Vastus medialis obliquus advancement in association with patellectomy in cases of highly comminuted patellar fractures

The results of 13 total patellectomy, combined with vastus medialis obliquus [VMO] advancement in 13 patients followed-up for 9-to-40 months were analyzed. The patients included 9 [69.2%] males, and the other 4 [30.8%] were females. Their ages ranged from 20-to-40 years old. The indication for patellectomy was severely comminuted fracture of the patella. A direct blow to the patella was the causative trauma for all cases; 9 [69.2%] fractures were closed, and 4 [30.8%] were opened. Associated injuries were reported in 3 [23.1%] patients: Colles' fracture, forearm bones fracture, and open intercondylar-supracondylar fracture femur. Functional assessment of the patients was carried out using the scoring scales described by Marshall, et al., 1977; and Levack, et al., 1985 [18-21]. The overall results according to Marshall, et al., were scored 7.5/8 points which considered excellent - and scored 8.2/9 points according to Levack, et al., which considered good. This technique appears to give better functional results as regards pain, discomfort, range of knee movements, quadriceps function and functional activities including: walking, running jumping, and squatting

Mini-screw fixation for certain fractures of the phalanges and the metacarpals

68 patients with phalangeal or metacarpal fractures were treated in the emergency department at Bab-Elshareia university hospital and health insurance hospital by open reduction and internal fixation using inter-fragmentary lag screw stabilization technique. Operative stabilization was considered because we failed to restore fracture alignment at closed attempts, or fractures failed to maintain closed reduction in plaster immobilization after conservative trials, Phalangeal fractures were accounted for 45 [66.2%] of the total, the remaining 23[33.8%] were metacarpals. There were 59 [86.8%] males and 9[13.2%] females. The youngest patient was 18 years old and the oldest was 55; the mean age was 27 years. All fractures were unstable. The fracture pattern was displaced spiral in 49 [72.1%] cases and displaced oblique in the remaining 19[27.9%]. There were 39[57.4%] injuries to the left hand, 29[42.6%] to the right, and in no instance was there an injury to both hands. Considering all 68 fractures, direct blow was accounted for 80.9% of the total, whereas indirect forces was instrumental in only 19.1% of the fractures. Most of the injuries 39[57.4%] had occurred in young labor men. Athletic injuries, 20[29.4%] fractures had occurred in young adult students. Indoor injuries, 9 [13.2%] fractures had occurred only in females, most of them were in the 5th decade of life. All injuries were closed single-bone fracture. None of the fractures was pathological none was intra-articular and none of the patients had other additional injuries elsewhere, but one, suffered in addition, ipsilateral fracture distal radius. The overall results at final follow-up were excellent in 61[89.7%] patients, and good in 7[10.3%]