Avascular Necrosis Of Head Research Articles

Results and analytical outcomes of proximal humerus plating in adults with proximal humerus fracture

Fracture of proximal humerus is the second most common fracture of the upper extremity, following distal forearm fractures. Aim of the present study was to evaluate the efficacy of proximal humerus internal locking system (PHILOS) plate fixation for proximal humerus fractures. Functional outcomes of 12 men and 18 women aged 22 to 78 (mean, 58) years who underwent PHILOS plate fixation for proximal humeral fractures were reviewed. Indications for surgery were 2 part (n=9), 3 part (n=14) or 4-part (n=7) closed proximal humeral fractures with angulation of more than 45 degrees or displacement of more than 1 cm. Functional outcomes and shoulder range of movement were assessed based on the Constant scoring system. All patients will be followed up at monthly intervals for 6 months. During this period patient, will be motivated for physiotherapy and gradual normal use of the affected limb. Fracture union will be assessed clinically and radiologically. In our study of fracture proximal humerus union in most of the cases (24) occurring between 10- 14 weeks. Range of union time was 8 to 18 weeks. one case of avascular necrosis of head occur in our case. In out of 30 cases excellent result in 7 cases, Good in16 cases Satisfactory in 5 cases and Poor in 2 cases were obtained. The PHILOS plate fixation is effective treatment for proximal humeral fractures particularly in osteoporotic bones.

A case study of role of Pancha tikta ghruta kshira basti in Avascular Necrosis of head of femur

Aim: To evaluate the role of panchatikta ghrita kshira basti in Avascular Necrosis of the head of femur Objectives:1. To evaluate the role and mechanism of action of Pancha tikta ghrita kshira basti in AVN.Observation: Follow up was taken after every week in Karma basti karma given to the patient for seven days.Observations were noted in the form of improvement in clinical parameters. Conclusion: Conclusion was drawn from above data.

Study of clinical and functional outcome of total hip replacement in avascular necrosis of femoral head

Avascular necrosis (AVN) of the femoral head is one of the common causes of painful hip in a young adult. Since young age is associated with high functional demand AVN may have a devastating effect on the quality of life. The natural course of this disease is one of relentless progression with eventual collapse of the femoral head followed by secondary osteoarthritic changes in the hip. The management depends upon many factors including severity and location of necrotic lesion, patient factors and probability of collapse. Total hip replacement (THR) is needed in cases of collapse of femoral head, severe pain, osteoarthritis or destruction of hip joint. However there has been debate over whether THR is a viable option for AVN considering unique pathophysiology of AVN. Moreover the factors like functional outcome after surgery implant longevity and need for revision surgeries must be considered while doing total hip arthroplasty. In this context we conducted this prospective observational study to find out the clinical and functional outcomes of THR in patients with of AVN. Aims and Objectives: To study the clinical and functional outcome of total hip replacement in avascular necrosis of femoral head. Material and methods: Patients admitted to department of orthopedics in a tertiary care hospital in a metropolitan city with diagnosis of AVN were included in the study after taking into consideration a pre-defined inclusion and exclusion criteria for the study. Sample size of 30 was considered following statistical formula and admission registry of our hospital. Patients were recruited to the study after approval from institutional ethical committee and informed consent of patients. A detailed history was taken and thorough clinical examination was done in all patients. All patients were assessed with Harris hip score and points were allocated for each components of the score, which formed base line statistics for our study. Further patients were followed up at 6 weeks, 12 weeks and 24 weeks. Patients who could not turn up to the hospital were contacted over telephone and outcome was assessed through set of questionnaire based on Harris hip score. Result: The study consisted of 30 patients diagnosed to be having avascular necrosis of head of femur. Out of these 30 patients 23 were males and 7 patients were females with a M: F ratio of 1: 0.30. The most common age group affected was 21-40 years (43.33%) followed by 41-60 years (33.33%) and 61-80 years (23.33%). Majority of the patients with AVN had a body mass index between 25 to 29.99 (36.67%). Co-morbidities like diabetes or hypertension were seen in 11 (36.67%) patients. 9 (30%) patients were having history of either alcohol consumption or smoking. 13 patients had some predisposing factor for AVN in the form of either alcohol consumption, steroid therapy, history of trauma or pregnancy and rest of the patients were found to be having idiopathic AVN. The most common presenting complaints in the studied cases were found to be pain and difficulty in walking (90%) and most of the patients (43.33%) had symptoms for more than 1 year. Majority of the patients had right hip joint involvement (56.67%) followed by left (36.67%) and only in 2 patients (6.67%) there was bilateral involvement of hip joint. Out of the study cases 28 (93.33%) patient had cemented total hip arthroplasty while non-cemented total hip arthroplasty was seen in only 2 (6.67%) patients. There was a statistically significant difference in preoperative and postoperative total Harris hip score, pain score, range of motion, gait and daily activities like climbing stairs and distance walked. Finally in this study 28 (93.33%) patients had excellent results while 2 (6.67%) had good functional outcome after total hip replacement for avascular necrosis of femoral head. Conclusion: There was significant improvement in clinical and functional outcome after Total Hip Replacement in patients with avascular necrosis of femoral head and we recommend Total hip replacement as surgical modality of treatment for Ficat and Arlet stage 3 and 4 of avascular necrosis of femoral head.

