Management of femoral head fracture by Ganz surgical dislocation of the hip.

INTRODUCTION: Posterior hip dislocation is the commonest type of hip dislocation. It is associated with femoral head fracture in 7% of cases. Urgent and congruent hip reduction is mandatory to improve clinical outcomes and avoid irreversible complications. The purpose of this study is to assess the safety and functional and radiological outcomes of surgical hip dislocation by Ganz technique for treatment of femoral head fracture. PATIENTS AND METHODS: In this retrospective study, 18 cases of femoral head fracture were included. Six cases had Pipkin type I and 12 had Pipkin type II fracture. They were treated through surgical hip dislocation. All cases were followed up for at least 24 months. Matta's criteria were used for radiological evaluation (plain radiographs). Functional evaluation was done using Harris Hip Score and modified Merle d'Aubigne and Postel score at final follow-up. RESULTS: No patients were lost during the follow-up period. No signs of infection or wound dehiscence were noted in this study. There was one case of osteonecrosis. All cases had labral injury, which was debrided. None of our cases needed suture anchor repair of the labrum. Radiographical evaluation according to Matta's criteria yielded anatomic fracture reduction in 17 patients but imperfect in 1 patient. According to Harris Hip Score, four Pipkin type I cases were rated as excellent and two as good. Among cases of Pipkin type II fracture, six were rated as excellent, four as good, one as fair, and one as poor. According to modified Merle d'Aubigne and Postel score, 11 cases had excellent results, 5 cases were rated as good, one as fair, while one case had poor results. CONCLUSION: Open reduction and internal fixation of femoral head fracture using surgical hip dislocation through Ganz approach is a viable treatment option and provides satisfactory results with low complication rate.

One sacroiliac screw for posterior ring fixation in unstable pelvic fractures.

Unstable pelvic injuries are considered uncommon and they are usually associated with high rate of morbidity and mortality. High energy blunt trauma and falling from height are usually the main mechanism of injury. It is a retrospective study that was performed in academic level I trauma center. From September 2015 to December 2019, a consecutive series of 26 patients (7 females), with average age of 32 years with unstable pelvic fracture were included in this study. All patients underwent reduction and percutaneous fixation with one sacroiliac screw posteriorly for each sacroiliac joint and anterior arch fixation of the pelvic ring with either platting or external fixator. The average duration of follow up was 36 months. Clinical results: at the final follow-up, all patients had complete radiological healing of the fractures. The subjective functional assessment yielded excellent for twenty-two patients, good for two patients and fair for two patients. Posterior arch fixation of the pelvic ring with one sacroiliac screw beside anterior arch fixation in unstable fracture pelvis is a sufficient fixation method to maintain the requiring stability to allow complete union of the fracture. Level of Evidence: Therapeutic Level III.

Modified Stoppa Approach for the Treatment of Complex Acetabular Fractures.

Complex acetabular fractures are due to high-energy trauma in most cases. The operative management of these types of fractures is often difficult and technically challenging. Almost all of these types of fractures are treated through extensile approaches, and a variety of them have been described. Some of these approaches are associated with complications such as infection, heterotopic ossification, and increased blood loss in addition to increased operative time. This retrospective study was performed at an academic Level I trauma center. From January 2013 to March 2019, 21 patients with complex acetabular fractures were treated with open reduction and internal fixation through a single anterior modified Stoppa approach. The average operative time was 98.80 minutes (range, 60-180 minutes), the average follow-up time was 40 months (range, 24-72 months), and the average Harris Hip Score (HHS) was 87.85 (range, 75-100). At the latest follow-up, 12 (57.1%) patients had an excellent HHS, 8 (38.1%) patients had a good HHS, and 1 (4.8%) patient had a fair HHS. Complex acetabular fractures can be effectively managed by a modified Stoppa approach without the need for extensile or combined approaches. [Orthopedics. 2021;44(3):e353-e358.].

Repair of Traumatic Avulsed Achilles Tendon using Double Cerclage Trans-calcaneal Stainless Steel Sutures: Prospective Study and Review of Literature.

