Cementless acetabular component after acetabular fracture

Acetabular fractures are serious and uncommon orthopedic injuries. Many of these fractures may potentially result in late complications such as post-traumatic arthritis, osteonecrosis of the femoral head and chondrolysis. These complications can occur with and without initial surgical treatment. Total hip replacement for these patients has produced results inferior to those in patients with nontraumatic arthritis. The purpose of this study is to evaluate the results of total hip arthroplasty with a cementless acetabular component in patients with posttraumatic arthritis. In this study, twenty one hips [in twenty one patients] with posttraumatic arthritis due to fracture of the acetabulum were treated with delayed primary total hip arthroplasty with a cementless acetabular component. The average age at the time of hip replacement was 50.5 years [range, 37 to 62 years]. The interval between the initial acetabular fractures and the hip replacement was 30 months [range, 14 to 52 months]. Nine patients [42.8%] had previous open reduction and internal fixation of their acetabular fracture while twelve patients [57.2%] were treated nonoperatively. Eleven hips [52.4%] required bone grafting of the acetabular defects. Three of the nine hips [33.3%] with a previous open reduction and internal fixation required bone-grafting of the acetabular defects compared with eight of the twelve hips [66.7%] treated by closed means. The average duration of follow-up was 42 months [range, 24 to 60 months]. Evaluation of our patients included the clinical and the radiological assessment. The Harris hip score was used for clinical assessment. The average clinical results of our patients were considered good [87.6 points]. Nine patients [42.8%] had excellent results, eleven patients [52.4%] had good results, and one patient [4.8%] had a poor result. Radiographic analysis revealed that eighteen components [85.7%] met the criteria for stable fixation. A complete radiolucency, <1 mm wide [possibly unstable], was seen around two reconstructions [9.5%]. One acetabular component [4.8%] was surrounded by a complete radiolucency of >2 mm in width. This component was classified as unstable. Total hip arthroplasty with cementless acetabular component after old acetabular fractures is usually difficult because of bone defects, extensive scarring, heterotropic ossification, and retained implants in patients with previous internal fixation. Despite these difficulties, the clinical results are encouraging

Arthroscopic biodegradable meniscal arrow repair

The importance of the meniscus in both the function and longevity of the knee has been well established. Consequently, preservation of the meniscus is a worthwhile surgical goal. Arthroscopic all-inside meniscal repair techniques have become popular to avoid the potential complications of other techniques and decrease the operative time. The arrow is a bioabsorbable device with barbs that are placed across a meniscal tear. In this study, 23 patients with 23 isolated meniscal tears underwent arthroscopic repair with the Meniscus Arrow system. The average patient age was 30.5 years [range, 19 to 38.5]. Eighteen meniscal tears [78%] were in the medial meniscus, and 5 tears [22%] in the lateral meniscus. Nineteen meniscal tears [82.6%] were repaired within 8 weeks of injury [acute tears]. The remaining 4 tears [17.4%] were repaired after 8 weeks from the injury [chronic tears]. There were 15 [65%] vertical [longitudinal] tears, and 8 [35%] bucket handle tears. Five tears [21.7%] were at the menisco-capsular junction, 12 tears [52.2%] in the red/red zone, and 6 tears [26%] in the red/white zone. The average follow-up was 15.5 months [range, 12-24 months]. Evaluation by Lysholm knee score showed that 11 patients [47.8%] had excellent result, 8 patients [34.8%] good result, 1 patient [4.3%] fair result, and 3 patients [13%] poor result. No infection or neurovascular complications occurred in any patient. The use of biodegradable Arrows for meniscal repairs has many advantages as regard the all-inside technique, pull-out strength equal to horizontal suture method, short operative time, easy surgical technique, good clinical results, and low risk of neurovascular complications

