The Knee
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A variety of surgical approaches have been employed previously for the open reduction and internal fixation of the fractures of lateral and posterolateral tibial plateau. However, the commonly used lateral approach does not provide adequate exposure and access to the posterolateral aspect of the lateral tibial plateau. We developed a new approach with osteotomy of fibular head to solve this problem and report its preliminary result. ⋯ The new approach provides excellent visualization, which can facilitate the reduction and internal fixation for lateral or posterolateral tibial plateau fractures, and shows encouraging results.
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Management of a displaced comminuted patellar fracture is challenging. Tension band wiring and lag screw fixation are not suitable for such a fracture pattern. Stainless steel wiring with various configurations has been the mainstay of treatment. ⋯ The mean score at the final follow-up was 27 points (25 to 30) using the Böstman method. There was no complication except breakage of one cable at the sixth week after the operation and the fracture had united despite the breakage. This technique is simple and effective for these difficult fractures and avoided prolonged immobilisation of the knee.
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Peri-articular fractures of the knee in the young and elderly pose several management dilemmas. Over the last decade enormous interest has been generated in various fixation modalities, none proving to be an ideal stabilisation method. The problem is compounded by a lack of well-designed studies comparing various treatment options. In this article, the issues surrounding the diagnostic and management strategies of peri-articular fractures of the knee are discussed.
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The purpose of this study was to evaluate the functional outcome of surgical reconstruction of the posterior cruciate ligament (PCL). In particular we wanted to document the recovery of knee muscle function. Twenty three patients underwent single bundle reconstruction of the PCL. ⋯ Knee flexion peak torque demonstrated an average percentage deficit from the normal side of 24% at 12 months and 14% at 24 months. The deficits for extension were 35% and 9% for the same time points. PCL reconstruction is associated with a satisfactory clinical outcome but muscle function abnormalities may persist for 2 years.
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Review Meta Analysis
Is a tourniquet beneficial in total knee replacement surgery? A meta-analysis and systematic review.
Proponents of tourniquets postulate that they optimise intra-operative visibility and reduce blood loss. This study compared the outcomes of tourniquet assisted to non-tourniquet assisted total knee replacement (TKR). A systematic review was undertaken of the electronic databases Medline, CINAHL, AMED and EMBASE, in addition to a review of unpublished material and a hand search of pertinent orthopaedic journals. ⋯ There was a trend for greater complications in tourniquet compared to non-tourniquet patients. There was no difference between the groups for any other outcome measure assessed. In conclusion, this systematic review has found that there is no advantage to using a tourniquet in knee replacement surgery for reduction of transfusion requirements.