IMHS clinical experience in the treatment of peritrochanteric fractures. The results of a multicentric Italian study of 981 cases.

This retrospective study evaluates the results obtained in five Italian departments of traumatology in the treatment of peritrochanteric (pertrochanteric and subtrochanteric) fractures by the intramedullary hip screw (IMHS; Smith & Nephew Richards, Memphis, TN, USA) nail. One thousand two hundred and seventy-three patients were treated with the IMHS nail between March 1992 and February 2000. The results of these operations were evaluated clinically and radiological in 981 patients. The 90.3% of patients could walk unaided or with simple support. Because of the low complication rate requiring re-operation (postoperative shaft fractures, screw penetrated the acetabulum, cut out and non-union) (1.7%), we think that this device is an advance in the treatment of peritrochanteric fractures.

Comparison of surgical treatments for knee dislocation.

This retrospective study compared three surgical procedures for acute knee dislocation. Eleven patients (group 1) underwent direct repair of the cruciate ligaments, 6 patients (group 2) underwent anterior cruciate ligament (ACL) reconstruction with hamstring tendons and posterior cruciate ligament (PCL) reattachment, and 6 patients (group 3) underwent PCL reconstruction with ipsilateral bone-patellar tendon-bone and ACL reconstruction with doubled semitendinosus and gracilis tendons. Average follow-up was 6.9 years (range: 24 months to 19 years). Surgical results were evaluated using the IKDC evaluation form, KT-2000 arthrometer, and Lysholm and Tegner scores. Statistical analysis was performed using Fisher's exact test and the Cochran-Mantel-Haenszel test to compare different surgical procedures. In terms of stability and range of motion, results were less favorable after direct repair and cruciate ligament reattachment. Better results were reported after combined ACL and PCL reconstruction. Average side-to-side total anteroposterior translation as measured by the KT-2000 arthrometer at 20 degrees +/- 5 degrees of knee flexion was 6.67 mm, 3.6 mm, and 3.2 mm in groups 1, 2, and 3, respectively. At final International Knee Documentation Committee (IKDC) evaluation, only 2 group 3 patients achieved a group qualification A, while a group qualification B was achieved by 5 patients (2 patients in group 1, 2 patients in group 2, and 1 patient in group 3). Nine patients in group 1, 4 patients in group 2, and 3 patients in group 3 achieved group qualifications C and D (fair or poor results). Based on these results, we do not recommend reattachment of the cruciate ligaments after knee dislocation for obtaining a stable knee with full range of motion.