This paper reports a singular case of pathological fracture through a large osteolytic lesion of the mid-femur consequent on reaction to a hip prosthesis. Not only metal particles but also polyethylene fibres were found at this site, some 15 cm from the prosthesis. The case sheds an interesting light on the reaction to prostheses.
The use of two implants to manage concomitant ipsilateral femoral
shaft and proximal femoral fractures has been indicated, but no
studies address the relationship of dynamic hip screw (DHS) side
plate screws and the intramedullary nail where failure might occur
after union. This study compares different implant configurations
in order to investigate bridging the gap between the distal DHS
and tip of the intramedullary nail. A total of 29 left synthetic femora were tested in three groups:
1) gapped short nail (GSN); 2) unicortical short nail (USN), differing
from GSN by the use of two unicortical bridging screws; and 3) bicortical
long nail (BLN), with two angled bicortical and one unicortical bridging
screws. With these findings, five matched-pairs of cadaveric femora
were tested in two groups: 1) unicortical long nail (ULN), with
a longer nail than USN and three bridging unicortical screws; and
2) BLN. Specimens were axially loaded to 22.7 kg (50 lb), and internally
rotated 90°/sec until failure.Objectives
Methods
Benefits of early stabilization of
The April 2024 Children’s orthopaedics Roundup. 360. looks at: Ultrasonography or radiography for suspected paediatric distal forearm fractures?; Implant density in scoliosis: an important variable?; Gait after paediatric
The December 2023 Children’s orthopaedics Roundup. 360. looks at: A comprehensive nonoperative treatment protocol for developmental dysplasia of the hip in infants; How common are refractures in childhood?; Femoral nailing for paediatric
Aims. Bone turnover markers (BTMs) follow distinct trends after fractures and limited evidence suggests differential levels in BTMs in patients with delayed healing. The effect of vitamin D, and other factors that influence BTMs and fracture healing, is important to elucidate the use of BTMs as surrogates of fracture healing. We sought to determine whether BTMs can be used as early markers of delayed fracture healing, and the effect of vitamin D on BTM response after fracture. Methods. A total of 102 participants aged 18 to 50 years (median 28 years (interquartile range 23 to 35)), receiving an intramedullary nail for a tibial or
We performed a retrospective review of all patients
admitted to two large University Hospitals in the United Kingdom
over a 24-month period from January 2008 to January 2010 to identify
the incidence of atypical subtrochanteric and
Aims. Osteopetrosis (OP) is a rare hereditary disease that causes reduced bone resorption and increased bone density as a result of osteoclastic function defect. Our aim is to review the difficulties, mid-term follow-up results, and literature encountered during the treatment of OP. Methods. This is a retrospective and observational study containing data from nine patients with a mean age of 14.1 years (9 to 25; three female, six male) with OP who were treated in our hospital between April 2008 and October 2018 with 20 surgical procedures due to 17 different fractures. Patient data included age, sex, operating time, length of stay, genetic type of the disease, previous surgery, fractures, complications, and comorbidity. Results. The mean follow-up period was 92.5 months (25 to 140). Bony union was observed in all of our patients. Osteomyelitis developed in two patients with
The management of children’s fractures has evolved
as a result of better health education, changes in lifestyle, improved
implant technology and the changing expectations of society. This
review focuses on the changes seen in paediatric fractures, including
epidemiology, the increasing problems of obesity, the mechanisms
of injury, non-accidental injuries and litigation. We also examine
the changes in the management of fractures at three specific sites:
the supracondylar humerus,
The October 2014 Children’s orthopaedics Roundup. 360 . looks at: spondylolisthesis management strategies; not all cervical collars are even; quality of life with Legg-Calve-Perthe’s disease;
Malpositioning of the trochanteric entry point
during the introduction of an intramedullary nail may cause iatrogenic
fracture or malreduction. Although the optimal point of insertion
in the coronal plane has been well described, positioning in the
sagittal plane is poorly defined. . The paired femora from 374 cadavers were placed both in the anatomical
position and in internal rotation to neutralise femoral anteversion.