Total hip replacement in sickle cell disorder: A preliminary report of challenges and early outcome of 21 consecutive patients

The aim of this study is to describe the pattern of presentation osteoarthritic patients with sickle cell disorder (SCD) in our environment, determine the implant sizes taking the peculiar nature of the pathology and our operating environment into consideration, highlight the challenges and technical difficulties encountered during the procedure, measure the functional outcome and observe complications of treatment, recommend ways of improving outcome. Between November 2008 and November 2012, 29 consecutive primary total hip replacements (THRs) were performed on 21 patients with avascular necrosis of the head of femur secondary to SCD. Patients' evaluation was performed at two different times of follow-up (1 and 5 years, respectively). Twenty-one patients were available at 1 year as well as 5-year follow-up. The mean preoperative Harris Hip Score was 20.17 ± 11. The mean postoperative Harris Hip Score was 92.25 ± 13 (P < 0.001) at 1 year and 88.75 ± 10 (P < 0.001) at 5 years. Eighteen patients had regional anesthesia while three had general anesthesia. The average cup size used was 49.43 with a range of 46-54. The average liner size was 49.43 with a range of 46-54. The head size used in all patients was 28. The average stem size was 6.57 with a range of 6-8. The offset used in all the patients was standard All the patients had 1-2 screw fixation of the acetabular shell. Four patients had complications as follows: periprosthetic fracture 1, superficial wound infection 1, pulmonary complication 1, and abdominal crisis 1. THR is a veritable means of treatment of patients with avascular necrosis of the femoral head arising from SCDs. The challenges encountered during the surgery are related to the quality of bone of the affected patient. Arthroplasty Surgeons in our environment must be fully prepared for the challenges by ensuring a preoperative plan that will take care of the technical problems such as recreating femoral canals, wiring of intraoperative fractures as well as treatment of acetabular defects. A detailed planned total hip arthroplasty can be performed in patients with SCD in younger patients with good clinical benefits.

Different surgical methods to manage avascular necrosis of head of femur

A prospective study was carried out on 30 patients who underwent core decompression, bipolar hemiarthroplasty, cemented/uncemented Total Hip Replacement in Department of Orthopaedics, NRI Institute of Medical Sciences. This study has shown that, the mean age of patients in the study group was 42.30±11.43 years. About 43.3% of the avascular necrosis patients in the study group belonged to 31-40 years age group. The sex distribution of the study group has shown that, about 76.7% of the patients were males and 23.3% were females. The mean ROM score of study group during preoperative stage was 2.40±1.25 and postoperative stage was 4.63±0.49. The difference between the ROM scores during pre and postoperative stage was statistically significant. The type of implant used in eth study group. Stryker implant was used in 73.3% and Link implant was used in 26.7% of the study group. In the study group, most (93.3%) of the patients had no complications. The common complication in the study group was foot drop in 2 patients which is 6.7%. Analysis shows the complications of total hip replacement according to type of implants used in the study group. Most (93.3%) of the patients in the study group had no complications. But for 1 patient used link implant had foot drop and for 1 patient used stryker implant had foot drop. The outcome after total hip replacement was excellent in 80.0% of the study group. About 20.0% of the study group had good outcome.

