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The treatment of complex tibial plateau fractures is a challenge for even experienced orthopedic surgeons. While it is established that type and timing of surgical treatment depends on the involvement of soft tissues, there is no agreement in the literature about post-surgical weight-bearing on the operated limb: it ranges from a total ban to a partial concession of 6 to 12 weeks. Weight-bearing modulation can be difficult in physically challenged or frail patients such as the elderly, with a real risk of hypokinesis, bedridden and related complications. To allow the early treatment of these fractures and immediate weight-bearing, we connected a circular external fixator (CEF) to a hinged knee external fixator (HEF) with specific axial load resistance characteristics. This hybrid technique, which we have called CHEF-K (Circular and Hinged External Knee Fixation), maintains and combines the mechanical characteristics of both devices. In selected cases we early stabilized the fracture in a minimally-invasive way associated with CEF, then protecting the osteosynthesis with HEF which bypassed the fracture during loading while also allowing movement of the knee. In the first case described herein, a 78-year-old woman showed rapid functional recovery, being able to walk without aids after 4 weeks. [ABSTRACT FROM AUTHOR]

Fractures of the posteromedial tibial plateau are infrequent, for this reason also their clinical description and their treatment is poorly represented in the literature. Only six cases in the literature describe the avulsion fracture of the posterior medial tibial plateau at the insertion of the semimembranous muscle. The mechanism of injury, described in the various articles, however, does not appear univocal, as well as the type of treatment. The analysis of the literature revealed the need for adequate imaging and stable surgical synthesis, in order to obtain an optimal functional recovery. [ABSTRACT FROM AUTHOR]

Purpose: To determine if initial treatment affects the outcome of total hip arthroplasty (THA) after acetabular fracture. Methods: 49 patients (49 hips) initially treated non-operatively followed some months later by THA in conjunction with acetabular reconstruction (Group 1) and 29 patients (29 hips) who had undergone THA after a previous osteosynthesis (Group 2) were assessed. The mean follow-up was 11.7 (range 5–23) years. Results: 3 acetabular components were revised for aseptic loosening in Group 1 and 2 in Group 2. The survival rate for cup loosening at 16 years was 90.6% (95% confidence interval [CI], 78.1–100) for Group 1 and 94.1% (95% CI, 86.5–100) for Group 2 (p = 0.76). There were 2 sciatic palsies in Group 2 after osteosynthesis. The mean preoperative clinical score and postoperative range of mobility were better in Group 1. There were more heterotopic ossifications in Group 2. Conclusion: Despite the good results found in both groups, THA after previous osteosynthesis for acetabular fractures had more complications than a primary THA in conjunction with acetabular reconstruction. [ABSTRACT FROM AUTHOR]