Malunited distal radius fractures

In this prospective study, 64 malunited distal radial fractures were operated upon for the correction of the deformity and restoration of the normal anatomical relationship in the radiocarpal and distal radioulnar joint [DRUJ]. Postoperatively, the patients were involved in an intensive rehabilitation program till restoration of the maximum functional recovery. The patients were followed up for a minimum of 12 months. The final results were assessed both clinically and radiologically with correlation to the type of fracture and timing of the surgical intervention. Fifty-one patients in this series had excellent results, ten had good, three had fair, and none was rated as poor. The study revealed that thorough preoperative assessments of the plain X-rays, CT, and/or MRI and operative restoration of the normal anatomical relations are essential to achieve good results in these difficult cases

Management of chronic scapholunate dissociation. Combining scapholunate ligament reconstruction and Blatt's capsulodesis

In this study, we reviewed prospectively 27 cases of chronic scapholunate dissociation treated by scapholunate ligamentous reconstruction combined with Blatt's dorsal capsulodesis. The diagnosis was based on clinical and radiological criteria. The scapholunate gap, scapholunate angle, carpal height, and the type of instability were all evaluated pre-and postoperatively. The results in our series were analyzed clinically and radiologically following a minimum follow up of 18 months. The patients reported relief of the preoperative pain and discomfort with only a moderate reduction postoperatively in the wrist movement and in grip strength

Surgical management of trapezio-metacarpal joint arthritis. Comparison of two techniques

Osteoarthritis at the base of the thumb affecting the trapeziometacarpal [TMC] joint is a common, painful and disabling condition that severely compromises function of the entire hand. Successful treatment is based on an understanding of the specific anatomy and the unique functional attributes of the human hand and thumb. Surgical procedures for this problem include extra articular ligamentous reconstruction, partial or complete resection of the trapezium with or without tendon interposition arthroplasty, arthrodesis of the trapeziometacarpal joint, osteotomy of the thumb metacarpal, silicone interposition arthroplasty and total joint arthroplasty. The results of this prospective study were represented in which qualitative and quantitative outcomes were assessed clinically and radiographically in 47 thumbs in 40 patients with thumb basal joint arthritis affecting the trapeziometacarpal joint treated with beak ligament reconstruction with tendon interposition arthroplasty [LRTI] [group I including 25 thumbs] or with arthrodesis of the TMC joint [group II including thumbs]

Retrograde closed unreamed interlocking nailing for multiple-level femoral fractures

In a prospective study for the treatment of multiple-level femoral fractures, the results of retrograde, closed unreamed, interlocking technique through the inter-condylar notch of the femur were evaluated. Russell-Taylor tibia1 nail was used in all cases. There were twelve fractures [five were open] in twelve patients; ten were males and two were females. Nine patients had other skeletal trauma and one had rupture of the spleen. The average operative time was 65 minutes [range 45 to 100 minutes]. Blood loss was minimal [average 150 ml]. The average follow up was 19 months [range 11-32 months]. Union occurred without additional surgery within 17 weeks in all, but one patient needed autogenous bone grafting about the most proximal fracture site at the twentieth week. All patients regained full knee motion within four weeks. No cases of infections, screw or nail failures, patellofemoral [PF] problems or problems about the hip were recorded. In most of cases [8 out of 10], simultaneous management of other skeletal or non skeletal trauma was possible. At the terminal follow up, it was evident that retrograde closed unreamed interlocking nailing is a competent method in the treatment of multiple-level femoral fractures, especially in those with multi system and/or multiple skeletal trauma

Vascularized Fibular grafts in the management of bone tumors and pathological bone lesion

The advent of the free vascularized fibular graft [FVFG] has offered a great tool for the orthopaedic surgeon which enables him to bridge gaps created after the resection of bone tumors and pathological bone lesions. This technique has made it more feasible for the orthopaedic surgeon to radically resect and completely remove all of the pathological lesion knowing that a functional extremity will still be a possible outcome. Cases with bone tumors and pathological lesions as well as cases of chronic osteomyelitis and infected nonunion are represented in this paper, demonstrating the versatility and applicability of the free and pedicled vascularized fibular graft in such cases