Introduction : Imageless navigation has been successfully integrated in knee arthroplasty but its effectiveness in total hip arthroplasty (THA) has been debated. It has consistently been shown that navigation adds significant time and cost to the operation. Further, the relative success of traditional hip replacements has impeded the adoption of new techniques.Methods : We compared the operative time between fifty total hip replacements with and without the use of imageless navigation by a single senior surgeon in a retrospective study. We employed standard statistical tools to compare the two methods. A correlation-based analysis was used to delimit the “learned” phase of imageless navigation to make comparisons meaningful.Results : Contrary to what has previously been reported, there was no significant difference between operative time in navigated, when compared to traditional operations (p  = 0.498). Only fourteen operations were required to delimit the learning phase of this operation.Discussion : This is the first study that demonstrates no added operative time when using imageless navigation in THA, achieved with an improved workflow. The results also demonstrate a very reasonable learning curve.

/pdf/imageless-navigation-total-hip-arthroplasty-an-evaluation-of-1429amhgl5.pdf

Imageless navigation total hip arthroplasty - an evaluation of operative time.

We congratulate Mouzopoulos et al. [1] on their excellent study and efforts to solve the controversies in the management of displaced fracture of the femoral neck in an elderly age group. We agree with the authors that total hip arthroplasty (THA) is cost effective and has a better functional outcome in elderly patients with subcapital femoral neck fracture, but we would like to have some clarifications of their study with respect to the following points:

https://link.springer.com/content/pdf/10.1007%2Fs00264-008-0631-y.pdf

Comment on Mouzopoulos et al.: The four-year functional result after a displaced subcapital hip fracture treated with three different surgical options

Dear Editor:

We read the article by Sadiq et al [1] with great interest

We agree with the author that the management of type III supracondylar fractures in children is technically difficult, and that complications are common; cubitus varus is the most prevalent complication We went through the relevant literature and found that in the management of type III supracondylar fractures the traction method has been a standard treatment in previous years, but nowadays it is an uncommon method, as alternative methods are available for equivalent or better treatment The traction method requires prolonged hospitalisation and is more expensive, and there is difficulty in accurately holding and radiographically assessing the reduction [2]

The use of skeletal traction has far better results than the use of skin traction in these fractures [3] The authors have said that because of increased swelling and distorted anatomy they preferred to use the traction method for a period of 2 weeks For severely swollen elbows we provide traction for 24–48 h, which may make a big difference in ease and safety of closed or open pinning after 2 or 3 days This will decrease the hospital stay and thus expenditure, and ensure maintenance of reduction

The incidence of cubitus varus was unacceptably high in most series regardless of the type of skin traction used, despite isolated good results [4, 5] The results are poor in patients over the age of 10 years [6]

We also feel that the lateral traction method is difficult in posterolateral displacements as the distal spike penetrates the brachialis muscle, which prevents reduction The psychological problems that the patient and parents experience with prolonged traction will be greater than those associated with the pinning method

/pdf/comment-on-sadiq-et-al-management-of-grade-iii-supracondylar-1tmba6mscx.pdf

Comment on Sadiq et al.: Management of grade III supracondylar fracture of the humerus by straight-arm lateral traction.

We read with interest the article “Ipsilateral hip and femoral shaft fractures treated with intramedullary nails” by M. Shantharam Shetty, M. Ajith Kumar, Sandeep S. Ireshanavar, and Sudhakar. The topic was nicely described [1]. The treatment of ipsilateral fracture poses a challenging task for planning surgery with intra-operative and post-operative complications including, most devastating of all, non-union of fractured neck of femur. We suggest that if ipsilateral fracture of neck of femur is suspected in a fractured shaft of femur, in addition to lateral views of the hip, CT scan of the hip should be performed [2]. Moreover, treatment is determined by whether the fractured neck of femur is displaced or undisplaced. In our experience, if the fractured of neck of femur is displaced after insertion of the reconstruction nail with distal interlocking for the fracture of shaft of femur, the femoral neck fracture is reduced by applying traction. However, instead of acting at neck of femur, the traction acts at fracture of shaft of femur and distracts it; thus, it is very difficult to reduce femoral neck accurately. Therefore we prefer a retrograde femoral nail followed by multiple cannulated cancellous screws for displaced fracture neck of femur [3]. If in undisplaced fracture of neck of femur reconstruction nails are planned, the femoral canal should be overreamed 1.5–2 mm larger than the nail to allow adjustment of anteversion angle [4]. We feel this article would have been more informative if these points had been considered in planning of fixation in these complex fractures.

Comment on Shetty et al.: Ipsilateral hip and femoral shaft fractures treated with intramedullary nails.

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Comment on Mouzopoulos et al.: The four-year functional result after a displaced subcapital hip fracture treated with three different surgical options

Comment on Sadiq et al.: Management of grade III supracondylar fracture of the humerus by straight-arm lateral traction.

Comment on Shetty et al.: Ipsilateral hip and femoral shaft fractures treated with intramedullary nails.