Level IV, retrospective case series.

Background:When primary fixation of proximal femoral fractures with implants fails, revision osteosynthesis may be challenging. Tracts of previous implants and remaining insufficient bone stock in the proximal femur pose unique problems for the treatment. Intramedullary implants like proximal femoral nail (PFN) or surface implants like Dynamic Condylar Screw (DCS) are few of the described implants for revision surgery. There is no evidence in the literature to choose one implant over the other. We used the reverse distal femur locking compression plate (LCP) of the contralateral side in such cases undergoing revision surgery. This implant has multiple options of fixation in proximal femur and its curvature along the length matches the anterior bow of the femur. We aimed to evaluate the efficacy of this implant in salvage situations.Materials and Methods:Twenty patients of failed primary proximal femoral fractures who underwent revision surgery with reverse distal femoral locking plate from February 2009 to November 2012 were included in this retrospective study. There were 18 subtrochanteric fractures and two ipsilateral femoral neck and shaft fractures, which exhibited delayed union or nonunion. The study included 14 males and six females. The mean patient age was 43.6 years (range 22–65 years) and mean followup period was 52.1 months (range 27–72 months). Delayed union was considered when clinical and radiological signs of union failed to progress at the end of four months from initial surgery.Results:All fractures exhibited union without any complications. Union was assessed clinically and radiologically. One case of ipsilateral femoral neck and shaft fracture required bone grafting at the second stage for delayed union of the femoral shaft fracture.Conclusions:Reverse distal femoral LCP of the contralateral side can be used as a salvage option for failed fixation of proximal femoral fractures exhibiting nonunion.

Therapeutic, Level IV: Case study.

No abstract

Hallux varus is an uncommon deformity in which the great toe is angled medially at the metatarsophalangeal joint. It exists in congenital as well as acquired forms. Congenital hallux varus is less common than the acquired type and is best addressed in infancy. If the deformity is not addressed early, or is undercorrected, the soft tissue imbalance will create osseous changes that maintain the deformity into adolescence or adulthood. Presentation of such neglected congenital hallux varus in adolescence or adulthood is rare. Its true incidence is not known. Several procedures have been described in the literature to correct congenital hallux varus presenting in infancy. To our knowledge, however, there is no recommended management strategy for correction of congenital hallux varus deformity presenting in adolescence or adulthood. In this article we describe an innovative technique to correct neglected congenital hallux varus by a simple, inexpensive, and reproducible method, which does not require plastic surgery.Level of Evidence: Diagnostic Level 4. See Instructions for Authors for a complete description of levels of evidence.

Fingertip injuries are extremely common injuries and generally result from blunt or crushing trauma that causes compression of the nail plate to the underlying bony surface. This may result in nail plate disruption, nail bed laceration, volar pulp loss or even amputations. Modified dorsal tension band suture technique is a well established, simple and useful procedure for the management of dorsal element disruptions. Partial or complete nail plate avulsion, nail bed lacerations with or without fracture of the distal phalanx can be treated by this technique. We treated 260 patients with 288 fingertip injuries by modified dorsal tension band suture technique that resulted in the reformation of normal nail plate. All patients showed excellent aesthetic and functional outcome and returned to their pre-injury occupational activity. The purpose of presenting this article is to evaluate and document the clinical outcome associated with this simple surgical technique which does not require specific hand surgery training. Keywords: Finger tip injury; nail bed laceration; partial nail plate avulsion; complete nail plate avulsion; figure of 8 loop.