Lateral Femoral Cutaneous Nerve Palsy Research Articles

Sonographic Evaluation of the Lateral Femoral Cutaneous Nerve: Single-Institution Experience and Pictorial Review.

The location of the lateral femoral cutaneous nerve (LFCN) makes it susceptible to injury with trauma, external compression, and iatrogenic injury. The objectives of this study were to report the single-institution efficacy of LFCN visualization on ultrasound (US), define the clinical characteristics of patients with LFCN palsy, and describe sonographic appearances of LFCN abnormalities by pictorial review. A retrospective chart review of LFCN cases evaluated using US at a single institution was performed, documenting rate of visibility on US, mode of nerve injury, and US imaging findings. Nerve visibility rates on US were correlated with magnetic resonance imaging (MRI) when both modalities were used. Imaging findings were confirmed with clinical/surgical history and follow-up. Retrospective review found that 170 patients underwent US for LFCN evaluation in the last 10 years. Injury was associated with surgical intervention in 56% of cases, and perineural scarring was the most common pathology described using US. Lateral femoral cutaneous nerve was visible on US in 97% of cases; MRI visualized LFCN in 60%. Chart review showed US as an effective tool in evaluating LFCN pathology, with a higher visualization rate than MRI. Through pictorial review, the array of LFCN pathology sonographically detectable is demonstrated.

Traumatic bilateral acetabular fracture secondary to high-energy trauma in healthy adults

BackgroundBilateral acetabular fracture is a very rare presentation among the trauma patients, as the pattern and the degree of the forces required to fracture both acetabula is very unique. The primary purpose of this study is to report a series of adult patients presenting with post-traumatic bilateral acetabular fracture without any history of pathological or metabolic bone disease.Patients and methodsIn this retrospective study, 18 cases of traumatic bilateral acetabular fracture were included. There was predominance of both column (four patients on left and six on right) followed by anterior column (two patients left and four on right) and posterior wall (three patients left and right). They were treated surgically through open reduction and internal fixation. All cases were followed up for at least 13 months. Matta’s criteria were used for radiological evaluation on plain radiographs. Functional outcome was evaluated using the Merle d’Aubigne and postel score at final follow-up.ResultsNo patients were lost during the follow-up period; there was one case of surgical site infection. There were three cases of postoperative osteoarthritis, one case of heterotrophic ossification, one case of persistent sciatic nerve palsy and one case of lateral femoral cutaneous nerve palsy. The radiological evaluation according to Matta’s criteria revealed anatomic reduction in 12 patients, imperfect reduction in three patients while other three patients had poor reduction. According to modified Merle d’Aubigne and Postel score, 10 cases were rated as excellent, five cases as good and three cases presented fair (one case) to poor (two cases) results.ConclusionWe report an unusual case series of bilateral acetabular fracture successfully managed surgically with good clinical outcome. With the increasing incidence of route traffic accidents, such cases would probably be recurrent in the upcoming years.

Lateral Femoral Cutaneous Nerve Injury Using an Anterior-Based Muscle-Sparing Approach to the Hip: A Clinical and Cadaveric Analysis with Review of Literature

AbstractThe alternative anterior hip approach between the tensor fascia lata and gluteus medius (the modified Watson-Jones approach, Röttinger approach, anterior-based muscle-sparing [ABMS] approach, and ABLE approach) may decrease the risk of lateral femoral cutaneous nerve (LFCN) palsy. A retrospective case study, systematic literature review, and cadaveric study were performed to assess the risk for LFCN palsy with the ABMS compared with the direct anterior (DA) approach. Consecutive patients who underwent total hip arthroplasty (THA) using ABMS were identified and assessed for LFCN palsy. A systematic review of LFCN injury with ABMS and DA approaches was conducted. In four fresh cadavers (eight hips), ABMS and DA approaches were performed and the LFCN identified. The proximity of the LFCN to the fascial incision was measured and compared between ABMS and DA approaches. In 64 consecutive ABMS THA (mean age: 57.3 ± 13.5 years, 42% female, mean body mass index: 30.2 ± 5.3 kg/m2), two hips (3.2%) had an LFCN palsy. In combination with the systematic literature review, the risk of LFCN palsy was less with ABMS (0.3%, 7/2,609 hips) compared with DA (3.1%, 638/20,402 hips, p < 0.001). In eight cadaveric hip dissections, the LFCN was significantly further away from the ABMS fascial incision (mean: 67.6 ± 9.1 mm), compared with the fascial incision of the DA approach (mean: 18.5 ± 3.5 mm, p < 0.0001). The risk of LFCN palsy was found to be 10-fold greater with the DA approach compared with the ABMS approached in this combined retrospective case series and systematic literature review. The anatomic location of the ABMS fascial incision was significantly farther from the LFCN, contributing to the decreased risk of LFCN injury.

