Objectives: To evaluate the use of surgical management in displaced scapular neck fractures. Subjects and Methods: 14 adult male patients (average age 34 years, range 19–44) with displaced scapular neck fractures were treated by open reduction and internal fixation in Al-Jahra Hospital, Kuwait from April 2000 to January 2004. Patients’ clinical and radiological results were analyzed retrospectively. Results: The average follow-up was 20 months (range 6–30 months). Anatomical or near-anatomical reduction of the fracture with excellent clinical function was obtained in 12 patients (86%) and with good functional outcome in 2 patients (14%). One patient with associated head injury developed heterotopic ossification connected to the lateral border of the scapula. Conclusion: The results of this report show that open reduction and internal fixation of grossly displaced scapular neck fractures are the treatment of choice for these injuries to restore the normal biomechanics of both glenohumeral and scapulothoracic joints and allow favorable clinical outcome.
Objectives: To review the primary and the final results of surgical management of ipsilateral femoral neck and shaft fractures. Subjects and Methods: Seventeen patients (2 female, 15 male, average age 37 years, range 20–60) with ipsilateral femoral neck and shaft fractures were treated by compression plate fixation for the femoral shaft fractures and dynamic hip screw or cannulated cancellous screw fixation for the neck fractures in Al-Razi and Al-Jahra Hospitals, Kuwait, from March 1996 to June 2002. The clinical and radiological primary and final results were analyzed retrospectively. Results: The average follow-up for the primary outcomes was 3.6 years (range 2–6 years). 100% union of the femoral neck fractures, 0% osteonecrosis of the femoral head and 77% union of the shaft fractures were achieved. Complications of femoral shaft fractures, nonunion and metal failure, occurred in 4 (23%) patients and postsurgical infection occurred in 1 patient. At the final follow-up, 15 (88%) patients achieved good clinical outcome and 2 (12%) had fair outcome. Conclusion: Our results show that compression plate fixation for the femoral shaft fracture and dynamic hip screw or cannulated screw fixation for the neck fracture in combination injury is a reliable and adequate technique.
Objective: The aim of this study is to investigate healing of fractures in patients with concomitant head injuries and to measure blood hormone levels to elucidate the mechanism of a possible accelerated osteogenesis. Materials and Methods: One hundred and sixty-two patients were included in this study and divided into 3 cohorts: group A with head injuries only (n = 52); group B with head injuries as well as long-bone fractures (n = 50); group C with long-bone fractures only (n = 60). Fracture-healing parameters including time of appearance and thickness of the bridging callus, and blood hormonal assays were measured and compared using Student's t test. Results: The mean time to healing was significantly lower in cohort B (6.9 ± 2.9 weeks) than C (22.4 ± 8.7 weeks; p = 0.001). The mean thickness of the healing callus was significantly higher in cohort B (26.3 ± 9.7 mm) than C (8.1 ± 5.9 mm; p = 0.002). The mean healing rate was also higher in cohort B (4.5 ± 2.3 mm/week) than C (0.38 ± 0.21 mm/week; p = 0.001). Blood hormonal assays in group B showed higher values of parathyroid hormone and growth hormone than in group C. However, adrenaline and noradrenaline values were lower in group B than in group C at all measured time intervals, and correspondingly leptin was lower in all groups (p = 0.001). Corticosteroid values were normal in group B compared to slightly higher values in group C, also at all measured time intervals. Conclusion: In this study, healing of fractures in patients with concomitant head injuries was accelerated, thereby indicating an involvement of a combined neurohormonal mechanism.
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