Churchill JL, et al.
Am J Sports Med. (2019); 47(11):2589-95
While historical teaching has been that full thickness cartilage delaminations cannot heal directly to bone, this, and other, case series indicate that primary fixation of purely chondral fragments may succeed. Clinical records and radiological studies were reviewed for 10 patients (all male, age range 10 - 25 years, 8 skeletally immature). These patients underwent direct surgical repair of single fragment, displaced, full thickness, purely chondral defects of the knee (~2 cm diameter mean defect size, 4 trochlear, 4 patellar, 2 lateral femoral condylar) using a variety of screws, darts, or nails. Mean follow-up was 4.6 years (range 1.1 - 14.2 years) showing “excellent” clinical results with mean International Knee Document Committee (IKDC) score of 95 (range 87 -100), Marx Activity Scale of 14 (range 8 - 16), Tegner Activity Scale of 7 (range 5 - 9), and 9/10 patients returned to sports. MR imaging was performed on 8/10 knees at 3.5 - 6 months following surgery and showed complete bony attachment of the fragment for all repairs. The authors recommend that primary internal fixation of large, displaced cartilage fragments be considered as a viable treatment option for young patients.
Extensor tendon entrapment on computed tomography imaging of distal radius fractures.
Nigh ED, et al.
J Wrist Surg. (2019); Dec 20 [Epub ahead of print] DOI: 10.1055/s-0039-3402424
Retrospective review of orthopedic admissions to a single level 1 trauma center over a 12 year period yielded 846 patients with a distal radial fracture, 183 (21% of total, median age 45, 129 male, 4 with bilateral fractures) of whom had a preoperative CT. Retrospective, consensus image review by a musculoskeletal radiologist and a 4th year radiology resident determined the AO-OTA fracture category and tendon entrapment status. Tendon entrapment was judged to be present if at least 50% of the tendon cross-section was between major fracture fragments. Additionally, when a retrospective CT diagnosis of tendon entrapment was made, the original radiology report was reviewed for concordance. Sixteen (8.7%) retrospective CT diagnoses of tendon entrapment were made, only 6 (38%) of which were noted in the original radiology reports. All entrapments were of extensor tendons: extensor pollicis longus (EPL, 11 patients, 69%), extensor digitorum communis (EDC, 2 patients), and one each for extensor pollicis brevis, extensor carpi radialis longus, and extensor carpi ulnaris. Most entrapments were associated with complete articular and multifragmentary AO-OTA fracture patterns. The EPL tendons were most often entrapped between dorsally and volarly displaced fragments and were associated with a displaced Lister tubercle. The 2 EDC entrapments were associated with injuries of the distal radioulnar joint. The authors note that their 8.7% CT-based frequency of tendon entrapment is roughly 6 times greater than clinically/surgically based reports. However, review of operative notes for the diagnosed tendon entrapments in this study confirmed only one of the CT diagnoses and identified tendon lacerations in 4 (25%) of cases with 2 of the torn tendons diagnosed by CT as entrapped. The authors believe that the entrapments were either not noted in the reports, undiagnosed at surgery because of the volar operative approach, or reduced by operative manipulations. The importance of searching for entrapped tendons on preoperative CTs is highlighted by a case of a prospectively missed tendon entrapment (identified by retrospective review) that became symptomatic after the operative reduction and required reoperation.
Abstracted by C. S. Winalski, M.D.
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A case series of successful repair of articular cartilage fragments in the knee . Skeletal Radiol 49, 659 (2020). https://doi.org/10.1007/s00256-020-03390-3