromise, a staged treatment is generally accepted as the best way to take care of these devastating fractures and is considered a local ‘damage control’ strategy. The axial cuts from the CT scan images are essential in order to define the location of the main fracture line, the fracture pattern (sagittal or coronal) and the number of fragments. All of this information is crucial for pre-operative planning, incision placement and articular surface reduction. No single method of fixation is ideal for all pilon fractures, or suitable for all patients. Definitive decision making is mostly dependent on the fracture pattern, condition of the soft-tissues, the patient’s profile and surgical expertise.
Cite this article: Tomás-Hernández J. High-energy pilon fractures management: state of the art. EFORT Open Rev 2016;1:354-361. DOI: 10.1302/2058-5241.1.000016.
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Affiliation(s)
- Jordi Tomás-Hernández
- Department of Orthopaedic and Trauma Surgery, Hospital Vall d'Hebron, Barcelona, Spain
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12
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Tomás-Hernández J, Monyart JM, Serra JT, Vinaixa MR, Farfan EG, García VM, Feliu EC. Large fracture of the anteromedial tibial plateau with isolated posterolateral knee corner injury: case series of an often missed unusual injury pattern. Injury 2016; 47 Suppl 3:S35-S40. [PMID: 27692105 DOI: 10.1016/s0020-1383(16)30604-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Tibial plateau fractures are a heterogeneous group of lesions with multiple fracture patterns. They are often associated with soft tissue injuries, the lateral meniscus and the anterior cruciate ligament (ACL) being the most common structures affected. The purpose of this article is to present a case series of an often missed unusual injury pattern that consists on the association of a large anteromedial tibial plateau fracture with a posterolateral (PL) knee corner injury without involvement of the cruciate ligaments. The diagnosis of PL complex injury may go unrecognized in a considerable number of cases and delay on the treatment decreases the success rate of soft tissue repairing. The importance of a high index of suspicion and a proper early diagnosis with an MRI is of paramount importance. We also describe the current surgical management used by the authors and review of the current literature.
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Affiliation(s)
- Jordi Tomás-Hernández
- Department of Orthopaedic and Trauma Surgery, Trauma Unit, Hospital Vall d'Hebron - Universitat Autonoma de Barcelona (UAB), Passeig Vall d'Hebron, Barcelona, Spain.
| | - Joan Minguell Monyart
- Department of Orthopaedic and Trauma Surgery, Knee Unit, Hospital Vall d'Hebron - Universitat Autonoma de Barcelona (UAB), Passeig Vall d'Hebron, Barcelona, Spain
| | - Jordi Teixidor Serra
- Department of Orthopaedic and Trauma Surgery, Trauma Unit, Hospital Vall d'Hebron - Universitat Autonoma de Barcelona (UAB), Passeig Vall d'Hebron, Barcelona, Spain
| | - Merce Reverté Vinaixa
- Department of Orthopaedic and Trauma Surgery, Knee Unit, Hospital Vall d'Hebron - Universitat Autonoma de Barcelona (UAB), Passeig Vall d'Hebron, Barcelona, Spain
| | - Ernesto Guerra Farfan
- Department of Orthopaedic and Trauma Surgery, Trauma Unit, Hospital Vall d'Hebron - Universitat Autonoma de Barcelona (UAB), Passeig Vall d'Hebron, Barcelona, Spain
| | - Vicente Molero García
- Department of Orthopaedic and Trauma Surgery, Trauma Unit, Hospital Vall d'Hebron - Universitat Autonoma de Barcelona (UAB), Passeig Vall d'Hebron, Barcelona, Spain
| | - Enric Castellet Feliu
- Department of Orthopaedic and Trauma Surgery, Knee Unit, Hospital Vall d'Hebron - Universitat Autonoma de Barcelona (UAB), Passeig Vall d'Hebron, Barcelona, Spain
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