Association of pai-1 promoter sequence variations in idiopathic avascular necrosis of head of femur

Association of pai-1 promoter sequence variations in idiopathic avascular necrosis of head of femur

Equal Primary Fixation of Resurfacing Stem, but Inferior Cup Fixation With Anterolateral vs Posterior Surgical Approach. A 2-Year Blinded Randomized Radiostereometric and Dual-energy X-Ray Absorptiometry Study of Metal-on-Metal Hip Resurfacing Arthroplasty

BackgroundThe anterolateral (AntLat) surgical approach may spare the blood supply to the femoral head and improve the accuracy of cup positioning in metal-on-metal hip resurfacing arthroplasty. Thereby, potentially lessen complications such as avascular head necrosis, femoral neck narrowing and fracture, improve implant fixation, and lessen periprosthetic bone mineral density (BMD) loss. MethodsBetween November 2008 and January 2012, a randomized clinical trial was performed at Aarhus University Hospital. A total of 49 patients (28 males) were allocated to metal-on-metal hip resurfacing arthroplasty by the AntLat (n = 25) or the posterior (Post; n = 24) surgical approach. Patients were followed with radiostereometric analysis, measurements of periprosthetic BMD, clinical outcome scores of Harris hip score and visual analogue scale, serum metal ions, and conventional radiographs. ResultsAt 3 months, cups in the AntLat group had higher total translations of mean 1.00 ± 0.70 mm vs mean 0.64 ± 0.45 mm in the post group (P = .04), and higher total rotations of mean 2.44° ± 1.36° vs mean 1.39° ± 1.17° in the Post group (P = .002). All migrations of cup and stem were similar at 1 and 2 years postoperative (P > .07). At 1 year, periprosthetic BMD since postoperative at the medial side of the stem was reduced to mean 98.45% ± 8.57% in the AntLat group, and increased to mean 105.57% ± 11.07% in the Post group (P = .02), but measurements were comparable at 2 years (P = .05). ConclusionCups inserted by the AntLat approach migrated more until 3 months postoperative. This illustrates a less good primary cup fixation with the AntLat approach; however, all cups were well-fixed after 3 months' follow-up indicating a good secondary fixation.

MRI in Evaluation of Avascular Necrosis of Head of Femur

The purpose of the study was to describe the role of Magnetic Resonance Imaging in evaluation of Avascular necrosis of femoral head and study the age, gender, symptoms among the study group. MRI examination of 48 patients who were clinically suspected with Avascular necrosis of femoral head and referred to department of Radiology, Osmania general hospital, Hyderabad were studied. All patients were imaged using a 1.5 tesla MRI scanner (SignaHDxt; GE Medicalsystems). MRI is the most sensitive means of diagnosing avascular necrosis (AVN). This imaging modality provides the criterion standard of noninvasive diagnostic evaluation and is more sensitive than CT scanning or planar scintigraphy. In addition, MRI is much more sensitive than plain film radiography for detecting avascular necrosis (AVN). MRI is indispensable for the accurate staging of avascular necrosis (AVN), because images clearly depict the size of the lesion, and gross estimates of the stage of disease can be made. MRI does not employ ionizing radiation and both hip joints can be imaged simultaneously. 48 patients were evaluated in our study. MRI helps in accurate staging of Avascular necrosis of femoral head. Screening of asymptomatic contralateral hips is important as most of the times the disease is bilateral and early core decompression can prevent progression of the disease.

Severely Damaged Hip Joints from Avascular Necrosis in a patient with Sickle Cell Trait: Case Report

Background: Avascular necrosis of the femoral head is an increasingly recognized entity especially in the context of sickle cell disease. This entity is however less frequently seen in sickle cell trait; consequently, fewer cases of hip damage secondary to avascular necrosis in persons with sickle cell trait have been reported. This case shows how avascular necrosis can occur, affecting both hip joints in patients with sickle cell trait. Case presentation: We present the case of a 13-year-old Black African male with sickle cell trait who presented with a 1-year history of progressive bilateral hip pain and deformity. He was diagnosed with bilateral avascular femoral head necrosis and benefited from analgesics and physiotherapy. Conclusion: Avascular necrosis of the head of the femur is a complication often seen in patients with sickle cell disease but rarely in those with sickle cell trait. This case report shows the infrequent presentation of avascular femoral head necrosis in the context of sickle cell trait and also the limitation of low resource settings in performing hip replacement surgeries and other curative treatment options for this disabling and debilitating condition.

