Ipsilateral Femoral Head Research Articles

Treatment of a femoral neck fracture combined with ipsilateral femoral head and intertrochanteric fractures: A case report

Treatment of a femoral neck fracture combined with ipsilateral femoral head and intertrochanteric fractures: A case report

Short-to-Mid-Term Outcomes of Ipsilateral Femoral Head Autograft Combined with Uncemented Total Hip Replacement for Partial Periacetabular Defects Following Tumor Resection.

Periacetabular tumors, especially in young to middle-aged patients with invasive benign tumors or low-grade malignant tumors involving type II or II + III, present significant challenges due to their rarity and the complexity of the anatomical and biomechanical structures involved. The primary difficulty lies in balancing the need to avoid unfavorable oncological outcomes while maintaining postoperative hip joint function during surgical resection. This study aimed to evaluate the effectiveness and reliability of a surgical method involving partial weight-bearing acetabular preservation combined with the use of an uncontaminated femoral head autograft to reconstruct the segmental bone defect after intra-articular resection of the tumorous joint, providing a solution that ensures both oncological safety and functional preservation of the hip joint in these patients. We conducted a retrospective study with a follow-up period of at least 36 months. From January 2010 to October 2020, we reviewed 20 cases of patients under 60 year of age with periacetabular invasive benign tumors or primary low-grade malignant tumors. All patients underwent reconstruction of the tumorous joint using autologous femoral head grafts. Data collected included patient age, gender, tumor type, preoperative and postoperative visual analog scale (VAS) scores, Musculoskeletal Tumor Society (MSTS) scores, Harris Hip Scores (HHS), patient survival rates, postoperative tumor recurrence, and surgical complications. To analyze the data, we utilized various statistical methods, including descriptive statistics to summarize patient demographics and clinical characteristics, and paired sample t-tests to compare preoperative and postoperative scores. The study included 20 patients, and a total median follow-up was 83 months. Their pathologic diagnoses comprised 13 giant cell tumors (GCTs), 5 chondrosarcomas, one chondroblastoma, and 1 leiomyosarcoma. Postoperatively, the median differences in vertical and horizontal center of rotation (COR) were 3.8 and 4.0 mm. Median limb length discrepancy (LLD) postoperatively was 5.7 mm (range, 2.3-17.8 mm). Two patients (10%) experienced delayed wound healing, resolved with antibiotics and early surgical debridement. One patient experienced dislocation 3 months postoperatively, which was promptly addressed under general anesthesia without further dislocation. Through multiplanar osteotomy with limited margins, femoral head autograft, and uncemented total hip replacement for pelvic segmental bone defects in selected patients in type II or II + III appears to be an encouraging limb-sparing surgery worthy of consideration for carefully selected patients.

ARTICULAR FEMORAL HEAD FRACTURE MANAGEMENT: A COMPREHENSIVE SYSTEMATIC REVIEW

Background: Femoral head fractures (FHFs) are relatively rare injuries usually caused by high-energy trauma. They typically occur after a posterior dislocation, and approximately 5 to 15 of posterior hip dislocations involve FHFs. FHFs may also occur simultaneously with acetabular fractures, with an estimated incidence of 29.2 In addition, the incidence of ipsilateral femoral head and neck fractures (iFHNF) is low. However, iFHNFs, as a special type of fracture, have the worst prognosis among all FHFs The aim: The aim of this study to show about articular femoral head fracture management. Methods: By comparing itself to the standards set by the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020, this study was able to show that it met all of the requirements. So, the experts were able to make sure that the study was as up-to-date as it was possible to be. For this search approach, publications that came out between 2014 and 2024 were taken into account. Several different online reference sources, like Pubmed and SagePub, were used to do this. It was decided not to take into account review pieces, works that had already been published, or works that were only half done. Result: In the PubMed database, the results of our search get 17 articles, whereas the results of our search on SagePub get 489 articles, on Google Scholar 8050 articles. Records remove before screening are 5860, so we get 2696 articles fos screening. After we screened based on record exclude, we compiled a total of 12 papers. We included five research that met the criteria. Conclusion: Open reduction and internal fixation of femoral head fracture using surgical hip dislocation through Ganz approach is a viable treatment option and provides satisfactory results with low complication rates.