Anterior cervical interbody fusion using carbon fiber cages

Anterior decompression and inter body fusion is a widely accepted surgical treatment for patients with cervical disc herniations and cervical spondylosis. Tricorticaf iliac crest autograft has been considered the classic method but problems such as graft collapse, and extrusion still persist. Cages were introduced because of their theoretical ability to prevent graft collapse. Carbon fiber cages for anterior cervical fusion will be evaluated in this study. Thirty two patients with symptomatic cervical disc disease were treated by anterior cervical discectomy and fusion using carbon fiber cages packed with autogenous bone graft. The average duration of symptoms was 9.3 months [range, 2-15 months]. The average follow-up was 28 months [range, 12-36 months]. All patients had neck pain. Twenty one patients [65.6%] had a single level affection, and eleven patients [34.4%] had double level affection with a total of 43 disc lesions. Fifteen patients [46.9%] had radiculopathy without myelopathy, ten patients [31.2%] had myelopathy without radiculopathy and seven patients [21.9%] had myeloradiculopathy. Four patients [12.5%] had sphinctric disturbances. Twenty seven patients [84.4%] had complete relief of neck pain. All patients improved neurologically postoperatively, except 2 patients [6.2%] with myelopathy although their symptoms stopped to progress. Maintenance of cervical lordosis or correction of kyphosis occurred in 29 patients [90.6%]. Fusion occurred in 40 disc lesions [93%]. Subsidence [< 5mm] occurred in 6 disc spaces [14%]. There were no implantrelated complications. Carbon fiber cages represent a good option to restore the intervertebral disc space and promote fusion in cervical disc surgery. Furthermore, the bone fusion can be easily assessed because of radiolucency of these cages

Management of tibial plafond fractures with ilizarov external fixator

Eighteen tibial plafond fractures in eighteen patients were treated with the Ilizarov external fixator. Twelve patients [66.7%] were males and six [33.3%] were females, and the average age was 36.5 years [range, 23 to 52 years]. The mechanism of injury included thirteen motor-vehicle accidents [72.2%] and five falls from a height [27.8%]. Eleven fractures [61%] were closed and seven [39%] were open [five grade, and two grade]. The fractures were classified according to AO classification system. There were four type Al, three type A2, three type B2, four type C2, and four type C3 fractures. Associated injuries occurred in 6 patients [33.3%] and included an abdominal injury [2 patient], a second long bone fracture [3 patients], and a proximal fracture in the same tibia [one patient]. Open reduction and internal fixation of the fibula fracture was performed in 8 patients [44.5%] using a tubular plate. The ankle joint was crossed with a hindfoot half ring in the type C fractures [44.5%]. Minimal internal fixation with interfragmentary screws was performed in 6 fractures [33.3%]. The average follow-up was 30.5 months [range 24 to 36 months]. All fractures united. The average time of healing was 4.5 months [range, 2.5-6 months]. Seven fractures [39%] were excellent, five [27.8%] good, three [16.6%] fair, and three [16.6%] poor according to the functional ankle score. Pin track infection occurred in four patients [22.2%]. Minimal skin necrosis around the wound was observed in two patients [11%]. Malunion in the form of 15° valgus occurred in one fracture [5.5%].Two patients [11%] had shortening of their legs ranging between 1 to 2 cm

One-stage treatment of neglected congenital dislocation of the hip

One-stage operative procedure for neglected congenital dislocation of the hip in 16 children [18 hips] was evaluated in this study. Nine patients had dislocation of the left hip, five had dislocation of the right and two had bilateral dislocation. None of the patients had a previous treatment of the dislocation. The average duration of follow up was 2 years and 11 months. Open reduction with shortening and derotation of the femur was done for all hips. In nine hips, varus angulation, for excessive valgus, was added to the osteotomy. Salter innominate osteotomy was performed in ten hips. According to Severin's system for radiographic evaluation, 14 hips had excellent or good results. The range of motion was assessed using the rating system of Ferguson and Howorth. Ten hips were excellent, five were good, two were fair and one was poor. Avascular necrosis was developed in one hip which gave a fair clinical result. A limb- length discrepancy of more than 1 cm [2.2 cm] occurred in one patient at the latest follow up. In one hip, instability, which led to subluxation, developed postoperatively which needed operative revision and the capsulorrhaphy was tightened

Management of relapsed clubfeet by soft tissue distraction using the ilizarov method

Nineteen feet with relapsed clubfeet in 14 patients were treated by soft tissue distraction using the Ilizarov method. There were nine unilateral and five bilateral deformities in ten boys and four girls. They had an average of three [range of 2-5] previous surgical interventions; all were in the form of soft tissue release. The average time taken for the correction of the deformity till frame removal was 10.5 weeks [range of 9-12 weeks] and the average follow up period was 2.4 years [range of 1-4 years]. Twelve feet were graded as excellent, 5 as good and 2 as fair results. The frame was well tolerated by all children and their parents until a full correction of the deformity occurred

