Fracture Of Greater Trochanter Research Articles

Comparative analysis between dynamic hip screw and proximal femoral nail the management of intertrochanteric femoral fracture

Peritrochanteric fractures are common in the elderly people. The frequency of these fractures has increased primarily due to the increasing life span and more sedentary life style brought on by urbanization. There are various forms of internal fixation devices used for Peritrochanteric Fractures. The most commonly used devices are the Dynamic Hip Screw (DHS) with Side Plate assemblies and proximal femoral nail (PFN). The present study was conducted in 30 cases of stable intertrochantric fractures of femur, classified according to AO classification. All patients were regularly followed up and Harris Hip Score was used for evaluation for the results. All the patients of stable intertrochantric fracture treated with PFN or DHS were allowed partial weight bearing at 4 weeks and full weight bearing at 15 weeks. Most of the patients treated with DHS had excellent outcome (86.66%) as compare to the patient treated with PFN having excellent outcome in 53.33%. Among complications for PFN difficult reduction was seen in 1 patient (6.6%), greater trochanter fracture was seen in 1 patient (6.6%), Hip pain was seen in 1 patient (6.6%) and shortening (> 1cm) was seen in 1 patient (6.6%). In DHS, common complications were superficial infection in 1 patient (6.6%), Hip Pain in 1 patient (6.6%) and shortening (> 1cm) in 3 patients (20%). The range of motion calculated by the Harris Hip Scoring system treated by both the implants i.e. PFN and DHS was good and was almost the same (95% CI:0.83P1.30,P=0.72). Both implants had equal time of union and had few complications in stable fractures but at long term follow up most of patient operated with PFN complained of implant related complications like greater trochanter Pain and anterior thigh pain.

Impact of Femoral Stem Design on Failure After Anterior Approach Total Hip Arthroplasty

BackgroundAn increased rate of complications related to femoral component failure has been described with less invasive total hip arthroplasty (THA). This study evaluated the incidence of femoral complications associated with the direct anterior approach for THA. MethodsRetrospective review was performed of the initial 1120 consecutive patients who underwent direct anterior THA by 2 surgeons. ResultsA total of 899 patients (80.3%) had a 2-year follow-up (range, 2-8 years). Complications within 90 days occurred in 20 patients (1.8%): 10 calcar fractures, 1 greater trochanter fracture, 1 canal perforation, 3 hematomas, 2 dislocations, 2 superficial, and 1 deep infection. Nine patients (1%) underwent revision: 5 for aseptic femoral loosening (0.55%), 1 for periprosthetic joint infection, 1 for dislocation, 1 for hip flexor irritation, and 1 for a damaged polyethylene liner.Of the 5 patients with aseptic femoral loosening, 3 had a short, mediolateral tapered stem, 1 cemented stem, and 1 S-ROM stem placed to bypass a canal perforation. There were no revisions for aseptic loosening in the collared, fully hydroxyapatite (HA)-coated compaction broached or triple tapered proximal fit and fill stem designs (70.6% of all stems). Revision rate for femoral loosening was significantly higher for tapered wedge over HA-coated, compaction broached stems (P < .005). ConclusionPain and function improved predictably with a 0.55% rate of femoral loosening at 2-year follow-up. Among collared, fully HA-coated and triple taper fit and fill femoral stems, there were no instances of revision for aseptic loosening vs 3 in the short stem, collarless mediolateral tapered group.

