Introduction and objectives

High-energy pelvic fractures are life-threatening injuries. Approximately 15% to 30% of patients with high-energy pelvic injuries are hemodynamic unstable, hemorrhagic shock remains the main cause of death in patients with pelvic fractures, with an overall mortality rate from 6% to 35%. The correlation between fracture pattern and mortality in polytrauma with pelvic fracture has been previously investigated. However, the purpose of our investigation was to evaluate the relationship of hemodynamic instability with the pelvic fracture pattern according to different classifications.

Introduction and purpose: The most commonly found degenerative changes in the wrist can be included in two basic patterns of advanced carpal collapse: On the one hand scapholunate advanced collapse (SLAC) and on the other scaphoid nonunion advanced collapse (SNAC). To treat this collapse, Watson described the so-called four-corner arthrodesis, which includes the lunate, capitate, pisiform and hamate bones. The aim of this study is to assess the results obtained using fixation with a Spider plate.

Materials and methods: In this study we included a series of 20 patients that underwent 4-corner arthrodesis with a Spider plate. These cases had stage II or III advanced degeneration of the wrist both SLAC and SNAC. We have also used this technique for other indications such as osteochondral lesions of the head of the capitate, mediocarpal arthritis or mediocarpal instability.

Results: Mean follow-up was 16 (7–25) months. An important decrease in pain was seen in all cases and postoperative values were as follows: palmar flexion, 38° (range: 12–46); dorsal flexion, 30° (range: 12–45); radial deviation, 12° (range: 0–16); ulnar deviation, 24° (range: 15–40). An increase in fist force was seen after surgery. The arthrodesis healed in all cases, with a slight decrease in carpal height index after surgery.

Conclusions: This surgical technique has allowed us to obtain good results determined clinically and by means of X-rays, as well as early motion after surgery.

Introduction: The anatomical complexity of the acetabulum and the difficulty of classifying fractures mean that treatment plans change continuously.

The decision to treat surgically involves evaluating the type of fracture, individual factors, the hospital’s possibilities and the surgeon’s experience.

Materials and methods: We carried out a retrospective review of 81 patients treated surgically for acetabular fractures between January 1994 and December 2003 with minimum follow-up of one year. 49 patients were followed up for more than 3 years. The patients’ ages were between 19 and 74. We reviewed the type of fracture, presence of dislocation, injury mechanism, associated sciatic injury, surgical approach and time to weight-bearing. We evaluated clinical (Merle d’Aubigne) and radiological results at one and three years.

Results: One patient required total hip replacement after a year and four at three years. According to the Merle d’Aubigne scale, there were 63 excellent results, 14 good and 4 fair at one year (81 cases), and 41 good and excellent, 6 fair and 2 poor at three years (49 cases).

There was one case of intraarticular screw, another with an incarcerated bone fragment and another of sub-capital fracture.

Conclusions: In treatment, careful classification is essential to choose the appropriate surgical approach and achieve better reduction.

Good reduction improves the functional prognosis. The worst outcomes were in elderly patients. In young patients the outcome was related to the damage to joint cartilage.

Purpose: To compare the results of reconstruction of the anterior cruciate ligament (ACL) using autologous patellar bone-tendon-bone (BTB) graft with four semitendinous-medial rectus bundles (STMR). Our technique involved a double incision and attachment with an interference screw.

Materials and methods: Non-randomised prospective study of 296 athletes operated on between 1988 and 2001: 202 BTB and 94 STMR. The mean ages were 22.8 and 21.6, males 52.9% and 58.5%, right knee involved in 54.46% and 54.3% of cases and mean follow-up of 13.7 and 12.4 months in the BTB and STMR groups, respectively.

The evaluation of the results was based on the IKDC protocol and pre- and post-surgical anterior tibial displacement was evaluated with the radiological Lachman test and Telos® arthrometer.

Results: The final IKDC evaluation was excellent or good in 86% and 89%, post-surgery Lachman tests showed less than 3 mm in 58.6 and 50.6%, from 4 to 8 mm in 33.3% and 31.6%, the athlete dropping sports activity in 9.3 and 3.4%, infection in 3 and 2 cases, stiffness in 2 and 2 cases and discomfort on kneeling in 8.7 and 2.2% of athletes in the BTB and STMR groups, respectively.

Conclusions: We found no clinical differences between the two procedures. Anteroposterior stability was better in the BTB group. There was less discomfort on kneeling and fewer athletes dropped sports in the STMR group.

