Use of the Tip-Apex Distance in predicting Dynamic Hip Screw Cut Out in Intertrochanteric Fracture of the Femur in Asian Population

The objective of this study was to assess the rate of screw cut out in elderly patients treated with the dynamic hip screw and the relationship to the Tip Apex Distance (TAD). This is a retrospective radiological evaluation of 100 cases of elderly patients with intertrochanteric fracture treated with dynamic hip screw fixation surgically treated between 1998 and 2002. The incidence of screw cut out was assessed and correlation of risk of cut out with the TAD was assessed. The rate of screw cut out was 9.0% and the average length of time to screw cut out was 3.8 months (range, 1 to 6 months) postoperatively. The incidence of screw cut out increased significantly when the TAD was 20 mm or more. The screw cut out rates were 2.9%, 20.0%, 30.8%, 50% and 100% for TAD of 20-24 mm, 25-29 mm, 30-34 mm, 35-44 mm and > 45 mm respectively. Overall, a TAD of 20mm or more was associated with a statistically significant screw cut out risk in this Malaysian population.

Non-Hodgkin’s Lymphoma Masquerading as Psoas Abscess: A Case Report

We report here a rare presentation of an extra-nodal non- Hodgkin’s lymphoma. Both clinical presentation radiological findings were suggestive of psoas abscess. Surgical debridement was performed and histopathological examination of the tissue sample revealed the diagnosis of non-Hodgkin’s lymphoma. It is therefore important to note that non-Hodgkin’s lymphoma can mimic psoas abscess and that psoas lesion with vertebral involvement does not necessarily indicate infection. It is always advisable to obtain needle biopsy to establish diagnosis before embarking on surgical intervention. The practice to send any suspicious tissue obtained intra-operatively for histopathological examination is also warranted.

Use of Unlocked Intramedullary Nailing in Winquist Type I and II Femoral Isthmus Fracture

Interlocked intramedullary nailing is accepted as the gold standard for femoral shaft fractures. However for Winquist type I and II femoral fractures at the isthmus region, unlocked intramedullary nailing (Küntscher nailing) is still a good option. We performed a retrospective study on 86 patients with a total of 88 femoral shaft fractures around the isthmus that presented at our institution between 1 January 1988 and 31 August 2003. All patients (84.1% Winquist type I and 15.9% Winquist Type II fractures) were treated with unlocked intramedullary nail. The average time to union was 16 weeks with 97.7% rate of union. There were two cases (2.3%) of infection and non-union each. Overall results were comparable to standard interlocking intramedullary nailing. We conclude that unlocked intramedullary nailing is a good treatment option for Winquist Type I and II femoral fracture around the isthmus with its good union rate and minimal complications.