Early results of a novel technique using multiple small tantalum pegs for the treatment of osteonecrosis of the femoral head: a case series involving 26 hips.

The introduction of a trabecular tantalum rod has been proposed for the management of early-stage osteonecrosis of the femoral head but serves as a single-point of support of the necrotic lesion. We describe a technique using two or three 4.2 mm (or later 4.7 mm) tantalum pegs for the prevention of collapse of the necrotic lesion. We prospectively studied 21 patients (26 hips) with non-traumatic osteonecrosis of the femoral head treated in this manner. Of these, 21 patients (24 hips) were available for radiological and clinical evaluation at a mean follow-up of 46 months (18 to 67). Radiological assessment showed that only eight hips deteriorated according to the Association Research Circulation Osseous classification, and four hips according to the Classification of the Japanese Investigation Committee of Health and Welfare. Functional improvement was obtained with an improvement in the mean Harris hip score from 65.2 (33.67 to 95) to 88.1 (51.72 to 100), the mean Merle D'Aubigné-Postel score from 13 (6 to 18) to 16 (11 to 18), a mean visual analogue score for pain from 5.2 (0 to 9.5) to 2.6 (0 to 7), and the mean Short-Form 36 score from 80.4 (56.8 to 107.1) to 92.4 (67.5 to 115.7). Of these 24 hips followed for a minimum of 18 months, three were considered as failures at the final follow-up, having required total hip replacement. One of the hips without full follow-up was also considered to be a failure. In more than two-thirds of the surviving hips a satisfactory clinical outcome was achieved with promising radiological findings. The estimated mean implant survival was 60 months (95% confidence interval 53.7 to 66.3).

Digital coverage with flaps from the same or neighboring digits.

OBJECTIVE: Several flaps can be dissected from the same or neighboring digits for the reconstruction of relatively large soft tissue digital defects. MATERIAL AND METHODS: In a 6-year period, 106 large soft tissue digital defects were reconstructed with the use of flaps in 101 patients. For the reconstruction of 75 fingertip defects 73 neurovascular, island or advancement flaps (42 homodigital, 18 heterodigital, 13 advancement) and 2 thenar flaps were used. The 31 defects of the proximal and middle phalanges were reconstructed with 3 intermetacarpal and 28 cross-finger flaps (17 de-epithelialized and 11 classic for dorsal and palmar defects respectively). RESULTS: All flaps survived. Subjectively, the results were rated as good or excellent in 69 of 73 distal defects reconstructed with neurovascular island or advancement flaps and in 29 of 31 proximal defects treated with cross-finger and intermetacarpal flaps. The mean DASH score was 4.1 and 3.34 for the neurovascular island/advancement flaps and the cross-finger flaps respectively. CONCLUSIONS: This study elucidates the indications and presents the advantages and disadvantages of flaps used for reconstruction of proximal and distal digital defects. Good results can be obtained with appropriate flap selection and meticulous surgical technique.

Complex regional pain syndrome type I as a consequence of trauma or surgery to upper extremity: management with intravenous regional anaesthesia, using lidocaine and methyloprednisolone.

Complex regional pain syndrome type I (CRPS-I) is a known complication after surgery or trauma to the upper extremity and is difficult to treat. A simple and easily tolerated method of treatment that includes intravenous regional anaesthetic block with lidocaine and methyloprednisolone is presented. One hundred and sixty-eight patients with CRPS-I of the upper extremity were treated in a 5-year period. At the end of treatment 88% of the patients reported minimal or no pain. After a mean follow-up of 5 years (range 28 months to 7 years) complete absence of pain was reported by 92% of patients. The symptoms of the acute phase of the syndrome were reversed. Early recognition and prompt initiation of treatment is very important for the course of the disease as symptoms can be reversible when treatment starts early. Permanent results with a functional upper extremity and very satisfactory pain relief can be anticipated.