Comparison between Bipolar Hemiarthroplasty and Total Hip Arthroplasty for Unstable Intertrochanteric Fractures in Elderly Osteoporotic Patients

The present study was conducted to compare bipolar hemiarthroplasty (BA) with total hip arthroplasty (THA) in treatment of unstable intertrochanteric fractures in elderly osteoporotic patients. The THA group included 14 males and 26 females with a mean age of 73.4 years, and the BA group included 27 males and 45 females with a mean age of 76.5 years. Significant difference existed between the two groups in operation time, blood loss, transfusion volume and cost of hospitalization, while no remarkable difference was identified in hospitalization period, general complications, joint function, pain, rate of revision and mortality. No dislocation was observed in BA group while 3 occurred in THA group. The results indicated that for unstable intertrochanteric fractures in elderly osteoporotic patients, BA seems to be a better or more reasonable choice compared with THA for the reason of less blood loss, shorter operation time, lower cost and no dislocation

Effects of Stem Design and Pre-Cooling Prostheses on the Heat Generated by Bone Cement in an<i>In Vitro</i>Model

The necrotizing effects of the heat, particularly at more than 50 °C, produced by the exothermic polymerization process associated with the acrylic implant cement polymethylmethacrylate (PMMA) are well documented. The temperature changes that occur are dependent on the thickness of the PMMA. The current study investigates the hypothesis that the heat produced by the bone cement may be reduced by the choice of stem design and by pre-cooling the hip prosthesis. The thermal alterations at the bone-cement interface were measured in an in vitro model. The results indicated that a temperature decrease of approximately 7 °C could be achieved by pre-cooling the prosthesis, and by changing the shape of the prosthesis stem from flat and wide to round.</jats:p

Biodegradable implants in the treatment of scaphoid nonunions

We reviewed 12 male patients with scaphoid nonunions treated by open reduction, bone grafting, and internal fixation with biodegradable implants made of self-reinforced poly-L-lactic acid. Mean patient age was 22.5 (20-25) years. Ten patients had type D2 scaphoid nonunions with a fracture line in the middle one third, one patient had type D2 nonunion with a fracture line in the proximal one third, and one patient had type D1 distal one-third fibrous union. The mean wrist score (modified Mayo wrist score) was 20.8 (10-40) preoperatively and improved after 22-80 months (55-90). All nonunions healed, and the mean solid union time was 4.5 (3.5-7) months. We obtained excellent results in five patients, good results in four, fair results in two, and a poor result in one. The results of this study offer a valid alternative in the fixation of scaphoid nonunions. The major advantage of biodegradable materials is to eliminate the requirement for the removal of the fixation material

Late Reconstruction of Neglected Metacarpal Shaft Defects Due to Gunshot Wound

We evaluated eight patients after delayed treatment of nine metacarpal bone defects due to gunshot injuries. The mean length of the metacarpal defects was 3 cm and the average time between the gunshot injury and the reconstruction surgery was 10 months. Although all of the patients had been treated with wound irrigation and debridement immediately following injury, no attempt had been made to repair the metacarpal defect or to maintain metacarpal length. As a result, serious shortening had occurred. After the original length of the metacarpal had been restored by distraction of the soft tissues (1 mm/day), a tri-cortical iliac bone graft was inserted into the bone defect. The average follow-up time was 15 months. Clinical and radiological union was established in all cases after an average of 12 weeks. The mean grip strength of the hand and the mean range of motion of the metacarpophalangeal joint increased by 24% and 60%, respectively

Late reconstruction of neglected metacarpal shaft defects due to gunshot wound

We evaluated eight patients after delayed treatment of nine metacarpal bone defects due to gunshot injuries. The mean length of the metacarpal defects was 3 cm and the average time between the gunshot injury and the reconstruction surgery was 10 months. Although all of the patients had been treated with wound irrigation and debridement immediately following injury, no attempt had been made to repair the metacarpal defect or to maintain metacarpal length. As a result, serious shortening had occurred. After the original length of the metacarpal had been restored by distraction of the soft tissues (1 mm/day), a tri-cortical iliac bone graft was inserted into the bone defect. The average follow-up time was 15 months. Clinical and radiological union was established in all cases after an average of 12 weeks. The mean grip strength of the hand and the mean range of motion of the metacarpophalangeal joint increased by 24% and 60%, respectively