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1
Kanchanomai, Chaosuan, Panurungsit Muanjan, and Vajara Phiphobmongkol. "Stiffness and Endurance of a Locking Compression Plate Fixed on Fractured Femur." Journal of Applied Biomechanics 26, no. 1 (2010): 10–16. http://dx.doi.org/10.1123/jab.26.1.10.
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The effects of locking screw position (long column fixation—long distance between the nearest screws to the fracture—and short column fixation—short distance between the nearest screws to the fracture) and fracture gap size (1-mm and 8-mm transverse fracture gap) on stiffness and fatigue of fractured femur fixed with a locking compression plate (LCP) were biomechanically evaluated. The stiffness of 1-mm fracture gap models and that of intact femoral model were in the range of 270–284 N/mm, while those of 8-mm fracture gap models were significantly lower (155–170 N/mm). After 1,000,000 cycles of loading, no fracture of LCP of 1-mm fracture gap models fixed in either long column or short column fashions occurred. On the other hand, the complete fractures of LCPs of 8-mm fracture gap models fixed in long column and short column fashions occurred after 51,500 and 42,000 cycles of loading, respectively. These results suggest that the full weight loading may be allowed for the patient with 1-mm transverse femoral fracture fixed with an LCP. On the other hand, the full load of walking should be avoided for the patient with 8-mm transverse femoral fracture fixed with an LCP before adequate healing.
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Gupta, Ravi, and Ashwani Soni. "Iliofemoral Approach to Acetabulum." Trauma International 3, no. 1 (2017): 14–16. http://dx.doi.org/10.13107/ti.2017.v03i01.038.
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Surgical approach to acetabulum fractures depend on the type of fracture and fracture displacement along with surgical preference of the surgeon. Ilio-femoral approach is one of the most important approaches for acetabular fractures. It allows access to anterior column as well as anterior wall fractures. This symposium article details the surgical technique as well as indications and shortcomings of this approach. Keywords: Ilio-femoral appraoch, acetabulum fractures, anterior column fractures.
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Erwin, Erwin, Deni Noviana, Dany Umbu, and Tri Isyani Tungga Dewi. "Management Femoral Fracture in Cats using Intramedullary Pin and Wires Fixation." International Journal of Tropical Veterinary and Biomedical Research 3, no. 2 (2018): 32–35. http://dx.doi.org/10.21157/ijtvbr.v3i2.12333.
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On April 2016, Veterinary Teaching Hospital, Faculty of Veterinary Medicine, Bogor Agricultural University (VTH FKH IPB) received 4 cases of femoral fractures in cats caused by trauma. Two cats suffered oblique diaphysis fracture femoral, one cat suffered comminuted diaphysis fracture femoral, and one cat suffered epiphyseal fracture femoral (column femoral and trochanter major). All cats were treated by open surgery using intramedullary pins (Steinmann) and cerclage wires (Kirschner). Fracture recovery went without complication and all cats were able to move their feet one week after surgery.
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Noorisa, Riswanda, Dwi Apriliwati, Abdul Aziz, and Sulis Bayusentono. "THE CHARACTERISTIC OF PATIENTS WITH FEMORAL FRACTURE IN DEPARTMENT OF ORTHOPAEDIC AND TRAUMATOLOGY RSUD DR. SOETOMO SURABAYA 2013 – 2016." (JOINTS) Journal Orthopaedi and Traumatology Surabaya 6, no. 1 (2019): 1. http://dx.doi.org/10.20473/joints.v6i1.2017.1-11.
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Fracture is a neuromuscular damage due to tissue trauma or discontinue of bones. Fractures of the lower limbs due to accidents have the highest prevalence among other fractures in Indonesia. The aim of this study is to determine the characteristic of patients with femoral fracture in Department of Orthopedic RSUD Dr. Soetomo Surabaya.This research is retrospective observational. We analyzed medical records of all stay in patient in Department of Traumatic and Orthopedic RSUD Dr. Soetomo Surabaya during 1 January 2013 – 31 December 2016. Of the 972 enumerated, 112 subjects with femoral fracture were analyzed for study. The observed variable of patients’ profile include: sex, age, cause of fracture, type of wound, location of fracture, place of accident, time of accident.Our observational study during three years has concluded several findings as following. The most common cases of fracture is occurred at the age 15 – 24 with 40 cases (36%). Most of the cases is dominated by male gender (72%). Traffic accident (92%) is the major cause of fracture, which mostly occurred on the street (92%) at 06:01 A.M. until 12:00 A.M (28%). Closed wound (71%) is commonly found in femoral fracture. The most common type of femoral fracture has a closed wound (71%) and located in column of femur (46%). The most common cases of femoral fracture are occurred on male at the productive age due to traffic accident injury.
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Sethuraman, Saranya A., Ashlyn S. Morse, Javier Z. Guzman, Robert Cristofaro, and David E. Asprinio. "Favorable Outcome Twenty-Two Months after Delbet Type Ib Capital Femoral Transepiphyseal Fracture and Posterior Column Acetabular Fracture in a Fifteen-Year-Old Male." Case Reports in Orthopedics 2022 (April 21, 2022): 1–6. http://dx.doi.org/10.1155/2022/1843367.
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Case. A fifteen-year-old male patient sustained a posteriorly dislocated right capital femoral Delbet type Ib epiphyseal fracture-separation and a right acetabular posterior column fracture after a low-energy trip and fall. The capital femoral epiphysis was closed reduced and fixed with cannulated screws on an urgent basis. He underwent acetabular osteosynthesis via a Kocher-Langenbeck approach two days thereafter. Twenty-two months after injury, he was weight-bearing on the right lower extremity without radiologic evidence of avascular necrosis or clinical evidence of pain or functional deficit. Conclusion. Fracture-separation of the capital femoral epiphysis comprises only 8% of skeletally immature femoral neck fractures in the Delbet and Colonna classification. Prognosis is worse with ipsilateral hip dislocation due to the risk of avascular necrosis from disruption of the medial femoral circumflex artery. Urgent referral to a trauma center and treatment by appropriate specialists enables good long-term results after this uncommon traumatic injury pattern.
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Touet, Amadeo, Yannick Schmiedt, Jessica Köller, et al. "Impact of Patient-Specific Hip Joint Geometry on the Morphology of Acetabular Fractures." Journal of Clinical Medicine 13, no. 23 (2024): 7332. https://doi.org/10.3390/jcm13237332.
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Background: Acetabular fractures continue to pose a major challenge in clinical practice, not least because of the growing geriatric population. While the influence of the force vectors on fracture formation is well established, the impact of anatomical factors on fracture morphology remains poorly understood. The aim of this study was to investigate patient-specific hip joint geometry, identify structural risk factors and correlate these with the resulting fracture patterns. Methods: This retrospective cohort analysis included 226 patients (Mdn age = 58 yrs.) with acetabular fracture categorized by Judet/Letournel and the AO/OTA classification. Computed tomography (CT) datasets of the injured and contralateral sides were analyzed using multiplanar reconstruction. Parameters included modified center-edge (CE) angle (Wiberg), rotation angles (Ullmann and Anda), acetabular sector angle (Anda), true caput-collum-diaphyseal (CCD) angle, femoral head diameter and volume, as well as femoral neck length, circumference, and diameter. In addition, intrarater reliability within a subcohort was assessed for the metric measurements and inter-rater analysis for the classification of the entire sample. Results: The primary analysis showed direct effects of femoral head diameter, femoral neck length and femoral head size on the fracture type according to AO/OTA (type A/B/C), whereby this effect was particularly seen between type A and type C fractures (p = 0.001). Ordinal regression identified femoral head diameter as the only significant predictor (p = 0.02), with a 25% increased likelihood of complex fractures per unit of change. Low-energy trauma doubled the risk of severe fractures. Specific findings include a higher acetabular anteversion in anterior column fractures. Age correlated positively with the cause of injury and fracture type. The inter-rater reliability for fracture classification was excellent, as was the intrarater reliability of the measurements. Conclusions: This study suggests that anatomical factors, particularly proximal femoral geometry, have an impact on acetabular fracture morphology—in addition to factors such as trauma type and patient demographics.
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Mai, Thanh Cong Chien, Thanh Tan Nguyen, Huu Thuyet Nguyen, et al. "INJURED MORPHOLOGY AND SELECT THE CORRESPONDING APPROACH OF POSTERIOR TIBIAL PLATEAU FRACTURES ON COMPUTED TOMOGRAPHY WITH THREE-DIMENSIONAL RECONSTRUCTION." Tạp chí Y Dược học Cần Thơ, no. 8TA (November 25, 2024): 44–50. https://doi.org/10.58490/ctump.2024i8ta.2536.
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Background: Posterior tibial plateau fractures occur when a fall causes the femoral condyle to impact the knee joint while it is in a bent position. This fracture type is not typical among accident cases and normally is relative to high-energy trauma. A computed tomography with a threedimensional knee joint can accurately establish the knee joint performance to evaluate and diagnose articular surface, type of fractures and surgical planning. Objectives: To examine the morphology of posterior tibial plateau fractures using 3D CT scans. To select and determine the appropriate surgical approach for each type of fracture. Materials and methods: This study included 25 cases of posterior tibial plateau fractures, all of which were treated using three-dimensional CT scans at Can Tho University of Medicine and Pharmacy Hospital and Can Tho Central General Hospital from June 2022 to April 2024. Results: Samples in the study comprised 25 patients, out of whom male respondents were 40%, and female respondents were 60%. The average age was 39.84 ± 14.37 with the highest proportion being the age group 16-40 years old (48%). Isolated fractures of the posterolateral column accounted for 4%, isolated fractures of the posteromedial column for 8%, fractures involving the posteromedial and medial columns for 24%, and posterolateral and lateral column fractures for 16%. The most complex fractures, involving all three columns, accounted for the highest rate of 48%. Most patients underwent surgery in the supine position (92%) for the anterolateral, anteromedial, and posteromedial approach, with 2 patients in the prone position for the reverse L-shaped approach. Our choice of surgical approach is relatively consistent with international studies. Conclusions: The research provides many morphological tibial plateau fractures with 3D CT scans to support classifying the posterior tibial plateau fractures and assists the surgeon in selecting the most suitable surgical approach and optimizing bone fixation techniques tailored to each specific fracture type.
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Wibowo, Arif, and Mohammad Zaim Chilmi. "Modified Stoppa Approach For Concomitant Anterior And Posterior Pelvic Ring Fracture: A case report." Hip and Knee Journal 3, no. 1 (2022): 44–50. http://dx.doi.org/10.46355/hipknee.v3i1.104.
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BACKGROUNDModified Stoppa approach was performed to access the site of anterior column fracture instead of the Ilioinguinal approach to reduce morbidity.CASE SUMMARYA 24-year-old female suffered a serious traffic accident when she was riding a motor cycle collided with a car from the front and fell off when dodged a hole on the road. Then, the patient was beneath a moving car after falling. Several hours after accident at the hospital, she diagnosed as closed pelvic fracture of right superior inferior pubic rami and right sacroiliac joint disruption, closed fracture of right shaft femur. After improvement the condition in the ward, open reduction and internal fixation for the femoral fracture and for the pelvis fracture were performed using a modified stoppa approach to access the fracture site.CONCLUSION Treatment using the modified Stoppa approach was suitable for anterior column fracture, in which pelvic fractures were sufficiently exposed, the fracture was conveniently reduced, less complications occurred, and curative effect was satisfactory.