Optimising Soft-Tissue Balancing in Hip Hemiarthroplasty Surgery Using a Simple Planning Protocol.

Introduction Intracapsular neck of the femur fractures are some of the most common fragility fractures with significant morbidity and mortality. Cemented hemiarthroplasty is the standard treatment in most cases. Restoring the horizontal offset and leg length is important to optimize the outcome of hip hemiarthroplasty. Preoperative templating based on a scaled radiograph is common prior to total hip arthroplasty surgery to achieve optimum offset and leg length. It is not routine to have scaled radiographs available prior to a hemiarthroplasty surgery. Our simple non-scaled radiograph templating protocol (NSRTP) was introduced to help establish the correct offset and leg length in the absence of scaled radiographs. Methods A retrospective, comparative, case-control study was carried out in an acute hospital setting. Scaled radiographs were not available for any patients in the study, as is usual for hemiarthroplasty patients in our hospital. One group had surgery without any templating. The other group had surgery using the NSRTP. The NSRTP determined optimal ipsilateral offset based on preoperative measurement of the contralateral hip offset and ipsilateral head diameter on unscaled radiographs together with intraoperative measurement of the diameter of the ipsilateral femoral head removed at surgery. To help achieve the correct length, the NSRTP also included assessment and restoration of the contralateral greater trochanter tip-to-head relationship. The neck cut was tailored to restore the correct relationship. Results Twenty-three patients underwent hemiarthroplasty surgery without any templating and 23 had surgery using the NSRTP. The implants used were C-STEM™ (DePuy Synthes, Raynham, Massachusetts, United States) and SPECTRON (Smith & Nephew plc, London, United Kingdom); stems were used together with monopolar heads. The stems were available in standard and high offset versions and with a variety of neck lengths, allowing the correct combination to be selected to restore offset. When the NSRTP was used, horizontal offset and leg length were restored to within 2 mm of the contralateral hip in 22 patients out of 23. There was a statistically significant improvement in restoration of offset and leg length when the NSRTP was used, compared to the control group. Conclusion Restoration of the offset and leg length is important to maximize the outcome of hip arthroplasty surgery. Preoperative templating is helpful to achieve offset and leg length in total hip replacement. In the absence of scaled radiographs, NSRTP enables restoration of offset and leg length to within 2 mm of normal in more than 96% of patients. This protocol requires knowledge of the offset of the hemiarthroplasty stems being used, which is easily available from the relevant manufacturer.

Legg-Calvé-Perthes disease following Ender nail fixation of a pediatric femoral fracture.

Introduction and importanceLegg–Calvé–Perthes disease (LCPD) sometimes occur in children, however it is difficult to diagnose it at the early stage especially in the cases there are no complaints of symptoms. Femoral shaft fractures in children cause various complications such as leg-length discrepancy, nonunion and malunion, refracture, and osteonecrosis of the femoral head. We presented a rare case in which a pediatric patient developed LCPD after femoral shaft fracture.Case presentationA healthy 8-year-old boy sustained a left femoral diaphyseal fracture following a pedestrian car accident. Fixation was achieved using retrograde Ender nails; bone union was confirmed at 3 months postoperatively, and the Ender nails were removed at 8 months postoperatively without any problems. Unfortunately, the morphological change of the ipsilateral femoral head and subtle symptoms were missed until the femoral head collapsed. LCPD was successfully treated with intertrochanteric varus osteotomy, which achieved a good clinical result.Clinical discussionAlthough the reason for the ipsilateral LCPD after the femoral shaft fracture is unclear, this case highlights the need for close postoperative follow-up of pediatric femoral fractures resulting from high-energy trauma to prevent the misdiagnosis of this coincidental complication.ConclusionThis case report describes a missed ipsilateral LCPD after a femoral diaphyseal fracture caused by high-energy trauma. Close postoperative follow-up with a detailed assessment and vigilant interpretation of postoperative radiography is imperative to avoid delayed/missed diagnosis of conditions for which early management may provide better outcomes.

