Introduction

Knee arthrodesis is a useful limb salvage technique to maintain function in patients with complex and infected total knee arthroplasties (TKA). There are a number of commonly used external fixators, but no consensus on which of these are optimal.

The aim of this study was to synthesise the current literature to guide clinical decision making and improve patient outcomes. We systematically review the literature to compare outcomes of external fixators in arthrodesis following infected TKA.

The use of intramedullary implants in Osteogenesis Imperfecta (OI) patients to treat and prevent fractures, non-unions and limb deformities has been well established. To serve this purpose different implants are available from non-telescoping rods such as Rush rods and Kirschner wires, to telescoping rods such as the Dubow-Bailey rod, the Sheffield rod and the Fassier-Duval (FD) rod (Pega Medical, Laval, Quebec, Canada). The purpose of this study is to report on the long-term results of the femoral Fassier-Duval rod.

A retrospective chart review of all patients with OI who underwent a femoral intramedullary Fassier-Duval rodding between 2002 and 2017 and followed for an average of 12 years at the Shriner's Hospital, Montreal, Quebec, Canada was performed.

A total of 81 patients underwent femoral FD rodding between 2002 and 2017. Twenty-seven children undergoing 83 procedures had completed a minimum 10-year follow up with complete charts and these were included here. The average follow up time was 12 years (10–15 years). Fifty procedures were initial rodding surgeries and 30 (36.1%) were revision surgeries. A total of 69 complications were reported in the medical record and confirmed on x-ray. The 3 most common complications were a bent rod 24 (34.8%), femur fracture 16 (23.2%) and loss of telescoping in 12 (17.4%) of patients. The 3 most common cause of revision were femur fracture 16 (53.3%), broken rod 5 (16.7%) and coxa vara in 3 (10%) of patients. The average time from initial surgery to the first revision was 5.9 years.

Long term performance of femoral FD rodding shows that despite improved functioning with these rods, certain complications are to be expected, most commonly a risk of femoral fracture requiring revision surgery.

The anterolateral ligament (ALL) is considered as an important stabilizer of the knee joint. This ligament prevents anterolateral subluxation of the proximal tibia on the femur when the knee is flexed and internally rotated. Injury of the ALL was not investigated in patients with knee dislocation. The aim of the current research is to study the prevalence and characteristics of ALL injury in dislocated knees.

A retrospective review of charts and radiological images was done for patients who underwent multiligamentous knee reconstruction surgery for knee dislocation in our institution from May 2008 to December 2016. Magnetic resonance imaging (MRI) was used to describe the ALL injury. The association of ALL injury with other variables related to the injury and the patient's background features was examined.

Forty-eight patients (49 knees) were included. The mean age of the patients was 32.3 ± 10.6 years. High energy trauma was the mechanism of dislocation in 28 (57.1%) knees. Thirty-one knees (63.3%) were classified as knee dislocation (KD) type IV. Forty-five (91.8%) knees had a complete ALL injury and three (6.1%) knees had incomplete ALL injury. Forty (81.6%) knees had a complete ALL injury at the proximal fibres of the ALL, while 23 (46.9%) knees had complete distal ALL injury. None of the 46 (93.9%) knees with lateral collateral ligament (LCL) injury had normal proximal ALL fibres (p = 0.012). Injury to the distal fibres of the ALL, as well as overall ALL injury, were not associated with any other variables (p >0.05). Moreover, all patients with associated tibial plateau fractures (9, 18.4%) had abnormality of the proximal fibres of the ALL (p = 0.033).

High grade ALL injury is highly prevalent among dislocated knees. The outcomes of reconstructing the ALL in multiligamentous knee reconstruction surgery should be investigated in future studies.

YouTube is one of the main sources for learning clinical skills. This study aims to assess the educational outcomes of medical students from self-directed learning about knee arthrocentesis through searching and using YouTube videos in comparison to traditional supervisor-led sessions.

Seventy-one medical students were randomly assigned in three groups. Group A had a classic supervisor-led clinical session, where the supervisor demonstrated the procedure. Group B students were provided with links to YouTube videos of knee arthrocentesis that were deemed of high educational quality, while group C searched and learned from any YouTube video they found appropriate based on the learning objectives provided. The students' performance pre- and post-feedback was examined using a checklist that was based on the guidelines of the American Academy of Family Physicians on knee arthrocentesis.

Pre-feedback, statistically significant higher mean scores for group A were noted in identification of an appropriate puncture site (p = 0.015), puncture site sterilization (p = 0.046), wearing sterile gloves (p < 0 .001), and direction of needle insertion (p < 0.001). The overall mean scores before feedback for group A, group B and group C were 17.9 ± 1.9, 14.9 ± 2 and 15.4 ± 1.8, respectively (p < 0 .001). None of these scores was below 60% of the total possible score (total score = 21). The overall mean scores after feedback for group A, group B and group C were 21, 20.9 ± 0.3 and 21, respectively (p = 0.037).

Without appropriate feedback to the learners from an instructor, YouTube videos cannot replace traditional supervisor-led sessions in learning knee arthrocentesis.

Aims

To systematically review the outcomes and complications of cosmetic stature lengthening.