Long-term survivorship of the Corail™ standard stem

IntroductionThe Corail™ stem, which was first introduced in 1986, has since been modified twice: first to make the neck thinner and then to change the location of the laser markings. The survival and complications of the first-generation straight, titanium, hydroxyapatite-coated stem are known; however, there is little specific information about the latest-generation stem. This led us to conduct a retrospective study to determine the: (1) long-term survival; (2) clinical and radiographic outcomes; (3) complications; and (4) risk factors for revision of the newest Corail™ stem. HypothesisThe newest Corail™ AMT (Articul/EZE™ Mini Taper) standard stem has comparable survival to prior models. Patients and methodsThis single-center, retrospective study included 133 patients (140 hips), who underwent primary total hip arthroplasty (THA), between January and December 2004, in which a Corail™ Standard stem was implanted using a posterolateral approach. Patients who underwent revision THA, THA due to femoral neck fracture or who received lateralized (offset) stems were excluded. The mean age at the time of THA was 69±13 years [35–92] in 85 men (61%) and 55 women (39%) who had a mean BMI of 27kg/m2±11 [16–39]. At the latest follow-up, 32 patients (32 hips) had died and 8 patients (8 hips) had less than 3 years’ follow-up, thus were not included in the clinical evaluation. The Merle d’Aubigné (PMA) score was collected. The stem's survivorship was calculated using the Kaplan-Meier method with revision for aseptic loosening and revision or implant removal for any reason as the end-points. The Cox model was used to analyze risk factors for revision. The mean follow-up was 10±3 years [3–12]. ResultsThe PMA score was 12±2.6 [5–17] preoperatively and 16±2.7 [7–18] at the last follow-up (P<0.00001). Eighteen complications (12.8%) were recorded at the last follow-up. There were 15 early complications: 6 dislocations, 5 calcar fractures (4 treated by wire cerclage and 1 by stem change plus wire cerclage), 2 greater trochanter fractures (treated non-surgically) and 2 cases of sciatic nerve palsy. There were 3 late complications: 2 cases of iliopsoas irritation and 1 ceramic insert fracture. Stem survival for surgical revision due to aseptic loosening was 98% (95% CI: [0.96–1]). At 12 years, 95% of stems had not been revised or removed (95% CI: [0.92–0.99]). Being less than 58 years of age at the time of surgery was the only risk factor significantly associated with stem revision for any reason (P=0.04). ConclusionSurvival of the Corail™ Standard stem is similar to that of previous generation stems. The changes made in this stem solved the neck failure problem and did not induce new complications. Level of evidenceLevel IV (retrospective study).

Is soft tissue repair a right choice to avoid early dislocation after THA in posterior approach?

BackgroundDislocation is the second most common complication after total hip arthroplasty (THA). The effectiveness of soft tissue repair to reduce dislocation rate is still debated and thus a meta-analysis was conducted.MethodsA systematic search in PubMed, Embase, and Cochrane databases was conducted for this meta-analysis. Inclusion criteria: clinical comparative trials on the use of soft tissue repair including rotators and capsule repair in primary THA. The main data outcome were the incidences of early hip dislocation after primary THA. HSS score, incidence of other complications was also included in the outcomes.ResultsA total of 4816 cases were included for the analysis from ten studies (3 RCTs/7 Retrospective trials). Overall, the soft tissue repair group showed a significant lower early dislocation rate and higher HSS score compared to the no repair group; but no significant difference was observed between the two groups in regards to the early dislocation rate in RCT studies only. The capsule repair group showed a significant lower early dislocation rate than no capsule repair group while no significant difference was observed between the rotators repair group and no rotators repair group. In all included studies, 4 greater trochanter fractures, 2 sciatic nerve palsies and 1 infection were reported in soft tissue repair group while no cases were observed in the no repair group.ConclusionsThe efficacy of soft tissue repair is positive but still not conclusive to reduce the early dislocation rate after primary THA while soft tissue repair may bring more other complications. Capsule repair seems more effective than rotators repair only.

Case report rare greater trochanter fracture

Introduction: The Greater Trochanter fracture is a rare injury. It is of two types, True fracture which occurs only in Adults or as Epiphyseal separation which are found in adolescent population. It is caused by direct hit or fall muscular disruption displacement of trochanteric fracture is secondary to short external rotators with forceful abduction with leg in external rotation. Case report: In this case report, 26 year male presented with pain over hip with weakness in abduction and limping. On X ray it was greater trochanter fracture which was fixed with cancellous screw, the outcome was good. The patient reverted to his obvious activities with normal range of movement. Conclusion: The surgical minimally invasive treatment have better outcome with early mobilization, good range of hip movement especially abduction post operative in adult.

