Strategies in Trauma and Limb Reconstruction

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2011 | April | Volume 6 | Issue 1

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Original Article

Mostafa Abdelkhalek, Mohamed Abdelwahab, Ayman M. Ali

Bipolar versus fixed-head hip arthroplasty for femoral neck fractures in elderly patients

[Year:2011] [Month:April] [Volume:6] [Number:1] [Pages:6] [Pages No:1 - 6]

Keywords: Femoral neck fractures, Hip prosthesis, Arthroplasty

   DOI: 10.1007/s11751-010-0100-1  |  Open Access |  How to cite  | 


Between 2002 and 2007, fifty elderly patients with displaced femoral neck fractures were treated with hip replacement at Emergency Hospital, Mansoura University. Patients were randomly selected, 25 patients had either cemented or cementless bipolar prosthesis, and another 25 patients had either cemented or cementless fixed-head prosthesis. There were 34 women and 16 men with an average age of 63.5 years (range between 55 and 72 years). All patients were followed up both clinically and radiologically for an average 4.4 years (range between 2 and 6 years). At the final follow-up, the average Harris hip score among the bipolar group was 92 points (range between 72 and 97 points), while the fixed-head group was 84 points (range between 65 and 95 points). Radiologically, joint space narrowing more than 2 mm was found in only 8% (2 patients) among the bipolar group, and in 28% (7 patients) of the fixed-head group. Through the follow-up period, total hip replacement was needed in two cases of the bipolar group and seven cases of the fixed-head group. Bipolar hemiarthroplasty offered a better range of movement with less pain and more stability than the fixed-head hemiarthroplasty in elderly patients with displaced femoral neck fractures.


Original Article

Vassilios Nicolaides, Spyridon Galanakos, Andreas F. Mavrogenis, Vasileios I. Sakellariou, Ioannis Papakostas, Constantinos E. Nikolopoulos, Panayiotis J. Papagelopoulos

Arthroplasty versus internal fixation for femoral neck fractures in the elderly

[Year:2011] [Month:April] [Volume:6] [Number:1] [Pages:6] [Pages No:7 - 12]

Keywords: Femoral neck fracture, Arthroplasty, Internal fixation, Harris hip score

   DOI: 10.1007/s11751-010-0099-3  |  Open Access |  How to cite  | 


We studied 140 patients with femoral neck fractures treated from January 1999 to December 2006. There were 68 men and 72 women with a mean age of 72 years (range 60–80 years). Seventy patients were treated with closed reduction and internal fixation (group A), and 70 patients with hip arthroplasty (group B). The duration of surgery, length of hospitalization, complications, postoperative Harris hip score, and need for reoperation were recorded. Group B had significantly higher blood loss, increased surgical time and length of hospitalization compared to group A patients. The Harris hip score was significantly higher in group B at the 3, 6, and 12-month follow-up evaluations; however, the differences were no longer significant at the 24-month evaluation. The overall complications rate was 18.6% (13 patients) in group A compared to 25.7% (18 patients) in group B; this was not statistically significant (P = 0.309). A statistically significant difference was found regarding reoperation rate in group A (11.4%, eight patients) compared to group B (1.4%, one patient) (P = 0.016). Arthroplasty compared to internal fixation for displaced femoral neck fractures is associated with a significantly higher functional score and lower risk of reoperation at the cost of greater infection rates, blood loss, and operative time.


Original Article

Mahmoud A. Mahran, Mohamed A. ElGebeily, Nabil A. M. Ghaly, Mootaz F. Thakeb, Hany M. Hefny

Pelvic support osteotomy by Ilizarov's concept: Is it a valuable option in managing neglected hip problems in adolescents and young adults?

[Year:2011] [Month:April] [Volume:6] [Number:1] [Pages:8] [Pages No:13 - 20]

Keywords: Pelvic support osteotomy, Hip osteotomy, Femoral reconstruction osteotomy, Neglected hip dislocation, Pelvic support femoral reconstruction, Neglected hip problems in pediatric age group, Ilizarov hip reconstruction

   DOI: 10.1007/s11751-011-0104-5  |  Open Access |  How to cite  | 


For evaluating pelvic support osteotomy as a salvage procedure in managing neglected hip problems in adolescents and young adults, PSO was performed for 20 hips in 20 patients (5 men and 15 women). The mean age was 21.5 years. The etiology was neglected developmental dysplasia of the hip in 9 patients, post-septic hip sequelae in 9 patients, and paralytic dislocation due to poliomyelitis in 2 patients. All patients were treated by two osteotomies: a proximal femoral osteotomy to support the pelvis and correct the flexion and rotational deformities of the hip and a distal varization and lengthening osteotomy. Final clinical evaluation was done 6 months after frame removal. The mean external fixation time was 6.4. Lengthening and mechanical axis parallelism was achieved in all patients. At the final follow-up and according to a predesigned scoring system, there were 7(35%) excellent results, 6(30%) good results, 7(35%) fair results, and no poor results. Hip reconstruction by Ilizarov's concept can be technically demanding and involving lengthy period wearing the frame but found to be a valuable salvage procedure for numerous neglected hip problems particularly in young patients.


