BACKGROUND: Adult patients with cerebral palsy (CP), who have advanced degenerative arthritis of the hip, have been treated with resection arthroplasty and arthrodesis. Although total hip arthroplasty (THA) has also been used as one of the alternative options, there are few studies on contemporary bearings used in THA. Therefore, we evaluated the results of the contemporary ceramic-on-ceramic THA in adult patients with CP. METHODS: From January 2005 to December 2007, five adult CP patients (5 hips) underwent THA using contemporary ceramic-on-ceramic bearings. All patients were able to stand or ambulate with intermittent use of assistive devices at home. We retrospectively reviewed the series to determine the results of THA in terms of pain relief, improved function, and durability of prosthesis. RESULTS: There were 3 men and 2 women with a mean age of 35.9 years. All patients had pain relief without decline in mobility postoperatively. One hip was dislocated, which was treated successfully with closed reduction and an abduction brace for 2 months. There was no ceramic fracture, loosening, or osteolysis during the mean follow-up of 6.8 years (range, 5.8 to 8.3 years). CONCLUSIONS: Cementless THA using contemporary ceramic-on-ceramic bearings is a useful option for the treatment of advanced degenerative arthritis of the hip in ambulatory adults with CP.
Adult ; Arthroplasty, Replacement, Hip/*methods ; Biocompatible Materials ; Ceramics ; Cerebral Palsy/*complications ; Female ; Hip Joint/*surgery ; Hip Prosthesis ; Humans ; Male ; Osteoarthritis, Hip/etiology/radiography/*surgery ; Prosthesis Design ; Retrospective Studies ; Treatment Outcome

BACKGROUND: We analyzed the extent of the comminution in the acetabular weight-bearing area, the clinical and radiographic results, and the complications after a minimum 2-year follow-up of the modified Stoppa approach for the treatment of acetabular fractures, and we attempted to evaluate the efficacy of the operative technique. METHODS: All of the 22 patients, who needed the anterior approach for the treatment of acetabular fractures at our hospital from November 2007 to November 2010, were subjected to surgery via the modified Stoppa approach. Fracture pattern, operative time, blood loss during the operation, quality of reduction, number of bony fragments in the acetabular weight-bearing area, and postoperative complications were assessed by retrospectively analyzing the medical records and the radiographic examinations. The results after the operation were analyzed based on the criteria of Matta. RESULTS: The clinical results were excellent in 3 cases, good in 13 cases, and poor in 4 cases, while the radiographic results were excellent in 5 cases, good in 13 cases, and poor in 2 cases. Although the quality of reduction and the clinical results according to the extent of comminution were statistically significant (p = 0.03 and p = 0.04, respectively), the radiographic results were not statistically significant (p = 0.74). CONCLUSIONS: It can be concluded that the modified Stoppa approach could be used as an alternative to the classic ilioinguinal approach. In addition, comminution of the acetabular fracture was an important factor causing non-anatomic reduction and finally unsatisfactory clinical results.
Acetabulum/injuries/radiography/*surgery ; Adult ; Aged ; Female ; Fracture Fixation, Internal/*methods ; Fractures, Bone/radiography/*surgery ; Fractures, Comminuted/radiography/surgery ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome ; Weight-Bearing ; Young Adult

BACKGROUND: The Targon FN implant was developed in 2007 to treat intracapsular neck of femur fractures. Early results from the design centre have shown good results in terms of fracture complications. We wished to see if these results can be reproduced in an independent institution. METHODS: The records of consecutive patients, treated with this implant between 2008 and 2011 at Queen Elizabeth Hospital, were identified and collected for this study. Operations were performed by all grades of surgeons under supervision as appropriate. These patients went on to have both clinical and radiological assessment for fracture healing and function. RESULTS: Fifty-one patients were identified with 43 patients available for final follow-up. The average age was 66 years with a minimum follow-up of 24 months. A non-union rate of 0% in the undisplaced fracture group and 1 in 12 (8%) in the displaced fracture group was observed. An avascular necrosis rate of 6% and 8% was observed for undisplaced and displaced fracture types, respectively. No significant change in premorbid to postoperative ambulation was observed and there was no wound complication. CONCLUSIONS: Our study shows similar results with those of the design centre and which are superior to those currently found in the literature for the more traditional fixation methods. It also shows that the promising results with this new implant as seen from the design institutions can be reproduced by all cadres of surgeons in non-specialist practice.
Adult ; Aged ; Aged, 80 and over ; *Bone Plates ; Bone Screws ; Female ; Femoral Neck Fractures/radiography/*surgery ; Follow-Up Studies ; Fracture Fixation, Internal/*instrumentation/methods ; Humans ; Male ; Middle Aged ; Prosthesis Design ; Retrospective Studies ; Young Adult

