Faculty Bibliography

Two hundred fifty consecutive intertrochanteric fractures treated with a sliding hip screw (SHS) over a three year period were reviewed and specific types of technical pitfalls identified. Most pitfalls were technique dependent and potentially preventable with proper attention to the principles of fracture reduction and insertion of the device. Pitfalls encountered with the use of the SHS occurred as a result of either poor fracture reduction or implant insertion. Problems related to fracture reduction included poor radiographic visualization, posterior sag, varus angulation, and internal rotation of the femoral shaft in relation to the femoral neck. Potential pitfalls encountered during SHS insertion included superior guide wire placement, guide wire breakage or penetration into the hip joint or pelvis, loss of reduction during lag screw insertion, improper screw-barrel relationship, and improper plate application. Finally, the SHS may not be the implant of choice for all extracapsular hip fractures (i.e., the reverse obliquity fracture). This paper identifies the various pitfalls that may occur with the use of the SHS for the fixation of intertrochanteric hip fractures. Illustrative cases are provided and guidelines for avoiding these surgical pitfalls suggested

Unstable intertrochanteric hip fractures are characterized by comminution of the posteromedial cortex, resulting in a fragment of variable size containing the lesser trochanter. Controversy exists as to whether it is necessary to perform reduction and fixation of this fragment. This case lends further support to the practice of fixating the lesser trochanteric fragment in unstable intertrochanteric fractures

Bovine peripheral blood lymphocytes were examined for their binding to anti-immunoglobulin serum, peanut agglutinin, and mu, alpha, and epsilon heavy chain specific antisera by immunofluorescence. The percentage of total lymphocytes with positive staining was determined independently by flow cytometry and fluorescence microscopy. The correlation of data from both methods was best for analysis of total surface immunoglobulin and IgM bearing cells. The percentage of lymphocytes bearing surface immunoglobulin (B cells) was determined using both whole antiserum and a F(ab')2 reagent. Quantitation by flow cytometry did not show a significant difference when the two reagents were used, whereas fluorescence microscopy revealed a significant difference (p less than .05). The mean percent of total surface immunoglobulin bearing cells was 30 +/- 3% by either method. Flow cytometry gave significantly larger values than fluorescence microscopy for samples stained with fluorescein conjugated peanut agglutinin. Peanut agglutinin binding cells comprised 70 +/- 3% by flow cytometry and 51 +/- 3% by fluorescence microscopy. Similarly, there was a significant difference between both methods when IgA bearing lymphocytes were examined. Percentages of immunoglobulin E, A, and M bearing lymphocytes as well as total B and T cells in spleen and bronchial lymph node were determined by immunofluorescence using the cytofluorograph. Peanut agglutinin binding cells were less numerous in spleen and lymph node than in peripheral blood. Immunoglobulin E bearing lymphocytes increased from 0.07% in peripheral blood to 4% in spleen and 1.9% in lymph node. In this paper we demonstrate how flow cytometry can be used to examine a large number of samples in a rapid and reproducible manner. This is the first report in which bovine lymphocytes bearing surface IgE are quantitated.