Primary total hip arthroplasty for displaced intracapsular fracture of the femoral neck: Medium-term functional and radiographic outcomes

The number of complications after primary total hip arthroplasty for displaced intracapsular fractures of the femoral neck is higher than that after operations for osteoarthritis. The aim of this study is to evaluate the number of complications and mid-term functional and radiological findings of patients after primary THA for displaced intracapsular fractures of the femoral neck. Between 1995 and 1998, we operated on a total of 89 patients for acute displaced intracapsular fractures of the femoral neck, i.e. Garden Type 3 and 4. In all the patients we evaluated intraoperative and early postoperative complications. We reviewed clinical and radiological results in 65 patients. The only intraoperative complication was abruption of the greater trochanter. Early postoperative complications occurred in 13 patients (15%). The specific complications, THA dislocation, occurred in 3 patients. Non-specific complications were recorded in 10 patients. No delayed healing of the surgical wound, neural lesion or early, delayed or late infection was recorded. Of 65 patients followed-up for an average of 78 months (range, 62–109 months), 8 patients underwent revision surgery. Of 57 patients with primary THA, very good and good clinical results according to the Harris Hip Score were recorded in 48 patients (84%) and poor results in only 2 patients (4%). Nine of 57 followed-up patients showed radiological signs of loosening (16%). The radiolucent line could be seen in 3 patients in the region of the cup, in 1 patient in the region of the femoral component and in 5 patients in both components. Clinical complaints that would result in indication for reimplantation were recorded in none of the mentioned patients. Number of complications, functional results and resumption of full self-reliance by patients after THA for an intracapsular fracture of the femoral neck are so positive that we consider the indication of THA for a displaced femoral neck fracture fully justified.     

老年股骨转子间骨折的治疗与康复效果观察

目的 观察关节置换与内固定治疗高龄股骨转子间骨折在康复疗效上的差异。方法 我们将其随机分到两组中（治疗组1和治疗组2），治疗组1行人工股骨头置换术，治疗组2行骨折内固定术。结果 两组在手术时间、术中出血量、术后引流量差异无显著性，无统计学意义（P〉0．05）。在住院时间、术后开始下地时间、术后早期并发症、术后内科合并症及功能恢复等方面进行比较，差异有显著性（P〈0．05）。结论 老年股骨转子间骨折关节置换术疗效好。     

髓内钉生物学固定技术治疗严重股骨骨折

目的总结应用闭合复位髓内钉内固定技术，按生物学固定原则（biologic osteosynthesis，BO）治疗严重股骨骨折的经验．方法自2002年3月至2004年6月间，应用闭合复位髓内钉内固定技术，按BO原则治疗46例严重股骨骨折．结果无围手术期并发症及术后感染病例．术后随访6月-2a，平均12月，骨折达到临床愈合时间4—12月，平均6．8月，下肢功能恢复按膝关节Merchant评分标准，优31例，良13例，中2例．结论采用闭合带锁髓内钉生物学固定技术治疗严重股骨骨折可以获得满意的疗效．     

A review of the epidemiology of tinea unguium in the community

Tinea unguium is a common, chronic fungal infection of the nails. Many epidemiological studies have looked at the frequency with which this condition is seen in hospital outpatients clinics or mycological laboratories along with other dermatomycoses. Only recently have studies begun to emerge looking at the prevalence of this condition in populations. Hospital and mycological laboratory-based studies give valuable information about tinea unguium prevalence in a particular clinic, but cannot be compared with other studies due to confounding factors inherent in the different people attending individual clinics. From population-based studies the prevalence of tinea unguium lies between 2 and 8%. Tinea unguium increases steadily with age. It is infrequent but definitely found in children. With the increasing life expectancy in the Western world the prevalence of tinea unguium is likely to increase further without adequate prevention and treatment.     

Nail melanoma: a review of the literature with recommendations to improve patient management

In this review, the current state of knowledge concerning nail melanoma is summarized. The pathogenesis, histological findings, clinical presentation, treatment and prognosis of this rare form of cutaneous melanoma are discussed. Important clinical clues to the early diagnosis of nail melanoma are highlighted and recommendations to improve the management of patients are suggested.     