Predicting intertrochanteric extension of greater trochanter fractures of the hip on plain radiographs

IntroductionIt is important to distinct between isolated greater trochanter (GT) fractures and complete intertrochanteric (IT) extension to prevent unwanted morbidities. Aim of this study was to determine if there was any particular fracture pattern, of GT fractures on a plain radiograph of the hip which could predict IT extension. MethodRetrospective review of radiographs of 49 patients with a GT fracture who presented in the last 10 years (January 2005–December 2015). All images were reviewed by a consultant musculoskeletal radiologist and an orthopaedic surgeon. The AP plain radiographs were assessed to look for fracture angle and length of the fracture. The fracture length was taken as a percentage and was measured as the length of the fracture crossing the intertrochanteric line/the total length of the intertrochanteric line. The fracture angle was measured as the angle between a line drawn from the most superior point of the fracture on the lateral cortex of the GT, to a perpendicular line along the medial cortex of the femoral shaft. The subsequent MRI and CT scans were assessed to see if there was true intertrochanteric extension. Results32 patient were female and 17 male. 27 CT scans of which 8 showed complete IT extension. 22 had MRI scan of which 6 showed complete extension. The mean fracture length of patients with complete extension was 56% with a range of 50%–63%. The mean fracture length of patients with incomplete extension was 33% with a range of 12%–55%. The mean fracture angle for patients with complete extension was 39° with a range of 35–42°. The mean fracture angle for patients with incomplete extension was 58° with a range of 44–124°. ConclusionFor greater trochanter fractures that do not cross >50% of the IT line and do not have a fracture angle between 35 and 42° do not require further imaging as they will not have complete intertrochanteric extension.

Favorable Early Results of Impaction Bone Grafting With Reinforcement Mesh for the Treatment of Paprosky 3B Acetabular Defects

BackgroundWe present the early institutional experience with the use of impaction bone grafting, mesh augmentation, and cement fixation of an all-polyethylene cup for the treatment of Paprosky 3B acetabular defects during revision total hip arthroplasty. MethodsBetween 2005 and 2014, 21 patients (9 men, 12 women) with Paprosky 3B acetabular defects who underwent revision total hip arthroplasty using this technique were reviewed clinically and radiographically. Average age and body mass index were 72.4 (range, 48-91) years and 24.5 (range, 18.9-31) kg/m2, respectively. All patients underwent revision for aseptic loosening. Surgical technique included the use of a peripheral mesh to contain the defect, followed by impaction of morselized fresh-frozen bone graft and cement fixation of a polyethylene cup. ResultsComplications occurred in 6 patients (29%) including limp (2), sciatic nerve palsy that resolved (1), limb length discrepancy (1), and greater trochanteric fracture (1). After an average follow-up of 47 months (range, 13-128 months), the average Hospital for Special Surgery hip score was 35.5 (range, 20-40). Radiographic assessment revealed cephalad cup migration of 2.29 mm (range, 0-20 mm) and medial migration of 1.57 mm (range, 0-6 mm). One patient has radiographic loosening and no symptoms 120 months postoperatively. No patient returned to the operating room for a related reason or is scheduled to undergo acetabular re-revision surgery. ConclusionImpaction bone grafting is a reliable technique for the treatment of Paprosky 3B acetabular defects. It restores bone stock like no other available for addressing these defects. Longer follow-up is required to assess potential deterioration of fixation.