Giant cell tumors of long bones: a preliminary report of treatment and outcome

The present study was performed to determine whether there is a difference in the functional outcome and recurrence rate after different methods of treatment of giant-cell tumor of long bones. Thirty-four patients, 23 females and 11 males with a mean age of 26 years were treated. According to the grading system developed by Campanacci et al., three lesions were grade I, 20 lesions were grade II and 11 lesions were grade III. The follow up ranged from 12-40 months with an average of 15 months. The patients were evaluated with regard to pain, postoperative function and local recurrence. Twenty- two patients were treated by curettage, while 12 by resection. After curettage, liquid nitrogen was used in 14 patients and high speed burr only was used in 8 patients. After curettage, the cavity was filled with autograft [iliac bone chips] in 15 patients and cement in 7 patients. After wide resection, arthrodesis was performed in five patients, endoprostheses were inserted in five patients and replacement of the distal radius by an ipsilateral fibular graft for two patients. Four of the 34 patients had a local recurrence during a mean follow up period of 15 months, including three patients having recurrence after curettage and one after resection. The functional result according to Mankin's classification was excellent in 19 patients, good in seven patients, fair in four patients and failed in four patients

Mobile - bearing knee arthroplasty: clinical results

Twenty three primary cemented mobile-bearing total knee arthroplasties were implanted in nineteen patients. All implants were of a posterior cruciate-retaining design and allow translation of the polyethylene in the anteroposterior plane and its rotation about the longitudinal axis of the limb. Fifteen patients [17 knees] had osteoarthritis and four patients [6 knees] had rheumatoid arthritis. The average follow-up was 30 months. Preoperatively, the average flexion contracture was 11.5° [range, 0°-25°] and the range of motion 100° [range, 50°-130°] At final follow-up, no knee had a flexion contracture. The average postoperative range of motion was 120° [range, 80°-140°]. Preoperatively the average knee score was 38 points, the average function score was 42 points and the average pain score was 16 points according to the scoring system of the Knee Society. At the time of most recent follow-up, the average knee score was 90 points, the average function score was 82 points and the average pain score was 43 points. Nineteen knees [82.6%] in this study had no evidence of radiolucent lines around any component. Superficial infection was detected in one knee. Patellar dislocation occurred in two knees [3-4 weeks postoperatively] which needed lateral retinacular release

Arthroscopic anterior cruciate ligament reconstruction with quadruple hamstring grafts

Arthroscopic anterior cruciate ligament reconstruction with quadruple hamstring grafts was performed for 26 patients with an average age of 27.5 years [range, 19 to 42]. Eighteen patients were male [69%] and eight patients [31%] were female. Fourteen left knees [54%] and twelve right knees [46%] were injured. All the patients had unilateral ACL insufficiency without other ligamentous injuries, and no patient had a history of previous knee surgery. The medial meniscus was injured in 5 knees, and the lateral meniscus in 3 knees. Average follow-up was 20 months [range; 15-30 months]. At 12 months after surgery, two patients had ruptured their graft. These two patients were excluded from further analysis and from the final results. According to Lysholm Knee Score, twenty one patients [87.5%] had good or excellent results. Overall IKDC assessment revealed that twenty two patients [91.7%] were assessed as normal or nearly normal. A grade 0 Lachman test [A] was demonstrated in 16 patients [67%]. Six patients [25%] had grade one laxity [B] and two patients [8%] had grade two laxity [C]. A grade 0 pivot shift testing [A] was demonstrated in 18 patients [75%]. The remaining 6 patients [25%] had a grade 1 pivot shift [B]. Anterior kneeling pain was present in 3 patients [12.5%] at the most recent follow-up. Hamstring pain was felt in 4 patients [16.7%]. Three patients had pain in the lower third of the hamstring muscles and one patient had pain in the middle third

Total hip arthroplasty for ankylosed hips

Sixteen spontaneously ankylosed hips were converted to total hip arthroplasties in 12 patients. The average length of follow up was three years. The predominant indications for conversion were progressively disabling pain in the low back, contralateral hip pain, loss of function due to immobility or malposition of the hip, processive pain and instability of the ipsilateral knee. Many problems were faced in this kind of hip arthroplasty including difficult exposure, tissue contracture, atrophy of hip abductors and distortion of anatomy, especially in patients who developed this ankylosis after infection. Long rehabilitation period should be expected in such cases. The postoperative range of motion was markedly improved. The average arc of flexion for all hips was 85 degrees. The average arc of abduction-adduction was 47 degrees [32 of abduction to 15 degrees of adduction] and the rotational arc averaged 42 degrees [18 degrees of internal rotation to 24 degrees of external rotation]. Three hips in this study were rated as failures

