Constantinos D Apostolou

Fixation of proximal humerus fractures using the PHILOS plate: early experience.

Proximal humeral fractures, especially in elderly patients, remain a challenging problem for the surgeon because the complication rate for these fractures still remains high. The internal locked system (PHILOS) plate is a new device used for proximal humerus fracture fixation is designed to decrease the high complication rate. We prospectively evaluated our early experience using this system. Twenty patients with fractures of the proximal humerus were treated with a PHILOS plate from September 2001 to January 2004 at Princess Alexandra Hospital in Harlow, UK. Functional assessment was done using the Constant shoulder score. Two patients who had brachial plexus injury were evaluated only with the visual analogue score because we thought that the Constant objective assessment would be unreliable. Complications were monitored. The mean Constant score was found to be 76.1% (range, 30-100%). The preliminary results seem to be satisfactory. According to our experience, the plate design provides stable fixation with a good functional outcome and eliminates most hardware problems such as failure and impingement syndrome. The PHILOS plate is suitable for the majority of fractures providing that the correct surgical technique is used.Level of Evidence: Therapeutic study, level IV (case series). See the Guidelines for Authors for a complete description of levels of evidence.

Distal intramedullary nail interlocking: the flag and grid technique.

Summary: Distal interlocking in intramedullary nailing of long bone fractures accounts for a significant proportion of the total fluoroscopy and operative time. We describe a modification of the “perfect circles” freehand technique employing a metallic grid temporarily attached to the skin of the lateral surface of the femur or to the medial surface of the tibia that acts as a fixed “navigational” aid. The position of the distal nail holes in relation to the grid is fluoroscopically ascertained. Subsequently, under fluoroscopic control, a modified Steinmann pin with a metallic handle attached to its blunt end (“flag”) is used to accomplish targeting and to create the screw holes, affording improved visualization. This technique was compared with the traditional freehand technique in 2 groups of patients. Use of the modified technique led to reduction of radiation exposure and total distal interlocking time, and there were no significant complications related to the technique.

Fat embolism after uncemented total hip arthroplasty.

The authors present a 59-year-old woman who had a severe fat embolism syndrome develop after an uncemented total hip arthroplasty. The fat embolism syndrome was confirmed by clinical, laboratory, and imaging findings. The patient had a favorable outcome most likely related to early supportive therapy, her healthy background, and young age.

Reaming versus broaching in cemented hip arthroplasty : Mechanical stability in cadaver femora

Introduction We used an experimental hip model to assess the mechanical stability of a hip prosthesis, and compared the femoral medullary canal preparation techniques of reaming and broaching. Methods 15 pairs of cadaveric femora had a simulated replacement, the right femur with a reaming technique and the left with a broaching technique. Both femurs were radiographed to assess component positioning and cement mantle. The femurs were osteotomized 30 days after the procedure. The shear strength of the interface was studied at 4 different levels along an aluminum rod during push-out tests. Results The overall mean value of the interface failure load was 15% lower with the reaming technique (6.5 kN for the reaming technique versus 7.7 kN for the broaching technique; p = 0.02). Interpretation Broaching was superior to reaming for the preparation of the femoral canal, and should be used in order to increase primary stability. Further in vivo studies are required to account for factors such as intramedullary pressure, bleeding and surgical variations, which could not be accounted for in our study.

Ipsilateral fractures of the proximal, mid-shaft and distal humerus

This report describes the evaluation, diagnosis and conservative treatment of an 80-year-old woman with a non-pathological ipsilateral fracture of the proximal, mid-shaft and distal humerus. The treatment goal was the prompt return of the patient to a satisfactory functional status without surgical intervention. The spiral diaphyseal fracture was reduced with manual traction without anaesthesia, and a U-slab casting was applied. Immobilisation was preserved for 6 weeks, and fracture healing progressed normally. Then the patient entered a rehabilitation programme with passive and active exercises. Complex fractures of the humerus are rare and often are misdiagnosed. Conservative treatment in an aged, self-sufficient patient with low activity demands or patients with multiple medical problems is a reasonable option with satisfactory results.RésuméLe cas décrit l’évaluation, le diagnostic et le traitement conservateur d’une fracture ispilatérale trifocale non pathologique de l’humérus chez une patiente âgé de 80 ans. Le but du traitement était de rétablir rapidement une fonction satisfaisante sans intervention chirurgicale. La fracture diaphysaire spiroïde fut réduite par traction manuelle sans anesthésie et un pansement de type Dessault fut mis en place. L’immobilisation fut de six semaines, la fracture consolida régulièrement, puis la patiente bénéficia d’une rééducation active et passive. Les fractures complexes de l’humérus sont rares et souvent cause de faux diagnostics. Le traitement conservateur chez une patiente âgée, autonome, ayant une activité limitée et présentant de multiples problèmes médicaux, apparaît comme une solution de sagesse.

Mechanical Stability of Total Hip Replacement Using Pressurization of Bone Cement During Curing: Push-out Tests in Cadaver Femora

An experimental model was used to assess the mechanical stability of a cemented hip prosthesis, comparing the result from applied pressurization versus its absence during the curing process. Twelve pairs of cadaveric femora underwent simulated total hip replacement. The right femurs were pressurized for 10 minutes in the upper surface of the construct. The applied pressure was 325.4 KPa. All the femurs were osteotomized 30 days postoperatively and push-out tests were performed. The mean failure load at the cement-bone interface was found to be 58% higher with the pressurization technique (7.619 KN versus 4.817 KN) (P <.001). The amount of pressure we used proved advantageous, however the required physical effort proved exhausting. The design of a new surgical instrument could possibly resolve the problem.