OKOJ, Volume 13, No. 5

Repair of a Chronic Ruptured Quadriceps Tendon With a Medial Gastrocnemius-Hemisoleus-Calcaneal Block Flap

Rupture of the extensor mechanism of the knee is a rare and serious complication of total knee arthroplasty, with rupture of the quadriceps tendon being an especially difficult type of such injury to manage. The failure of direct suture repair, autograft augmentation, or a local procedure to repair the extensor mechanism of the knee leaves the surgeon with limited options for restoring its function. For this situation, we present a technique for repair of a chronic ruptured quadriceps tendon using a novel flap consisting of medial gastrocnemius and hemisoleus muscle and Achilles tendon and terminating in a block of calcaneal bone, which provides a well-vascularized flap-tendon-bone block interposition that restores the extensor mechanism of the knee by spanning the gap in the quadriceps tendon.

    • Keywords:
    • quadriceps reconstruction

    • medial gastrocnemius–hemisoleus–calcaneal bone flap

    • extended medial gastrocnemius rotational flap

    • Subspecialty:
    • Adult Reconstruction

Open and Closed Management of Pediatric Forearm Fractures

Fractures of the forearm are common injuries in the pediatric population. The mechanism of their occurrence is usually indirect trauma, such as a fall onto an outstretched hand during play or athletic activity. The classification of forearm fractures is based on the location in the affected bone(s) and the pattern of injury, in addition to a description of the magnitude of fracture angulation, displacement, shortening, and rotation. The vast majority of pediatric forearm fractures may be treated with closed reduction and immobilization, with serial radiographs used to monitor the maintenance of adequate fracture alignment during bone healing. In general, the younger the patient and more distal a fracture, the greater is the potential for fracture remodeling, although the observed imperfect correlation between the radiographic appearance and functional outcome of forearm fractures in pediatric patients makes the choice of their treatment a challenge in any particular case. Fractures for which an acceptable alignment cannot be obtained or maintained, open fractures, and those associated with significant soft-tissue or neurovascular compromise may be treated surgically. Viable options for the surgical treatment of pediatric forearm fractures include closed or open reduction and intramedullary fixation of one or both bones of the forearm; open reduction and internal fixation using a plate and screw construct; and hybrid techniques. Complications of the treatment of pediatric forearm fractures include refracture, loss of motion, cosmetic deformity, delayed union, nonunion, malunion, infection, and compartment syndrome.

    • Keywords:
    • pediatric trauma

    • forearm fracture

    • both-bone fracture

    • closed reduction

    • percutaneous pinning

    • intramedullary nailing

    • open reduction and internal fixation

    • Subspecialty:
    • Trauma

    • Pediatric Orthopaedics

Removal Versus Retention of Orthopaedic Trauma Implants

Most options for the surgical treatment of orthopaedic trauma involve the application of some type of implant or device in order to permanently or temporarily restore the anatomy or function of a joint or other skeletal anatomic structure. Symptomatic implants should be removed only after being ascertained as the source of symptoms, and although asymptomatic implants that are not the source of unwanted effects can be left in place for long periods, the timely removal of an implant that has accomplished its purpose has the benefit of reducing the potential for risks of its retention, such as infection, osteopenia, bone weakening and fracture, and in rare instances carcinogenesis. Standing against these benefits of implant removal are the risks that accompany it, which include possible refracture of the bone or other structure treated with the implant, difficulty in removing the implant, and infection or other complications of the surgery needed for its removal. This article reviews the literature and discusses recommendations pertaining to the decision to retain or remove an internal fixation device that has achieved its purpose, with identification of techniques for effective removal and methods by which to avoid complications.

    • Keywords:
    • implant removal

    • implant retention

    • orthopaedic trauma

    • symptomatic implant

    • Subspecialty:
    • Trauma