The Kocher-Langenbeck approach combined with robot-aided percutaneous anterior column screw fixation for transverse-oriented acetabular fractures: a retrospective study

ObjectiveTransverse-oriented acetabular fractures (TOAFs), including transverse, transverse with posterior wall and T-shaped fractures, are always challenging for double-column reduction and fixation with minimally invasive method. The purpose of this study is to compare the therapeutic effects of robot-aided percutaneous anterior column screw fixation versus minimally invasive anterior plate fixation for TOAFs based on the Kocher-Langenbeck (K-L) approach.MethodsPatients suffering TOAFs that were fixed by robot-aided percutaneous anterior column screw fixation or minimally invasive anterior plate fixation associated with posterior fixation via the K-L approach were divided into two groups: group A (screw fixation) and group B (plate fixation). Surgical time, blood loss, incision length for anterior fixation and complications were recorded. Fracture reduction quality was evaluated using criteria described by Matta. Fracture healing was assessed on the series of pelvic radiographs at each follow-up. Functional outcomes were investigated using the modified Postel Merle D’Aubigne score at the final follow-up.ResultsTwenty-nine patients with TOAFs, including 12 patients in group A and 17 patients in group B, were evaluated for study eligibility. The mean surgical time of anterior fracture fixation was 18.7 ± 4.6 min in group A and 33.4 ± 5.0 min in group B (P < 0.001). The amount of intraoperative blood loss was 615.6 ± 178.7 ml in group A and 719.3 ± 199.0 ml in group B (P < 0.001). Incision length for anterior fixation was 9.0 ± 1.8 mm in group A and 81.2 ± 7.3 mm in group B (P < 0.001). The complications related to the surgery of anterior column only occurred in group B (lateral femoral cutaneous nerve palsy in 1 patient and groin discomfort in 1 patient). No significant differences in reduction quality, hospital stay, fracture healing time and functional results were noted between the two groups.ConclusionThe K-L approach combined with robot-aided anterior column screw fixation is a safe and effective option for TOAFs. Compared with minimally invasive anterior plate fixation, robot-aided screw fixation has obvious advantages on surgical time, blood loss, and invasiveness. The K-L approach combined with minimally invasive anterior plate fixation can also be a reliable alternative for TOAFs, with the similar reduction quality and functional results.

INFIX-safe and effective surgical option for complex fracture patterns of the anterior pelvic ring: A prospective single center study

BackgroundComplex fracture patterns of anterior pelvic ring are a challenge and usually needs extensive surgeries. The purpose of this study was to evaluate INFIX as a minimally invasive procedure for such injuries in terms of feasibility, outcomes and complications in the Indian population. MethodsPatients with complex fracture patterns of anterior pelvic ring were selected for anterior INFIX application along with standard posterior stabilization. Outcomes were assessed radiographically by Matta's criteria and amount of displacement. Post-operative CT scan for relation of implant to vital structures and Doppler at varying hip flexion for possible vascular occlusion was used. Functional outcomes included both disease specific scores (Majeed score, IOWA pelvic score) and quality of life scores (SMFA, SF-12). Complications were also noted. Results12 cases out of 112 patients had complex fracture pattern of the anterior ring. Most common injury pattern were LC-3 and VS (n = 6 and 3) Young and Burgess type. The average follow up was 6 months. Fracture reduction as per Matta's criteria was excellent in 10 (83.3%) cases and good in 2 (16.6%) cases with functional outcomes excellent in 11 cases, and a mean Majeed score of 92.67 ± 5.8. The average SMFA score was 51 ± 4.39 and mean SF-12 scores for physical and mental health were 48.493 ± 6.74 and 56.370 ± 4.04 respectively. Complications noted were lateral femoral cutaneous nerve palsy (1/24 nerves), skin dehiscence (n = 2), infection (n = 2) and sacral nonunion (n = 1). ConclusionINFIX is a safe and effective minimally invasive technique for addressing complexfracture patterns involving the anterior half of pelvic ring with excellent fracture reduction, radiological and functional outcomes and predictable fracture healing.