Dana Farber Protocol (DFCP) for Treatment of Adolescents and Young Adults with ALL, Single Institution Experience in Saudi Arabia

Background:Recent reports indicate that adolescents and young adults (AYA) have a better outcome when treated with pediatric protocols rather than adult ones. Many explanations were raised to explain that including the more intense pediatric protocols and different disease biology.Patients & Methods: This is a retrospective study that included AYA patients diagnosed as ALL and treated at King Abdulla Medical City (KAMC),Saudi Arabia, in the period from mid 2011- March 2015.Results: 37 patients were included in this study including 25 males and 12 females with a ratio of 2:1. The median age at diagnosis was 19.4 y. At presentation the mean number of WbCs was 63.7 x 109/L + 103.4 (range 1.9 to 500,000 x109/L), HB 8.87 + 2.3 gm/L (range 6.5-15.2 gm/L), platelets 59 x 109/L + 43.9 (range 8-100,000 x109/L. Bone marrow blasts ranged from 35 -99% with a mean and median of 80.3 + 18.5, 84 % respectively. B-cell phenotype constituted the majority of cases 29/37(78.3%). Cytogenetics using karyotyping and FISH Panel for ALL (done in Mayo clinic,USA) revealed Very high risk cytogenetics (Philadelphia, MLL, complex cytogenetics, hypodiploidy in 14/37 (37.8%) patients, Intermediate / high 16 patients (43.2%) and 7 (18.9%) with favorable cytogenetics (hyperdiploidy, tetraploidy, del p16).Complete remission was confirmed in 35 of 37 patients (94.5%). (one did not achieve remission while response was not evaluable in another patient who died during induction due to hepatic failure). Repeat cytogenetics at the time of D28 BM evaluation was done in 29/37 patients while in 8/37 it was not done for technical reasons. Cytogenetic remission was confirmed in 18 out of 21 with cytogenetic abnormality (85.7%).After a median follow up period of 12 m (range 3-52.5 m).. Leukemia free survival ranged from 3 to 52.5 m with a median of 10.5 m, mean 17.5 {CI (95%) 12.61-22.53}: while median survival was 12m with a mean of 18.5m {CI (95%) 13.6-23.5}.As a whole 6 cases relapsed (5 in the first 18 m and 1 after 4 Y) and 1 was primary resistant constituting (7/35 18.9% of cases) while response could not be documented in one patient who died during induction. Of the 6 relapsed cases, 4 of them due to disease progression and non-responsive to salvage treatment or transplant procedureToxicity included febrile neutropenia in virtually all patients with negative cultures in 20/37 patients (54%) while Gram negative sepsis was confirmed in 12/37 patients (32%). Major complications occurred in 9/37 patients (24.3%) and include: septic shock that required ICU (1 patient), typhilitis (1 patient), pancreatitis (2 patients), avascular necrosis of head of femur (2 patients).neuropathy ≥ GIII (2 patients)In conclusion: Although DFCP is an effective treatment for AYA with ALL, Yet toxicity can not be overlooked. DisclosuresNo relevant conflicts of interest to declare.

Timing of surgery for open reduction and internal fixation of displaced proximal humeral fractures

