Background/Purpose The purpose of this study was to evaluate the clinical and radiographic outcomes of primary cementless total hip arthroplasty (THA) with acetabular defect reconstruction using structural bone grafts. Methods Between 2001 and 2012, 10 hips in eight patients with uncontained superolateral acetabular bone defects were reconstructed with femoral head grafts at the time of primary cementless THA. The mean age at surgery was 61.7 years. Patients were followed-up for a mean of 5.8 years for evaluation. Results With either revision or loosening as endpoints, the survival rate of the structural grafts was 100%. Significant improvements in clinical outcomes in terms of the Visual Analogue Scale for Pain (from 9.5 to 3.3, p = 0.005) and Harris Hip Score (from 32.7 to 73.9, p = 0.005) were noted. Conclusion Uncontained superolateral acetabular bone defects can be effectively reconstructed with structural bone grafts during primary THA, with excellent short- to midterm survival rate and significantly improved clinical outcomes.
We report the case of a 36-year-old lorry driver who sustained left dorsal radiocarpal fracture dislocation and left median nerve injury in a traffic accident in 2010. Emergency operation of closed reduction, cross-wrist-bridging external fixation, percutaneous transradial styloid Kirschner wire fixation, decompression of left median nerve, and repair of the partially torn palmar radiocarpal ligament were performed under general anaesthesia. Because of the persistent depressed dorsal articular rim fracture of left distal radius, another operation of open reduction, corticocancellous bone grafting, and dorsal buttress plating was performed 5 days after the initial operation. Six months after the operation, the patient enjoyed good range of wrist motion but weak twisting power, especially in supination. There was no radiological feature of radiocarpal subluxation.
This article is about two patients having vascular injuries complicating total hip arthroplasty because of intraoperative indirect injuries. One patient had a delayed presentation of acute lower limb ischaemia, in which he required amputation of his left second toe because of ischaemic gangrene. The other patient had acute lower limb ischaemia leading to permanent muscle and nerve damage because of delayed recognition. Both patients had vascular interventions for the indirect vascular injuries. Preoperative workup for suspicious underlying peripheral vascular disease, intraoperative precautions, and perioperative period of vascular status monitoring are essential for prevention and early detection of such sinister events.
a b s t r a c tObjective: The aim of this retrospective study was to analyse the clinical outcome of the application of stainless steel 2.0-mm locking compression plate (LCP) system for the treatment of comminuted hand fractures in Asian adults. Methods: Six patients who had comminuted hand fractures were treated by open reduction and internal fixation with the application of stainless steel 2.0-mm LCP (AO Compact Hand System; Synthes, Oberdorf, Switzerland) from December 2009 to October 2010. The total arc of motion of fingers, grip power, complications, and additional surgery were recorded. Results: Three out of six patients eventually restored good hand functions in terms of the total arc of finger motion (>220 ) and grip power. The commonest complication was skin impingement in finger region by the implant (4 cases). Another common complication was restricted range of motion (3 cases). One patient had minimal degree of malrotation of his left little finger. Additional surgery was required in all the patients for implant removal (6 cases), tenolysis (3 cases), and capsulotomy (2 cases). Conclusions: The stainless steel 2.0-mm LCP is useful for the fixation of unstable comminuted hand fractures, especially in metacarpal bones, because of its advantage of better stability, which allows more aggressive rehabilitation. However, its design is not very versatile and, therefore, limits its use in the finger region. Its bulkiness frequently causes implant impingement. The patients must be informed about the chance of implant removal later.
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