Supracondylar femoral fractures in elderly patients treated with the dynamic condylar screw and the retrograde intramedullary nail: a comparative study of the two methods.

INTRODUCTION: The objective of this study is to present the results of surgical management of supracondylar fractures of the femur (types A and C according to the AO/ASIF classification) in elderly patients with the use of two different methods of fixation: the mini open dynamic condylar screw fixation (DCS) and the closed retrograde intramedullary nailing (RIN). MATERIALS AND METHODS: Eighty patients with supracondylar fractures of the femur were treated from January 1994 to June 2000 and 72 of them followed up completely. There were 25 (34%) men and 47 (65%) women with a median age of 73.2 years (range 60-88 years). In patients with the same type of fracture, the chosen method was random, one after the other (alternately). RIN was used in 35 patients, and DCS was used in 37. The mean operative time for the DCS fixation group was 145 min (range 115-180 min), whereas for the RIN group it was 92 min (range 76-110 min) (p<0.001) with an average estimated blood loss of 310 cc (range 120-450 cc) and 118 cc (range 90-165 cc), respectively (p<0.001). The mean follow-up was 28 months (range 18-42 months). RESULTS: According to the criteria set by Schatzker and Lambert, excellent results were recorded in 18 (51%), good in 11 (31%), moderate in 3 (9%), poor in 3 (9%) patients with RIN and excellent in 19 (51%), good in 11 (30%), moderate in 4 (11%) and poor in 3 (8%) patients with DCS (p>0.05). The complications that occurred in the RIN group were 2 (6%) stiffness of the knee (mean flexion 80 degrees), 2 (6%) non-unions, 2 (6%) varus deformity and in the DCS group 2 (5%) haematomas, 4 (11%) stiffness of the knee (mean flexion 73 degrees) and 2 (5%) non-unions. CONCLUSION: Although the two methods appear to have the same percentage of excellent results and same time to bony union, RIN is preferable to DCS in terms of less blood loss and shorter operating time.

Femoral osteomyelitis due to Aspergillus nidulans in a patient with chronic granulomatous disease.

13 cases of osteomyelitis caused by Aspergillus nidulans have been previously reported in patients with chronic granulomatous disease (CGD). All of them have been associated with simultaneous pulmonary infection and have had an extremely poor outcome. We report an unusual case of femoral osteomyelitis due to A. nidulans in a 16-year-old male with CGD, without pulmonary involvement. Treatment with liposomal amphotericin B and granulocyte colony-stimulating factor as well as extensive surgical debridement followed by prolonged treatment with itraconazole resulted in an excellent clinical response.

Dislocation of bipolar hemiarthroplasty following breakage of the polyethylene ring.

Dislocation after bipolar hemiarthroplasty is rare. In classical dislocations of bipolar prosthesis, the prosthetic femoral head escapes from the natural acetabular cavity. Two cases of a bipolar hip prosthesis are presented in which the dislocation occurred between the cup and the metallic ball head 4 and 12 months postoperatively. The reason for the dislocation was fracturing of the edge of the polyethylene ring - either due to impingement at the full flexion position of the hip or to dislocating forces in extreme positions of the metallic ball head. To avoid this complication we recommend installation of the notch of the polyethylene ring be at the peripheral half of the acetabular cup.