Fixation options for reconstruction of the greater trochanter in unstable intertrochanteric fracture with arthroplasty.

Introduction:With the aggravation of population aging, the incidence of intertrochanteric fracture also increases dramatically. Patients are often elderly accompany with severe osteoporosis and various complications. Therefore, we should select an individualized treatment based on the each patient's state. Arthroplasty is recommended for unstable fractures with obvious osteoporosis, ipsilateral femoral head necrosis or arthritis. Rigid fixation of the greater trochanter with arthroplasty is challenging because of the powerful pulling forces created by multiple muscles being transmitted to the greater trochanter. Currently, there are few contemporary literatures on the evaluation of unstable intertrochanteric fracture with efficient fixation of the greater trochanter. Moreover, there is no consensus to choose which implant to immobilize the greater trochanter. The purpose of this study was to review previous literatures and provide a valuable guidance.Conclusions:The locking plate, which not only provides rigid fixation but also results in lower rate of postoperative complications. However, further prospective randomized and cohort studies are needed.

Bilateral femoral head reshaping and mosaicplasty in Legg-Calvé-Perthes disease residual deformity.

Residual hip deformity secondary to Perthes disease may lead to early symptomatic joint degeneration. The altered anatomy results in biomechanical and biological problems that can be surgically addressed in adolescents or young adults with hip preservation procedures. This case report aims to demonstrate a customized surgical treatment performed on a 15-year-old male who developed painful hips with significant intra- and extra-articular impingement, secondary to bilateral Leg–Calvé–Perthes disease residual deformity. Intra-articular procedures were executed through a safe surgical dislocation of the hip, with a mosaicplasty using osteochondral autografts from the exceeding peripheral ipsilateral femoral head, a femoral head–neck osteochondroplasty and a labrum repair. A relative lengthening of the femoral neck was also carried out with a trochanteric advancement to solve the extra-articular issues. On follow-up, he referred to a substantial improvement in pain and function, being his radiographic studies satisfactory. At 4 and 5 years from surgery, the patient was able to exercise regularly with minimal complaints, with a Harris Hip Score of 85.85% and a Hip Outcome Score of 94.1% for activities of daily life and 86.1% for sports. In patients with hip deformity after healed Perthes disease, treatment strategies that address both the morphological disturbance of coxa magna, plana and breva, as well as the biological concerns arising from osteochondral injuries or labral tears, and mechanical dysfunctions lead to improvements in symptomatology, function and medium-term prognosis. Further procedures to address residual adaptative acetabular dysplasia would favor outcomes of conservative hip surgery in the sequelae of LCPD.

Promising outcomes of hip mosaicplasty by minimally invasive anterior approach using osteochondral autografts from the ipsilateral femoral head.

