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Article
Outcome of Transcapitellar K-wire Fixation for Radial Neck Fractures

Author: Ali A. Ali
Journal: Mustansiriya Medical Journal مجلة المستنصرية الطبية ISSN: 20701128 22274081 Year: 2014 Volume: 13 Issue: 1 Pages: 26-32
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

Background: Fractures of the radial neck are mainly seen in children and require meticulous management to avoid elbow disabilities. Age, grade of the fracture and association with other elbow injuries affect the surgical approach to be used for treatment. Aim: This study was performed to detect the outcome of using transcapitellar K-wire fixation for treatment of radial neck fractures. Patients & Methods: Twelve patients with displaced (Broberg-Morrey II, III & IV) radial neck fractures were included. Eight patients (Group A) were children below skeletal maturity (10-18 years) and four patients were over 18 years of age (Group B) who achieved full skeletal maturity. Kaplan’s approach for open reduction and internal fixation using K-wires was used, and the patients were followed up for 6 months. Each patient was assessed for outcome according to predefined criteria ranging from excellent to good, fair and poor. Results: In group A, two patients had excellent outcome, one patient had fair outcome and the rest had good outcome. In group B, two patients had good outcome while the other two had fair outcome; however, none of the patients had poor outcome. Valgus deformity of >10oand elbow stiffness of >20o developed in three patients, with stiffness mainly affecting supination & extension. Of the patients with fair outcome, one developed implant failure due to poor compliance, while another patient developed neuropraxia of the posterior interosseous nerve that resolved spontaneously. Conclusion: Several surgical methods have been proposed for treatment of radial neck fractures with variable results and outcomes. While open reduction and K-wire fixation may not be the first line of these methods, it remains a safe method and provides advantages like short operative time, no exposure to image intensifier, less blood loss and less risk of neurovascular injury. However, for optimal results with minimal complications, the procedure requires early intervention, good patient compliance and prolonged follow-up.


Article
Unipolar Versus Bipolar Hip Hemiarthroplasty in the Treatment of Femoral Neck Fractures in the Elderly

Authors: Ali A. Ali --- Saad M. Rashed --- Mushtaq T. Hussien
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2014 Volume: 13 Issue: 4 Pages: 475-485
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND: Hip fractures are associated with high morbidity and mortality, which require a treatment plan that ensures a good outcome with minimal complications. Different treatment modalities and arthroplasty prosthesis are available and widely used.OBJECTIVE: The aim of this study was to compare the short outcome of surgical treatment of femoral neck fractures in elderly using unipolar and bipolar hip hemiarthroplasty.PATIENTS AND METHODS: Thirty four patients with intracapsular femoral neck fractures ranging from Garden’s class II to class IV were enrolled in the study for surgical intervention using either unipolar hemiarthroplasty (Group A: 14females, 6 males) or bipolar hemiarthroplasty (Group B: 10 females, 4 males). Patients were followed up for up to 2 years by Harris Hip Score to assess the outcome of the surgery. RESULTS: The average hip score for patients per group over the whole follow-up period showed better results in group B than in group A. Average score results were higher in all grades among group B patients. However, the difference from scores of group A patients was statistically insignificant (p>0.05). Patients of both groups had a negative correlation of age to score outcome regardless of sex and grade of fracture. In group A patients, score points for pain, stiffness, range of motion and support/locomotion were all higher during the first six months of follow up. The scores started to decline gradually after 18 months towards the end of the follow up period. In group B patients, the score points for the same parameters were all significantly lower than Group A patients during the first 3-6 months of follow up but started to increase to significantly higher levels towards the end of the follow up period.CONCLUSION: The short-term advantages of unipolar hemiarthroplasty may outweigh its long-term complications in elderly patients with limited daily activities and/or associated serious medical illnesses. In younger age patients with more ambulatory activities and greater life expectancy, bipolar hemiarthroplasty offers a better solution.

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