Clinical and roentgenographic evaluation of bipolar prostheses with noncemented anatomic medullary locking femoral stems.

Fifty-six DePuy anatomic medullary locking femoral bipolar prostheses were reviewed clinically and roentgenographically in 50 patients at an average follow-up period of 30 months (range, 24-71 months). Forty-four of the implantations were in 40 male and 12 were in ten female patients. Forty-five devices were placed in primary operations, while 11 were used in revisions. The overall average age was 53.5 years. The average Harris hip scores for the primary bipolars were 29.8 preoperative and 77.3 postoperative, while the revision bipolars had Harris hip scores of 35.9 preoperative and 75.1 postoperative. Nearly one-half (47%) of all primary and 54% of the revision patients experienced pain to some degree on ambulation. Roentgenographically, all femoral components appeared to be well fixed biologically. Roentgenographic changes occurred with time in both primary and revision prostheses. On roentgenographic zonal analysis of primary prostheses, radiolucencies greater than 1 mm were present most frequently in the most proximal lateral zone and at the distal tip of the prosthesis. Although the use of noncemented bipolar prostheses generally shows acceptable clinical results, noncemented fixed acetabular components with noncemented femoral components produce a more satisfactory clinical result.

Open reduction and internal fixation of delayed union and nonunion of the distal humerus.

Nonunion of a condylar fracture of the distal humerus rarely occurs, but when present it is difficult to manage. We recommend internal fixation of the nonunion in combination with decortication and autogenous iliac crest bone grafting along with careful selection and placement of the implant. Postoperatively, the goal is preservation of elbow motion until the nonunion heals. We reviewed the cases of five patients who had surgery for nonunion of this fracture, all of which healed within 2-3 months after surgery. At final follow-up their average arc of motion was 88 degrees.