Traction Time, Force and Postoperative Nerve Block Significantly Influence the Development and Duration of Neuropathy Following Hip Arthroscopy

To (1) evaluate the individual and combined effects of traction time and traction force on postoperative neuropathy following hip arthroscopy, (2) determine if perioperative fascia iliaca block has an effect on the risk of this neuropathy, and (3) identify if the these items had a significant association with the presence, location, and/or duration of postoperative numbness. Between February 2015 and December 2016, a consecutive cohort of hip arthroscopy patients was prospectively enrolled. Traction time, force, and postoperative nerve block administration were recorded. The location and duration of numbness were assessed at postoperative clinic visits. Numbness location was classified into regions: 1, groin; 2, lateral thigh; 3, medial thigh; 4, dorsal foot; and 5,preoperative thigh or radiculopathic numbness. A total of 156 primary hip arthroscopy patients were analyzed, 99 (63%) women and 57 (37%) men. Mean traction time was 46.5 ± 20.3minutes. Seventy-four patients (47%) reported numbness with an average duration of 157.5 ± 116.2days. Postoperative fascia iliaca nerve block was a significant predictor of medial thigh numbness (odds ratio, 3.36; 95% confidence interval, 1.46-7.76; P= .04). Neither traction time nor force were associated with generalized numbness (P= .85 and P= .40, respectively). However, among those who experienced numbness, traction time and force were greater in patients with combined groin and lateral thigh numbness compared with those with isolated lateral thigh or medial thigh numbness (P= .001 and P= .005, respectively). Postoperative neuropathy is a well-documented complication following hip arthroscopy. Concomitant pudendal and lateral femoral cutaneous nerve palsy may be related to increased traction force and time, even in the setting of low intraoperative traction time (<1hour). Isolated medial thigh numbness is significantly associated with postoperative fascia iliaca blockade. IV, case series.

Reducing Lateral Femoral Cutaneous Nerve Palsy in Obese Patients in the Beach Chair Position: Effect of a Standardized Positioning and Padding Protocol.

To report on the effectiveness of a standardized patient positioning and padding protocol in reducing lateral femoral cutaneous nerve (LFCN) palsy in obese patients who have undergone shoulder surgery in the beach chair position. We retrospectively reviewed the medical records of 400 consecutive patients with a body mass index (BMI) of ≥30 kg/m who underwent either open or arthroscopic shoulder surgery in the beach chair position by a single surgeon. Before June 2013, all patients were placed in standard beach chair positioning with no extra padding. After June 2013, patients had foam padding placed over their thighs underneath a wide safety strap and underneath the abdominal pannus. Flexion at the waist was minimized, and reverse Trendelenburg was used to position the shoulder appropriately. Patient demographic and surgical data, including age, sex, weight, BMI, presence of diabetes, procedure duration, American Society of Anesthesiologists (ASA) grade, and anesthesia type (general, regional, regional/general) were recorded. Symptoms of LFCN palsy were specifically elicited postoperatively in a prospective fashion and identified clinically by focal pain, numbness, and/or tingling over the anterolateral thigh. The median age was 58.0 years, and the study consisted of 142 male (36%) and 258 female (64%) subjects. Five cases (3.6%) of LFCN palsy occurred with conventional beach chair positioning, and a single case (0.4%) occurred with the standardized positioning and padding technique (P = 0.02). Median age, sex, presence of diabetes, median BMI, surgery type, and surgical time were not significantly different between the patients who did and did not develop LFCN palsy. All cases resolved completely within 6 months. The occurrence of LFCN palsy following shoulder surgery in the beach chair position remains uncommon, even among obese patients. Use of a standardized positioning and padding protocol for obese patients in the beach chair position reduced the prevalence of LFCN palsy. Level III (prognostic).

