Yehuda Amit

Monteggia and equivalent lesions. A study of 41 cases.

Forty-one patients who suffered from a Monteggia fracture and were treated between 1984 and 1993 were reviewed retrospectively using a new motion score of the elbow joint. There were 14 children and 27 adults of whom 34 were available for review. The results in children were significantly better than those of the adults. Among the adults, the final results of the patients who had a Bado Type 1 equivalent injury were significantly worse than those of the other groups, especially when associated with a fracture of the radial head. The type of fracture, open or closed, the presence of a fracture of the olecranon, and the energy level of the trauma did not have any significant prognostic value. Good correlation was shown between the new motion score and the Figgie elbow score. The Bado Type 1 equivalent injuries should be considered as a special subgroup of the Monteggia lesion, necessitating extra attention in treatment and rehabilitation, and a close followup of the patient.

The epidemic of ankle fractures in the elderly--is surgical treatment warranted?

Abstract Ankle fractures in the elderly are extremely common (up to 184 fractures per 100,000 persons per year, and of these approximately 20%–30% occur in the elderly). The medical literature contains no research that has investigated ankle fractures in the elderly. A prospective, randomised study was conducted of 84 patients with displaced ankle fractures, who were over the age of 65 years and were assigned to operative or conservative treatment after closed reduction. The results of treatment assessed according to the American Orthopedic Foot and Ankle Society (AOFAS) Score showed a mean of 91.37 ± 8.96 in the non-operated group compared with 75.2 ± 14.38 (P = 0.001) in the operated group. The costs of treatment were accordingly higher. These results call for consideration of a non-operative approach to the treatment of well-reduced ankle fractures in the elderly. Increased efforts should be invested in the prevention of these common fractures.

A simple method for removal of a fractured intramedullary nail

Fatigue failure of an intramedullary nail may occur if there is delayed or nonunion of the fracture (Zimmerman and Klasen 1983; Winquist, Hansen and Clawson 1984; Bucholz, Ross and Lawrence 1987) and the distal end of the fractured nail is then difficult to remove. Several methods have been described (B#{246}hler 1968; Yoslow and LaMont 1986; Mooney, Chabon and Poehling 1991) to which we add a simple and reliable technique. Patients. From 1986 to 1991 we treated five patients with fractured femoral intramedullary nails, all associated with painful delayed union or nonunion. Four nails were of the locking type and one was a K#{252}ntscherpattern. They had been in place for one to four years. Technique. The operation is performed with the patient on a fracture table with image-intensifier control. The intramedullary canal is opened at the greater trochanter (Taylor 1992) and any locking screws are removed. The proximal part of the nail is removed and a nail which is 1 mm smaller in diameter than the fractured nail is passed down the intramedullary canal and gently impacted into the opening ofthe distal nail fragment. Both nails are then removed (Fig. 1). If there is delayed or nonunion the intramedullary canal is then reamed and a nail of larger diameter is inserted. Results. In all five cases the removal of the distal nail fragment was easy and uneventful with no difficulties during extraction. The average time taken was ten minutes (7 to 15).

Primary reconstruction of traumatic bony defects using allografts.

Abstract We retrospectively reviewed 207 patients suffering from traumatic bone defect who had been treated at our institution between 1973 and 1993. Three types of traumatic bone defects were identified: I, minor; II, major cortical; III, major articular. Each type was further subdivided into: A, open injury; B, closed injury. The proposed treatment modality of each type was included within each classification. Types II and III posed the greatest difficulties in management. However, massive bone allografts can be successfully used in these situations, even in the early phases of treatment, but only given specific prerequisites.

Versatile Utilization of Massive Bone Allografts in Orthopedic Surgery.

The clinical use of massive bone allografts in orthopaedic surgery has become common practice in tumour operations and primary and revision total joint replacement. In certain special clinical situations associated with large bone loss, such as trauma, limb-length discrepancy repair or even infection, massive bone allografts can be successfully used. We present our treatment results of 47 patients who suffered from major bone loss due either to trauma, limb-length discrepancy repair, or infection. Our results (> 2 years minimum follow-up to allow full-bone allograft incorporation) indicate that the use of massive bone allografts in these special and delicate medical conditions is feasible, and have good functional results.

Bone allograft in revision total knee replacement.

Revision total knee replacement (TKR) is often associated with the necessity to reconstruct a certain amount of bone loss. In a retrospective study we reviewed the records of 137 patients who had undergone revision TKR in our department between 1990 and 1996, due to loosening or inflection. Bone allografts were used in 91 patients (67%) to accomplish stable, new prostheses. Three types of bone loss were identified in this group: Type I - minor, Type II – moderate, and Type III – large bone defects, located on either side of the knee joint – A, or both sides – B.The treatment results of these 91 patients, according to the type of bone loss, are presented, showing good functional outcome when utilizing bone allografts in revision TKR. However, careful preoperative planning, identification of bone loss type, and a well-equipped bone bank are mandatory to the success of the operation.

Catastrophic failure due to massive osteolysis of both acetabular and femoral components in a metal-on-metal hip arthroplasty: a demonstrative case report

Metal-on-metal (MOM) bearing surfaces in total hip arthroplasty have been recently shown to have acceptable survivorship properties, and they have certain advantages and disadvantages when compared to conventional metal-on-polyethylene bearing surfaces. Like traditional metal-on-polyethylene bearings, these metal-on-metal implants may also suffer from catastrophic failure. Patients can develop a local reaction to the metal ions produced by the articulation and present with pain or early loosening due to the local inflammatory reaction. The possible effects of MOM wear debris and its corrosion products are still the subject of debate. This case report represents an unusual situation in a 63-year-old woman in which extensive lysis derived in massive femoral osteolysis and hip arthroplasty catastrophic failure.

The treatment of haemophilic intraosseous bone cyst of the talus

Abstract Subchondral bone cysts are commonly noted in radiographs of joints of persons with haemophilia. Articular chondral integrity is partially dependent upon a trans-osseal blood supply. Bone cysts disrupt this physiological pathway. Ensuing chondrolysis may expose the cyst contents to the joint cavity. This article reports upon the clinical and radiological improvement in a child with a subchondral bone cyst of the talus which was surgically treated. One may hypothesise regarding the connection between “open” chondral cysts and chronic intra-articular synovitis which leads to the frequently noted osteoarthropathy.