Total hip arthroplasty for management of neglected fracture neck femur in old patients

The aim of this study was to evaluate functional and radiological findings of patients after primary total hip arthroplasty for neglected intracapsular fracture of the femoral neck in old patients. Between January 2007 and February 2009, we treated 19 consecutive cases of neglected intracapsular fracture of the femoral neck in old patients by total hip arthroplasty; there were 11 males and 8 females with a mean age 55 [range, 50-65] years. The right hip was involved in 9 patients and left hip in 10 patients. Six patients had been injured in road traffic accidents and 13 patients had fallen from considerable height. The interval between injury and surgery has ranged from 8 months to 2 years with an average 11 months. Avascular necrosis of the femoral head was presented in 15 patients with neck resorption and non union with neck resorption in 4 patients. Total hip arthroplasty was done for all patients; cemented total hip arthroplasty was done for 11 patients, cementless total hip arthroplasty for 3 patients and hybrid total hip arthroplasty for 5 patients. The mean duration of follow up was 23 [range, 17-30] months. The patients were evaluated both clinically and radiologically, 15 patients out of the nineteen had no pain and 4 patients had mild pain. Radiologically, there were no signs of loosening

Dome-shaped high tibial osteotomy guided by circular wire

The aim of this study was to evaluate the early results of dome-shaped high tibial osteotomy in patients with medial compartment osteoarthritis of the knee with varus deformity. The average preoperative duration of symptoms was 5.1 years. The average age was 50.71 years [range, 42-59 years] at the moment of operation. The mean follow-up was 16.6 months [10 - 22 months]. We assessed the degree of arthrosis according to Ahlb'ack in three-grade scale. The patients with varus deformity had mean preoperative and postoperative tibiofemoral angles of 4.4 WHITE BULLET varus [0 WHITE BULLET 11 WHITE BULLET] and 5.7 WHITE BULLET valgus [4 WHITE BULLET -100], respectively. The patients were assessed according to the system developed by the Knee Society Scoring System. The mean preoperative Knee Score was 52 and the Knee Functional Score was 53,while the mean postoperative Knee Score was 82 and the Knee Functional Score was 84. Although the indications for arthroplasty of the knee are more frequent nowadays, the authors recommend not to forget dome-shaped high tibial osteotomy in the treatment of angular deformity of the knee with osteoarthritis. After a mean duration of follow-up 16.6 months, we found that the dome-shaped high tibial osteotomy of the proximal part of the tibia provided satisfactory clinical results for patients with osteoarthritis of the knee

Surgical resuls of opend reduction and plating of humeal shaft fractures assotiated with radial nerve palsy

The purpose of the present study was to assess early surgery in fractures humerus with radial nerve palsy versus conservative treatment. Nine patients with immediate complete radial nerve palsy complicating a fracture of the shaft of the humerus were reviewed. In all patients the radial nerve was explored and the fracture was fixed within one to two weeks of the accident. At exploration, interposition between the bone fragments or lacerations of the radial nerve was found in all fractures. The mean follow-up time was 9 months [range, 4-15]. There were 6 men and 3 women [mean age 39.1 years, 16 - 76]. There were 3 fractures of the mid-third and 6 fractures of the distal third of the humerus. All patients had complete return of radial-nerve function within three to six months after surgical exploration. This study confirms that radial nerve palsy is found especially in fractures located at the junction of the middle and the distal third of the humeral shaft. Because we found nearly always a macroscopically lesion of the nerve in this type of fracture, we believe an early exploration in spiriod fractures at that junction is better than conservative method

Alignment and soft tissue balance of severe varus knee in total knee replacement

Twenty-nine cases of severe arthritic knee with various degrees of varus deformity [15°-20°] were treated by total knee replacement. Twenty-one [72.4%] of cases were due to osteo-arthritis of knee while the rest [27.6%] were due to rheumatoid arthritis; bilateral affection was reported in 2 patients. There were 20 males and 7 females whose age ranged from 60 to 74 years. The deformity was partially correctable in nine [31%] cases and fixed in twenty [69%] cases. The aim of surgery was to achieve normal alignment of the limb and joint line and to balance the soft tissue structures on both sides of the joint. This required augmentation of medial compartment in 3 [10.3%] cases by bone graft and fixation by cancellous screws. Normal limb alignment was achieved in twenty-five [86.2%] cases. Four [13.8%] cases had residual varus deformity that ranged from [3°- 5° varus]. In three [10.3%] cases lateral laxity was sill present despite the soft tissue surgery

Effects of tourniquet release on blood loss in total knee replacement

Thirty patients undergoing total knee arthroplasty were divided into two groups to determine the effects of tourniquet release and hemostasis on postoperative blood loss. Patients were randomly divided in two groups. In-group A, the tourniquet was deflated intraoperatiye after the prosthetic components were settled and hemostasis was done. In-group B, the tourniquet was released after the wound was closed and compressive bandage was applied. The aim of the current study was to estimate the effects of tourniquet release and cementing on blood loss associated with total knee replacement. Mean postoperative blood loss was 882.83 ml [325-1.317] in-group A and 743.32 ml [320-1.173] in-group B. Variables such as anti-inflammatory drug use; anesthetics; soft tissue release; and component fixation were analyzed. There was no significant difference between the two groups in terms of postoperative blood loss, decrease in hemoglobin, transfusion need or incidence of wound or thromboembolic complications The diagnosis was osteoarthritis in 83.3% of cases and rheumatoid arthritis in 16.7%. All prostheses were cemented and posterior stabilized knee prostheses were used in all cases. The mean length of surgery was 150 minutes in-group A and 120 minutes in-group B. We conclude that tourniquet release for hemostasis is not an effective means of limiting postoperative blood loss or reducing transfusion need after primary total knee replacement