INTRODUCTION: Achilles sleeve avulsion results in a direct disruption of the triceps surae-calcaneal complex from its insertion. It represents a surgical challenge to all orthopedic surgeons as a little tissue is available for direct repair of the achilles tendon into its insertion. Methods of fixation include suturing of the avulsed bone fragment, screw fixation, tension band wiring and suture anchors. In this study, we will present a new technique for repairing of the achilles sleeve avulsion injury using double cerclage stainless steel sutures. PATIENTS AND METHODS: Seven patients with sleeve avulsion of the achilles tendon were included in this study. Only post traumatic cases were involved. Repair of the avulsed tendon using double cerclage stainless steel sutures had been done for all patients. Postoperatively all patients had below knee cast for 4 weeks. Physiotherapy started after cast removal. Patients were followed at 3, 6, 12, 24 months. Pain was measured using VAS score. The AOFAS score was measured at the last follow up. RESULTS: All patients were followed for at least 24 months. Six males and one female were included in this study. The mean time for returning to work was about 15 weeks. One complication (delayed wound healing) occurred in one patient and healing was well after treatment with antibiotics and continuous dressing. The AOFAS score was excellent for six patients and good for one patient. CONCLUSION: Double cerclage stainless steel sutures can be used safely to treat patients with achilles sleeve avulsion fracture with a satisfactory clinical outcome.

Cementless total hip arthroplasty in the treatment after acetabular fractures.

INTRODUCTION: The outcomes of total hip arthroplasty (THA) for the treatment of posttraumatic arthritis after acetabular fractures were inferior to those after primary non-traumatic THA. METHODS: This study was performed in academic level I trauma center. From January 2011 to December 2014, a consecutive series of 21 patients (9 females), with average age of 56.7 years (range 29-75 years) who had posttraumatic hip joint arthritis after acetabular fractures, were included in our study. All patients underwent cementless THA. The average duration of follow-up was 26 months (range 24-36 months). RESULTS: At the latest follow-up, all patients could walk independently, thirteen (62%) patients had excellent Harris hip score, five (24%) had good HHS, and 3 (14%) had fair score. WOMAC scale decreased from 63 (range 42-92) to 4 (range 0-19). Two patients (9.5%) had heterotopic bone formation which did not affect the activity of the patients. There were no signs of loosening of the acetabular cups or around the femoral stem. CONCLUSION: Cementless THA is an ideal treatment for posttraumatic hip arthritis with anatomic restoration of the hip center to improve the functional results and decrease the incidence of complications and revision rate.

Simultaneous open reduction and internal fixation and total hip arthroplasty for the treatment of osteoporotic acetabular fractures.

INTRODUCTION: Surgical treatment of acetabular fractures in elderly people is challenging. The main aim of this study is to evaluate retrospectively the indications, results and the complications of simultaneous open reduction and internal fixation (ORIF) and acute total hip replacement (THR) in the management of displaced acetabular fractures. METHODS: This study was performed in an academic level I trauma centre. From January 2011 to December 2014, a consecutive series of 18 patients (eight females), with average age of 66 years (range 35-81 years) who had displaced acetabular fractures were included in our study. All patients underwent ORIF and simultaneous acute THR. The average duration of follow up was 21.7 months (range 12-36 months). RESULTS: At the latest follow up, all patients could walk independently. Thirteen patients (72.7 %) had excellent Harris hip scores HHS, five, patients (27.7 %) had good results. All fractures were healed and the acetabular autologous bone grafts were well incorporated. There were no delayed unions or non-unions. Two patients (11 %) had heterotropic bone formation which did not affect the activity of the patients. There were no signs of loosening of the acetabular cups however one patient had 2 mm medial migration of the cup. No vertical migration was observed, and there were no signs of loosening around the femoral stem. CONCLUSION: ORIF and simultaneous THR is a good option for the treatment of certain types of acetabular fractures particularly in elderly population.

Medial pivot knee in primary total knee arthroplasty.

Total knee arthroplasty (TKA) with a medial pivot design was developed in order to mimic normal knee kinematics; the highly congruent medial compartment implant should improve clinical results and decrease contact stresses. Clinical and radiographic mid-term outcomes are satisfactory, but we need other studies to evaluate long-term results and indications for unusual cases.