Recent studies demonstrated promising results of mosaicplasty for femoral head osteochondral lesions using posterior and lateral approaches. This study aimed to evaluate outcomes of mosaicplasty using ipsilateral femoral head autografts by minimally invasive anterior approach. The hypothesis was that this surgical technique would grant satisfactory clinical outcomes with considerable improvement of clinical scores. A consecutive series of 27 mosaicplasties, to treat osteochondral lesions of the femoral head measuring 1.6 ± 0.7cm2 (range 0.8-4.0) in patients aged 28.7 ± 7.4years (range 19-44), was evaluated using the mHHS and WOMAC scores at minimum follow-up of 12months. All patients were operated by minimally invasive anterior (Hueter) approach and osteochondral plugs were harvested from the non-weight-bearing portion of the femoral head. Adjuvant osteoplasty was necessary for some patients at the acetabulum (n = 3), femur (n = 14) or both (n = 2). Three patients were excluded due to concomitant periacetabular osteotomies or shelf procedures, one patient could not be reached, and another was revised to THA. This left 22 patients for clinical assessment at 39.4 ± 23.2 months (12.0-90.2). Their mHHS improved from 56.3 ± 12.6 to 88.4 ± 9.9, and WOMAC improved from 45.1 ± 16.9 to 80.6 ± 13.0. Two patients (8.4%) underwent arthroscopy at 13 and 30 months to remove painful residual cam-type deformities. Regression analyses revealed that net improvement in WOMAC decreased with lesion size (p = 0.002) and increased with follow-up (p = 0.004). Hip mosaicplasty using autografts from the ipsilateral femoral head, performed by minimally invasive anterior approach, granted satisfactory outcomes and functional improvements. Caution is, however, advised for lesions > 2cm2 (diameter > 16mm) which may be a threshold limit for this procedure. Level IV, Case series.

The disappearance of femoral head and neck resulting from extensive bone defect caused by secondary syphilis: a case report and literature review

BackgroundTreponema Pallidum (TP), the pathogen of syphilis, commonly infects bones in cases of congenital and tertiary syphilis, but it is rare in the primary and secondary stages. With its mild symptoms and rare clinical findings, it might be easy to dismiss the diagnosis of early syphilis. Usually, effective results can be achieved after the conventional strategy of antibiotic treatments, mainly penicillin. To our knowledge, our case is so far the most serious reported case of destructive bone lesion in secondary syphilis, and our treatment for the case is the first strategy using total hip arthroplasty in secondary syphilis.Case presentationWe present the case of a 71-year-old man with local repeated pain and dysfunction in the right hip. Radiologic examinations showed the disappearance of the ipsilateral femoral head and neck. After excluding the aetiologies of cancer metastasis and tuberculosis, we confirmed the diagnosis of syphilitic arthritis. The patient received the medical treatment of antibiotics and the surgical treatment of total hip arthroplasty. At the follow-up of 1, 3, and 5.5 years after the operation, the patient presented with a pain-free and functional hip prosthesis without local signs of infection and loosening.ConclusionsThis report highlights the difficulties of early diagnosis of secondary syphilis with bone involvement. Bone defect of the femur with secondary syphilis, especially at the proximal femur, was an extremely rare complication in the previous reports. Our case was the first case of a patient who experienced the disappearance of femoral head and neck caused by secondary syphilis. Follow-up after the operation proved the successful treatment of the extensive bone defect of femur by total hip arthroplasty.

Acetabular Reconstruction With Femoral Head Autograft After Intraarticular Resection of Periacetabular Tumors is Durable at Short-term Followup.

