Introduction: There is controversy in medical literature regarding the use of electromagnetic fields to promote bone healing. Methods: After designing and building devices capable of generating an electromagnetic field for this study, their safety was confirmed and the electromagnetic therapy was randomly allocated and compared to placebo in patients with fracture of the femoral diaphysis. Treatment began six weeks after the fracture and it was administered once a day, during 1 h, for eight consecutive weeks. Twenty devices were built, 10 of which were placebo-devices. Between June 2008 and October 2009, 64 patients were randomized in two different hospitals and were followed for 24 weeks. The mean age was 30 years (18-59) and 81% were males. Results: Healing observed at week 12 was 75% vs. 58% (p= 0.1); at week 18, it was 94% vs. 80% (p= 0.15); and at week 24, it was 94% vs. 87% (p= 0.43) for the device group and the placebo group, respectively. Discussion: This study suggests that an electromagnetic field stimulus can promote earlier bone healing compared to placebo in femoral diaphyseal fractures. Faster bone healing translates into sooner weight bearing, which – in turn – permits quicker return to normal daily activities.

Background: Lateral patellar dislocation can become a recurrent problem after the first episode. Identifying those patients who are at increased risk of redislocation is important for the treatment decision-making process. Purpose: To identify clinical and radiologic risk factors for recurrence of patellar dislocation after a first episode. Study Design: Case-control study; Level of evidence, 3. Methods: The study included patients with lateral patellar dislocation and a 1-year minimum follow-up who were seen between 2011 and 2018. Patients aged 10 to 65 years were included. Patient characteristics, physical examination (patellar apprehension, J sign), and radiographs were reviewed. The Caton-Deschamps and Insall-Salvati ratios were used to evaluate patella alta. High-grade trochlear dysplasia was defined as Dejour types B, C, and D. Results: A total of 130 patients (139 knees) with primary lateral patellar dislocation were included. Recurrent dislocation was seen in 83 knees (59.71%). Stepwise logistic regression analysis demonstrated that Caton-Deschamps ratio ≥1.15 (OR, 2.39; 95% CI, 1.09-5.22; P = .029), age <21 years (OR, 2.53; 95% CI, 1.11-5.77; P = .027), and high-grade trochlear dysplasia (OR, 4.17; 95% CI, 1.90-9.17; P < .001) were significantly associated with patellar redislocation. Based on the presence of these factors, the probability of dislocation after a first lateral patellar dislocation was 31.2% with no factors present, 36.6% with any 1 factor present, 71.7% with any 2 factors present, and 86.2% if all 3 conditions were present. Conclusion: The results of this study indicated that patella alta, high-grade trochlear dysplasia, and age <21 years were independent risk factors for patellar redislocation after a first episode, with an additive effect when they were present together. This may help to guide the type of treatment for these patients.

The proposed four-column classification showed the highest intra and inter-observer agreement. When taking into account the agreement that occurs by chance, Schatzker classification showed the highest inter-observer kappa, but again the four-column had the highest intra-observer kappa value. The proposed classification is a more inclusive classification for the posteromedial and posterolateral fractures. We suggest, therefore, that it be used in addition to one of the classic classifications in order to better understand the fracture pattern, as it allows more attention to be paid to the posterior columns, it improves the surgical planning and allows the surgical approach to be chosen more accurately.

BackgroundHip and knee arthroplasty aims to restore the joint function and to improve health-related quality of life (HRQoL) in patients with articular damage. It is important to quantify the HRQoL improvement and when this is achieved. The Oxford knee score and the Oxford hip score were developed to evaluate patients after knee and hip arthroplasty. We sought to evaluate HRQoL changes in the short and mid term following either primary or revision hip and knee arthroplasty.MethodsProspective cohort study during a 20-month period (August 2013 to March 2015) in a tertiary referral hospital. Primary arthroplasties secondary to osteoarthritis and any-cause revisions were included (328, 160 knees, and 88 hips). They were divided into 4 groups: (1) primary knee replacement, (2) primary hip replacement, (3) revision knee replacement, and (4) revision hip replacement. Oxford knee and hip scores were obtained prior the surgery and compared with the short- and mid-term follow-up scores.ResultsFollow-up in the short term and mid term was: 75.6% and 67.4%, respectively. Improvement was found in both short-term and mid-term follow-up for each group and for the overall group in HRQoL as measured by the Oxford knee and hip scores (P < .001). The greatest improvement was seen in the short term with an increase of 21 points for primary knee arthroplasty; 24 points for primary hip arthroplasty; 22 points for revision knee arthroplasty; and 23 points for revision hip arthroplasty.ConclusionsImprovement in HRQoL in patients following primary or revision hip or knee arthroplasty is crucial and can be achieved early after the surgery.