Outcomes of Concomitant Fractures of the Radial Head and Capitellum: The "Kissing Lesion".

BACKGROUND: Radial head compression against the capitellum may cause concomitant fracture of the capitellum. The purpose of this study was to investigate if radial head fracture type is associated with a concomitant fracture of the capitellum. PATIENTS AND METHODS: Data were identified from five area hospitals. We retrieved records of patients older than 18 years of age who underwent treatment for concomitant capitellum fracture and radial head fracture between January 2002 and January 2013. Patients with olecranon fractures or trochlea fractures were excluded. RESULTS: A total of 10 patients with a radial head fracture and a concomitant capitellum fracture were included. Based on the operative reports, nine radial head fractures were classified as Hotchkiss modification of the Mason classification type II, and one was classified as type I. Based on the available radiographs and computed tomography, three capitellum fractures were type I, and seven were type II according to the Grantham classification. CONCLUSION: Surgeons have to be alert to capitellar damage in case of a Hotchkiss type II radial head fracture. LEVEL OF EVIDENCE: This is a level IV, therapeutic, retrospective study.

Influencing factors on the functional level of haemophilic patients assessed by FISH.

Joint destruction in early adulthood brings the patients to the orthopaedic clinics. If a haemophilic patient becomes disabled, it shows a number of factors such as timely diagnosis, availability of appropriate treatment depending on the country, access and affordability to treatments and equally importantly the responsibility of the patient in managing self care by remaining compliant by prescribed treatment regimen. We assessed the functional level by functional independence score in haemophilia (FISH). Overall, 104 patients with haemophilia A and 29 with haemophilia B were evaluated. We assessed the function of the patients by FISH. We divided the sum scores into weak (FISH score 8-16), moderate (17-24), and good (25-32). For evaluating the level of functional deficit in a 2 × 2 table, we categorized the weak and moderate levels into Disordered Group and the good level into Not-Disordered Group. The average age was 26.9 ± 14.24. Each 1 year increase in age can increase 1.07 fold the possibility of being placed in Disordered Function Group. Severe haemophilia can increase 7.34 fold, presence of inhibitor can increase 9.75 fold and home self-care increases 3.89 fold the possibility of being placed in Disordered Function Group. To decrease the burden of the cost on patient, family and the government, education plays the most important role. We suggest that we send a trained team of physician and nurses to the deprived villages and cities instead of waiting for the patient to refer to our Care Center.

Does percutaneous kyphoplasty have better functional outcome than vertebroplasty in single level osteoporotic compression fractures? A comparative prospective study.

Purpose. To evaluate the relative differences in surgical outcome of kyphoplasty (KP) versus vertebroplasty (VP) in the patients with single level refractory osteoporotic compression fractures (OCFs). Method. From August 2008 to May 2012, we intermittently treated 57 patients with single level OCF by PV and KP (Groups A and B, resp.). We used visual analogue scale (VAS) and short form 36 (SF36) questionnaire to measure functional recovery and followed them for six months. Independent samples t- and Kendall's tau-b tests were for statistics. Results. In terms of age, number, and bone mineral density of the patients, there were no significant differences between the two groups. In both groups, VAS and SF-36 scores improved significantly and remained relatively stable throughout the follow-up period. We had 9 and 6 asymptomatic cement extravasations and 5 and 8 new vertebral fractures in Group A and B, respectively. In comparing the two groups, the results indicated that KP almost failed to show any significant higher effect relative to VP during this period. Conclusions. In considering the high cost of KP relative to VP in the developing countries like Iran, there is no logical reason to use KP in a single level refractory OCF in these regions.