Outcome of Cemented Bipolar as Primary Management of Comminuted Unstable Intertrochanteric Fracture Femur in Elderly Sudanese Patients

Unstable intertrochanteric fractures in osteoporotic bones of elderly patients was a real challenge that face orthopedic surgeon because of difficult anatomical reduction, poor bone quality and complication of prolonged bed redden or limited ambulation. The aim of study was to assess the clinical outcome of cemented bipolar as primary management of comminuted intertrochanteric fracture femur in elderly Sudanese patients. Material and methods: (30) Elderly Sudanese patients with unstable intertrochanteric fractures (kyle type III or IV) treated by primary hemiarthroplasty using a cemented bipolar prosthesis. Suture or wire fixations were used for reconstruction of greater trochanter fracture. Harris hip score was used for the clinical evaluation. Result: There was a significant relation between age and kyle classification (p value 0.05). According to Harries hip score 17 out of 30 had a good to excellent result (56.7 %) If the patients with a fair result were also included, the percentage goes up to (93.4%). Conclusion: The primary cemented bipolar hemiarthroplasty in unstable intertrochanteric fracture in elderly patients' dose provide staple, pain free with early mobilization, better range of motion and less complication rate in short term follow up.

Radiological analysis of component positioning in total hip arthroplasty using the anterior approach

BACKGROUND: The direct anterior approach for total hip replacement is gaining popularity among surgeons and patients alike, as it is a minimally invasive technique, and a true muscle-sparing operation. Reported advantages of this approach include decreased post-operative pain, faster post-operative mobilisation and a low incidence of hip dislocation. Optimal component positioning is vital for the longevity of total hip replacements. Poor positioning leads to increased dislocation rates, accelerated bearing wear, limited range of motion and higher rates of revision surgery. Minimally invasive surgery strives for smaller incisions, and muscle-sparing dissection. This may result in poor acetabular exposure, and subsequent sub-optimal component positioning. The direct anterior approach is generally done supine on a traction table with/without the use of intra-operative fluoroscopy. This study describes the surgical technique performed with the patient in the lateral decubitus position, without the use of traction, and without intra-operative imaging. We then report on the radiographic outcomes and complications using this approach. METHODS: We retrospectively reviewed 150 patients who had total hip replacements done via the direct anterior approach. Clinical notes were evaluated for patient demographics, body mass index, and post-operative complications. The post-operative radiographs were analysed for acetabular component position inclination and anteversion. RESULTS: The radiographic analysis showed a mean cup inclination of 41.1° (range 27.9-61.1°) and anteversion of 18.33° (range 11.2-25.3°). A total of 95.97% (95% CI) of the components were within the safety zones, as described by Lewinnek, (inclination 40 ± 10°, anteversion 15 ± 10°).23 There were five outliers with regard to cup inclination. Three had excessively abducted cups, which were noted to be in patients with increased BMI >35 kg/ m2. The remaining two were excessively adducted. There were no outliers with regard to cup anteversion There were no dislocations, deep infections or femoral nerve palsies. Two patients required re-operation: one for a periprosthetic fracture and another for a greater trochanter fracture with late displacement. There were six cases of thigh swelling which resolved on discontinuation of oral anti-coagulation, four episodes of soft tissue inflammation responding to physiotherapy, four clinically observed leg length discrepancies, two minor stitch abscesses, and two transient lateral cutaneous nerve palsies. CONCLUSION: The direct anterior approach, done in the familiar lateral decubitus position, as described in this study, is safe and reliable, with an acceptable complication rate. The radiographic results for acetabular component placement are comparable to other surgical approaches, as well as to the direct anterior approach using a fracture table and intraoperative imaging.