Pelvic reconstruction after periacetabular tumor resection is technically difficult and characterized by a high complication rate. Although endoprosthetic replacement can result in immediate postoperative functional recovery, biologic reconstructions with autograft may provide an enhanced prognosis in patients with long-term survival; however, little has been published regarding this approach. We therefore wished to evaluate whether whole-bulk femoral head autograft that is not contaminated by tumor can be used to reconstruct segmental bone defects after intraarticular resection of periacetabular tumors. In a pilot study, we evaluated (1) local tumor control, (2) complications, and (3) postoperative function as measured by the Musculoskeletal Tumor Society score. Between 2009 and 2015, we treated 13 patients with periacetabular malignant or aggressive benign tumors with en bloc resection, bulk femoral head autograft, and cemented THA (with or without a titanium acetabular reconstruction cup), and all were included for analysis here. During that time, the general indications for this approach were (1) patients anticipated to have a good oncologic prognosis and adequate surgical margins to allow this approach, (2) patients whose pelvic bone defects did not exceed two types (Types I + II or Types II + III as defined by Enneking and Dunham), and (3) patients whose medical insurance would not cover what otherwise might have been a pelvic tumor prosthesis. During this period, another 91 patients were treated with pelvic prosthetic replacement, which was our preferred approach. Median followup in this study was 36 months (range, 24-99 months among surviving patients; one patient died 8 months after surgery); no patients were lost to followup. Bone defects were Types II + III in five patients, and Types I + II in eight. After intraarticular resection, ipsilateral femoral head autograft combined with THA was used to reconstruct the segmental bone defect of the acetabulum. In patients with Types I + II resections, the connection between the sacrum and the acetabulum was reestablished with a fibular autograft or a titanium cage filled with dried bone-allograft particles which was enhanced by using a pedicle screw and rod system. Functional evaluation was done in 11 patients who remained alive and maintained the femoral head autograft at final followup; one other patient received secondary resection involving removal of the femoral head autograft and internal fixation, and was excluded from functional evaluation. Endpoints were assessed by chart review. Two patients experienced local tumor recurrence. Finally, eight patients did not show signs of the disease, one patient died of disease for local and distant tumor relapse, and four patients survived, but still had the disease. Three of these four patients had distant metastases without local recurrence and one had local control after secondary resection but still experienced system relapse. We observed the following complications: hematoma (one patient; treated surgically with hematoma clearance), delayed wound healing (one patient; treated by débridement), deep vein thrombosis (one patient), and hip dislocation (one patient; treated with open reduction). The median 1993 Musculoskeletal Tumor Society score was 83% (25 of 30 points; range, 19-29 points), and all patients were community ambulators; one used a cane, three used a walker, and nine did not use any assistive devices. In this small series at short-term followup, we found that reconstruction of segmental bone defects after intraarticular resection of periacetabular tumors with femoral head autograft does not appear to impede local tumor control; complications were in the range of what might be expected in a series of large pelvic reconstructions, and postoperative function was generally good. Level IV, therapeutic study.

Ipsilateral femoral head osteochondral transfers for osteochondral defects of the femoral head.

Osteochondral defects of the femoral head are rare. Several treatment options have been described, though there is currently no consensus on the appropriate management of these lesions. Five patients underwent femoral head osteochondral autograft transfer for treatment of ipsilateral femoral head osteochondral defects via surgical hip dislocation between 2011 and 2014 at our institution. The mean age of the patients was 24.8 (16–37) years. There were four females and one male. Mean follow-up was 53.8 (30–64) months. Four patients reported complete resolution of preoperative pain, return to baseline activities and were satisfied with their results. Harris hip scores improved from a mean 60.8 (30–87) to 86.6 (44–100). There was no radiographic evidence of progression of the femoral head defects. There were no operative complications. Osteochondral autograft transfer from the ipsilateral femoral head using a surgical hip dislocation demonstrated good clinical and radiographic outcomes at midterm follow-up in our cohort and may be considered a suitable option for management of these lesions in select patients. Further research and follow-up is warranted to more clearly define the indications and outcomes of this procedure.

Traumatic hip dislocation with associated femoral head fracture.

Dislocation of the hip is a critical injury that results from high-energy trauma. This paper describes a case of posterior dislocation of the right hip in a 35-year-old woman with associated ipsilateral femoral head fracture. Initial treatment included reduction of the right hip through posterior approach and fixation of the femoral head fracture with three absorbable screws. After 15-month follow-up, a full range of motion has been achieved and there are no signs of avascular necrosis, hip instability, or limping. The authors describe their method of surgery.

