Intrafocal pinning for dorsally displaced distal radius fractures

Intrafocal pinning of dorsally displaced distal radius fractures, as described by Kapandji in 1976, was very popular during the last two decades of the last century. This method has clear economic advantages over other modern methods of internal fixation such as locking plates. The authors aim at presenting the results of a series of 56 patients operated for distal radius fractures between 1994 and 1999. All patients were clinically reviewed and radiographically assessed at a mean of 16 months follow-up. The authors believe that intrafocal pinning remains a valuable method for the treatment of dorsally displaced extra-articular distal radius fractures; however, it should be used with caution in presence of epiphyseal and dorsal metaphyseal comminution

Forefoot adduction in children. Management and treatment

Forefoot adduction is a common condition between metatarsus adductus, Z-shaped foot and residual clubfoot. This deformity is located in a pure transverse plane at Lisfranc's joint. Isolated metatarsus adductus is corrected spontaneously for the majority of newborns. In rare uncorrected cases, it could result in Z-shaped foot with a functional hindfoot valgus to equilibrate the resistant metatarsus adductus. As well, in residual clubfoot, recurrent metatarsus adductus varus is observed, usually in children over three years. In flexible metatarsus adductus the treatment is conservative. The surgery is proposed in toddlers and after failure of conservative treatment. Procedures carried out on metatarsals gave good results on short term, but showed a high rate of recurrence and growth disturbance. Osteotomies proximal to the Lisfranc's joint: calcaneo-cuboid fusion, anterior resection of calcaneus, and opening wedge osteotomy of medial cuneiform, gave permanent correction but they act only on one of the sides of deformity. Therefore, the theory of elongated lateral column associated with a shortened medial column is crucial in dealing with this deformity: combining opening wedge osteotomy of cuneiform with closing wedge osteotomy of cuboid described by Jawish et al. in children over 4 years allows - in all causes of metatarsus adductus stiffness - a lateral shifting of forefoot. Concerning the associated heel's valgus, it is corrected in Z-shaped foot after the double osteotomy cuneiform/cuboid. However, in complicated treated clubfoot a particular treatment for the posterior tarsal is necessary

Importance of putting a registry for hip arthroplasty in Lebanon

A registry for hip arthroplasty is an excellent method for the surveillance of complications and of short-, mid- and long-term results of a procedure which is becoming increasingly more frequent. Surveillance may lead to improvement of results, reflected by a decrease in the rates of revisions performed after primary surgery, and of health expenses. In addition, registry data can be used for epidemiological studies. This article proposes a financial projection of savings which can be obtained as a result of hip revision rate reductions

[Core decompression in stage 1 idiopathic necrosis of the femoral head]

The osteonecrosis of the femoral head is a progressive multi-etiologieal disease; its prim urn inoveizs is circulatory and the pathophysiology is still unexplained. Ficat and Arlet classified this disease into 5 stages from 0 to IV. The progression from one stage to another is inevitable if surgical treatment is not performed early. The MRI is currently the investigation of choice in detecting infraradiological stage I necrosis. The core decompression as proposed by Ficat and Arlet allows to excise the necrotic zone, confirm the histological diagnosis, decompress the intramedullary increased pressure and favor the ncovascularization of the femoral head. The aim of this study is to present the mid-term results of the core decompression in a series of 17 hips in 16 patients with an average age of 46 years that were operated upon in stage I idiopathic necrosis of the femoral head, 4 to 6 weeks after the symptoms appeared. The MRI demonstrated the zone of necrosis iii 16 hips. The histological examination confirmed the diagnosis of necrosis in 16 hips including the one which was negative on MRI. The Merle d'Aubigne hip score was used for the clinical evaluation and showed to be less than 15 in all hips preoperatively. This score improved to 18 [full value] after a mean follow-up of 8 years, ranging from 3 to 13 years. The X-rays of the operated hips remained normal at the final follow-up in all cases. The very high percentage [100%] of recovery and healing in stage I femoral head necrosis hi this series may be explained by the absence of obvious etiological factors [idiopathic necrosis] and moreover by the short delay between the onset of the symptoms and the operative treatment. We believe that the MRI is the examination of choice that should be done early hi patients with a painful hip and normal X-rays and that core decompression performed soon is an excellent procedure to treat stage I idiopathic necrosis of the femoral head