Immediate results of treatment periprosthetic femoral fractures after hip replacement

Periprosthetic fractures are one of the most serious complications after hip replacement. Nineteen periprosthetic femoral fractures operated on during the period 2011-2015 were followed-up retrospectively. Periprosthetic fractures were classified according to the Vancouver classification. The functional results were evaluated using Harrison scale. Bone healing and implant stability were evaluated clinically, on plain radiographs and computed tomography. The periprosthetic fractures in all patients occurred in the postoperative period. Time from operation until fracture varied from 2 weeks to 11 years. A wedge-shaped cemented or cementless stems were implanted during the first surgery: Versys ET, Spotorno, CPT (Zimmer, США): cementless fixation was performed in 16 (84,2%) patients, hybrid -in 2 (10,5%) and cemented fixation - in 1 (5,3%) patient. The fractures of greater trochanter were diagnosed in all patients with type A periprosthetic fractures. In type B1 periprosthetic fracture (8 patients) open reduction, cerclage wiring and internal plate osteosynthesis were applied. Loosening stems in 3 patients with type B2 fractures were replaced with Wagner cementless revision component (Wagner SL Revision Stem). Angle-stable plate osteosynthesis and cerclage wiring were also performed. Closed reduction and internal minimal invasive plate osteosynthesis were performed in patients with type C periprosthetic fractures. Bone consolidation was achieved in 18 (94,7%) patients, the average term was 14,3±5,2 weeks. The average Harris hip score in all patients 3 months after treatment was 64,9±16,7 points, and in 12 patients (63,2%) after a year - 86,5±15,9. Femoral periprosthetic fractures require a specialized approach to choosing the treatment tactic depending on the fracture type and quality of bone tissue. It is necessary to evaluate the femoral component stability, especially in differential diagnosis of type B1 and B2 periprosthetic fractures. Computed tomography is one of the necessary methods of diagnosis.

Is magnetic resonance imaging necessary in isolated greater trochanter fracture? A systemic review and pooled analysis.

BackgroundIsolated fractures of the greater trochanter (GT) of the femur are uncommon and few studies have assessed the diagnosis and appropriate therapeutic schedule for these fractures. The current data regarding assessment of isolated fractures of the GT are limited to a few reviews based on the experience of a single institution. Therefore, we asked the following questions: (1) what proportion of cases has an associated extension of the fracture into the intertrochanteric region in isolated GT fracture and (2) what are the treatment options and outcomes of GT fractures with occult intertrochanteric fractures.MethodsWe conducted a systematic review of published studies that evaluated patients who displayed isolated GT fracture on routine radiographic examination and underwent a magnetic resonance imaging (MRI) scan because of the suspicion of extension into the intertrochanteric region. A structured literature review of multiple databases (PubMed, EMBASE, CINAHL, and Cochrane systematic reviews) referenced articles from 1950 to 2015.ResultsA total of 110 patients were identified from 7 published studies. MRI documented isolated GT fractures diagnosed on initial radiographs in only 11 of 110 patients (10 %). In 99 patients (90 %), MRI examinations revealed extension of the fracture into the intertrochanteric region. Surgical fixation was necessary for 61 patients, with a pooled percentage of 55 %. No complications were observed after surgery.ConclusionsOur study has helped to elucidate further the assessment of isolated fracture of the GT. We believe that MRI is a reasonable option for patients presenting with isolated GT fracture on plain radiographs.

Short-Term Outcomes and Complications After Rejuvenate Modular Total Hip Arthroplasty Revision

BackgroundThe early short-term outcomes and complications after revision of the recalled Rejuvenate modular neck hip arthroplasty have not been previously reported. This study’s purpose is to describe the early outcomes and complications after revision of the Rejuvenate modular femoral neck. MethodsA retrospective cohort included 92 patients with 92 Rejuvenate modular neck total hip arthroplasty (THA) who underwent revision surgery between July 2011 and April 2014. Preoperative, 1-year, and 2-year patient-reported outcome measures including Western Ontario and McMaster Universities Arthritis Index (WOMAC) and Short Form 12 (SF-12) were described in 92 patients. ResultsComplications arose in (12 of 92) 13% of patients including 8 greater trochanteric fractures, 1 intraoperative periprosthetic acetabular fracture, 2 dislocations, 1 early aseptic loosening, and 1 infection requiring a 2-stage revision. Overall, 66% of patients with a complication required reoperation. Significant changes were noted between preoperative and 1- and 2-year outcomes with respect to WOMAC pain score (P = .0031), WOMAC total score (P = .021), SF-12 mental component score (P < .0001), and physical component score (P < .0001). ConclusionsPatients can expect an improvement in pain (WOMAC pain) and function (total WOMAC, SF-12 Physical Health Composite Scale), but overall worsening in the SF-12 mental component scores. Patients’ physical function improvements are offset by worsened mental function scores. Patients undergoing revision of Rejuvenate modular neck THA implants should be counseled on modest functional improvements and relative frequency of complications.

