Osteoporosis is characterized by decreased trabecular bone volume, and microarchitectural deterioration in the medullary cavity. Blood and femoral bone marrow suspension Aims
Methods
The Coronal Plane Alignment of the Knee (CPAK) classification is a simple and comprehensive system for predicting pre-arthritic knee alignment. However, when the CPAK classification is applied in the Asian population, which is characterized by more varus and wider distribution in lower limb alignment, modifications in the boundaries of arithmetic hip-knee-ankle angle (aHKA) and joint line obliquity (JLO) should be considered. The purposes of this study were as follows: first, to propose a modified CPAK classification based on the actual joint line obliquity (aJLO) and wider range of aHKA in the Asian population; second, to test this classification in a cohort of Asians with healthy knees; third, to propose individualized alignment targets for different CPAK types in kinematically aligned (KA) total knee arthroplasty (TKA). The CPAK classification was modified by changing the neutral boundaries of aHKA to 0° ± 3° and using aJLO as a new variable. Radiological analysis of 214 healthy knees in 214 Asian individuals was used to assess the distribution and mean value of alignment angles of each phenotype among different classifications based on the coronal plane. Individualized alignment targets were set according to the mean lateral distal femoral angle (LDFA) and medial proximal tibial angle (MPTA) of different knee types.Aims
Methods
Induced membrane technique is a relatively new technique in the reconstruction of large bone defects. It involves the implantation of polymethylmethacrylate (PMMA) cement in the bone defects to induce the formation of membranes after radical debridement and reconstruction of bone defects using an autologous cancellous bone graft in a span of four to eight weeks. The purpose of this study was to explore the clinical outcomes of the induced membrane technique for the treatment of post-traumatic osteomyelitis in 32 patients. A total of 32 cases of post-traumatic osteomyelitis were admitted to our department between August 2011 and October 2012. This retrospective study included 22 men and ten women, with a mean age of 40 years (19 to 70). Within this group there were 20 tibias and 12 femurs with a mean defect of 5 cm (1.5 to 12.5). Antibiotic-loaded PMMA cement was inserted into the defects after radical debridement. After approximately eight weeks, the defects were implanted with bone graft.Objectives
Methods
Although the importance of lateral femoral wall
integrity is increasingly being recognised in the treatment of intertrochanteric
fracture, little attention has been put on the development of a
secondary post-operative fracture of the lateral wall. Patients
with post-operative fractures of the lateral wall were reported
to have high rates of re-operation and complication. To date, no
predictors of post-operative lateral wall fracture have been reported.
In this study, we investigated the reliability of lateral wall thickness
as a predictor of lateral wall fracture after dynamic hip screw
(DHS) implantation. A total of 208 patients with AO/OTA 31-A1 and -A2 classified
intertrochanteric fractures who received internal fixation with
a DHS between January 2003 and May 2012 were reviewed. There were
103 men and 150 women with a mean age at operation of
78 years (33 to 94). The mean follow-up was 23 months (6 to 83).
The right side was affected in 97 patients and the left side in
111. Clinical information including age, gender, side, fracture
classification, tip–apex distance, follow-up time, lateral wall
thickness and outcome were recorded and used in the statistical
analysis. Fracture classification and lateral wall thickness significantly
contributed to post-operative lateral wall fracture (both p <
0.001). The lateral wall thickness threshold value for risk of developing
a secondary lateral wall fracture was found to be 20.5 mm. To our knowledge, this is the first study to investigate the
risk factors of post-operative lateral wall fracture in intertrochanteric
fracture. We found that lateral wall thickness was a reliable predictor
of post-operative lateral wall fracture and conclude that intertrochanteric
fractures with a lateral wall thickness <
20.5 mm should not
be treated with DHS alone. Cite this article:
In patients with traumatic brain injury and fractures
of long bones, it is often clinically observed that the rate of bone
healing and extent of callus formation are increased. However, the
evidence has been unconvincing and an association between such an
injury and enhanced fracture healing remains unclear. We performed
a retrospective cohort study of 74 young adult patients with a mean
age of 24.2 years (16 to 40) who sustained a femoral shaft fracture
(AO/OTA type 32A or 32B) with or without a brain injury. All the
fractures were treated with closed intramedullary nailing. The main
outcome measures included the time required for bridging callus
formation (BCF) and the mean callus thickness (MCT) at the final
follow-up. Comparative analyses were made between the 20 patients
with a brain injury and the 54 without brain injury. Subgroup comparisons
were performed among the patients with a brain injury in terms of
the severity of head injury, the types of intracranial haemorrhage
and gender. Patients with a brain injury had an earlier appearance
of BCF
(p <
0.001) and a greater final MCT value (p <
0.001) than
those without. There were no significant differences with respect
to the time required for BCF and final MCT values in terms of the
severity of head injury (p = 0.521 and p = 0.153, respectively),
the types of intracranial haemorrhage (p = 0.308 and p = 0.189,
respectively) and gender (p = 0.383 and
p = 0.662, respectively). These results confirm that an injury to the brain may be associated
with accelerated fracture healing and enhanced callus formation.
However, the severity of the injury to the brain, the type of intracranial
haemorrhage and gender were not statistically significant factors
in predicting the rate of bone healing and extent of final callus formation.
Breast cancer is generally managed surgically with adjuvant agents which include hormone therapy, chemotherapy, radiotherapy and bisphosphonate therapy. However, some of these adjuvant therapies may cause adverse events, including wound infection, neutropenia, bone marrow suppression and fever. The simultaneous presentation of osteonecrosis and osteomyelitis has not previously been described in patients with breast cancer undergoing hormone therapy and chemotherapy. We report a patient with breast cancer who developed bone infarcts in both legs as well as osteomyelitis in the right distal tibia after treatment which included a modified radical mastectomy, hormone therapy and chemotherapy. Simultaneous osteonecrosis and osteomyelitis should be considered in patients with breast cancer who are receiving chemotherapy and hormone therapy who present with severe bone pain, especially if there have been infective episodes during treatment.
We evaluated 31 patients with bilateral dysplastic hips who had undergone periacetabular osteotomy for early (Tönnis grade 0 or 1) or moderate (Tönnis grade 2) osteoarthritis in one hip and total hip replacement for advanced (Tönnis grade 3) osteoarthritis in the other. At a mean follow-up of 5.5 years (2 to 9) after periacetabular osteotomy and 6.7 years (3 to 10) after total hip replacement, there was no difference in the functional outcome in hips undergoing osteotomy for early or moderate osteoarthritis and those with a total hip replacement, as determined by the Merle d’Aubigné and Postel score and the Western Ontario and McMaster Universities osteoarthritis index. More patients preferred the spherical periacetabular osteotomy to total hip replacement (53% vs 23%; p = 0.029). Osteoarthritis secondary to hip dysplasia is often progressive. Given the results, timely correction of dysplasia by periacetabular osteotomy should be considered whenever possible in young patients since this could produce a favourable outcome which is comparable with that of total hip replacement.