The objective of this study was to validate the
efficacy of Takeuchi classification for lateral hinge fractures
(LHFs) in open wedge high tibial osteotomy (OWHTO). In all 74 osteoarthritic
knees (58 females, 16 males; mean age 62.9 years, standard deviation
7.5, 42 to 77) were treated with OWHTO using a TomoFix plate. The
knees were divided into non-fracture (59 knees) and LHF (15 knees)
groups, and the LHF group was further divided into Takeuchi types
I, II, and III (seven, two, and six knees, respectively). The outcomes
were assessed pre-operatively and one year after OWHTO. Pre-operative
characteristics (age, gender and body mass index) showed no significant
difference between the two groups. The mean Japanese Orthopaedic
Association score was significantly improved one year after operation
regardless of the presence or absence of LHF (p = 0.0015, p <
0.001, respectively). However, six of seven type I cases had no
LHF-related complications; both type II cases had delayed union;
and of six type III cases, two had delayed union with correction
loss and one had overcorrection. These results suggest that Takeuchi
type II and III LHFs are structurally unstable compared with type
I. Cite this article:
The treatment of a chronic posterior dislocation of the shoulder is often determined by the size of the associated impression fracture of the humeral head. Our hypothesis was that patients with a chronic unreduced posterior dislocation of the shoulder and a defect in the humeral head involving between 25% to 50% of the articular surface, would do better if reconstructed with an allograft from the femoral head rather than treated by a non-anatomical reconstruction. We reviewed ten men and three women with a mean age of 42 years (36 to 51) at a mean follow-up of 54 months (41 to 64) who had this procedure. At follow-up, nine had no pain or restriction of activities of daily living. Their mean Constant-Murley shoulder score was 86.8 (43 to 98). No patient had symptoms of instability of the shoulder. Reconstruction of the defect in the humeral head with an allograft provides good pain relief, stability and function for patients with a locked, chronic posterior dislocation where the defect involves between 25% and 50% of the circumference of the articular surface.
Between 2003 and 2007, 99 knees in 77 patients
underwent opening wedge high tibial osteotomy. We evaluated the effect
of initial stable fixation combined with an artificial bone substitute
on the mid- to long-term outcome after medial opening-wedge high
tibial osteotomy (HTO) for medial compartmental osteoarthritis or
spontaneous osteonecrosis of the knee in 78 knees in 64 patients
available for review at a minimum of five years (mean age 68 years;
49 to 82). The mean follow-up was 6.5 years (5 to 10). The mean
Knee Society knee score and function score improved from 49.6 ( Opening-wedge HTO using a stable plate fixation system combined
with a bone substitute is a reliable procedure that provides excellent
results. Although this treatment might seem challenging for older
patients, our results strongly suggest that the results are equally
good. Cite this article:
The June 2013 Hip &
Pelvis Roundup360 looks at: failure in metal-on-metal arthroplasty; minimal hip approaches; whether bisphosphonates improve femoral bone stock following arthroplasty; whether more fat means more operative time; surgical infection; vascularised fibular graft for osteonecrosis; subclinical SUFE; and dentists, hips and antibiotics.
Severe acute respiratory syndrome (SARS) is a newly described infectious disease caused by the SARS coronavirus which attacks the immune system and pulmonary epithelium. It is treated with regular high doses of corticosteroids. Our aim was to determine the relationship between the dosage of steroids and the number and distribution of osteonecrotic lesions in patients treated with steroids during the SARS epidemic in Beijing, China in 2003. We identified 114 patients for inclusion in the study. Of these, 43 with osteonecrosis received a significantly higher cumulative and peak methylprednisolone-equivalent dose than 71 patients with no osteonecrosis identified by MRI. We confirmed that the number of osteonecrotic lesions was directly related to the dosage of steroids and that a very high dose, a peak dose of more than 200 mg or a cumulative methylprednisolone-equivalent dose of more than 4000 mg, is a significant risk factor for multifocal osteonecrosis with both epiphyseal and diaphyseal lesions. Patients with diaphyseal osteonecrosis received a significantly higher cumulative methylprednisolone-equivalent dose than those with epiphyseal osteonecrosis. Multifocal osteonecrosis should be suspected if a patient is diagnosed with osteonecrosis in the shaft of a long bone.