BACKGROUND: We assessed the frequency and types of ankle fractures that frequently occur during parachute landings of special operation unit personnel and analyzed the causes. METHODS: Fifty-six members of the special force brigade of the military who had sustained ankle fractures during parachute landings between January 2005 and April 2010 were retrospectively analyzed. The injury sites and fracture sites were identified and the fracture types were categorized by the Lauge-Hansen and Weber classifications. Follow-up surveys were performed with respect to the American Orthopedic Foot and Ankle Society ankle-hindfoot score, patient satisfaction, and return to preinjury activity. RESULTS: The patients were all males with a mean age of 23.6 years. There were 28 right and 28 left ankle fractures. Twenty-two patients had simple fractures and 34 patients had comminuted fractures. The average number of injury and fractures sites per person was 2.07 (116 injuries including a syndesmosis injury and a deltoid injury) and 1.75 (98 fracture sites), respectively. Twenty-three cases (41.07%) were accompanied by posterior malleolar fractures. Fifty-five patients underwent surgery; of these, 30 had plate internal fixations. Weber type A, B, and C fractures were found in 4, 38, and 14 cases, respectively. Based on the Lauge-Hansen classification, supination-external rotation injuries were found in 20 cases, supination-adduction injuries in 22 cases, pronation-external rotation injuries in 11 cases, tibiofibular fractures in 2 cases, and simple medial malleolar fractures in 2 cases. The mean follow-up period was 23.8 months, and the average follow-up American Orthopedic Foot and Ankle Society ankle-hindfoot score was 85.42. Forty-five patients (80.36%) reported excellent or good satisfaction with the outcome. CONCLUSIONS: Posterior malleolar fractures occurred in 41.07% of ankle fractures sustained in parachute landings. Because most of the ankle fractures in parachute injuries were compound fractures, most cases had to undergo surgical repairs.
Adult ; Ankle Fractures/classification/etiology/radiography/*surgery ; Ankle Injuries/etiology/radiography/*therapy ; Ankle Joint/radiography/*surgery ; Aviation ; Bone Plates ; Fracture Fixation, Internal ; Fractures, Comminuted/etiology/radiography/surgery ; Fractures, Open/etiology/radiography/surgery ; Humans ; Male ; Military Personnel ; Retrospective Studies ; Young Adult

BACKGROUND: The locking plates are often used for internal fixation of closed tibial fractures. The use of a locking plate as an external fixator is still controversial, particularly for closed fractures. The purpose of this study is to evaluate the results of external fixation using the femoral less invasive stabilization system (LISS) plate in proximal metaphyseal fractures of the tibia. METHODS: We prospectively evaluated 35 patients (26 males and 9 females) with a mean age of 42 years (range, 21 to 62 years) who presented with fresh tibial proximal metaphyseal fractures. According to the AO Foundation and Orthopaedic Trauma Association (AO/OTA) classification, the fractures were identified as type 41-A2 in 18 cases and type 41-A3 in 17 cases, including 25 closed fractures and 10 open fractures. The femoral LISS plate was used to fix these fractures, which was placed on the anteromedial aspect of the tibia as an external fixator. The mean follow-up period was 18 months (range, 13 to 22 months). RESULTS: All fractures healed in a mean time of 14 weeks (range, 10 to 20 weeks). There was no case of nonunion, deep infection, and loosening of screws and plates. One month after the appearance of cortical bridging on biplanar radiographs, the locking plate was removed within 3 minutes in the clinic without any difficulty. According to the Hospital for Special Surgery (HSS) knee scoring system and American Orthopaedic Foot & Ankle Society (AOFAS) ankle scoring system, the mean HSS score was 91 (range, 85 to 100) and 98 (range, 93 to 100), and the mean AOFAS score was 94 (range, 90 to 100) and 98 (range, 95 to 100) at 4 weeks postoperatively and final follow-up, respectively. CONCLUSIONS: For proximal metaphyseal fracture of the tibia, external fixation using the femoral LISS plate is a safe and reliable technique with minimal complications and excellent outcomes. Its advantages include ease of performing the surgery, use of a less invasive technique, and convenience of plate removal after fracture healing.
Adult ; *Bone Plates ; External Fixators ; Female ; Fracture Fixation/*instrumentation/methods ; Humans ; Male ; Middle Aged ; Prospective Studies ; Tibial Fractures/radiography/*surgery ; Young Adult