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Wang, WenTao, Federico Canavese, Zhu Xiong, ShengPing Tang, ShunYou Chen, and ShengHua He. "Management of pediatric femoral neck fractures from classification to surgery: a review of indications based on anatomic and radiographic features of the proximal femur." EFORT Open Reviews 10, no. 3 (2025): 125–40. https://doi.org/10.1530/eor-2024-0129.
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This review focuses on the anatomic and radiographic characteristics of the pediatric proximal femur and the advantages and disadvantages of different protocols for the management of pediatric femoral neck fractures (PFNFs) in terms of fracture classification, reduction methods, reduction quality and fixation methods, with the goal of proposing an optimal treatment protocol for PFNFs to reduce the incidence of postoperative complications. The anatomic and radiographic characteristics of the pediatric proximal femur, including the presence of an active growth plate, an immature femoral calcar, greater trabecular density and plasticity and a relatively immature blood supply are very different from those of the adult proximal femur. Treatment protocols for PFNFs must differ from those for adult femoral neck fractures. PFNFs with posterior translation, and those with comminuted medial-posterior columns, are associated with a higher postoperative complication rate. This review suggests that the degree of damage to the nutrient vessels along the posterior femoral neck and the stability of the medial-posterior column of the femoral neck should be well assessed in patients with PFNFs for both classification and treatment purposes. Anatomic reduction through an anterior approach, placement of a small number of implants in the mid-inferior part of the femoral neck and additional external support are effective in reducing postoperative complications in patients with PFNFs.
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M, Tangguh Satria, and Achari Yazid. "A Rare Case of Femoral Column Fracture in Children with Closed Reduction and Spica Cast: A Case Report." RA JOURNALS OF APPLIED RESAERCH 09, no. 09 (2023): 501–5. https://doi.org/10.5281/zenodo.8370226.
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<strong>Background:</strong> Femoral column fracture is a rare case fracture in children. This is usually caused by high-energy trauma, such as falling from a height, or, in some cases, can also occur due to pathological fractures or repetitive trauma, such as running or jumping. Femoral column fractures can occure several complications, such as avascular necrosis (AVN), coxa vara, malunion, and osteonecrosis. Therefore, appropriate treatment is needed to reduce the risk of complications that may occur. <strong>Case Presentation: </strong>A 15 year old boy came to the emergency room with complaints of pain in base of his right thigh after falling while jumping over a tennis net with focus on his right leg. On examination, vital signs were normal, pain in the right groin had limited range of motion (ROM), and no other injuries or pain were found in his parts of the body. Then treatment was carried out using the closed reduction method and the installation of a spica cast without internal fixation. <strong>Conclusion:</strong> Although there is still a lot of controversy regarding the best time and method for administering therapy, determining the Delbet classification is very helpful as a consideration in choosing treatment and patient prognosis. In this case, treatment was given using close reduction and spica cast techniques with the consideration that anatomical reduction could be achieved.
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Grin, Alexey A., Alexander A. Markov, Anastasiya V. Danilova, and Konstantin S. Sergeev. "Experience with the use of bioactive calcium phosphate-coated implants in multicomponent traumatic damage to the hip joint." N.N. Priorov Journal of Traumatology and Orthopedics 27, no. 3 (2020): 67–72. http://dx.doi.org/10.17816/vto202027367-72.
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Objective. To study the effectiveness of using implants with a bioactive calcium-phosphate coating on the example of treating a patient with combined fractures of the acetabulum and the neck of the femur.
 Materials and methods. A 52-year-old patient, injured as a result of a traffic accident with multicomponent damage to the right hip joint (transcervical fracture of the femoral neck and a high two-column fracture of the acetabulum). Osteosynthesis of the femoral neck fracture is made by three cannulated screws with a calcium-phosphate coating (patent of the RU No. 81427). For the osteosynthesis of the acetabular fracture, a reconstructive plate with a calcium-phosphate coating was used (patent of the RU No. 113945).
 Results. Despite the heavy, multi-component destruction of the hip joint, consolidation of the fractures ensued. The remote result is tracked for 10 years. On the score scale of the functional results Harris 89 points, the result is rated as good.
 The conclusion. The use of imantates with bioactive calcium-phosphate coatings from hydroxyapatite promotes activation of reparative processes in the region of fractures.
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Zhang, Ruipeng, Yingchao Yin, Wei Chen, et al. "Characteristic analysis and surgical exploration for acetabular roof fractures: Multicenter retrospective cohort study." PLOS ONE 20, no. 2 (2025): e0317932. https://doi.org/10.1371/journal.pone.0317932.
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Background Acetabular roof was a crucial structure for maintaining the stability of hip joint; however, its important role was not especially emphasized in the Letournel-Judet classification system. Acetabular roof was segmented into the roof column and roof wall in Three-column classification and fracture in this area alone was defined as A3 injury. The purpose of this study was to explore the characteristics and surgical strategy of A3 injury. Methods Patients with roof column/wall fractures received surgical management from January 2015 to 2019 January at nine level-1 trauma centers were retrospectively analyzed. Fracture data, surgical incision, operation time, blood loss, fracture healing and relevant complications were recorded to explore fracture characteristics and appropriate surgical strategy. Reduction quality was assessed based on postoperative radiographic examination. Merle d’Aubigné score was used to assess the functional outcome during the follow-up. Results A total of 60 patients met the inclusion criteria in this study. Mean operation time was 112.83±21.77 min, and mean intraoperative blood loss was 396.67±182.00 ml. Satisfactory reduction quality was obtained in 49 cases (81.67%). All fractures healed well at an average mean of 3.07 months. Satisfactory outcomes were obtained in 46 cases (76.67%), and mean Merle d’Aubigné score was 15.53±1.33 points at the final follow-up. Reduction quality and functional outcome showed no statistical difference in three subtypes (P<0.05). Reduction quality and functional outcome presented positive correlation in three subtype fractures (P<0.05). The complication rate was 11.67% (7/60) in this study. Conclusion The injury mechanism of A3 injury was the direct impaction from femoral head on acetabular roof. Reduction and fixation of A3 injury were technique demanding, and poor prognosis may be accompanied even treated by experienced surgeons. Appropriate surgical strategies (Table 5) based on fracture characteristics in three subtypes of A3 injury were the premise of accepted prognosis.
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Kumar, Ravi, Divyansh Sharma, Bahrat Bhushan, Mukand Lal, and Sandeep Kashyap. "Evaluation of Functional Outcome and Complications after Open Reduction and Internal Fixation of Acetabulum Fractures." IAR Journal of Medical Sciences 3, no. 02 (2022): 100–105. http://dx.doi.org/10.47310/iarjms.2022.v03i02.014.
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Background: The present study was done to evaluate the functional outcome and complications after open reduction and internal fixation of acetabulum fractures. Material and methods: The present study was done in 44 patients of fracture acetabulum managed by open reduction internal fixation in the Department of Orthopaedic surgery, Indira Gandhi Medical College, Shimla. Results: There were 16 prospective (36.4%) and 28 retrospective (63.6%) cases. The mean age was 45.07 years with maximum number of 39 (88%) patients in the age group of 21- 60 years. Majority (77.3%) of the patients was males and 22.8 % were females. Modified Merle d’Aubigne and postel (MDA) score was excellent in 77%patients, good in 13%, fair in 10%. Matta’s radiological score at final follow up was excellent in 54.55%, good in 36.36%, fair in 4.55% and poor in 4.54% patients. The average Modified Harris Hip score was 94 at final follow up in 44 patients. Patients with anterior column fracture had HHS of 96 at final follow up; posterior wall fracture patients had average HHS of 92 at final follow up. Two patients had complications. One patient had femoral head fracture along with fracture of posterior wall developed AVN and also had subsequently Secondary OA with post-operative subluxation of femoral head. Thus three complications were seen in this patient. Another patient with fracture dislocation with fracture of posterior wall developed AVN and subsequently secondary OA 5 year after surgery. No patient developed sciatic nerve injury post operatively. None of patients developed postoperative sciatic nerve palsy. No patient died during treatment or follow up. Conclusion: Open reduction and internal fixation as a gold standard for acetabulum fractures which is indicated with excellent to good results in majority of the patients as assessed by Modified Merle d’Aubigne score, Modified Harris hip score and Matta Radiological score with minimal complications at final follow up.
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Zhang, Zhendong, Hui Cheng, Ningtao Ren, et al. "Treatment of osteonecrosis of the femoral head in Ficat stage III after femoral neck fracture in children and adolescents by basicervical femoral neck rotational osteotomy." Bone & Joint Journal 107-B, no. 6 Supple B (2025): 70–75. https://doi.org/10.1302/0301-620x.107b6.bjj-2024-1105.r1.
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AimsOsteonecrosis of the femoral head (ONFH) after femoral neck fracture poses challenges in children, particularly at Ficat stage III. Limited effective treatments are available. This study explores basicervical femoral neck rotational osteotomy (BFNRO) for ONFH following fracture of the femoral neck in children and adolescents, and evaluates its outcomes.MethodsChildren and adolescents with ONFH (Fiat stage III) following fracture who underwent BFNRO at our centre from June 2017 to September 2022 were included. Follow-up exceeded one year, with data on modified Harris Hip Score (mHHS), range of motion (ROM), patient satisfaction, femoral head collapse, necrotic area repair, leg length, and osteoarthritis (OA) progression recorded.ResultsThis study included 15 patients (15 hips; eight male and seven female) with a mean age of 12.9 years (10 to 17). Nine patients had BFNRO alone, and six had combined periacetabular osteotomy. Rotation angles varied from 70° to 90° for anterior rotation and 110° to 135° for posterior rotation. Nine patients had femoral neck fixation in a varus position (10° to 30°). The postoperative contour of the weightbearing area of the femoral head has significantly improved in all patients. At a mean follow-up of 28.6 months (12.2 to 72.7), mean mHHS significantly improved (65.2 (SD 8.6) to 90.2 (SD 5.8); p < 0.001). Only one patient showed femoral head further collapse. Patients experienced no/mild hip pain (visual analogue scale 0 to 3), slight restriction in ROM, and mild limb shortening. Two patients had OA progression. No infections or nerve injuries were observed, and no arthoplasies undertaken.ConclusionEven with late stage ONFH after fracture, BFNRO in children and adolescents can provide positive early to mid-term results by relocating the necrotic area and restoring the integrity of the anterior-lateral column of the femoral head, thereby preventing femoral head collapse and delaying the onset of severe OA.Cite this article: Bone Joint J 2025;107-B(6 Supple B):70–75.
