Survey of Current Articles Published on Total Ankle Arthroplasty and Ankle Fusion

In the United States, ankle fusion is more commonly performed than total ankle arthroplasty (TAA) for treatment of degenerative joint disease of the ankle. However, recent advances in implant design and technique have led to a renewed interest in research on TAA. To shed light on current research trends and limited data rather than examine the merits between both methods, we performed a PubMed search of studies on TAA and ankle fusion between January 1, 2009, and January 1, 2015, published in both the American edition of the Journal of Bone and Joint Surgery (JBJS) and Foot & Ankle International (FAI). We chose these journals because of their combined audience of both a specific orthopaedic subspecialty and the general orthopaedic community. A total of 132 articles met our inclusion criteria, with 76% and 3% of articles on TAA alone and ankle fusion alone published in JBJS, respectively, and 61% and 19% in FAI, respectively. Additionally, we found that a relatively small number of authors accounted for 65% of the articles in JBJS and 18% in FAI. The replacement of one procedure by the other will not likely occur in the near future, but our findings indicate a current research trend toward TAA more than ankle fusion. The clinical impact of an increased amount of studies on TAA has yet to be determined

Sciatic Nerve Palsy After Operative Treatment of Subtrochanteric Femur Fracture Resulting from Postoperative Hematoma: A Case Report

Treatment of subtrochanteric femur fractures can be difficult owing to high risk of complications. No cases of sciatic nerve palsy after hematoma following open reduction and intramedullary nailing of a subtrochanteric femur fracture have been reported. We describe a 28-yearold man who presented with a subtrochanteric fracture in the left femur after a motor-vehicle collision, in whom open reduction and intramedullary nailing led to an immediate postoperative hematoma and sciatic nerve palsy. Prompt diagnosis and early wound exploration resulted in complete resolution of the palsy at 1 month postoperatively. Our findings reinforce the importance of prompt diagnosis and treatment in limiting long-term complications for patients who develop postoperative sciatic nerve palsy associated with hematoma after undergoing operative treatment of subtrochanteric femur fractures

Open Lumbosacral Dislocation: A Case Report

Open injuries in the lumbar spine are rare. We describe a 20-year-old woman who presented with persistent weaknesses due to an associated lumbar plexus injury. She underwent surgical treatment of lumbosacral dislocation with prompt reduction with debridement and stabilization. At 7 months postoperatively, her symptoms showed signs of recovery. We believe the immediate reduction of the dislocation prevented permanent neurological injury, and stabilization helped healing and early mobilization. In keeping with the classical teaching of open fracture treatment, prioritizing early initiation of intravenous antibiotics and prompt debridement and stabilization may have helped decrease the long-term morbidity and overall sequelae of this unique and devastating injury

Suspected Propofol-Related Infusion Syndrome After Lumbar Spinal Fusion With Total Intravenous Anesthesia: A Case Report

Propofol-related infusion syndrome (PRIS) is a welldocumented yet rare complication of prolonged infusions of propofol. It is characterized by a myriad of metabolic abnormalities, including cardiac arrhythmias, rhabdomyolysis, acute kidney injury, metabolic acidosis, and other disturbances. First described in children receiving extended propofol infusions to maintain sedation while in the intensive care unit, PRIS has now been described in every age group. It typically results in death. Management of this potentially devastating complication involves supportive treatment of the metabolic problems encountered and discontinuing the use of propofol. We describe a patient with suspected PRIS who underwent a two-stage lumbar spine procedure with total intravenous anesthesia, using propofol as the anesthetic. At 6-weeks postoperatively, he could walk without assistive devices and did not require pain medication. Findings of the current case may help inform healthcare providers of the possibility of PRIS after spinal fusion, allowing for a potentially lifesaving diagnosis

Primary Fusion for Treating High-Energy Intraarticular Fractures of the Distal Tibia: A Review

