Hartshill rectangle fixation in unstable lower cervical spine injury

15 patients, 14 males and one female, 17 -60 years of age, mean 32 years. They were managed in Khoula and Royal Hospitals, Muscat, Sultanate of Oman, January 1990 - September 1992. Accidents were in road traffic 11, faIl from height 4. Neural involvement: Complete quadriplegia 10, incomplete 2, none. 3. Fracture type: Burst fracture of the vertebral body 7, fracture-dislocation 6, dislocation 2. Level: C4: 2, C4/5: 1, C5: 4, C5/6: 3, C6/7: 4, C7: 1. Emergency: Cervical collar support, care of the general condition X-rays, CT scan and skull traction. When the general condition was stabilised surgery was performed, with a delay of 12 hours to 4 weeks, mean 6 days. The operation was performed through a posterior approach. Residual displacement was corrected. Size of the Hartshill rectangle used: 5 mm thickness, 5 - 7 cm length. Number of vertebrae included in fixation: 3 segments in fracture, 4 segments in dislocations and fracture-dislocations. Post-operative care: Removal of skull traction on the operating table and application of a soft collar. Non-paralysed patients: Out of bed walking after 5-7 days. Paralysed patients: Care of skin and bladder, gradual ambulation on wheel-chair according to condition. Mortality: 1 case from diabetes insipidus. Patients received with complete quadriplegia had no neurological improvement. Those with no paralysis remained the same. The 2 patients with incomplete paralysis: 1 complete recovery, 1 partial recovery. Complications were kept to a minimum and rehabilitation was facilitated

Painless subtrochanteric osteoid osteoma presenting with lengthened femur A case report

An 11-year-old boy suffered from limb length discrepancy. He had limitation of the last degrees of flexion and external rotation of the left hip with wasting of the muscles of the thigh. The left lower limb was found 2 cm longer than the normal right side. There was a painless osteoid osteoma in the subtrochanteric region of the left femur

Results of different types of internal fixation in subtrochanteric fractures

Forty six patients, 32 males and 14 females with closed subtrochanteric fractures of the femur were treated surgically in Khoula Hospital Muscat, Sultanate of Oman in the period 1990 -1993. Their age was 17 - 58 years, mean 36. The cause of injury was road traffic accident 33, industrial accident 6, sports trauma 2, fall from height 5. According to Waddell's classification the fracture was Type I in 8 cases, Type II in 4 cases and Type III in 34 cases. They were treated, initially with skin traction. Surgery was done when the general condition and other injuries allowed. The delay before surgery ranged between one and 11 days, average 5. The method of fixation used was dynamic hip screw in 27, dynamic condylar screw in 5, condylar blade-plate in 3 and interlocking intramedullary nail in 11 cases. Post-operative ambulation depended on the presence or absence of other injuries. Full weight bearing was allowed after fracture union. Type I and Type II fractures healed well with no complications. Type III fractures were associated with valgus reduction in 16.7% of the cases treated with DHS, varus reduction in 40% of cases treated with DCS and flexion-abduction position of the main proximal fragment in 57.1% of cases of closed intramedullary nailing. Deep infection occurred in one case. Loosening of the hip screw occurred in 2 cases treated with DCS. No cases of delayed or non-union were encountered. The results in general were satisfactory and comparable with those reported in the literature during the last 2 decades

Fractures and dislocations of the talus

Twenty-one talar injuries in 19 patients were reviewed. They were 16 males and 3 females, aged 4 - 70, mean 27.1 years. They were managed in Khoula Hospital, Muscat, Sultanate of Oman, between January 1990 and June 1992. The accidents were: road traffic 11, fall from height 6, soccer game 1, gunshot 1. According to Hawkins' classification the injuries were in the talar neck [14], of which 4 were with subtalar dislocation, and 8 with both subtalar and ankle dislocation. Seven [33.4%] of the talar neck fractures were associated with malleolar fractures. The remaining injuries were in the talar head [1], talar dome [4], posterior tubercle of the talar body [1], peritalar dislocation [1]. Six cases [28.7%] were open. The treatment followed was: Simple plaster in closed undisplaced cases 3 [14.3%], and plaster cast fixation after closed manipulation in one [4.8%]. Open fractures were debrided. Open reduction followed by internal fixation with Kirschner wires or screws, or both, was done in 14 cases [66.7%]. Blair's fusion was performed in a neglected case. One patient died fromhead injury. The main complications were avascular necrosis [9 = 42.9%], stiffness [15 = 71.4%], nonunion [2 = 9.5%] and delayed skin healing [6 = 28.6%]. The follow-up was 5 - 24 months, mean 8.7 months. The overall results were satisfactory in cases which were not displaced and which were treated early. Those received late or with displacement were fraught with complications that considerably undermined their functional results