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Willey, Michael C., Elizabeth Scott, and J. Lawrence Marsh. "Early Total Hip Arthroplasty for the Treatment of Acetabular Fractures." Journal of Hip Surgery 03, no. 03 (2019): 161–70. http://dx.doi.org/10.1055/s-0039-1692199.
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AbstractEarly total hip arthroplasty in patients with acetabular fractures is considered in rare situations with specific indications. Generally, this treatment option is considered in patients older than 55 or 60 years, but the physiological age must also be considered. The patient should be functional and ambulatory before the injury and healthy enough to tolerate the insult of a surgical procedure of this magnitude. Preexisting conditions such as osteoporosis and osteoarthritis encourage consideration of total hip arthroplasty. Specific injury patterns are predictive of fixation failure in older patients with acetabular fractures. These findings represent worse articular injury and low bone density that would intuitively lead to failure. This “gull sign” or “seagull sign” describes either the central–superior dome impaction seen in high-transverse fractures or the impaction of the subchondral bone on the intact edge of a partial posterior column fracture. Other radiographic predictors of failure in posterior wall fractures include comminution of more than three fragments, involvement of the superior dome in high posterior wall fractures, and marginal impaction. Older patients have a high incidence of these radiographic findings, predictive of fixation failure without arthroplasty. Other injury characteristics including concomitant displaced femoral neck fracture and femoral head injury are also indications for total hip arthroplasty in older patients. Acute hip arthroplasty can be performed using the posterolateral, direct lateral, anterolateral, and anterior approaches to the hip. There are also reports of patients who underwent combined approaches to the hip for stabilization of the injury using the anterior intrapelvic approach and ilioinguinal approach. Combined approaches are generally not recommended. Extended approaches are not recommended or necessary for early arthroplasty in acetabular fractures. This review article highlights recent trends of early total hip arthroplasty in senior patients with acetabular fracture, and the indications for the procedure, complications, clinical outcomes, and technical considerations, with cases to highlight these concepts.
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Egli, R. J., M. J. B. Keel, J. L. Cullmann, and J. D. Bastian. "Secure Screw Placement in Management of Acetabular Fractures Using the Suprapectineal Quadrilateral Buttress Plate." BioMed Research International 2017 (2017): 1–7. http://dx.doi.org/10.1155/2017/8231301.
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Acetabular fractures involving predominantly the anterior column associated with a disruption of the quadrilateral surface can be treated with instrumentation implementing the stabilization of the quadrilateral surface. The recently introduced suprapectineal quadrilateral buttress plate is specifically designed to prevent secondary medial subluxation of the femoral head, especially in elderly patients with reduced ability for partial weight bearing. Whereas there are guidelines available for safe screw fixation for the anterior and posterior columns, there might be a concern for intra-articular placement of screws placed through the infrapectineal part of the quadrilateral buttress plate. Within this report we analyzed retrospectively screw placement in 30 plates in postoperative CT scans using algorithms for metal artifact reduction. None of the screws of the buttress plate penetrated the hip joint. We describe the placement, length, and spatial orientation of the screws used for fracture fixation and suggest that the use of intraoperative image intensifiers with a combined inlet-obturator view of 30–45° best projects the screws and the hip joint. Preoperative knowledge of approximate screw placement and information for accurate intraoperative imaging may contribute to safe acetabular fracture fixation and may reduce operating time and limit radiation exposure to the patient and the personnel. This trial is registered with KEK-BE: 266/2014.
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Selvaratnam, Veenesh, Sunil Panchani, Henry Wynn Jones, Amol Chitre, Anthony Clayson, and Nikhil Shah. "Outcomes of acute fix and replace in complex hip posterior fracture dislocations with acetabular fractures : a minimum of 3 years follow-up." Acta Orthopaedica Belgica 87, no. 4 (2021): 635–42. http://dx.doi.org/10.52628/87.4.08.
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Simultaneous open reduction and internal fixation of acetabular fractures combined with total hip replacement (THR) have some potential advantages over the more traditional approach in specific patient subgroups. The aim of this study was to evaluate the outcomes of patients who had the “fix and replace” construct for complex posterior hip fracture dislocation treated at our tertiary referral pelvic unit. This was a retrospective review of prospectively collected data for patients who underwent this procedure between 2011-2018 with a minimum of 3 year follow up. Data collected were: patient demographics, date of injury, injury pattern, fixation methods, type of implants used and post-operative complications. There were 14 patients with a mean age of 63.2 years (range 43-94 years) who underwent this procedure between 2011-2018. The mean follow up was 58 months. All cases involved a posterior wall fracture and six cases had an associated posterior column involvement. Femoral head autograft was used in 13 patients (93%). Six patients (43%) had their posterior acetabular wall reconstructed with a femoral head autograft. Seven patients had a fully cemented (THR) and the seven others had a hybrid implant. There were no surgical related complications. From our study we can conclude that the acute “fix and replace” construct for complex posterior hip fracture dislocation yields good clinical outcomes in the short and medium term with low complication rate. It is best performed by a surgeon who specialises in both acetabular and hip arthroplasty surgery.
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Meinhard, B. P., C. Misoul, D. Joy, and R. Ghillani. "Central acetabular fracture with ipsilateral femoral-neck fracture and intrapelvic dislocation of the femoral head without major pelvic-column disruption. A case report." Journal of Bone & Joint Surgery 69, no. 4 (1987): 612–15. http://dx.doi.org/10.2106/00004623-198769040-00020.
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Siregar, Chairiandi, Syahrul Ramadan Rambe, and Rizal Renaldi. "Surgical hip dislocation for posterior hip dislocation with femoral head fracture pipkin classification type II: A case report." Jurnal Prima Medika Sains 6, no. 2 (2024): 226–30. https://doi.org/10.34012/jpms.v6i2.5664.
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Introduction: Surgical hip dislocation is a powerful and safe approach. It allows for simultaneous treatment of intra-articular pathologies, either preexisting or as a result of trauma, and improves long-term results. It can be used to treat a wide variety of intra-articular pathologies that would be extremely challenging or impossible arthroscopically or with other common open approaches to the hip. Surgical hip dislocation has been used in the trauma setting for open reduction and internal fixation of femoral head fractures and posterior wall acetabular fractures that do not extend into the posterior column. Case Report: A 28-year-old male with a posterior hip dislocation had difficulty flexing and extending his hip, internal rotation, and shortening his leg. During physical examination, we found a prominent head left femur on the posterior gluteus. During an X-ray examination, we found a posterior dislocation of the femoral head with a fracture. Treatment: Open reduction is preferable whenever there is a nonconcentric hip reduction. This reduces the risk of additional trauma, thus avoiding abrasion to the articular cartilage and bone contusion at the head of the femur. The surgeon who performs open reduction must be fully familiar with the surgical anatomy of the hip and must be aware of the fixation techniques used on fractures in this region. The fragment can be fixed both with 2.0-mm Herbert screws or mini fragment screws, taking care of the head of the implant into the articular cartilage. The joint capsule should always be repaired. When femoral head impaction is present, and the patient is an adult, the goal is to save the femoral head. In this situation, it is preferable to use the Watson-Jones or anterolateral approach with greater trochanteric osteotomy to perform the controlled dislocation of the hip.
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Wan, Yizhou, Sheng Yao, Kaifang Chen, et al. "Treatment of anterior column posterior hemitransverse fracture with supra-ilioinguinal approach." Journal of International Medical Research 49, no. 1 (2021): 030006052098282. http://dx.doi.org/10.1177/0300060520982824.
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Objective To report the feasibility and effect of the supra-ilioinguinal approach for treatment of anterior posterior hemitransverse fracture of the acetabulum. Methods Nineteen consecutive patients who underwent treatment for an anterior column posterior hemitransverse fracture of the acetabulum from January 2013 to June 2018 were retrospectively analyzed. All patients underwent treatment by the single supra-ilioinguinal approach with at least 1 year of follow-up. Results The mean time to surgery, operative time, incision length, and blood loss were 10.2 ± 3.8 days, 157 ± 125 minutes, 10.2 ± 0.6 cm, and 876 ± 234 mL, respectively. According to the Matta scoring system, the reduction quality was excellent in 13 patients, good in 6, and poor in 0. According to the Merle d'Aubigné scoring system, the outcome at the last follow-up was excellent in 12 patients, good in 5, fair in 1, and poor in 1. Postoperative complications occurred in three patients (deep vein thrombosis in one, lateral femoral cutaneous nerve injury in one, and both complications in one). Conclusions Use of the supra-ilioinguinal approach for treatment of anterior column posterior hemitransverse fracture of the acetabulum produced excellent clinical results because of the direct visualization of the anterior column and quadrilateral plate.
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Mohammad, S., A. Port, and R. J. Montgomery. "TRANSEPIPHYSEAL FRACTURE OF THE FEMORAL NECK WITH DISLOCATION OF THE FEMORAL HEAD AND FRACTURE OF THE POSTERIOR COLUMN OF THE ACETABULUM IN A CHILD." Journal of Bone and Joint Surgery. British volume 84-B, no. 1 (2002): 113–15. http://dx.doi.org/10.1302/0301-620x.84b1.0840113.
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Zhang, Z., D. Luo, H. Cheng, et al. "TREATMENT OF OSTEONECROSIS OF THE FEMORAL HEAD IN FICAT III STAGE AFTER FEMORAL NECK FRACTURE IN CHILDREN AND ADOLESCENTS BY BASICERVICAL FEMORAL NECK ROTATIONAL OSTEOTOMY." Orthopaedic Proceedings 106-B, SUPP_16 (2024): 35. http://dx.doi.org/10.1302/1358-992x.2024.16.035.
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Osteonecrosis of the femoral head after femoral neck fracture (ONFHpoFNFx) poses challenges in children, particularly at Ficat III stage. Limited effective treatments are available. This study explores basicervical femoral neck rotational osteotomy (BFNRO) for ONFHpoFNFx in children and adolescents and evaluates its outcomes.Children and adolescents with ONFHpoFNFx (Ficat stage III) underwent BFNRO at our center from June 2017 to September 2022 were included. Follow-up exceeded 1 year, with data on modified-Harris-hip-score (mHHS), range of motion (ROM), patient satisfaction, femoral head collapse, necrotic area repair, leg-length, and osteoarthritis progression recorded.This study included 15 cases (15 hips), with 8 males and 7 females, averaging 12.9 years in age (range: 10–17 years). Nine cases had BFNRO alone, and six had combined PAO. Rotation angles varied from 70° to 90° for anterior rotation and 110° to 135° for posterior rotation. Nine patients had femoral neck fixation in a varus position (10° to 30°). The postoperative contour of the weight-bearing area of the femoral head has significantly improved in all patients. With an average follow-up of 28.6 months (range: 12.2–72.7 months), mHHS significantly improved (65.2 to 90.2, P<0.001). Only one patient showed femoral head collapse. Patients experienced no/mild hip pain (VAS=0-3), slight restriction in range of motion, and mild limb shortening. Two patients showed osteoarthritis progression. No infections, joint replacements, or nerve injuries were observed.Even in cases of ONFHpoFNFx in the late stage, BFNRO in children and adolescents can still yield positive early to mid-term results by relocating the necrotic area and restoring the integrity of the anterior-lateral column of the femoral head, thereby preventing femoral head collapse and delaying the onset of severe osteoarthritis.
