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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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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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review was undertaken of the electronic databases Medline, CINAHL, AMED and EMBASE, in addition to a review of unpublished material and a hand search of pertinent orthopaedic journals.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.
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Simultaneous bilateral avulsion fractures of the tibial tuberosity is a rare injury. Since it was first described in 1955, there have been eight similar cases. ⋯ Like the previous reports, our patient had a satisfactory result from open reduction and internal fixation of both fractures. Despite being bilateral, these injuries have a low complication rate and good outcome comparable with that of unilateral avulsion fractures of the tibial tuberosity.
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Review Case Reports
Bone marrow edema syndrome of the knee: a case report and review of the literature.
The authors present a 45-year-old man with bone marrow edema syndrome (BMES) of the medial condyle of the knee. Early diagnosis of BMES was based upon clinical, bone scintigraphy and magnetic resonance (MRI) findings. ⋯ Within 2 months after the operation, the patient was pain-free and he resumed his previous activities. At 1-year follow-up examination, MRI showed complete resolution of all signal abnormalities; at 3-year follow-up the patient remained symptom-free and with no functional limitations.