BackgroundOpen reduction and internal fixation is one established method for treatment of displaced fractures of the proximal humerus. However, the timing of surgery and its effect on complications have not yet been investigated in the literature. Hence, aim of this study was to analyze the occurrence of complication following locked plating of proximal humeral fractures when surgery was delayed in comparison to early intervention. MethodsBetween February 2002 and November 2010, 497 patients with displaced proximal humeral fractures were treated by open reduction and locked plating. 329 patients were available for follow-up with a minimum of 12 months after surgery. Outcome analysis included radiographic evidence of loss of fixation (>10° of secondary displacement), screw-cutout and avascular head necrosis. Outcomes were analyzed with regards to age, gender and fracture pattern and were compared between time intervals in which the primary surgery had been conducted; early intervention (<48h), timely scheduled for surgery (3–5 days) and delayed intervention (>5 days). ResultsOf 329 patients (68.4% women; median age at time of surgery: 69.9 years, 95% Confidence Interval (CI) 68.2, 71.2) the median time between fracture incident and surgical intervention was 3.2 days (95%CI: 3.1, 3.3). Surgery was performed in a 2-part fracture at a median of 3.3 days (95%CI: 3.2, 3.4) after trauma, in a 3-part fracture after 3.3 days (95%CI: 3.1, 3.4), in a 4-part fracture 2.9 days (95%CI: 2.8, 3.0), in head split type fracture 2.2 days (95%CI: 2.0, 2.4) and in dislocation type fracture 0.8 days after trauma (95%CI: 0.7, 0.9, p = 0.40). Loss of fixation was observed in 12.8% (n = 42 patients), of which in 4.9% (n = 16) screw cutout was evident and in 6.8% of cases (n = 20) avascular head necrosis was diagnosed. Patients in which complication was observed were treated at median 2.5 days after trauma (95% CI, 1.8, 3.2), in comparison, patients without evidence of complications were treated at a median of 3.2 days (95% CI, 2.8–3.8, p = 0.35). The odds ratio regarding occurrence of complications for patients treated <48 hours was 0,924, for patients in which surgery was performed 3–5 days after the incident the odds ratio was 0,836 and in patients treated > 5 days the odds ratio was 1,637. ConclusionsLoss of fixation following open reduction and internal fixation of proximal humeral fractures was not more frequently observed when surgery was performed 3–5 days after the incident in comparison to early intervention (<48h). However, a delay of intervention > 5 days is related to significant increase of complications. Thus, if open reduction and internal fixation is indicated, reconstruction of the proximal humerus should be performed within 5 days of the fracture event. In head split and dislocated fracture types anatomic reconstruction completed within 48h from the incident may be beneficial with regards to risk of avascular necrosis.

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Patient selection for shorter femoral stems.

The right patient selection with the correct surgical treatment are prerequisite for a positive result in total hip arthroplasty (THA). Short stem implants demand a shorter anchoring length in accordance with the proper indication. Although appropriate indications for short stems have been discussed in the literature, there currently is no clear definition. The lack of an accepted categorization of short hip stems complicates the situation further. This article briefly reviews the literature and highlights the authors' results and experiences in short stem THA in an effort to establish a proper discrimination between indications and contraindications for the Metha short stem. Results presented include a retrospective data collection and follow-up examination of 126 patients who underwent short stem THA with 2- and 4-year results. Anchoring principles of the short stem are reviewed, and a complication and failure analysis based on 7 femoral revisions in 1092 short stem THAs is presented. Selection criteria for short stem THA are patients younger than 70 years with primary osteoarthritis and dysplastic femoral deformities, and indications of avascular head necrosis. Adequate bone quality must be confirmed intraoperatively, assessing whether the bone structure in the area of the femoral neck is strong enough to support the short stem load transmission. Coxa vara and high dysplastic femoral neck antetorsion are contraindications for short stems. Wide and short femoral necks, implant undersizing, and a deep stem position below the femoral osteotomy compromise stability and must be avoided with an appropriate surgical technique. Long-term data are not yet available.

Management of Proximal Humeral Fractures with Proximal Humerus Locking Plate—A Prospective Study: 以肱骨近端鎖定鋼板治療近端肱骨骨折—個前瞻性的研究

