Acetabular fractures: classification and surgical treatment of 65 cases

The material of this study was composed of 65 cases of fracture of the acetabulum treated surgically, in two hospitals in Cairo over the period between January 1982 and December 1988. There were 60 males [92.3%] and 5 females [7.7%], aged 35 to 52 years. Most of them sustained the injury in a motor-car accident [58 or 89.3%]. There were 79 associated head, chest, abdominal or skeletal injuries, or 1.1 associated injury per case. The follow up period was 14- 84, average 48 months. They could be classified into two categories and 14 types. Category A included isolated, and Category B, combined fractures. The overall result was satisfactory in 40 cases [61.5%]. There were more satisfactory cases among those operated in the first few days, and the number of satisfactory cases diminished gradually the more the treatment was delayed. There were more satisfactory cases in Category A than in Category B fractures. The latter category included more severe fractures. One patient died early postoperatively from pulmonary embolism. Other cases of early general complications of fat embolism and white lung syndrome [1 case], deep vein thrombosis [6], and pulmonary embolism [2] resolved themselves safely. Early postoperative sciatic nerve palsy [2] recovered spontaneously. Early deep wound infection [2] ended in destruction of the hip joint and its pathological dislocation. Late complications compromised the functional results: avascular necrosis of the head of the femur [2], capsulitis ossificans [20], myositis ossificans [3], pathological dislocation from late deep infection [1], traumatic osteoarthritis of the hip [12]

Iliac crest graft: late postoperative evaluation of 228 donor sites

A retrospective study of 228 iliac crest graft donor areas was carried out in 220 patients after iliac graft donation. The average follow up period was 89 months. The commonest indications were ununited fractures and cavity filling. The complications were all avoidable. The persistence of pain [58 cases] was due to scar problems, infection, hernia, and lateral cutaneous nerve of the thigh entrapment. Iliac crest deformity followed uneven taking, big defect left fractures and irregularity of growth in children. In the non-symptomatizing cases the incision had been done distal to the iliac crest, the graft had been taken posteriorly and/or anteriorly, without leaving a defect, and the iliac edge was smooth and even, and the scar was a primary intention nonadherent one. A precise surgical technique, gentle handling and paying due attention to this part of the operation, pre and postoperatively, lead to the avoidance of the postoperative complications

Osteoid osteoma of the femoral ends

Ten cases of osteoid osteoma are described in the proximal [6 cases] and distal [4 cases] ends of the femur. Age 17-28 years, mean 21.7 years. Sex: males 8, females, 2. Diagnosis: Iocalised pain and tenderness, referred pain, sometimes sciatic like, guarded neighbouring joint, hip or knees, synovial effusion. X-rays: nidus mainly cortical, not more than 1 cm in diameter, surrounded by sclerosis. Preoperative localisation and confirmation by conventiontal or computerised tomography. Preoperative localisation by image intensifier, K-wire pointing in the lesion and X-rayed, X-ray of resected block of bone. Treatment: Removal of a bony block containing the lesion; reinforcement of defective cortex by cancellous bone graft; non weight bearing ambulation until operated bony site gets consolidated. All cases were relieved of pain by simple excision. One case of subtrochanteric osteoid osteoma had a fracture caused by careless early weight bearing

Posterior fracture-dislocation on the hip joint

The material presented comprised 38 cases, 36 males and 2 females, aged 20-52, mean 38 years, collected during 1981-1988, all treated surgically and studied prospectively. According to the study of the line of action of the force of the accident on the acetabulum, and to clinical, X-rays in different views and computerised tomographic analysis, the fractures of the acetabulum could be differentiated into six types: 1] superior marginal [4 cases], and 2] posterosuperior marginal [13 cases] fractures, 3] posterior wall [6 cases], and 4] posteroinferior wall fractures [3 cases], 5] posterior wall fractures with transverse acetabular fractures [3 cases], 6] comminuted posterior acetabular wall fracture with interposed fragment [9 cases]. In addition 8 cases had femoral fractures in the head [2], the neck [2] or the shaft [4]. Surgery was performed during the first week in 25 cases, the second in 9, the third in 2, and the fourth week in 2 cases. Two to four lag screws were used to fix the acelabular fracture in 20 cases, a buttress plate in 14, and both plate and inter-fragmentary screws in 4 cases according to the type of fracture. Patients were out of bed in the average after 3 days, stitches removed after 12 days, on partial weight bearing after 6 weeks, and full weight bearing after 3 months. They were followed up for 7-96, mean 48 months. Two cases developed avascular necrosis of the femoral head. Two cases presented with sciatic nerve palsy that eventually recovered. The overall results were satisfactory in 35 cases [92%] who had painless hips, with no limitation of movement of the hip [16 cases], or had less than 30% limitation of the range of movement in one or two directions [19 cases]

treatment of ununited fractures of the carpal scaphoid by styloidectomy and bone grafting

Many procedures were described for treatment of non-union of the scaphoid. Radial styloid-ectomy and grafting of the pseudarthrosis were used to treat 27 cases of scaphoid non-unions. 25 cases were available for the final evaluation. The technique and results are here presented. The procedure has led to union in 21 cases. The function of the wrist and hand has definitely improved. There has been marked relief of pain in most of the cases. The improvement in the grip strength has been moderate. The range of movements of the wrist has mildly increased

Operative treatment of intercondylar Y and T shaped fractures of the lower end of the humerus

Intercondylar Y and T shaped fractures of the lower end of the humerus are uncommon and difficult to treat. Surgical management is recommended to achieve a successful outcome. It is important to reconstruct accurately the capitellum and trochlea and to obtain rigid secure internal fixation so as to permit early controlled postoperative active range of motion. In this series, 23 patients with these fractures were treated by open reduction and internal fixation through a trans-olecranon approach. Approximately 70% good to excellent results were obtained

safer, new surgical approach for tibial plating

To avoid wound complications of incisions for tibial plating, a long incision curved lateraly overlying the lateral muscle compartment of the leg, has been used prospectively, in plating of sixty fractures of the tibial shaft. This is a report of the technique and definitely better results of such an approach which can be used in dealing with fresh as well as ununited fractures of the tibial shaft. The excellent results we obtained have permitted us to recommend this type of exposure to avoid the well-known, but not as well documented, complications of more classic ones