Original Article

Hisam Muhamad Ariffin, Nidzwani M. Mahdi, Shaharuddin A. Rhani, Azmi Baharudin, Mohamad Hassan Shukur

Modified hybrid fixator for high-energy Schatzker V and VI tibial plateau fractures

[Year:2011] [Month:April] [Volume:6] [Number:1] [Pages:6] [Pages No:21 - 26]

Keywords: High-energy tibial plateau fractures, Severe soft tissue injury, Hybrid external fixator

   DOI: 10.1007/s11751-011-0105-4  |  Open Access |  How to cite  | 


High-energy tibial plateau fractures associated with severe soft tissue injury are difficult to manage. The risk of wound complications following open reduction and internal fixation is notably high owing to extensive soft tissue dissection. Alternatively, application of hybrid external fixator minimizes soft tissue dissection and provides adequate fracture stabilization to allow early range of motion and correction of any mal-alignment. With this technique, soft tissue complications particularly surgical site infections are expected to be significantly reduced. This prospective study aims to determine the effectiveness of a modified hybrid external fixator in the management of high-energy tibial plateau fractures. Thirty-three patients with high-energy Schatzker V and VI tibial plateau fracture with severe soft tissue injury precluding formal open reduction were enrolled into the study. The fixator was a construct combining the Ilizarov ring with a monolateral external fixator. The results—bony union, range of motion, and associated complications of the treatment—were assessed. All fractures united within an average time of 14 weeks. Neither loss of reduction nor surgical site wound breakdown/osteomyelitis was noted. Eight patients developed superficial pin track infection and one septic arthritis of the knee joint. Hybrid external fixation is a safe option for complex high-energy tibial plateau fractures by simultaneously providing adequate fracture stabilization and protection of soft tissue healing to achieve bony union. The complication is mainly related to pin tract infection.


Original Article

Jan Gessmann, Hinnerk Baecker, Birger Jettkant, Gert Muhr, Dominik Seybold

Direct and indirect loading of the Ilizarov external fixator: the effect on the interfragmentary movements and compressive loads

[Year:2011] [Month:April] [Volume:6] [Number:1] [Pages:5] [Pages No:27 - 31]

Keywords: Ilizarov, External fixator, Weight bearing, Indirect loading, Interfragmentary movement

   DOI: 10.1007/s11751-011-0103-6  |  Open Access |  How to cite  | 


The amount of weight bearing and the force transmission to the frame have an important influence on the results of treatment with an Ilizarov external fixator. The frame provides beneficial interfragmentary movements and compressive loads at the fracture site through elastic wires. Mobilisation can be achieved by applying a weight-bearing platform at the distal end of the fixator. The effect on the interfragmentary movements and the compressive loads in indirect and direct loading were analysed in this study using a composite tibia bone model. Displacement transducers were attached to measure the interfragmentary movements and to detect relative movements of the bone fragments and movements between the rings. The compressive loads in the osteotomy were measured with loading cells in the defect zone. The weight-bearing platform had a substantial effect on the biomechanical behaviour of the frame. It led to an indirect force transmission through the fixator with respect to the osteotomy, resulting in lower compressive loads, lower interfragmentary movements and higher mechanical stress on the frame.



Olimpio Galasso, Massimo Mariconda, Giorgio Gasparini

Repeated floating elbow injury after high-energy trauma

[Year:2011] [Month:April] [Volume:6] [Number:1] [Pages:5] [Pages No:33 - 37]

Keywords: Floating elbow injury, Recurrence of fractures, Open reduction and internal fixation, Difficult hardware removal

   DOI: 10.1007/s11751-011-0102-7  |  Open Access |  How to cite  | 


The floating elbow is an uncommon injury occurring both in children and in adults. Two reports of rare variants of floating elbow injury have been published, but to the best of our knowledge, no recurrence of this injury has been described. We present a complex pattern of floating injury, occurring in the same limb 3 years after a floating elbow lesion, which included supracondylar fracture of the humerus and associated ipsilateral midshaft fracture of forearm bones. Satisfactory outcomes were finally obtained. This clinical case illustrates the importance of carefully assessing floating elbow injuries when they occur to optimize the surgical strategies and the adequate timing of the treatment. A comprehensive literature review of the floating elbow injuries is here reported.



Soulat Naim, Nikolaos Gougoulias, David Griffiths

Patellar tendon reconstruction using LARS ligament: surgical technique and case report

[Year:2011] [Month:April] [Volume:6] [Number:1] [Pages:3] [Pages No:39 - 41]

Keywords: Patellar tendon, Rupture, LARS, Extensor mechanism, Reconstruction

   DOI: 10.1007/s11751-010-0101-0  |  Open Access |  How to cite  | 


Neglected patella tendon ruptures require reconstruction using tendon grafts. The LARS ligament has been successfully used in cruciate and collateral knee ligament reconstruction. We present a technique using LARS ligament for the reconstruction of a chronic patella tendon rupture in a low-demand patient. The result after 1-year follow-up was deemed successful.


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