One-stage bilateral open reduction through a medial approach in developmental dysplasia of the hip.

The outcome of one-stage bilateral open reduction through a medial approach for the treatment of developmental dysplasia of the hip in children under 18 months was studied in 23 children, 18 girls and five boys. Their mean age at operation was 10.1 months (6 to 17) and the mean follow-up was 5.4 years (3 to 8). Acceptable clinical and radiological results were achieved in 44 (95.7%) and 43 (93.5%) of 46 hips, respectively. Excellent results were significantly evident in patients younger than 12 months, those who did not require acetabuloplasty, those whose ossific nucleus had appeared, and in those who did not develop avascular necrosis. One-stage bilateral medial open reduction avoids the need for separate procedures on the hips and has the advantages of accelerated management and shorter immobilisation and rehabilitation than staged operations.

Missed musculoskeletal injuries in a University Hospital in Riyadh: types of missed injuries and responsible factors.

Eighty missed musculoskeletal injuries in 51 patients in King Khalid University Hospital are analysed. The diagnostic failure rate was 0.6 per cent of all injured patients seen in the emergency room and 6 per cent of admissions under orthopaedic care. The three commonest sites of missed injury were the knee (16 injuries), the foot and ankle (14 injuries) and the hip and pelvis (13 injuries). Twenty-four (47 per cent) presented initially with multiple injuries. In 48 of these patients (60 per cent) there were one or more complaints related to the missed injury. Factors responsible for inadequate diagnosis included breaking of clinical routine, inadequate clinical examination, ignoring the patient's complaints and positive physical signs, and lack of or misinterpreted and inadequate X-rays.

Incidence of proximal femur fracture in an urbanized community in Saudi Arabia.

Osteoporosis, an age-related disorder, is a major contributor to bone fractures among the elderly, especially postmenopausal women. Variable incidence have been reported from different geographical areas, however, none as yet from Saudi Arabia. We have reviewed case records of Saudi residents of Riyadh city, who were 40 years or older and who were admitted to any of the local acute-care hospitals over a period of 12 months (July 1990-June 1991) with a diagnosis of proximal femur fracture (PFF). Of these, 103 were diagnosed with PFF; 52 (50%) were male and 51 (50%) were female. Eighty-eight (85%) patients reported mild trauma as the precipitating cause for their fracture (41 males and 47 females). The median and mean (SD) age of all patients were 75 and 73 (14) years, respectively, with no significant difference between male and female patients. The incidence per 100,000 of PFF for males in age groups 40-49, 50-59, 60-69, and over 70 years was 7, 22, 36, and 251, respectively; the incidence per 100,000 for females in the same age groups was 4.5, 14.6, 7.9, and 394, respectively. The female:male ratios for the same age groups were 0.6, 0.7, 2.2, and 1.6. The incidence of PFF for male and female patients over the age of 50 years was 71 and 100, respectively, with a female:male ratio of 1:4. The anticipated incidence of osteoporotic fracture in Saudi Arabia is expected to be higher than the present one with the population's anticipated increase in life expectancy.(ABSTRACT TRUNCATED AT 250 WORDS)

Ultrasonography detection of radiolucent foreign bodies in soft tissue compared to computed tomography scan.

Thirty-one patients with suspected radiolucent foreign bodies (wooden splinters) in soft tissues of extremities were investigated by plain radiography, computed tomography (CT) scan and ultrasonography to the area suspected clinically. Ultrasonography detected and localized radiolucent foreign bodies in 18 of the 31 patients, while only 14 were seen on CT scan. Following surgical exploration, the presence of foreign bodies was confirmed in 20 patients; thus, the accuracy of ultrasonography was 90% while that of CT scan was 70%. The size of foreign body, the presence of infection or the delay in diagnosis had no effect on results. Ultrasonography is clearly a reliable method of detecting radiolucent foreign bodies in soft tissues of extremities.

Free fibular graft still has a place in the treatment of bone defects.

We report on 27 patients illustrating the use of non-vascularized single fibular strut graft, augmented with a corticocancellous bone graft to bridge bone defects. The indications were varied and included infection, fracture with bone loss, non-union, bone tumour, bone cyst and congenital pseudarthrosis. Primary union was achieved in 92 per cent. Stress fracture occurred in 26 per cent and no significant fibular graft hypertrophy occurred. The aim of this paper is to show that the non-vascularized single fibular graft, if augmented with corticocancellous bone graft along its whole length, is a simple procedure that is still valid to bridge bone defects.

Treatment of ipsilateral fractures of the femoral neck and shaft.

We studied 43 patients with ipsilateral femoral shaft and femoral neck fractures who had dynamic hip screw fixation alone or in combincation with dynamic compression plate. All patients except two were diagnosed early; 37 patients had other associated injuries. There were 41 males and two females. The follow-up ranged from eight months to four years (mean 2-1/2 years). Six patients were lost to follow-up. Fracture of the neck of the femur healed in all 37 patients. Four patients had delayed union and two patients developed nonunion of the shaft of the femur. The aim of this paper is to show our experience and results using one technique for the treatment of such fractures.