Introduction. The debate regarding the importance of preserving the blood supply to the femoral head (FH) and neck during hip resurfacing arthroplasty (HRA) is ongoing. Several surgeons continue to advocate for the preservation of the blood supply to the resurfaced heads for both the current HRA techniques and more biologic approaches for FH resurfacing. Despite alternative blood-preserving approaches for HRA, many surgeons continue to use the posterior approach (PA) due to personal preference and comfort. It is commonly accepted that the PA inevitably damages the
Aim: To evaluate the results of hip resurfacing done using the Ganz trochanteric flip osteotomy. Introduction: Long term survivorship of hip resurfacing depends on preservation of blood supply to the head of the femur. The most important artery supplying the head of femur is the
Introduction. The vascular anatomy of the femoral head and neck has been previously reported, with the primary blood supply attributed to the
Introduction: Dividing the short external rotators 2 cm from their insertion into the femur should preserve the
Posterior interoseous nerve (PIN) syndrome is an entrapment of the
Diaphyseal fractures can be divided into three groups comprising the basic types of fractures: fractures of both bones (radius and ulna), fracture dislocations, i.e., fractures of one of the bones accompanied by dislocation of the head of the other bone in the respective radioulnar joint, the Galeazzi fracture or the Monteggia fracture, and isolated fractures of one of the two bones – the radius or the ulna. Photographs are decisive for diagnosis of the anteroposterior and lateral projections. Each must simultaneously visualize the elbow and wrist joints in order not to neglect potential injuries located there. The basic aim is full restoration of the function of the forearm with emphasis on supination-pronation movement. This requires anatomical union particularly in regard to the ulna, which has a critical importance for the function of the forearm. In fracture dislocations, it is also necessary to restore stability in the respective radioulnar joint. For the above-mentioned reasons, almost all diaphyseal fractures (except for non-dislocated or minimally dislocated fractures of the ulna) are indicated for surgery. Our procedure depends on the condition of the fracture and the general condition of the patient. Plate fixation represents the gold standard for closed fractures – open fractures of Degrees I and II and some Degree III fractures classified according to Tscherne. More extensive defects of soft tissues require cooperation with a plastic surgeon. The standard implants are dynamic compression plates (3, 5 DCP) with holes for 3.5 mm cortical screws. The surgical approach to the ulna is relatively simple. In fractures of the proximal half of the radius, we prefer the Henry approach in fractures of the proximal half of the radius because, unlike the Thompson approach, it allows safe dissection up to the radial head without damaging the
Introduction. Precise knowledge of the Femoral Head (FH) arterial supply is critical to avoid FH avascular necrosis following open and arthroscopic intra-capsular surgical procedures about the hip. The Medial Femoral Circumflex Artery (MFCA) provides the primary FH vascular contribution. Distribution of vascular foramina at the Femoral Head-Neck Junction (FHNJ) has been reported previously using an imaginary clock face. However, no quantitative information exists on the precise Capsular Insertion (CI) and intra-capsular course of the MFCA Terminal Branches (TBs) supplying the FH. This study seeks to determine the precise anatomic location of the MFCA's TBs supplying the FH, in order to help avoid iatrogenic vascular damage during surgical intervention. Methods. In 14 fresh-frozen cadaveric hips (9 left and 5 right), we cannulated the MFCA and injected a polyurethane compound. Using a posterior approach, careful dissection of the MFCA allowed us to identify and document the extra- and intra-capsular course of the TBs penetrating the FHNJ and supplying the FH. An H-type capsulotomy provided joint access while preserving the intracapsular Retinaculum of Weitbrecht (RW), followed by circumferential capsulotomy at the acetabular margin exposing the FH. The dome of the FH was osteotomized 5 mm proximal to the Articular Border (AB) providing a flat surface for our 360° scale. Right-side equivalents were used for data processing. Results. Gross dissection revealed a constant single branch arising from the transverse MFCA penetrating the capsule at the level of the anterior-inferior neck at 177° (range 167–187°), then courses within the medial RW obliquely (elevated from the neck) to the posterior-inferior FHNJ (Figure 1). This vessel was found to have an average of 5 TBs (range 3–9) penetrating the inferior FHNJ 4 mm (range 1–7 mm) from the AB at 204° (range 145–244°; 14% . 10. /. 69. anterior; 86% . 59. /. 69. posterior). In 79% (. 11. /. 14. ) of specimens, an average of 1.5 branches (range 1–3) arising from the ascending MFCA entered the Femoral Capsular Attachment (FCA) at 244° (range 216–269°), running subsynovial through the neck, and terminating in 2 TBs (range 1–3) penetrating the inferior-posterior FHNJ 5 mm (range 3–9) from the AB at 254° (range 207–281°). The
Introduction: Whereas in traumatic avascular necrosis of the femoral head (ANFH) loss of the femoral head’s blood supply is due to a mechanical event, in non-traumatic AFNH it is the result of a wide variety of etiologies (e.g. alcoholism, hypercortisonism, etc.), which have in common that they lead to an intravascular complication with subsequent malperfusion of the femoral head. Additionally, for part of non-traumatic ANFH no causative factors are known, why they are called idiopathic. A mechanical cause for nontraumatic ANFH – as e.g. a repetitive trauma of the femoral head supplying