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Coutin, Julia V., Daniel D. Lewis, Stanley E. Kim, and David J. Reese. "Bifocal Femoral Deformity Correction and Lengthening Using a Circular Fixator Construct in a Dog." Journal of the American Animal Hospital Association 49, no. 3 (2013): 216–23. http://dx.doi.org/10.5326/jaaha-ms-5836.
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A 7 mo old male rottweiler was evaluated for a right hind limb lameness caused by malunion of a Salter-Harris type II fracture. Radiographs and computed tomography (CT) revealed that the right distal femur had valgus, procurvatum, external rotation, and was 35% (70 mm) shorter than the contralateral femur. Distal femoral wedge ostectomies were performed to acutely correct the angular and rotational deformities. Lengthening of the femur was accomplished by distraction osteogenesis performed over 53 days at a second, proximal diaphyseal osteotomy using a circular fixator construct. This bifocal approach yielded approximately 30 mm of femoral lengthening and a confluent column of regenerate bone that bridged the distraction gap. When evaluated 14 mo after surgery, the dog held the right hip, stifle, and hock in a slightly extended posture when standing and had a subtle asymmetric hind limb gait. The stride of the right hind limb was slightly shortened with compensatory circumduction of the left hind limb during the swing phase of the stride.
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Manzoor, Qazi Waris, Asif Sultan, and Bashir Ahmed Mir. "Osteosynthesis of Common Acetabular Fractures Operated on Through a Single Posterior (Kocher-Langenbeck) Approach with or without Trochanteric Flip Osteotomy. A Case Series." Ortopedia Traumatologia Rehabilitacja 23, no. 4 (2021): 271–77. http://dx.doi.org/10.5604/01.3001.0015.2364.
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Background. The Kocher-Langenbeck approach is recommended in the majority of common posterior acetabular injuries. Trochanteric osteotomy can be used to extend the exposure of the Kocher-Langenbeck approach superiorly and anteriorly. We evaluated the functional outcome of common acetabular fractures operated on through the Kocher-Langenbeck approach with or without trochanteric flip osteotomy. Material and methods. This prospective study enrolled 42 patients with posterior wall, posterior column, transverse, posterior wall with posterior column, transverse with posterior wall and both column acetabular fractures. The Kocher-Langenbeck approach was used in 35 patients and trochanteric flip osteotomy was done in 7 patients. The radiological outcome was evaluated by Matta’s criteria and the functional outcome was evaluated using modified Merle d'Aubigné and Postel criteria. Results. D’Aubigne Postel scores at the final follow-up were excellent in 12 patients, good in 18, fair in 8 and poor in 4. Thirty-seven patients had congruent reduction (anatomical in 29, imperfect in 8) and 5 patients had non-congruent reduction on radiographs as per Matta’s criteria. Radiographic congruity (88.09%, 37 out of 42 cases) correlated fairly well with the functional outcome (excellent or good functional outcome in 71.4%, 30 out of 42 cases). The complications included traumatic nerve palsy (3 cases), iatrogenic nerve palsy (2 cases), deep venous thrombosis (2 cases), wound infection (3 cases), non-congruent reduction (5 cases), 8 cases of osteoarthritis of hip, 2 cases of avascular necrosis of femoral head and 3 cases of heterotrophic ossification. Conclusions. 1. Surgical treatment of common acetabular fractures with major posterior involvement can be attempted via a single posterior approach (Kocher-Langenbeck with or without trochanteric flip osteotomy) and leads to good-to-excellent results in a majority of the cases. 2. It is superior to conservative management, which has been found to be accompanied by a much higher rate of complications. 3. A thorough study of the pre-operative radiographs, Judet’s views and 3D-reconstructed CT images helps in classifying the fracture and thereby assigning or not assigning it for the posterior approach.
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Agus Kresnadi and Jifaldi Afrian Maharaja Dinda Sedar. "Neglected hip fracture dislocation in young adult treated with total hip arthroplasty and bone graft." World Journal of Advanced Research and Reviews 19, no. 3 (2023): 1208–13. http://dx.doi.org/10.30574/wjarr.2023.19.3.1976.
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Background: Hip fractures is estimated to occur in 176/100.000 population in Indonesia. Inadequate treatment or over negligence of hip fractures will result in significant morbidity. Bone graft can be added to support acetabular bone loss but the concept is still early. Here presented a unique neglected cases of hip fracture dislocation, treated with Total Hip Arthroplasty (THA) augmented with bone graft. Case Report: A-26-year-old female came to the outpatient clinic with chief complaint of pain on left hip. The pain intensified the last two weeks on her left hip and worsens upon weight-bearing. The patient has had a motor vehicle accident 8 months ago where her hip was not treated due to lack of funding. On physical examination, pain on palpation and limited ROM was observed. The patient was then planned for THA with posterior approach. Acetabular bone loss was filled with bone graft. Postoperative, the patient regained her walking capability and the pain subsided. Postoperative hip radiograph showed an optimally placed acetabular implant with inclination of 36.1o on the normal side and 42.3o on the THA side, CORA (center of rotation angulation) 100 mm on the normal side and 99 mm on the THA side from midline, and 79 mm on the normal side and 81 mm on the THA side from trans sacrogluteal line. Discussion: Few literatures describe neglected hip fracture dislocation cases. Neglected hip fracture dislocation causing joint incongruity and cartilage damage, with osteoarthritis risk increased. Some authors described THA as a treatment of choice. Type of surgical treatment, approach, and implants needs to be adjusted to the patient’s lifestyle and condition to achieve satisfactory result. Posterior approach has the advantage of being able to directly access the fracture dislocation site. Bone grafting can be used in THA as a structural buttress. In this case, femoral head was used to augment posterior column and acetabular wall. Cementless acetabular implant is the treatment of choice for young patients. Conclusion: Total hip arthroplasty augmented with bone graft is a viable and recommended treatment option for neglected hip fractures or hip fractures in general.
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Agus, Kresnadi, and Afrian Maharaja Dinda Sedar Jifaldi. "Neglected hip fracture dislocation in young adult treated with total hip arthroplasty and bone graft." World Journal of Advanced Research and Reviews 19, no. 3 (2023): 1208–13. https://doi.org/10.5281/zenodo.11894652.
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<strong>Background</strong>: Hip fractures is estimated to occur in 176/100.000 population in Indonesia. Inadequate treatment or over negligence of hip fractures will result in significant morbidity. Bone graft can be added to support acetabular bone loss but the concept is still early. Here presented a unique neglected cases of hip fracture dislocation, treated with Total Hip Arthroplasty (THA) augmented with bone graft. <strong>Case Report</strong>: A-26-year-old female came to the outpatient clinic with chief complaint of pain on left hip. The pain intensified the last two weeks on her left hip and worsens upon weight-bearing. The patient has had a motor vehicle accident 8 months ago where her hip was not treated due to lack of funding. On physical examination, pain on palpation and limited ROM was observed. The patient was then planned for THA with posterior approach. Acetabular bone loss was filled with bone graft. Postoperative, the patient regained her walking capability and the pain subsided. Postoperative hip radiograph showed an optimally placed acetabular implant with inclination of 36.1<sup>o</sup> on the normal side and 42.3<sup>o</sup> on the THA side, CORA (center of rotation angulation) 100 mm on the normal side and 99 mm on the THA side from midline, and 79 mm on the normal side and 81 mm on the THA side from trans sacrogluteal line. <strong>Discussion</strong>: Few literatures describe neglected hip fracture dislocation cases. Neglected hip fracture dislocation causing joint incongruity and cartilage damage, with osteoarthritis risk increased. Some authors described THA as a treatment of choice. Type of surgical treatment, approach, and implants needs to be adjusted to the patient’s lifestyle and condition to achieve satisfactory result. Posterior approach has the advantage of being able to directly access the fracture dislocation site. Bone grafting can be used in THA as a structural buttress. In this case, femoral head was used to augment posterior column and acetabular wall. Cementless acetabular implant is the treatment of choice for young patients. <strong>Conclusion</strong>: Total hip arthroplasty augmented with bone graft is a viable and recommended treatment option for neglected hip fractures or hip fractures in general.
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Pranata, Soehartono Hadi, Putu Astawa, and I. Wayan Suryanto Dusak. "Faktor risiko untuk fungsi hip yang buruk pada pasien dengan patah tulang kolum femur pasca hemiarthroplasti bipolar tiga bulan pasca operasi." Intisari Sains Medis 11, no. 3 (2020): 1113–18. http://dx.doi.org/10.15562/ism.v11i3.777.
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Introduction. As one of the frequent problems globally, fractures of the column femur may cause morbidity and mortality if not well-treated. The most common treatment for hip fracture is bipolar hemiarthroplasty. Hemiarthroplasty generally has good results, but with increasing patient age, implant function deteriorates. Through this research, the authors were interested in investigating the factors that may contribute to the functional outcome of bipolar hemiarthroplasty procedure, including Leg Length Discrepancy (LLD), osteoporosis, the diameter of the femoral head, stem malposition, and implant loosening.Methods. This is a case-control study. The case group was patients with Harris Hip Score (HHS) < 70 (poor hip function), while the control group was patients with HHS > 70. X-ray examination was performed to evaluate for the LLD, stem malposition, osteoporosis, femoral head diameter, and implant loosening three months after surgery. The result was tabulated in 2x2 tables, then descriptive and inferential analysis was conducted.Results. Chi-square tests for LLD, osteoporosis and femoral head diameter yielded p = 0.012, p = 0.026, and p = 0.002 respectively, showing significant differences in HHS at three months after bipolar hemiarthroplasty surgery (p <0.05). While the chi-square test for implant loosening and stem malposition resulted in p = 0.469 and p = 0.115, neither of these showed significant differences between groups (p> 0.05).Conclusion. Differences in leg length (LLD), osteoporosis, and diameter of the femoral head were risk factors for the poor functional outcome (HHS <70) at three months after surgery in patients who underwent bipolar hemiarthroplasty due to fracture of the femoral column. Meanwhile, the stem malposition and loosening of the implant have not been shown any association with HHS <70. Pendahuluan. Sebagai salah satu masalah yang sering terjadi secara global, patah tulang kolum femur dapat menyebabkan morbiditas dan mortalitas jika tidak diobati dengan baik. Pengobatan yang paling umum untuk patah tulang panggul adalah hemiarthroplasti bipolar (bipolar hemiarthroplasty). Hemiarthroplasti umumnya memiliki hasil yang baik, tetapi dengan bertambahnya usia pasien, fungsi implan memburuk. Melalui penelitian ini, penulis tertarik untuk menyelidiki berbagai faktor yang dapat berkontribusi terhadap hasil fungsional setelah prosedur hemiarthroplasti bipolar, termasuk perbedaan panjang tungkai (leg length discrepancy / LLD), osteoporosis, besar diameter kepala femur, malposisi stem, dan pelonggaran implan.Metode. Studi menggunakan desain kasus-kontrol. Kelompok kasus adalah pasien dengan Harris Hip Score (HHS) < 70 (luaran fungsional buruk), sedangkan kelompok kontrol adalah pasien dengan HHS > 70. Pemeriksaan foto polos dilakukan untuk melihat LLD, malposisi stem, osteoporosis, diameter kepala femur, dan pelonggaran implan. Data disusun dalam bentuk tabulasi silang kemudian analisis deskriptif dan inferensial.Hasil. Uji chi-square untuk LLD, osteoporosis dan diameter kepala femur menghasilkan nilai p = 0,012, p = 0,026, dan p = 0,002 berturut-turut, menunjukkan perbedaan yang bermakna dalam hal HHS pada tiga bulan pasca operasi pada pasien dengan fraktur kolum femur setelah hemiarthroplasti bipolar (p < 0,05). Sementara uji chi-square untuk pelonggaran dari implan dan malposisi stem menghasilkan nilai p = 0,469 dan p = 0,115, keduanya tidak menunjukan perbedaan bermakna antar kelompok (p > 0,05).Simpulan. Perbedaan panjang tungkai (LLD), osteoporosis, dan besar diameter kepala dari tulang femur merupakan faktor risiko untuk luaran fungsional yang buruk (HHS < 70) setelah hemiarthroplasti bipolar setidaknya tiga bulan setelah pembedahan pada pasien dengan fraktur kolum dari tulang femur. Faktor malposisi stem dan pelonggaran dari implant belum terbukti menjadi faktor risiko.
