Fracture Of Greater Trochanter Research Articles

Greater trochanter fractures: MR assessment and its influence on patient management

Eight patients with nondisplaced greater trochanteric (GT) fractures diagnosed by conventional radiographs were evaluated with magnetic resonance (MR) imaging. MR imaging demonstrated unsuspected intertrochanteric (IT) extension in each of the eight patients. This resulted in unanticipated surgical intervention in six of eight patients. Nondisplaced GT fractures are often more extensive and complex than they appear on conventional radiographs. MR imaging is useful in determining the extent and morphology of these fractures, information valuable for orthopedic management, and should be considered for definitive assessment in these patients.

Impaction bone grafting in revision hip surgery. A high incidence of complications.

We have reviewed retrospectively 68 revisions of the femoral component in arthroplasties of the hip in 65 patients, using impaction bone grafting, at a median of three years (1 month to 6 years). We employed the cemented Exeter X-Change technique in 36 patients and the uncemented Bi-Metric allografting method in 32. The 37 bone defects were grade 3 or grade 4 on the Endo-Klinik classification. The Mayo hip score improved from a mean of 32 (SD +/- 18) to 62 (SD +/- 15). Most (25) of the 34 complications occurred in grade-3 and grade-4 defects; nine were intraoperative diaphyseal fractures and eight fractures of the greater trochanter. All the fractures united. The risk of intraoperative fracture was prevented by supporting the bone with wires in 16 hips, with reinforcement mesh in 18 and by a plate in six. Early migration of the stem of more than 10 mm during the first year indicated rotational instability; it occurred in three cases. In difficult revision cases with large defects of the femoral bone, bone-impaction techniques carry a high risk of complications.

Early osteolysis with hylamer acetabular liners

We reviewed 78 patients with Hylamer acetabular liners (DePuy-Dupont Orthopedics, Warsaw, IN), with a mean follow-up of 3.8 years (range, 2–6 years), for signs of osteolysis secondary to polyethylene wear. Nine patients (11.5%) showed osteolysis greater than 1 cm 2. One patient had a greater trochanter fracture through a lytic area, one patient required a revision at 4 years for severe acetabular and femoral lysis with lesser trochanter fracture, and a second patient is awaiting revision.

Paper #16 Fractures through osteolytic lesions in the proximal femur in uncemented total hip arthroplasty

OF METHODS AND RESULTS: Six patients (ages 25 to 66 years) presented with acute-onset hip pain five to eleven years following successful uncemented total hip arthroplasty. Five patients with painful abduction, tenderness over the greater trochanter, and positive Treadelenberg sign had radiographic evidence of fractures through osteolysis lesions in the greater trochanter. Four of these were non-displaced. One patient with severe groin pain had a displaced fracture of the lesser trochanter. Afi patients were physically very active aud recalled gradual aching for one to four weeks followed by acute onset pain after trivial trauma. Two of the hips with greater trochanteric fractures that had significant polyethylene wear and the hip with the lesser trochanteric fracture underwent revision of the polyethyleoc component and curettage and bone grafting of the osteolysis lesions with internal fixation in one greater anti the lesser trochanteric fractures. All hips treated nonoperatively with protected ambulation experienced symptomatic relief after three to four weeks and gradually resumed normal activities. Hips treated with surgery resumed full activity after six weeks. Two cysts treated without surgery continue to enlarge radiegraphically and the other cysts are still present on xrays, requiring continued close follow-up.

Proceedings of the British Medical Ultrasound Society 26th annual meeting. Scarborough, 14-16 December 1994. Abstracts.

AIM: To assess the role of ultrasound in management of patients with symptomatic total hip replacements (THR). MATERIALS AND METHOD: 26 patients with symptoms following THR (2–11 years post-surgery) were examined sonographically using a 5–6 MHz curvilinear transducer (Diasonics Prisma) over a 12 month period. Any fluid collection was aspirated for bacteriology and any soft tissue masses were core biopsied for histological assessment. Ultrasound appearances as well as transducer compression tenderness were noted. RESULTS: Ultrasound diagnoses included: wear debris granulomata, 14 (definite, 5; probable, 6; possible, 3); prosthetic infection, 3 (2 with sequestra at level of femoral component tip); trochanteric wire problems, 10 (granulation tissue formation, 3; bursa formation, 3; infection, 2; haematoma, 1; compression tenderness without focal ultrasound abnormality, 1); femoral shaft fracture, 1; greater trochanter fracture, 1; acetabular screw granulation tissue, 1; heterotopic ossification, 3; ?ceramic femoral head fracture, 1; normal study (but possible early loosening on X-ray), 3. CONCLUSION: Ultrasound is an extremely useful method of initial evaluation of symptomatic total hip replacements.

Fractures of the proximal femur : Sikorski J. M., Davis N. J. and Senior J. (1985) The rapid transit system for patients with fractures of proximal femur. Br. Med. J.290, 439

ip fracture is among the most common injuries necessitating hospital admission. Fractures of the hip include fractures of the proximal femur and pelvic ring and may be classified as pathologic or nonpathologic. Regardless of the type of fracture, however, hip fractures can lead to substantial morbidity and mortality. This article discusses the epidemiology of fractures of the proximal femur and the evaluation and treatment of nonpathologic and osteoporotic pathologic proximal femoral fractures. The specific types of proximal femoral fracture discussed are intertrochanteric, femoral neck, subtrochanteric, and greater trochanteric fractures. A future article in this journal will discuss fractures of the pelvic ring, including sacral and acetabular injuries. EPIDEMIOLOGY OF PROXIMAL FEMORAL FRACTURES Between 220,000 and 250,000 proximal femoral fractures occur in the United States each year 1,2 ; 90% of these fractures occur in patients older than 50 years. 1,2 In younger patients, proximal femoral fractures are usually the result of high-energy physical trauma (eg, highspeed motor vehicle accidents) and usually occur in the absence of disease. Intertrochanteric and femoral neck fractures account for 90% of the proximal femoral fractures occurring in elderly patients. 1 Proximal femoral fractures in elderly patients are often pathologic, usually resulting from minimal-to-moderate physical trauma to areas of bone significantly affected by osteoporosis. However, pathologic fractures can occur at any age; typically, these fractures result from low-energy injuries and may be characterized by unusual fracture patterns. 3