Minimally invasive treatment for anterior pelvic ring injuries with modified pedicle screw-rod fixation: a retrospective study

BackgroundPelvic ring injuries constitute only 2 to 8% of all fractures; however, they occur in 20% of polytrauma patients. High-energy pelvic fractures often result in mechanical instability of the pelvic ring. Successful treatment of unstable pelvic ring fractures remains a challenge for orthopedic surgeons. This study presents a novel internal fixation method for stabilizing unstable anterior pelvic ring fractures using a minimally invasive modified pedicle screw-rod fixation (MPSRF) technique.MethodsThis retrospective study included six patients with unstable pelvic ring injuries who underwent MPSRF, with or without posterior fixation. Intraoperative parameters such as blood loss, operative time, complications, and quality of reduction (Matta criteria) were recorded and evaluated by a blinded reviewer.ResultsIn the present clinical series, the mean operative times and mean blood loss for unilateral versus bilateral anterior ring fixations were 176.0 min versus 295.6 min, and 153.3 mL versus 550.0 mL, respectively. No iatrogenic neuropraxia of the lateral femoral cutaneous nerve or femoral nerve palsy occurred. The reduction quality, graded by the Matta criteria, was excellent in five patients and good in one patient.ConclusionsThere were no infections, delayed unions, nonunions, or loss of reductions during the follow-up period. Only one patient suffered from a broken rod at 4 months postoperatively. The modified technique represents a novel, minimally invasive procedure for the treatment of anterior pelvic ring fractures and offers a reliable and effective alternative to currently available surgical techniques.

Prevalence and Risk Factors for Lateral Femoral Cutaneous Nerve Palsy in the Beach Chair Position

To report on the prevalence of lateral femoral cutaneous nerve (LFCN) palsy in patients who had undergone shoulder surgery in the beach chair position and to identify patient and surgical risk factors for its development. We retrospectively reviewed the medical records of 397 consecutive patients who underwent either open or arthroscopic shoulder surgery in the beach chair position by a single surgeon. Patient demographic and surgical data including age, gender, weight, body mass index (BMI), diabetes, procedure duration, and anesthesia type (general, regional, regional/general) were recorded. LFCN palsy symptoms were recorded prospectively at the initial postoperative visit and identified clinically by focal pain, numbness, and/or tingling over the anterolateral thigh. The median patient age was 59.0years and consisted of 158 males (40%) and 239 (60%) females. Five cases of LFCN palsy were identified for a prevalence of 1.3%. These patients had a higher median weight (108.9kg vs 80.7kg, P= .005) and BMI (39.6 vs 29.4, P= .005) than the patients who did not develop LFCN palsy. Median age, gender, diabetes, and surgical time were not significantly different between the groups. All cases resolved completely within 6months. LFCN palsy after shoulder surgery in the beach chair position in our study has a prevalence of 1.3%, making it an uncommon complication. Patients with elevated BMI should be counseled about its possible occurrence after shoulder surgery in the beach chair position. Level IV, prognostic.

Simultaneous Bilateral Hip Arthroscopy in Adolescent Athletes With Symptomatic Femoroacetabular Impingement.

Femoroacetabular impingement represents a common cause of hip pain in adolescents. The purpose of the present study was to evaluate the safety and efficacy of simultaneous bilateral hip arthroscopy for bilateral symptomatic femoroacetabular impingement in adolescent athletes. Clinical data were collected in a prospective database on patients who underwent unilateral or simultaneous bilateral hip arthroscopy and included complications, reoperation rate, and return to play time. Differences in International Hip Outcome Tool (iHOT)-12 scores according to hip side and postoperative follow-up time (preoperative, 1.5, 3, 6, 12, and 24 mo) were evaluated using a 2×6 repeated-measures analysis of variance with post hoc repeated-measures 1-way analysis of variance and Bonferroni-corrected paired t tests. In total, 24 patients (36 hips) were studied, of whom 12 underwent simultaneous bilateral hip arthroscopy (24 hips) and a case-matched control group of 12 patients underwent unilateral hip arthroscopy. There were 5 males in each group (41.7%). Average age was 15.7 and 16.5 years in the bilateral and unilateral groups, respectively. No patients were lost to follow-up. In the bilateral group, a significant increase in mean iHOT-12 score was observed between 1.5- and 3-month follow-up (61.8 vs. 82.8, respectively; P=0.003), and 6-, 12-, and 24-month follow-up (91.4, 95.1, and 96.6, respectively, P=0.004). At all follow-up times, there were no significant differences in mean iHOT-12 scores or other outcome measures between bilateral and unilateral cohorts. Time to return to preinjury level of activity was similar between the bilateral and unilateral groups (4.7 vs. 4.9 mo, respectively; P=0.40). One transient lateral femoral cutaneous nerve palsy occurred in each group, though no other complications were documented. No patients required revision surgery by latest follow-up. Bilateral simultaneous hip arthroscopy is safe and reproducible in adolescent athletes, achieving equivalent outcomes, and similar rehabilitation time when compared with unilateral surgery. Level II-therapeutic study.

