[Stump problems after a lower limb amputation]. / Stompklachten na een beenamputatie.

Problems in the amputation stump occur frequently in lower limb amputees. These problems can range from skin defects to serious vascular insufficiency and have a major impact on the amputee's quality of life. We illustrate this with 2 patients aged 20 and 65. The first patient developed a Candida skin infection of the stump skin as a result of silicone liner use. She was successfully treated with miconazole/hydrocortisone and hygiene measures. The second patient developed progressive lower limb ischemia that resulted in a stump wound and claudication. He was treated with vascular surgery. Patients with stump problems should be referred to a rehabilitation physician for thorough examination of the stump in determining the cause of the symptoms and subsequent instalment of adequate treatment.

High revision rate after treatment of femoral neck fractures with an optionally (un)cemented stem.

BACKGROUND: The advantages of uncemented and cemented components in hip arthroplasty have been subject of debate. We have studied on a hemiprosthesis, which can be optionally implanted with or without cement. Since the stem geometry and surface in cemented arthroplasty differs from the uncemented one and cannot be fused into one general design, we hypothesised that this hemiprosthesis used without cement has a considerable high revision rate, based on aseptic loosening. METHODS: A hemiprosthesis, which is designed for both cemented and uncemented fixation, was used (Conquest, Smith&Nephew). Preoperatively, the choice of whether to use cement or not was based on the shape and bone quality of the femoral canal. Revision rate and indication, mortality, perioperative complications and radiographic features of 151 consecutive hips in 146 patients were evaluated. RESULTS: Twenty-three stems (15%) were implanted with cement and 128 (85%) without. After a mean follow-up of 2 years, a revision rate of 8.6% and a survival percentage of 90% (CI 85-95) were observed. Twelve uncemented stems warranted revision, compared with one cemented stem. Revision because of aseptic loosening was necessary in 7 (6%) stems, all uncemented. No differences in operation-related mortality and morbidity were observed. CONCLUSION: Because of the rather high revision rate, the authors advice not to use this hemiprosthesis without cement.

Neurovascular complications and functional outcome in displaced supracondylar fractures of the humerus in children.

We retrospectively studied the complications associated with a displaced supracondylar fracture of the humerus in children and its treatment. Between 1978 and 1997, 200 displaced fractures were treated by operative means. In 190 cases closed reduction and percutaneous pinning was performed. In 10 cases vascular impairment or unsatisfactory reduction necessitated open exploration. Functional and cosmetic success was achieved in 90% of all operated children. In 33 (16.5%) of all cases we found neurological impairment. All recovered without sequelae, except for one case with persistent radial nerve palsy which recovered after a sural nerve interposition graft. Transient neurological problems are common in this fracture. A mini-open procedure is recommended for the ulnar Kirschner wire (K-wire) to prevent iatrogenic ulnar nerve injury.