Modern retrograde intramedullary nails versus periarticular locked plates for supracondylar femur fractures after total knee arthroplasty.

This study purpose is to analyze outcomes of modern intramedullary (IM) nails with a locked distal screw versus periarticular locking plates for peri-prosthetic supracondylar femur fractures in TKA. Ninety-five consecutive fractures in 91 patients were retrospectively reviewed. Fixation included 29 knees with a retrograde IM nail and 66 periarticular locked plates. Six patients died and 4 were lost to follow-up. There were 2 (9%) nonunions in the IM nail group and 12 non-unions/delayed-unions (19%) in the locked plate group (P = 0.34). A mean of 5.0 distal screws was used in locked plates versus 3.8 distal screws in the IM nails (P < 0.001). Despite a greater quantity of screws in the distal fragment, the failure rate of locked plating was twice that of IM nail fixation.

The effect of lordosis, disc height change, subsidence, and transitional segment on stand-alone anterior lumbar interbody fusion using a nontapered threaded device.

In this study, we retrospectively evaluated 37 consecutive patients who underwent stand-alone anterior lumbar interbody fusion (ALIF); for indications that included degenerative disc disease, concordant pain on discography, disc space collapse of more than 50%, and failure of nonoperative management for at least 4 consecutive months. Patient demographics, procedural data, and prospective Short Form 36 General Health Survey composite scores were collected. Mean follow-up was 24.2 months. In this cohort of patients with degenerative disc disease, there was no loosening or migration of implants. Stand-alone ALIF using a threaded interbody fusion device provided excellent clinical results and return-to-work rates with few complications. Increased lordosis was associated with increased subsidence and less favorable outcome. Patients with a transitional segment displayed relatively smaller increases in lordosis and better outcomes than patients without a transitional segment.

Soft tissue coverage of the elbow in a developing country.

Two cases that required soft tissue coverage to the anterior aspect of the elbow are presented. A fasciocutaneous intercostal perforator chest wall flap was used for one patient when only skin and fascia coverage was required. A latissimus dorsi myocutaneous flap was used to provide soft tissue coverage and supply motor power for elbow flexion after contracture release in the other. The surgical techniques for each of these flaps are discussed in the context of addressing soft tissue traumatic injuries about the elbow in a developing country with limited resources.

Intertrochanteric hip fractures treated with the trochanteric fixation nail and sliding hip screw.

The primary treatment options for intertrochanteric hip fractures are a sliding hip screw (SHS) and an intramedullary device, with each having its own advantages and disadvantages. The authors retrospectively compared all intertrochanteric hip fractures between 2003 and 2005 using a cephalomedullary nail--the trochanteric fixation nail (TFN)--to those using a SHS. Outcome measures included the following parameters: age, gender, fracture classification, operation time, blood loss, transfusions, complications, follow-up, length of stay, and hospital cost. A total of 95 patients were included in the study (51 SHS and 44 TFN). The two groups were similar in age (p = .52), blood loss (p = .20), follow-up (p = .13), length of stay (p = .63), and hospital costs (p = .70). The TFN procedure required shorter operative times (56.5 min, p < .004) and was used in more complex fracture patterns (p < .03). The SHS group had fewer blood transfusions (1.2 units, p < .0008). The SHS group had a higher complication rate of 19.6%, versus the TFN group's 11.4% rate (p = .13). The TFN is an appropriate and acceptable treatment method for intertrochanteric hip fractures.