Twenty-three patients with thirty hips of slipped capital femoral epiphysis were treated in our department, KK Women's and Children's Hospital, Singapore between 1997 and 2005. Except one patient lost of follow-up, twenty-four SCFEs with more than 2 years (25 to 73 months, average 38.5 months) follow-up were reviewed. This study is to evaluate the effectiveness and outcome of our protocol: Russell traction followed by gentle manipulative reduction with a
This study compares outcomes of fixation of subtrochanteric femoral fractures using a
Aims. Proximal femur fractures treatment can involve anterograde nailing with a single or double cephalic screw. An undesirable failure for this fixation is screw cut-out. In a single-screw nail, a tip-apex distance (TAD) greater than 25 mm has been associated with an increased risk of cut-out. The aim of the study was to examine the role of TAD as a risk factor in a cephalic double-screw nail. Methods. A retrospective study was conducted on 112 patients treated for intertrochanteric femur fracture with a double proximal screw nail (Endovis BA2; EBA2) from January to September 2021. The analyzed variables were age, sex, BMI, comorbidities, fracture type, side, time of surgery, quality of reduction, pre-existing therapy with bisphosphonate for osteoporosis, screw placement in two different views, and TAD. The last follow-up was at 12 months. Logistic regression was used to study the potential factors of screw cut-out, and receiver operating characteristic curve to identify the threshold value. Results. A total of 98 of the 112 patients met the inclusion criteria. Overall, 65 patients were female (66.3%), the mean age was 83.23 years (SD 7.07), and the mean follow-up was 378 days (SD 36). Cut-out was observed in five patients (5.10%). The variables identified by univariate analysis with p < 0.05 were included in the multivariate logistic regression model were screw placement and TAD. The TAD was significant with an odds ratio (OR) 5.03 (p = 0.012) as the screw placement with an OR 4.35 (p = 0.043) in the anteroposterior view, and OR 10.61 (p = 0.037) in the lateral view. The TAD threshold value identified was 29.50 mm. Conclusion. Our study confirmed the risk factors for cut-out in the double-screw nail are comparable to those in the
Prophylactic pinning of the contralateral hip in the treatment of slipped upper femoral epiphysis has been shown to be safer than continued observation of the contralateral hip. This treatment remains controversial due to the potential for harm caused to an apparently unaffected hip. There is evidence that pinning of an already slipped epiphysis causes growth disturbance of the proximal femur, however Hagglund showed that there is not necessarily growth arrest at the physis after pinning, as the slip occurs at the hypertrophic layer of the growth plate with no damage to the germative layer. This was confirmed by Guzzanti who confirmed that a
Lateral malleolar plating is associated with complication rates of up to 30%. The fibular nail is an alternative fixation technique, requiring a minimal incision and tissue dissection, with the potential to reduce the incidence of complications. We reviewed our results of 105 unstable ankle fractures fixed with the Acumed fibular nail between 2002 and 2010. The mean age was 65 years and 72% of patients had significant systemic medical comorbidities. A number of different locking screw configurations were assessed over the study period. A proximal blocking screw resulted in satisfactory stability in 93%,
Introduction. Scaphoid nonunions remain controversial with regard to optimal management. The objective of this article is to compare our clinical experience in the treatment of patients with scaphoid nonunion using distal radius non vascularised bone graft with that of iliac crest bone graft. Material & Methods. We conducted a prospective randomized study comparing the clinical, functional and radiographic results of 42 patients treated for scaphoid nonunion using a non-vascularised bone graft from the dorsal and distal aspect of the radius (group I), relative to 46 patients treated by means of a conventional non-vascularised bone graft from the iliac crest (group II). All nonunions were stabilized with
Our aim was to compare the one-year post-operative
outcomes following retention or removal of syndesmotic screws in
adult patients with a fracture of the ankle that was treated surgically.