Knee Joint Osteochondral Reconstruction Using Fresh Femoral Head Autograft

We present the management of polyarticular osteonecrosis in a 17-year-old female, with marked symptoms involving both hips and one knee. As a complication of chemotherapy to treat leukaemia, the articular surfaces of both femoral heads and the right knee lateral femoral condyle collapsed, resulting in significant pain and disability. For this unusual case a novel technique was employed, using a method we believe has not been described previously. The articular surface of the knee was reconstructed using fresh bulk osteochondral autograft harvested from the ipsilateral femoral head during a simultaneous total hip arthroplasty. Reconstructive options in young patients with multiple joints involved are often restricted, and suitable osteochondral allografts can be difficult to obtain. Fresh osteochondral auto-grafting enabled rapid osseous integration and articular surface reconstruction using living host cartilage, resulting in an excellent clinical outcome. Although uncommon, concurrent avascular necrosis of multiple large joints is occasionally encountered, and management options are particularly limited in young patients. We recommend this innovative technique be considered in those patients who satisfy the criteria for bulk osteochondral grafting procedures where total hip replacement is also required. J Med Cases • 2013;4(12):803-810 doi: http://dx.doi.org/10.4021/jmc1524w

Hip Resurfacing and Conventional THA: Comparison of Acetabular Bone Stock Removal, Leg Length, and Offset

The purpose of this study was to compare total hip arthroplasty (THA) and hip resurfacing arthroplasty (HRA) with regard to the amount of acetabular bone stock removed and the ability to restore leg length and offset. Anteroposterior pelvis radiographs of 153 consecutive THAs and 84 consecutive HRAs were compared. Excluded patients were those with prior hip surgery, those in which a best-fit circle could not be adequately matched to the femoral head, and those with preoperative radiographic findings that precluded consideration for HRA (ie, disease severity, deformity, leg-length discrepancy). A significant difference was found between THA and HRA with regards to age and sex but not primary diagnosis. Relative differences in acetabular bone removal were compared using a ratio of acetabular implant diameter to preoperative ipsilateral femoral head diameter measured with a best-fit circle. The ratio of acetabular cup diameter to preoperative ipsilateral femoral head diameter was significantly greater following THA than following HRA, indicating relatively more acetabular bone removal in THA procedures. Mean leg-length discrepancy was significantly greater following THA than following HRA. Offset was increased to a greater extent following THA than following HRA. Overall, HRA was associated with relatively less acetabular bone stock removal and less alteration in leg length and offset than was THA.

Knee Joint Osteochondral Reconstruction Using Fresh Femoral Head Autograft

We present the management of polyarticular osteonecrosis in a 17-year-old female, with marked symptoms involving both hips and one knee. As a complication of chemotherapy to treat leukaemia, the articular surfaces of both femoral heads and the right knee lateral femoral condyle collapsed, resulting in significant pain and disability. For this unusual case a novel technique was employed, using a method we believe has not been described previously. The articular surface of the knee was reconstructed using fresh bulk osteochondral autograft harvested from the ipsilateral femoral head during a simultaneous total hip arthroplasty. Reconstructive options in young patients with multiple joints involved are often restricted, and suitable osteochondral allografts can be difficult to obtain. Fresh osteochondral auto-grafting enabled rapid osseous integration and articular surface reconstruction using living host cartilage, resulting in an excellent clinical outcome. Although uncommon, concurrent avascular necrosis of multiple large joints is occasionally encountered, and management options are particularly limited in young patients. We recommend this innovative technique be considered in those patients who satisfy the criteria for bulk osteochondral grafting procedures where total hip replacement is also required. J Med Cases. 2013;4(12):803-810 doi: https://doi.org/10.4021/jmc1524w

Coxofemoral joint tuberculosis: regarding one case

Figure 1 – Pelvic panoramic AP radiography, showing a decrease in the articular space on the right, besides a flattening of the ipsilateral femoral head. IntroductIon For centuries tuberculosis has plagued humankind1, being considered the main cause of death due to a single infectious agent in adults all over the world, according to WHO data2. This disease can take several forms, such as pulmonary, lymphatic, genitourinary, among others. One of them is osteoarticular tuberculosis, which has existed for thousands of years and still strikes children and adolescents with a stable incidence in both developed and developing countries. The osteoarticular disease constitutes 10 to 20% of extrapulmonary tuberculosis cases and 1% to 3% of all tuberculosis cases2-6. The bone impairment is predominant in the vertebral column7. As to joint impairment, it is less usual and occurs, in 50 to 73% of cases, in load-bearing joints, such as the hip and the knee8-10. The occurrence of tuberculosis in the coxofemoral joint is reported in a pediatric patient at a Teaching Hospital, showing how difficult the early diagnosis of this disease can be.

