Femoral neuropathy caused by enlarged iliopsoas bursa associated with osteonecrosis of femoral head--a case report

We analyzed the mechanical and histological variables after the attachment of an autogenous tendon graft to cortical or cancellous bone. We reconstructed the medial collateral ligament of the knee in 33 Japanese white rabbits, using a bone socket procedure. The floor of the bone socket was cortical bone in group A and cancellous bone in group B.

Mechanically, the pull-out test showed a tendency towards an increase in maximum failure load, with 10.9 N, 35 N and 37 N in group A, and 11 N, 18 N and 36 N in group B at 2, 4 (statistically significant difference) and 8 weeks after surgery, respectively. Histologically, the attachments were immature at 2 weeks. At 4 weeks, granulations had matured and Sharpey's fiber-like structures were seen. These fibers were more abundant in group A than in group B. At 8 weeks, the attachments in both groups were rather like the normal 4-zone structure. With time, tendon attachments matured in both groups.

Our study showed that reattachment of tendons to cortical bone may be bettter than to cancellous bone.     

髋关节表面置换术后股骨头坏死导致股骨颈骨折一例报道

患者男,57岁,住院号235227,美国人,体重85k。因左髋关节表面置换术后（resurfacing arthroplasty of the hip joint,RSAH）5个月,疼痛和活动受限2d人院。该患者于5个月前因左髋骨性关节炎在天津市第一中心医院骨科行髋关节表面置换术,手术采用髋关节后外侧入路,安装假体为Dupey的ASR假体。术中未发生股骨颈切迹,术后X线复查假体位置良好,单拐辅助部分负重6周后弃拐正常活动。     

髂腰肌血肿致股神经麻痹1例

患者 ,男 ,6 1岁 ,主因风湿性心脏病主动脉瓣置换术后1个月、左下肢麻木无力 3d入院。患者于 1个月前行主动脉瓣人工置换术 ,术后生活及一般情况良好 ,口服华法林 ,每日3 5mg。 3d前无诱因出现左下肢麻木 ,行走无力 ,并逐渐加重至无法站立。查体生命体征正常 ,左侧腹股沟区及臀部分别可见 6cm× 10cm的瘀血斑 ,腹股沟区压痛 ,髋关节屈曲不能伸直 ,Thomas征阳性 ,大腿上段前侧和小腿前内侧感觉减退 ,股四头肌肌力Ⅱ级 ,萎缩不明显 ,膝腱反射减弱。化验凝血酶原时间测定 34s。血常规 :血红蛋白 (Hb) 89g/L ,红细胞压积 (HCT) 0 2 6 ,血小…     

Femoral neuropathy caused by retroperitoneal hematoma

Iliacus hematoma causing femoral neuropathy are mostly seen as a result of anticoagulation. Hematoma can occur even while correctly managed anticoagulant treatment because of drug interactions and/or coagulopathies caused by liver disease. Between 1999 and 2001 a 81 and a 68-year-old man were treated in our department because of retroperitoneal hematoma on the left side. Spinal disease and discus abnormalities were excluded with abdominal ultrasound, CT and MRI. The hematomas were operated on because of the progressive complaints and in one patient because of fever and sepsis. After the operation the patients were fast mobilised with help. To decrease the damage and to be cost-effective, hematomas causing neuropathy or other complications should be drained or operated on as soon as possible.     

Femoral neuropathy caused by iliacus hematoma

Two cases of femoral neuropathy caused by iliacus hematoma occurring during anticoagulant therapy are described. The pathogenesis and the clinical picture of this particular pathology are discussed and the necessity of early surgical decompression is emphasized.     

