Delayed fixation of intravascular fractures of the femoral neck in patients younger than 50 years of age

Intracapsular fractures of the femoral neck in young adults are relatively uncommon injury. Accurate reduction and stable internal fixation of such fractures are advocated within the shortest possible time after injury to reduce the risk of non-union and a vascular necrosis in such younger population. Due to the infrequent incidence of these factures in the young adult, little information is available regarding the influence of fracture displacement, timing of surgery, method of reduction and fixation on the outcome of such injuries. The purpose of this study was to analyse the effect of the timing of surgery on the incidence of non-union and a vascular necrosis after internal fixation of femoral neck fractures in these patients. This retrospective study included 16 young adults [14 males and 2 females] between 19 to 48 years of age [average 33.9 years] with intravascular fractures of the femoral neck who were treated by closed reduction and internal fixation and were followed up for a minimum of three years. Twelve patients [75%] had displaced fractures of the femoral neck. The average time lag between injury and surgery was 37.1 hours [6-24]. The patients were divided into two groups; six patients [37.5%] were treated within 12 hours after injury and surgery was 37.1 hours [6-124]. The patients were divided into two groups; six patients [37.5%] were treated within 12 hours after injury [early fixation group]. All the patients were treated by closed reduction and multiple screw fixation. The average age of the patients in the early fixation group [6 patients] was 36.7 years and was 32.2 years in the late fixation group [10 patients]. There was one female patient in each group. There were 5 displaced fractures [83.3%] in the early fixation group, and 7 displaced fractures [83.3%] in the early fixation group. The average time lag between injury and surgery was 9.3 hours in the early fixation group and 53.7 hours in the late fixation group. All fractures united within an average period of 90.1 days [range 60 - 124]. No statistically significant difference was found in the duration of fracture union with regard to gender distribution, mechanism of injury, fracture displacement, and timing to fixation. Till the end of the follow up period [average 42.5 months], there was no case of a vascular necrosis developed among the patients included in this study. The rate of non-union and avascular necrosis was not affected by a delay of more than 12 hours before fixation of intracapsular fractures of the femoral neck in young adults. Other factors might be more influential determining the rate of avascular necrosis after such fractures like anatomical reduction of the fracture and rigid internal fixation using multiple screws. However, the advantages of early fixation of such injuries in younger age group can not be under-estimated

furlong hydroxyapatite ceramic-coated hip arthroplasty A 6- to 10- years follow-up study

The aim of this study was to describe the clinical and radiographic results of implantation of hydroxyapatite ceramic-coated total hip arthroplasty. Thirty total hip replacements were performed in 28 patients using Furlong hydroxyapatite-coated hips. The right hip was operated upon in 12 patients, the left in 14 patients and both hips were operated upon in 2 patients. The average period of follow up was 7.9 years [range 6-10 years]. The study concluded that the encouraging clinical and radiological results support the continued use of hydroxyapatite ceramic coated components in hip arthroplasty, especially for young patients

Arthroscopic treatment of septic arthritis of the knee in adults. Report of 24 cases

In this study, 24 adult patients with septic knee arthritis were treated by a program including arthroscopic drainage, debridement by synovectomy and postoperative suction-irrigation. The patients started a continuous passive motion using CPM machine in the immediate postoperative period. This protocol achieved 83.3% cure rate from a single arthroscopic session with no evidence of recurrences or osteomyelitis over the follow-up period. The mean range of knee motion at the end of the follow-up period was 110 degrees. The immediate institution of passive motion of the knee after the arthroscopic procedure in the presence of continued washout of the joint cavity by irrigation-suction is a new update in the regimen of treating septic arthritis of the knee introduced in this study. The application of this technique helps in a better cleansing of the joint cavity and drainage of the necrotic debris and harmful proteolytic enzymes. The early results of arthroscopic management of pyogenic arthritis of the knee joint were promising provided that it is done as early as possible after the onset of symptoms and as one item in an integrated program aiming to control infection as well as preservation of the knee joint function

Surgical repair of complete acromioclavicular dislocation augmented with PDS bands. Technique and results

In this study, 23 patients presenting with complete acromioclavicular [AC] joint dislocations were managed by surgical reconstruction. According to Rockwood and Matsen classification, 16 patients had type III lesion, 4 had type IV and 3 patients had type V lesion. The AC as well as the coracoclavicular [CC] ligaments were reconstructed. Augmentation of the reconstruction was done using resorbable 5- and 10-mm PDS bands. The results were assessed postoperatively using the University of California at Los Angeles [UCLA] end-result score. Twenty patients had excellent and good results, while three patients were rated as poor. No calcification of the ligaments was found postoperatively. Two patients had AC joint arthrosis

Elbow joint dislocation: radiographic and arthroscopic correlation

Elbow joint dislocation is not an uncommon injury. Together with disruption of the joint capsule and collateral ligaments, associated skeletal and soft tissue injuries can occur. Traumatic articular surface lesions can occur in association with elbow dislocation. The presence of associated chondral and osteochondral fractures may not be recognized unless the joint is explored. The aim of this prospective study was to assess the arthroscopic findings after closed reduction of elbow dislocation. Twelve patients with elbow joint dislocation were included in the study. There were 8 men and 4 women, with a mean age of 39.9 years. The right elbow was affected in 5 cases [41.7%]. After closed reduction of the joint dislocation under general anaesthesia, post-reduction plain radiography of the elbow joint was done and elbow arthroscopy was performed for all the patients thereafter. The mean duration between injury and arthroscopy was 3.5 days. In two cases [16.7%], a small intra-articular bony fragment was seen in plain radiography of the elbow joint after joint reduction; this was associated with slight widening of the joint space. in the remaining 10 cases [83.3%], there was no radiographic evidence of any intra-articular bone fragments. Widening of the joint space after closed reduction was also seen in another two cases [16.7%] with no intra-articular bony fragment in plain radiography. Arthroscopic examination revealed the presence of loose chondral and osteochondral fragments in 9 cases [75%]. In four cases [33.3%], a single intra-articular cartilaginous loose fragment was identified. In 2 cases [16.7%], there was more than one chondra fragment [2 - 3fragments] inside the elbow joint. in another 3 cases [33.3%], a loose osteochondral fragment was seen arthroscopically inside the joint cavity. Arthroscopic wash out of the haematoma was carried out in all the cases. The intraarticular loose fragments were removed arthroscopically in seven out of nine cases. in the remaining two cases open removal of these fragments was carried out together with surgical repair of the anterior joint capsule and ulnar collateral ligament. No intra -operative or post-operative complications related to the anaesthesia or the arthroscopic procedure was encountered in this study. Thus, arthroscopic examination of the elbow after reduction of the joint has added more information in 7 out of the 12 cases [58.3%] constituting the material of this study regarding the presence of unseen intra-articular loose fragments. It also added more information in 4 patients [33.3%] regarding the presence of undetected collateral ligament injury. Arthroscopy was shown to be reliable in identifying associated lesions of the articular cartilage. Post-reduction arthroscopic lavage and debridement of the elbow joint might improve joint range of movement and reduce the chances of having late degenerative changes