Prevention of fatal pulmonary thromboembolism by heparin prophylaxis after surgery for hip fractures.

From 1960 through 1975, 337 patients with surgically treated acute fracture of the hip received subcutaneously administered heparin to prevent thromboembolic disease according to various regimens. Four hundred and three patients received no heparin. The incidence of fatal pulmonary embolism was 3.5 per cent in the 403 patients who reveived no heparin and 0.0 per cent in the 147 patients who were treated by the currently used regimen of prophylaxis, as follows: With the dose modified according to the coagulometer-test time, patients received 2,500 units on admission and every six hours until the day before operation. Then they were given 5,000 to 10,000 units eight to ten hours before surgery and 2,500 units every six hours after surgery until they were fully mobilized.

Cemented internal fixation for supracondylar femur fractures in osteoporotic patients.

Seventeen, supracondylar femur fractures in 15 severely osteoporotic patients (average age, 81.9 years) were treated with a 95 degree supracondylar plate and dynamic compression screw supplemented with intramedullary methyl methacrylate and massive cancellous bone graft harvested from the distal femoral metaphysis. Interfragmentary compression and rigid fracture fixation was obtained in all cases with the use of the A-O compression device. Patients were allowed early protected weight bearing without external immobilization. At follow-up observation (average, 2.1 years), bony union was noted in all cases, and knee flexion averaged 100.4 degrees. There were no malunions or cases of implant failure. Complications included two early postoperative deaths and three femur fractures above the plate. This technique was effective in rapidly restoring patient mobility while avoiding the complications of implant failure.

Retrograde femoral nailing between an ankylosed hip and a stiff knee.

We describe a case of retrograde nailing of a comminuted infraisthmal femur fracture between an ankylosed hip and a stiff knee stemming from heterotopic bone and soft-tissue contracture. A tibial nail directed through the medial femoral condyle was used. At 1 year follow-up the fracture has united anatomically, and the patient has been rehabilitated to his preinjury functional status.

Treatment of pelvic fractures and associated dislocations.

Fractures of the pelvis result in high morbidity and mortality as a result of uncontrolled hemorrhage and associated soft tissue damage. Early reduction and fixation of these fractures has been shown to result in control of hemorrhage, decreased morbidity and mortality, and improved function. Seventeen pelvic fractures, so treated, are reported. Despite a high complication rate of almost 75%, surgical fixation resulted in rapid control of hemorrhage, restoration of hip joint congruity, early mobilization of the patient, and decreased incidence of decubitus ulcers, bronchopneumonia, thrombophlebitis, and urinary tract infection.

Ender rod versus compression screw fixation of hip fractures.

Eighty-seven matched pairs of patients with extracapsular hip fractures were treated with either Ender rod or compression screw and plate fixation. The data obtained both perioperatively and from one to 39 months postoperatively showed no significant differences with respect to infection rate, mortality, length of stay, or ultimate functional status. In the Ender rod group, 66.7% of the patients experienced technical problems, compared with 10.3% of patients in the compression screw group. The Ender technique offered few practical advantages and an unacceptably high level of problems, even when patients with only stable fractures were considered.

An isolated, closed, complex dislocation of the metacarpophalangeal joint of the long finger: a unique case.

A unique case of an isolated, closed, complex metacarpophalangeal (MP) joint dislocation of the long finger is reported. The deep transverse metacarpal ligaments play an integral role in the stability of the metacarpophalangeal (MP) joints because of their firm bilateral attachments to the palmar plate. The partial rupture of this ligament during the course of trauma prevents closed reduction. Essential correction consists of incision of the remaining fibers of the ligamentous connection to the palmar plate.

Intraosseous glomus tumor in the ulna. A case report.

Glomus tumors are benign vascular tumors composed of round to oval uniform cells associated with vascular structures, usually found in the soft tissue of the nail bend. A 24-year-old woman with a two-year history of progressive right elbow pain and swelling was found to have a histologically characteristic intraosseous glomus tumor in this unusual location. Excision was followed by complete relief of symptoms.

Open tibial fractures treated by anterior half-pin frame fixation.

Forty-two open tibial fractures were treated with anterior half-pin frame fixation, weight bearing as tolerated, and early reconstruction of the soft tissue envelope. Thirty fractures were followed to completion of therapy. The infection rate was 7.1%, nonunion rate, 3.0%, and pin tract infection rate, 0.5%. Problems of malunion (23.3%) and of secondary fractures around lag screws (17.6%) may be reduced by early cancellous bone grafting and limited use of minimal internal fixation.