Objectives:To review comminuted patella fracture in the elderly patients and examine the surgical options to avoid complications such as fixation failure and poor functional outcome. To provide an example of mesh augmentation in comminuted patella fracture in the elderly patients.Data Sources:A literature review was conducted by the authors independently using Ovid, Medline, Cochrane, PubMed, and Clinical Key in English. We aimed to review data on patients older than 65 with comminuted patella fracture. Search conducted between July and December 2015.Study Selection:Search terms included patella fracture, elderly, and fixation failure. Abstracts were included if they were a case report, cohort series, or randomized control trial. Further inclusion criteria were that they were available in full text and included patient age(s), operative details, follow-up, and outcome discussion.Data Extraction:Each study was assessed according to its level of evidence, number of patients, age of patients, fracture patterns described, complications of treatment, and results summarized.Data Synthesis:Paucity of data and heterogeneity of studies limited statistical analysis. Data are presented as a review table with the key points summarized.Conclusion:In patella fracture, age >65 years and comminuted fracture pattern are predictors of increased fixation failure and postoperative stiffness, warranting special consideration. There is a trend toward improved functional outcomes when augmented fixation using mesh or plates is used in this group. Further level 1 studies are required to compare and validate new treatment options and compared them to standard surgical technique of tension band wire construct.

1b.

Multiple acceptable options are available for the correction of distal femoral deformity associated with knee arthritis. The treatment modality should be chosen based on the extent of deformity and attention to preservation of the collateral ligaments. Surgical options range from osteotomy alone, arthroplasty with intra-articular correction, or arthroplasty with extra-articular correction. Different implant choices and fixation methods for the osteotomy possess advantages and disadvantages which need to be considered carefully. In addition to discussing principles of management based on current literature, this article includes a case report using a previously undescribed technique using corrective osteotomy, intramedullary nail fixation, and total knee arthroplasty with computer navigation.

Purpose In up to a fifth of total knee replacements (TKR), surgeons are not capable of achieving good clinical and functional results. Despite comprehensive diagnostic workup, an underlying cause is not always identified in these patients. The purpose of this study is to compare native and prosthetic trochlear anatomies, to evaluate a potential source of morphologic mismatch and theoretically, of poor clinical outcomes. Methods Native trochlear angles of 4116 knee CTs from 360 Knee Systems database of arthritic pre-operative TKR patients were evaluated. A semi-automated tridimensional analysis was performed to define the native trochlear angle in the coronal plane (NTA) among other 142 parameters. An active search was conducted to identify currently available TKR models; prosthetic trochlear orientation in the coronal plane (PTA) was extracted from the technical data provided by manufacturers. Results The mean native trochlear angle (NTA) was 1.6° ± 6.6° (valgus) with a range from − 23.8° (varus) to 30.3°(valgus). A valgus NTA was present in 60.6% of the knees and 39.4% of them had a varus NTA. 89 TKR models were identified; trochlear details were available for 45 of them, of which 93% were designed with a valgus orientation of the prosthetic trochlear angle (PTA) and 6.9% showed a neutral (0°) PTA. Varus alignment of PTA was not present in any system. Angular numeric values for PTA were available for 34 models; these ranged from 0° to 15° of valgus, with a median value of 6.18° (SD ± 2.88°). Conclusion This study shows a significant mismatch between native and prosthetic trochlear angles. A relevant proportion of the studied knees (41.45%) fall out of the trochlear angle range of currently available implants; representing a potential source for biomechanical imbalance. While further research is warranted to fully understand the clinical implications of the present study, manufacturers may need to take these findings into account for future implant designs. Level of evidence Level III, retrospective cohort study.