Background: The Hansson Twin Hook (HTH) is an alternative to the sliding hip screw in the treatment of trochanteric fractures. In osteoporotic bone, biomechanical tests indicate better fixation properties of the HTH than of the lag screw. Our aim was to evaluate the technical results of the HTH in a larger series of osteoporotic patients with intertrochanteric fractures. Many surgeons were involved to assess, if the device was user-friendly.

Patients and Methods: In a prospective bicentric study, 55 surgeons used the HTH and a standard plate in 157 consecutive patients with intertrochanteric fractures, of which 83% were unstable. The mean age of the patients was 83 years. The patients were followed regularly clinically and radiographically for at least 4 months with a final control at 2 years.

Results: Technical intraoperative errors were done in 7 of the patients. The reduction of the fracture was inaccurate in these cases; hence the HTH had not been placed centrally in the femoral head. Two of the 7 intraoperative errors developed into failures of fixation (1.3%) during the 2-year period.

Interpretation: The HTH achieves adequate fixation purchase in osteoporotic bone, has a low failure rate and is easy to use.

Introduction: The most common method for internal fixation of olecranon fractures is AO tension band wiring (TBW). A number of complications related to this technique have been described, such as subcutaneous prominence of the device, skin irritation, infection, loss of extension in the elbow joint and non-union.

To avoid those complications Dr. Robert J. Medoff has designed a new device, the ulnar sled, which will be shown on a picture.

The objective of this cadaver study was to determine the stability of olecranon fracture fixation with the ulnar sled and compare it with AO method.

Methods: In six matched pairs of fresh-frozen arms a fracture of the olecranon was created and stabilized with either TBW or the ulnar sled.

The ulnar sled (US) group: The two free legs of the sled were inserted into two pre-drilled holes from the tip of the olecranon into the ulna medullary cavity of the ulna. The washer was then placed with its slot over the prominence of the sliding plate and with a screw fixed bicortically into the ulna, through the distal part of the proximal oval washer hole. Compression over the fracture site could be observed visually and the washer was finally fixed with another bicortical screw in its distal hole.

The TBW group: In the TBW group the AO technique with oblique bicortical K-wires and the two-knot-modification was used.

Mechanical Testing: First the brachialis and then the triceps muscle were sequentially loaded with 5 kg (50N) for 20 cycles in three different angles: 45, 90 and 135. The fracture displacement was measured before and after loading.

Results: The increase in the fracture gap after 20 cycles of loading for the two fixation techniques will be shown in a table. There was no significant increase of the fracture gap for either device when loading the brachialis muscle at any of the three flexion angles. The fracture displacement in 90 in triceps loading was 0.23mm in the the US group and in 0.19mm in the TBW group. This difference was not significant (p> 0.05). Similar results were obtained for the other flexion angles. Almost no displacement was observed in brachialis loading with either method.

Discussion: The results suggest that the ulnar sled method is a stable surgical method for fixation of uncommuted olecranon fractures when compared to TBW.

We compared 54 patients treated by a Medoff sliding plate (MSP) with 60 stabilised by a compression hip screw (CHS) in a prospective, randomised study of the management of intertrochanteric femoral fractures. Four months after the operation femoral shortening was determined from radiographs of both femora.

In unstable fractures the mean femoral shortening was 15 mm with the MSP and 11 mm with the CHS (p = 0.03). A subgroup in which shortening was classified as large, comprising one-third of the patients in each group, had a similar extent of shortening, but more medialisation of the femoral shaft occurred in the CHS (26%) than in the MSP (12%) group (p = 0.03). Five postoperative failures of fixation occurred with the CHS and none with the MSP (p = 0.03). The marginally greater femoral shortening seen with the MSP compared with the CHS appeared to be justified by the improved control of impaction of the fracture. Biaxial dynamisation in unstable intertrochanteric fractures is a safe principle of treatment, which minimises the rate of postoperative failure of fixation.

The Medoff sliding plate (MSP) is a new device used to treat intertrochanteric and subtrochanteric fractures. There are three options for sliding; either along the shaft or the neck of the femur, or a combination of both.

In a prospective series of 108 consecutive displaced intertrochanteric fractures we used combined dynamic compression. The patients were followed clinically and radiologically for one year. All fractures healed during the follow-up period. The only postoperative technical failure was one lag-screw penetration.

Combined compression of the MSP gives increased dynamic capacity which reduces the risk of complications. The low rate of technical failure in our series compares favourably with that of the sliding hip screw or the Gamma nail but randomised trials comparing the MSP with other hip screw systems are necessary to find the true role of the MSP with its various sliding modes.

Cardiac and neurological functions were evaluated at the time of operation in 81 randomly selected elderly patients who had sustained a fracture of the neck of the femur. Although only one-fifth of the patients had clinical signs of senile dementia or cerebrovascular disease on admission to hospital, more than half had seriously abnormal EEGs including 12 of the 15 patients who died within six months. ECGs before operation showed that patients with signs of arrhythmia or previous myocardial infarction had a much lower survival rate than those with normal or other pathological ECG signs. Nerve conduction velocity findings proved inconclusive when correlated with survival or return home. Routine EEG and ECG examinations are of value in detecting underlying dysfunctions which may not be observable clinically on admission but are important prognostic indicators for survival or return home, and may be implicated as causative factors of fracture in the elderly.