Objective To introduce a new technique of navigated femoral nailing using noninvasive registration of the contralateral femur to control reduction and intramedullary nailing of femoral shaft fracture and discuss preliminary clinical results. Methods A new navigation module was employed to control femoral fracture, rotation and fixate femoral fraeture based on anteversion of the contralateral femur. In order to measure the femoral antcversion of the healthy femur intraoperatively, a non-invasive registration tech-nique was used. After minimal invasive reference arrays were fixed on the fraeture side, images of the frac-ture side were mandatory for femoral antevrsion measurements. Closed reduction and nailing was performed under computer navigation according to data of the contralteral side of the femur. Postoperative CT scanning on bilateral femur was done to observe specific anteversion and compare with intraoperative results of naviga-tion system. Results A total of 14 patients with femoral fractures obtained successful fixation and reduc-tion, with no intraoperative or postoperative complications. Postoperative CT scans were acordant with the intraoperative navigated measurements, with anteversion deviation within 3° between both sides. Conclu-sions Navigated femoral nailing using nnninvasive registration of the contralateral femur to control fracture fixation and reduction can help control anteversion measurements of the fracture site and reduce the inci-dence of femoral malrotation after closed reduction and intramedullary nailing.

Background: The use of hinged designs is usually reserved for severe deformities or instability in contemporary total knee arthroplasty (TKA). Results have been mixed with some authors reporting relatively high incidences of complications. The aim of this study is to present the results of primary TKA performed with a hinged prosthesis with a minimum 10-year follow-up. We also examined the factors that influence survivorship of this prosthesis. Methods: A total of 238 primary TKA procedures were performed using hinged prostheses. Indications included osteoarthritis, rheumatoid arthritis, posttraumatic deformity, and arthritis. Clinical outcomes were assessed using the Hospital for Special Surgery score. Radiologic assessment was performed at each follow-up. Survivorship was calculated based on the Kaplan-Meier method. All complications were documented. Results: Mean follow-up was 13.5 years (standard deviation [SD], 3.4). Mean flexion at final review was 118° (SD, 20°). Fifty-four percent and 20% reported excellent and good functional scores, respectively. Survivorship was 94% at 13.5 years in patients over 60 years of age and 77% in patients less than 60 years of age. Survivorship in patients with preoperative varus deformity was 96% and that in valgus knees was 79%. Conclusions The results of this study suggest that when rotating hinges are used for primary TKA, the best results are achieved in patients over 60 years old. The indications for this design in the setting of primary TKA include significant deformities, severe bone loss, and ligamentous laxity.

Compartment syndrome of the thigh is a rare condition, potentially resulting in devastating functional outcome. Increasing intracompartmental pressure which suppresses microcirculation and capillary perfusion may lead to cellular anoxia and muscle ischemia. The muscle compartments in the thigh have a more compliant fascia and blend anatomically into the open compartments of the pelvis, thus compensating higher volumes than the compartments in the lower leg. We present a previously unreported case in which the limb of a 36-year-old man was run over by a 25-ton truck. He presented with a sensomotor deficit in his left lower leg with full paralysis of the shank muscles and absence of all foot pulses. CT scan showed a huge haematoma in the thigh with active bleeding out of the popliteal artery into the haematoma which has already expanded into the muscle compartments of the lower leg. The limb had a disastrous compartment syndrome of the thigh and lower leg with disruption of the popliteal neurovascular bundle; however, no bones in the limb were fractured. A complete fasciotomy of all the lower limb muscle compartments was immediately performed. The artery was reconstructed with interposition of the smaller saphenous vein, which was already interrupted through the initial trauma.
Accidents, Traffic ; Adult ; Compartment Syndromes ; physiopathology ; Humans ; Leg ; blood supply ; innervation ; Male ; Thigh ; blood supply ; innervation