Cementless stem stability in dysplastic osteoarthritis of the hip--12 years' experience.

BACKGROUND: The aim of this paper is a retrospective assessment of artificial hip joint function and stability of cementless stems of varied design used in the treatment of deformative and degenerative dysplastic changes in the hip. MATERIALS AND METHODS: The study enrolled 182 patients treated by cementless total hip arthroplasty. The average age of the patients was 44 years and the follow-up time ranged from 2 to 22 years (16.7 years on average). The following features were assessed: endoprosthesis survival judex according to Kaplan-Meier's criteria, functional outcome of the treatment on the Harris Hip Score (HHS) and endoprosthesis stability and changes in periprosthetic bone tissue over time, according to McGovern, Callaghan and Engh. RESULTS: The study revealed a considerable importance of the method chosen for matching the type of endoprosthesis to the anatomy of the dysplastic hip. The highest probability of long endoprosthesis survival time, correct implant placement and good stability in the femoral canal was obtained in the group with anatomical stem implants. The function of the operated hip in the study group had improved three times by the third year of follow-up. CONCLUSIONS: In dysplastic arthrosis, in which the proximal part of the femur has a narrow canal, the intertrochanteric area is often deformed and the angle of antetorsion greatly increased, better stability and osteointegration as well as a considerable functional improvement and extension of survival time can be obtained through using the so called anatomical stem, with anteflexion and antetorsion, fitted in the intertrochanteric area of the bone.

Elliptical head hemiarthroplasty in the treatment of femoral neck and head fractures--preliminary report.

BACKGROUND: The aim of his study is to evaluate efficacy of elliptical head hemiarthroplasty in treatment of femoral neck and head fractures and related complications in young patients under 55 years of age. MATERIAL AND METHODS: Uncemented elliptical head hemiarthroplasty was performed in 14 patients aged 28-55, mean age of 46,7 years, out of whom 12 diagnosed with a femoral neck fracture or related complications and 2 with a femoral head fracture. Mean follow-up period was 4,5 years, range from 10 months to 6 years. The Harris Hip Score was applied for evaluation of functional results. The radiographic analysis was based on standard anteroposterior and axial radiographic projections. Acetabular cartilage erosion was assessed according to the Wetherell et al radiographic method of measurement. RESULTS: The functional results ranged from 58 to 97 points, mean 85,28 points (according to the HHS). The radiographs revealed no signs of stem loosening. No cartilage erosion or migration of the prosthesis were observed in the study. CONCLUSION: An elliptical shape of the prosthetic head reflects the anatomy of the hip reducing the risk of acetabular cartilage erosion and migration of the prosthesis. We conclude that modular elliptical head hemiarthroplasty can be a useful method of management of femoral neck or head fractures and related complications in younger patients.

Comparison analysis of the operative treatment results of the femoral neck fractures using side-plate and compression screw and cannulated AO screws.

INTRODUCTION: Femoral neck fractures are among the most frequent and the most dangerous types of musculoskeletal injuries in the elderly population. There is general agreement that because of the morphology of the fracture, internal fixation is the treatment of choice irrespective of the degree of displacement. The optimal surgical treatment of femoral neck fractures remains controversial despite constant progress in the surgical management of such fractures and still remains a serious therapeutic problem. The goal of the present study was to compare the outcome in patients who underwent surgery of femoral neck fractures with AO screws; a compression screw and a side-plate; and a compression screw and a side-plate with an additional AO screw. MATERIAL AND METHODS: The study group included 112 patients who underwent surgery for femoral neck fracture with the use of AO screws; a compression screw and a side-plate; and compression screw and a side-plate with an additional AO screw, at the Orthopaedic Department at Vendsyssel Hospital, Hjörring, Northern Orthopaedic Division, Denmark, between 1 January 2004 and 31 December 2005. Garden's classification was used to classify femoral neck fractures. Implant position and fracture reduction were categorised according to recommendations by Tornkvist and Lindequist. RESULTS AND CONCLUSIONS: Irrespective of fracture morphology, compression screw and side-plate fixation provides better stabilisation to the bony fragments and improves early mobilisation in comparison with AO screws.

Epidemiology of distal radius fractures in own material--own experience.

BACKGROUND: Although distal radius fractures constitute 1/6 of all fractures in humans, epidemiology of the fracture has been a subject of limited number of publications in Polish medical literature. MATERIALS AND METHODS: Epidemiological data of 395 patients (277 females, 118 males) diagnosed with distal radius fracture and treated between January 2003 and May 2005 were collected. 81 patients were seen at 12-month and over follow-up and then categorized according to the AO classification system. They were also examined for subsequent osteoporotic fractures. BMD values were analysed in patients who had undergone bone density scans. RESULTS: Distal radius fractures constituted 18% of all fractures (77% of forearm fractures) treated during the study period. The mean age of patients was 58 years (females 63.5, males 44.8). Respective age groups presented significant gender-related differences in morbidity. The morbidity in women increased rapidly in the 6th decade of life, whereas was fairly stable in men. An analysis of fracture mechanism also pointed to osteoporotic changes as a pathogenic factor. CONCLUSION: Distal radius fractures are the most common fractures in humans. This type of fracture especially in women and older age groups is due to osteoporotic changes and constitutes a risk factor of subsequent osteoporotic fractures. Despite many morphological forms, distal radius fractures in almost 2/3 cases can be allocated into 4 main subgroups.

Efficacy of closed reduction and maintenance of surgical outcome in plaster cast immobilization in different types of distal radius fractures.

BACKGROUND: The aim of this paper is to evaluate the results maintaining after closed reduction of distal radius fracture and to assess difficulties in restoration of the articular surface continuity with reference to the type of fracture according to the AO classification. MATERIAL AND METHODS: 65 patients were included in the study (40 female, 25 male), mean age of 59 years (19-84), diagnosed with the distal radius fracture, treated by closed reduction and a plaster cast immobilization. The mean immobilization period was 40 days (25-50). Secondary dislocations were assessed since closed reduction until follow-up in respective AO groups. Mean follow-up was 624 days ( 374-1210). For the evaluation of secondary dislocations we have applied radiographic parameters defining the distal radius morphology: RIA, RL, UV, RW, PI. In assessment of the articular surface restoration, the articular surface step-off and gap were measured following closed reduction in relevant AO groups. RESULTS: The most significant secondary dislocations occurred in group C3 then A3 and C2. Statistically significant differences in secondary dislocations within respective types of fractures were observed between groups A2 and A3 ( p<0.05). Type C fractures presented statistically significant differences between groups: C1 and C3; C2 and C3 as to chances of restoring the articular surface continuity by closed reduction (p<0.05), whereas no such a difference was observed between group C1 and C2. CONCLUSIONS: The AO classification is a tool which with accuracy characterizes the complex pathomorphology of distal radius fractures and includes essential elements differentiating respective fracture groups. We conclude that in group A3, C2 ,C3 the result of closed reduction is difficult to maintain with a plaster cast immobilization. Additionally, the restoration of articular surface continuity in type C3 fractures can hardly be achieved by closed reduction.