Stabilization of pediatric femoral shaft fractures by titanium elastic nails

The technique of elastic stable intramedullary nailing [ESIN] is a simple surgical procedure that has the advantage of having low morbidity, it needs short hospitalization and it avoids the difficulties and complications and long hospital stay of conservative management. The aim of this work is to focus on the technique and results of treatment of pediatric fracture femur by Titanium elastic nail. Thirty seven patients with fracture shaft femur had been treated by elastic stable intramedullary nail stabilization [ESIN]. The age ranged from 5 to 14 years. Union was achieved in 5 to 10 weeks [average 8.9]. All nails extracted after an average period of 17.9 [14 - 40 weeks]. No deformity were encountered at the end of treatment. No major complications occurred during the course of management. It had been concluded that elastic nail is a safe; reliable, low costing option of management of Pediatric fracture femur leading to favorable results

Closed retrograde locked nailing of the diaphyseal humeral fractures

Locked intramedulary nailing of humeral shaft fractures combines the advantages of intramedulary nailing with the added fixation of locked principles allowing for the extension of indications of interlocked nailing as in comminuted fractures. Also the interlocking nailing is superior to plating of diaphyseal fractures as it is a load sharing and control of bending stresses. In addition, the closed technique preserves the soft tissue blood supply and the fracture haematoma preserving the biologic process of fracture healing undisturbed. With retrograde technique most of the complications related to the shoulder joint and rotator cuff violation can be avoided. Fourteen patients with humeral shaft fractures had been treated by retrograde closed locked nailing using interlocking humeral nails. The average follow up period was four months [range from 3 to 10 months]. The average healing time of all fractures was eight weeks. After consolidation, the elbow function was excellent in twelve patients [85.7%], the shoulder function was excellent in thirteen patients [92.9%]. The functional end results were excellent in nine patients [64.2%], good in three patients [21.4%], fair in one patient [7.1%], and poor in one patient [7.1%]. Two patients [14.2%] had postoperative radial nerve palsy. There was comminution at the fracture site in three cases. There was one case [7.1%] of deep infection. Two patients [14.2%] had shortening and one case [7.1%] had varus deformity. There were no cases with implant failure. We concluded that closed retrograde locked nailing of fractures of the humeral shaft is an excellent method of fixation with added benefit over antegrade nailing that it does not affect the shoulder movement or disturb the rotator cuff insertion site

Fixation of subtrochanteric femoral fractures: a review of two different methods of treatment

A review of twenty two cases of comminuted Subtrochateric fracture of the femur treated by two different methods is presented. Seven Cases were treated by Russel Taylor intramedullary nail and 15 cases by DHS according to the fracture geometry. The average follow up period was 19.4 weeks [11-30] The average time to union was 14.2 weeks [10-21] No major complications were encountered It had been concluded that if technical details and proper indication for each type of treatment are respected the outcome will be satisfactory

Talar neck fractures: study of 15 cases

Fractures of the talus comprise a broad spectrum of injuries and re-quire an individualized approach to their evaluation and management, creating a challenging clinical entity for the orthopedic surgeon. Under-standing the unique patterns of injury associated with these fractures and the development of an individualized plan of treatment for each case produces the best outcome possible. Fifteen cases of talar neck fracture in fifteen patients were treated and followed. The mechanism of injury was dorsiflexion in 75%, plantar flexion in 10%, eversion in 5% and unknown in 10%. The fracture was complete un displaced in 16.7%, complete dis-placed fracture of the talar neck with dislocation of the posterior part of the subtalar joint in 41.7% and complete with total posterior dislocation of the talar body in 41.7%. The degree of displacement was directly proportional to the severity of the injury, the displacement at the fracture site was usually associated with subluxation or dislocation of the posteriorpart of the subtalar joint. The results of cases with dislocation of the subtalar joint were better after open reduction and internal fixation. In cases of complete subtalar dislocation inspite of the major damage to the blood supply of the talar body at the time of injury good functional results can be achieved with early, accurate stable reduction, rigid fixation of the talar neck and by passing its weight bearing function to facilitate the revascularization of the talus

Core decompression for femoral headavascular necrosis

Background: necrosis of the femoral head is a progressively debili-tating lesion,which usually leads to the destruction of the hip joint in pa-tients between 20 and 50 years of age. The ultimate goal of treatment of patients with osteonecrosis of the hipis preservation of the femoral head.However, the development of a successful strategy to treat this disease has been difficult because neither the etiology nor the natural histo-ry of osteonecrosis of the hip has been defined clearly.Core decompression of the hip is one of the most commonly done surgi-cal procedures to treat the early stages of osteonecrosis of the femoralhead.However, there is no general consensus among investigators regardingneither the specific indications for this procedure, nor the specific tech-nique of core decompression that would optimize results.The data available suggest that core decompression is more effectivethan non operative treatment particularly for patients with limited involve-ment of the femoral head

Patients: we studied 28 hips in 16 patients, ten patients weremales and the age ranged from 22 to 51. One patient was post traumaticwhile all other had no history of relevant trauma . Core decompressionwas performed for all patients and the Harris hip score [ HHS ] was usedfor their preoperative and post operative evaluation

Results: at the beginning of the study the number of hips with ex-cellent and good HHS was 7 and 4 respectively at the end of follow up thenumber of cases with HHS excellent and good increased to 8 and 6 while the number of cases with HHS fair and poor had decreased. Paired sample cor-relation test for all cases at different stages of diagnosis and follow up was0.003 which is highly significant, and means that there is strong correla-tion between the score preoperative and postoperatively

Conclusion: core decompression is a simple procedure with low mor-bidity that has a good outcome in the early stages of the disease compared to non operative treatment