Unstable intertrochanteric fractures in elderly patients are associated with a high rate of complications and poses difficulty in fixation. Cemented calcar replacement hemiarthroplasty may be a suitable treatment in these patients. The aim of this study is to assess the clinical and functional results of the use of such a prosthesis in old patients with an unstable intertrochanteric fracture of the femur.
Thirty patients were included in this prospective study, mean age 66 years. All the patients had unstable intertrochanteric fractures. Only patients with type III, IV, or type V fractures according to the Evans’ classification were included in the study. Functional and radiological results were assessed after a mean follow-up period of 22 months.
At the end of the study, only 24 patients were available for evaluation. The mean follow-up period was 22 months (range, 18–36 months). At the last follow-up, the mean Harris hip score was 85 points. Radiologically, all stems were stable, without significant changes in alignment or progressive subsidence. No infection or thromboembolic complications were encountered.
Cemented bipolar hemiarthroplasty with calcar replacement is a good option for unstable intertrochanteric fractures in the elderly. It allows early weight bearing and rapid return to prefracture activity and does not have the difficulty and complications of internal fixation of this complex fracture.
Despite the application of modern locking plate technology, complications remain common after fixation of proximal humeral fractures in elderly patients. Varus deformity and intra-articular hardware are most often responsible; fortunately, both of these complications can be avoided. Recent advances in imaging, reduction techniques, fixation methods, and postoperative care have made surgical outcomes more reliable. Particular attention should be paid to obtaining high-quality fluoroscopic images, avoiding varus reductions, supporting the osteoporotic humeral head, using appropriate screw length, using tension band sutures liberally, and protecting the construct postoperatively. Using these methods, many proximal humeral fractures in patients older than 75 years can be fixed reliably.
In the Hoffer technique, the tendons of the latissimus dorsi (LD) and teres major (TM) muscles are transferred to the rotator cuff posterior to the long head of the triceps muscle, which significantly improves external rotation and abduction range of motion in the shoulders of children with obstetric brachial plexus palsy (OBPP) with internal rotation contracture.
Ten children with OBPP C5/C6 pattern were included in the study and underwent simultaneous subscapularis recession and transfer of the LD and TM tendons to the rotator cuff through a single posterior incision. The age at the time of surgery ranged from 3 years and 3 months to 14 years and 1 month, with an average age of 7 years. The age at initial evaluation ranged from 1 year and 6 months to 9 years and 8 months, with an average of 5 years and 11 months.
There was significant improvement in the degree of active shoulder abduction, from a mean 72° (range 40–90°) preoperatively to 136° (range 90–180°) postoperatively. The preoperative passive shoulder external rotation averaged from 78° (range 0–100°) to 64°. The postoperative active external rotation ranged from 0 to 90°.
Transfer of LD and TM tendons through a single incision to the rotator cuff significantly increases the degree of abduction and external rotation in children with OBPP having internal rotation contracture.
Numerous pelvic osteotomies for the treatment of developmental dysplasia of the hip have been described.
To compare the outcome of two types of pelvic osteotomy, Salter and Dega, for the treatment of late-diagnosed developmental dysplasia of the hip.
This prospective study included 32 patients (36 hips), 18 girls and 14 boys, mean age 2.3±0.5 years. Patients were randomized for management with Salter or Dega pelvic osteotomy after open reduction and capsulorrhaphy with or without femoral shortening osteotomy. The Salter osteotomy group included 19 hips and the Dega osteotomy group included 17 hips. The median follow-up period was 12 months (range 9–20 months).
We achieved an overall success rate of 88.9% in the 36 hips, with no significant difference between the two techniques (89.5% in the Salter group and 88.2% in the Dega group, P=1.000). Both techniques achieved comparable reduction of the acetabular index (20.3±9.0π in Salter vs. 22.0±8.9° in Dega group, P=0.565). There was no significant difference in the center-edge angle between the two groups (34.8±13.0° in the Salter group and 37.4±12.1° in the Dega group, P=0.554).
We achieved comparable results with Salter and Dega osteotomy. The latter has a further advantage of avoiding a second surgery required in the Salter technique to remove hardware.
Recent studies have shown favorable outcome with closed reduction and pinning for displaced complete fractures of the distal radius in children compared with closed reduction and casting alone, which showed a high rate of redisplacement in addition to complications that develop from extreme positions for maintaining reduction and anxiety developed from remanipulation of fractures.
During the period between July 2008 and July 2010, 30 cases of metaphyseal fractures of the distal radius were managed by closed reduction and primary pinning with the application of a forearm cast.
No case of redisplacement was reported until complete healing, and no major complications were observed.
It appears that primary pinning for distal radius fractures is a simple and safe method that can be used as an alternative to closed reduction and casting alone in the treatment of displaced metaphyseal fractures of the distal radius in children (from 5 to 12 years), and this study supports previous studies on this method of treatment.