ABSTRACT
INTRODUCTION: Fractures of the proximal humerus are very common, but controversy still exists about the preferred type of operative treatment in displaced fractures. MATERIALS AND METHODS: We followed 15 patients (12 female and 3 male, average age 70 years) with 15 dislocated type II (9) and III (6) proximal humeral fractures after helix wire osteosynthesis. RESULTS: A nonunion developed in seven cases (47%). Three patients were reoperated (prosthesis: 2, repair: 1). Seven patients were available for follow-up (average: 14 months). Three patients had a Constant score of 80 or more and four patients had a score under 70 points. CONCLUSION: The results of the helix wire osteosynthesis for proximal humeral fractures are poor and we do not recommend its further use.
Subject(s)
Fracture Fixation, Internal/instrumentation , Fractures, Ununited/etiology , Shoulder Fractures/surgery , Adult , Aged , Bone Wires , Female , Fractures, Ununited/surgery , Humans , Male , Middle Aged , Treatment OutcomeABSTRACT
BACKGROUND: Dislocation after total hip arthroplasty (THA) is one of the most common major complications, and occurs more often through a posterior approach. We performed a retrospective study to determine the incidence of early dislocation and the relationship to the type of prosthesis and the surgeon's experience. METHODS: A group of 884 consecutive primary THAs (746 cemented and 138 cementless) approached through a posterior incision with repair of the posterior soft tissues was followed for a mean of 30 months. RESULTS: The overall dislocation rate was 1.36% (cemented: 1.1%; cementless: 2.9%). All dislocations were posterior and occurred within 6 months after surgery, 91% within 6 weeks. Dislocations were most common in rheumatoid patients (3.8%). Two revisions (0.23%) of the acetabular cup were performed for recurrent dislocations. The dislocation rate was not higher in the operations performed by less experienced surgeons. CONCLUSION: The early dislocation rate after primary THA through a posterior approach with repair of the posterior soft tissues was low, especially in cemented THA. Less experienced surgeons were not associated with a higher dislocation rate.
Subject(s)
Arthroplasty, Replacement, Hip/adverse effects , Arthroplasty, Replacement, Hip/methods , Hip Dislocation/epidemiology , Adult , Age Factors , Aged , Aged, 80 and over , Arthritis, Rheumatoid , Clinical Competence/statistics & numerical data , Female , Hip Dislocation/etiology , Humans , Incidence , Male , Middle Aged , Retrospective Studies , Sex Factors , Time FactorsABSTRACT
The suggestion that the knee behaves like a closed kinematic chain has been tested experimentally. The tibial joint surfaces were replaced by a deformable material and new surfaces were moulded by flexion and extension of the knee. The results support the closed kinematic chain theory; the newly moulded joint surfaces strikingly resemble the original joint surfaces. Inferences are drawn to explain why a fracture of the tibial condyle will remould with early mobilisation of the knee; why a jerk is elicited in tests for anterolateral instability; and why a flexion-compression force alone is unlikely to damage the menisci.