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McMahon, Samuel E., Owen J. Diamond, and Laurence A. Cusick. "Coned hemipelvis reconstruction for osteoporotic acetabular fractures in frail elderly patients." Bone & Joint Journal 102-B, no. 2 (2020): 155–61. http://dx.doi.org/10.1302/0301-620x.102b2.bjj-2019-0883.r2.
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Aims Complex displaced osteoporotic acetabular fractures in the elderly are associated with high levels of morbidity and mortality. Surgical options include either open reduction and internal fixation alone, or combined with total hip arthroplasty (THA). There remains a cohort of severely comorbid patients who are deemed unfit for extensive surgical reconstruction and are treated conservatively. We describe the results of a coned hemipelvis reconstruction and THA inserted via a posterior approach to the hip as the primary treatment for this severely high-risk cohort. Methods We have prospectively monitored a series of 22 cases (21 patients) with a mean follow-up of 32 months (13 to 59). Results The mean patient age was 79 years (67 to 87), and the mean ASA score was 3.3 (3 to 5). Three patients had high-energy injuries and 18 had low-energy injuries. All cases were associated fractures (Letournel classification: anterior column posterior hemitransverse, n = 13; associated both column, n = 6; transverse posterior wall, n = 3) with medialization of the femoral head. Mean operative time was 93 minutes (61 to 135). There have been no revisions to date. Of the 21 patients, 20 were full weight-bearing on day 1 postoperatively. Mean length of hospital stay was 12 days (5 to 27). Preoperative mobility status was maintained in 13 patients. At one year, mean Merle d’Aubigné score was 13.1 (10 to 18), mean Oxford Hip Score was 38.5 (24 to 44), mean EuroQol five-dimension five-level (EQ-5D-5L) health score was 68 (30 to 92), and mean EQ-5D-5L index score was 0.68 (0.335 to 0.837); data from 14 patients. Mortality was 9.5% (2/21) at one year. There have been no thromboembolic events, deep infections, or revisions. Conclusion The coned hemipelvis reconstruction bypasses the fracture, creating an immediately stable construct that allows immediate full weight-bearing. The posterior approach minimizes the operative time and physiological insult in this vulnerable patient population. Early results suggest this to be a safe addition to current surgical options, targeted at the most medically frail elderly patient with a complex displaced acetabular fracture. Cite this article: Bone Joint J 2020;102-B(2):155–161.
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Mbatha, S., M. Duma, S. Maqungo, and L. Marais. "Complications of surgically managed pelvic and acetabular fractures." SA Orthopaedic Journal 22, no. 2 (2023): 68–74. http://dx.doi.org/10.17159/2309-8309/2023/v22n2a1.
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BACKGROUND: High energy pelvic and acetabular fractures frequently occur in conjunction with multiple system injuries and have been associated with morbidity and mortality. We aimed to identify the risk factors associated with complications in patients with pelvic and/or acetabular fractures treated surgically in a resource-constrained clinical setting. METHODS: We performed a retrospective review of adult patients younger than 65 years treated surgically over a three-year period at a tertiary and regional hospitals in South Africa. Epidemiological data as well as trauma-, fracture- and treatment-related factors were compared in patients who developed complications and those who did not, at a mean follow-up of ten months (interquartile range 4-14 months; range 0-31. RESULTS: Eighty-eight patients were included. Complications were encountered in 41% of the cohort. Factors associated with adverse events were age above 35 years (p = 0.008); transverse sacral fractures (p = 0.008); partial articular acetabular fractures with isolated column and/or wall involvement (p = 0.014); Kocher-Langenbeck approach (p = 0.001); posterior acetabular wall fixation (p = 0.002); fixation with plate and screws (p = 0.012); and follow-up period more than 6 months (p = 0.025). Complications encountered were heterotopic ossification, postoperative sepsis, unplanned reoperation, implant failure, postoperative neurological deficit, venous thromboembolism, femoral head osteonecrosis, osteoarthritis and limb length discrepancy. No association was found between adverse events and injury severity score, comorbidities or other associated injuries. CONCLUSION: Complications were common within three years in patients with pelvic and acetabular fractures treated surgically in a developing setting. While an increased Injury Severity Score was not associated with complications, certain fracture- and surgery-related factors may be associated with an increased risk. Heterotopic ossification was the most common adverse event despite formal gluteus minimus debridement and the use of NSAIDs. Further studies are needed to determine the medium- to long-term complications as well as the functional outcome of surgery and the complications of surgery. Level of evidence: Level 4.
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Shearman, Alexander D., Aresh Hashemi-Nejad, Marcus JK Bankes, and Angus D. Lewis. "Surgical management of chronic pelvic instability following periacetabular osteotomy nonunion." HIP International 30, no. 6 (2020): 787–92. http://dx.doi.org/10.1177/1120700020922202.
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Introduction: Periacetabular osteotomy (PAO) is an established treatment for symptomatic acetabular dysplasia in skeletally mature individuals without arthritis. Pelvic nonunion and associated stress fractures are under-reported. Nonunited stress fractures can cause continued buttock pain and pelvic instability. The aim of this study is to report on our experience managing patients with ongoing pain following nonunion of PAO. Patients and methods: 8 patients presented to a tertiary referral pelvic service with symptomatic PAO nonunion between 2015-2018. All patients underwent open reduction internal fixation of the superior pubic ramus nonunion, with ipsilateral iliac autograft, at an average of 48.1 (15–82) months following initial osteotomy. Demographic and perioperative data were recorded. Follow-up was on average to 9.9 months, once union was confirmed radiographically. Results: All patients were female and average age was 31.8 (18–41) years. In 7/8 (87.5%) patients a modified Stoppa approach was successfully utilised. 1 patient required an ilioinguinal approach due to the amount of rotational correction. All patients went on to union at the superior pubic ramus and reported improvement in mechanical symptoms. 5/8 (62.5%) patients were noted to develop union of the posterior column or inferior pubic ramus stress fracture indirectly. 2/8 (25%) patients developed progression of intra-articular pain, despite restoration of pelvic stability. 1 patient required intraoperative transfusion due to femoral vein injury. There were no other complications seen in this series. Conclusions: To our knowledge, this is the largest case series of surgically managed PAO nonunion. Pelvic instability resulting from nonunion and stress fracture can be satisfactorily addressed by mobilising, grafting and plating the nonunion at the superior pubic ramus. The modified Stoppa approach is suitable in most cases, allowing excellent exposure whilst minimising the insult to soft tissues. The altered anatomy of the pelvis following PAO should be anticipated to reduce the risk to nearby neurovascular structures.
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Prashant, Nath Gupta, and Jha Dilip. "Radiological Study of Long Bones and Vertebral Column in Patients with Thyroid Dysfunctions." International Journal of Toxicological and Pharmacological Research 12, no. 10 (2022): 214–22. https://doi.org/10.5281/zenodo.11453088.
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<strong>Background: </strong>Bone health is a constant worry. Thyroid hormones have an impact on bone mineral homeostasis and bone mineral density. Once we reach what is known as our peak bone mass as an adult, we start to lose bone. There are several ways to evaluate bone health, however the majority of them only provide a general idea rather than a precise representation. Dual-energy X-ray absorptiometry (DXA), the industry standard method for determining bone mineral density, has been used to estimate bone mass (BMD). However, the gold standard for determining bone density and revealing its precise state is bone mass assessment. The most accurate indicator of fracture risk is the assessment of bone mass. The relationship between thyroid conditions, bone mineral density, osteoporosis, long bones, and the vertebral column is still up for debate. The purpose of the current study is to fill in these gaps in our knowledge of how thyroid diseases affect long bones and vertebrae. <strong>Aim:</strong> Radiological examination of the vertebral column and long bones in thyroid disease patients. This study’s primary goal is to assess the alterations in long bones and vertebrae brought on by various thyroid diseases. <strong>Material and Method: </strong>The study group included both male and female participants, ranging in age from 18 to 60 years. The study participants were split up into three groups. 50 hypothyroid patients, both male and female (25) in Group I, 50 euthyroid individuals, both male (25) and female (25) in Group II, and 50 hyperthyroid patients, both male (25) and female (25), were in Group III (25). The quantity of bone minerals per unit volume of bone tissue is calculated using the term “bone mineral density” (BMD). By employing dual energy X-ray absorptiometry, it is computed as grams per square centimeter of bone tissue (DEXA). <strong>Results: </strong>The current study’s findings demonstrated that hypothyroid patients’ femoral neck and lumbar vertebral BMD was substantially higher than that of euthyroid subjects. The results of the present investigation demonstrated that, when compared to euthyroid control subjects, hypothyroidism patients had significantly higher BMD, lower serum calcium, and higher vitamin D levels. In contrast, patients with hyperthyroidism of both sexes had significantly lower BMD at the femoral neck and lumbar vertebra when compared to euthyroid control participants. In contrast to euthyroid controls, hyperthyroidism patients of either sex had considerably higher serum calcium levels. However, both male and female hyperthyroidism patients had significantly lower levels of vitamin D compared to euthyroid individuals. <strong>Conclusion: </strong>As a result, we recommend that each patient with hypothyroidism or hyperthyroidism have their BMD, blood calcium, and vitamin D levels measured. Patients with hypothyroidism and hyperthyroidism may benefit from assessment of BMD, serum calcium, and vitamin D to maintain the conditions of healthy bones. To adopt a proper screening program for healthy bone architecture and reduce the risk of fracture in thyroid problem patients, however, studies on a broader population are necessary.
