In this retrospective study, we present our experience using open Küntscher nailing (K-nailing) which is still performed in developing countries for femoral fractures. Of 157 acute fractures treated between January 2003 and December 2009, 100 were stable (63.7%) and 135 were located within the middle third of the shaft (86%). Comminution was absent or minimal in 135 (86%) cases. Fracture union was achieved at an average of 14 weeks (range, 10 -25). The duration of follow-up was 17 months (range, 6 -36). Final evaluation showed that 129 (82.2%) patients had a good result according to modified Kempf's criteria. The predominant complications were infection (n=5; 3.2%), nonunion (n=9; 5.5%), implant failure (n=11; 7%), and malunion (n=27; 17.3%). Open reduction and fixation with a tight fitting Knail can give good results in selected acute femoral shaft fractures but knowledge of potential complications is needed.
We present a case of combined avulsion fracture of the tibial tubercle (AFTT) and avulsion of the patellar ligament in a 15-year-old boy. This injury was treated by open reduction and fixation of both lesions using staples with satisfactory results. This constellation of injury is rare but a high index of suspicion is needed when faced with a displaced AFTT. Open reduction and internal fixation should be the treatment of choice.
Closed Hackethal's technique using K-wires gives satisfactory results in terms of bone union and elbow and shoulder function in selected humeral shaft fractures. The articulated support precludes the transolecranon traction.
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