Reconstruction of gluteus medius muscle in revision total hip arthroplasty

Objective The aim of this study is to observe the effect of our surgical treatment method for abductor defects in hip revision cases. Methods We retrospectively evaluated a consecutive series of eight patients (eight hips) with a defect of the hip gluteus medius muscle from April 2012 to April 2014 who underwent revision and gluteus medius muscle reconstruction. 7 patients with loosening of components (2 periprosthetic joint infections), 1 repeated dislocation after hemiarthroplasty. There was one case with moderate pain and 7 cases with severe pain. 8 cases were severe limp, needed crutches or braces walking aids, gluteal medius muscle strength was ≤3, and the Trendelenburg sign was positive in all patients. The average age was 50 years old (31-69 years old), 2 men and 6 women. One patient with a gluteus medius muscle completely disrupted from insertion at greater trochanter, which underwent knit suture. One patient had a greater trochanter fracture resulted in ascending of gluteus medius muscle. During revision, fracture was reducted and fixed by 2.0 Kirschner wire and cable. Three patients with defects of gluteus medius muscle; we applied gluteus maximus fascia lata muscle valvuloplasty. One patient with deficiency of both gluteus medius muscle and greater trochanter. Gluteus maximus was directly reattached to the proximal of femoral stem. Results All patients were followed up for an average of 18 months (range, 14-35 months). The mean Harris Hip score increased from 57 to 85, pain was remarkably relieved, ROM of hip and myodynamia was improved. Preoperative abductor strength ≤3, 6 months after surgery abductor strength was increased with average of 1-2 level. Conclusion Reconstruction of hip abductor tendon of gluteus medius muscle deficiency would be effective in hip revision surgery. Key words: Reoperation; Arthroplasty, replacement, hip; Treatment outcome

Is the Anterior Approach Safe? Early Complication Rate Associated With 5090 Consecutive Primary Total Hip Arthroplasty Procedures Performed Using the Anterior Approach

BackgroundFew publications have raised concern with the safety of the anterior approach (AA) to total hip arthroplasty (THA). The purpose of this study is to report the early complications with AA THA in a combined, multicenter patient population from three different institutions. MethodsThe study cohort consisted of 5090 consecutive primary procedures in 4473 patients who had undergone THA utilizing the anterior approach between August 2006 and July 2013. Surgeries were performed by five surgeons at three sites that maintain prospective databases. Preoperative, intraoperative, and postoperative data were recorded on all patients. Demographic data including age, gender, and BMI were queried, as well as all intraoperative and postoperative complications in the first 90 days. ResultsThe 5090 patients had a mean body mass index of 27.5, and mean age of 63.6 years. The overall 90-day complication rate was 1.9%. There were 41 intraoperative femur fractures including 29 calcar fractures, 9 greater trochanter fractures and 3 femoral shaft fractures. There were 7 postoperative femur fractures including 3 greater trochanter fractures, 2 calcar fractures, and 2 femur fractures. Other complications included 15 superficial infections, 5 deep infections, 12 dislocations, 8 hematomas, 3 cases of cellulitis, 2 sciatic nerve palsies, 1 peroneal nerve palsy, and intrapelvic bleed. The nonsurgical complication rate was 1.4%. Deep vein thrombosis occurred in 0.3% of cases. ConclusionThis large multicenter study of consecutive AA THAs demonstrates an acceptable risk profile within the first 90 days after surgery.