Shoulder hemiarthroplasty for malunited proximal hurmeral fractures

In this study, hemiarthroplasty [Neer II prosthesis] was used for the treatment of malunited fractures of the proximal humerus in eight patients [five men and three women with an average age of 57 years, range of 45-68 years]. The average time from initial injury to operative intervention was 13.5 months [range 4-23 months]. The patients were followed up for an average of 18 months [range 12-24 months]. Six patients had a complete painless shoulder. Active total elevation improved from an average of 25 degrees [range 15-35 degrees] preoperatively to 90 degrees [range 70-100 degrees] postoperatively. The external rotation improved from 15 degrees [range 10-20 degrees] preoperatively to 35 degrees [range 25-45 degrees] postoperatively and internal rotation improved from an average of S1 preoperatively to L1 postoperatively

Anterior decompression and stabilization of thoracolumbar burst fractures

Twelve patients with thoracolumbar burst fractures were managed with one-stage anterior decompression, fusion and instrumentation with Kaneda system. The indications for surgery were neurologic deficit secondary to canal compromising 50% or more, kyphotic deformities greater than 20 degrees, 50% or more loss of the vertebral body height and progressive neurologic deficit. The average follow up was 14 months [range 10-18 months]. After the anterior decompression, the neurologic function improved by at least one grade, except in one patient with complete paralysis. The postoperative kyphotic angle ranged from -5 to 15 degrees [average 5 degrees] and it ranged from -3 to 18 degrees [average 6.7 degrees] at the most recent follow up. No serious complications were developed during all surgeries. During the follow up, implant failure occurred in two patients

Posterior wall acetabular fractures clinical outcome of surgical treatment

Fifteen patients with postterior wall acetabular fractures were treated surgically. All the fractures resulted from high energy traum a, most with associated injuries. Forteen of these patients were followed up to at least 9 months, only one was lost for follow up. Clinical outcome was analyzedd according to Harris hip score and also radiografically. In 78.4% of the patients the surgical procedure was judged successful [Harris hip score 80 points or more]. Injury of the femoral head lead to bad clinical outcome though no significant statistical correlation was possible because we had this injury just once in our series and because this case had another complication as well [Avascular necrosis of the head of femur]. Quality of reduction was found to influence the clinical outcome with positive statistical correlation. Open reduction and internal fixation of displaced posterior wall acetabular fractures though surgically demanding procedure can give very good result when patients are managed properly through experienced and organized team with clear and stable system of management

Posterior lumbar interbody fusion in spondylilytic sponydlolisthesis

Stabilization after decompression of spondylolytic spondylolisthesis is difficult because of a lack of fusional bone mass, gap between the transverse process bases and incompetent anterior disc support. Adding posterior lumbar interbody fusion [PLIF] to the procedure offers anterior support, reduction and a broad fusion base. Eleven female patients, with spondylolytic spondylolisthesis were treated by posterior decompression, pedicle screw fixation and PLIF using 2 pieces of iliac tricortical bone grafts. The patients were followed for a mean of 1 year, and were evaluated both clinically and radiologically. All 11 patients were improved except one who is still complaining of back pain due to graft collapse and non-union

protocol for management of cubitus valgus secondary to non-united fractures of the lateral condyle of the humerus

This study included eighteen patients with cubitus valgus secondary to non-united fractures of the lateral condyle of the humerus. Ulnar nerve decompression by simple release at the elbow was done in 14 patients, with corrective osteotomy in 8 patients and as a single procedure in 6 patients. Anterior transposition of the ulnar nerve was performed in four patients with corrective osteotomy [two cases] and as a single procedure [two cases]. In one patient, ulnar nerve transposition was done as a secondary procedure after the failure of simple nerve release to relieve all the symptoms of ulnar neuropathy. Thus, corrective osteotomy was done in ten patients, the procedure used was the opening wedge displacement osteotomy. All the patients showed satisfactory results regarding neurological symptoms as well as the correction of deformity and elbow joint pain and stability. The elbow joint range of movements was reduced from 10 to 25 degrees in four cases, however the functional outcome was accepted by the patients

Evaluation of the role of posterolateral spinal fusion in dorso-lumbar injuries fixed with pedicular rod systems

This study included 80 patients with unstable dorsolumbar injuries treated by transpedicular rod fixation systems [10 had unstable wedge fractures, 55 had unstable burst fractures and 15 had fracture- dislocations]. Patients were classified into 2 groups of 40 patients each: Group A included cases with posterolateral spinal fusion performed at the time of surgery and Group B included patients with fracture stabilization only without grafting. Posterolateral fusion was found to increase the long-term spinal stability and reduce the complications related to implant failure