A prospective case series for a minimally invasive internal fixation device for anterior pelvic ring fractures.

BackgroundExternal fixation is commonly used as a means of definitive fixation of pelvic fractures. Pin site infection is common, with some cases of osteomyelitis and inpatient nursing can be challenging. The aim of this study is to report the outcomes and complications of an alternative minimally invasive technique, known as INFIX, utilising spinal pedicle screws inserted into the supra-acetabular bone and connected by a subcutaneous rod.MethodsA single-centre prospective case series was performed. The primary outcome measures were fracture stability and displacement at time of implant removal and intra- and post-operative complications.ResultsTwenty-one patients were recruited, with 85.7 % of fractures being lateral compression type. Mean follow-up was 342 days. Mean application time was 51 min (range 44–65). Nineteen were removed electively, with mean time to removal 109 days. All cases were stable with no displacement. Two cases were removed emergently, one due to wound infection and the other due to lateral femoral cutaneous nerve neuropathic pain. Twelve patients sustained a lateral femoral cutaneous nerve palsy, with 20/42 nerves being affected. Improvement in all lateral femoral cutaneous nerve symptoms were reported with removal. Nine patients developed asymptomatic heterotopic ossification, and there were three deep infections and one symptomatic due to the bar.ConclusionsMinimally invasive internal fixation with the INFIX for anterior pelvic ring fractures is an alternative to anterior external fixation. However, a higher rate of lateral femoral cutaneous nerve palsy is noted, and the implant is not well tolerated by all patients. Further studies are required to define fracture types and patients best suited to the technique and how LFCN complications may be minimised.Trial registration ACTRN12616001421426. Registered 12 October 2016. Retrospectively registered.

Lateral Femoral Cutaneous Nerve Palsy After Spinal Fusion for Adolescent Idiopathic Scoliosis (AIS).

Prospective study of consecutive patients. The purpose of the study was to evaluate the incidence, risk factors, and time to resolution of lateral femoral cutaneous nerve palsy (LFCNP) after posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS). No prior studies have prospectively evaluated the prevalence of LFCNP exclusively in the treatment of AIS. Between June 2014 and May 2015, patients undergoing PSF for AIS were examined preoperatively, postoperatively, and at follow-up clinic visits until the resolution of the LFCNP. All neurologic examinations were performed by attending pediatric orthopedic surgeons. Patients who underwent staged, revision or anterior procedures, had preoperative neurologic deficits or neuropathy, were excluded. A total of 55 patients with an average age of 14 years (10-21) were enrolled. Twenty-five percent (14/55) of patients had a postoperative LFCNP. There were no other postoperative neurologic deficits. Of the 14 patients with an LFCNP, 57% of these were bilateral. Fourteen percent (2/14) of these patients had absent sensation to light touch, whereas 85% (12/14) had decreased sensation. No patients reported experiencing pain associated with the LFCNP or tenderness when the anterolateral thigh was palpated. The LFCNP did not limit postoperative mobilization or prolong hospital stay. The LFCNP was noted to resolve in an average of 3.6 days (1-18); 6/14 (43%) resolved after 1 day. No correlation was observed between occurrence of LFCNP and sex, age, height, body mass index, length of fusion, Cobb angle, or blood loss. The occurrence of LFCNP was associated with heavier weight (P = 0.032) and longer operative times (P = 0.016). Resolution of the LFCNP was associated with longer operative time (P = 0.010). LFCNP occurred in 25% of AIS patients undergoing PSF. Risk of LFCNP increased with longer operative times and heavier patient weight. On average, LFCNP resolved in less than 4 days and did not cause any pain or limitations. 2.

Outcome of peri-acetabular osteotomy for hip dysplasia in teenagers.

