At 6 week review, the patient complained of increasing pain, inability to fully weight bear and a decreased range of movement. 35 fixed flexion deformity, 30 degrees external rotation and 20 degrees of valgus of the leg. Radiographs revealed a transverse supracondylar fracture extending through the level of the pin fixation. Subsequent surgery involved an osteotomy to correct the deformity and application of a lateral femoral plate After fixation direct inspection of the retained anterior cruciate ligament, revealed and intact graft that functioned through the full range of movement. At nine months, the patient is fully weight bearing has returned to her pre-injury sporting level and has a range of movement of 0–110 degrees. There was no objective knee instability and the patient is satisfied with the outcome. Femoral fractures have rarely been reported in the literature following ACL reconstruction and these are usually associated with drilling of an enlarged femoral tunnel. We report a rare case of a transverse supracondylar femoral fracture following ACL reconstruction, with the fracture occurring through the fixation tract not the femoral tunnel.
This preliminary report demonstrates the effective use of Apapore in the management of benign cystic bone lesions. The use and development of bone graft substitutes over the past ten years has increased dramatically to improve their osseo-integration to a level similar to autografting techniques without the drawbacks of comorbidity from the graft site. Apapore is a synthetic bone graft substitute which consists of a scaffold of synthetic phase-pure hydroxy apatite with micro- and macroporosity and inter-connectivity to favour bone repair. Nineteen patients (12M:7F) with a mean age of 18.6years (8–33 years) having had procedures for the management of benign cystic lesions of bone with grafting using Apapore were followed up retrospectively for a mean period of 8 months (1–16months). In each case the diagnosis of a benign cystic lesion was made histologically prior to surgery. The subsequent definitive procedure was performed by a consultant on the Bone Tumour Unit at the Royal National Orthopaedic Hospital (Stanmore) in each case involving curettage and impaction of Apapore into the cavity in a standard fashion as a general anaesthetic procedure in the operating theatre. There have been no complications to date. All patients have made uneventful recoveries. Short-term radiological follow-up demonstrates excellent incorporation of the bone graft substitute and osseo-integration.
This study addresses four questions: Does laminar flow exist in our operating theatres? Do perioperative warming blankets affect laminar flow? Do perioperative warming blankets cause displacement of particles into a wound perioperatively? Do conventional theatres have adequate airflow? It has been widely recognised that laminar flow theatres decrease colony forming units in operating theatres and thus decrease the risk of infection in arthroplasty surgery. It is also accepted that perioperative warming blankets improve patient haemodynamic stability and may reduce the risk of wound infection. However, there has been great debate as to whether these perioperative warming blankets cause disruption of laminar flow and excess displacement of dust into a wound, and thus increase the risk of infection of total joint arthroplasty surgery. Using digital video imaging and airflow measurement techniques as used in formula 1 racing design, this independent study reveals that the Bair Hugger system has no effect on laminar flow or paticle displacement. It also shows that factors out of the surgeon’s control disrupt laminar flow and that general theatre design may be inherently flawed. This would seriously affect the risk of infection.
