The flexibility and convenience of using a standard orthopaedic table in periarticular knee fractures:Allowing ligamentotaxis and improving imaging accessibility

Tibial plateau and distal femoral fractures are common injuries presenting a significant operative challenge.Complexity of the fracture often needs multi-planar surgical access.A combined two-staged procedure is frequently suggested both in supine and prone position to address this issue.However,this will significantly increase the operative time and eventually impact the outcome,in addition to the complications associated with prone positioning.In this study we used a standard orthopaedic table to position these patients in order to grant access to the postro-medial and a postro-lateral structures while the patient stays in supine setup,at the same time,giving the flexibility to change the alignment from valgus to varus and vice versa.This facilitates fracture reduction while addressing the anatomical structure of the knee.A further advantage is the unobstructed imaging access throughout the surgical fixation.This facilitates the reduction in operative time hence leading to a better outcome in these difficult fractures.We tested this positioning technique in more than 40 patients over a 4-year period at two different centres in the United Kingdome.We found that this approach is safe,reproducible and relatively easy to set up in the two centres.

Distraction ligamentotaxis for complex proximal interphalangeal joint fracture dislocations:a clinical study and themodified pins rubber band traction system revisited

Background:The purpose of this study is to present our experience with the modified pins and rubber band traction system, discuss problems encountered, and make recommendations to optimize outcomes. Methods:Data was collected prospectively from November 2013 to March 2017 at a tertiary referral hospital in Melbourne, Australia. Patients with closed complex proximal interphalangeal joint fracture dislocations that were considered unsuitable for other surgical options were included in the study. Patients underwent dynamic skeletal distraction using the modified (Deshmukh) pins rubber band traction system. Outcomes were measured using the Nominal Rating Scale for pain;Disabilities of the Arm, Shoulder, and Hand (DASH) score;active and passive range of motion;patient rating scale;and complications. Results:Twenty patients underwent the procedure, and 19 were included in analyses. At the final follow-up assessment, an average of 62° and 77° was achieved for proximal interphalangeal joint active and passive range of motion, respectively. Pain levels were low (median score of 0 at rest and 1 ranging, out of 10). Four patients suffered minor pin site infections. Conclusion:Distraction ligamentotaxis is a useful part of the armamentarium, especially in the absence of more suitable procedures. It is important to select appropriate patients, educate, and ensure adherence to postoperative therapy. Employing the Deshmukh frame modification streamlines the theatre processes, and removal of wires at approximately 4 weeks minimizes risk of pin site infection.

Role of Joshi＇s external stabilization system with percutaneous screw fixation in high-energy tibial condylar fractures associated with severe soft tissue injuries

Purpose： The treatment of high-energy tibial condylar fractures which are associated with severe soft tissue injuries remains contentious and challenging. In this study, we assessed the results of Joshi＇s external stabilization system （JESS） by using the principle of ligamentotaxis and percutaneous screw fixation for managing high-energy tibial condylar fractures associated with severe soft tissue injuries. Methods： Between June 2008 and June 2010, 25 consecutive patients who were 17-71 years （mean, 39.7）, underwent the JESS fixation for high-energy tibial condylar fractures associated with severe soft tissue injuries. Out of 25 patients, 2 were lost during follow-up and in 1 case early removal of frame was done, leaving 22 cases for final follow-up. Among them, 11 had poor skin condition with abrasions and blisters and 2 were open injuries （Gustilo-Anderson grade I ＆ 11）. The injury mechanisms were motor vehicle accidents （n - 19）, fall from a height （n = 2） and assault （n - 1）. The fractures were classified according to Schatzker classification system. Results： There were 7 type-V, 14 type-Vl and 1 type-IV Schatzker＇s tibial plateau fractures. The average interval between the injury and surgery was 6.8 days （range 2-13）. The average hospital stay was 13 days （range, 7-22）. The average interval between the surgery and full weight bearing was 13.6 weeks （range 11-20）. The average range of knee flexion was 121° （range 105°-135°）. The normal extension of the knee was observed in 20 patients, and an extensor lag of 5°-8° was noted in 2 patients. The complications included superficial pin tract infections （n 4） with no knee stiffness. Conclusion： JESS with lag screw fixation combines the benefit of traction, external fixation, and limited internal fixation, at the same time as allowing the ease of access to the soft tissue for wound checks, pin care, dressing changes, measurement of compartment pressure, and the monitoring of the neurovascular status. In a nutshell, JESS along with screw fixation offers a promising alternative treatment for high- energy tibial condylar fractures associated with severe soft tissue injuries.