Rotating platform total knee replacement implants have been marketed to allow more precise approximation of normal knee kinematics and enhance patella tracking. At liberty of rotation, the distinct mobile polyethylene insert design does have its pitfalls in spite of purported merits. We report a case of lateral knee pain following rotating platform total knee replacement, attributable to iliotibial band impingement by the rotating polyethylene insert. Prompt treatment via arthroscopic release circumvented a traumatic and costly revision procedure.

Percutaneous fixation method has been applied in Schatzker type III joint depressed-type lateral tibial plateau fracture. We report a 76-year-old man suffering from a small joint depressed-type posterolateral tibial plateau fracture with surgical reduction and fixation with a novel guidance of posterior cruciate ligament (PCL) reconstruction femoral template under X-ray and arthroscopic assistance. The concept of sequential tunnel drilling in ligament reconstruction has been applied in bone impaction tunnel creation beneath the articular step with the PCL jig. Avoidance of multiple bone guide pin drilling and accurate guide pin insertion and hence screw fixation was also achieved by use of the PCL template. As illustrated, we believe that the PCL jig is a good armamentarium and adjunct equipment to achieve a more precise minimally invasive operation in special anatomical positions such as the postero-lateral tibial plateau under careful surgical planning. 中 文 摘 要 經皮內固定方法早已在外側脛骨平台骨折 (Schatzker type 3)中得到應用。我們的報告中, 一個76歲男子患了 小關節凹陷型後外側脛骨平台骨折。我們在放射線和關節鏡的輔助下使用後交叉韌帶重建股骨模板(Posterior Cruciate Ligament Jig)做了手術復位和固定。使用後交叉韌帶重建股骨模板鑽探韌帶隧道(sequential tunnel drilling) 的概念早已應用在建立骨嵌塞的隧道了。這種模板固定法可以避免多發性骨導針鑽孔並允許準確的 導銷插入。我們認為這種方法是一個很好的固定法以實現在特殊解剖位置更精確的微創手術。我們在文章中 提到的後外側脛骨平台骨折, 就是一個很好的例子。

Broken medullary tubes have been used for intramedullary (IM) nailing of femoral and tibial fractures. In these reported cases, fragments of the medullary tube were retrieved by opening the fracture sites or left in situ, which might jeopardize periosteal blood supply. We herein present the case of a 58-year-old woman who underwent IM nailing for proximal humeral fracture, which was complicated by breakage of the medullary tube intraoperatively. Different instruments including guide rods, straight forceps, and cement extract hook were used to retrieve the retained fragments from the medullary canal, but these attempts were unsuccessful. Finally, the fragments were successfully removed using an anterior cruciate ligament (ACL) ENDOBUTTON depth gauge. This case highlights that medullary tubes can break during humeral IM nailing, which could be minimized by ensuring integrity of the medullary tube prior to surgery and disposing medullary tubes with more than 100 exposures. A novel method of using ACL ENDOBUTTON depth gauge to retrieve retained tube fragments is recommended because of its long and slim design.