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Fineman, Igor, J. Patrick Johnson, Pier-Luigi Di-Patre, and Harvinder Sandhu. "Chronic renal failure causing brown tumors and myelopathy." Journal of Neurosurgery: Spine 90, no. 2 (1999): 242–46. http://dx.doi.org/10.3171/spi.1999.90.2.0242.
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✓ Brown tumors (osteoclastomas) are histologically benign lesions that are caused by primary or secondary hyperparathyroidism. Secondary hyperparathyroidism is a frequent complication of chronic renal failure. Skeletal brown tumors are relatively uncommon, and brown tumors that involve the spine are considered very rare. The authors present the case of a 37-year-old woman with systemic lupus erythematosus and hemodialysis-dependent anuric renal failure, in whom spinal cord compression developed due to a brown tumor and pathological fracture at T-9. The patient underwent transthoracic decompressive surgery and spinal reconstruction in which cadaveric femoral allograft and instrumentation were used. Brown tumors of the vertebral column require surgical treatment if medical therapy and parathyroidectomy fail to halt their progression or if acute neurological deterioration occurs. In patients with renal failure bone healing is delayed and there is an increased risk that healing will fail because the metabolic derangements can result in severe osteoporosis. Surgical reconstruction of the spine may require the use of augmentation with instrumentation and aggressive treatment of hyperparathyroidism to achieve successful outcomes.
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Orenes Vera, A. V., L. Montolio-Chiva, I. Vázquez-Gómez, et al. "AB0711 USEFULNESS OF THE TRABECULAR BONE SCORE AS A PREDICTOR OF VERTEBRAL FRACTURE IN PATIENTS WITH AXIAL SPONDYLOARTHROPATHY." Annals of the Rheumatic Diseases 79, Suppl 1 (2020): 1650.3–1651. http://dx.doi.org/10.1136/annrheumdis-2020-eular.5932.
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Background:In axial spondyloarthritis (axSpA) the risk of vertebral fracture is increased, not always corresponding with the values of bone mineral density (BMD). One possible explanation is that syndesmophytes interfere with these values. We consider whether the evaluation of trabecular microarchitecture by an accessible methodlike the Trabecular Bone Score (TBS), that does not involve additional irradiation neither seem to be influenced by the presence of syndesmophytes, may be an advantage to estimate the risk of fracture.Objectives:To estimate the prevalence of vertebral fractures in patients with axSpA. To assess the diagnostic accuracy of TBS and BMD for vertebral fracture, and if it is influenced by the presence of syndesmophytes. To analyze the correlation between the absolute values of BMD and TBS in the lumbar spine.Methods:Cross-sectional study. Patients were consecutive recruited. We collected demographic (sex, age), clinical (syndesmophytes, vertebral fracture, BASDAI, BASFI, time of evolution of axSpA, treatment) and analytical variables [vitamin D (1,25-OHD), CRP and ESR]. The BMD was determined using the Lunar Prodigy ProTM densitometer from GE Healthcare, to which the TBS iNsight® software version 2.2 was added to perform the TBS analysis. The presence of fracture was evaluated by radiology. The statistical analysis was performed with the SPSS 22.0 and OpenEpi softwares.Results:84 patients were included, 60 men and 24 women, with a mean age of 59 years (± SD 13). 51.2% had lumbar syndesmophytes. The prevalence of fractures was 13.7%, 95 CI (7.8-22.9). 51.2% were treated with NSAIDs, and 48.8% with biological drugs. The evolution of axSpA was > 10 years in 65.5%. The mean scores of BASDAI and BASFI were 3.7 and 4.3 respectively (± SD 2.2 and 2.3). The mean CRP value was 8.5 mg / L (± SD 8.4), ESR 12.2 mm / h (± SD 11.4) and 1.25-OHD 27.9 ng / dL (± SD 13.6).According to the lumbar and femoral T Score, 9.5% and 15.5% of the patients were in the range of osteoporosis respectively.19% patients had a low TBS value (≤1.23).Regarding the influence of syndesmophytes on TBS and BMD values, we found significant differences in lumbar spine BMD (p = 0.01) but not in total hip and femoral neck BMD (p = 0.2 and 0.3 respectively) nor in the TBS (p = 0.1).Regarding the correlation of TBS and BMD values of the spine, no correlation was observed in patients with syndesmophytes, while a moderate correlation (r = 0.4, p = 0.02) was observed in patients without syndesmophytes.In the univariate analysis, the factors related to the presence of vertebral fracture were age, female sex, absolute BMD values in the lumbar spine and total hip, and TBS values. No relationship was found with the rest of the variables. In the multivariate analysis, only the TBS showed a significant association with the presence of fractures (p =0.02).Regarding the predictive capacity of fractures, TBS showed a higher sensitivity than that of BMD (55.6% versus 18.2% and 30% of BMD in the spine and hip respectively), being the specificity comparable (85.3% versus 91.3% and 85.1% of BMD in column and hip respectively).Conclusion:the prevalence of fractures was 13.7% among the patients studied, 95 CI (7.8-22.9). The presence of syndesmophytes influenced the values of lumbar BMD but not the hip BMD or those of the TBS. We found a correlation between the values of BMD of the spine and TBS only in patients who did not have syndesmophytes. Only TBS values were significantly related to the presence of fractures in the multivariate analysis. TBS showed greater sensitivity with similar specificity than BMD for the detection of vertebral fractures.Disclosure of Interests:Ana V Orenes Vera: None declared, L Montolio-Chiva: None declared, I Vázquez-Gómez: None declared, Eduardo Flores: None declared, Elia Valls-Pascual Grant/research support from: Roche, Novartis, and AbbVie, Speakers bureau: AbbVie, Lilly, Pfizer, MSD, Novartis, Janssen, Bristol Myers Squibb, UCB Pharma, À Martínez-Ferrer: None declared, Desamparados Ybañez: None declared, Luis García-Ferrer: None declared, María Vega-Martínez: None declared, Magdalena Graells-Ferrer: None declared, A Sendra-García: None declared, V Núñez-Monje: None declared, Inmaculada Torner Hernández: None declared, Juanjo J Alegre-Sancho Consultant of: UCB, Roche, Sanofi, Boehringer, Celltrion, Paid instructor for: GSK, Speakers bureau: MSD, GSK, Lilly, Sanofi, Roche, UCB, Actelion, Pfizer, Abbvie, Novartis
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Podet, Adam G., Kevin D. Morrow, Jared M. Robichaux, Jessica A. Shields, Anthony M. DiGiorgio, and Gabriel C. Tender. "Minimally invasive lateral corpectomy for thoracolumbar traumatic burst fractures." Neurosurgical Focus 49, no. 3 (2020): E12. http://dx.doi.org/10.3171/2020.6.focus20366.
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OBJECTIVEThe need for anterior column reconstruction after thoracolumbar burst fractures remains controversial. Here, the authors present their experience with minimally invasive lateral thoracolumbar corpectomies for traumatic fractures.METHODSBetween 2012 and 2019, 59 patients with 65 thoracolumbar fractures underwent 65 minimally invasive lateral corpectomies (MIS group). This group was compared to 16 patients with single-level thoracolumbar fractures who had undergone open lateral corpectomies with the assistance of general surgery between 2007 and 2011 (open control group). Comparisons of the two groups were made with regard to operative time, estimated blood loss, time to ambulation, and fusion rates at 1 year postoperatively. The authors further analyzed the MIS group with regard to injury mechanism, fracture characteristics, neurological outcome, and complications.RESULTSPatients in the MIS group had a significantly shorter mean operative time (228.3 ± 27.9 vs 255.6 ± 34.1 minutes, p = 0.001) and significantly shorter mean time to ambulation after surgery (1.8 ± 1.1 vs 5.0 ± 0.8 days, p < 0.001) than the open corpectomy group. Mean estimated blood loss did not differ significantly between the two groups, though the MIS group did trend toward a lower mean blood loss. There was no significant difference in fusion status at 1 year between the MIS and open groups; however, this comparison was limited by poor follow-up, with only 32 of 59 patients (54.2%) in the MIS group and 8 of 16 (50%) in the open group having available imaging at 1 year. Complications in the MIS group included 1 screw misplacement requiring revision, 2 postoperative femoral neuropathies (one of which improved), 1 return to surgery for inadequate posterior decompression, 4 pneumothoraces requiring chest tube placement, and 1 posterior wound infection. The rate of revision surgery for the failure of fusion in the MIS group was 1.7% (1 of 59 patients).CONCLUSIONSThe minimally invasive lateral thoracolumbar corpectomy approach for traumatic fractures appears to be relatively safe and may result in shorter operative times and quicker mobilization as compared to those with open techniques. This should be considered as a treatment option for thoracolumbar spine fractures.
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Makker, Harish. "Symposium on Pelviacetabular Fractures Part II." Trauma International 3, no. 1 (2017): 5. http://dx.doi.org/10.13107/ti.2017.v03i01.035.
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Dear Friends, Orthopaedics was a nascent branch some 60 years back, when it was born out of Surgery. There were few dynamic personalities working as orthopaedician under General Surgeons and they had to fight for their existence. We have come a long way from there and now, there may be more than 17 sub branches [specialties] in orthopaedics itself. Currently, it is not possible for an orthopaedician to be a master of all the sub branches, hence the need for separate symposium issue in the Journal, for Pelvis and Acetabulum Injuries. [Till the time, may be, when we may have a separate journal for Pelvis and Acetabulum in India]. This is the second part of the Symposium Issue on Pelvis and Acetabulum, and we have covered five chapters written by different masters of the field from AIIMS Delhi, PGI- Chandigarh, Apollo Delhi etc Each article has some important take home messages which I would like to draw the attention of the reader, As in the chapter on –Dual Approach, the author has very well explained why dual approach-? and which approach first for certain T fractures and T type fractures. In the article on Ilio Femoral Approach-author has emphasized need for fractures lateral to iliopectineal line. In the chapter on Pelvic fractures, the author has explained importance of posterior ligaments complex, in lateral compression and vertical shear fractures and variants of lateral compression type fractures. In the article on Digastric Flip Osteotomy- There comes a time in acetabular fractures-posterior wall and or posterior column fractures when simple Kocher-Langenbeck Approach seems handicapped and you need to have some extension, as in cases of cranial extension of posterior wall fractures and /or need to retrieve loose segments from acetabular joint when with all efforts made by traction, space seems wanting. Hope you will find it helpful in your day to day practice as the authors have put their combined experience in preparing these manuscript. I also take this opportunity to invite you to 4th Cadaveric Pelvi-Acetabular fracture fixation workshop on 11th November in Lucknow We will soon have the third issue of the symposium in hand Dr Harish Makker Symposium Editor – Trauma International.
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Shah, Urvil, Mohan Desai, Vinay Samant, and Chandan Mehta. "Dual Mobility in Extreme Situations of Revision Hip Arthroplasty: A Case Series of 3 Cases and Review of Literature." Journal of Orthopaedic Case Reports 14, no. 12 (2024): 185–91. https://doi.org/10.13107/jocr.2024.v14.i12.5068.
