Primary Total Elbow Replacement (TER) is gaining popularity as a primary treatment option for osteoporotic fractures of the elbow, particularly in patients with low demand. The aim of this study was to assess the clinical and functional efficacy of TER as a primary treatment for comminuted distal humerus fractures in the elderly. We retrospectively reviewed twenty-three patients (22 females and 1 male) who were treated with primary total elbow replacement for complex, intra-articular fractures of the distal humerus in the elderly between March 2000 and January 2010. The average age of the patients was seventy-five years (ranging from 66 to 94 years). Postoperative elbow function was assessed using the Mayo Elbow Performance Score. The radiological assessment was performed using antero-posterior and lateral radiographs done at follow-up appointments.Introduction
Methods
The use of the dynamic hip screw is common practice for the fixation of intertrochanteric fractures of the femur. The success of this procedure requires accurate guide wire placement. This can prove difficult at times and can result in repeated attempts leading to longer operating time, multiple tracks and more importantly greater radiation exposure to both patient and operating staff. We hypothesised that rather than using the standard anterior-posterior projected image (Figure 1) of a proximal femur, rotating the intensifier image (Figure 2) so that the guide wire appears to pass vertically makes it easier to visualise the projected direction of the guide wire. Fifty Specialist Registrars, thirty participating in the London hip meeting 2009, ten from Oxford and ten from Northern deanery orthopaedic rotations were involved in the study. They were presented with standard AP and rotated images of the femoral neck on paper using 135 degree template to replicate the DHS guide. The participants were asked to mark the entry point on the intertrochanteric area of femur on the image where they would have placed the guide wire. They did this on both standard AP and rotated images aiming for the centre of the head of the femur. Fig. 1 Standard AP image Fig. 2 Rotated imageIntroduction
Methods
