Introduction: For the health-care system and for society in general,
Among elderly Caucasians,
The histological findings from the heads of femur or bone biopsy taken from 90 patients with suspected pathological
Introduction: Fractures of the neck of femurs in amputees have been reported sporadically in literature. We reviewed a series of 19 amputees who presented with a
Aim: To assess the functional outcome and longevity of patients who are mentally competent when they sustain an intra-capsular
Background:
Introduction: We report on the long-term follow up of a previously published randomised controlled trial comparing Hemiarthroplasty (HEMI) and total hip arthroplasty (THA) for the treatment of intracapsular
Literature suggests that joint orthopaedic and geriatric care, and geriatric orthopaedic rehabilitation units, would provide best care for
Background:
The ideal operative treatment of displaced sub capital femoral fractures in the elderly is controversial. Recently, randomised controlled trials have suggested a better outcome with the use of total hip arthroplasty (THA) to treat displaced intra capsular fractures of the femur for elderly patients in good health. More recently the concept of dual mobility cups is being promoted to avoid dislocations in this cohort of patients. However, overall there is limited evidence to support the choice between different types of arthroplasty. Dislocation remains a main concern with THA, especially when a posterior approach is used. We analysed the outcome of 115 primary THR (112 cements and 3 uncemented) THR using a posterior approach with soft tissue repair in active elderly patients presenting with displaced intra capsular
Although resurfacing hip replacement (RHR) is associated with a more demanding patient cohort, it has achieved survivorship approaching that of total hip replacement. Occasional failures from
Long-term prospective RCT comparing hemiarthroplasty (HEMI) and total hip arthroplasty (THA) for the treatment of intracapsular
Aim: To evaluate the effect of Warfarin, the prevalence of acceptable level of INR by the anaesthetist, leading to delay of surgery in patients with
A new and very unstable intertrochanteric fracture complex is described. The intertrochanteric fracture with extension into the femoral neck is rare but results in an extremely high failure rate because of its instability. A ten-year retrospectic analysis of patients (246) with intertrochanteric fractures treated with a sliding compression hip screw at Hennepin County Medical center was performed. Of these 246 fractures, 20 were classified as fractures with a major intertrochanteric component with extension into the
The study aims to compare the short-term results of cemented and cementless total hip arthroplasty {THA} in active patients > 80 years of age with
Abstract. INTRODUCTION.
Introduction. Osteogenesis imperfect (OI) is a geno- and phenotypically heterogeneous group of congenital collagen disorders characterized by fragility and microfractures resulting in long bone deformities. OI can lead to progressive femoral coxa vara from bone and muscular imbalance and continuous microfracture about the proximal femur. If left untreated, patients develop Trendelenburg gait, leg length discrepancy, further stress fracture and acute fracture at the apex of the deformity, impingement and hip joint degeneration. In the OI patient, femoral coxa vara cannot be treated in isolation and consideration must be given to protecting the whole bone with the primary goal of verticalization and improved biomechanical stability to allow early loading, safe standing, re-orientation of the physis and avoidance of untreated sequelae. Implant constructs should therefore be designed to accommodate and protect the whole bone. The normal paediatric femoral neck shaft angle (FNSA) ranges from 135 to 145 degrees. In OI the progressive pathomechanical changes result in FNSA of significantly less than 120 degrees and decreased Hilgenreiner epiphyseal angles (HEA). Proximal femoral valgus osteotomy is considered the standard surgical treatment for coxa vara and multiple surgical techniques have been described, each with their associated complications. In this paper we present the novel technique of controlling femoral version and coronal alignment using a tubular plate and long bone protection with the use of teleoscoping rods. Methodology. After the decision to operate had been made, a CT scan of the femur was performed. A 1:1 scale 3D printed model (AXIAL3D, Belfast, UK) was made from the CT scan to allow for accurate implant templating and osteotomy planning. In all cases a subtrochanteric osteotomy was performed and fixed using a pre-bent 3.5 mm 1/3 tubular plate. The plate was bent to allow one end to be inserted into the proximal femur to act as a blade. A channel into the femoral neck was opened using a flat osteotome. The plate was then tapped into the femoral neck to the predetermined position. The final position needed to allow one of the plate holes to accommodate the growing rod. This had to be determined pre operatively using the 3D printed model and the implants. The femoral canal was reamed, and the growing rod was placed in the femur, passing through the hole in the plate to create a construct that could effectively protect both the femoral neck and the full length of the shaft. The distal part of the plate was then fixed to the shaft using eccentric screws around the nail to complete the construct. Results. Three children ages 5,8 and 13 underwent the procedure. Five coxa vara femurs have undergone this technique with follow-up out to 62 months (41–85 months) from surgery. Improvements in the femoral neck shaft angle (FNSA) were av. 18. o. (10–38. o. ) with pre-op coxa vara FNSA av. 99. o. (range 87–114. o. ) and final FNSA 117. o. (105–125. o. ). Hilgenreiner's epiphyseal angle was improved by av. 29. o. (2–58. o. ). However only one hip was restored to <25. o. In the initial technique employed for 3 hips, the plates were left short in the neck to avoid damaging the physis. This resulted in 2 of 3 hips
Aims. Evaluate if treating an unstable
The Nottingham Hip Fracture Score (NHFS) was developed in 2007 as a predictor of 30-day mortality after hip