The incidence of acetabular fractures in the elderly has recently shown a marked increase due to the combination of greater longevity for the population as a whole and a relative decrease in the incidence of alcohol-related trauma in younger adults. The compromised physiologic reserve and the diminished healing capacity of the typical elderly patient have an adverse effect on the potential for a favorable clinical outcome. The presence of osteopenic bone or degenerative arthritis and the effects of previous radiation therapy to the hip and pelvis hamper diagnostic imaging and the utility of some treatment alternatives that were designed primarily for younger patients. The diverse clinical presentations include major polytrauma, minor trauma, and insufficiency fractures. An assessment of the prior health and functional status of the patient is crucial in determining the optimal therapeutic protocol. Treatment options vary according to the clinical presentation and include conservative methods, percutaneous fixation in situ, open reduction, and acute total hip arthroplasty. The feasibility of acute total hip arthroplasty rests on the use of newly developed techniques for minimally invasive stabilization of the acetabular fracture with cables and the application of morselized or structural autograft harvested from the femoral head. Whichever surgical method is chosen, the objective is rapid mobilization of the patient on a walker or crutches. Late complications that may occur after nonoperative or operative treatment include posttraumatic arthritis, nonunion, wound infection, and heterotopic bone formation.

Acetabulum↗

PubMedDate not supplied

Partial resection of the scapula and a release of the long head of triceps for the management of Sprengel's deformity.

Previous surgical methods to address Sprengel's deformity by an attempted relocation of the scapula have achieved a limited functional improvement. A novel method was devised that includes a partial scapular resection, a removal of any omovertebral communication, and a release of the long head of triceps from the scapula. The results of eight cases are presented in which this method was used on 5 males and 3 females patients (age range, 19 months to 9 years). Early postoperative, active-assisted motion exercises for the patients were encouraged. On average, flexion improved from 100 degrees to 175 degrees and abduction improved from 90 degrees to 150 degrees. In one patient, a second operation was performed to remove an exostosis that followed the primary procedure. Initially, two keloid scars followed the use of a curvilinear incision. However, subsequently, this problem was eliminated by the use of a transverse incision. The new method seems to provide highly favorable functional and cosmetic results with a low morbidity.

Child↗

PubMedDate not supplied

Combined Maquet and proximal tibial valgus osteotomy.

A combined Maquet and proximal tibial valgus osteotomy has been used to treat patients presenting with anterior and medial compartmental degenerative arthritis. Patients with clinically symptomatic lateral compartmental disease, gross instability, or a nonfunctional range of motion were excluded. Thirty-four knees in 31 patients whose average age was 59.6 years were studied. Follow-up periods range from six to 36 months (mean, 16 months). Results have been tabulated with respect to the patient's preoperative radiographs and clinical knee ratings. The surgical technique has been the same throughout the series and is notable for the absence of metallic fixation and for the division of the tibiofibular joint proximally without an associated fibular osteotomy. Neither nonunion nor peroneal nerve dysfunction was encountered postoperation. To date, 68% of the results have been graded as good to excellent, 20% as fair, and 12% have failed. No correlation was found between preoperative radiographic rating and postoperative result.

Adult↗