Identification of the medial femoral safe zone for drilling during dynamic hip screw side plate fixation: A CT angiogram tracing of the profunda femoris artery

Objectives

Iatrogenic injury of the Profunda Femoris Artery (PFA) at time of hip fixation surgery can increase morbidity and mortality and prolong the hospital stay. This is an injury that tends to pass unnoticed as a cause of postoperative deterioration despite being frequently reported in the literature. Our study aims to describe the anatomy of the PFA in relation to the medial femoral cortex with specific emphasis on its orientation relative to the position of a sliding hip screw side plate construct. By doing so we are able to present clear guidance to orthopaedic surgeons on how to avoid iatrogenic PFA injury at the time of hip fracture fixation.

The hip in arthrogryposis

Journal of Children's Orthopaedics - Hip dislocation is seen in approximately 30 % of children with amyoplasia and approximately 50 % of these will be bilateral. Closed...     

Bloqueo bilateral del grupo de nervios pericapsulares (PENG) como analgesia en cirugía de cadera infantil

Effective management and control of peri- and postoperative pain in hip surgery is essential in order to minimize the use of opioids and their adverse effects. Effective regional analgesia for hip pain is made particularly challenging by the complex innervation of the hip joint. Standard regional techniques can be associated with complications, including incomplete anesthesia, hypotension, or lower limb weakness. We present the case of a 5-year-old girl with a history of infantile cerebral palsy who underwent bilateral varus derotation osteotomy and adductor tenotomy due to paralytic dislocation. She received bilateral PENG block and femoral cutaneous nerve block - a simple technique that covers all the nerves involved in the sensory innervation of the joint capsule without the need for multiple injections.     

Salvage of a failed valgus osteotomy for non-union of an unstable pertrochanteric fracture

Salvage of a failed valgus osteotomy for nonunion of an unstable pertrochanteric fracture is reported. A valgus intertrochanteric osteotomy was performed for a failed sliding hip screw fixation of an unstable pertrochanteric fracture at another institution. Four months following osteotomy, the fracture was still un-united with two distal screws of the hip plate broken and a coxa vara deformity. Reconstruction was performed with a nine-hole 95° angle blade plate and cancellous bone graft, because the insufficient fixation of the distal fragment was considered to be the main reason for failure. The osteotomy was healed at six months post-surgery and the patient reported complete resolution of symptoms. Intertrochanteric valgus osteotomy is an effective procedure for mal-union and non-union of pertrochanteric fracture but stable fixation is required for a good result. The blade of the angle plate offers good purchase of the proximal fragment and secures it under rotational and bending stresses. We recommend that distal fragments should be fixed with at least seven cortices for this type of osteotomy.     

人工全髋关节置换术治疗56例强直性脊柱炎的临床研究

[目的]探讨人工全髋关节置换术治疗强直性脊柱炎的疗效。[方法]对56例（98髋）强直性脊柱炎患者行人工全髋关节置换术，其中42例（76髋）进行了平均5．6（2．5～10．5）a的随访。[结果]至末次随访时，Harris评分由术前的平均26．8（4～51）分提高到了术后的平均85．2（55～94）分，优良率为89．5％。1例感染行Ⅱ期翻修；2例在扩髓时出现股骨颈或股骨距裂缝骨折，但未到达小粗隆以下，未予特殊处置；1例出现足下垂，术后3个月后恢复，1例深静脉血栓，余病例无假体松动、断裂以及脱位发生。异位骨化发生率9．2％（7髋），但对功能无明显影响。[结论]人工全髋关节置换术治疗强直性脊柱炎可以明显缓解髋关节疼痛，恢复关节功能，与其它病因的全髋关节置换术相比，并无较高的危险因素。     

超高龄老人髋部骨折的手术治疗

目的　探讨 80岁以上老年人髋部骨折围手术期处理经验。方法　对 4 6例 80岁以上老年人髋部骨折手术治疗方法及结果进行回顾性总结。结果　 4 6例患者均安全度过围手术期 ,手术优良率 89 7%。结论　对高龄患者要有充分认识和准备 ,大部分患者能接受手术治疗并获得优良效果     

Vitamin D receptor genotype and risk of osteoporotic hip fracture in elderly women of Utah: an effect modified by parity

Introduction The associations between vitamin D receptor (VDR) Bsm I and Fok I genotypes, parity, and risk of osteoporotic hip fracture were evaluated in a statewide population-based case-control study in Utah.Methods Women age 50–89 years with hip fracture (n=882) were ascertained via surveillance of 18 Utah hospitals from 1997 to 2001. Age-matched controls were randomly selected (n=897). Participants were interviewed in their homes, and blood samples were collected for genotyping.Results In logistic regression analyses that controlled for multiple confounders, Bsm I VDR genotype but not Fok I genotype was associated with risk of osteoporotic hip fracture (OR bb vs. BB genotype: 0.68; 95% CI: 0.50, 0.95). In similar analyses, no overall association was observed between parity status and risk of osteoporotic hip fracture. However, the effect of VDR genotype was modified by parity status. Among nulliparous women (n=140), Bsm I genotype was not associated with risk of hip fracture (OR bb vs. BB: 0.82; 95% CI: 0.28, 2.4); among primiparous women (n=133), bb genotype was associated with increased risk of hip fracture (OR bb vs. BB: 3.30; 95% CI: 0.96, 11.29); among multiparous women (n=1,400), bb genotype was associated with decreased risk of hip fracture (OR bb vs. BB: 0.59; 95% CI: 0.42, 0.84).Conclusion VDR Bsm I genotype was associated with risk of hip fracture in Utah women, and this effect was modified by parity status. Hormonal or lifestyle factors related to parity may underlie this interaction.     

Migration of a Kirschner wire from the greater trochanter to the popliteal fossa: a case report

Migration of Kirschner (K) wires from the upper extremity joints has often been reported, but it is less common from the lower extremities. In this report, we describe an 85-year-old man treated, during a hip replacement procedure, with a K-wire because of a trochanteric fracture; after one year, the K-wire was found in the popliteal fossa. This report illustrates the first case of K-wire migration in the popliteal area of the knee and suggests avoiding the use of free K-wires without any tension banding.     

Patient-proxy response comparability on measures of patient health and functional status

The present study evaluates the response comparability between 361 elderly hip fracture patients admitted from the community to seven Baltimore area hospitals between 1984 and 1986 and interviewer selected proxies on items pertaining to patients' pre-fracture health and functional status. Agreement across items ranges from very poor to good and varies with respect to the health or functional area assessed. Proxies tend to overestimate patient disability relative to the patients themselves, especially with regard to capacity to perform instrumental activities of daily living. Although proxies who report the greatest contact with patients respond most comparably to the patients, when they do disagree, proxies with the greatest patient contact tend to overestimate patient disability. The authors suggest that attention to item construction and phrasing may improve response comparability.