We aimed to report our initial experience with the use of cementless, rectangular, dual-taper, straight femoral stem (SL-PLUS) with bipolar head prosthesis in femur neck fractures.

We operated 50 consecutive patients (28 women, 22 men; age ranged from 41 to 99 years; mean age 74) due to femur neck fractures and inserted the above-mentioned prosthesis. We used cemented femoral stem in severely osteoporotic patients. According to the Garden’s classification, there were 12 type II, 34 type III and 4 type IV fractures. We used direct lateral or posterolateral approach to insert the prosthesis. The entire operating time did not exceed 90 minutes and severe bleeding was not seen, in any patient. All patients were allowed to full weight bearing by a walker within the first postoperative 48 hours. We could evaluate the functional outcome of 25 patients who survived and had at least 6 months complete follow-up. We used Harris’ hip score for evaluation of the patients’ functional outcomes. Eight patients were lost to follow-up within the first postoperative 3 months, 15 patients died within the first postoperative 8 months and two patients could not walk due to an initial cerebrovascular disorder. The data of 15 patients, who passed away, showed that, mean age was 82 (70–99) years, 13 of 15 them were older than 75 years, 9 were man and 6 were woman, there were 2 type 2, 11 type 3 and 2 type 4 fractures.

Mean age of the included patients was 70 (41–88) years. There were 18 women and 7 men. There were eight type II, 15 type III and 2 type IV fractures. After a mean follow-up period of 17 (6–27) months, the mean hip score of 25 patients was 77 (51–96) points. There were two excellent (90–100 pts), 7 good (80–89 pts), 12 fair (70–79 pts) and 4 poor (< 70 pts) functional outcomes. Similar mean hip scores were observed between ≤70 (77.9 pts) and > 70 years (75.8 pts) age groups (P=0.849), between man (78.0 pts) and woman (76.1 pts) patients (P=0.297) and between Garden type II (70.9 pts) and Garden types III–IV (79.3 pts) fractures (P=0.075).

The rate of obtaining a satisfactory or fair functional outcome in the surviving elderly patients who were initially treated using a cementless, rectangular, dual-taper, straight femoral stem with bipolar head prosthesis due to femur neck fractures was 84% at the early postoperative period. Age, gender and type of the fracture do not influence the functional outcome. The risk of early postoperative mortality seems to increase in patients older than 75 years and with displaced fractures.

This kind of prosthesis can be preferred to lessen the operation time, intraoperative bleeding, to avoid the peroperative complications due to bone cement application and to allow early postoperative rehabilitation in femur neck fractures of the geriatric population.

The aim of this retrospective study was to assess the effects of several preoperative and intraoperative factors on the final clinical and radiological outcomes in pediatric hip fractures.

Forty-four pediatric patients with a hip fracture were treated at our department between January 1998 and September 2007. Thirty-nine patients with a minimum follow-up period of 1 year were included the study. Three patients had inadequate follow-up and two died at the early postoperative period. Mean age of 39 patients were 11.1 (4–16) years. There were 22 boys and 17 girls. The two main etiologic factors were traffic accident and fall from height. Associated injury was present in 15 patients and the pelvis and distal radius fractures were the two most common. The type of the hip fracture according to the Delbet classification was type II in 21, type III in 14 and type IV in 4 patients. Two patients were treated by a hip spica under general anesthesia and 37 were surgically treated by internal fixation using mostly 3 cancellous screws. Ratliff’s clinical and radiological assessment system was used to assess the final outcome and Ratliff’s classification was used for grading the avascular necrosis of the femoral head (AVN). The effects of patient age, gender, fracture type, fracture displacement, laterality, intervention time and capsulotomy on the final outcome were evaluated and a P value less than 0.05 was considered significant.

Mean follow-up was 3.1 (1–9.5) years and the final outcome was satisfactory (good) in 28 (72%) and unsatisfactory (fair or poor) in 11 (28%) patients. AVN was observed in 11 (28%) patients. No significant correlation was found between the final outcome and age (< =10 yrs vs. > 10 yrs; P=0.288), laterality (P=0.477), gender (P=0.158), intervention time (< =24 hours vs. > 24 hours; P=1.0), capsulotomy (P=0.609) or amount of displacement (displaced vs. non-displaced; P=0.078). However, there was a significant correlation between the final outcome and fracture type (worst in type II; P=0.014).

The risk of AVN is nearly 30% in pediatric hip fractures and it is the main determinant of the final outcome. The final radiological and clinical outcomes are correlated significantly with fracture type. Besides, fracture displacement may influence the final outcome. As, cervical femoral neck fractures (mainly displaced) have a higher risk of unsatisfactory outcome in children, the patients and parents should initially be warned about this subject.

Arthrography is a valuable diagnostic tool in pediatric orthopaedics. Although it is considered safe for systemic use of water-soluble contrast media, toxicities in some tissues have been identified.

The goal of this study is to describe the ultrastructural alterations induced by intra-articular two water soluble contrast media, namely Dimeglumine and Iopromide, in rabbit joint cartilage.

60 rabbit knees were used in this study, 20 receiving 1 ml injections of Dimeglumine, 20 receiving 1 ml injections of Iopromide and the remainder of the knees served as control and injected 1 ml physiological saline. The animals were killed after 1 hour, 1 day, 1 week and 2 weeks and a specimen of the knee cartilage were immersed in to %5 Glutaraldehyde + Phosphate buffer solution and fixed for overnight at +5° C. Tissues were postfixed in %1 Osmium Tetroxide solution for 1 hour and samples were routinely proccessed for electron microscopy.

In the knees injected with SF, the cartilage appeared normal on transmission EM examination and only rare chondrocytes with small glycogen and lipid vacuoles were observed, whereas in those injected with Dimeglumine and Iopromide, increased activation of cells, glycogen and lipid accumulation, collagen fibrils in matrix and especially in those injected with Iopromide decreased matrix around the cells were present in the cartilage. There were very rare picnotic cells in these samples. Contrast agents have local effects as well as systemic effects. In this study detrimental local effects of contrast agents have been demonstrated by high dose exposure in rabbit joint cartilage. We concluded that further work is needed to determine if these effects are of clinical importance.