Fracture of the acetabulum in a 14-year-old patient: 20-year review.

A case report of 14-year old female with an acetabular fracture involving the anterior column and posterior column-posterior wall is presented here and the findings on 20-year follow-up are described.

Anterior margin articular fractures of the distal radius.

Twenty anterior articular margin distal radial fractures were treated in an 11-year period. The size of the articular fragment was determined by the lateral radiograph to be either < or > 50% of the articular surface. Seventeen patients were > 60 years of age, range: 40 to 78; average age: 67. Seven were initially treated by closed manipulation, but four lost position and were internally stabilized. The remaining 13 were primarily stabilized by application of an anterior plate. Twelve patients were followed > 2 years and eight > 5 years, with an average follow-up of 3.8 years. The greater loss of wrist extension in the smaller articular fragment group was statistically significant. All patients treated by plate stabilization returned to their prefracture activities. In this fracture, the T-plate proved to be a satisfactory stabilizing implant.

Fractures of the shaft of the femur treated with a single AO plate.

During a ten-year period 37 femoral diaphyseal fractures were treated by a solitary AO (Arbeitsgemeinschaft für Osteosynthesefragen [Association for the Study of Problems of Internal Fixation]) plate. Thirty fractures united following the internal stabilization. The seven that received an autogenous cancellous bone graft with the plate united. Twenty nongrafted fractures that stabilized in the first week resulted in one nonunion and four delayed unions. Ten nongrafted fractures were stabilized more than one week following injury resulting in one delayed union and one nonunion. Two femurs united after the addition of a bone graft without disturbing the previously applied plate in the fifth month after initial stabilization. A new plate and bone graft produced union in the remaining five. Higher union rates have been reported with the intramedullary nail. A plate rather than an intramedullary nail is the preferred implant in fractures that are either comminuted or infraisthmal or in the presence of a femoral prosthetic stem.

Hip replacement in a Charcot joint: a case report and historical review.

A 61-year-old woman with a neuropathic joint was treated by total hip arthroplasty. Histologically, the absence of any osseous repair process in this hip is consistent with reports that neuropathic fractures of the femoral neck generally fail to unite. The fragments of necrotic bone found in the synovium are characteristic of the pathologic process. The above-described patient is typical of the preataxic stage. The seven-year successful result of total hip arthroplasty is most likely explained by the fact that the patient was not ataxic. Because of the unpredictability of neurosyphilis, seven years should not be considered the touchstone of success. From this experience there is no recommendation or even a suggestion that hip arthroplasty should be performed on ataxic patients.

Compression osteotomy of the tibia.

Compression osteotomy of the tibia is to allow knee motion postoperatively without case immobilization. Rigid internal stabilization by axial compression and tension band wiring enhances union. The rigid internal stabilization prevents loss of position of the osteotomy, often seen in other techniques. The benchmark for this osteotomy operation is no fractures of the osteotomy fragments, no position loss, no thromboemboli, and no deep wound infections.

The Amsterdam suspension. Balanced suspension after hip surgery.

The Amsterdam Suspension is an easily applied, mechanically efficient and inexpensive apparatus for use in postoperative treatment of patients with either hip fractures or arthroplasties. Amsterdam suspension allows lower extremity exercises to be started in the immediate post surgical period by markedly reducing the gravitation load on the extremity.