Minimally invasive plate osteosynthesis for comminuted femoral fractures

This prospective study presented 27 male patients with unilateral closed comminuted femoral fractures treated by the minimally invasive plate osteosynthesis technique. They were 6 subtrochanteric, 3 diaphyseal and 18 distal fractures. Indirect reduction was done without exposure of the comminuted fragments. Two separate incisions were used for sub-muscular insertion of the plate. DHS was used in 7 cases, broad DCP in 2 cases and condylar buttress plate in the 18 distal fractures. The mean follow-up interval was 18 months [range 9-28 months]. All fractures united [100%] without bone grafting alter a mean interval of 4.3 months [range 3-5 months]. No cases of nonunion or infection were reported. According to Neer's scale, the results were excellent and satisfactory in 24 cases [88.9%] and unsatisfactory in 3 patients [11.1%] with no failures. Few complications occurred in the form of 1 cm shortening in two cases and 10 degrees valgus in two cases. The minimally invasive plate osteosynthesis technique proved to be useful for treatment of comminuted femoral fractures, especially those in which the interlocking nail can not be used. It is technically not difficult, has a high rate of success and low incidence of complications

Intracapsular femoral neck fracture in young adults, the unsolved fracture: results of fixation by cannulated cancellous screws

Sixteen young adult patients [13 males and 3 females; their ages ranged between 20 and 52 years with an average of 36.1 years] with unilateral intracapsular femoral neck fractures were treated and followed-up after cannulated cancellous screw fixation. The preoperative Garden stage was 4 in 10 cases, 3 in 5 and 2 in one case. Fixation was performed within 48 hours after injury in 12 patients and was delayed more than 48 hours in the remaining 4 cases. After an average follow-up interval of 3.7 years [range between 1 and 10 years], 14 cases [87.5%] united in a good position. According to D'Aubigne and Postel scale, the hip score was excellent in 4 patients [25%], good in 7 [43.75%], fair in one [6.25%] and poor in 4 cases [25%]. Two cases [12.5%] of avascular necrosis of the femoral head [AVNFH] were treated by hemiarthroplasty and 2 cases [12.5%] of nonunion were treated by valgus osteotomy and healed within 8 months after osteotomy. Intracapsular hip fracture in young age is still considered the unsolved fracture due to the debilitating complications of AVNFH and nonunion in such young active individuals. However, early fixation by cannulated cancellous screws was found to be an effective and technically simple method with comparatively fewer complications

ilioinguinal approach for surgical treatment of acetabular fractures

Between 1998 and 2002, 20 patients [16 males and 4 females, with an average age at time of surgery 44.1 years] with unilateral displaced acetabular fractures were treated surgically through the ilioinguinal approach and followed-up for an average time of 27.3 months [range 13-38 months]. The fracture types were ten anterior column, six associated both columns and two anterior fracture with posterior lip fracture. According to D'Aubigne and Postel scale, excellent and good clinical results were obtained in 13 patients, fair in 5 and poor in 2. The reduction was anatomical in 6 cases, satisfactory in 10 and unsatisfactory in 4 cases. The final radiographic results were considered excellent and good in 13 patients, fair in 6 and poor in 2 according to Matta's grading system. Complications were few, only two cases of superficial wound infection and one patient with permanent lateral cutaneous nerve of thigh injury. There were no reported cases of ectopic ossification in this series

Arthroscopic release of the diabetic persistent frozen shoulder

Sixteen diabetic patients who developed frozen shoulder which failed to respond to conservative treatment were subjected to arthroscopic shoulder release between January 2000 and March 2001. They had persistent pain, stiffness and limited function. They were followed up for an average period of 22 months, ranging between 19 and 24 months and evaluated according to the modified score of UCLAwith an average improvement of 16.25 points; 3 patients scored excellent [18.75%], 12 good [75%] and 1 fair [6.25%] result. In addition, the patients were assessed preoperatively and postoperatively for forward flexion, external rotation, abduction and internal rotation. The study revealed a good measurable increase in the range of motion in all planes. The study also considered arthroscopic release of the diabetic persistent frozen shoulder to be an effective method of treatment

Management of stage 3 Kienbock's disease by scapho-trapezio-trapezoid fusion [STT Fusion]

In this study, 34 patients having unilateral stage 3 Kienbock's disease were followed up after scapho-trapezio arthrodesis [STT fusion] between 1997 and 2002 [24 females and 10 males with an average age at the time of surgery of 23.2 years]. The follow up ranged between 12 and 52 months with an average of 38.7 months. In conclusion, in spite of the decreased postoperative range of motion, STT fusion is effective in reducing the pain and improving the grip strength in cases of Kienbock's disease. STT fusion improves and prevents the collapse of the carpus in stage 3 Kienbock's disease. The decreased postoperative range of motion [ROM] could be improved by adding radial styloidectomy to STT fusion to decrease radioscaphoid impingement. The adjustment of scaphoid orientation intra-operatively is a technical defect which should be taken in consideration to have a better outcome from STT fusion

Isolated post-traumatic rotary sub-luxation of the scaphoid: Management by triscaphoid arthrodesis

Eight patients with unilateral chronic wrist pain were operated upon by triscaphoid arthrodesis [scaphoid fused to both trapezium and trapezoid]. All the patients had a history of trauma and clinically had a positive scaphoid shift test. Radiologically all the patients were proved to have static [type 2] rotary subluxation of the scaphoid. The average postoperative follow up period was three years and two months. Evaluation of the results showed that in spite of postoperative decreased range of motion of the wrist, a significant improvement of pain and function was observed