Electrical stimulation in the treatment of osteonecrosis of the femoral head--a 1-year follow-up

To date, there is no completely satisfactory method for the treatment of osteonecrosis of the femoral head. "Conservative" management leads to a high failure rate, and surgical results have been inconsistent and disappointing. The study described in this article seeks to evaluate the role of electrical stimulation in conjunction with decompression and bone grafting. A total of 82 hips have been included to date, of which 42 with a minimum follow-up of 1 year have been evaluated. Pain relief and improved function have been noted in the majority of hips operated on, both with and without electrical stimulation. Careful radiologic assessment using a comprehensive new method of evaluation has shown some degree of progression in the majority of cases, however. No effects of electrical stimulation per se have been demonstrated to date. It must be emphasized that this is a preliminary report with a minimum follow-up of 1 year. Final conclusions await the completion of the study, when all patients have been followed for a minimum of 3 years.     

Bone remodeling of a femoral head after transtrochanteric rotational osteotomy for osteonecrosis associated with slipped capital femoral epiphysis: a case report

A rare case of a 12-year-old boy on whom a joint-preserving operation for osteonecrosis after slipped capital femoral epiphysis (SCFE) was performed, is described. Firstly, in situ pinning was performed for acute-on-chronic SCFE. However, osteonecrosis and collapse of the femoral head occurred at 7 months after surgery. Secondly, transtrochanteric rotational osteotomy (TRO) was performed against progression of the collapse of the femoral head. Eight years of X-ray observation revealed bone remodeling at the osteonecrotic region. No documentation has been reported about the potential of bone remodeling of a femoral head with osteonecrosis after SCFE. This case indicates that a joint-preserving operation such as TRO is capable of promoting bone remodeling in such circumstances.     

Femoral neuropathy associated with anticoagulant therapy.

The English literature concerning femoral neuropathy associated with anticoagulant therapy is reviewed. Anatomical dissections were carried out in order to determine how the neuropathy might be produced. It is postulated that hemorrhage occurs within the iliacus muscle and that a pressure neuropathy of the femoral nerve ensues. Conservative management is recommended. The condition is probably more prevalent than previously thought, as evidenced by the fact that two cases were diagnosed in as many years by one orthopedic surgeon in a 300-bed general hospital.     

Aseptic osteonecrosis of the femoral head in thalassemia minor: a case report

We report a case of aseptic necrosis of the femoral head in a 14-year-old black adolescent with thalassemia minor disclosed by physical examination and blood tests. No other anomaly could be identified. Despite the very probably secondary nature of the aseptic osteonecrosis of the femoral head and the absence of any other etiology, it is highly difficult to demonstrate the causal effect of thalassemia minor. We reviewed the literature and discuss the pathogenesis of this association.     

Subcapital fractures associated with extensive osteonecrosis of the femoral head

The authors reviewed 10 patients with subcapital fractures associated with extensive osteonecrosis of the femoral head and distinguished these fractures from traumatic femoral neck fractures The mean age of the patients was 52 years (range, 36-68 years). Nine patients were younger than 60 years. Eight patients had risk factors for osteonecrosis. Necrosis was extensive and involved nearly the whole femoral head. Fracture occurred at the junction between a necrotic bone and reparative bone and extended downward through the reparative interface to the healthy inferior cortex of the femoral neck. Patients experienced hip pain that was aggravated gradually during a period of 1 to 24 weeks before diagnosis of the fracture. In all patients, the opposite femoral head was involved with osteonecrosis. In two femoral heads, slight collapse or subchondral fracture (crescent sign) also was observed. No patient had a history of precipitating trauma. In patients younger than 60 years with a subcapital fracture, fracture associated with extensive osteonecrosis of the femoral head should be suspected when a history of trauma is not obvious, when the opposite hip shows findings of osteonecrosis, and when the patient has a risk factor of osteonecrosis. In these fractures, osteosynthesis rarely should be considered because of the high failure rate caused by additional progression of extensive osteonecrosis and the probability of nonunion.     

Pseudoaneurysm of the superficial femoral artery associated with osteochondroma--a case report

Osteochondromas, the most common benign bone tumor, often go undetected and seldom cause significant clinical sequelae. Rarely they present as an arterial pseudoaneurysm, usually of the popliteal or superficial femoral artery. The authors present the case of a 14-year-old male with a distal superficial femoral artery pseudoaneurysm accompanied by distal embolization from a femoral exostosis.