Introduction and purpose: An analysis was made of the patients’ clinical and radiographical evolution after surgical treatment of osteochondritis dissecans of the knee (ODK) by means of reinsertion, abscission and an osseocartilaginous autograft. An assessment of prognostic factors was also performed.

Materials and methods: Retrospective revision of 30 patients (mean age: 30 years), 5 of them with bilateral involvement. A reinsertion of the fragment was performed in 11 knees, an abscission was used in 18 and an autograft in 6. A clinical assessment using Hughston’s criteria and SF12 was carried out; a radiographical evaluation was also performed using weight-bearing A/P views with the knee flexed 45°. Using the variance analysis test, a study was made of the relationship between clinical status, age, localization, extension, stability, type of treatment, timescale of evolution and degree of joint impingement. The average evolution was 19 years.

Results: Pain was reported as mild or nonexistent by 75, 50 and 21% of patients treated with reinsertion, abscission and grafting respectively. The higher the degree of joint impingement, the worse the patients’ pain level and their joint balance. At the time of treatment, the highest degrees of joint impingement were found in older patients, in lesions in weight-bearing areas, lesions with an intraarticular free fragment, lesions treated with grafting and those with over 15 years’ evolution.

Conclusions: Osteoarthritic changes are frequent after surgical treatment of osteochondritis dissecans, especially in lesions situated in weight-bearing areas. The more joint impingement there is, the worse the expected clinical prognosis. We recommend early treatment of symptomatic lesions and the reinsertion of the osteochondral fragment.

Introduction and Objectives: The goal of cementless endoprosthetic hip surgery is to improve bone attachment. The gold standard method for evaluating periprosthetic bone characteristics is densitometry. This study was designed to compare periprosthetic bone mass in 2 groups of patients: less than 3 years and more than 3 years after implantation.

Materials and Methods: A total of 195 type ABG-II total hip prostheses were implanted from November 1997 to March 2003. This implant is a hemispheric cup coated with hydroxyapatite, which can additionally be anchored with screws and a short anatomic stem with metaphyseal fixation. DeLee and Gruen zones were analysed.

Results: During the study period, patients with implants less than 3 years old showed no significant changes in bone mineral density around the stem or the cup. In area 7, a statistically significant reduction was noted after 3 years (0.5218g/cm3, p< 0.001). In Gruen’s zones 3 and 4 a non-significant gain was observed after 3 years (1.1618g/cm3).

Discussion and Conclusions: In cup studies, a statistically insignificant increase in density was observed in zone I after 3 years. Noteworthy findings included a loss of function in DeLee zone III and Gruen zones 1 and 7, which has not yet had clinical consequences (at a maximum 6 year follow-up time).

Introduction and Objectives: Periprosthetic fractures are a common phenomenon in revision surgery and following trauma. Treatment strategies range from replacement with a larger stem, metal plates with Dall-Miles wires, and Partridge straps. Our objective is to evaluate the clinical use of Partridge osteosynthesis in periprosthetic femoral fractures.

Materials and Methods: In a period of 6 years (1997–2003), 45 patients presenting with femoral fractures with a hip prosthesis were treated with the Partridge system using nylon material for cerclage and flexible nylon plates (Stryker-Howmedica). Of these, 20 were localised proximal to the tip of the prosthesis (Whittaker Type I), 12 on the tip (Type II), and 13 distal to the tip of the prosthesis (Type III). The study group consisted of 25 females and 20 males, with a mean age of 79.5 years. Mean time between implantation and fracture was 4.5 years. In 78% of the patients (35 of 45), surgery was performed within 48 hours. Open reduction of the fracture was performed, and 6–8 nylon straps were used in most cases. Partridge plates were used in 5 cases. Mean surgical time was 55 minutes, with a mean blood loss volume of 500 milliliters.

Results: There were minor recovery complications in 8 patients (12.6%). There were no deep wound infections. Of the 45 patients, 60% regained their pre-fracture level of function within 6 months. Mean hospital stay duration was 19 days, and 93% of the fractures consolidated with an exuberant callus within the one-year follow-up period. A higher level of care was required by 25% of patients.

Discussion and Conclusions: This simple method of osteosynthesis is indicated for rapid recovery following stabilisation of a periprosthetic femoral fracture. Even with a mobilised prosthesis, the fracture often consolidates with an abundant callus, and the patient is then able to move.