Cases Report: Clavicular Fractures after Hook-Plate Fixation Surgery

The clavicular hooked plate had been used worldwide for fixation the unstable fracture of the distal clavicle and displaced acromioclavicular joint dislocation.  Although it has been widely accepted as the new device used, some complications were still present. The reported complications include acromion fracture, clavicle fracture at the medial end of the hook plate, recurrent acromioclavicular joint subluxation, disengagement of plate as well as subacromial pain and impingement. There were few reports about complications after hook plate fixation surgery. The present study reported 2 cases of clavicle fracture at the medial end of the hook plate after the operation. The first case was diagnosed with displaced fracture at distal end of right clavicle (Neer type II) and the second case was diagnosed with displaced right acromioclavicular joint (Rockwood type IV).  All fracture lines were initiated beneath the medial end of hook plate and adjacent to medial screw which indicated a weak point. Additionally, the stress at the medial end of the hook plate was increased. Both patients were received conservative treatment and were not performed re-fixation surgery. They achieved clavicle union with a good functional result

Complications after Total Knee Arthroplasty: Stiffness, Periprosthetic Joint Infection, and Periprosthetic Fracture

Total knee arthroplasty (TKA) is one of the most successful surgical procedures with effective treatment in patients suffering from end-stage knee osteoarthritis. The goal of the operation is to improve pain, correct the deformity, and increase function. However, complications after surgery are the important factors related to dissatisfied TKA. Stiffness, periprosthetic joint infection (PJI), and periprosthetic fracture are among the most common complications following TKA and usually raise issues as concern points for both patients and the surgeons. Each complication needs precise assessment and specific care to prevent further serious issues. In this chapter, the authors will focus and describe all of these three frequent complications in details from their definition to management

Medial Closing-Wedge Distal Femoral Varus Osteotomy via Lateral Approach: The Modified Technique for Treating Valgus Osteoarthritic Knee as Case Series

Objective: The medial closing-wedge distal femoral varus osteotomy (MCW-DFVO) was an excellent operation for painful valgus lateral unicompartmental osteoarthritic (OA) knee, especially in the young patient. Originally, it requires a medial approach that has more precarious. On top of that, releasing of the iliotibial band that is the deforming force needs added incision. Therefore, this study aims to describe the modified surgical technique of MCW-DFVO that uses a lateral approach and lateral plating to treat the valgus OA knee. Additionally, we also reveal the outcomes of our technique as the case series. Materials and Methods: Ten patients (12 knees) who underwent MCW-DFVO via a lateral approach were retrospectively reviewed. The inclusion criteria were age 18-60 years, isolated lateral compartmental OA knee (Kellgren-Lawrence grade 3-4), no significant patellofemoral pain, and range of motion (ROM) > 90 degrees. We excluded the inflammatory joint disease, unstable knee (femorotibial joint subluxation > 1 cm), and prior surgical procedure. Demographic data, pre- and postoperative ROM, radiographic outcomes, complications, and survivorship were recorded. Results: The mean age, body mass index, and preoperative ROM were 55.3 ± 4.0 years, 25.4 ± 3.7 kg/m2 and 113.3 ± 11.5 degrees, respectively. The preoperative mechanical femorotibial angle was 162.3 ± 4.8 degrees, and the final post-operative alignment was 182.3 ± 2.6 degrees. Overall mean operative time of this technique was 92.5 ± 26.7 minutes. During the mean follow-up period of 8.3 ± 3.1 years, all osteotomy were united and the final postoperative ROM was decreased to 108.8 ± 11.7 degrees. One knee required plate removal due to hardware irritation, and another knee required subsequent total knee arthroplasty at 1 and 8.5 years after MCW-DFVO, respectively. The survivorship of this technique was 91.7% at the mean survival time of 13.8 years (95% confidence interval, 11.9 – 15.7 years). Conclusion: This study proposed the modified surgical technique of MCW-DFVO via a lateral approach. This technique provided the excellent correction angle, union rate and survivorship

Retrieval Analysis of Polyethylene in Total Knee Arthroplasty in Thailand: A Case Report

Objective: Retrieval analysis is one of the effective methods that can provide the information on in-vivo characteristics of wear implants. The clinicians can correlate the damage pattern from this method with other findings in a reproducible manner. Nevertheless, there has been no previous retrieval analyses of PE wear in total knee arthroplasty (TKA) in Thailand. Case Presentation: A 80-year-old female underwent left TKA due to osteoarthritic knee in 1994. She was 135 cm in height and weighed 42.7 kg. The cemented posterior stabilized press-fit condylar (PFC) (Depuy, Warsaw, IN, US) total knee system was used. Patellar resurfacing was performed with a cemented all-polyethylene implant. The femoral component was cobalt-chrome, while the tibial component was titanium alloy. A 12.5-mm thickness of stabilized plus tibial insert was used. After surgery, her knee had functioned well for 20 years. One year ago, she had intermittent swelling and effusion of the knee, together with occasional pain. The symptoms had gradually progressed with increasing episodes of giving way. She was diagnosed with aseptic loosening of TKA and consequently underwent revision TKA in 2014. All components were removed and retrieval analysis of PE tibial insert was performed at the National Metal and Materials Technology Center (MTEC), Thailand. Wear assessment of the articulating and non-articulating surfaces was performed in 16 zones. We found that PE wear was present in 11 zones without any backsides wear. The stereomicroscopy was performed, in which the scratches and delamination of the PE surface were demonstrated. The specimen was cut and analyzed using a scanning electron microscopy (SEM) to observe the insides of PE. Delamination, subsurface cracking and damage were identified in the damaged zones. In the metal part of PE, the surface damage and metal wear debris were also displayed using SEM. Conclusion: This retrieval analysis could demonstrate various modes of wear on UHMWPE. However, we propose that future studies, which are based on the association between wear of UHMWPE and possible precipitating factors, are mandatory