Total arthroplasty for acute hip fractures, early results of eleven cases

We treated eleven elderly patients who suffered traumatic injury to the hip causing fracture or fracture- dislocation by primary total hip arthroplasty. There were 4 males and 7 females whose age ranged from 54 to 71 years [mean=61.7]. The injuries encountered were: six displaced subcapital fractures [Garden III and IV]; four Pipkin type [III] and [IV] posterior fracture-dislocation and one Seinsheimer type [IV] subtrochanteric fracture. We used 9 standard cemented, 1 long stem cemented and 1 cementless hip prosthesis, 3 acetabular re-enforcement rings were also used. Autologous bone graft was used in 3 cases to reconstruct acetabular defects and in 1 case to augment bone healing in subtrochanteric fracture. The follow up ranged from 18 to 36 months [mean=25.3], at 18 months the Harris hip score ranged between 38 and 85 [mean=66]. There were 2 cases of posterior dislocation, 2 cases of significant leg length discrepancy, 1 case of iliofemoral DVT and 1 case of significant intrapelvic cement intrusion. THA for acute hip fracture is a technically demanding procedure that yields higher complication rate but can give good clinical results and implant short term survival, nevertheless, it should be reserved for a well selected group of patients and should be done in specialized centers

Proximal femoral osteotomy in Perthes disease

Upper femoral osteotomy is a recognized treatment for selected patients with Perthes disease. This series included 15 patients with 17 affected hips. These were 6 males and 9 females. The average age was 5.6 years [5-11 years] at the onset of the disease and the interval between the onset of the disease and the operation was 7.5 months [2-22 months]. The mean age at the operation was 6.2 years [5-11.5 years]. The assessment of our results was according to P. EDVARDSEN el al. 1981 scoring system: We had the following results: Good: 8 Hips - Fair: 5 hips - Poor: 4 hips

Management of unstable segmental tibial fractures by closed rush nailing

Fifteen cases with fresh unstable segmental tibial fractures were managed by closed reduction using image intensifier and fixation by closed Rush nails. The average age in this series was twenty nine years old. Road traffic accidents predominated as the causative trauma. All fractures were closed except in two cases were open grade I. All the cases were operated upon on the day of admission or next day, except those with open grade I, operated upon ten days after admission. A proposed numerical scoring system was used in the final assessment of the results. Accordingly, eight fractures [53.3%] graded as excellent, four fractures [26.7%] graded as good and three fractures [20%] graded as fair. All fractures united in average period of sixteen weeks, except three of them showed delayed union. The use of closed non-reamed nailing is beneficial in the primary stabilization of unstable tibial fracture and this method adheres to the principles of conservative treatment, but at the same time secures the initial reduction

Management of lumbar spondylolisthesis using Luque segmental spinal fixation technique

Our series included twenty patients had lumbar spondylolysis or spondylolisthesis. Nine of them were males and eleven were females. The average age of patients was 36 years old. Eleven came complaining of chronic low back pain [55%], five were complaining of chronic low back pain and unilateral sciatica [25%], two patients had low back pain with bilateral sciatica [10%] and two patients had low back pain with neurological deficit [10%]. All patients had tried conservative methods of treatment for at least three years before surgery which was indicated after failure of conservative methods. The surgical procedure included decompression if required, internal fixation of the spine using Luque segmental spinal fixation technique and fusion. A proposed numerical system was used for final assessment of our results. Accordingly, 95% achieved satisfactory results and 5% achieved unsatisfactory results. Functionally, most patients have improved, where 45% had excellent results, 35% had good, 15% had fair results while only 5% had poor results. Fusion occurred in 80% in average time of nine months. Segmental spinal instrumentation with rectangular rods and sublaminar wires is a dependable method for fixing lytic lumbar spondylolisthesis so long reduction is not required

Growth pattern in cardiac patients in relation to somatomedin and growth hormone levels

General patterns of growth as well as serum levels of Growth hormone[GH] and Somatomedin-C [Sm-C] were assessed in 25 healthy infants and children and in 58 patients with heart diseases [25 with rheumatic heart disease, 18 with congenital acyanotic heart disease and 15 with congenital cyanotic heart disease]. Obvious growth retardation of variable degrees was present in cardiac patients being more pronounced in congenital heart disease patients, mostly the cyanotic types. A highly significant lower serum levels of both GH and Sm were detected in cardiac patients compared to control. There was no significant difference between the serum levels of GH in the three studied groups of patients, while a highly significant difference in the serum levels of Sm existed between them. A significant lower serum levels of GH and Sm were encountered in patients below the 10th percentile, compared to those above the 10th percentile. The results of this work point to the endocrinal contribution in the development of growth retardation in cardiac patients, as suggested by the low levels of GH and Sm found in cardiac patients