Cemented metal-on-metal total hip replacement with 28-mm head: prospective, long-term, clinical, radiological and metal ions data.

PURPOSE: The aim of this study was to evaluate the long-term clinical, radiological and metal ion blood concentration results following 28-mm metal-on-metal cemented total hip replacement using Metasul(®) acetabular component and polished, cannulated Allopro CF-30 (Sulzer-Medica, subsequently Centerpulse-Zimmer, Winterthur, Switzerland) femoral component. METHODS: Prospective follow-up of patients operated between 1997 and 2000 at a district general hospital. RESULTS: Seventy-nine patients (89 implants) with female predominance and median age of 66 years (IQR 45-87 years) were prospectively followed up for mean 13 years (11-14 years). There was significant improvement in Harris hip score (paired Student's t test p = 0.0001). The mean plasma cobalt and chromium levels were 1.3 µg/L (IQR 0.5-23.9) and 3.6 µg/L (IQR 1.0-22), respectively. Elevated plasma metal ions >7 µg/L were noted in four asymptomatic patients with negative ultrasound examination. Radiolucent lines were present in various zones but majority were stable. One femoral component was revised due to aseptic femoral loosening. Three acetabular and one femoral component have radiologically failed but not revised yet. The Kaplan-Meier survival at 14 years was 92 % for failure as endpoint. CONCLUSION: The long-term survival of Metasul(®) cemented total hip replacements using 28-mm metal-on-metal head is comparable with metal on polyethylene bearing devices.

Traumatic pediatric olecranon injury: a report of suture fixation and review of the literature.

Elbow injuries make up to 3% to 4% of all emergency department presentations and are often difficult to diagnose. These injuries are often missed on radiographs because of the large cartilaginous component of the pediatric elbow resulting in malunion. Fractures around the elbow joint are one of the leading causes of litigation claim, and awareness of the pitfalls in diagnosis of these subtle injuries is necessary for a prompt diagnosis. Fracture of the olecranon epiphysis is rare and often being described around puberty and in association with osteogenesis imperfecta. Management using K-wire tension band fixation has been described in the past, which can lead to growth arrest in younger patients.We hereby present a missed rare sleeve-type open olecranon epiphyseal fracture in a young child, highlighting the pitfalls in the diagnosis of these injuries. This article also reviews various options to manage such a rare fracture and also suggests an alternative method of transosseous suture fixation with an excellent result.