Concomitant valgus hip osteotomy in operative fixation of displaced proximal femoral neck fractures.

Total hip arthroplasty (THA) is considered the preferred treatment for displaced proximal femoral neck fractures. However, in many countries this option is economically unviable. To improve outcomes in financially disadvantaged populations, we studied the technique of concomitant valgus hip osteotomy and operative fixation (VOOF). This prospective serial study compares two treatment groups: VOOF versus operative fixation alone with cannulated compression screws (CCSs). In the first series, 98 hip fixation procedures were performed using CCS. After fluoroscopic reduction of the fracture, three CCSs were placed. In the second series, 105 VOOF procedures were performed using a closing wedge intertrochanteric osteotomy with a compression lag screw and lateral femoral plate. The alignment goal was to create a modified Pauwel's fracture angle of 30°. After fluoroscopic reduction of fracture, lag screw was placed to achieve the calculated correction angle, followed by inter-trochanteric osteotomy and placement of barrel plate. Patients were followed for a minimum of two years. Mean follow-up was 4.6 years (4.1 to 5.0) in the CCS group and 5.5 years (5.25 to 5.75) in the VOOF group. The mean Harris Hip Score at two-year follow-up was 83.85 in the CCS group versus 88.00 in the VOOF group (p < 0.001). At the latest follow-up, all-cause failure rate was 29.1% in the CCS group and 11.7% in the VOOF group (p = 0.003). The total cost of the VOOF technique was 7.2% of a THA, and total cost of the CCS technique was 6.3% of a THA. The VOOF technique decreased all-cause failure rate compared to CCS. The total cost of VOOF was 13.5% greater than CCS, but 92.8% less than a THA. Increased cost of VOOF was considered acceptable to all patients in this series. VOOF technique provides a reasonable alternative to THA in patients who cannot afford a THA procedure.

Percutaneous K-wire fixation for femoral shaft fractures in children.

From November 2001 to January 2004, sixty-five children with femoral shaft fractures were treated by closed reduction and percutaneous K-wire fixation. The aims of the treatment were early mobilisation, easy nursing care and rapid rehabilitation. Kirschner wires were introduced under image-intensifier control from the distal or proximal metaphyseal region of the femur, avoiding injury to the physeal plate. The average duration of hospital stay was 4 days, including training for non-weight bearing axillary crutch walk. Union was achieved in all cases between 6 and 10 weeks (average, 8 weeks). No significant complications were encountered, except refracture in one case. K-wires were removed after an average of 5 months. This is a simple and easy-to-learn technique with the added advantage of cost effectiveness.

Comparison of the results of sinus track culture and sequestrum culture in chronic osteomyelitis.

A prospective observational study was conducted at J. N. Medical College, Aligarh Muslim University, to compare the bacterial flora obtained from sequestrum culture and sinus track culture and to evaluate their antibiotic sensitivity. A total of 62 patients with chronic osteomyelitis were enrolled (38 males and 24 females). Sinus track cultures were done taking all aseptic precautions and the results were compared. Thirty three patients out of 62 showed a discrepancy between the bacterial flora grown from sinus track and sequestrum cultures.