Implantless patellar fixation in medial patellofemoral ligament reconstruction

Purpose:The medial patellofemoral ligament(MPFL)acts as primary restraint to lateral patellar dislocation and its rupture has been reported in almost all cases of acute patellar dislocation.Various surgical techniques have been described for MPFL reconstruction,using many femoral and patellar fixation techniques and different grafts.This article details our technique for MPFL reconstruction using semitendinosus graft which avoids the use of implant at patellar end.Methods:Twenty patients(8 males and 12 females)with complaints regarding acute and chronic lateral patellar instability were evaluated and treated by MPFL reconstruction procedure.The mean age of patients was 21 years(range 17-34 years).MPFL reconstruction was performed using semitendinosus graft passing through two parallel,obliquely directed tunnels created in patella.Fixation of graft was done with an interference screw only at the femoral end.Mean follow-up period after intervention was 26.4 months(range 23-30 months).Results were evaluated using Kujala score.Results:All patients gained adequate patellar stability and full arc of motion.No incidence of patella fracture was noted.There were no postoperative complications related to the procedure.There was no recurrence of instability in patella at final follow-up.Conclusion:Passing the graft through the tunnels in patella without use of any implant has given excellent functional outcome and moreover has the advantages of less implant-related complications and cost-effectiveness.

Dsteosynthesis with long volar locking plates for meta- physeal-diaphyseal fractures of the distal radius

Objective：Metaphyseal-diaphyseal fractures of the distal radius are a major treatment dilemma and orthopaedic surgeons have to pay due consideration to restoration of anatomy of distal radius together with rotation of the radial shaft and maintenance of radial bow and interosseous space.We performed this study to evaluate the clinic-radiological outcome of metaphyseal-diaphyseal fractures of the distal radius treated with long volar locking plates.Methods：This prospective study involved 27 patients （22 males and 5 females） with metaphyseal-diaphyseal fracture of the distal radius.Their mean age was （30.12±11.48） years （range 19-52 years） and the follow-up was 26.8 months （range 22-34 months）.All patients underwent open reduction and internal fixation with a long volar locking plate.According to AO/OTA classification,there were 7 type A3,13 type C2 and 7 type C3 fractures.Subjective assessment was done based on the disabilities of the arm,shoulder and hand （DASH） questionnaire.Functional evaluation was done by measuring grip strength and range of motion around the wrist and the radiological determinants included radial angle,radial length,volar angle and ulnar variance.The final assessment was done according to Gartland and Werley scoring system.Results：Postoperative radiological parameters were well maintained throughout the trial,and there was significant improvement in the functional parameters from 6 weeks to final follow-up.The average DASH scores improved from 37.5 at 6 weeks to 4.2 at final follow-up.Final assessment using Gartland and Werley scoring system revealed 66.67%（n=l8） excellent and 33.33% （n=9） good results.There was one case of superficial infection which responded to antibiotics and another carpel tunnel syndrome which was managed conservatively.Conclusion：Volar locking plate fixation for metaphyseal-diaphyseal fractures of distal radius is associated with excellent to good functional outcome,early rehabilitation and minimal complications.