treatment of subtrochanteric fractures of the femur by a gamma interlocking nail

This is a study of 14 patients who sustained subtrochanteric femoral fractures that were internally fixed by a standard gamma interlocking nail. There were ten females and four males. Their average age at operation was 61.5 years. According to the mechanism of injury, eight patients sustained minor trauma and the other six were involved in high-energy trauma. With the exception of a single patient, the operation was performed within the first three days of admission. Thirteen patients were mobilized within the first two postoperative days. All fractures united at an average period of 3.4 months [range 2-8 8 months]. At final follow-up, 12 patients returned to their pre- Injury pattern of walking and the other two had a mild limp. Complications of the procedure included intraoperative fracture of the external cortex of the femur in a single patient, leg shortening in seven, trochanteric bursitis in two, superficial wound infection in two, varus deformity of more than 20 degrees in two and deep vein thrombosis in a single patient. None of these complications materially affected the end result. The gamma nail proved to be an effective device in treating such difficult fractures by permitting early weight bearing and achieving solid union in all the cases

Proximal open wedge tibial osteotomy fixed by puddu osteotomy plate combined with arthroscopic microfracture in medial gonathrosis of the knee with varus defomity

The material of this study consisted of 22 patients, 18 females and 8 males with a mean age of 46.4 years [range 35-50 years]. Preoperative physical examination included assessment of pain, tenderness, range of motion, varus deformity and presence of instability. Standing anteroposterior radiograph of both knees was performed to determine the degree of the tibio-femoral varus angle. All patients had arthroscopic debridement and micro-fracture for the degenerative cartilage combined with proximal open wedge osteotomy fixed by Puddu osteotomy plate. Autogenous bone graft was used to fill the wedges in all patients. Postoperatively the knee was mobilized in a CPM, patients were allowed non-weight bearing ambulation with knee brace. Partial weight bearing started at 6 weeks and full weight bearing at average 12 weeks. The combination of arthroscopic debridement and micro-fracture with proximal open wedge osteotomy fixed by Puddu wedge plate provided a simplified technique for treatment of medial gonarthrosis of the knee with varus deformity in patients less than 50 years old