American Research Journal of Orthopedics and Traumatology

Purpose: clinical and radiological evaluation of the results of the technique of elevation and grafting of osteochondral marginal impaction fragment of posterior wall acetabular fractures and complications assessment in follow up period 1-3 years.Methods: Twenty patients were available for this study had fracture acetabulum with marginal impaction fragment. Elevation, reduction and bone graft impaction of the defect was the technique in all cases. Follow up was 1-3 years. Evaluation of patient was done clinically and radiologically.Results: Radiologically, according to the Matta’s criteria of reduction quality there were anatomic reduction in 16 patients (80%), and satisfactory reduction in 4 patients(20%). Clinical assessments based on modified Merle d’Aubigné and Postel score include 4 (20%) excellent scores and 12 (80%) good scores, and 3 (15%) fair results, and poor in one patient who had revision by total hip replacement.Conclusion: Diagnose of marginal impaction fragment preoperatively makes operative technique by elevation, reduction, bone graft packing, and fixation become mandatory to obtain anatomic reduction and favorable outcome. This technique should be completed before final fixation of the main fracture acetabulum.

Flavio Bravo1, Dante Parodi2, Carlos Tobar3, Jonathan Torres4

Hip arthroscopy is a widely used surgical technique to treat several pathologies, among them, hip impingement, which is the main current indication. Major complications haven’t been described thoroughly in literature. One of these major complications is the femoral neck fracture. Its frequency ranges from 0.07% to 1.9% following arthroscopic femoral neck osteochondroplasty for femoroacetabular impingement. A femoral neck fracture was reported after a hip arthroscopy procedure in a patient diagnosed with FAI, treated through osteosynthesis in situ with cannulated screws. Change due to the FAI can be corrected surgically with different techniques, however, arthroscopic treatment is the most commonly used, with lower complications rate and faster rehabilitation. Femoral neck fracture is an infrequent complication, but the risk increases with certain intrinsic patient factors and osteoporosis. Early menopause may predispose to hip fracture in patients undergoing arthroscopic femoroplasty.

Background: The advances in bone lengthening for treatment of moderate congenital femoral deficiency have the advantages of preserving the limb function and decreasing the psychosocial burden on the patients.Patients and Methods: sixteen patients 10 males and 6 females with unilateral Paley Type 1A unilateral proximal femoral deficiency were treated with distraction osteogenesis bone lengthening. The mean follow up period in this prospective study was 36 months (range: 30 – 48 months). The Pediatric Orthopaedic Society of North America Pediatric Outcomes Data Collection Instruments (PODCI) score was used for clinical and functional outcome of the patients. The calculation of growth inhibition or stimulation in this study was began just after removal of the external fixator until 2 years after its removal.Results: The mean length gained at the end of the procedure was 6.5 cm (SD ±3; range, 4 – 8.5 cm). The mean correction of femoral length discrepancy was 105 % (SD ± 45; range, 85% –165%) with overlengthening of 2-4 cm (average 3cm) in 6 patients (37.5 %). Ten patients (62.5 %) reached the equal femoral length in comparison to the normal femur. According to the PODCI score categories surveyed, the standardized and normative scores were accepted.Conclusion: The surgical technique of femoral lengthening in patients with Paley Type 1A proximal femoral deficiency is a successful and well tolerated technique.

Waleed Nafea MD1, Ahmed M El-Naggar2

Background: Perilunate fracture dislocations (PLFD) are high-energy injuries, produced by wrist hyperextension. Isolated Perilunate dislocations are rare and can be missed.Patients and methods: 20 patients (15 males, 5 females) suffered from traumatic trans-scaphoid perilunate fracture dislocation, all cases were palmar dislocation. Right wrists were injured in 14 patients and left wrists in 6 patients. The mean age of the patients at the time of injury was 33 years (range 19 to 45). The fracture scaphoid was fixed using Herbert screw in 16 cases, and K-wires in 4 patients. Clinical function was evaluated by the Cooney clinical scoring system. Plain X-ray was done for all patients preoperative, direct postoperative, and every visit until the end of follow up period. The radiological outcome included the revised carpal height ratio, radio-lunate angle (RL), scapholunate angle (SL), and presence or absence of midcarpal arthritis.Results: The average follow-up period was 20 months (range 18 –30). Clinically, according to the clinical scoring system described by Cooney, there were 6 (30%) patients with excellent results, 10 (50%) good, and 4 (20%) fair and no poor results were recorded during follow up period. Radiologically, the scaphoid fracture was united in all cases with no evidence of avascular necrosis. The average SL and RL angles in the early postoperative period were 46.5 and −6.0 degrees, respectively. At the last follow-up, average SL and RL angles were 52 and 4.5 degrees, respectively which is significant (p: 0.002). Revised carpal height ratio was 1.53 at the last follow-up.Conclusion: Closed reduction and percutaneous fixation of scaphoid fracture is considered an effective method for management of acute trans-scaphoid perilunate fracture dislocation provided that accurate anatomic reduction of carpal bones is achieved.

Donald Buchanan1, Neil Shastri-Hurst2, Samuel Odede3, Paresh Sonsale4, Brian Banerjee4

PurposeThe Heart of England Foundation Trust has a catchment area of 1.5 million and admits more than one thousand patients with a proximal femur fracture annually. In an aging population, many of these are centenarians. In England and Wales in 2012, there were 12320 centenarians. Given the poor outcomes reported in this patient group further study is important. We report one of the largest known series assessing outcomes and examining the implications for resource allocation.MethodsThirty-two centenarians with a proximal femur fracture who were admitted between January 2000 and April 2012 were compared with a group of 33 patients aged between 60-95 years. Patient outcomes were measured in terms of mortality, mobility, and post operative residential status.ResultsThe average age amongst centenarians was 101.71 years, with a female preponderance in both groups. Three quarters of younger patients lived at home compared with 40.6% aged ≥100 years. As expected, younger patients had better pre-morbid mobility, with 42.42% walking independently compared with 9.37% of centenarians. The distribution of fracture types was similar in both groups.Centenarians’ stay was 10.1 days greater than younger patients, whilst in-hospital mortality was 18.8% compared with 34.4% (younger vs centenarians). Thirty day mortality was almost double in centenarians whilst 120 day mortality, at 62.5% compared with 21.2% in the younger patients was statistically significant.Upon discharge, two thirds of younger patients returned home, compared with only 15.6% of centenarians. Of the younger patients, 42.4% regained pre-fracture mobility compared with 15.6% of centenarians. None of the younger patients were unable to walk post-operatively compared with more than 33% of centenarians.ConclusionsOur findings support previous studies which show that centenarians have poor outcomes with a 120 day mortality exceeding 50%. Such patients require prolonged hospitalisation and social care support. It emphasises the requirement for preventative resource allocation to an aging population.