Background:The optimal operative method for acromioclavicular joint reconstruction remains controversial. The modified Weaver-Dunn method is one of the most popular methods. Anatomic reconstruction of coracoclavicular ligaments with autogenous tendon grafts, widely used in treating chronic acromioclavicular joint instability, reportedly diminishes pain, eliminates sequelae, and improves function as well as strength. Objective:To compare clinical and radiologic outcomes between a modified Weaver-Dunn procedure and an anatomic coracoclavicular ligaments reconstruction technique using autogenous semitendinosus tendon graft.Methods:Twenty patients (mean age, 39 years) with painful, chronic Rockwood type III acromioclavicular joint dislocations were subjected to surgical reconstruction. In ten patients, a modified Weaver-Dunn procedure was performed, in the other ten patients; autogenous semitendinosus tendon graft was used. The mean time between injury and the index procedure was 18 month (range from 9 – 28). Clinical evaluation was performed using the Oxford Shoulder Score and Nottingham Clavicle Score after a mean follow-up time of 27.8 months. Preoperative and postoperative radiographs were compared.Results:In the Weaver-Dunn group the Oxford Shoulder Score improved from 25±4 to 40±2 points. While the Nottingham Clavicle Score increased from 48±7 to 84±11. In semitendinosus tendon graft group, the Oxford Shoulder Score improved from 25±3 points to 50±2 points and the Nottingham Clavicle Score from 48±8 points to 95±8, respectively.Conclusion:Acromioclavicular joint reconstruction using the semitendinosus tendon graft achieved better Oxford Shoulder Score and Nottingham Clavicle Score compared to the modified Weaver-Dunn procedure.

Purpose Post-traumatic arthritis is one of the leading causes of joint disability. This study aims at outlining outcomes of total knee arthroplasty in post-traumatic arthritis and technical difficulty and reviewing literature regarding this issue Patients and methods We analyzed the outcome of total knee arthroplasty following post-traumatic arthritis in 15 patients with unilateral involvement. Ten had stable arthritic knees treated with posterior stabilized (PS) prosthesis, while five with unstable arthritic knees treated as follows: three with ligamentous instability managed by constrained condylar prosthesis and two with osseous deficiency, metal augmentation used together with stemmed constrained condylar prosthesis (CCK). Average follow-up 6 years, mean age 49.8 years at time of arthroplasty. Patient outcomes were evaluated on the basis of Knee Society score. Results Mean clinical knee society scores (CKSS) at latest follow-up improved from 43.6 ± 11.66 points to 77.3± points postoperatively while mean functional knee society score (FKSS) improved from 40. ± 6.3 to 76.6 ± 84 postoperatively. Patients with stable knees had a higher mean values, both clinical and functional KSS, while unstable knees were poorer. Complications occurred in three cases, one with wound dehiscence with prolonged drainage treated by antibiotics and daily dressings until the wound closed completely, one was complicated by infection and improved by serial debridement, and the third case had aseptic loosening which required revision surgery. Conclusion Total knee arthroplasty for post-traumatic arthritis decreases pain and improves knee function. However; the procedure is not as simple as primary arthroplasty as it is technically demanding and requires adequate planning.

Aim: Pathologic fractures occur as a result of weakening of the mechanical properties of bone. There are many conditions, which lead to bone softening. There are neoplastic and non-neoplastic diseases that cause pathologic fractures. The aim is to evaluate and to highlight on value of prophylactic fixation of impending fractures in abnormal bone situation to prevent occurrence of pathological fracture and its complications. Patients and methods:Between 2003 and 2009, study on forty-nine patient (35 females and 14 males) between the age of 20 and 65 years with an average age of 49.9 years with expected possibility of fractures of lower extremities. The entire patient with fractures risks prophylactic fixation has done. Different types of fixation either surface plating (dynamic hip screws), medullary (Gamma nails or locking nail) or external fixation in cases unsuitable for surgery was used according to the type and the site of the deformity in combination of management of primary condition.Results: Most patients had significant relief of pain. 35 (71.5%) of patients with impending fracture were ambulatory after therapy and able to walk outdoor while 10 (20.5%) of patients could walk inside door. Three patients (6%) using wheel chair, and they were on renal dialysis. Only one patient (2%) was not able to walk, and he was not cooperative for unknown reason. The mean duration of hospitalization was 21 days (range from 7 to 35 days). That time included preoperative period of investigation and preparation and post-operative surgery and rehabilitation.Discussion: Pathological fractures create a serious morbidity in patients with bone disease. Orthopedic surgeons who look after patients with skeletal lesions should focus on proactive treatments designed to prevent pathologic fractures before they occur. Prophylactic fixations have decreased morbidity compared with patient's sustained fractures before fixation. Conclusion:Surgical fixation of fractures in weight-bearing long bones with impending fractures provides pain relief, and a functionally stable and durable construct. It helps early an ambulation and prevents fracture's complication. It allows independent function and avoids irretrievable catastrophes.

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