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From 1968 to 1977 13 supracondylar fractures of the femur in patients aged 16 to 82 years were treated by fixing the fracture with a Wright knee plate. The technique described is bone suture rather than rigid fixation. Reasonably good functional results were obtained in all cases.
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Sixty consecutive intertrochanteric femoral fractures were treated with the Asiatic gamma nail followed by early postoperative weight bearing. Cutting-out of the lag screw from the femoral head occurred in six fractures and were analysed radiographically with regard to fracture type (Evans' classification), osteoporosis (Singh grade), accuracy of post-operative reduction (neck-shaft angle and diastasis of the fracture), and location of the lag screw in the femoral head (depth, height, and antero-postero-posterior radiograph and large antero-posterior deviation of the lag screw were significantly related to the increased incidence of the screw cutting-out. This suggests that deep insertion of the lag screw on the antero-posterior view with central placement on the lateral view is an optimal location in the femoral head. The ¿cut-out index' (the multiplication value of the depth and the anteroposterior deviation of the lag screw in the femoral head) is an excellent measure of the risk of the lag screw cutting-out.
This study analyses the relationship between the level of experience of both surgeon and radiographer and the radiation dose administered in theatre, during fixation of extracapsular proximal femoral fractures. From the 63 dynamic hip screw procedures performed, 10 were done by Senior House Officers (SHOs), 10 by Consultants and 43 by Registrars, whereas Basic Radiographers were involved in all cases. Fractures were classified as two part, three part or four part. A four part fracture required higher levels of radiation dose and screening time as compared with a two part fracture. All two part fractures were screened by radiographers of similar experience; however, the radiation dose and screening time were different amongst different levels of surgeon. The highest radiation dose and screening times were recorded when an SHO was the operating surgeon and the lowest when a registrar was the surgeon. The two part and three part fractures performed by registrars were subdivided according to the experience of the radiographer. In both cases a statistically significant difference was found between the dose of radiation administered in theatre and the years of experience of the radiographers (p < 0.05).
Distal femoral fractures are rare and usually complex. Mostly, they are fixed with the Dynamic Condylar Screw (DCS) or the 95 degrees condylar plate (CP). The simplicity of applying the DCS compared with the CP led us to investigate whether any possible mechanical deficiencies of the CP would detract from its technical advantages, thus limiting the indications for its use in the treatment of fractures of the distal femur. An in vitro investigation was carried out to measure the stability of a Y-osteotomy (with and without medial metaphyseal bone defect) stabilized either with the CP or the DCS. 8 pairs of human cadaveric femora classified according to their bone density were used. CP and DCS were applied to 1 bone in each pair by means of three lag screws (anterior, posterior and through the plate). Physiological loading was simulated and measurements were taken at the level of the osteotomy in the frontal and sagittal planes in order to assess rotational instability and the amount of gap opening in the vertical branch of the osteotomy. There was no relevant difference in the mechanical properties of the two fixations for fractures without medial defect, even if the stability of the fixation was reduced by removing the distal screw. Furthermore, interfragmental movement was minimal. In the frontal plane, simulated closure resulted in closure of the medial branch of the osteotomy in every case without any opening of the vertical branch of the osteotomy. In the sagittal plane, the closure of all branches of the osteotomy was confirmed for 11 bones and a rotation of the condyle was observed in 5 bones (3 CP, 2 DCS). Removing the distal lag screw did not increase the instability. Even in osteoporotic bones, the DCS provided the same stability as the CP. For simple Y-osteotomies, the CP did not offer any technical or mechanical advantages. The stability in the frontal plane however was significantly reduced in osteotomies with medial defect. The amplitude of interfragmental movement on all bones fixed by the CP, except for 1 pair, was greater than those fixed by the DCS. The absence of the anterior lag screw did not reduce stability. However, the absence of the lag screw within the implant considerably weakend the fixation--more so for the CP than for the DCS. Instability reached a maximum without any lag screw at all, which again was more pronounced for the CP than for the DCS. The Dynamic Condylar Screw (DCS) must be regarded as the implant of choice both technically and mechanically even in osteoporotic bones, but the distal condylar block must be at least 4 cm in length.
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Proximal tibial articular fractures are caused by a variety of mechanisms and are characterized by numerous distinct fracture patterns. Surgical treatment for other than minimally displaced or nondisplaced fractures is recommended to restore joint congruity and limb alignment, and to allow early, stable, knee motion.
The study reviewed in this article evaluated a group of patients who underwent surgical therapy for calcaneal fractures at a Level I trauma center. One group of patients was treated after outpatient referral to the center, whereas the other group was admitted to, and underwent surgery at, the center. This study attempted to determine which patient risk factors or injury characteristics might lead to an increased rate of wound-healing complications. Bohler's angle is a classic radiographic method of determining the severity of calcaneal injury in this group of patients. The question posed by the authors of this study was: Does a drastic correction in Bohler's angle lead to an increased incidence of wound-healing complications? The authors do not recommend undercorrection of Bohler's angle but urge avoidance of overcorrection and stress the importance of early surgical fixation after lateral skin wrinkling is found.
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Nine years after treatment of symphysiolysis and dislocation of the left sacroiliac joint, a screw was spontaneously voided during urination. Unstable plate fixation of the symphysis pubis probably caused screw migration into the bladder, creating a fistula with abscess formation and septic complications.
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