Indirect reduction and biological internal fixation of comminuted subtrochanteric fractures of the femur.

BACKGROUND: Surgical treatment of comminuted subtrochanteric fractures may be associated with high incidences of non-union and implant failure. Biological fixation may solve this problem by encouraging rapid callus formation which buttresses the medial cortex. METHODS: In all, 33 patients with comminuted subtrochanteric femur fractures underwent indirect reduction and biological internal fixation. The mean age of the group was 39.12 (19-64) years. RESULTS: Patients were followed up for a mean of 24.6 (12-66) months. Union was achieved within a mean of 15.10 (13-22) weeks, with no cases of delayed union or non-union but with limb-length discrepancy, mean 1.22 (1-2) cm, in nine cases. According to the Traumatic Hip Rating Scale, functional results were excellent in 23 and good in 10 cases. CONCLUSIONS: Indirect reduction and biological internal fixation yield acceptable results in comminuted fractures. These good results can be attributed to early weight-bearing with rapid solid callus formation and early union, which are particularly advantageous in comminuted subtrochanteric fractures, avoiding the implant failure which is not uncommon in these fractures.

Closed reduction and percutaneous fixation of supracondylar fracture of the humerus and ipsilateral fracture of the forearm in children.

We treated 22 children with a supracondylar fracture of the humerus and an ipsilateral fracture of the forearm by closed reduction and percutaneous fixation. There were four Gartland type-II and 18 Gartland type-III supracondylar fractures of the humerus. There were fractures of both bones of the forearm in 16 and of the radius in six. Both the supracondylar and the distal forearm fractures were treated by closed reduction and percutaneous fixation. The mean follow-up time was 38.6 months. At the latest follow-up there were 21 excellent or good results and one fair result. There were no cases of delayed union, nonunion or malunion. Five nerve injuries were diagnosed on admission and all recovered spontaneously within eight weeks. No patient developed a compartment syndrome.

Assessment of variations in the measurement of hip ultrasonography by the Graf method in developmental dysplasia of the hip.

The purpose of this study was to assess the variations in the measurement of hip ultrasonography using the Graf method in developmental hip dysplasia. Twenty-two observers independently analyzed 20 hip ultrasonograms on two occasions. Intraobserver and interobserver agreement ratios on the exact Graf classification were 65% and 51%, respectively. Intraobserver and interobserver agreement ratios on the treatment method according to the hip type were 76% and 64%, respectively. Average intraobserver and interobserver differences were 4.0 degrees and 5.1 degrees for the alpha angle, and 5.9 degrees and 10.1 degrees for the beta angle, respectively. It was concluded that having a basic knowledge of the Graf method was the key point, and the observer's previous number of examinations had no effect on the results.

Intraobserver and interobserver reliability of Kalamchi and Macewen's classification system for evaluation of avascular necrosis of the femoral head in developmental hip dysplasia.

This study evaluates the intraobserver and interobserver reliability of the Kalamchi and MacEwen's classification system of avascular necrosis of the femoral head. Radiographs of 48 developmentally dysplastic hips that had an average follow-up of 40.5 months (range: 36 to 52 months) and that had been treated by the same operative technique were interpreted twice by four experienced pediatric orthopaedic surgeons. When the absence or presence of avascular necrosis was taken into consideration the average intraobserver agreement percentage and kappa coefficient were 86% and 0.71, respectively. The average interobserver agreement percentage and kappa coefficient were 83% and 0.66, respectively. When the agreement on the type of avascular necrosis was analyzed, the average intraobserver agreement percentage and kappa coefficient were 85% and 0.74, respectively. The average interobserver agreement percentage and kappa coefficient were 81% and 0.66, respectively. No statistically significant difference was found between the rates of avascular necrosis of four observers. The Kalamchi and MacEwen's classification system was found to be reliable and reproducible.

The effect of using a tourniquet on the intensity of postoperative pain in forearm fractures. A randomized study in 32 surgically treated patients.

We have analysed the relationship between the intensity of postoperative pain and the use of a pneumatic tourniquet in procedures for operative fixation of fractures of the forearm. Thirty-two patients were divided randomly into two groups as a control (NT) and tourniquet (T). The pain scores in the NT group were significantly lower. Patients over the age of 30 had notably more pain than those younger after the use of a tourniquet. Avoidance of the tourniquet gave better postoperative analgesia in male patients and in those with comminuted fractures. When a tourniquet was used the best results were obtained if it was kept inflated for less than one hour.

Biomechanical analysis of the effects of single high-dose vitamin D3 on fracture healing in a healthy rabbit model.

In a previous ultrastructural study, the benefit of a single high dose of vitamin D3 on fracture healing in a healthy animal model was demonstrated. This study examined the biomechanical consequences of applying a single high dose of vitamin D3 in a healthy rabbit model subsequent to femoral fracture. The fracture load, the values of energy absorbed until fracture and the flexural rigidity values of the vitamin D group were significantly higher than the corresponding ones of the control group in the case of fracture. On the other hand, for intact bones, those values did not differ significantly between the two groups. It was concluded that single high-dose vitamin D3 application had positive effects on fracture healing in a healthy animal model, as far as the parameters related to mechanical strength are concerned.

The relationship between the use of tourniquet and the intensity of postoperative pain in surgically treated malleolar fractures.

The purpose of this study was to examine whether application of a pneumatic tourniquet to the lower extremity during open reduction and internal fixation of malleolar fractures had an effect on the intensity of postoperative pain or not. It was found in males and patients older than 30 years of age that postoperative pain with tourniquet use was harder to control compared with others not in these groups.

Measurement of vertebral rotation in idiopathic scoliosis using the Perdriolle torsionmeter: a clinical study on intraobserver and interobserver error.

This study was designed to determine the reliability and accuracy of the Perdriolle torsionmeter. Fifty-four observers were divided into three groups according to their previous experience in the field of orthopaedics and the treatment of scoliosis. Each observer, on two separate occasions, measured the apical vertebral rotation on preoperative and postoperative roentgenograms of three idiopathic thoracic scoliotic curves using the torsionmeter. For all groups, there was no statistically significant difference (P > 0.05) between the average of the first and the average of the second measurements on vertebral rotation of any of the curves. In the curve with the highest frontal Cobb angle and vertebral rotation of more than 30 degrees, there was a statistically significant difference (P = 0.03) between the average measurements of the three groups of observers. We concluded that, as both intraobserver and interobserver error risks were insignificant, the torsionmeter can be accurately used by everyone in the fields of orthopaedics provided the vertebral rotation is not greater than 30 degrees and the curve is mild or moderate. The reliability and accuracy of the torsionmeter was found to be questionable at more than 30 degrees of vertebral rotation because of increased risk of interobserver error.