[Show abstract][Hide abstract] ABSTRACT: To evaluate surgical outcomes of ipsilateral femoral neck and shaft fractures.
Between April 1997 and September 2004, 29 men and 8 women (mean age, 37 years) underwent fixation of femoral neck and shaft fractures using a dynamic compression plate plus a dynamic hip screw or screws. There were 30 femoral neck and 7 pertrochanteric fractures. Functional results were assessed according to the Friedman and Wyman classification.
The mean follow-up period was 49 months. Of the femoral neck fractures, 34 united in a mean of 4 months; 33 of them healed anatomically and one with a 6-degree varus angulation. No osteonecrosis of the femoral head was noted. Of the femoral shaft fractures, 32 united in a mean of 6 months, 5 were non-unions (2 persisted even after revision surgery). Seven patients developed infections (5 superficial and 2 deep), which resolved with debridement and antibiotic treatment. Functional results were good in 29 patients, fair in 5, and poor in 3.
The use of dynamic hip screws and compression plates for ipsilateral femoral neck and shaft fractures is reliable in achieving bone union with few complications.
Preview · Article · May 2008 · Journal of orthopaedic surgery (Hong Kong)
[Show abstract][Hide abstract] ABSTRACT: To evaluate treatment results of intramedullary fixation using multiple Kirschner wires for diaphyseal forearm fractures.
Between January 2001 and January 2004, 184 patients (122 men and 62 women) with 288 displaced diaphyseal forearm fractures underwent intramedullary fixation using multiple Kirschner wires. The wires were inserted by opening the fracture site because radiographic facility for closed pinning was unavailable. The time to union, functional recovery, and the complication rates were assessed.
11 patients were lost to follow-up, leaving 173 whose data was analysed. In 167 (97%) of the patients the fractures united, and in 14 (8%) of them union was delayed. The mean time to union for closed fractures was 13 (range, 7-16) weeks and for open fractures it was 15 (range, 12-22) weeks. The mean time in cast was 6 (range, 3-14) weeks. In all, 34/173 (20%) had complications: superficial infection (n=13), deep infection (n=4), cross-union between bones (n=4), open fracture 'needing' a skin graft (n=2), radial nerve palsy (n=3), paraesthesia (n=1), and non-union (n=7). Among the 173 analysed patients, the infection rate was 10% and the non-union rate was 4%. 130 (75%) of the patients had the wires removed; no re-fracture occurred after wire removal. Based on the Anderson criteria, 47 (27%) of the patients attained excellent, 78 (45%) satisfactory, and 39 (23%) unsatisfactory results. In 9 (5%) of the patients, union failed (7 plain non-union and 2 due to chronic osteomyelitis).
Kirschner wires are much cheaper than plates and screws, and require minimal expertise for insertion and removal. They remain acceptable for stabilising displaced diaphyseal forearm fractures in developing countries.
Preview · Article · Jan 2008 · Journal of orthopaedic surgery (Hong Kong)