Introduction

Throughout the years treatment of patellar fractures have been held in much controversy and various treatment procedures have been described. In the literature, there are only a few studies that compare the results of the different treatment modalities.

INTRODUCTION

In recent years the age of world's population has risen and with it there has been a significant increase in the frequency of hip fractures in the elderly. These fractures are known to increase morbidity and mortality. However, little is known about the frequency and characteristics of patients who sustain a second hip fracture. We examined the incidence and the underlying associated medical disorders of patients with a second fracture in the other hip.

Introduction: There is still controversy regarding which method of internal fixation of intraarticular hip fracture is ideal. The purpose of this study was to evaluate the outcome and complications following the fixation of such fractures with cannulated cancellous screws with two different types of triangular configurations of these screws: one superior and two inferior and vice versa.

Methods: Between January 2006 and December 2008, one hundred and twelve femoral neck fractures in 125 patients (mean age of 67 years) were treated by closed reduction and internal fixation (CRIF) by titanium cannulated screws, using alternately these configuration types of fixation. Twelve patients were lost to follow-up. Ninety-eight fractures in 93 patients were followed to union or revision surgery, with a mean duration of follow-up of twenty one months. There were 52 Garden I fractures, 34 Garden II fractures and 12 Garden III and IV fractures. Fifty-one were treated with standard configuration of 2 inferior and one superior screws (group 1), while 47 were treated with reverse placement (group 2). There was no statistic difference regarding age, sex and Garden’s classification between the two groups. The quality of reduction, accuracy of implant placement and rates of nonunion and osteonecrosis were evaluated.

Results: 83/98 fractures (85%) had at follow-up good-to-excellent reduction and fifteen (15%) had a fair or poor reduction. There was a nonunion of seven fractures (7 %) and avascular necrosis of the femoral head (AVN) in five (5%). There were no deep infections. Seventy one patients (83%) had a good functional outcome (as compared to 85/93 Pts- 91% – prior to fractures). Six patients (four with nonunion and two with avascular necrosis) went through revision surgery (THR). There was no difference in the quality of reduction, number of nonunion and AVN and functional outcome between both groups of fixation. There was a difference in the outcome which depended on the Garden type of fraction and the accuracy of reduction. Most complications were observed in Garden’s III and IV fractures with inaccurate reduction.

Conclusions: Excellent reduction and accurate implant placement is the main reason for a good outcome after close reduction and internal fixation of intraarticular hip fractures. We didn’t find any difference in the outcome following fixation in two different configurations of the screws.

Introduction: The traditional methods for the treatment of femoral shaft fractures of children consists of closed reduction and either spica casting or fixation by external fixator. There are also reports on the treatment of such injuries by open reduction and internal fixation by plate. In the last years the method of minimal invasive fixation of such fractures with elastic nails became popular in children over 6–7 year old. The purpose of this paper is to present our experience with elastic nail fixation of femoral shaft fractures of children.

Material and Methods: We present a series of 43 children aged 3–13 year old, mean age: 6.5y, follow-up 2–4 years, mean 2.5 years) with shaft fractures of the femur. 12 children were under 5 year of age. Seven of them were poly-trauma patients. There were no open fractures. Each patient was treated by closed reduction and percutaneous nail insertion under C-arm imaging intensifier control. Fixation was accomplished by a knee immobilizer alone. Early non-weight-bearing mobilization was encouraged until appearance of callus formation. Subsequently, weight-bearing was encouraged.

Results: The results of all cases were excellent. All fractures were united within 7–14 weeks, with an average of 9 weeks. There were not any cases of femoral fractures through nail insertion. There was no decrease in the range of hip and knee motion. None of the patients had complications such as infection, malalignment or neurovascular injury. There was two cases of bursitis around the tip of the nail in the supracondylar region, which was resolved by early pin removal. Removal of the pins was done 6–9 months following operations.

Conclusions: Closed reduction and minimal invasive fixation of femoral shaft fractures by use of Nancy Nails is safe, simple and useful in children with femoral shaft fractures, even in young children under the age of 5 years, and especially in cases of poly-trauma. This minimally invasive procedure allows for early mobilization with no loss of range of motion or associated complications.

Introduction: Fractures of the scapula are rare injuries. When they do occur, they are usually caused by high-energy trauma and some of the patients may have significant associated injuries. Most fractures are minimally displaced and amenable to nonsurgical treatment. Open reduction and internal fixation of intra-articular fractures are considered if there is a glenohumeral sub-luxation secondary to fracture or if there is an intra-articular displacement greater than 5 mm.

Patients and Methods: This study consisted of 33 Pts from Israel and Macedonia (28 M, 5F, 18–74 year old, mean 43.5Y) followed for 2–5 years (mean 3.5Y). Fractures were classified according to Idelberg following analysis of plain radiographs and computerized radiographs. 26 patients had undisplaced or minimally displaced fractures of the glenoid and were treated conservatively by collar and cuff for three weeks, then followed by physiotherapy. The remaining seven patients had comminuted fractures with marked displacement of the glenoid and some degree of shoulder subluxation and were treated surgically. Six patients were treated by open reduction and osteosynthesis by rigid plates (3) or by screws alone (3). The 7^th patient who was treated surgically, a 73-year-old female, had a displaced fracture of the glenoid associated with comminuted fracture of the proximal humerus. She was treated by internal fixation of the fractured glenoid by 2 screws, followed by hemi-arthroplasty of the shoulder. All patients were evaluated by the Constant’s Shoulder Score and by radiographs.

Results: Overall results were excellent and good in 27/33 Pts (82%). They were almost free of pain and most of them had almost complete ROM of the affected shoulder. In the group of the patients treated conservatively for undisplaced or minimal displaced fractures of the glenoid 22/26 (85%) had satisfactory results. Five of the patients treated surgically (71%) had excellent and good results, with some better results in less comminuted fractures. The remaining 2/7 Pts treated surgically had fair results. One of them had a comminuted fracture of the glenoid and the other patient had an associated compound fracture of the proximal humerus and a shoulder hemiarthroplasty.

Conclusions: Based on this study it seems that most fractures of the glenoid – undisplaced or minimally displaced – can be treated conservatively. However, for patients with displaced glenoid fractures, best results can be obtained with open reduction and internal fixation by screws or by plates. This should be followed by intensive physiotherapy.