Peri-acetabular osteotomy, especially curved peri-acetabular osteotomy, is an effective surgical procedure for re-orientating the acetabulum. However, there have been few reports on this procedure in teenagers. The purpose of this study was to investigate the treatment outcomes of curved peri-acetabular osteotomy in teenagers. We retrospectively reviewed 33 hips in 27 teenage patients with acetabular dysplasia who underwent curved peri-acetabular osteotomy between 1995 and 2012. The mean age was 17.0 years (range, 14-19 years). The mean follow-up duration at the most recent physical examination was 33.3 months (range, 24-96 months). All hips were evaluated in terms of the Harris hip score, radiographic measurements, and complications. The mean Harris hip score improved from 80.1 points pre-operatively to 95.4 points post-operatively (p < 0.001). There were significant differences in all of the radiographic measurements between the pre-operative and post-operative values (p < 0.001). One major complication occurred (symptomatic ischial nonunion) and required subsequent surgery. Nine hips had minor complications, including nonunion of the superior ramus osteotomy (four hips), superficial stitch abscess (two hips), and transient lateral femoral cutaneous nerve palsy (three hips). Satisfactory results can be obtained clinically and radiographically after curved peri-acetabular osteotomy in adolescents. Osteotomy for acetabular dysplasia is effective in teenagers.

The Femoral and Lateral Femoral Cutaneous Nerve Palsy After Periacetabular Osteotomy Operation

Acetabular dysplasia is a complex multi-plane deformity of the acetabulum, which results in the development of osteoarthritis at an early age in young adults. A female patient at age of 24 was admitted to our rehabilitation clinic because of hip pain and weakness. The patient had had bilateral hip joint dysplasia and she had been operated from right side on December 25, 2013 by Ganz tecnique which is called periacetabular osteotomy. After the surgery, the patient had limitation of hip joint and limping. When the patient was admitted to our clinic, the patient’s hip muscles force was 2/5, knee muscles force was 5/5 and she has hypoesthesia at L2-3 dermatomes. Her EMG result exposed femoral and lateral femoral cutaneous nerve injury. The patient could walk with a canedien. We took the patient for rehabilitation treatment to strengthen her muscles and to decrease hip pain and hip limitation. The aims of treatment for acetabular dysplasia are the normalization of the relationship between the femoral head and acetabulum on weight bearing position, and to provide a painless, stable, and functional hip in the long term. There may be several complications after hip surgery such as nerve or vessel injury, acetabular osteonecrosis, arthrosis, intraarticular osteotomy, heterotopic ossification, pulmonary emboli, deep vein thrombosis (DVT), and RSDS (algoneurodistrofia). J Med Cases. 2015;6(2):74-76 doi: https://doi.org/10.14740/jmc2033w

The Femoral and Lateral Femoral Cutaneous Nerve Palsy After Periacetabular Osteotomy Operation

Acetabular dysplasia is a complex multi-plane deformity of the acetabulum, which results in the development of osteoarthritis at an early age in young adults. A female patient at age of 24 was admitted to our rehabilitation clinic because of hip pain and weakness. The patient had had bilateral hip joint dysplasia and she had been operated from right side on December 25, 2013 by Ganz tecnique which is called periacetabular osteotomy. After the surgery, the patient had limitation of hip joint and limping. When the patient was admitted to our clinic, the patient’s hip muscles force was 2/5, knee muscles force was 5/5 and she has hypoesthesia at L2-3 dermatomes. Her EMG result exposed femoral and lateral femoral cutaneous nerve injury. The patient could walk with a canedien. We took the patient for rehabilitation treatment to strengthen her muscles and to decrease hip pain and hip limitation. The aims of treatment for acetabular dysplasia are the normalization of the relationship between the femoral head and acetabulum on weight bearing position, and to provide a painless, stable, and functional hip in the long term. There may be several complications after hip surgery such as nerve or vessel injury, acetabular osteonecrosis, arthrosis, intraarticular osteotomy, heterotopic ossification, pulmonary emboli, deep vein thrombosis (DVT), and RSDS (algoneurodistrofia). J Med Cases. 2015;6(2):74-76 doi: https://doi.org/10.14740/jmc2033w

Periacetabular osteotomy for the treatment of developmental dysplasia of the hip in adults