A marker was placed at the apparent apex of the greater trochanter,
and the lateral and anterior offsets from the axis of the femoral
shaft were measured on anteroposterior and lateral photographs. Greater
trochanteric morphology and trochanteric overhang were graded. The mean anterior offset of the apex of the trochanter relative
to the axis of the
The impact of a diaphyseal femoral deformity on knee alignment varies according to its severity and localization. The aims of this study were to determine a method of assessing the impact of diaphyseal femoral deformities on knee alignment for the varus knee, and to evaluate the reliability and the reproducibility of this method in a large cohort of osteoarthritic patients. All patients who underwent a knee arthroplasty from 2019 to 2021 were included. Exclusion criteria were genu valgus, flexion contracture (> 5°), previous femoral osteotomy or fracture, total hip arthroplasty, and femoral rotational disorder. A total of 205 patients met the inclusion criteria. The mean age was 62.2 years (SD 8.4). The mean BMI was 33.1 kg/m2 (SD 5.5). The radiological measurements were performed twice by two independent reviewers, and included hip knee ankle (HKA) angle, mechanical medial distal femoral angle (mMDFA), anatomical medial distal femoral angle (aMDFA), femoral neck shaft angle (NSA), femoral bowing angle (FBow), the distance between the knee centre and the top of the FBow (DK), and the angle representing the FBow impact on the knee (C’KS angle).Aims
Methods
The removal of well-fixed bone cement from the femoral canal during revision of a total hip replacement (THR) can be difficult and risks the loss of excessive bone stock and perforation or fracture of the
The aims of this study were to develop an automatic system capable of calculating four radiological measurements used in the diagnosis and monitoring of cerebral palsy (CP)-related hip disease, and to demonstrate that these measurements are sufficiently accurate to be used in clinical practice. We developed a machine-learning system to automatically measure Reimer’s migration percentage (RMP), acetabular index (ACI), head shaft angle (HSA), and neck shaft angle (NSA). The system automatically locates points around the femoral head and acetabulum on pelvic radiographs, and uses these to calculate measurements. The system was evaluated on 1,650 pelvic radiographs of children with CP (682 females and 968 males, mean age 8.3 years (SD 4.5)). Each radiograph was manually measured by five clinical experts. Agreement between the manual clinical measurements and the automatic system was assessed by mean absolute deviation (MAD) from the mean manual measurement, type 1 and type 2 intraclass correlation coefficients (ICCs), and a linear mixed-effects model (LMM) for assessing bias.Aims
Methods
Seventy-nine cases of fracture of the
The April 2023 Children’s orthopaedics Roundup360 looks at: CT scan of the ipsilateral femoral neck in paediatric shaft fractures; Meniscal injuries in skeletally immature children with tibial eminence fractures: a systematic literature review; Post-maturity progression in adolescent idiopathic scoliosis curves of 40° to 50°; Prospective, randomized Ponseti treatment for clubfoot: orthopaedic surgeons versus physical therapists; FIFA 11+ Kids: challenges in implementing a prevention programme; The management of developmental dysplasia of the hip in children aged under three months: a consensus study from the British Society for Children's Orthopaedic Surgery; Early investigation and bracing in developmental dysplasia of the hip impacts maternal wellbeing and breastfeeding; Hip arthrodesis in children: a review of 26 cases with a mean of 20 years’ follow-up
A study of the contamination of suckers used during total hip replacement has been undertaken. Thirty suckers used throughout the operation had their tips cultured: from 11 of these bacteria were grown. The organisms found were those which have previously been implicated in deep infection of total hip replacements. In subsequent operations a further 31 suckers were used for cleaning only the
We describe two patients with a diffuse haemangioma of the lower limb complicated by pathological fracture of the
Forty comminuted or unstable fractures of the
We have undertaken a prospective study in patients with a fracture of the