BackgroundDisplaced proximal humeral fractures, which used to be treated conservatively in the past, often had compromised functional results. With the advancement of technology, these fractures are now more often managed operatively, fulfilling the demands of an active and productive life style by the patients. The aim of this study was to assess the functional outcome of management of proximal humeral fractures with Philos (Synthes; Johnson and Johnson, West Chester, Pennsylvania, USA) plate fixation. MethodsIn this prospective study, 40 patients aged 18–80 years (mean age 52.4 years) with fractures of the proximal humerus, including two-, three-, and four-part fractures, were treated by open reduction internal fixation with Philos plating. Patients were functionally evaluated based on subjective (35 points) and objective (65 points) parameters as per the constant scoring system. ResultsAll these operated patients were followed up for 18–36 months (average 27.3 months). Functional outcome based on the constant scoring system showed excellent results in 20 (50%), good in eight (20%), and moderate in eight (20%) patients. Four (10%) patients had poor functional results. Out of six cases of four-part fracture dislocations, avascular necrosis of the humeral head was observed in two patients. One of these two patients had avascular necrosis of the head along with nonunion of the fragment to the shaft. ConclusionPhilos plate fixation for proximal humeral fractures provides good stable fixation with good functional outcome and minimal complications.

English

Ipsilateral femoral neck and shaft is primarily found in younger individuals, usually in their third or fourth decades. Patients are usually involved in high-energy trauma. The overall incidence of associated neck and shaft fracture ranges from 2.5% to 9%. The majority of these injuries are the result of motor vehicle accidents or falls from a height. Ipsilateral femoral neck fractures are usually nondisplaced and, therefore, difficult to diagnose. Study of twenty five cases of ipsilateral neck and shaft fractures managed by reconstruction nail is presented. Pelvic film with hips in 20 degrees of internal rotation is recommended to avoid missing the diagnosis at the initial workup of the patient .We had no patient with delayed diagnosis of neck fracture. All patients were operated as early as the general condition of the patient permitted. Delay in treatment was mainly due to associated major non orthopaedic injuries. There were 22 males and 3 female patients. Mean age in males was 40.14+/- 10.98 yrs and females was 40.33+/- 7.64yrs age. All the patients were followed up for six months of till the union of both the fractures. There were two cases of non-union of the femoral neck fracture, one case of avascular necrosis of head and four patients hadvarusmalunion at neck. There were three cases of non-union and ten cases of delayed union of femoral shaft fracture. Femoral shaft fracture determined the total union period. Shaft complications were managed with or without secondary procedures as compared to femoral neck complications, which usually required more extensive procedures. It is concluded thatReconstruction nailing is a good treatment option in patients with undisplacedfracture of neck but it should not be preferred in displaced femoral neck fractures because of difficulties in reducing the fracture and its maintenance during nail insertion

MicroRNA genes diversity analysis between bone tissue of alcohol avascular necrosis femoral head and normal femoral head

Objective To observe expression variation of microRNA (miRNA) between bone tissue of alcohol avascular necrosis femoral head and normal femoral head and discuss miRNA change relation between them.Methods It is tested for miRNA for five normal femoral head tissue and alcohol avascular necrosis femoral head tissue.it is thus clear that there are up regulation has-miR-29a-st and downregulation genes has-miR-486-5p-st.they are went on reverse transcriptase-polymerase chain reaction (RT-PCR).Results Four hundred genes were analysed between between bone tissue of alcohol avascular necrosis femoral head and normal femoral head with miRNA gene chip.clear down regulation has-miR-486-5p-st and up regulation has-miR-29a-st were went on PCR,the average value of has-miR-29a-st 2-~Ct is 1.06 ±0.09 and 1.93 ± 1.12 for bone tissue of alcohol avascular necrosis femoral head and normal femoral head; the average value of has-miR-486-5p-st2-~Ct is 1.88 ± 25.37 and 1.70 ± 0.98 (variation ＞ 2 times moreover P ＜ 0.05).Conclusion There is obvious up regulation and down regulation miRNA genes between bone tissue of normal femoral head and alcohol avascular necrosis femoral head.which is possible to take on main regulation action to speeding up necrosis femoral head. Key words: Alcohol avascular necrosis of femoral head; Gene chip

Critical factors in cut-out complication after gamma nail treatment of proximal femoral fractures

