Seven-year outcome following Colles' type distal radial fracture. A comparison of two treatment methods.

Eighty-five patients were reviewed 7 years after prospective randomization to bridging external fixation or plaster immobilization for treatment of a Colles' type distal radial fracture. The Gartland and Werley score showed that most patients in each group had an excellent or good outcome and patient satisfaction was comparable and high in both groups. The fixator group had significantly less radial shortening (P<0.05). Despite a high level of radiographic malunion (50%) overall function, range of movement and activities of daily living were not limited. Twenty-five per cent of patients had minor radiological signs of post-traumatic arthritis although only one patient was symptomatic. We conclude that, in the long term, external fixation of distal radius fractures does not confer an improved outcome when compared to plaster immobilization.

Retrograde intramedullary nail for metastatic lesion of the lower tibia.

Two cases of distal tibial metastases are presented, and a suggestion is made for a method of treatment.

Dall-Miles plating for periprosthetic B1 fractures of the femur.

Eight patients (9 fractures) who have been treated with Dall-Miles plating in this unit between April 1996 and October 1997 for ipsilateral periprosthetic fractures around total hip replacement (7 cases) and total knee replacement (2 cases) have been reviewed. Four were men, and 4 were women. The average age at the time of operation was 77 years (range, 65-89 years). The average follow-up period was 14.6 months (range, 6-24 months). Three fractures healed satisfactorily with no evidence of malunion (3 of 9). The final result was unsatisfactory in the other 6 fractures. The femoral component had been inserted in a varus position in all the failures but was in a neutral position in the 3 successes. Procedures other than Dall-Miles plating might be more appropriate in the management of periprosthetic fractures in which the femoral component is in a varus position.

134 tibial shaft fractures managed with the Dynamic Axial Fixator.

We have reviewed the results of 134 tibial shaft fractures treated with the Dynamic Axial Fixator. In 86 closed fractures, the average union time was 4 months. 76 fractures had united by 5 months; delayed union occurred in 7 cases. 3 closed fractures failed to unite. In 48 open fractures, the union time was related to the severity of soft tissue trauma. The average union time was 5 months for grade II and 6 months for grade III open fractures. 33 open fractures had united by 5 months and delayed union occurred in 11 fractures. 4 open fractures failed to unite. The commonest complication was minor pin site infection, which was seen in 34 percent. These responded rapidly to treatment and external fixation continued. Major pin site infections were uncommon (5 percent) and none led to any serious sequelae. We have found the Dynamic Axial Fixator a safe and reliable device for treating fractures of the tibial shaft.

Surgical treatment of bone tumours.

Orthopaedic surgery can now offer much more than amputation for a patient with bone tumours. R. G. Checketts, Consultant Orthopaedic Surgeon at the Sunderland General Hospital, describes the alternatives open to patients.

Intertrochanteric femoral fractures. Mechanical failure after internal fixation.

In a prospective study we assessed the causes of mechanical failure in a series of 230 intertrochanteric femoral fractures which had been internally fixed with either a sliding hip screw or a Küntscher Y-nail. The overall rate of mechanical failure was 16.5%; cutting-out of the implant from the femoral head was the cause in three-quarters of the instances. Implants placed posteriorly in the femoral head cut out more often (27%) than those placed centrally (7%). The cut-out rate was also determined by the quality of the fracture reduction, but age, walking ability and bone density (assessed by the Singh grade and metacarpal indices) had no significant influence. We conclude that these fractures should be reduced as accurately as possible and it is imperative that the implant is placed centrally within the femoral head.

Intertrochanteric fractures of the femur: a prospective study comparing the use of the Küntscher-Y nail and a sliding hip screw.

This prospective randomized study has compared the use of the Küntscher-Y nail and a sliding hip screw in the treatment of intertrochanteric fractures of the femur. For patients whose general health was good, the use of the sliding hip screw was associated with a significantly lower 1-year mortality rate. The use of the sliding screw also resulted in a higher proportion of 1-year survivors regaining their prefracture level of mobility. There was no difference in the rates of cutting-out of the two implants but use of the Küntscher-Y nail was associated with a greater incidence of shortening.

The timing of surgery for intertrochanteric femoral fractures.

The effect of the timing of operative treatment on the mortality and morbidity of a consecutive series of 230 patients with intertrochanteric fractures of the femur has been studied. It was found that the mortality rate was not influenced by the timing of surgical treatment. Loss of mobility and the frequency of pressure sores and chest infections were also not influenced by the timing of surgery. Those patients who underwent early operative treatment had a lower rate of urinary tract infection, but this was partially due to the better general health of these patients. It is concluded that the timing of operative treatment of these fractures is not an important determinant of outcome.

The effects of trochanteric osteotomy on abductor power.

A series of 167 patients with Charnley-type total hip replacements were studied retrospectively to determine the incidence of trochanteric non-union, the degree of postoperative trochanteric displacement, and the relation between these two complications. The power in the hip abductor muscles, measured with a load-cell device, was significantly reduced if the trochanteric fragment had displaced proximally by more than 3 cm; 12% of those studied fell into this group and, as a consequence, had a poorer result. It was concluded that displacement of the trochanter was of greater importance than bony union in determining function in the replaced hip. Because these unwanted problems may compromise an otherwise successful operation, it is suggested tentatively that trochanteric osteotomy should be abandoned except for difficult primary operations or for revision procedures.