Closed interlocked nailing in comminuted and segmental femoral shaft fractures.

One hundred eight femoral shaft fractures in one hundred six adults were treated by closed intramedullary interlocked nailing. Ninety-two fractures were severely comminuted and 16 fractures were segmental. The procedures were done with the patients in the supine position. A modification of the cylinder guide for fixation of the distal screws is described. All the fractures healed in an average of 18 weeks (range, 12-24 weeks). Dynamization was performed in 15 fractures. There were two postoperative complications, which did not ultimately affect the clinical results. No infections or delayed unions were observed. Closed intramedullary interlocked nailing seems to be the treatment of choice for comminuted and segmental fractures of the femoral shaft provided that all the technical details are followed by the surgeon.

Iatrogenic arterial trauma associated with hip fracture surgery.

During a 5 year period, 1417 patients with various types of hip fractures were surgically treated. Three cases of iatrogenic arterial injuries occurred during the correction procedures, giving an incidence of 0.21%. In 2 patients the profunda femoral and in one the common femoral artery were involved. The mechanisms of injury were: a protruding screw, beyond the medial border of the femur in the first patient, arterial tear, due to bone speculae in the second and external pressure to the artery from an avulsed lesser trochanter in the third. The clinical findings were false aneurysms in two and distal ischaemia in the third patient. All patients were surgically treated. Early diagnosis of this type of injuries is the cornerstone for a good outcome.

The innervation of the human meniscus.

Fourteen menisci from seven anatomic specimens were examined to identify their innervation. After staining by a modified gold chloride method, the menisci were sectioned on a sliding microtome and were studied under a light microscope. Free nerve endings in the peripheral and the medial thirds of the meniscal body were identified, and three types of encapsulated mechanoreceptors were found in the anterior and posterior horns. Based on these findings and a review of the relevant literature, it is considered that menisci both receive and transmit proprioceptive information. Therefore, they not only are stabilizers of this joint, but also contribute to the function of deep sensitivity.

Ipsilateral fractures of the femur and tibia.

From October 1987 to September 1990, 32 patients with ipsilateral fractures of the femur and the tibia were treated. There were 20 men and 12 women with a mean age of 27 years (range 18-75 years). All were caused by road accidents. There were 7 femoral and 22 tibial open fractures. The management of the fractures was partially the same. The tibial fractures were reduced and stabilized by a unilateral external fixator, while in 29 out of 32 femoral fractures, a closed intramedullary nailing was performed. The remaining three patients with an open grade III fracture were initially treated by external fixation, with two of them converted into nailing. The time of hospitalization ranged from 12 to 105 days (mean 30 days). The femoral fractures healed in an average of 15.5 weeks, while the tibial fractures healed in 18.5 weeks. The evaluation of our results was made according to Karlstrom and Olerud's criteria. We achieved 81 per cent excellent or good results and 19 per cent acceptable or poor, in a follow-up time of 19.5 months.

Mechanoreceptors in the posterior cruciate ligament. Histologic study on cadaver knees.

The purpose of the study was to identify mechano-receptors in the healthy, human posterior cruciate ligament. Ten ligaments from 10 fresh cadavers were studied with light microscopy. In addition to free nerve endings, two types of encapsulated mechanoreceptors were identified. They were located at the femoral and tibial attachments, and on the surface of the ligament. These findings support the hypothesis that the posterior cruciate ligament has an anatomic basis for a discriminating afferent flow of nerve impulses to the central nervous system. Therefore, its neural network may play a role in regulating the contraction of muscle groups that are fundamental to knee stability.

Soft tissue recurrence of osteoclastoma.

We report a case of osteoclastoma of the distal radius originally treated by curettage, then by resection and bone replacement. There was a soft tissue recurrence of the tumor 13 years later.

Fractures and epiphyseal deformities in beta-thalassemia.

Sixty-two patients with beta-thalassemia (36 men and 26 women) were investigated in a survey of the incidence and distribution of fractures. Patient ages ranged from 10 to 32 years (mean, 16.7). The examination consisted of a detailed orthopedic and roentgenographic skeletal survey. Fractures are a frequent occurrence in beta-thalassemia (Cooley's anemia). One in three patients had sustained fractures. In one of five, fractures were multiple or recurrent. The fractures, however, were not entirely responsible for the high incidence of deformities. Only one patient had a malunited limb-deforming fracture. The high incidence of deformities was caused by the premature fusion of the epiphyses of the long bones; the pathogenesis of beta-thalassemia-induced epiphyseal fusion is obscure. Thirty patients of the 62 patients developed epiphyseal abnormalities, generally in the lower tibial and fibular, upper humeral, and lower femoral epiphyses. The ensuring deformities are severe and frequently occur in patients older than 12.

Lateral dislocation of the elbow.

A rare case of a pure lateral dislocation of the elbow joint is presented. Attempts at closed reduction were unsuccessful. At operation the anconeus muscle was found to be interposed between the articular surfaces of the joint preventing reduction.

Avulsion of the triceps tendon.

Two cases of the rare injury of avulsion of the triceps tendon are presented. The difficulties in clinical diagnosis and proper evaluation of the roentgenographic findings whenever present are discussed and the treatment is outlined.