treatment of subtrochanteric fractures of the femur by a gamma interlocking nail

This is a study of 14 patients who sustained subtrochanteric femoral fractures that were internally fixed by a standard gamma interlocking nail. There were ten females and four males. Their average age at operation was 61.5 years. According to the mechanism of injury, eight patients sustained minor trauma and the other six were involved in high-energy trauma. With the exception of a single patient, the operation was performed within the first three days of admission. Thirteen patients were mobilized within the first two postoperative days. All fractures united at an average period of 3.4 months [range 2-8 8 months]. At final follow-up, 12 patients returned to their pre- Injury pattern of walking and the other two had a mild limp. Complications of the procedure included intraoperative fracture of the external cortex of the femur in a single patient, leg shortening in seven, trochanteric bursitis in two, superficial wound infection in two, varus deformity of more than 20 degrees in two and deep vein thrombosis in a single patient. None of these complications materially affected the end result. The gamma nail proved to be an effective device in treating such difficult fractures by permitting early weight bearing and achieving solid union in all the cases

Anterior cruciate ligament reconstruction: a comparison of patellar tendon and doubled semitendinosus - gracilis tendon grafts

The purpose of this prospective, randomized clinical trial was to compare the outcome of anterior cruciate ligament reconstruction in a group of patients using a patellar tendon autograft [PT group], with the outcome of reconstruction in another group using a double-looped semitendinosus-gracilis autograft [STG group]. There were no significant differences between both groups regarding age, sex, preoperative level of activity, ligament laxity or delay before reconstruction. The material consisted of sixty patients [31 in PT group and 29 in STG group] who were followed up for at least 1 year. The protocol of accelerated rehabilitation program as well as the method of follow-up were the same for all patients. At final follow-up evaluation, there were no statistically significant differences between both groups regarding Lysholm score, Tegner activity score, ligament stability, thigh atrophy, range of movements, incidence of patellofemoral crepitus or functional muscle recovery. The most striking difference was a significantly higher percentage of kneeling pain in PT group [74%] than in STG group [10%]. The study, therefore, showed that a patellar tendon graft with interference screw fixation, and a doubled semitendinosus-gracilis tendon graft with endobutton fixation proximally and staples distally, gave equivocal results based on subjective, objective and functional evaluation

patellar compression syndrome: treatment by miniopen lateral retinacular release

The purpose of this prospective study was to evaluate the results of lateral retinacular release in the treatment of patients suffering from the patellar compression syndrome [PCS], a painful compressive arthropathy of the lateral facet of the patella. Fifty two kness in 42 patients were included in the study. The criteria for inclusion were the presence of complaints of anterior knee pain with no predominant instability, clinical signs pointing to lateral retinacular tightness, and radiological evidence of lateral patellar tilt with minimal subluxation. Furthermore, Those patients were selected after they failed to respond to a minimum of 3 months of conservative treatment that entailed isometric quadriceps-strengthening exercises, restriction of activities that require prolonged knee flexion and administration of anti-inflammatory agents. At operation, all patients were subjected to a comprehensive arthroscopic examination of the knee joint. Consequently, the release was performed through a 3cm skin incision. A satisfactory result was achieved in over 84% of the cases. The complication rate was low and included one case with medial patellar subluxation and another with minor wound infection. None of the knees were complicated by postoperative haemarthrosis. The data indicated that significantly better results can be achieved in patients who have positive clinical signs pointing to patellor tighthness, namely well localized lateral parapatellar tenderness, a positive medial patellar glide test and a positive medial apprehension test. Poorer results are to be expected in patients with severe arthritic changes involving the lateral patellar facet

outcome of fracture neck femur in children: a long-term follow up

This is a long-term follow up study of forty nine children with fracture of the neck of the femur who were treated and followed up at Hadra University Hospital. The age of these children at the time of injury ranged from 3 to 17 years [average of 10.2 years]. The follow up period averaged 9.3 years [range 5 to 19 years]. There were 23 males and 26 females. Thirty eight fractures [77.5%] were caused by major violence. There was a single transepiphyseal fracture, 25 transcervical fractures, 21 basicervical fractures and 2 intertrochanteric fractures. Five fractures were undisplaced. According to the method of treatment, the cases were grouped into 4 categories; five patients [10.2%] were treated by immobilisation in a hip spica; skeletal traction was used for treating two patients [4.1%]; internal fixation was the line of treatment in 36 fractures [73.5%]; and subtro chant eric osteotomy was the line of treatment in 6 cases [12.2%]. The overall results were good in 46.9%, fair in 24.5% and poor in 28.6% of patients. Better results were obtained in undisplaced fractures and in those displaced fractures where early anatomical reduction could be achieved and maintained throughout the treatment. Furthermore, the quality of reduction appeared to influence the occurrence of delayed complications such as avascular necrosis and non-union. Many early and delayed complications were encountered and reported. Avascular necrosis occurred in 40.8%, coxa vara in 38.8%, non union in 38.8%, premature epiphyseal closure in 40.8%, shortening in 59.1%, arthritic changes in 36.7%, coxa valga in 10.2%, coxa magna in 2% and post operative infection in 24.4% of patients

treatment of kienbocics disease by lunate excision and scaphocapitate Fusion

Excision of the lunate combined with scaphocapitate [SC] fusion was performed for 14 patients with stage III Kienbock's disease. The average age was 21 years and the period of follow-up averaged 14.8 months. The operation was done through a dorsal approach with the use of autogenous bone graft and K wire fixation for the scaphocapitate articulation. Satisfactory fusion occurred in all cases after an average of 8.3 weeks. The procedure was successful in preventing further carpal collapse and scaphoid subluxation. Degenerative arthritis occurred in five patients and mild superficial infection in two patients. The range of motion averaged 29.6° of palmarflexion, 31.1° of dorsiflexion, 22.1° of ulnar deviation and 5.7° of radial deviation. The grip strength averaged 73.9% of the uninvolved side. Pain was markedly reduced in over 85% of the patients, and more than 70% of the patients were able to return to their former heavy manual jobs