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Introduction: Dual mobility (DM) total hip replacement (THR) features an acetabular component with an unconstrained tripolar build which ensures a greater range of motion without provoking any dislocation. We report three cases with extremes of surgical misadventure where we carried out a revision arthroplasty with a DM cup. The causes of the failure of the primary arthroplasty were multifactorial, even individually, and ranged from instability due to component malposition, trochanteric fracture, intrapelvic prosthesis protrusion, etc. Case Report: (1) Case 1 is a 40-year-old male, who following a failed fixation of a right proximal femur shaft fracture had undergone a proximal femur replacement outside with a proximal femur bipolar prosthesis and presented with a dislocated prosthesis due to excessive anteversion of 40 degree of the stem. Revision was done by inserting a DM cup without revising the stem to preserve the valuable femoral bone stock. (2) Case 2 is an 84-year-old comorbid female, who had come with right protrusio acetabuli with bipolar prosthesis in situ. The patient was managed with bone grafting and insertion of a DM cup with a peripheral fit. Greater trochanter wiring was done for the greater trochanter fracture (GTF) along with prophylactic posterior column plating. (3) Case 3 is a 60-year-old male, who had left sided chronic THR instability. He has had three previous episodes of dislocation which started after 7 years, when the patient fell and had a GTF. Here, the causes of instability were multifactorial- GTF, malposition, and liner wear. Instead of using a constrained liner and predisposing the patient to impingement, we did an isolated revision with a DM cup only. Conclusion: The presented cases highlight the versatility and efficacy of utilizing a DM cup in revision arthroplasty for addressing diverse causes of primary hip arthroplasty failure. The adaptability is demonstrated in preserving the bone stock, managing bone loss, and addressing multifactorial instability, thereby emphasizing its widespread potential. Keywords: Dual mobility, revision total hip replacement, instability, protrusio, component malposition.
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Asakawa, Shunsuke, Takeo Mammoto, and Atsushi Hirano. "Proximal Femoral Fracture in Hip Arthrodesis Treated with Double Reconstruction Plates." Case Reports in Orthopedics 2017 (2017): 1–5. http://dx.doi.org/10.1155/2017/5246080.
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We present a rare clinical case of a 90-year-old female who sustained a proximal femoral neck fracture following long-standing hip arthrodesis. Since the fracture occurred relatively proximally and involved the pelvis, double-plate fixation was chosen to achieve rigid fixation. The reconstruction plate was placed at the posterior and anterior columns individually through single vertical incision. She was treated successfully, and she attained preinjury activity level. Proximal femoral fractures in arthrodesed hips need to be recognized as a fracture between the pelvis and femur. Rotational stress from the trunk and lower extremity requires rigid fixation to minimize the increase of displacement and the risk for nonunion.
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Solod, Eduard Ivanovich, A. F. Lazarev, A. A. Lazarev, et al. "Potentialities of Surgical Treatment for Acetabular Fractures Using Low-Invasive Techniques." N.N. Priorov Journal of Traumatology and Orthopedics 16, no. 2 (2009): 3–9. http://dx.doi.org/10.17816/vto20091623-9.
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Original technique of percutaneous osteosynthesis was applied for the treatment of 24 patients with acetabular columns fractures. The achieved results were compared to the results of osteosynthesis performed using open direct reposition of bone fragments (39 patients). The efficacy of low-invasive surgery in acetabular column fractures with regard to provision of fragments consolidation, prevention of femoral head aseptic necrosis development and achievement of early medical and social rehabilitation of patients was showed. Maintenance of fragments blood supply, use of minimal surgical approach and closed reposition are considered to be the progressive direction of internal osteosynthesis development.
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Xiao, Xingling, Jiahui Chen, Canbin Wang, et al. "Central dislocation of femoral head without involvement of acetabular anterior and posterior columns." Journal of International Medical Research 46, no. 8 (2018): 3388–93. http://dx.doi.org/10.1177/0300060518761786.
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Objective This study was performed to explore the treatment of central dislocation of the femoral head without involvement of the acetabular columns. Methods Preoperatively, a three-dimensionally printed model of the patient’s pelvis was manufactured according to the patient’s computed tomography data. An all-locking anatomical plate was designed based on the mirror of the ipsilesional semi-pelvis. The fracture was reduced using reduction forceps and femoral traction via the lateral rectus approach. The customized plate was used as a template for reduction of the quadrilateral plate fracture. Results Reduction and fixation of this patient’s fracture was achieved with a customized all-locking anatomical plate with a propeller shape via the lateral rectus approach. Conclusions This report describes an isolated quadrilateral plate fracture with central dislocation of the femoral head without involvement of the columns, which is a rare injury that has not yet been classified. It was effectively treated using a customized all-locking anatomical plate with propeller shape via the lateral rectus approach.
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Prado-Kittel, C., P. Zumelzu-Sánchez, A. Palma-Licandeo, G. Faúndez-Lillo, K. Ellenberg-Oyarce, and B. Jorquera-Adarme. "Continuous pericapsular nerve group blockade as analgesia for fracture of the posterior column and wall of the acetabulum; a case report and description of infusion regimen for extending analgesic effect to the distal femoral area." Revista Española de Anestesiología y Reanimación (English Edition) 67, no. 3 (2020): 159–62. http://dx.doi.org/10.1016/j.redare.2019.12.001.
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Skvortsov, A., R. Khabibyanov, M. Maleev, and P. Andreev. "SURGICAL ACCESS FOR RESTORATION OF FRACTURES OF THE LOWER DEPARTMENTS OF THE ANTERIOR COLUMN OF THE ACETABULAR WITH MOBILIZATION OF THE FEMORAL VASCULUS-NERVOUS BUNCH." Sciences of Europe, no. 137 (March 26, 2024): 63–68. https://doi.org/10.5281/zenodo.10874636.
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The paper presents a method developed by the authors for mobilizing the femoral neurovascular bundle, which allows improving the results of treatment of fractures of the lower parts of the anterior column and the body of the pubic bone, due to sufficient visualization of the anterior column in its lower parts, and the body of the pubic bone, while excluding iatrogenic complications, and reducing the duration of inpatient treatment and rehabilitation.
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Ramírez Stieben, Luis Agustín, Raquel Susana Dobry, Lucas Brun, et al. "O17 Evaluación de los niveles de vitamina D en pacientes adultos con diabetes tipo 2 y su relación con la densidad mineral ósea y la prevalencia de fracturas vertebrales." Revista de la Sociedad Argentina de Diabetes 54, no. 3Sup (2020): 102. http://dx.doi.org/10.47196/diab.v54i3sup.378.
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Introducción: niveles bajos de 25(OH)D se asocian a un deterioro de la función de las células beta, resistencia a la insulina y riesgo incrementado de diabetes mellitus tipo 2 (DM2). Por otra parte, la mayoría de los estudios reporta un incremento en el riesgo de fractura de cadera en DM2, pero los datos son contradictorios respecto de las fracturas vertebrales (FV).Objetivos: evaluar los niveles de 25(OH)D en pacientes adultos con DM2 y su relación con el control glucémico, severidad de la DM2 y factores de riesgo cardiovascular (RCV), y evaluar la densidad mineral ósea de columna lumbar (DMO-L) y de cuello femoral (DMO-CF) en conjunto con la prevalencia de FV.Materiales y métodos: estudio observacional, transversal, en el cual evaluamos los niveles de 25(OH)D y la prevalencia de FV morfométricas. Se evaluaron 209 pacientes con DM2 (grupo DM2) y 172 pacientes sin DM2, que se incluyeron como grupo control (GC). Se determinó el nivel de 25(OH)D, densidad mineral ósea (DMO) de columna lumbar (DMO-L) y cuello femoral (DMO-CF). Se obtuvieron radiografías de columna dorsolumbar para evaluar la presencia de FV morfométricas y calcificaciones de aorta abdominal (CAA). Se realizaron análisis de regresión logística. Las diferencias se consideraron significativas cuando p<0,05.
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SIQUEIRA, Mariana de Morais Lira Gouvea, Luiz Augusto CASULARI, Wladimir Magalhães de FREITAS, Marcos de Vasconcelos CARNEIRO, and Liliana Sampaio Costa MENDES. "RISK FACTORS ASSOCIATED WITH FRACTURE OF THE LUMBOSACRAL SPINE AND ITS COMPROMISE IN THE QUALITY OF LIFE OF CIRRHOTICS." Arquivos de Gastroenterologia 59, no. 1 (2022): 9–15. http://dx.doi.org/10.1590/s0004-2803.202200001-03.
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ABSTRACT Background Chronic hepatic disease is associated with osteoporosis, osteopenia or osteomalacia. Osteoporosis and fractures due to bone fragility present high prevalences and are more frequent in patients with liver cirrhosis than in the general population. The search for a diagnosis of osteopenia and osteoporosis in this population may allow early intervention and modify unfavorable outcomes. Objective To know the prevalence of osteopenia or osteoporosis and of fracture due to bone fragility in individuals with liver cirrhosis, the associated risk factors, and its compromise in their quality of life (QoL). Methods Observational, transversal study performed with 71 liver cirrhosis patients of the Hepatology Service of the Hospital de Base do Distrito Federal, Brasília, DF, Brazil, between July 2017 and December 2018. The patients were submitted to bone densitometry (DXA) of the lumbar spine and of the femoral neck, to x-ray of the lumbosacral spine and to the Chronic Liver Disease Questionnaire (CLDQ) for the evaluation of quality of life (QoL). The Fracture Risk Assessment (FRAX) major was calculated for patients >50 years old. The analyses were performed for the evaluation of the risk factors associated with lumbosacral spine fracture. Results The majority (62%) of the 71 evaluated patients was diagnosed with osteoporosis or osteopenia on DXA. Of the 44 patients with osteopenia or osteoporosis, 52.3% were female, with a mean age of 62.6±9.51 years old, with the majority (72.7%) being Child A, cirrhotics of alcoholic etiology (36.4%), and with an intermediate QoL according to the CLDQ (3.3). Regarding the patients with lumbosacral spine fracture, the mean age was 61.6±11.1 years old, 60% were female, most of them Child A (66.7%), of alcoholic etiology (46.7%), and with an intermediary QoL according to the CLDQ (3.5). The presence of osteopenia and/or osteoporosis was associated with lumbosacral fracture (P<0.001), without correlation with the other analyzed variables: age, body mass index, gender, presence and absence of ascites, Child-Pugh classification, vitamin D, calcium, and phosphorus serum concentration, cirrhosis etiology and FRAX major. Conclusion The prevalence of hepatic osteodystrophy was high, and the occurrence of lumbosacral spine fracture was more associated with osteoporosis and/or osteopenia among the cirrhotic patients studied. The QoL was intermediate and with no differences between cirrhotics with and without fracture.