矩形髓内钉固定对兔胫骨骨折骨痂含量和成骨细胞内骨形态生成蛋白含量影响

目的：探讨钢板和矩形髓内钉固定对兔胫腓骨骨折骨痂含量和成骨细胞内骨形态生成蛋白（BMP）含量的影响。方法：第1部分实验用新西兰兔24只,对同一动物的两侧下肢分别用矩形髓内钉和4孔不锈钢板固定,并分3批于固定后14,21,28 d处死。用免疫组化方法检测骨痂中成骨细胞中BMP的分布,用计算机图像分析系统将结果进行定量分析。第2部分实验用新西兰兔8只,同法制作动物实验模型,于术后56 d摄双侧胫骨X线片,将X线片经计算机图像分析处理系统对骨折处骨痂图像进行定量分析。结果：矩形髓内钉组术后56 d骨痂含量和术后14,21,28 d骨痂中成骨细胞内BMP含量均高于钢板组（P<0.05）。结论:矩形髓内钉内固定胫骨有利于骨折愈合。     

Estimation of the optimum loading of an antibiotic powder in an acrylic bone cement: Gentamicin sulfate in SmartSet HV

Background?In some countries, commercially available antibiotic powder-loaded acrylic bone cement is routinely used in joint replacement, while, in others, “off-label” formulations are used in selected procedures (where the antibiotic powder is blended manually with the powder of a plain cement in the operating room/theater by either the surgeon or approved personnel). In the latter situation, an arbitrary rather than a rational approach is used for deciding on the amount of the antibiotic that is blended with the cement powder (herein referred to as “the antibiotic powder loading”).

Methods and results?The first objective of this study was to present two methods for estimating the optimum loading of gentamicin sulfate powder that may be blended manually with the powder of a commercially available acrylic bone cement, ABC (Wopt). The second objective was to define the challenges associated with each of these methods. The loading (W) was optimized with respect to two key properties of the cured cement that were obtained simultaneously, namely (1) fatigue life in phosphate-buffered saline solution (PBS) at 37°C, and (2) the rate of elution of the gentamicin from the cement (E) in that medium. Three sets of specimens were used, containing 2.25, 4.25 and 11.50 wt/wt% of the gentamicin that was blended manually with the cement powder. The fatigue tests involved determining the number of cycles at which a specimen fractured (Nf) when subjected to fully-reversed tension-compression sinusoidal load, ± 15 MPa at 2 Hz. E was determined from the concentration of gentamicin in the PBS solution when the specimen fractured, using fluorescence polarization immunoassay for the measurement. Consistent with a priori expectations, it was found that, with increase in W, Nf decreased while E increased. Two approaches for obtaining an estimate of Wopt are described, a mathematical method and an empirical one, that lead to Wopt values of 6.50 wt/wt% and 4.78 wt/wt%, respectively. Thus, this antibiotic loading ranges from about the same to about 92% greater than that in SmartSet GHV Gentamicin, which is a commercially available bone cement used clinically and which has the same composition as SmartSet HV except for the presence of gentamicin sulfate in its powder (blended in by the manufacturer).

Interpretation?We present and critically compare two rational methods of determining the optimum loading of an antibiotic powder in an acrylic bone cement, which should serve as a guide when using “off-label” antibiotic powder-loaded acrylic bone cements in cemented joint replacements.     

Management of Total Femoral Bone Loss Using a Hybrid Cement Spacer Surgical Technique

Standard treatment for an infected total hip arthroplasty is 2-stage revision. Bone loss in infected total hip arthroplasty presents specific challenges during the first stage. This is especially the case when there is massive or complete loss of the femoral bone stock. We describe a technique successfully used in the setting of total femoral bone loss using a hybrid cement spacer. We describe 2 cases illustrating the technique and perioperative course. This technique is a potential solution for total femoral bone loss that allows the individual to maintain mobility before definitive surgery.     

二种途径灌注5-FU犬头颈部药物浓度的变化比较

目的:比较不同方法灌注5-FU后,犬舌及颌下淋巴结组织内的药物浓度。方法 :16只健康家犬称重后随机分为A组(舌动脉给药)和B组(股静脉给药)。分别行经舌动脉及股静脉持续24 h灌注5-FU。在12、24 h采集2组灌注侧舌体组织及下颌下淋巴结。反相高效液相色谱法(RP-HPLC)检测以上采集组织标本中5-FU含量。结果:全麻状态下,犬能耐受24 h舌动脉持续灌注5-FU并保持生命体征平稳。舌动脉灌注组舌体组织及颌下淋巴结内5-FU浓度,明显高于股静脉给药组。结论:5-FU舌动脉持续灌注后,舌及下颌下淋巴结的药物浓度均明显高于股静脉持续灌注。