Sherif Khaled

BackgroundThe option of primary total hip replacement in patients with fractured neck of femur gives satisfactory functional results, which evokes the idea of this research to study the outcome of total hip replacement (THR) in patients older than 60 years having fractured neck of femur.

Patients and methods

A total of 40 active patients older than 60 years were included in our series. Patients were operated after a mean of 5 weeks after fracture. All patients were operated on by THR, under regional anesthesia, using modified Hardinge approach in lateral position. Postoperatively, all patients were allowed to bear weight as tolerated on the second day after operation. All patients were followed up at 6 weeks, 3 months, 6 months, and every 6 months thereafter.

Results

The results were good in all patients at 3 months, excellent in 23 patients at 6 months, and excellent among all at 2-year follow-up, with mean harris hip score (HHS) of 94.

Conclusion

Primary THR is a good line of treatment in active patients older than 60 years with fractured neck of femur.

PURPOSE: Evaluation of management of the displaced intra-articular calcaneal fractures (DIACF) Sanders types II and III by using minimally invasive sinus tarsi approach and fixation by screws only technique.

METHODS: Open reduction using the limited lateral approach and internal fixation using screws only was studied in 33 patients with unilateral isolated simple DIACF with a mean age of 35 years (15 type II patients and 18 type III patients). All patients were evaluated both clinically and radiologically.

RESULTS: With a mean follow-up period of 28.8 months (range 12-53 months), no cases of failure of reduction or displacement of hardware were detected. The mean AOFAS was 91.73 points while the mean MFS was 95.09 points. Twenty-eight patients were able to resume their pre-injury level of work while the remaining five refrained to sedentary jobs. The mean pre-operative Bohlers' angle was 2.8° (range from -38º to 24º) while postoperatively it was 19.4° (range 5º to 49º). There was no statistically significant difference when comparing the results (AOFAS p-value 1.00, MFS p-value 0.81) between Sanders' type II and III fractures. One patient had postoperative superficial wound infection. Seven patients complained of prominent screw heads. Complex regional pain syndrome occurred in seven patients and was treated successfully at six months duration.

CONCLUSION: The limited open sinus tarsi approach can be used successfully to treat displaced Sanders type II and III fractures. It allows for adequate visualization and reduction. Fixation by screws only is also sufficient. It also clearly avoids the major wound complication problems.

BackgroundPosterior cruciate ligament (PCL) reconstruction remains a challenging operation. There are many factors to be considered in this technique, including graft material selection and method of fixation. This prospective study compared the clinical results of single-bundle PCL reconstruction using a hamstring tendon autograft, with a minimum follow-up of 2 years.

Patients and methods

A total of 26 patients were included in the study: 13 patients who started physical therapy on the second postoperative day and 13 who had their knees immobilized in full extension for 3 weeks. All patients had an isolated chronic PCL rupture. The evaluation parameters included the International Knee Documentation Committee scores and the Lysholm knee scores.

Results

The results showed a significant difference in the functional scores between the two groups. In contrast to many recent reports that favor early range of motion exercises, the results of this study showed better clinical results with delayed rehabilitation.

Conclusion

Protection of the knee early in the postoperative period improves the clinical results.

UNLABELLED: The aim of this study was to detect the accuracy of routine magnetic resonance imaging (MRI) done in different centres and its agreement with arthroscopy in meniscal and ligamentous injuries of the knee. We prospectively examined 70 patients ranging in age between 22 and 59 years. History taking, plain X-ray, clinical examination, routine MRI and arthroscopy were done for all patients. Sensitivity, specificity, accuracy, positive and negative predictive values, P value and kappa agreement measures were calculated. We found a sensitivity of 47 and 100%, specificity of 95 and 75% and accuracy of 73 and 78.5%, respectively, for the medial and lateral meniscus. A sensitivity of 77.8%, specificity of 100% and accuracy of 94% was noted for the anterior cruciate ligament (ACL). We found good kappa agreements (0.43 and 0.45) for both menisci and excellent agreement (0.84) for the ACL. MRI shows high accuracy and should be used as the primary diagnostic tool for selection of candidates for arthroscopy.

LEVEL OF EVIDENCE: 4.

Fifty-six patients who suffered from chronic persistent tennis elbow of more than six months duration were randomly assigned to two active treatment groups. Group 1 (n = 29) received high-energy extracorporeal shock wave treatment (ESWT; 1,500 shocks) at 18 kV (0.22 mJ/mm(2)) without local anaesthesia; group 2 (n = 27) underwent percutaneous tenotomy of the common extensor origin. Both groups achieved improvement from the base line at three weeks, six weeks, 12 weeks and 12 months post-intervention. The success rate (Roles and Maudsley score: excellent and good) at three months in the ESWT group was 65.5% and in the tenotomy group was 74.1%. ESWT appeared to be a useful noninvasive treatment method that reduced the necessity for surgical procedures.

BACKGROUND: Neglected unreduced posterior shoulder dislocation is a challenging orthopaedic problem.

PURPOSE: To evaluate the results of open reduction with posterior cruciate capsular repair for such cases. This corrects the wide posterior capsule, which is the main pathologic entity.

STUDY DESIGN: Case series; Level of evidence, 4.

METHODS: Over a period of 5 years, 17 patients with unreduced neglected posterior shoulder dislocation with an impression fracture involving less than 25% of the humeral head were treated by open reduction together with posterior cruciate capsular repair as described by Neer. The patients' average age was 48.5 years (range, 32.5-66 years). There were 14 men and 3 women. The dominant shoulder was affected in 14 cases.

RESULTS: After a minimum follow-up of 5 years (range, 5-10 years), the average UCLA score improved from 18 preoperatively to 33 postoperatively. The average modified Rowe score changed from 42.2 to 78.4 points. The American Shoulder and Elbow Surgeons Shoulder score showed an average of 40.3 points preoperatively and an average of 79.8 points at final follow-up. Three patients developed late osteoarthritic changes. Two had changes of mild degree, and 1 needed a total shoulder replacement.

CONCLUSION: Open reduction with posterior cruciate capsular repair offers a good solution for the problem of neglected unreduced posterior shoulder dislocation excluding cases with osteoarthritic changes and those with impression fracture involving less than 25% of the head.