A total of 51 patients (35 males, 16 females), with a mean age of
33.5 years (16 to 62), undergoing fibular osteosynthesis and syndesmotic
screw fixation, were randomly allocated to retention of the syndesmotic
screw or removal at three months post-operatively. The two groups
were comparable at baseline. One year post-operatively, there was no significant difference
in the mean Olerud–Molander ankle score (82.4 retention We conclude that removal of a syndesmotic screw produces no significant
functional, clinical or radiological benefit in adult patients who
are treated surgically for a fracture of the ankle. Cite this article:
Controversy surrounds the management of displaced
three- and four-part fractures of the proximal humerus. The percutaneous
Resch technique of stabilisation involves minimal soft-tissue dissection
and a reduced risk of stiffness and avascular necrosis. However,
it requires a second operation to remove Kirschner wires and the
humeral block. We describe a modification of this technique that
dispenses with the need for this second operation and relies on
a sequential pattern of screw placement. We report the outcome of
32 three- or four-part fractures of the proximal humerus treated
in this way at a mean follow-up of 3.8 years (2 to 8)). There were
14 men and 18 women with a mean age of 56 years (28 to 83). At final
follow-up the mean Oxford shoulder scores were 38 (31 to 44) and
39 (31 to 42), and the mean Constant scores were 79 (65 to 92) and
72 (70 to 80) for three- and four-part fractures, respectively. We
further analysed the results in patients aged <
60 years with
high-energy fractures and those aged ≥ 60 years with osteoporotic
fractures. There were no cases of nonunion or avascular necrosis. The results were good and comparable to those previously reported
for the Resch technique and other means of fixation for proximal
humeral fractures. We would recommend this modification of the technique
for the treatment of displaced three-part and four-part fractures
in patients both younger and older than 60 years of age.
Limited access surgery is thought to reduce post-operative morbidity and provide faster recovery of function. The percutaneous compression plate (PCCP) is a recently introduced device for the fixation of intertrochanteric fractures with minimal exposure. It has several potential mechanical advantages over the conventional compression hip screw (CHS). Our aim in this prospective, randomised, controlled study was to compare the outcome of patients operated on using these two devices. We randomised 104 patients with intertrochanteric fractures (AO/OTA 31.A1–A2) to surgical treatment with either the PCCP or CHS and followed them for one year postoperatively. The mean operating blood loss was 161.0 ml (8 to 450) in the PCCP group and 374.0 ml (11 to 980) in the CHS group (Student’s The PCCP device was associated with reduced intra-operative blood loss, less postoperative pain and a reduced incidence of collapse of the fracture.
The purpose of this study was to compare the clinical and radiological outcome of patients with intact, broken and removed syndesmosis screws after Weber B or C ankle fracture with an associated injury to the syndesmosis. We hypothesised that there would be no difference. Of a possible 142 patients who fulfilled our inclusion criteria, 52 returned for clinical and radiological assessment at least one year after surgery. Of these, 27 had intact syndesmosis screws, ten had broken screws, and 15 had undergone elective removal of the screw. The mean American Orthopaedic Foot and Ankle Society ankle/hindfoot score was 83.07 ( There was no difference in clinical outcome of patients with intact or removed syndesmotic screws. Paradoxically, patients with a broken syndesmosis screw had the best clinical outcome. Our data do not support the removal of intact or broken syndesmosis screws, and we caution against attributing post-operative ankle pain to breakage of the syndesmosis screw.
Fractures of the distal third of the humerus may be complicated by complete lesions of the radial nerve which may be entrapped or compressed by bone fragments. Indirect reduction and internal fixation may result in a permanent nerve lesion. We describe the treatment of these lesions by insertion of a bridge plate using the minimally-invasive percutaneous technique. Six patients were operated on and showed complete functional recovery. Healing of the fractures occurred at a mean of 2.7 months (2 to 3) and complete neurological recovery by a mean of 2.3 months (1 to 5). In one patient infection occurred which resolved after removal of the implant.