Athletes usually complain of an ongoing or chronic pain over the Achilles tendon, but recently even non-athletes are experiencing the same kind of pain which affects their daily activities. Achilles tendinosis refers to a degenerative process of the tendon without histologic or clinical signs of intratendinous inflammation. Treatment is based on whether to stimulate or prevent neovascularization. Thus, until now, there is no consensus as to the best treatment for this condition. This paper aims to review the common ways of treating this condition from the conservative to the surgical options.
*Achilles Tendon ; Humans ; Risk Factors ; Tendinopathy/etiology/*therapy

Snapping hip syndrome is a relatively common problem that can be easily managed with conservative treatment. This syndrome can be divided into external, internal and intra-articular types. Internal snapping hip syndrome is the rarest amongst these and its etiology is not well understood. We report a unique case of osteochondroma arising from the anterior inferior iliac spine (AIIS), which caused the internal snapping hip syndrome with hip pain and restriction of activity. This rare case of snapping hip syndrome from the AIIS was treated surgically and the symptoms completely disappeared after excision of the tumor.
Adult ; *Bone Neoplasms ; Female ; *Hip Joint/diagnostic imaging/physiopathology ; Humans ; *Ilium/diagnostic imaging/physiopathology ; *Joint Diseases/etiology/physiopathology ; *Osteochondroma

Antegrade transmalleolar drilling method is one of the options for the treatment of osteochondral lesion of talus (OLT). We present five patients who underwent tibial drilling for treatment of OLT and later developed distal tibial cystic formation induced by cartilage opening or heat necrosis during drilling. Antegrade transmalleolar drilling can be a possible option for the treatment of OLT if the lesion is not easily reachable; however, other viable treatment should be considered due to its possibility of distal tibial pathologic change.
Adult ; Ankle Joint/surgery ; Cartilage, Articular/*surgery ; Female ; Humans ; *Iatrogenic Disease ; Male ; *Musculoskeletal Diseases/etiology/surgery ; *Orthopedic Procedures/adverse effects/methods ; Talus/*surgery ; *Tibia/injuries/surgery ; Young Adult

A 24-year-old man with tuberculosis meningitis developed acute paraplegia and sensory disturbances 5 weeks after receiving conventional antituberculous therapy. Magnetic resonance imaging revealed an intradural extramedullary long segmental mass mimicking en plaque meningioma at the T2-T6 vertebrae levels. Prompt surgical decompression was performed. A histology examination of the mass revealed a tuberculoma. After surgery, the patient showed improved motor power and a normal bladder function. Intradural extramedullary tuberculoma of the spinal cord is rare complication of tuberculosis meningitis, which can occur as a response to conventional antituberculous therapy.
Diagnosis, Differential ; Humans ; Male ; Meningeal Neoplasms/*diagnosis ; Meningioma/*diagnosis ; Spinal Cord Diseases/*diagnosis/surgery ; Thoracic Vertebrae ; Tuberculoma/*diagnosis/surgery ; Tuberculosis, Meningeal/*diagnosis/surgery ; Young Adult

Necrotizing fasciitis (NF) is a deep infection of the subcutaneous tissue that progressively destroys fascia and fat; it is associated with systemic toxicity, a fulminant course, and high mortality. NF most frequently develops from trauma that compromises skin integrity, and is more common in patients with predisposing medical conditions such as diabetes mellitus, atherosclerosis, alcoholism, renal disease, liver disease, immunosuppression, malignancy, or corticosteroid use. Most often, NF is caused by polymicrobial pathogens including aerobic and anaerobic bacteria. NF caused by Staphylococcus aureus as a single pathogen, however, is rare. Here we report a case of NF that developed in a healthy woman after an isolated shoulder sprain that occurred without breaking a skin barrier, and was caused by Staphylococcus aureus as a single pathogen.
*Arm ; Coagulase/metabolism ; Fasciitis, Necrotizing/*etiology/microbiology/pathology/surgery ; Female ; Humans ; Middle Aged ; Shoulder Joint/*injuries ; Sprains and Strains/*complications ; Staphylococcal Infections/*etiology/microbiology ; Staphylococcus aureus/enzymology/isolation & purification