Objectives:The use of cement is associated with increased morbidity and mortality rate in elderly patients, hence cementless hemiarthroplasty is suggested. We evaluated the results of cementless hemiarthroplasty for femoral neck fractures in elderly patients with high-risk clinical problems.Materials and Methods:Forty-eight patients (29 females, 19 males) with a mean age of 88 years (range: 78 to 102 years). having femoral neck fractures were treated with the use of cementless hemiarthroplasty. Porous-coated femoral stems were used in 30 patients (62%) and modular type femoral revision stems in 18 patients (38%). Bipolar femoral heads were used in all patients. Radiological follow-up after operation was done at the one, three, six months and annually.Results:The mean follow-up period was 4.2 years (range: 18 months to eight years). None of the patients died during hospitalization. Medical complications occurred in six patients (12%) within the follow-up period and four patients (8%) died within this period. Only two hips were converted to total hip arthroplasty due to acetabular erosion. Femoral revision was planned for one patient with a subsidence of > 3 mm. None of the patients had acetabular protrusion or heterotopic ossification. The mean Harris-hip score was 84 (range: 52 to 92). Dislocation occured in one patient (2%).Conclusion:Cementless hemiarthroplasty is a suitable method of treatment for femoral neck fractures in elderly patients with high-risk clinical problems especially of a cardiopulmonary nature. This method decreases the risk of hypotension and fat embolism associated with cemented hemiarthroplasty.

The insertions of the menisci to the tibia are the most important restraints to extrusion from the knee joint, and are vital for the functional integrity of the menisci. The aim of the present study was to determine variations of tibial insertions of the medial menisci (MM) in newborn cadavers macroscopically and in adults by arthroscopy. Neonatal part of this study was performed on 40 knee joints of 20 Caucasian neonatal cadavers. Adult part was performed on 41 Caucasian adults, whose ages were between 17 and 66 unilaterally by arthroscopy. In neonatal cadavers, according to its insertion, anterior horn of MM was classified in five groups and type 4, in which it was inserted to the transverse ligament, was determined the most frequent one (45%) and posterior horn of MM was classified in three groups and type 3, in which it was inserted to both the posterior intercondylar area of tibia and medial tubercle of intercondylar eminence was determined the most frequent one (50%). In adults, anterior end of MM was most frequently inserted to both anterior intercondylar area of tibia and transverse ligament (76%) and posterior horn of MM was inserted to the posterior intercondylar area of tibia in all of them. This study provides comparative information about insertion of the MM for neonatals and adults, not to evaluate the variants of the insertion of the MM as a tear of the anterior cruciate ligament or a meniscal tear and not to complicate arthroscopy.

This study presents the surgical and functional outcomes of below-knee total leg amputation and Gustilo type III C open fracture cases that were considered appropriate for salvage treatment according to a more proactive approach, despite being candidates for amputation according to the current scoring systems. Nineteen patients (21 legs) underwent replantation-revascularization surgery. At least Chen Grade II functional level was the aim. A limb salvage operation was performed in 21 legs in 19 patients (18 male, 1 female). The mean age was 28.5 years (range: 11 to 42 years). Six legs in four patients presented with total amputation, and 15 legs in 15 patients had Gustilo Type III C open fractures. A successful replantation/revascularization was performed in 20 legs, with a Chen Grade I and Grade II functional outcome in 3 and 17 legs, respectively. None of these patients were eligible for salvage operation according to currently used scoring systems. Limb-preserving surgery performed upon the assessment of local and general conditions of the patients with traumatic below-knee amputations or Gustilo Type III C open fractures seems to be a viable therapeutic option that can serve to achieve Chen Grade II functional level in most patients.

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