Orthopaedic surgeons on-call often see patients with fractures of the distal tibia involving the articular surface, with extension proximal into the metaphysis, or intraarticular distal tibia fractures. These injuries pose unique challenges owing to the typical highenergy mechanism, articular-surface involvement, high degree of comminution, and typically large soft-tissue injury. Treatment has evolved greatly with the advent of modern fracture-fixation techniques and implants. However, a large percentage of patients continue to report poor subjective outcomes. Nearly all of these patients develop posttraumatic arthritis, with the most severe often requiring further reconstructive or fusion procedures once healed to treat the symptoms. Recent studies have described promising outcomes after treating certain fractures (eg, Lisfranc and subtalar) with primary fusion of the affected joints as the definitive method of fixation. Subsequently, there is increased interest in treating severe intraarticular distal tibia fractures with primary fusion of the tibiotalar joint. Few studies have reported on this topic, yet several case reports and small series of patients found successful outcomes with primary fusion. The purpose of this paper is to provide a brief review of intraarticular distal tibia fractures and primary fusion, covering reported treatment methods and outcomes. Although primary fusion may be a viable option in improving patient outcomes in certain fracture patterns and patients, more long-term studies comparing methods are needed to help surgeons decide definitive treatment

Correlating Patient-Specific Anthropometric Variables With Soft-Tissue Thickness at the Superolateral Arthrocentesis Entry Site to the Knee

Background: Irrigation for treating septic joints in adults in the emergency department is possible but requires the development of novel systems that fit all body habitus. However, varying body habitus and age of patients may affect the amount of soft tissue surrounding the knee joint capsule. We examined whether the dimensions of the soft-tissue thickness at the superolateral approach of entry to the arthrocentesis site correlated with patient anthropometric data such as age, sex, height, weight, and body mass index (BMI, kg/m2). Methods: Using the diagnosis code 844.2 (International Classification of Diseases, Ninth Revision), we reviewed findings of magnetic resonance imaging (MRI) of knees from 100 consecutive patients and gathered anthropometric data for each patient at the time of the MRI. We measured the soft-tissue thickness at the standard entry point for superolateral arthrocentesis. Results: Soft-tissue thickness at the arthrocentesis site ranged from 5.5 mm to 38 mm and averaged 13.8 mm. Of the independent variables considered, BMI was the most closely correlated with joint-space size albeit poorly (R2 = 0.46). Every unit of increase in BMI correlated with a predicted average soft-tissue thickness increase of 0.61 mm. Conclusions: The anthropometric data obtained from this study may help create a single, universal device for use in bedside joint irrigation. The correlation between BMI and soft-tissue thickness can guide future device designs

Predicting Vancouver Types B1 and B2 Periprosthetic Fractures of the Femur

Background: Periprosthetic fractures of the femur after primary total hip arthroplasty (THA) can be complex and difficult injuries to treat. Because of the increased prevalence of THA, an overall increase is anticipated in the incidence of this complication. Vancouver types B1 and B2 periprosthetic femur fractures (defined as fractures around or just below the stem, with well-fixed and loose femoral stems, respectively) are particularly challenging to accurately classify and thereby treat owing to the difficulty in interpreting stability of stems on initial radiographs. To determine whether the method of stem fixation (ie, cement or press fit) may be a predictor of types B1 and B2 fractures, we performed a PubMed search and independently assessed data from 11 studies with 293 patients. Methods: Studies were included that provided individual patient data (ie, fracture type, method of stem fixation, and stability of stem at the time of revision procedure). Only patients with Vancouver types B1 and B2 fractures were included. Statistical analysis was performed using a random-effects model, estimated with a restricted maximum likelihood method. Results: A total of 59 and 92 cemented stems were found to be loose and well fixed, respectively (39% and 61%, respectively; n = 151). A total of 17 and 63 uncemented stems were loose and well fixed, respectively (22% and 78%, respectively; n = 80). The overall estimate of the odds ratio was 0.96 (95% confidence interval, 0.86–1.06). Conclusions: Our findings suggest that fixation method of stems cannot significantly predict the likelihood of having Vancouver types B1 and B2 fracture patterns