Objective: To present initial experience of 12 cases of percutaneous plating of the comminuted fractures of the humerus using minimal access surgery and standard low-contact dynamic compression plate. Patients and Methods: Twelve patients (11 males and 1 female) with an average age of 29.8 years (range 17–46 years) with comminuted diaphyseal fractures of the humerus were treated by minimal access surgery using standard AO/ASIF implants. Fracture was reduced indirectly either by manipulation or by a femoral distractor. Image intensifier was used to monitor the reduction and fixation. The plate was fixed on the anterior surface of the humerus using proximal and distal minimal incision on the anterior aspect of the upper arm. Results: All fractures were united, and all patients had a good range of motion in the adjacent joints. In 1 patient, there was a transient neurological deficit. Conclusion: Percutaneous fixation of comminuted fractures of the humeral shaft is an alternative to standard open surgery, reducing the surgical impact and giving an excellent functional result.

Objective: To compare the difference in diameter of the medullary cavity of the humerus in Arab and South Asian patients in Kuwait. Subjects and Methods: In 46 patients (29 Arab, 17 South Asian) treated at Al-Razi Hospital, Kuwait, for diaphyseal fracture of the humerus, the medullary cavity of the humerus on the radiographs of the uninjured (contralateral side) was examined. Bone density was also measured. Statistical significance was calculated by parametric and nonparametric test using SPSS package. Results: South Asians had a significantly narrower medullary cavity (p < 0.05) and higher cortical indices (p < 0.05) than Arabs, and also a narrower external diameter of the humerus at levels 5 and 6 (p < 0.05). Conclusion: In cases of fracture of the humerus, radiographic measurements of the diameter of the medullary cavity of the uninjured side were essential in selecting the appropriate fixation device.

Objective: To present the clinical and radiological results of a minimally invasive technique, the fixation of two- and three-part fractures of the proximal humerus according to the Neer Classification System, using the intramedullary bundle-wiring Hackethal technique. Subjects and Methods: The operations were performed with the Hackethal technique (use of elastic titanium nails, Synthes) on 17 patients (8 males and 9 females) with two- and three-part fractures of the proximal humerus. In cases of two-part fracture only, intramedullary titanium nails were used while for three-part fractures, percutaneous cannulated screws were used to fix the greater tuberosity, followed by intramedullary insertion of titanium elastic nails. The clinical results were assessed using the Constant score and radiological assessment including the union and alignment of the proximal humerus. Preoperative and postoperative CT scans were performed along with 3D reconstruction in all cases for diagnostic and prognostic significance. Results: All fractures united in an average period of 12 weeks (range 10–17 weeks). In all patients, a good to excellent range of motion of the shoulder, and good to excellent muscular power and alignment were noted. The Constant score amounted to 81 points (range 64–98 points). There was no secondary loss of fixation and migration of implants. Conclusion: In cases of two-part fracture of the proximal humerus, the minimally invasive Hackethal technique alone and in cases of three-part fracture, the same technique with percutaneous cannulated screws provided excellent clinical and radiological results with a minimal risk of complication. It is an important alternative to open reduction and internal fixation of these difficult fractures.

Objective: To present initial experience of the first 71 cases of cementless total hip replacement in Al Razi Hospital. Subject and Methods: Between 1996 and 2004, total hip replacement was performed in 71 patients (40 male, 31 female, average age 40.7 years, range 17–74) using Zweymüller cementless prosthesis. The patients were followed clinically and radiologically over an average period of 36 months (range 6–84). The results were assessed according to Merle d’Aubigne clinical score. Radiological assessment included position of the implant, behavior of the prosthesis/bone interface and signs of osteointegration. Results: Average clinical score during the 3 years’ follow-up period was 17.8 points. Most of the implants were in optimal positions. No significant radiological modifications of the implant-bone interface were observed. Conclusion: Zweymüller total hip prosthesis gives excellent clinical and radiological results in short-term follow-up.

Objective: In this study we present the results of a series of cemented Exeter and cementless Zweymüller implants. Subject and Methods: Eighty-seven cemented and 95 cementless hip replacements for different hip pathologies were followed for an average period of 36 months for cementless and 60 months for cemented cases. Clinical results were calculated using the Merle d’Aubigne score. The orientation of the prosthetic components and the fixation of the cup and stem were analyzed. The clinical and radiological results were compared using statistical methods. Results: In the average period of 36 months in cementless and 60 months in cemented hip replacements the clinical results improved significantly when compared with the preoperative score (p < 0.05). Sixty-seven cemented acetabular cups (77.1%) were in the desired position (30–50°) and 20 cemented cups (22.9%) were outside this range. Seventy-six cups (80%) were in the desired degree of abduction and 19 (20%) were outside this range. All cups except 1 were anteverted or neutral. Of the femoral stems, 173 were in the neutral position, 5 in the valgus and 4 in the varus position. Cemented cups were more commonly loose and cemented and cementless stems did equally well. No significant differences in rate of complications were found. Conclusion: Cementless acetabular implants had better clinical results and a lower loosening rate at 3 years of follow-up compared to cemented implants at 5 years of follow-up. The cemented femoral implants were equally stable compared to the cementless ones.