Purpose of the study: From November 2001 to January 2008, among 110 patients who underwent surgery for spastic hands due to a central neurological disorder, the management involved surgical treatment of long finger intrinsic and extrinsic deformities in 57 brain injury adults. Material and methods: At least one procedure for the intrinsics and one for the extrinsics was performed during the same operative. Twelve patients had bilateral operations. The goal of the surgery and the treatment was established during multidisciplinary consultations with rehabilitation physicians, neurologists, surgeons and anaesthesists after a minute physical examination with selective neuromuscular blocks to differentiate muscle spasicity and tendon retraction from extrinsic and intrinsic disorders. The objective was established in the form of a contract with the patient and the family: hygiene and analgesia (47 patients), aesthetic aspect (15 patients, and/or function (21 patients.) For the spasticity and/or retraction of the exrinsics, we used 23 transfers of the FCP to the FCS, 6 Z lengthening of the FCP and the FCS, 14 intramuscular lengthening of the FCP and 11 of the FCS, 10 Page interventions, 10 selecive muscle disinsertions from the epitrochlears and one FCS tenotomy. Concerning the spasticity and/ol retraction of the intrinsic, we performed 4 neurotomies of the
The aticularis genu (AG) is the least substantial and deepest muscle of the anterior compartment of the thigh and of uncertain significance. The aim of the study was to describe the anatomy of AG in cadaveric specimens, to characterize the relevance of AG in pathological distal femur specimens, and to correlate the anatomy and pathology with preoperative magnetic resonance imaging (MRI) of AG. In 24 cadaveric specimens, AG was identified, photographed, measured, and dissected including neurovascular supply. In all, 35 resected distal femur specimens were examined. AG was photographed and measured and its utility as a surgical margin examined. Preoperative MRIs of these cases were retrospectively analyzed and assessed and its utility assessed as an anterior soft tissue margin in surgery. In all cadaveric specimens, AG was identified as a substantial structure, deep and separate to vastus itermedius (VI) and separated by a clear fascial plane with a discrete neurovascular supply. Mean length of AG was 16.1 cm ( ± 1.6 cm) origin anterior aspect distal third femur and insertion into suprapatellar bursa. In 32 of 35 pathological specimens, AG was identified (mean length 12.8 cm ( ± 0.6 cm)). Where AG was used as anterior cover in pathological specimens all surgical margins were clear of disease. Of these cases, preoperative MRI identified AG in 34 of 35 cases (mean length 8.8 cm ( ± 0.4 cm)).Aims
Methods
Our retrospective analysis reports the outcome of patients operated for slipped capital femoral epiphysis using the modified Dunn procedure. Results, complications, and the need for revision surgery are compared with the recent literature. We retrospectively evaluated 17 patients (18 hips) who underwent the modified Dunn procedure for the treatment of slipped capital femoral epiphysis. Outcome measurement included standardized scores. Clinical assessment included ambulation, leg length discrepancy, and hip mobility. Radiographically, the quality of epiphyseal reduction was evaluated using the Southwick and Alpha-angles. Avascular necrosis, heterotopic ossifications, and osteoarthritis were documented at follow-up.Aims
Methods
Legg–Calvé–Perthes’ disease (LCP) is an idiopathic osteonecrosis of the femoral head that is most common in children between four and eight years old. The factors that lead to the onset of LCP are still unclear; however, it is believed that interruption of the blood supply to the developing epiphysis is an important factor in the development of the condition. Finite element analysis modelling of the blood supply to the juvenile epiphysis was investigated to understand under which circumstances the blood vessels supplying the femoral epiphysis could become obstructed. The identification of these conditions is likely to be important in understanding the biomechanics of LCP.Objectives
Methods
The February 2014 Hip &
Pelvis Roundup360 looks at: length of stay; cementless metaphyseal fixation; mortality trends in over 400,000 total hip replacements; antibiotics in hip fracture surgery; blood supply to the femoral head after dislocation; resurfacing and THR in metal-on-metal replacement; diabetes and hip replacement; bone remodelling over two decades following hip replacement; and whether bisphosphonates affect acetabular fixation.
The February 2014 Research Roundup360 looks at: blood supply to the femoral head after dislocation; diabetes and hip replacement; bone remodelling over two decades following hip replacement; sham surgery as good as arthroscopic meniscectomy; distraction in knee osteoarthritis; whether joint replacement prevent cardiac events; tranexamic acid and knee replacement haemostasis; cartilage colonisation in bipolar ankle grafts; CTs and proof of fusion; atorvastatin for muscle re-innervation after sciatic nerve transection; microfracture and short-term pain in cuff repair; promising early results from L-PRF augmented cuff repairs; and fatty degeneration in a rodent model.
Metal-on-metal hip resurfacing (MOMHR) is available as an alternative
option for younger, more active patients. There are failure modes
that are unique to MOMHR, which include loosening of the femoral
head and fractures of the femoral neck. Previous studies have speculated
that changes in the vascularity of the femoral head may contribute
to these failure modes. This study compares the survivorship between
the standard posterior approach (SPA) and modified posterior approach
(MPA) in MOMHR. A retrospective clinical outcomes study was performed examining
351 hips (279 male, 72 female) replaced with Birmingham Hip Resurfacing
(BHR, Smith and Nephew, Memphis, Tennessee) in 313 patients with
a pre-operative diagnosis of osteoarthritis. The mean follow-up
period for the SPA group was 2.8 years (0.1 to 6.1) and for the
MPA, 2.2 years (0.03 to 5.2); this difference in follow-up period
was statistically significant (p <
0.01). Survival analysis was
completed using the Kaplan–Meier method. Objectives
Methods