Anterior dislocation of hip with ipsilateral femoral neck and head fracture

A 70-year-old male patient presented to our emergency department with trauma left hip following a fall. Physical examination revealed external rotation, slight flexion, adduction, and shortening of the affected limb. There was a palpable fullness in the groin. Radiographic examination revealed fracture neck of femur with femoral head dislocated anteriorly and lying in the obturator foramen. There was an associated femoral head fracture with a fragment of it in the acetabulum. Although this sort of injury has been reported once, the difference in our case lies in the age of the patient; the injury complex was caused by a less severe trauma and a unique mechanism of injury. Also a modification of Brumback classification is proposed to include such fractures more specifically in order to allow comparative analysis in such rare injuries as more and more such case reports are added to literature.

Giant bone island of femur with femoral head necrosis: a case report

A bone island is a hamartomatous malformation in the bone, unusually having a huge expansion. We report a rare case of giant bone island of femur concurrent with ipsilateral femoral head necrosis. Although roentgenographic features indicated the possible diagnosis of bone island, there were unusual findings, such as a huge expansion of the lesion, increased uptake of radionuclide on bone scan, and presence of symptoms. Cementless hemiarthroplasty was performed for femoral head necrosis and the diagnosis was confirmed by histology. Prosthesis insertion was considerably complicated by the presence of giant bone island located at the cut surface of the femoral neck. Despite concerns over the stability of the cementless prosthesis surrounded by bone island, roentgenograms at 4 years after surgery showed no evidence of loosening and the patient's symptoms completely disappeared.

Isolated Paget Disease of the Patella Complicated with Ipsilateral Femoral Head Bone Marrow Edema: A Case Report and Review of the Literature

The patella is rarely affected by Paget disease of bone. The authors report a 54-year-old lady with ipsilateral knee and hip pain, initially misdiagnosed as patella stress fracture and early degenerative hip arthritis, who was later found to have Paget disease of the patella with ipsilateral femoral head bone marrow edema.

Extensile triradiate approach in the management of combined acetabular fractures.

We investigated the results of combined acetabular fractures that were treated through the extensile triradiate approach in this study. Between January 1996 and January 2001, a total of 48 acetabular fractures were treated surgically (mainly combined fractures). Twenty-five of the combined acetabular fractures that were surgically treated through the triradiate approach with a minimum of 2 years' follow-up were included in the study. The mean patient age was 42 years. There were 8 both-column, 6 T-shaped, 2 anterior column/posterior hemitransverse, 4 transverse with comminuted roof area, 4 posterior wall with comminuted roof area, and 1 posterior column/posterior wall fracture. Associated injuries included two full-thickness chondral injuries of the head, one Pipkin type II fracture, five posterior and one central dislocation of the ipsilateral femoral head, and acetabular marginal impaction in four hips. The average follow-up was 44 months. The postoperative reduction was graded as excellent in 68% and imperfect in 8% of the patients. The hips were evaluated functionally according to the modified Postel-D'Aubigne score and rated as excellent in 7 patients (28%), good in 13 patients (52%), fair in 3 patients (12%) and poor in 2 patients (8%). There were 2 deep infections (8%), 2 avascular necroses of the head (8%), and 4 (16%) non-disabling heterotopic ossifications. Our results support the idea that open reduction with the triradiate approach provides good visualization and direct reduction of combined acetabular fractures. Its learning curve for combined fractures is shorter than that for single approaches and provides at least the same rate of anatomical reduction. It should be in the armamentarium of a surgeon dealing with such fractures.