Treatment results of bicondylar tibial fractures using hybrid external fixator.

Tibial condyle fractures affect knee stability and motion. Treatment of bicondylar type of tibial plateau fracture is a challenging problem. This study aimed at evaluating the application of hybrid external fixators with minimum deformation in these patients and the resulted outcomes. In this descriptive analytical study, 28 patients with bicondylar tibial plateau fractures treated by HEF device were evaluated. The surgeon used a semicircular and one circular wire instead of the one or two loop of conventional HEF device for a better range of motion of the knee joint. Treatment outcomes including quality of walking, union condition, knee range of motion, complications and the final outcome according to the knee score (rusmussen) were checked. Twenty-eight male patients, with the mean age of 40.54 +/- 13.83 years were enrolled in the study. Complications occurred in 8 (28.6%) patients; 7 cases with superficial infection and 1 patient with deep vein thrombosis. All complications were managed medically with no significant consequences left. All the patients were able to walk with no aid except in one case. In 96.4% and 89.3% of the cases, the clinical and radiological outcomes were good to excellent, respectively according to the knee score. In 85.7% of the patients, the knee range of motion was in normal limits. Application of hybrid external fixator using one and half ring instead of one or two fixator rings in treating bicondylar tibial fractures was associated with desired clinical and radiological results.

Efficacy of reverse triangle screw fixation in patients suffering from femoral neck fractures.

Although the fractures of femoral neck are not so common, their accompanying complications are more frequent and important. This research aims at studying the results of reverse triangle screw fixation in patients suffering from femoral neck fractures in two groups with perfect and imperfect position of the mentioned screw. In a cohort study, 51 patients with femoral neck fracture appointed for the so-called reverse triangle screw fixation were divided into two perfect and imperfect groups considering surgeon comment on position of the screws. The patients were followed up for 12 months and the resulted outcomes were compared. There were 34 patients in the perfect group with mean age of 48.7 +/- 18.6 (18-80) and 17 patients in the imperfect group with mean age of 50.4 +/- 15.9 (19-80) years old. Both groups were the same considering underlying causes and fraction grades. The overall frequency of nonunion and avascular necrosis was 7.8 and 3.9%, respectively. These rates were 2.9 and 0% in the perfect group and 17.6 and 12.5% in the imperfect group, respectively (p > 0.05). The mean Harris hip score and motion range of the hip at different directions in the perfect group were substantially higher than those of the imperfect one. According to present results, position of the screws determined by the surgeon after operating the reverse triangle screw fixation in femoral neck fractures may significantly affect the prognosis of patients.