Aims

This pilot study aimed to evaluate prospectively the use of inlet radiographs of the hip as an alternative method of the assessment of reduction after the surgical treatment of developmental dysplasia of the hip (DDH).

Although intramedullary nail fixation maybe highly indicated for comminuted and segmental humeral fractures that require operative treatment, the literature lacks reviews of this content. The aim of the present study is to prospectively evaluate the clinical and radiographic outcomes in patients with combined head and shaft fractures of the humerus who were treated by antegrade locking intramedullary nailing. During a period of four years 21 patients (9 men & 12 women) between 36 and 82 years old, with combined fractures of the humeral head and shaft, were operated by one surgeon. Three types of nail implants were used (Polarus long, Garnavos nail, True flex nail) and ante-grade technique was performed in all cases. The mean operating time was 105 min (50′–140′). The period of follow-up averaged 14.25 months (range, 9 to 18 months). Two patients were lost to follow up and one died before the callus formation procedure was accomplished. The functional assessment included determination of the Constant score and documentation of shoulder function as compared with the non injured extremity. Radiographic control was obtained during the follow-up intervals and at the final follow up. No neurovascular complications, deep wound infections or non-unions were recorded and all fractures were fully healed between 4 to 8 months post-operatively. In one case the nail was extracted before callus formation was achieved, because of acromion impingement. The results are judged as very satisfying, taking into account the comminution of the fractures. Further evaluation of the results, with comparable methods of internal fixation of such fracture patterns, is needed

Early detection and management of developmental dysplasia of the hip (DDH) yields simpler and more effective the treatment. Diagnosis by ultrasound has changed the clinical view of the disease. However, the need and the way of ultrasound screening is still controversial. Diagnosis by ultrasound has shown that morphological abnormalities may not be associated with clinical signs. In Hungary all newborns are screened clinically within the first and also the third week of life, and controlled at the age of four month. Clinical examination is performed by an Ortopaedic specialist. Ultrasound screening is first performed for children with clinical signs and for children at risk at three weeks of age. Radiological examination, when necessary, is first performed at the age of four month. In the five year timeline (2001–2005) that was re-evaluated 7339 children presented 9706 times for screening for DDH at the University of Szeged (Hungary) Department of Orthopaedics. Out of these cases 6991 (95.2%) children were found to be healthy and 348 (4.8%) were diagnosed for DDH. Children with dysplasia presented 896 times for treatment and follow-up. Patient compliance in the DDH group was average 2.5 visits, while for the healthy group it was only average 1.2 visits. Because of clinical signs or risk factors 1569 (21%) children had ultrasound examination, all-together 2169 times. 84% of the initial ultrasound examination showed Graf stage Ia hip. Out of the diagnosed 348 DDH cases 31 patients (Graf IIa-IIc) were administered with Pavlik harness, and 314 (Graf Ib-IIa) were treated with splinting. Remaining 3 cases were diagnosed late, where no ultrasound examination was performed. In the DDH cases 832 ultrsonographic examination was performed during the treatment (average 2.4 examination/case). Radiographic control of all treated children excluded avascular necrosis in all cases. For this population 14 first operative procedure was needed so far. In our experience clinical screening and selective ultrasound examination is effective in the screening and early detection of developmental dyspalsia of the hip. In our practice, we promptly treated all patients with detected morphological changes as a deficiency in hip development. This way selective screening has helped us in the management of developmental dyspalsia of the hip. Hopefully, with the selective indication the number of false positive cases was reduced, while the „silent” clinical instabilities were given a chance for better long term development

Purpose: Revision surgery for total hip arthroplasty (THA) is frequent and defect filling has become a daily problem. Morbidity and insufficient graft supply complicate the problem. Worry about the long-term outcome of certain allografts together with the nearly complete disappearance of xenografts has led to wide development of the use of synthetic ceramic materials. Material and methods: We have used two biphasic calcium phosphate (BCP) synthetic ceramics for revision THA since October 1996. The first is supplied in quadrangular granules measuring a few mm on a side. It is composed of 55% hydroxyapatite (HA) and 45% tri-calcium phosphate (TCP). It presents pores of approximately 400 microns in diameter, total porosity, total interconnection of 60%. It is indicated for filling bony defects. The second BCP is composed of 65% HA and 35% TCP with smaller pores (200 mm) and a non-totally interconnected porosity so the compression resistance is 20–30 MPa. This material is indicated for mechanical support more than filling. Sixty-six femurs and 75 acetabula were reconstructed with these materials and reviewed at three to seven years. Granules were used alone for cavitary bone defects, both for acetabular defects and femoral defects as well as for reconstruction along osteotomy borders or fractures. For stage II ace-tabular bone loss, and some stage III cases, we preferred large-sized press fit cups on the residual bone. When this was not possible for greater stage III and IV segmentary bone loss, reconstruction was achieved with supporting rings anchored in the obturator foramen and applied to disks or other shapes of the second more dense ceramic material which allows greater loading. This second BCP was also very useful when the femoral cortical was too thin to support fixation alone by transfemoral cerclage. The material provided supplementary compression resistance. Results and discussion: There were no biological problems. There were two mechanical acetabular failures and five femoral failures which were secondary to technique errors or poorly adapted implants. Radiographic controls visualised substitute integration in contact with the recipient site. The granules resorbed progressively. The central more dense zone of the ceramic retained its density unchanged at five years while the material was resorbed progressively on the periphery. Histologically, integration of both BCP ceramics was proven on examination of biopsies. Conclusion: Despite this still mid-term follow-up of seven years, we can confirm that BCP ceramics are an attractive alternative for revision THA. In our experience, these ceramic materials are safe and efficient if classical indications and techniques for revision surgery are respected

Endoprosthetic reconstruction following resection of 31 tumours of the proximal femur in 30 patients was performed using a Wagner SL femoral revision stem. The mean follow-up was 25.6 months (0.6 to 130.0). Of the 28 patients with a metastasis, 27 died within a mean follow-up period of 18.1 months (0.6 to 56.3) after the operation, and the remaining patient was excluded from the study 44.4 months post-operatively when the stem was removed. The two patients with primary bone tumours were still alive at the latest follow-up of 81.0 and 130.0 months, respectively. One stem only was removed for suspected low-grade infection 44.4 months post-operatively. The worst-case survival rate with removal of the stem for any cause and/or loss to follow-up was 80.0% (95% confidence interval 44.9 to 100) at 130.0 months. The mean Karnofsky index increased from 44.2% (20% to 70%) pre-operatively to 59.7% (0% to 100%) post-operatively, and the mean Merle d’Aubigné score improved from 4.5 (0 to 15) to 12.0 (0 to 18). The mean post-operative Musculoskeletal Tumour Society score was 62.4% (3.3% to 100%).

The Wagner SL femoral revision stem offers an alternative to special tumour prostheses for the treatment of primary and secondary tumours of the proximal femur. The mid-term results are very promising, but long-term experience is necessary.

We have assessed whether an epidural steroid injection is effective in the treatment of symptoms due to compression of a nerve root in the lumbar spine by carrying out a prospective, randomised, controlled trial in which patients received either an epidural steroid injection or an intramuscular injection of local anaesthetic and steroid. We assessed a total of 93 patients according to the Oxford pain chart and the Oswestry disability index and followed up for a minimum of two years. All the patients had been categorised as potential candidates for surgery.

There was a significant reduction in pain early on in those having an epidural steroid injection but no difference in the long term between the two groups. The rate of subsequent operation in the groups was similar.