BackgroundThe most common mechanical failure in the internal fixation of trochanteric hip fractures is the cut-out of the sliding screw through the femoral head. Several factors that influence this complication have been suggested, but there is no consensus as to the relative importance of each factor.The purpose of this study was to analyse the cut-out complication with respect to the following variables: patients’ age, fracture type, fracture reduction, implant positioning and implant design.Methods3066 consecutive patients were treated for trochanteric fractures with Gamma Nails between 1990 and 2002 at the Centre de Traumatologie et de l`Orthopedie (CTO), Strasbourg, France. Cut-out complications were identified by reviewing all available case notes and radiographs. Subsequently, the data were analysed by a single reviewer (AJB) with focus on the studied factors.ResultsSeventy-one cut-out complications were found (2.3%) of the 3066 trochanteric fractures. Cut-out failure associated with avascular head necrosis, pathologic fracture, deep infection or secondary to prior failure of other implants were excluded from the study (14 cases). The remaining 57 cases (1.85 %, median age 82.6, 79% females) were believed to have a biomechanical explanation for the cut-out failure. 41 patients had a basicervical or complex fracture type. A majority of cut-outs (43 hips, 75%) had a combination of the critical factors studied; non-anatomical reduction, non-optimal lag screw position and the characteristic fracture pattern found.ConclusionsThe primary cut-out rate of 1.85% was low compared with the literature. A typical cut-out complication in our study is represented by an unstable fracture involving the trochanteric and cervical regions or the combination of both, non-anatomical reduction and non-optimal screw position. Surgeons confronted with proximal femoral fractures should carefully scrutinize preoperative radiographs to assess the primary fracture geometry and fracture classification. To reduce the risk of a cut-out it is important to achieve both anatomical reduction and optimal lag screw position as these are the only two factors that can be controlled by the surgeon.

Avascular Necrosis of the Head of the Third Metacarpal Bone

Avascular necrosis of the metacarpal head named as ‘Dieterich disease’ is a very rare condition. Because of the lack of information about the natural course and treatment of this disease, the ideal treatment has not been established as yet. We report a case of avascular necrosis that occurred at the 3rd metacarpal head after fractures of the 4th and 5th metacarpal base; this was treated conservatively and obtained the spontaneous resolution.

A Case Report of Isolated Posterior Fracture Dislocation of Anatomical Neck of Humerus

Introduction: Fracture dislocation of anatomical neck of humerus is an extremly rare fracture. So, the best treatment for it and long term results are not well established. It is our duty to report each case of it to make material for a greater study. Material and method: A 27 years old man who is a victim of car accident is presented with shoulder and pelvic pain. In X- ray, there was a hollow glenoid and in CT scan, the fractured anatomical head is rotated and angulated posterior to glenoid (Figure 1). It was treated with hemiarthroplasty of shoulder. Results: By deltopectoral approach, we can remove head fragment and because there was no enough bone in subchondral region, we didn’t fix it and exchange it with cemented hemiarthroplasty of involved shoulder. Discussion: Because of complete dislocation of anatomical head of humerus and no soft tissue attachment to it, avascular necrosis of head of humerus can be highly anticipated. So, we choose hemiarthroplasty for him and we think because tuberosities are not detached, function will be good.

A pedicled bone graft from the acromion: an anatomical investigation regarding surgical feasibility

To investigate the technical feasibility of harvesting a vascularized bone graft from the acromion pedicled on the acromial branch. Complex fractures of the proximal humerus may result in partial or total avascular necrosis of the head fragment. Treatment of avascular necrosis of the humeral head is dependent upon the stage of disease as well as the dimension and location of necrosis. In general, the outcome is poor and complete restoration of the shoulder function is rarely attained. Contrary to osteonecrosis of carpal bones (where vascularized bone grafts have been routinely carried out for decades), reports of analogous procedures at the humeral head are anecdotal. Based on selective post-mortem computer-tomographic angiography of 5 and the dissection of 30 embalmed human cadaver shoulders, we describe the anatomy of the acromial branch of the thoracoacromial trunk. The main focus was the constancy of its anatomical course, its dimensions and potential use as a nutrient vessel for a pedicled bone graft from the acromion. The course of the acromial branch revealed a constant topographic relationship to anatomical landmarks. Its terminal branches reliably supplied the anterior part of the acromion. The vascularized bone graft could be sufficiently mobilized to allow tension-free transfer to the humeral head as well as to the lateral two-thirds of the clavicle. We demonstrated the feasibility of vascularized bone graft harvesting from the acromion. This technique could be a joint-preserving procedure for osteonecrosis of the humeral head or may assist in the revision of a clavicular pseudoarthrosis.