Outcomes of Operatively Treated Acute Knee Dislocations

Knee dislocation is a complex and rare injury often presenting in the context of high velocity trauma. The aim of this study is to establish the subjective outcomes of surgically treated knee dislocations. A total of 20 knees dislocations treated by open repair were reviewed. Their progress and outcomes were assessed by using a modified Lysholm score questionnaire. Data was obtained on patient demographics, details of injury, investigation, treatment, rehabilitation, 24 months objective outcome and subjective outcomes. Six patients had a vascular deficit and six had neurological deficits. The median range of motion was 0°-100°. Patients with an initially lower pre-injury level of function were able to return an activity level comparable to their pre-injury status. 22% of competitive athletes retuned to competitive sports. 38% of patients undertaking heavy activity returned to comparable pre-injury level of activity and 67% of patients undertaking moderate level of activity before injury returned to a comparable level after repair. 68% regularly had problems running, 70% problem squatting, 40% swelling and 42% problem with stairs. Most patients however did not have locking of the knee or problems with knees giving way. Patients pain scores decreased over time to an acceptable level. Despite the severity of the injury, majority of patients achieved a satisfactory outcome, although none of the patients reached the same level of function as before the injury. 80% of the patients were satisfied with their outcome. All dissatisfied patients suffered postoperative complications

Complications associated with clavicular fracture

The objective of our literature review was to inform orthopaedic nurses about the complications of clavicular fracture, which are easily misdiagnosed. For this purpose, we searched MEDLINE (1965-2005) using the key words clavicle, fracture, and complications. Fractures of the clavicle are usually thought to be easily managed by symptomatic treatment in a broad arm sling. However, it is well recognized that not all clavicular fractures have a good outcome. Displaced or comminuted clavicle fractures are associated with complications such as subclavian vessels injury, hemopneumothorax, brachial plexus paresis, nonunion, malunion, posttraumatic arthritis, refracture, and other complications related to osteosynthesis. Herein, we describe what the orthopaedic nurse should know about the complications of clavicular fractures. © 2009 National Association of Orthopaedic Nurses

Changes of bone turnover markers after marathon running over 245 km

We evaluated bone turn over markers, cortisol and parathyroid hormone (PTH) levels in male athletes after 245 km of marathon running. Sixteen athletes were studied five days before, immediately after, and 1, 3, and 5 days after the run. We used t-test and Pearson correlation for statistical analysis. Osteocalcin levels were significantly decreased from 4.6 μg/lit to 3.8 μg/lit (p < 0.05). Activity of b-ALP was significantly decreased from 66 U/lit to 61.5 U/lit (p < 0.05). PICP levels were also significantly decreased from 168 μg/lit to 153 μg/lit (p < 0.05). Hydroxyproline levels decreased after the run from 70 mmol/min to 65 mmol/min (p < 0.05). ICTP levels increased after the run but without being statistically significant, from 6.62 μg/lit to 7.0 μg/lit. Urine calcium decreased significantly by 68%, immediately after the run. Cortisol increased from 212 ng/ml to 455 ng/ml, and PTH levels increased from 12 pg/lit to 16 pg/lit immediately after the race (p < 0.05). Cortisol levels were significantly negatively correlated with osteocalcin (r = -0.61, p < 0.05) and b-ALP (r = -0.98, p < 0.05). PTH levels were significantly negatively correlated only with serum osteocalcin (r = -0.8, p < 0.05). These findings suggest a transient suppression in osteoblast function during the marathon run probably due to cortisol and PTH levels elevation. © Georg Thieme Verlag KG Stuttgart

Clinical and radiological outcomes after management of traumatic knee dislocation by open single stage complete reconstruction/repair

The purpose of our study was to analyze the clinical and radiological long-term outcomes of surgically treated traumatic knee dislocations and determine prognostic factors for outcome

The four-year functional result after a displaced subcapital hip fracture treated with three different surgical options

According to the literature, hip function after hip fracture is affected by the type of surgery. Our aim was to determine the correlation between surgical treatment of hip fracture and postoperative function in the elderly. Inclusion criteria were displaced hip fracture and age over 70 years. One hundred and twenty-nine participants were randomly divided into three groups according to the type of the surgical operation they underwent (hemi-arthroplasty [Merete, Berlin, Germany], total arthroplasty [Plus; De Puy, Warsaw, IN, USA] and internal fixation [Richards plate screw; Smith & Nephew, Memphis, TN, USA]). The function of the patients was estimated using the following parameters: the Barthel Index and Harris Hip Score, the range of passive hip motion, the gait speed of individuals, after 1 and 4 years of follow-up. The Barthel Index scores after 4 years of follow-up were 85.3, 82.6, 80.1 after total arthroplasty, hemi-arthroplasty and internal fixation respectively. Similarly, the Harris Hip Scores after 4 years of follow-up were 83.7, 79.5 and 73.6. The range of passive hip motion in the three groups of patients did not differ significantly (p > 0.05). Also, patients of the total arthroplasty and hemi-arthroplasty groups walked faster than the patients of the internal fixation group 4 years after discharge (p < 0.05). In conclusion, we believe that total hip arthroplasty is the treatment of choice for displaced subcapital hip fractures in patients over 70 years old