19 August 2016
Four Days on Complex Fractures in Australia
The first two days, led by Dr. Marinis Pirpiris, were dedicated to the various aspects of trauma. Keith Mayo and Takeshi Sawaguchi served as international speakers, in addition to a number of renowned Australian trauma experts.
Day 3—Arthroplasty and periprosthetic fractures
The AORecon portion of program started with an introduction by course chair Fares Haddad. Afterwards, the options of using arthroplasty as the preferred method in acute hip fractures were highlighted, as well as the need for the education in joint replacement and preservation, and collegiality among AO surgeons. Haddad also provided an overview on the status of current literature regarding using arthroplasty in fem neck fractures (Fx), with specific focus on the Sernbo study from Sweden (2002) and follow up. Andrew Shimmin talked about resurfacing in his presentation, outlining a thought process for it, due to the lack of existing guidelines.
Chaired by Shimmin, the second session highlighted on aspects of choosing arthroplasty after failed fixation versus non/operatic treatments. This included a long discussion with Michael Huo, Peter McCombe, and Dermot Collopy, with particular focus on cementing versus non-cementing and the use of spacers.
The section on periprosthetic fractures after total hip replacement, chaired by Huo, gave an insight on the classification as well as risk factors (both Haddad) before John Bare and Michael O'Sullivan looked at the procedural options, revision techniques, and algorithms. Bare finalized the session with a talk on treatment options in infected periprosthetic fractures, especially outlining the various aspects that need to be considered doing the debridement. During the discussion, Haddad encouraged all participants to look up the consensus paper on infected situations, which is accessible through many major journals.
The afternoon sessions on the first day of the AORecon portion of the event looked at arthroplasty after fractures around the knee and periprosthetic fractures after a TKA. In his talk about infected hardware, Scott Fletcher pointed out that it is advantageous to leave the metal in unless it is understood to be a clear benefit for the procedure.
Day4—Bone loss and periprosthetic infection
Day two of AORecon started with an extensive look bone loss and deformity hip topics and an overview on the classification of acetabular bone deficiency shown by Shimmin. Collopy opened the session explaining the choice of stem lengths and shapes in revision procedures. David Campbell explained the use of cement in acetabular fixation, including cages and impaction grafting. In his talk about bespoke acetabular revision, Haddad highlighted the advantages of customized cages and 3-D planning.
Augmentation, caging, and pelvic discontinuity were discussed by Huo before the management of femoral deformity in THR was presented by O'Sullivan. Bogdan Solomon then discussed the use of cement in cement solutions in revision THR. Haddad further presented thoughts of cementless revision to get back into the primary biomechanics.
Following Fletcher's view on the use of Interlocking stems and other salvage options, participants discussed various presented cases of femur deformities.
Continuing with the various aspects of bone loss and deformity in the knee, Shimmin looked at the extra-articular deformity and evaluations before F Haddad described fixation methods and zonal considerations for failed TKAs. Gauguin Gamboa discussed ligamentous deficiency or injuries, followed by Bare's talk about the available options in stiff knee arthroplasties and Bill Donnelly addressed the major issue of failed extensor mechanism, which should be treated with allograft reconstruction when possible.
Haddad stressed the general problems of infection for the patient and the little progress that has been made to address them with even increasing incident rates.
The final part of the meeting addressed various forms of complications such as sepsis and acute infection in periprosthetic fractures and following TKA and THA with presentations from Campbell, Bare, Haddad, Huo, and Vaibhav Punjabi showed aspects of revision surgery and salvage strategies in such situations.
Every session allowed for thorough interaction between participants and faculty and saw various lively discussions. The organizers appreciated the high interest for the presented topics and gladly recognized the event as a great stepping stone for more AORecon educational events in Australia in the future.