Purpose: Varus thrust is an posterolateral rotatory knee motion observed with severe varus patients. It shows a dynamic worsening of varus in the loading response (LR), while returning to a more neutral alignment during the initial contact (IC) of gait. This study examined the results of primary total knee arthroplasty in varus thrust osteoarthritis, including varus thrust motion, gait analysis. Materials and Methods: From March 2009 to March 2019, among 2,391 total knee arthroplasty who underwent total knee arthroplasty, 84 knees from 68 patients with varus thrust and more than a 20° varus deformity were enrolled in this study. The pre-operative and postoperative varus thrust amount (VTA), proximal tibiofibular overlap (PTFOL), and implant position (α, β, γ, and δ) were examined. The gait pattern was analyzed before and after surgery using the footscan ® (RSscan International, Olen, Belgium), evaluating the foot axis-center of pressure angle (FCA) of the ipsilateral foot at the IC and at the LR. The clinical outcomes were evaluated with Hospital for special surgery (HSS). Results: The changes in the VTA were from a pre-operative mean of 5.1° (3.1–7.2) to a mean of 1.9° (0.3–2.8) at the last follow-up (p=0.017). PTFOL changed from pre-operative mean of 18.1 mm (9.0–29.1) to post-operative mean of 11.0 mm (4.2–20.7) (p=0.029). The mean α, β, γ, and δ angle in the last follow-up was 94.6°, 90.3°, 3.86°, and 89.7°, respectively. The FCA in IC was corrected from a pre-operative mean of -1.8° (-1.0 to -4.4) to a post-operative mean of 2.3° (-1.1 to 4.1) (p=0.013). FCA in LR was similar from a pre-operative mean of 5.2° (1.0–7.2) to a post-operative mean of 6.0° (1.1–7.4) (p=0.823). The HSS was changed from a pre-operative mean of 45.7 to a post-operative mean of 86.2 in the last follow-up (p=0.011). Conclusion Standard total knee arthroplasty in the varus thrust knee showed satisfactory correction of the varus thrust amount and gait pattern, without recurrence of the varus thrust gait. Better clinical results were achieved in total knee arthroplasty of osteoarthritis with a varus thrust without using a constraining implant.

Purpose: Fractures of the capitellum of the humerus are relatively rare injuries, and the prevalence is known to be less than 1% of all elbow fractures. Since the capitellum forms an articular surface with the radial head, this fracture is considered to be an intra-articular fracture, and surgical treatment is required for the displaced fracture. Due to the rarity of this type of fracture, only a few studies on treatment have been published. We report the results of cases that underwent surgical treatment for capitellum fractures. Materials and Methods: Through a retrospective review, patients who underwent surgical treatment for a capitellum fracture from January 2002 to January 2020, and who could be followed-up for at least 12 months and were over 16 years old were included. A total of 19 patients who underwent open reduction and internal fixation with K-wires and headless compression screws were included.Radiographic analysis was carried out using simple radiographs taken to investigate the stability of the joint and the union of fractures.Clinical results were analyzed using the range of motion of the elbow, visualized pain score, Mayo Elbow Performance score (MEPS), Disabilities of the Arm, Shoulder and Hand (DASH) score, and postoperative complications were analyzed at the time of the final follow-up. Results: The average age of the patients was 57.3 years, and their average follow-up time was 22.6 months. Most of them were type I (n=12) as per the Bryan–Morrey classification. The radiographic analysis showed that bony union was obtained at the final follow-up in all cases, and there was no case of joint instability. The results of the clinical analysis showed that average flexion contracture was 9.7° (min 0°–max 30°), average further flexion was 130.3° (min 90°–max 145°), and average range of motion was 120.5°, and the average visualized pain score at the final follow-up was 1.3 (min 0–max 3). At the final follow-up, the average MEPS was 85.5 (min 75–max 95) and the average DASH score was 27.6 (min 5–max 46), which was satisfactory. Conclusion With early rehabilitation, capitellum fractures can be treated well without complications if the joint surface is aligned congruently with open reduction and firm fixation by using K-wire or headless compression screws.

Background: Studies have reported favorable outcomes using the paratricipital approach for fixation of distal humeral intra-articular fractures. However, literature evaluating the clinical results of the approach remains limited. The objective of this study was to compare clinical outcomes between type 13C2 and type 13C1 distal humeral fractures after open reduction and internal fixation performed using the same approach and same type of plate. Methods: A total of 52 adults with type 13C1 or 13C2 distal humeral fractures were treated surgically at our institution during 2006 to 2018. We retrospectively analyzed data from 29 of these patients (19 with type 13C1 fractures and 10 with 13C2 fractures) who met the inclusion criteria. All subjects were followed for a minimum of 2 years postoperatively. Clinical and radiologic results were analyzed to determine differences in outcomes between the two types of fractures. Clinical results were evaluated using elbow range of motion (ROM), Mayo Elbow Performance Score (MEPS), and Quick Disabilities of the Arm, Shoulder and Hand (Q-DASH) score. Alignment, fracture union, and presence of posttraumatic arthritis were evaluated radiologically. Results: The patients’ mean age was 51 years, and the mean duration of follow-up was 29 months. Mean ROM was 129.5° ± 21.5° in the type 13C1 group and 123.0° ± 20.6° in the 13C2 group (p = 0.20). Mean Q-DASH score was 12.6 ± 11.7 in the 13C1 group and 16.2 ± 19.8 in the 13C2 group (p = 0.60). Mean MEPS was 92.9 ± 8.5 in the 13C1 group and 85.0 ± 14.1 in the 13C2 group (p = 0.09). Carrying angle did not differ significantly between the 13C1 and 13C2 groups. No patient in either group exhibited nonunion or posttraumatic arthritis. Conclusions Although the paratricipital approach has the disadvantage of limited visualization of articular surfaces, there were no differences in surgical outcomes between type 13C1 and type 13C2 distal humeral fractures after fixation using this approach.Thus, surgeons may need to consider using the paratricipital approach for open reduction and internal fixation of 13C2 distal humeral fractures.