Screening time for extra-capsular proximal femoral fracture fixation; the difference between extra-medullary and intra-medullary implant usage.

The aim of this study was to compare the fluoroscopic screening time used for treatment of fractures of the trochanteric region of the femur using two different implant systems. Data were collected from 277 proximal femoral fracture fixations. A dynamic hip screw (DHS) was used in 145, and an intra-medullary hip screw (IMHS) was used in 132. There was no difference between the two groups with respect to age, gender or side. Altogether, there were 42% two parts, 35% were three parts and 23% were four parts extra-capsular neck fractures. There was no statistical difference in ionising radiation exposure in closed reduction of these fractures regardless of the fracture configuration or surgical experience of the surgeon. The mean screening time to implant a DHS in two part fractures was 0.48 min, for three part fractures it was 0.45 min and for four part fractures it was 0.46 min. The mean screening time to implant IMHS was 1.02 min for two part fractures, 0.96 min for three part fractures and 1.03 min for four part fractures. These differences were statistically significant (P < or = 0.05).

Comparison of expected vs. actual tunnel position in anterior cruciate ligament reconstruction.

In a prospective blinded non-randomised cohort study, 32 patients were assessed following anterior cruciate ligament reconstruction using autograft middle-third bone-patellar tendon-bone, over a period of 10 months. Two experienced surgeons performed the procedures, one using an arthroscopically assisted technique (16 patients) and the other by mini-arthrotomy (16 patients). A comparison was made between the positions of the tunnels as perceived by the surgeon intra-operatively with the actual position as shown on the post-operative X-ray. An independent blinded observer made the latter assessment. Actual vs. expected tunnel placement was analysed using the coefficient of correlation. The anteroposterior femoral tunnel position indicated perfect correlation (R(2)=1.00, P=0), and on the lateral view showed good correlation (R(2)=0.55, P=0.005). However, the tibial tunnel position anteroposteriorly showed poor correlation (R(2)=0.14, P=0.22), and on the lateral view no correlation (R(2)=0.07, P=0.36). The ideal tibial tunnel position is controversial, and in this study, two tibial tunnels were just anterior to the acceptable position and one was posterior. Altogether these three, and one other, were in very different positions to that expected by the surgeon. Surgeons may consider that before drilling the tibial tunnel, intra-operative confirmation of the guide-wire position would be helpful.