Treatment of a post-traumatic stiff knee after an open extensor apparatus injury by arthroscopic arthrolysis through a free flap

Extensor apparatus injury; Open patella fracture; Stiff kneeLesión del aparato extensor; Fractura de rótula abierta; Rodilla rígidaLesió de l'aparell extensor; Fractura de ròtula oberta; Genoll rígidOpen patella fractures have high complication rates. Post-traumatic joint stiffness is particularly common. The management of this complication is even more difficult if free flap was used to cover a soft tissue defect. Late surgical manipulation of free flaps can lead to their failure, with catastrophic consequences. The use of minimally invasive techniques could reduce the associated risks. We present a case of knee stiffness after the fix and flap treatment of a grade IIIB open patella fracture. We performed an arthroscopic arthrolysis with portals through the flap. The pedicle was preoperatively located and avoided. Joint range of motion remarkably improved without records of flap complications. We consider that the technique is feasible. Its success was based on the multidisciplinary collaboration between orthopaedic and plastic surgeons and rehabilitation medicine specialists

Single-injection nerve blocks for total knee arthroplasty: femoral nerve block versus femoral triangle block versus adductor canal block—a randomized controlled double-blinded trial

Femoral nerve block; Postoperative analgesia; Total knee arthroplastyBloqueo del nervio femoral; Analgesia postoperatoria; Artroplastia total de rodillaBloqueig del nervi femoral; Analgèsia postoperatòria; Artroplàstia total de genollIntroduction Femoral nerve block (FNB) is a well-established analgesic technique for TKA. However, it associates quadriceps weakness. Therefore, femoral triangle block (FTB) and adductor canal block (ACB) were proposed as effective alternative motor-spearing techniques. The primary objective was to compare quadriceps muscle strength preservation between FNB, FTB and ACB in TKA. The secondary objective was to analyze pain control and functional outcomes. Methods This is a prospective, double-blinded RCT. From April 2018 to April 2019, patients who undergo a primary TKA were randomized into three experimental groups: FNB-G1/FTB-G2/ACB-G3. Quadriceps strength preservation was measured as the difference in maximum voluntary isometric contraction (MVIC) preoperatively and postoperatively. Results Seventy-eight patients (G1, n = 22; G2, n = 26; G3, n = 30) met our inclusion/exclusion criteria. Patients with FNB retained significantly lower baseline MVIC at 6 h postoperatively (p = 0.001), but there were no differences at 24 and 48 h. There were no differences between the groups in functional outcomes at any time point. Patients in the FNB-G1 presented significant lower pain scores at 6 h (p = 0.01), 24 h (p = 0.005) and 48 h (p = 0.01). The highest cumulative opioid requirement was reported in ACB-G3. Conclusion For patients undergoing TKA, FTB and ACB preserve quadriceps strength better than FNB at 6 h postoperatively, but there are no differences at 24 and 48 h. Moreover, this early inferiority does not translate to worse functional outcomes at any time point. FNB is associated with better pain control at 6, 24 and 48 h after surgery, while ACB presents the highest cumulative opioid requirement. Clinical trial registration This study was registered in clinicaltrials.gov (NCT03518450; https://clinicaltrials.gov/ct2/show/NCT03518450; submitted March 17, 2018)

Single-injection nerve blocks for total knee arthroplasty : femoral nerve block versus femoral triangle block versus adductor canal block-a randomized controlled double-blinded trial

Introduction: Femoral nerve block (FNB) is a well-established analgesic technique for TKA. However, it associates quadriceps weakness. Therefore, femoral triangle block (FTB) and adductor canal block (ACB) were proposed as effective alternative motor-spearing techniques. The primary objective was to compare quadriceps muscle strength preservation between FNB, FTB and ACB in TKA. The secondary objective was to analyze pain control and functional outcomes. Methods: This is a prospective, double-blinded RCT. From April 2018 to April 2019, patients who undergo a primary TKA were randomized into three experimental groups: FNB-G1/FTB-G2/ACB-G3. Quadriceps strength preservation was measured as the difference in maximum voluntary isometric contraction (MVIC) preoperatively and postoperatively. Results: Seventy-eight patients (G1, n = 22; G2, n = 26; G3, n = 30) met our inclusion/exclusion criteria. Patients with FNB retained significantly lower baseline MVIC at 6 h postoperatively (p = 0.001), but there were no differences at 24 and 48 h. There were no differences between the groups in functional outcomes at any time point. Patients in the FNB-G1 presented significant lower pain scores at 6 h (p = 0.01), 24 h (p = 0.005) and 48 h (p = 0.01). The highest cumulative opioid requirement was reported in ACB-G3. Conclusion: For patients undergoing TKA, FTB and ACB preserve quadriceps strength better than FNB at 6 h postoperatively, but there are no differences at 24 and 48 h. Moreover, this early inferiority does not translate to worse functional outcomes at any time point. FNB is associated with better pain control at 6, 24 and 48 h after surgery, while ACB presents the highest cumulative opioid requirement. Clinical trial registration: This study was registered in clinicaltrials.gov (NCT03518450; https://clinicaltrials.gov/ct2/show/NCT03518450 ; submitted March 17, 2018)