Lower limb-lengthening by coloptosis-unilateral [uniaxial] versus circular frames

The results of limb-lengthening by callotasis technique using unilateral frames [Wagner or Kazem Ill distractors] were compared with those by using circular frames [Ilizarov fixator]. The method of lengthening was selected on the basis of the availability of the device at the time of the surgery. Unilateral frames were used in fourteen patients [fourteen procedures], while circular frames were used in seventeen patients [nineteen procedures]. There were l8 female patients and 13 male patients. The average age at the time of surgery was 12.4 years [range 9-28 years]. The rate of distraction in both systems was about one mm. per day divided on four increments after a latent period ranged from 5-15 days. The average gain in length was 5.8 centimeters in callotasis with the use of unilateral frames and 5.5 centimeters with the use of circular frames. The percentage of achievement from intended length was 94% in unilateral frames callotasis and 102% in circular frames callotasis. A total of 40 complications [24 mild, 12 moderate and 4 severe] were recorded in the fourteen patients managed by unilateral frames with an average 2.8 per case. For the seventeen patients managed by circular frames, the total complications were 14 [8 mild, 4 moderate and 2 severe] with an average 0.8 per case. From this study, it was found that although technically demanding, the circular fixation devices, being highly versatile system, provided a better grip for bone segments and allowed for correction of coexisting angulation or deformity with low complication rate. It was observed also that whatever the method of lengthening, there have been a significant complication rate. That necessitated great caution and consideration before embarking on the correction of limb discrepancy. This rat of complication declined as experience with the technique increased

Reamed intramedullary interlocking nail for open tibial shaft fractures: friend or foe

Thirty seven open fractures of the tibial shaft were treated with reamed intramedullary Interlocking nailing in 37 patients. All patients had a minimum of one year follow-up. The Internal ftxation was indicated because of a factor related either to the patient or to the fracture. There were 29 male patients and 8 female patients. Their mean age was 34 years [range, 18-55 years]. All cases were unilateral, 14 on left and 23 on right side. Most of the fractures were the result of high-energy trauma. There were 22 fractures [59.45%] Grade I and 15 fractures [40.55%] Grade II open fractures. Non were Grade III open fracture. There was no associated neurovascular injury. Mean time for fractures union was 25.2 weeks. It was 21.4 weeks for Grade I fractures and 29.5 weeks for Grade II fractures. Satisfactory results were gained in 32 fractures [86.4%]. Non union complicated 3 fractures and mal-union complicated 2 fractures. Infection occurred in 3 fractures, one superficial and 2 deep. Compartment syndrome was recorded in 2 fractures. No implant failure was recorded. From this study, it was observed that reamed locking intramedullary nailing could be safe and effective method for management of open tibial shaft fractures Grade I and II. It provided adequate stabilization of the fractures through bone-nail surface contact with low complication rate

Intertrochanteric osteotomy-a salvage procedure-in non-union of the femoral neck

A series of 22 patients with ununited femoral neck fractures were treated by a Pauwels intertrochanteric abduction osteotomy. All the patients were under 60 years of age, Bone scan was done for all patients before the surgery. Six of them showed radiological evidence of avascular femoral head necrosis before osteotomy, and 10 non-unions showd associated varus deformity. The average follow up was 3.6 years [range from 1.8 to 5.1 years]. Sixteen cases were consolidated without complications [72.7%] and six cases necessitated further surgical interference. We concluded that in young active patients under 60 years with ununited femoral neck fractures, intertrochanteric osteotomy provided a high proportion of good results even in the presence of avascular necrosis of the head provided that there has been no collapse. If osteotomy fails, prosthetic replacement is still possible

Interlocking intramedullary nailing assessment of its application to comminuted fractures of the femur

Twenty-six comminuted fractures of the shaft of the femur in twenty-four patients were treated with closed reamed interlocking intramedullary nailing.Seventeen fractures were closed [65.4%] and nine fractures were open [34.6%]. There were eighteen male patients and six female patients with an average age 32 years [range from 20 - 62 years]. The fractures were right sided in thirteen patients, left sided in nine patients, and bilateral in two patients. Fifteen fractures were type I and II comminution [61.6%]. Eleven fractures were severily comminuted [38.4%], type III and IV. The fractures involving the proximal and the distal thirds were classified as unstable fractures.Twenty-two [84.6%] of the fractures united at an average of five months without additional surgical intervention. All fractures were treated by static nailing and dynamization was not attempted due to the comminution present. The average time of follow up was eighteen months. There were four fractures with pseudoarthrosis [15.4%], three patients had shortening between 1-2 cm and two had lengthening between 1-2 cm .One patient only developed deep infection. Renailing was done in three patients.This study shown that closed medullary locked nailing could provide sufficient stability in comminuted fractures of the femoral shaft irrespective to the degree of comminution and the site of the injury. Through preservation of vascularization and soft tissue attachment, closed nailing could provide excellent bone healing capability. It might be the modality of choice in such type of fracture