Introduction

In most cases of stable type medial femoral neck fracture and some cases of dislocated medial femoral neck fracture, internal fixation was undertaken. Dual SC Screw (DSCS) System is an internal fixation device which has sliding mechanism and preventing mechanism of back out of the screw. The purpose of this study is to evaluate the results and complication of medial femoral neck fracture treated with DSCS.

Introduction

Plate fixations have been recommended for dislocated clavicle fractures. However, existing plates are inadequate for morphological compatibility with the clavicle. The aim of this study is to measure the anatomical shape of the clavicle and to compare the radiographical and clinical outcomes of our tree-dimensional (3D) reconstruction plate with conventional straight plate.

Aims

Dual SC Screw (DSCS) is a novel fixation device for the femoral neck fracture. DSCS is comprised of screw and barrel allowing sliding of the screw and preventing protrusion of the screw end. Two types of the barrels are available, threaded barrel (TB) and plate barrel (PB). Ordinarily, both barrels are implanted. Concept of the design is that the PB contributes stability to the screw against the varus force of the femoral head while the additional screw with TB prevents rotational deformity. The aim of this study was to represent clinical results after DSCS operation in patients with femoral neck fracture.

Thirty-three knees in thirty-three patients who underwent ACLR using four-strand semitendinousus and gracilis tendon in our hospital were included in this study. In 17 knees, we use a fluoroscopic-based navigation system (Vector Vision ACL, BrainLab. Inc.) for positioning of the tunnels (Group 1). In the remaining 16 knees, positioning of the femoral and tibial tunnels was done without navigation (Group 2).

In navigation operation, anteroposterior and lateral images of the knee were taken with a fluoroscope and captured into the computer. The optimal target points for bone tunnels were semi-automatically calculated and displayed on the screen. Femoral placement was determined based on the quadrant method. The target for tibial tunnel was set at 43% of tibial plateau AP length. Intraoperatively, positions of the drill guides were decided referring to both navigation image and arthroscopic image. We evaluated Lysholm score, International Knee Documentation Committee (IKDC) subjective score, Lachman test and pivot shift test at 1 year after operation and calculated bone tunnel position on the postoperative lateral x-ray films and expressed them as relative values against total AP length of the Blumensaat's line and of the tibia plateau.

Lysholm score, IKDC subjective score, Lachman test and pivot shift test were not significantly differed between the groups. The femoral tunnels were 74.2±3.3% in Group 1 and 71.7±6.0% in Group 2 along and the tibial tunnels were 42.1±1.4% in group 1 and 43.0±4.6% in group 2 along the tibia plateau. Although femur and tibial tunnel positions were not significantly differed between the groups, variation of bone tunnel position was significantly smaller in Group 1, indicating a good reproducibility. One pin tract infection occurred in Group 1. This case successfully treated with debridment and antibiotics containing cement filling.

Fluoroscopic navigation system is quite helpful for precise and reproducible creation of both femur and tibial tunnel. The results encourage us to use this system for double-bundle anatomical ACLR. However, a special care must be taken to avoid complication caused by tracker pin placement.

The ligament balance as well as the alignment is essential for successful total knee arthroplasty (TKA). However it is usually assessed and adjusted only at 0? and 90?. In order to evaluate the ligament balance at the other angles we have used a navigation system. Twenty-one patients underwent posterior stabilised mobile bearing TKA using a CT-based navigation system were included in this study. Immediately post-operation and still under anaesthesia, varus and valgus stresses were applied on operated knees manually at 0?, 30?, 60?, 90? and 120?. The ligament balance was calculated based on the angles under varus and valgus stress displayed on the navigation screen, presenting a relationship between the femoral and tibial cutting planes. The mean ligament balance angle at 0?, 30?, 60?, 90? and 120? were −2? ± 3.6?, −5.8? ± 7.9?, 5.0? ± 6.9?, −1.3? ± 5.4?, 7.9? ± 7.2?, respectively. At 0? and 90? balance was well adjusted, however in the other angles, it was quite varied. At 30? and 120?, the lateral side was loose, on the other hand, medial side was looser at 60? knee flexion angle. The good balance at 0? and 90? is understandable because the balance is assessed and adjusted in these angles. Regarding the other angles, the 30? and 120? results corresponded with previous studies; however, the 60? results did not correlate. Although the reason is unknown, it must be aware the mid-flexion and deep flexion instability is quite common. Further investigations about the impact on clinical outcomes of such instabilities and how to adjust them if they are critical are needed.

We treated patients with severe slipped capital femoral epiphysisor SCFE with a posterior tilt angle or PTA of greater than or equal to 60 degrees with a Sugioka transtrochanteric rotational osteotomy. We report on the clinical and radiologic results of tis method.

The study was performed on 8 cases (including 9 hips) of slipped capital femoral epiphysis, for which transtrochanteric rotational osteotomy of femoral head (Sugioka method) was carried out in author’s department from 1987 to 1996. The age of onset ranged from 9 to 14 years old (average: 11.6 years). There were 4 boys (4 hips) and 4 girls (5 hips). The follow-up period ranged from 2 years to 10 years (average: 4.4 years). Three of the treated hips were classified as chronic and 6 as acute on chronic. Preoperative head-neck angle (HNA) was 64 – 83 degrees (average: 68 degrees). All patients were performed a transtrochanteric rotational osteotomy of the femoral head which is known as the Sugioka method. The rotational angle was from 70 degrees to 90 degrees. The presence of pain, postoperative range of motion, PTA on postoperative X-rays, avascular necrosis and osteoarthritic change were examined as part of the evaluation of the clinical results.

Necrosis of femoral head was found in one case, while no pain was noted in the other cases, and the range of motion was generally satisfactory. In the radiologic results, PTA was improved to 10 – 25 degrees (average: 18.5 degrees).

Necrosis of femoral head was observed in one hip, but the results were satisfactory in 7 cases (8 hips). These results suggest that this technique is useful for the treatment of severe cases of slipped capital femoral epiphysis