Purpose. To review the outcome after open reduction and internal fixation using a periarticular raft construct through a locking plate without bone grafting for split-depression tibial plateau fractures. Methods. Records of 38 knees in 31 men and 7 women aged 25 to 75 (mean, 42.7) years who underwent open reduction and internal fixation using a periarticular raft construct through a locking plate without use of a bone graft or bone substitute for split-depression (>5 mm) proximal tibial plateau fractures (Schatzker type II or AO/OTA type 4.1 B3) were reviewed. The integrity of the articular surface was assessed using radiographs. The Rasmussen radiological score and clinical score, the Lysholm knee score, and the Tegner activity score were also assessed. Results. The mean follow-up period was 22.8 (range, 6-36) months. All patients achieved bone union after a mean of 13.2 (range, 8-26) weeks. The mean range of motion was 118º (range, 100º-130º). The Rasmussen radiological score was excellent in 27 patients, goodUse of a raft construct through a locking plate without bone grafting for split-depression tibial plateau fractures in 9, and fair in 2. The Rasmussen clinical score was excellent in 15 patients, good in 21, and fair in 2. The Lysholm knee score was excellent in 26 patients, good in 8, and fair in 4. 32 of the 38 patients recovered to their preoperative Tegner activity scores. Only one patient with severe comminution had loss of reduction after full weightbearing. Conclusion. Fixation using a periarticular raft construct through a locking plate without use of a bone graft or bone substitute for split-depression proximal tibial plateau fractures is a viable option.

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Category: Other Introduction/Purpose: Surgical site infection (SSI) after Foot & Ankle surgery ranges from 1.2% to 13.2%, higher than any other elective orthopaedic procedure. Infection is of concern for the patient and expensive for the healthcare system. SSI is multifactorial and can be divided into host-related and perioperative factors. Skin preparation is one of the key peri-operative factors in reducing SSI. The current literature supports a combined chlorhexidine and alcohol preparation technique, although there is some conflicting evidence. Most studies to date have used proxy outcomes such as growth from swabs shortly after skin preparation. There are no large scale studies which have looked at definitive clinical outcomes such as the rate of postoperative SSI. Methods: A retrospective review of data was undertaken for two longitudinal cohorts which were using two different skin preparation solutions and techniques due to a change in hospital protocol. Each cohort was continuous and derived from the same overall populationIn cohort 1, Povidine-Iodine (Betadinetm) followed by Alcoholic Chlorhexidine was used on swabs (Double prep group). In cohort 2, 2 Alcoholic Chlorhexidine was used in a prep stick applicator. Standard criteria for diagnosing surgical site infection were used. All open injuries, procedures for ongoing infection, amputations for osteomyelitis /diabetic foot and COVID- 19 positive cases were excluded. Results: After applying standard exclusion criteria, 919 elective F&A procedures in the Double prep group and 491 procedures were included for the Single prep groupAs these were continuous longitudinal cohorts of large scale from the same population, there is a justifiable presumption of group matchingIn cohort 1 there were 15 superficial infections (1.6%) and 3 deep (0.3%). In cohort 2 there were 18 superfical infections (3.6%) and 1 deep (0.3%). The total infections in cohort 1 were 18 (2%) and 19 in cohort 2 (3.9%)There was an increase in superficial, and therefore total infection rates, in the single prep group compared to the double prep group. These increases were statistically significant; p <0.05 with regards to superficial infection and total infection rates in the single prep group. Conclusion: Double skin preparation, with Povidone-Iodine followed by alcoholic Chlorhexadine, statistically significantly decreases foot and ankle surgical infection rates as compared to a single alcoholic chlorhexidine skin preparation

Background: Extensor mechanism failure secondary to knee replacement could be due to tibial tubercle avulsion, Patellar tendon rupture, patellar fracture or quadriceps tendon rupture. An incidence of Patella tendon rupture of 0.17% and Quadriceps tendon rupture of around 0.1% has been reported after Total knee arthroplasty. These are considered a devastating complication that substantially affects the clinical results and are challenging situations to treat with surgery being the mainstay of the treatment.Case Description: We report here an interesting case of a patellar tendon rupture of one knee and Quadriceps tendon rupture of the contralateral knee following simultaneous bilateral knee replacement in a case of inflammatory arthritis patient. End to end repair for Quadriceps tear and augmentation with Autologous Hamstring tendon graft was done for Patella tendon rupture.OUTCOME: Patient was followed up for a period of 1 year and there was no Extension lag with a flexion of 100 degrees in both the knees.DISCUSSION: The key learning points and important aspects of diagnosing these injuries early and the management techniques are described in this unique case of bilateral extensor mechanism disruption following knee replacements.