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WITHDRAWN: Editorial Summary: Challenges in Periarticular Fractures about the Knee
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Editorial Summary: Challenges in Periarticular Fractures about the Knee Gele B Moloney
Introduction
F
ractures of the distal femur and proximal tibia occur in a bimodal distribution, affecting younger patients who often sustain high energy trauma, and geriatric patients following low energy injuries. In both cases, these injuries have the potential to result in significant short- and long-term functional limitations. Complications including nonunion, malunion, and post-traumatic arthritis can result in need for reoperation and negatively impact long-term outcomes and raise health care costs. This issue seeks to focus on the challenges in treating periarticular fractures about the knee and solutions to help optimize care. Fractures of the distal femur are gaining recognition as problem fractures, specifically with regard to unsatisfactory rates of nonunion and perioperative mortality in geriatric patients. Treatment strategies must consider both injury and host characteristics and as well as patient demands and goals. Included articles will focus on both nailing and plating techniques, management of open fractures, including those
with bone loss, as well as treatment of nonunion, should it occur. Arthroplasty options, both acutely, and for nonunion, will also be discussed. Fractures of the proximal tibia present their own unique set of challenges due to complex anatomy, high forces across the knee, and risks of post-traumatic arthritis. Included is a discussion of strategies to achieve successful reduction and fixation while plating proximal tibia fractures and treatment of combined tibial plateau and tibial shaft fractures. The anatomy of the posterior knee is discussed and approaches which allow access to the posterior tibial plateau and their indications are reviewed. Use of fibular allograft to obtain reduction and augment fixation is explained in detail. By summarizing the most up to date literature, and providing novel treatment strategies, the authors hope to provide strategies for optimizing patient outcomes while minimizing complications and reoperation following treatment of this particularly challenging group of fractures.
Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA. Address reprint requests to Gele B Moloney UPMC Mercy, 1350 Locust Street, Suite 220, Pittsburgh PA 15219. E-mail: [email protected]
https://doi.org/10.1053/j.oto.2018.07.009 1048-6666/© 2018 Published by Elsevier Inc.
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Editorial Summary: Challenges in Periarticular Fractures about the Knee Gele B Moloney
Introduction
F
ractures of the distal femur and proximal tibia occur in a bimodal distribution, affecting younger patients who often sustain high energy trauma, and geriatric patients following low energy injuries. In both cases, these injuries have the potential to result in significant short- and long-term functional limitations. Complications including nonunion, malunion, and post-traumatic arthritis can result in need for reoperation and negatively impact long-term outcomes and raise health care costs. This issue seeks to focus on the challenges in treating periarticular fractures about the knee and solutions to help optimize care. Fractures of the distal femur are gaining recognition as problem fractures, specifically with regard to unsatisfactory rates of nonunion and perioperative mortality in geriatric patients. Treatment strategies must consider both injury and host characteristics and as well as patient demands and goals. Included articles will focus on both nailing and plating techniques, management of open fractures, including those
with bone loss, as well as treatment of nonunion, should it occur. Arthroplasty options, both acutely, and for nonunion, will also be discussed. Fractures of the proximal tibia present their own unique set of challenges due to complex anatomy, high forces across the knee, and risks of post-traumatic arthritis. Included is a discussion of strategies to achieve successful reduction and fixation while plating proximal tibia fractures and treatment of combined tibial plateau and tibial shaft fractures. The anatomy of the posterior knee is discussed and approaches which allow access to the posterior tibial plateau and their indications are reviewed. Use of fibular allograft to obtain reduction and augment fixation is explained in detail. By summarizing the most up to date literature, and providing novel treatment strategies, the authors hope to provide strategies for optimizing patient outcomes while minimizing complications and reoperation following treatment of this particularly challenging group of fractures.
Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA. Address reprint requests to Gele B Moloney UPMC Mercy, 1350 Locust Street, Suite 220, Pittsburgh PA 15219. E-mail: [email protected]
https://doi.org/10.1053/j.oto.2018.07.009 1048-6666/© 2018 Published by Elsevier Inc.
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