Use of external fixator in trochanteric fractures of femur.

External fixation of trochanteric fractures appears to be an effective option where major surgery is contra-indicated. A total of 26 cases of trochanteric fractures of femur (12 stable and 14 unstable) were treated with external fixation as other conventional treatment could not be applied due to associated comorbid factors related specially with the elderly age group and those unsuitable for major surgery and open trochanteric fractures. Ages of the patients varied from 38 to 93 (average being 64.8) years. Sixteen patients were female and 10 were male. Right side was affected in 12 and left side in 14 cases. All the cases were operated either by short general or spinal anaesthesia or even under local anaesthesia. All fractures united within 14-18 (average 16) weeks of time. According to Salvatti and Wilson scoring 10 patients showed good, 8 patients fair and 2 patients poor results. Out of other 6 patients, 2 patients died during course of treatment and 4 patients did not turn up for follow-up. Six patients suffered from superficial and two from deep pin tract infections. Other complications were noted such as bed sores in 2, mild to moderate degree of stiffness of both hips and knee joints in 2 and shortening of the affected limb (avarage 2 cm) in 17 cases. This procedure may be recommended to any patient with trochanteric fracture, who are unfit for major surgery and also for open fractures.

Prosthetic replacement of elbow in postburn bony ankylosis: long-term results.

Fifteen patients with 17 post-burn bony ankylosed elbows (two bilateral) fixed at a mean of 72.5 degrees +/- 27.5 degrees flexion were treated with Baksi sloppy hinge elbow arthroplasty. All patients agreed to avoid strenuous use of their replaced elbows. There were four males and 11 females whose ages varied from 21 to 48 years (average 31.6 years). One of the five patients who had severe anterior skin contracture required release. One patient died during the early follow-up period. During the follow-up studies which ranged from 11 to 23 years (average 14.1), eleven patients (68.7%) regained painless stable motion with mean recovery of arc of flexion from 20 degrees +/-10 degrees to 107.5 degrees +/-17.5 degrees with mean range of flexion 90 degrees +/-20 degrees . Good forearm motion was retained in all cases. According to the assessment score (Morrey BF, The elbow and it's disorder, 2nd edn. W.B. Saunders, Philadelphia, 1993), nine (56.2%) patients were recorded as excellent, two (12.5%) as good, and five (31.5%) as poor who were considered as failures. The five failures required removal of the prosthesis but retained acceptable elbow function due to periprosthetic fibrosis connecting the adjacent bone ends.

Modified Boytchev procedure for the treatment of recurrent anterior dislocation of the shoulder.

From January 1990 to December 1998, 48 patients with 50 recurrent anterior dislocations of the shoulder were treated using a modified Boytchev procedure. The age of the patients varied from 18 to 35 years (average 24.7 years). The follow-up period was in average 88 (26-132) months. Six patients were lost in follow-up. Forty-two shoulders showed excellent results. There was one traction injury of the musculocutaneous nerve and one patient with immediate recurrence of the dislocation. Superficial wound infection occurred in five cases, all of which were controlled by antibiotics.