Results of closed reduction and intramedullary K-wires fixation of long bones in children

To evaluate the use of long intra-medullary K-wires as a tool of fixation of long bone fresh fractures in children and to assess the rate of union and return to usual daily activity. Fifty six cases with different fractures including fracture humerus, forearm, tibia and femoral fractures were studied in the period between March 2004 and May 2008 at Saudi German Hospitals. The ages ranged from 4-13 years, male: female 41: 15. The ratio of humerus: forearm: tibia: femur fractures were 17: 28: 7: 4. Closed reduction under image was obtained in all cases and percutaneous fixation with K-wires was undertaken the diameter of K-wire differ according to the site, diameter of bone at its narrowest part and age of patient. The K-wires were embedded under the skin in femoral and tibial fractures and left protruding outside skin in forearm and most humeral fractures. Posterior slab applied for all patients in humeral and forearm fractures in the first 2 weeks then started active exercises in femoral and tibial fractures either cast or fracture braces were applied and partial weight bearing until early appearance of callus. The cases were evaluated according to union rate and return to pre-fracture activity which showed excellent results in humeral and forearm fractures with union of fracture within 4-7 weeks and return to pre-fracture activity on the 5-9 weeks. In femoral and tibial fractures the results were good for femoral fractures with union of all cases between 6-12 weeks and return to functional activity within 8-15 weeks but for tibial fractures the results were satisfactory with 2 cases of delayed union which ranged between 12-16 weeks and the rest of cases acheived full union within 8-12 weeks. But for all cases the alignment of the bone was restored and maintained. The method of percutaneous fixation of long bones fracture in children with the use of K-wires showed excellent results with rapid return to functional activity and union rate specially in humeral and forearm fractures, whereas in femoral and tibial fractures it has not show any difference in comparison to other methods of conservative treatment, the only advantage was ensuring good alignment of the bone and early rehabilitation with shorter hospital stay

Results of using inverted tibial nail in management of distal third femoral fractures

To evaluate the use of tibial nail in fixation of distal third fractures of femur in cases of fresh fractures, cases of non united fractures and cases of peri-prosthetic fracture of total knee replacement and to assess the union rate and the return to functional activity . Thirty patients were included in this study:-Eighteen cases [60%] fresh supracondylar fractures without intercondylar extension of these there were 2 cases segmental fracture of femur.-Eleven cases [36.7%] nonunited fracture distal femur of them 4 cases after fixation with dynamic condylar screw, 4 cases after fixation with femoral condylar buttress plate, one case after external fixator for open fracture distal femur and 2 cases non union after conservative management with cast only.- One case[3.3%] after periprosthetic fracture around total knee replacement . The age of patients ranged from 32 to 76 years, male to female 19 : 11 .The study was carried out at Saudi German Hospital A seer in the period between March 2003 and June 2005 with follow up ranged from 6 months to two years . The tibial nail was used in an inverted position as a tool of fixation of these fractures via transpatellar approach in 19 cases [63.3%], medial parapatellar approach in 3 cases [10%] and lateral approach 8 cases [26.7%] The patients were assessed according to union rate, return to functional activity and knee range of motion . In this study Schatzker and Lambert [1979] scoring system was used .The result was excellent in 25 cases [83.4%] with full range of motion, union of fracture between 10 to 16 weeks and return to sedentary functional activity within 5weeks postoperative . Three cases [10%] the ROM was limited ; one of them following periprosthetic fracture where the ROM was only 90 degrees pre-fracture but fully united within 12 months and the other 2 cases due to lack of cooperation with physiotherapist . One case [3.3%] of infection and one case [3.3%] of delayed union which necessitated re-exposure and bone grafting . The use of inverted tibial nail in fixation of distal femoral fractures is an excellent choice which can be used instead of supracondylar femoral nailing in low economic countries and when it is not available, and can be used with a relatively excellent results instead of condylar and dynamic condylar buttress plate with early return to weight bearing and func-tional activities . The only disadvantages is the arthrotomy of knee joint with subsequent arthroflbrosis which can be overcomed with trans patellar approach and early ROM ex-ercises from first day postoperative

Total hip arthroplasty following failed primary surgery of fracture neck femur

Reporting the problems and early results of total hip arthroplasty following primary surgery of fracture neck femur whether it was by open reduction and internal fixation or hemi-arthroplasty . Sixty Jive cases with failed primary surgery of fracture neck femur 26 cases with ORIF. 19 cases with Austin Moore prosthesis . 17 cases with Thompson prosthesis . 3 cases with Bipolar arthroplasty. Hardinge approach was used in all cases . Bone defects were evaluated and filled with bone graft if needed. The total hip prosthesis was then inserted. The approach used did not affect the duration of operation . Extraction of the prosthesis was difficult in 6 cases and this only was encountered in Thompson prosthesis [5 cases and Bipolar prosthesis [one case] . Cracks of the shaft of the femur occurred in 5 cases of patients with cemented prosthesis during cement removal but no evident fractures happened . Early wound complications were seen in one case after ORIF, and 2 cases of hemiarthroplasty . Early postoperative dislocation of the prosthesis were not encountered in any case . One case encountered 3 months post operatively . Harris Hip Score at the final follow up showed a mean 80.1 . At the end of follow up ; 38 cases [58.4%] had an excellent results . 15 cases [23.1%] had a good results . 7 cases [10.8%] had a fair results . 5 cases [7.7%] had a poor results