Objective To study the indications and mid-term outcomes of periacetabular osteotomy on adult patients of developmental dysplasia of the hip (DDH). Methods Twenty-five adult patients with DDH underwent periacetabular osteotomies through modified Smith-Peterson approach. There were 19 females and 6 males with an average age of 25.5 years (range, 18-45). Every patient had a single dysplasia hip, including 14 hips in the left, and the other 11 in the right. Three cases were operated formerly, 2 of them received Chari osteotomy and 1 received Salter osteotomy. Before operation 13 hips were T(o)nnis Grade 0 osteoarthritis, 9 hips were Grade Ⅰ , 3 hips were Grade Ⅱ. The Shenton line of 18 hips was broken. The lateral center-edge angle was 4.57°±7.39°, the anterior center-edge angle was 0.95°±6.02°, the horizontal tilt angle was 32.50°±5.96°, the femoral head extrusion index was 38.11％±5.70％, the Harris hip score was 75.32±7.51 points. Changes of the indexes mentioned above were observed during the period of follow-up.Results All patients were followed up for average 4.5 years (range, 2.0-7.5). Compared with the preoperative radiographic severity at the latest follow-up, 3 hips of T(o)nnis Grade Ⅰ improved to Grade 0, 2 hips of Grade Ⅱ improved to Grade Ⅰ, 1 hip of Grade Ⅰ changed into Grade Ⅱ. The incident of the break of Shenton line decreased to 10 hips. The lateral center-edge angle improved to 29.07°±5.81° the anterior centeredge angle improved to 29.52°±4.51°, the horizontal tilt angle decreased to 19.17°±4.95°, the femoral head extrusion index decreased to 24.20％±4.83％, the Harris hip score increased to 84.88±4.88 points. The major complication included 16 cases of lateral femoral cutaneous nerve palsy (7 cases of them didn't recover forever) and 1 case of ectopic ossification of Brooker Ⅰ . Conclusion Periacetabular osteotomy through a modified Smith-Peterson approach were performed to the dysplasia hip of adults, it can increase congruence,improve hip function; it can also prevent subchondral sclerosis and cysts forming, preserve joint space and delay the occurrence of osteoarthritis. Key words: Hip dislocation, congenital; Osteotomy; Acetabulum; Osteoarthritis, hip

Complications Associated with the Bernese Periacetabular Osteotomy for Hip Dysplasia in Adolescents

The Bernese (Ganz) periacetabular osteotomy is an effective surgical procedure to reorient the acetabulum, allowing restoration of anatomic femoral head coverage and medial translation of the hip in adults with hip dysplasia. However, it is a challenging surgical procedure, and we know of no study that has specifically analyzed the complications and associated factors seen with this procedure in adolescent patients. A retrospective clinical and radiographic review of a consecutive series of adolescent patients who underwent a Bernese periacetabular osteotomy for hip dysplasia was conducted. Eighty-three osteotomies were performed in seventy-six patients with an average age (and standard deviation) of 15.6 +/- 2.4 years. Significant improvement from the preoperative to the two-year follow-up evaluation was seen radiographically with regard to the lateral center-edge angle (-0.14 degrees to 35.5 degrees), the ventral center-edge angle (-5.13 degrees to 31.3 degrees), and the femoral head extrusion index (38.4% to 7.7%) (p < 0.0001 for all). There were three major complications, including excessive arterial bleeding requiring embolization in a patient with a prior acetabuloplasty, osteonecrosis of the acetabular fragment in a patient with severe dysplasia and subluxation of the hip, and osteonecrosis of the femoral head following combined periacetabular and femoral osteotomies in a patient with Charcot-Marie-Tooth disease. Eighteen hips (22%) had minor complications, including nonunion of the superior pubic ramus osteotomy (five hips), a superficial stitch abscess (four), and transient lateral femoral cutaneous nerve palsy (four). Nine hips (11%) underwent removal of symptomatic screws, and two required a second operation to reposition the acetabular fragment. An underlying diagnosis other than developmental dysplasia increased the prevalence of minor complications (p = 0.0017), while a major complication was more likely with longer surgery time, greater blood loss, and proximal femoral osteotomy. The Bernese periacetabular osteotomy is a joint-preserving procedure that very effectively corrects acetabular dysplasia in adolescent patients, providing improved radiographic results and a low rate of complications. Although the rate of minor complications is increased when there is an underlying diagnosis other than developmental dysplasia, no other predictors were identified. However, a major complication is more likely with a longer duration of surgery and with a concomitant femoral varus osteotomy.

