Severe injury to the knee and the surrounding area is frequently associated with injury to ligaments of the knee joint and structures in the popliteal fossa. This case involved a popliteal artery occlusion, severe bone loss of distal femur, loss of collateral ligaments, and extensor mechanism destruction of the knee. Initially, prompt recognition and correction of associated popliteal artery injury are important for good results after treatment. After successful revascularization, treatment for severe bone loss of distal femur and injury of the knee joint must be followed. We treated this case by delayed reconstruction using modular segmental endoprosthesis after revascularization of the popliteal artery. This allowed early ambulation. At 36 months after surgery, the patient had good circulation of the lower limb and was ambulating independently.
*Arthroplasty, Replacement, Knee ; Femur/*injuries/radiography/*surgery ; Humans ; Internal Fixators ; Knee Injuries/*surgery ; Knee Joint/surgery ; Male ; Middle Aged ; Popliteal Artery/*injuries/radiography/*surgery

BACKGROUND: Regarding reconstruction surgery of the anterior cruciate ligament (ACL), there is still a debate whether to perform a single bundle (SB) or double bundle (DB) reconstruction. The purpose of this study was to analyze and compare the volume and surface area of femoral and tibial tunnels during transtibial SB versus transportal DB ACL reconstruction. METHODS: A consecutive series of 26 patients who underwent trantibial SB ACL reconstruction and 27 patients with transportal DB ACL reconstruction using hamstring autograft from January 2010 to October 2010 were included in this study. Three-dimensional computed tomography (3D-CT) was taken within one week after operation. The CT bone images were segmented with use of Mimics software v14.0. The obtained digital images were then imported in the commercial package Geomagic Studio v10.0 and SketchUp Pro v8.0 for processing. The femoral and tibial tunnel lengths, diameters, volumes and surface areas were evaluated. A comparison between the two groups was performed using the independent-samples t-test. A p-value less than the significance value of 5% (p < 0.05) was considered statistically significant. RESULTS: Regarding femur tunnels, a significant difference was not found between the tunnel volume for SB technique (1,496.51 +/- 396.72 mm3) and the total tunnel volume for DB technique (1,593.81 +/- 469.42 mm3; p = 0.366). However, the total surface area for femoral tunnels was larger in DB technique (919.65 +/- 201.79 mm2) compared to SB technique (810.02 +/- 117.98 mm2; p = 0.004). For tibia tunnels, there was a significant difference between tunnel volume for the SB technique (2,070.43 +/- 565.07 mm3) and the total tunnel volume for the DB technique (2,681.93 +/- 668.09 mm3; p < or = 0.001). The tibial tunnel surface area for the SB technique (958.84 +/- 147.50 mm2) was smaller than the total tunnel surface area for the DB technique (1,493.31 +/- 220.79 mm2; p < or = 0.001). CONCLUSIONS: Although the total femoral tunnel volume was similar between two techniques, the total surface area was larger in the DB technique. For the tibia, both total tunnel volume and the surface area were larger in DB technique.
Adult ; Anterior Cruciate Ligament/injuries/surgery ; Anterior Cruciate Ligament Reconstruction/*methods ; Autografts ; Femur/*radiography/surgery ; Humans ; Imaging, Three-Dimensional ; Male ; Tendon Injuries/*radiography/rehabilitation/surgery ; Tendons/transplantation ; Tibia/*radiography/surgery

OBJECTIVETo investigate the diagnosis and treatment of the coronal fracture of the femoral condyle.

METHODSSeven patients with Hoffa fracture treated in our hospital in recent 7 years were enrolled in this study. Six patients were treated with surgical treatment, while one non-displaced fracture received conservative treatment. Fractures were reduced under direct vision and fixed with hollow lag screws. The knees were immobilized in extension with cast after operation, and flexion exercise was commenced 3 weeks later.

RESULTSAll the patients were followed up. According to Kumar functional assessment system,5 patients got excellent results, 1 good, and 1 fair.

CONCLUSIONRigid internal fixation with hollow lag screw and extension plaster fixation is the excellent way to treat the coronal fracture of the femoral condyle.

Adult ; Female ; Femoral Fractures ; diagnosis ; diagnostic imaging ; surgery ; therapy ; Femur ; diagnostic imaging ; injuries ; surgery ; Fracture Fixation, Internal ; Humans ; Male ; Middle Aged ; Radiography

OBJECTIVETo compare the radiographic and functional outcomes of nonoperative and minimally invasive methods in treating femoral subtrochanteric fractures in children.

METHODSForty-five children (male 28, female 17) aging from 4- to 15-years-old with femoral subtrochanteric fracture were managed with traction and cast application (16 cases), and elastic intramedullary nailing (29 cases). Early and late radiologic outcomes were respectively evaluated by Beaty and Theologis criteria. The outcomes of clinical effect were evaluated with Sanders scoring system.

RESULTSAll patients were followed up from 26 to 62 months with an average of 39.5 months. The fractures united in 45 patients. Early (at 4th week after treatment) satisfactory radiologic outcomes were respectively 6 cases and 26 cases between two methods of nonoperative and minimally invasive. Late (at 2nd year after treatment) satisfactory radiologic outcomes were respectively 11 cases and 28 cases between two methods of nonoperative and minimally invasive. According to Sanders scoring, 12 cases were excellent, 4 good with nonoperative methods; and 28 excellent, 1 good with minimally invasive methods. There were significant differences between the two groups in aforesaid aspect.

CONCLUSIONMinimally invasive methods provided more satisfactory alignment of fractures as well as better functional outcomes than nonoperative methods. It is the first choice to treat femoral subtrochanteric fractures in children.

Adolescent ; Casts, Surgical ; Child ; Child, Preschool ; Female ; Femur ; diagnostic imaging ; injuries ; surgery ; Fracture Fixation, Intramedullary ; Hip Fractures ; diagnostic imaging ; surgery ; therapy ; Humans ; Male ; Minimally Invasive Surgical Procedures ; Radiography ; Treatment Outcome