An important factor in the internal fixation of pertrochanteric fractures is the ability to maintain postoperative reduction. Excessive postoperative sliding of the lag screw or blade may result in reduction loss. We retrospectively analyzed the relationship between postoperative reduction and sliding. From Oct. 2009 to Sept. 2011, we treated pertrochanteric fractures using J-PFNA (Synthes) and InterTAN (Smith & Nephew) in 91 cases and 82 cases, respectively. We used postoperative radiographs to classify its reduction. Fractures were classified for its interfragmentary contact using the calcar femorale as a reference on the A-P plane while using the anterior cortex as a reference on the M-L plane.Introduction
Methodology
The usefulness of arthroscopic reduction for the intra-articular fracture of the distal radius has been reported, although it is technically difficult. Our hypothesis is that the reduction using the external fixator is useful as equivalent to the arthroscopic reduction for the intra-articular fracture of the distal radius fracture in the fixation with the volar locking plate.Background
Hypothesis
The purpose of this study was to examine if Sugioka's transtrochanteric rotational osteotomy (TRO) of the femoral head could be a valid option in treating idiopathic osteonecrosis of the femoral head. Thirty-two TROs performed in 29 patients between 1985 and 2006 were studied. Patient age at operation ranged from 16 to 56 years (average, 36 years). Thirteen hips were in women and 19 hips in men. Height was 165 cm and weight 63 kg (Body Mass Index 23) on average. Risk factors were corticosteroid use in 18 hips and excessive alcohol consumption in 15 hips (2 of them had both backgrounds), while neither of them was found with 1 hip. Bilateral hips were affected in 19 patients and 3 of them underwent bilateral TROs sequentially. The femoral head was rotated anteriorly in 26 hips and posteriorly in 6 hips. For fixation of the osteotomy site, large femoral screws had been used till 1995 (Group 1, 9 hips), and since 1996 an AO angle plate or a compression hip screw has been used (Group 2, 13 hips). Since 2003, pre-operative planning was performed more meticulously and the distal part of the joint capsule was cut after osteotomy as described by Atsumi (Group 3, 10 hips). The average follow-up period was 6.5 years (range, 2 to 21 years).Introduction
Methods
Long term outcome of cementless femoral stem with use of transtrochanteric approach was evaluated by clinical outcome and radiological change. 37 joints in 33 patients who underwent surgery in our department more than 15 years before (from 1986 to 1993) were studied. Used implants were Omnifit (Fit group, 19 joints: all joints were microstructured) and Ominiflex (Flex group, 18 joints: all joints were microstructured). The preoperative diagnosis was secondary osteoarthritis caused by dysplasia of hip (29 joints), osteonecrosis of femoral head (2 joints), rheumatoid arthritis (4 joints), and others (2 joints). Mean age at surgery was 51 years (Fit group, 54.2 years; Flex group, 50.2 years) and average postoperative follow-up period was 17.8 years (Fit group, 19 years; Flex group, 16.5 years). Clinical outcome was evaluated by Japanese Orthopedic Association hip score (JOA score) and absence or presence of thigh pain. In radiological evaluation, the fixation of implant was evaluated by Engh’s classification and the presence or absence of stress shielding, spot welds, radiolucent line, osteolysis, and sinking were studied. JOA score for Fit and Flex group was significantly improved from 35 to 79.3 points and 37 to 76.9 points, respectively. Improvement of pain and gait ability was marked. Thigh pain was observed in 1 joint only, in the Flex group. Radiological examination for Fit and Flex group showed bone ingrowth 100% and 61% of patients, respectively, showing good fixation for both groups. Radiological sign of Fit and Flex group showed stress shielding in 91% and 84%, spot welds in 73% and 44%, radiolucent line in 12% and 19%, osteolysis in 5.2% and 5%, and sinking in 0% and 11% of patients, respectively. Revision caused by loosening of stem was in only 1 joint in Flex group. For first generation of Omnifit/Omniflex stem, many cases of early loosening caused by surface structure characteristics had been reported. Long-term outcome in our department was relatively good compared to these earlier reports. Good initial placement of femoral component and sufficient canal fill ratio with use of transtrochanteric approach is one factor of this better result.
