The procedure was always performed with the patient in lateral position through a lateral transgluteal approach. We did not perform osteotomies of the greater trochanter or femur shortening osteotomies and the cup was placed where there was sufficient bone stock. The major determining factor in cup stability was the presence of sufficient anterior and posterior column. We also tried to insert the cup as medial as possible although in about half the group (25 out of 48), cup placement was superior and lateral. The limb length discrepancy was corrected by varying the neck length of the implant. A special stem was used in 5 cases. The mean intraoperative time was 65 mins with minimal soft tissue disruption as compared with the classic methods. The patients were mobilized postoperatively in a couple of days.
We reviewed 40 patients who underwent V-Y skin flap reconstruction following distal fingertip skin loss.Of the patients 35 were males and 5 females with an average age of 35 years at operation.Surgery was performed as an emergency in all patients.In all cases a single digit was involved.The majority of the injuries were transverse amputations.Mean advancement of the flap was 12 mm.At the follow-up evaluation (mean 2 years),8 patients complained of pain (2 with functional impairment),15 complained of cold intolerance,and 5 had nail deformities.Sensibility of advanced skin was normal in 28 cases,while two-point discrimination averaged 7 mm.This discrimination was virtually identical to contralatertal digits in 25 of the cases.Overall 28 patients were satisfied with their results,while the rest of them were mildly displeased,either with the functional impairment or with the appearance of the involved digits.
Evaluations of 32 adults with 50 complete digital nerve injuries were made more than 1 year after surgery. Twenty patients were men and 12 were women. The mean age of the patients at operation was 30 years. The mean follow-up time was 2 years. Patients were excluded if they had a skin graft, had a second surgery after digital nerve repair or graft, were diagnosed with diabetes, had additional proximal nerve injuries, had postoperative infections, had a complete digital amputation or had a dorsal digital nerve injury. According to the initial injury mechanism, patients were classified into three grades : grade I was defined as a sharp, clean-cut injury, grade II was mild crush and grade III was a severe crush injury. Overall, there were 30 primary digital nerve repairs, 12 secondary repairs and 8 secondary nerve grafts. Moving and static two-point discrimination was determined on both lateral aspects of the injured and contralateral uninjured digits. Digits with primary repairs in mild or severe crush injuries had significantly worse two-point discrimination compared with digits that had a primary repair of a simple laceration. Futhermore, in mild crush injuries, digits with secondary nerve grafting had significantly better results than those with primary repair. Patients under 30 years age had better results than those over 30 years. These results support the hypothesis that better recovery is obtained if tension is avoided at the nerve repair site in mild crush injuries.