Modified anterolateral approach in minimally invasive total hip arthroplasty.

Minimally invasive procedures for total hip arthroplasty (THA) provide less surgery related trauma, and perhaps a fast recovery and satisfaction. Using modified instruments, we reported clinical follow-up data for a modified anterolateral approach. Using specialised retractors to expose the acetabulum and femur, this single-incision technique preserved more gluteus medius tendon and provided access for soft tissue repair. The demographic data for 1003 patients undergoing THA with this technique are presented, including operative variables, complications, Harris Hip Score for clinical evaluation and cup inclination angle for radiographic evaluation. Average follow-up was 59 months (range 24-121). In 1077 primary THAs performed in 1003 patients, the median wound length was 6 cm (range 4.8-9.2), median operation time was 68 minutes (range 45-112). The mean perioperative blood loss was 422 mls (range 56-990). The median cup inclination angle was 44 degrees (range 33-54), median acetabular version angle was 17° (range 12-24) median length of hospitalisation was 4 days (range 3-8). A total of 22 (2.0%) complications were noted including 5 cases of stem subsidence, 4 cup loosening, 5 greater trochanter fractures, 4 infections, 2 intraoperative proximal femur fractures and 2 iliopsoas impingement. In total, 13 (1.2%) received additional surgery. No neurovascular injury or dislocation was noted. For the clinical results, Harris Hip Score improved from 53 (range 33-67) preoperatively to 94 postoperatively (range 87-100). Minimally invasive surgery via this modified anterolateral approach is a safe and reliable method.

Initial clinical experience of the use of digital tomosynthesis in the assessment of suspected fracture neck of femur in the elderly.

This study was undertaken to evaluate the use of digital tomosynthesis (tomogram) for diagnosis of suspected fracture neck of femur (NOF). We hypothesised that the use of cross-sectional imaging (MRI/CT) could be reduced by using tomogram to separate the patients with suspected NOF fractures that require MRI/CT scan from those who do not. Forty-one patients with a clinically suspected NOF fracture, following trauma, with negative AP and lateral hip X-rays, underwent a hip tomogram examination. Patients with a negative tomogram and clinically moderate to high probability of a hip fracture underwent MRI/CT within 48h. Tomogram identified fracture NOF in six patients, who underwent appropriate surgical treatment without needing further imaging. Fifteen patients, with negative tomogram examinations for fracture NOF and a low clinical probability of a fracture did not undergo additional MRI/CT scanning. At 6months of follow-up, none of the patients returned to the hospital with complications. Twenty patients with moderate to high clinical probability of fracture NOF with negative or inconclusive tomogram underwent additional MRI/CT scanning (19 MRI, 1 CT). Two patients showed fracture NOF, and one patient with greater trochanter fracture on tomogram showed fracture NOF on MRI scan. Seventeen patients showed soft tissue injury, bone oedema or pubic rami/acetabular fractures on MRI scan. Tomogram is a reliable imaging modality that can be used to select the patients who will need additional MRI/CT scan following negative or equivocal plain X-ray in patients with suspected hip fractures following fall. III.

Anterior locking plate reduces trochanteric fracture migrations during hip extension

