Interlocking nailing versus plating of humeral shaft fractures

Forty cases with humeral shaft fractures underwent surgical stabilization, 22 patients using a dynamic compression plate [DCP] and 18 patients using humeral antegrade interlocking intermedullary nailing [IMN]. There were 9 women and 31 men. Their ages ranged between 23 and 56 years with a mean of 30.4 years. The study was performed at the Saudi German Hospital, Jeddah, Saudi Arabia and King Fahad Hospital, Madina, Saudi Arabia, between October 1998 and May 2000. The range of follow up was 6 to 16 months with a mean of 9.1 months. The aim of the work was to compare the results of surgical stabilization of humeral shaft fractures using these two modalities of treatment as for the rate of fracture union, the incidence of complication and effect on shoulder and elbow function. Cases treated by DCP showed a higher rate of primary union than those treated by IMN, 90.9% and 83.3% respectively. The average duration to union was shorter in the DCP group of patient than the IMN group 18.5 weeks and 21 weeks respectively. The DCP plate group showed fewer complications, the most common being iatrogenic radial nerve palsy which resolved spontaneously in all patients. In the IMN group of patients, the most common complications were distraction of the fracture contributing to nonunion [22%] and impingement at the shoulder due to proximal nail protrusion a rotator cuff injury [16.7%]. It was concluded that dynamic compression plating of humeral shaft fractures resulted in a higher rate of union in a shorter duration of time with less complications than antegrade intramedullary interlocking nailing

Varus gonarthrosis. Combined arthroscopy and high tibial osteotomy with internal fixation using the fork plate

The aim of this study was to report the arthroscopic findings in cases of varus gonarthrosis and the results of treatment of such cases by combined arthroscopy and high tibial osteotomy with internal fixation using the fork plate. The subjects of this study were 87 cases [71 females and 16 males]. The mean age was 53.6 years with range of 42 to 61 years. The study was performed during the period from January 1995 to June 1997. History was obtained for the presence of knee pain and its response to medical treatment. All cases were examined for tenderness over the joint line, knee deformity, range of knee movement and knee instability. Standing anteroposterior radiographs of both knees were examined for medial compartment arthrosis, presence of metaphyseal varus with determination of the tibiofemoral angle. Lateral views are examined for signs of patellofemoral involvement. All patients underwent combined arthroscopy and high tibial lateral closed wedge osteotomy with internal fixation by the fork plate. The results showed that at arthroscopy, 27 cases suffered a tear of the medial meniscus and 5 cases suffered a tear of the lateral meniscus, 8 cases showed grade II and III degenerative changes of the lateral tibiofemoral compartment and 19 cases showed patellofemoral degeneration grade II, III and IV. At four weeks postoperatively, 80 patients regained their preoperative range of knee movement. The overall results were graded according to the hospital special surgery knee score. In the present study, 78 patients showed satisfactory results and 9 cases showed unsatisfactory results. The results were satisfactory in 87.5% of patients with lateral tibiofemoral compartment degeneration and in 84.2% of patients with patellofemoral degeneration. The study showed that fork plate provides rigid internal fixation allowing early rehabilitation and rapid return of joint function. Mild or moderate affection of the lateral tibiofemoral and the patellofemoral compartments did not affect the clinical result. Over one third of the patients suffered a meniscal tear manageable by arthroscopy