9. Clinical Outcomes of Tibial Shaft Fractures in Patients over Age Fifty Treated by Intramedullary Nailing
Louis A. Bley, MD
Advisor: Mark Vrahas, MD
Discussor: A. Seth Greenwald, D-Phil Oxon

Louis Bley

Seth Greenwald

Dr. Louis Bley performed a retrospective review of 42 patients, over age 50, whose tibial fractures were treated with IM nailing at two Boston- area hospitals. Classification of the fractures revealed 38%O. T. A type A, 31%O. T. A type B, and 31%O. T. A. type C. Twenty-four percent were open fractures. Average time to clinical union was 23. 5 weeks, with average time to radiographic union recorded as 24 weeks. Delayed union occurred in 36%, and nonunion in 17%, with 44%of patients requiring at least one additional surgery to achieve union. Malunion was more common in fractures above the isthmus.

In his discussion, Dr. Greenwald noted the higher rate of complications in patients with open fractues than in other published studies. He com- mended the study for addressing some medical comorbidities but urged further analysis of other factors, including tobacco, alcohol use, and steroid use on outcome. He encouraged further evaluation of how the type of nail and locking mechanism used may have affected fusion rates.

10. Tibial Tubercle Osteotomy in Revision Total Knee Arthroplasty
Sonu Ahluwalia, MD
Advisor: Dennis Burke, MD
Discussor: Andrew Freiberg, MD

Sonu Ahluwalia

Andrew Frieberg

Noting that adequate exposure in revision total knee arthroplasty is frequently challenging, Dr. Sonu Ahluwalia evaluate the outcomes of twenty- two patients who underwent tibial tubercle osteotomy during their revision procedures. The procedure entailed a proximal step cut, distal feathering, retention of lateral soft tissue, minimum 8cm length, and minimum 3-wire fixation, performed by a single surgeon. Dr. Ahluwalia found that all demonstrated union by 6 months, with two healing with superior migration. There was a 10 degree extensor lag in one patient who did not clinically need a revision. The Knee Society Pain and Function Scores increased an average of 30 and 24 points, respectively. Re-osteotomy was performed in five re-revisions for infection with a 100%union rate.

Dr. Freiberg congratulated the authors on their review. He noted the reliable healing with this technique, making it an excellent choice for revision, by avoiding the scar formation or soft tissue weakening seen with other techniques for exposure. He did note that fixation with four cerclage wires has twice the strength of three wires, and would likely prevent the proximal migration seen in two of these patients.