BackgroundGreater trochanter fractures or osteotomies fixed with lateral plates still present high rates of complications. Unblocked greater trochanter anterior movement during hip extension might be a possible cause of failure. This study aimed to determine, under stair climbing conditions, the biomechanical behaviour of a greater trochanter fragment and the impact of an anterior locking plate on its migration. MethodsEighteen femurs paired from nine fresh frozen cadaveric specimens were tested on a quasi-dynamic stair climbing cycling test bench. Left and right sides with greater trochanter fractures were randomly fixed either with an antero-lateral locking plate or with a lateral locking plate. Migrations, defined as the remaining movements of the unloaded greater trochanter fragment, were measured for all 18 femurs. FindingsDuring hip extension, multi-directional greater trochanter fragment movements occurred and showed a back-and-forth anterior rotation. The lateral locking plate failed due to greater trochanter fragment rotation around the superior axis and anterior translation. The antero-lateral locking plate significantly reduced greater trochanter anterior migration (−0.9mm±1.6) compared to the lateral locking plate (9.6mm±9.5). InterpretationHip extension provides a plausible explanation for the high rate of post-operative failures of greater trochanter fixations. An antero-lateral locking plate represents an efficient surgical alternative counteracting the multi-directional greater trochanter movements occurring during hip extension.

A 5–8 Year Retrospective Follow-Up of the C-Stem AMT Femoral Component: Patient Reported Outcomes and Survivorship Analysis

We report midterm functional, radiographic and survivorship data for the cemented, triple taper C-stem AMT femoral component from a consecutive cohort of 415 hip arthroplasties in 386 patients at a non-developer centre. Follow-up ranges were from 60 to 99months, with a mean of 76months. 32 hips were lost to follow-up. The median OHS was 40, median SF-12 mental component score (MCS) was 50, and median SF-12 physical component score (PCS) was 39. At 99months follow up, stem survivorship is 96.9% (95% confidence interval (CI) 82.5–99.5), and construct survivorship is 96.0% (95% CI 84.2–99.0). Adverse events such as calcar fracture, greater trochanter fracture and dislocation were rare at <1%. There have been no revisions for aseptic loosening.

Early Clinical and Radiographic Results of Minimally Invasive Anterior Approach Hip Arthroplasty

We present a retrospective review of the early results and complications in a series of 35 consecutive patients with 43 total hip arthroplasties performed through an anterior muscle sparing minimally invasive approach. We found the early complication rates and radiographic outcomes comparable to those reported from arthroplasties performed via traditional approaches. Complications included dislocation (2%), femur fracture (2%), greater trochanteric fracture (12%), postoperative periprosthetic intertrochanteric fracture (2%), femoral nerve palsy (5%), hematoma (2%), and postoperative iliopsoas avulsion (2%). Radiographic analysis revealed average cup anteversion of 19.6° ± 6.6, average cup abduction angle of 48.4° ± 7, stem varus of 0.9° ± 2, and a mean leg length discrepancy of 0.7 mm. The anterior approach to the hip is an attractive alternative to the more traditional approaches. Acceptable component placement with comparable complication rates is possible using a muscle sparing technique which may lead to faster overall recovery.

Biomechanical Analysis of Trochanteric Fracture Fixations Using a Y-Shaped Locking Plate

Clinical evidence suggests that the use of Y-shaped locking plates with anterior and lateral locking screws provide improved primary fixation stability over the use of straight locking plates in the treatment of greater trochanter (GT) fractures. However, it remains unclear how the use of cable cerclages, in replacement or addition to the locking screws, would impact the primary fixation stability. Nine surgical fixations were tested on a dynamic test bench through 27 sawbones experiments. These fixations on the GT and bone shaft (BS) included locking screws alone, cable cerclages alone, or 7 combinations of both. Migrations, defined as the remaining movements of the unloaded GT fragment, were measured for all 9 fixations submitted to dynamic stair climbing cycling after an experimental plan. Under dynamic stair climbing conditions: (1) Y-shaped locking plates fixed by locking screws alone (vs cable cerclages alone) significantly reduced GT migrations, (2) adding cable cerclages to screws provided no significant reduction of migrations, and (3) cable cerclages alone can be used on the BS but is not recommended on the GT. Y-shaped locking plates with anterior and lateral locking screws improved primary stability of GT fractures over fixation with cable cerclages. Cable cerclages provided acceptable primary stability when screw fixations were unachievable but on the BS only.