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Trevisani, Virgínia Fernandes Moça, Rachel Riera, Aline Mizusaki Imoto, Humberto Saconato, and Álvaro Nagib Atallah. "Teriparatide (recombinant human parathyroid hormone 1-34) in postmenopausal women with osteoporosis: systematic review." Sao Paulo Medical Journal 126, no. 5 (2008): 279–84. http://dx.doi.org/10.1590/s1516-31802008000500007.
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CONTEXT AND OBJECTIVE: Osteoporosis is defined as a disease characterized by low bone mass and deterioration of the bone tissue microarchitecture. Teriparatide stimulates the formation and action of osteoblasts, which are responsible for bone formation, thus promoting bone tissue increase. The aim was to assess the effectiveness and safety of teriparatide for treating postmenopausal osteoporosis. METHODS: A systematic review was conducted using the Cochrane Collaboration methodology. RESULTS: 1) Teriparatide 20 µg or 40 µg versus placebo: there was a benefit from teriparatide, considering the following outcomes: reduction in the number of new vertebral and non-vertebral fractures, and increased whole-body, lumbar and femoral bone mineral density. 2) Teriparatide 40 µg versus alendronate 10 mg/day for 14 months: there was no statistical difference regarding the incidence of new vertebral or non-vertebral fractures, although in the group that received teriparatide there was greater bone mineral density increase in the whole body, lumbar column and femur. 3) Estrogen plus teriparatide 25 µg versus estrogen: there was a benefit, considering the following outcomes: reduction in the number of new vertebral fractures, and increased whole-body, lumbar and femoral bone mineral density after three years. CONCLUSIONS: When teriparatide is intermittently administered in low doses, it reduces the incidence of vertebral fractures (67%) and non-vertebral fractures (38%) and increases bone mineral density in the lumbar column and femur. There is a need for studies with longer observation in order to allow conclusions regarding the safety and duration of the therapeutic effects.
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Mahadik, Sujay K., Sasha Martyres, Mrutyunjay S. Gaonkar, Anish W. Isapure, and Shrikant B. Deshpande. "Functional outcome of distal femoral fractures managed surgically using locking compression plate laterally and augmented with titanium elastic nail system medially." Asian Journal of Medical Sciences 12, no. 3 (2021): 81–87. http://dx.doi.org/10.3126/ajms.v12i3.32982.
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Background: Distal femur fractures are generally due to high velocity trauma particularly form road traffic accidents and fall from height. The treatment of distal femur fractures has evolved from conservative to operative to fixation of both lateral and medial columns of femur.
 Aims and Objective: The aim of this study was to evaluate the functional outcome of operated cases of comminuted fracture of lower end of femur fixed with locking compression plate laterally and augmented with titanium elastic nail system medially.
 Materials and Methods: The present study was a prospective study carried out in Bharati Vidyapeeth Medical College and Hospital, Sangli after approval from institutional ethical committee. In this study, 20 patients with communited fracture of lower end of femur were included on the basis of a predefined inclusion and exclusion criteria. Detailed history was taken and clinical examination was done in all cases. After preanesthetic evaluation and relevant investigations patients were treated by reduction (close or open) and fixation was done by locking compression plate laterally and augmented with titanium elastic nail system medially. Patients were followed up at 6, 10 and 14 weeks for functional outcome by Neer’s scoring system and degree of flexion at knee joint.
 Results: Out of 20 studied cases there were 16 (80%) males and 4 (20%) were females with a M:F ratio of 4:1. The mean age of male patients was found to be 42.81+/-14.79 whereas mean age of female patients was 40.5 +/- 14.36. The mean age of male and female patients was found to be comparable with no statistically significant difference (P=0.78). Most of the patient were diagnosed with the fracture of AO TYPE C3 (7 cases), followed by AO TYPE C1 (4 cases). Full weight bearing was achieved in 8 (40%) patients within 18 weeks whereas remaining 12 (60%) patients required more than 20 weeks for full weight bearing. 14 (70%) patients had excellent outcome whereas, Good, Fair and poor outcomes were seen in 4 (20%), 1 (5%) and 1 (5%) patient. On one-way ANOVA analysis, showed that the flexion was significantly higher in 12 weeks as that of the 6 weeks (P =<0.0001). Further the flexion was significantly higher in 24 weeks as that of the 6 and 12 weeks (P =<0.0001).
 Conclusion: Our study found that locking compression plating laterally augmented with titanium elastic nail system medially for comminuted distal femoral fractures is a good fixation system and provides good angular stability.
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Vijendra, Parmar, Tandiya Amit, Zuber Mohammad, and Jain Rahul. "Functional Outcomes of Medial Column Augmentation in Comminuted Distal Femur Fractures: A Comparative Study." International Journal of Pharmaceutical and Clinical Research 15, no. 8 (2023): 1400–1404. https://doi.org/10.5281/zenodo.11522046.
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<strong>Background:</strong> Distal femoral fractures, often caused by high-energy incidents, present challenges due to comminution and subsequent complications. Non-union of the femur, resulting from factors like severe open fractures, infections, or implant failures, leads to functional limitations and reduced quality of life. Commonly, open reduction and internal fixation (ORIF) methods are employed, utilizing various devices such as locking plates, condylar screws, blade plates, and intramedullary nails. Deformities arising from distal femur fractures demand anatomical reconstruction. <strong>Aims and Objective:</strong> The study aims to evaluate the functional outcomes of comminuted distal femur fractures treated with lateral locking compression plate fixation and medial column augmentation using either the titanium elastic nailing system or a buttress plate. <strong>Materials and Methods:</strong> Twenty patients aged 18 and above with comminuted distal femur fractures were included. Preoperative assessment involved clinical examination and radiographs. Surgical procedures comprised lateral plate fixation and medial column augmentation with either the titanium elastic nailing system or a buttress plate. Follow-up evaluations occurred at 4, 12, and 24 weeks to assess knee range of motion and radiological union. Outcome assessment utilized the Lysholme knee scoring system. <strong>Results:</strong> Most patients achieved union in under 14 weeks, with an average union time of 15.15 weeks. Knee range of motion varied from <60° to >120°. Outcomes based on the Lysholme knee scoring system revealed 35% of patients achieving excellent results, 45% achieving good results, and limited complications—55% of patients had no complications, while 15% experienced knee stiffness. <strong>Conclusion: </strong>The study underscores the efficacy of lateral locking compression plate fixation combined with medial column augmentation in managing complex comminuted distal femur fractures. This approach provides reliable fixation and favorable functional outcomes. Lateral locking compression plate fixation with medial column augmentation proves effective in treating comminuted distal femur fractures, yielding stable fixation and promising functional results.
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Cruz, S., and J. Blanco. "Tuberculosis osteoarticular, dificultades diagnósticas actuales: reporte de un caso clínico." Revista Chilena de Estudiantes de Medicina 9, no. 1 (2016): 71–76. https://doi.org/10.5354/0718-672x.2016.74833.
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Introducción: La tuberculosis (TB) es la segunda enfermedad infecto-contagiosa con mayor mortalidad mundial. En Chile, la incidencia de Tuberculosis extrapulmonar (TBEP) corresponde al 25% de los casos del total. La TB osteoarticular representa el 10-20% de los casos de TBEP, siendo la ubicación más frecuente la columna vertebral. Caso clínico: Paciente de sexo femenino, 76 años con antecedentes de encefalitis límbica autoinmune en corticoterapia de larga data. Consulta por dolor dorso-lumbar de 2 meses de evolución, irradiado a zona inguinal izquierda, con impotencia funcional de extremidad inferior ipsilateral, sin antecedente traumático, sin fiebre, refiere contacto epidemiológico de TB durante juventud, nunca estudiada, ni tratada. Al examen físico, extremidad inferior izquierda en rotación externa, acortada, con limitación a la flexión y rotación interna; dolor en palpación de vértebras torácicas bajas. Examen neurológico normal. Radiografía de pelvis Antero-Posterior informa fractura subcapital de cabeza femoral izquierda. Tomografía computada de columna muestra fracturas en T6 y T11, y además osteopenia difusa. Se hospitaliza en Hospital Clínico de la Universidad de Chile para estudio etiológico y resolución quirúrgica. Se presenta caso en Equipo Multidisciplinario, sin consenso respecto a etiología de fracturas atraumáticas. Se realiza prótesis total de cadera y biopsia de fémur que informa osteomielitis granulomatosa sugerente de TB osteoarticular. Se maneja fracturas vertebrales ortopédicamente e inicia terapia anti-TB. Discusión: En base a hallazgos radiológicos, es difícil diferenciar la TB osteoarticular de otros trastornos degenerativos, inflamatorios o neoplásicos, por lo que es importante una alta sospecha con fin de llegar a un diagnóstico y tratamiento precoz.
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Belenky, I. G., G. D. Sergeev, B. A. Mayorov, S. G. Semenov, and A. V. Benin. "EXPERIMENTAL AND THEORETICAL VALIDATION OF DOUBLE COLUMN INTERNAL FIXATION THEORY FOR DISTAL FEMORAL FRACTURES." Traumatology and Orthopedics of Russia 23, no. 3 (2017): 86–94. http://dx.doi.org/10.21823/2311-2905-2017-23-3-86-94.
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KAÇIRA, BURKAY KUTLUHAN, MUSTAFA ÖZKAYA, UYGAR KIRAN, FAIK TÜRKMEN, MEHMET ARAZI, and TEYFIK DEMIR. "BIOMECHANICAL FIXATION STRENGTH COMPARISON OF ILIOINGUNIAL AND MEDIAL STOPPA APPROACHES ON ANTERIOR COLUMN FRACTURES." Journal of Mechanics in Medicine and Biology 16, no. 06 (2016): 1650081. http://dx.doi.org/10.1142/s0219519416500810.
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Background: Both the ilioinguinal and Stoppa approaches have been used as standard methods for treating anterior column fractures of the pelvis. Objective: We aimed to compare the rigidity of pelvises that were treated using these two approaches. Methods: Fifteen synthetic pelvises were used as test models. Of these, 5 pelvises did not undergo any treatment (control group), and 10 pelvises underwent treatment of one column using the ilioinguinal approach and the other using the medial Stoppa approach (treated group). The compression test was performed on all pelvises, and rigidity of the pelvises was compared between the control and treated groups. Results: A statistical difference was found in the angle between the center of the femoral head and the line from the pubic symphysis to load application between the control and treated groups, using the ilioinguinal approach. The parametric displacement was greater in the treated group using the ilioinguinal approach than in the control group. There were no significant differences between the control and treated groups using the Stoppa approach, and the ilioinguinal approaches. Conclusion: Clinically, the Stoppa approach has several advantages over the ilioinguinal approach. However, based on the compression test, there was no difference in biomechanical rigidity between the fixations performed using these two approaches.
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Selek, Ozgur, and Ahmet Y. Sarlak. "The Central Dislocation of Femoral Head in the Transverse and Both Column Acetabular Fractures: Is It Really Medialized?" Hip & Pelvis 29, no. 3 (2017): 182. http://dx.doi.org/10.5371/hp.2017.29.3.182.
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