Intertrochanteric fractures of the femur treatment by gamma nail

The aim of this work was to evaluate the results of the treatment of intertrochanteric fractures of the femur using gamma nail. The study included 37 patients [17 males and 20 females]. The average time lapse before surgery was 1.7 days. Closed reduction under image intensifier followed by fixation using the gamma nail was the procedure in all cases. Ambulation started after 48 hours and patients were discharged after being safe on either a walking frame or elbow crutches. Outpatient physiotherapy continued, thereafter. Patients were followed up for at least one year. Plain radiographs were taken immediately after surgery, then throughout the follow up. By six months, four patients died due to medical reasons. For the rest of the patients, the duration of follow-up ranged from 12 to 19 months. By the end of the follow-up period, the level of mobility was diminished when compared with the pre-injury level. Pain was present in 42.4% of patients. Fracture reduction was satisfactory in most of patients. All fractures have healed within six months. The neck- shaft angle ranged 115-1400 and diminished to 105-1400 at the end of the follow-up. The distance between the tip of screw and the articular surface was also diminished. The location of the screw within the femoral head was not significantly changed

Magnetic resonance imaging [MRI] and core decompression in the early management of acute unilateral adult hip pain secondary to osteonecrosis of the femoral head

The objective of our study was to evaluate the efficacy of diagnosis and treatment of early cases of adult AVN of the femoral head, using an early sensitive and specific modality as MRI, coupled with the use of a simple surgical intervention capable of stopping the vicious circle of complications due to the ischemia and ending by necrosis and collapse of the femoral head. Our patients were six, five males and one female. Their age ranged between 30-60 years [mean=45.7 SD of 12.8 years]. Five patients attended the OPD with minimal hip pain, one of them associated with mild limping. The one female patient was accidentally discovered during MR examination of the pelvis. The possible etiological factors were steroids in three patients [50%], alcohol in two patients, and two patients were considered as idiopathic. On plain radiographs, classified according to the Ficat and Arlet staging, five patients were preradiological, one patient preclinical and one patient radiological [minimal osteoporosis]. MRI 1.5T was used in the following sequences T1 TSE, T2 TSE and SPIR. The most valuable early MR sign of AVN, bone marrow oedema, was present in all patients [100%]. Double subchondral line was elicited in only five patients [83.3%]. Surgery was planned according to the MR stage of AVN which ranged in our selected patients between 0-1 according to Ficat. Modified core decompression surgery was performed in all patients. Clinical and MR follow up examinations three and six months were performed. All the patients rendered free from pain or limping by six months. At three months MRI follow-up, bone oedema persisted in all patients, while the vascularized core appeared in 50% of them. However, at six months, bone oedema disappeared with appearance of the vascularized core in all patients. In conclusion, a high level of clinical awareness about AVN should be present while dealing with adult hip pain. MRI is a sensitive and specific modality in the early diagnosis, staging, and sole modality for operative planning for AVN. Modified core decompression technique; in early stages of AVN, is an easy, reliable, and quick intervention that is available to most of orthopaedic surgeons, to stop the vicious cycle of ischemia and necrosis

Functional outcome of calcaneal fractures treated either conservatively or operatively; a comparative study

The aim of this paper is to compare the functional results of treatment of displaced intracalcaneal fractures after operative and conservative management. Thirty seven patients with 42 feet having displaced intra-articular calcaneal fractures were included in this study. These were divided into two groups. Cases in group I were treated by open reduction and internal fixation, while those in group II were treated conservatively. In both groups, the injury was common in males, in the 3rd and 4th decades of life. Most of them were heavy manual workers. Falling from a height was the commonest mode of injury. All patients were assessed by stndard plain radiographs and CT scans. In group I, surgery was done after an average of 4.3 days. The extended lateral approach was used with calcaneal or 3.5mm reconstruction plates. In group II, intensive rehabilitation program started as soon as pain and swelling allowed. Only non-weight bearing ambulation was allowed in both groups till the fractire has healed rodiologically. The results were assessed using a 15-question patient-surgeon visual analogue scale. By the end of the follow up period, which exceeded 24 months in both groups, the overall results were significantly more satisfactory in group I [86%] than in group II [40%]. The rate of complications with the operative group was also low. The conclusion is; CT scans have improved the managementt of intraarticular calcaneal frractures. The results of conservative treatment can not be accepted in the modern era of orthopaedic practice. On the other hand, the results of open reduction and internal fixation are accepted, being more or less satisfactory by the patient, and reproducible

Primary internal fixation for displaced clavicular fractures in adults; evaluation of the results

The aim of this study: To evaluate the indications of internal fixation in clavicular fractures as a primary procedure. Twenty one adult patients with midshaft fractures of the clavicle were included in this study. Open reduction and internal fixation using either 1/3 tubular or 3.5 mm reconstruction plates was performed while the patient adjusted in the beach-chair position. A broad-arm sling was used for four weeks. Exercises of the shoulder started after the first week and increased to full range after the discard of the sling. Heavy activities were not allowed until the fracture has united. All fractures were united in due course without delay. The range of motion and level of function of the affected shoulder were comparable to the sound side. One patient sustained a fall ten days after surgery. The result was a broken plate that has been revised. Hypertrophic scar and keloid formation occurred in two patients. Lastly, one patient developed infection that subsided after the proper antibiotics were given, according to the anti-biogram, and repeated dressings. Open reduction and internal fixation for fractures of the clavicle yielded satisfactory results regarding fracture healing and shoulder function. However, possible scar problems and the need for a second operation for hardware removal should be considered. In view of this, it is the feeling from this series that the classic, relatively low, indications for operative treatment of fractures of the clavicle are still valid and a primary procedure should not be the standard line of management

Role of MR imaging in evaluation, detection, and management of early neuropathic foot changes in diabetic patients

The objective of this study was to evaluate the efficiency of MR imaging in the detection of early neuropathic changes in diabetic foot before the start of moderate or major complications. The aim was early preventive care and conservative treatment for those group of diabetic patients. Seven patients known to have uncontrolled diabetes, all attended the outpatient clinic with unilateral foot pain and limping for the first time. Each patient was subjected to thorough clinical and laboratory examination. Radiologically, foot and ankle standard radiographs were taken as well as MR imaging with TI, T2, T2* and STIR sequences in orthogonal planes. Conservative management was carried out during the one-month duration of follow-up. The mean age of the examined patients was 30 years. The main presented symptoms and laboratory findings were pain and limping with elevated ESR in all patients. MR imaging without contrast injection, soft tissue high intensity on T2 and STIR sequences, was present in all patients. However, on plain radiographs of the foot and ankle region, only soft tissue swelling and regional osteoporosis were noticed in the studied patients. Although the studied number of cases is limited, the opinion that MR imaging is the modality of choice in the diagnosis of early inflammatory and neuropathic changes in diabetic feet was supported