new method to decrease the occurrence of embolic events during total hip replacement

The goal of this study is to assess the efficacy of a modified surgical technique, designed to limit the increase in intramedullary pressure during insertion of the prosthesis and to reduce intra-operative embolic events. Forty patients treated with total hip replacement in Tanta university hospitals divided into 2 groups [group 1] treated with conventional cementing technique and [group 2] treated with a modified cementing technique with a cannula inserted into the intertrochanteric region of the femur to decrease the intramedullary pressure to avoid the increase of the intramedullary pressure after application of the cement and insertion of the stem. There was a significant difference between the incidence of embolism and increased pulmonary artery pressure [detected by trans-thoracic Echocardiography] between both groups of patients where the incidence of both were found to be much lower when the modified technique was used. Also the changes in the hemodynamic parameters [heart rate, blood pressure, and central venous pressure] accompanying the appearance of emboli in Echocardiography especially grades 2 and 3 embolism were found to be significant in the conventional cementing group [p<0.05]. The changes in the respiratory parameters [decreased oxygen saturation, decreased arterial oxygen tension, decreased end tidal CO2, and increased arterial CO2] accompanying the appearance of emboli in Echocardiography especially grades 2 and 3 embolism were found to be significant in the conventional cementing group [p<0.05]. Modified surgical technique [A vacuum drainage of the proximal femur along the linea aspera] was found to be effectively reducing the incidence of embolization during cemented hip arthroplasty

Trochanteric fractures, the best method of treatment

unstable trochanteric fracture is a problematic fracture especially in osteoporotic patients. No method of treatment can be considered to be a golden line of treatment for all types of fractures. The aim of this work is to compare the results of treatment of unstable trochanteric fracture by using dynamic hip screws, hooked plate and proximal femoral nail. This study was done in Tanta university hospitals during the period January 2000 till December 2006. Three hundred and thirteen patients were included in this study. However, 20 patients were excluded; 7 due to death and 13 were lost during the period of follow up. The patients were divided into 3 groups according to the method of treatment. Group A included 120 patients [68 males and 52 females] treated by DHS. Group B included 110 patients [46 males and 64 females] treated by hooked plate. Group C included 63 patients [30 males and 33 females] treated by PFN. According to Dubigne and Postel grading, in group A, 99 from 120[82.5%] were satisfied while 21 [17.5%] were unsatisfied. In group B, 61 patients from 110[55.5%] were satisfied and 49 patients [44.5%] were unsatisfied. However, in group C, 57 patients from 63 [90%] were satisfied while only 6 patients [10%] were unsatisfied. The average healing time was 14 weeks with using DHS, 19 weeks with using hooked plate and 12 weeks with using PFN. Post-operative X-ray showed a valgus position of the femoral neck in 18 [15%] out of 120 patients treated by DHS. Varus malposition had occurred in 30 patients [25%]. Valgus deformity occurred in 50% of patients with hooked plate while varus deformity occurred in 41.66% of the patients. On the other hand, only 4 patients [6%] in group C developed varus malposition. Lag screw cut out occurred in 13 patients [11%] in group A. Revision by arthroplasty was done in 7 cases and 6 treated conservatively due to the bad general condition of the patients. Implant removal was done after 2 years from complete union. In group C, only 3 patients [5%] had lag screw cut out; 2 treated conservatively and the lag had removed after union and only one required revision using arthroplasty. Implant failure had occurred in 11 patients [10%] in group B and revision was done in all of them. In treating unstable trochanteric fractures, PFN provides superior results on comparison with DHS or HP. DHS is another accepted alternative when the lag screw is inserted correctly and centrally. However, hooked plate is an inferior alternative when compared with PFN or DHS