Minimally invasive versus conventional exposure for total hip arthroplasty: a systematic review and meta-analysis of clinical and radiological outcomes

Over the past decade, minimally invasive surgery has gained popularity as a means of optimising early postoperative rehabilitation and increasing patient satisfaction and cosmesis following total hip arthroplasty (THA). However, this surgical exposure has also been associated with increased risk of iatrogenic nerve injury and implant mal-positioning due to limited visibility compared to conventionally larger surgical incisions. The purpose of this meta-analysis was to compare the outcomes of these two surgical exposures. A systematic review of the published and unpublished literature was conducted to include all randomised and non-randomised controlled trials comparing the clinical and radiological outcomes of minimally invasive and conventional THA procedures. In total, 28 studies met the eligibility criteria and included 2,849 hips, i.e. 1,428 minimally invasive compared to 1,421 conventional THAs. The meta-analysis of the current evidence base showed that minimally invasive THA is associated with a significantly increased risk of transient lateral femoral cutaneous nerve palsy (p = 0.006) with no significantly better outcome.

Distraction External Fixation in Lateral Compression Pelvic Fractures

To observe the results and describe the technique of closed reduction and placement of a two-pin supra-acetabular external fixator, followed by immediate weight bearing, in the treatment of displaced vertically stable lateral compression pelvic fractures. Prospective, consecutive. Regional trauma center. A consecutive series of fourteen patients with displaced, vertically stable lateral compression pelvic fractures who were transported to a regional trauma center. Surgical treatment with closed reduction and maintenance of the distraction force with a two-pin, single-bar, supra-acetabular external fixator, followed by immediate weight bearing. Healing rate and time, operative blood loss and time, quality of reduction, time to full weight-bearing, and incidence of complications, including neurovascular deficits, loss of reduction, nonunion, pin tract infections, and chronic pain. A symmetric reduction of both hemipelves was achieved in all fourteen patients. Time to healing averaged 8.2 weeks (seven to twelve weeks), and no fixator required removal before healing. There were no delayed unions or nonunions, and none of the fractures displaced significantly after initial reduction. Average surgical time was thirty-seven minutes (range, twenty-five to sixty minutes) with an estimated blood loss of less than fifty milliliters. Patients were allowed to bear full weight immediately and were able to do so without ambulatory assistive devices within an average of twelve days (range, three to eighteen days). Complications consisted of three minor pin tract infections, one temporary lateral femoral cutaneous nerve palsy, one late pin tract abscess, and one patient with chronic low-back pain. Treatment of type B lateral compression injuries of the pelvic ring with anterior distraction external fixation is a highly effective yet relatively simple and minimally invasive treatment method. Surgical time and blood loss are minimal, and patients can be effectively and rapidly mobilized. Based on our experience, we believe this method to be a valuable tool in the treatment of these fractures.

Distraction external fixation in lateral compression pelvic fractures.

To observe the results and describe the technique of closed reduction and placement of a two-pin supra-acetabular external fixator, followed by immediate weight bearing, in the treatment of displaced vertically stable lateral compression pelvic fractures. Prospective, consecutive Regional trauma center A consecutive series of fourteen patients with displaced, vertically stable lateral compression pelvic fractures who were transported to a regional trauma center. Surgical treatment with closed reduction and maintenance of the distraction force with a two-pin, single-bar, supra-acetabular external fixator, followed by immediate weight bearing. Healing rate and time, operative blood loss and time, quality of reduction, time to full weight-bearing, and incidence of complications, including neurovascular deficits, loss of reduction, nonunion, pin tract infections, and chronic pain. A symmetric reduction of both hemipelves was achieved in all fourteen patients. Time to healing averaged 8.2 weeks (seven to twelve weeks), and no fixator required removal before healing. There were no delayed unions or nonunions, and none of the fractures displaced significantly after initial reduction. Average surgical time was thirty-seven minutes (range, twenty-five to sixty minutes) with an estimated blood loss of less than fifty milliliters. Patients were allowed to bear full weight immediately and were able to do so without ambulatory assistive devices within an average of twelve days (range, three to eighteen days). Complications consisted of three minor pin tract infections, one temporary lateral femoral cutaneous nerve palsy, one late pin tract abscess, and one patient with chronic low-back pain. Treatment of type B lateral compression injuries of the pelvic ring with anterior distraction external fixation is a highly effective yet relatively simple and minimally invasive treatment method. Surgical time and blood loss are minimal, and patients can be effectively and rapidly mobilized. Based on our experience, we believe this method to be a valuable tool in the treatment of these fractures.