Functional outcome of four-corner arthrodesis for treatment of grade IV scaphoid non-union.

Functional limitations and pain are end results of scaphoid nonunion with progressive carpal collapse and radiocarpal arthritis. The aim of this study was to assess the functional outcome of four-corner arthrodesis with scaphoidectomy for the treatment of grade IV scaphoid nonunion with Scaphoid Nonunion Advanced Collapse (SNAC) stages II and III. Ten patients with symptomatic grade IV non union of the scaphoid and a mean duration of non unions of 12.1 +/- 2.81 months were treated using the four-corner arthrodesis technique. A dorsal midline longitudinal approach centered over the third metacarpal-capitate-lunate-radius axis, excision of the scaphoid, neutral alignment of the remaining carpal bones, and arthrodesis of the capitate, hamate, lunate, and triquetrum, were performed. Kirschner wires were used to secure the arthrodesis in all cases. A below-elbow thumb spica cast was applied for 3 months. Follow up period ranged from 8 to 24 months, with a mean of 16 +/- 4.7 months. All patients were assessed both functionally for pain, range of motion and grip strength, and radiographically for evidence of fusion and carpal alignment. Good results were achieved in 7 patients (70%) according to the modified Mayo Wrist Scoring Chart. There were no intraoperative complications. Postoperatively, one patient suffered superficial wound infection One patient showed dorsal impingement of the capitate and radius. Also, two patients suffered reflex sympathetic dystrophy. No patients showed deep infection or nonunion. The Four-corner Arthrodesis technique is a motion-sparing, limited arthrodesis that reliably results in pain relief, improved grip strength, and overall patient satisfaction with low associated non union and complication rates.

Results of treatment of displaced supracondylar humeral fractures in children by percutaneous lateral cross-wiring technique.

Seventy children with displaced type II and III supracondylar fractures of the humerus were managed with percutaneous lateral cross-wiring technique from January 2006 to January 2007. There were 54 boys and 16 girls with a mean age of 6.1 +/- 3.07 years. All patients were operated within 24 h after trauma using the Dorgans percutaneous lateral cross-wiring technique. Patients were followed up for a mean period of 6.1 +/- 2.6 months and assessed both radiologically for union; and functionally and cosmetically according to Flynn's criteria. All patients achieved solid union. Functionally, all patients achieved satisfactory results, while cosmetically, 91.4% of patients had satisfactory results and 8.6% had unsatisfactory results. The most frequently occurring complications were minor pin tract infection in six patients, deep infection in two patients, and 32 patients suffered excessive granulation tissue formation mostly around the proximal pin. There was no iatrogenic neurological injury either for the ulnar or for the radial nerves. The obtained results and minor complications reported signify this technique as a viable treatment method for displaced type II and III supracondylar fractures in children.

Safety and reliability of external fixation for basicervical and intertrochanteric fractures in high-risk elderly patients.

Forty elderly patients with basicervical and pertrochanteric fractures were managed with uniplanar AO external fixator under regional anaesthetic block of the femoral nerve and lateral cutaneous nerve of the thigh from April 2003 to March 2006. The mean age of the patients was 67.9 +/- 5.5 years. External fixator application was performed under radiological control after closed reduction had been obtained. Comorbid factors, duration of surgery, duration of hospitalisation, complications, walking ability, time to union and mortality rate were recorded. Patients were followed up for a mean period of 12 +/- 4.5 months. Superficial pin tract infection occurred in 13 patients, healing in varus >10 degrees and with shortening >2 cm occurred in six patients, and one patient suffered a spontaneous ipsilateral femoral neck fracture after removal of the fixator. The mean time for union was 10.4 +/- 1.2 weeks. Rapid union rate and minor complications obtained in the present study are comparable to those obtained with standard internal fixation techniques. Minimal intraoperative blood loss, short operative time and early patient mobilisation are advantages signifying uniplanar external fixator application under regional anaesthetic block to be a viable option in treatment of basicervical and pertrochanteric fractures in high-risk elderly patients.