ABSTRACT
Total hip replacement for adults with severe acetabular dysplasia presents a difficult problem because deficient bone stock and soft tissue contractures usually prevent sitting at the normal anatomic level. The rationales of high hip center are due to high failure rate of bulk structural weight bearing graft, good short-term result of hemispherical cementless acetabular component in revision surgery, high hip center but not lateral which does not adversely affect the biomechanics of the hip, and intimate apposition with viable host bone. We represented the short-term results of 21 total hip replacements with proximal placement of the acetabular cup than the anatomical position that is normally used. The mean duration of follow up was 18 months(range, 12-58 months) and the mean age of the patient was fifty-one years(range, thirty to sixty-seven years). Most of these hips had a major deficiency or defect of the acetabular bone stock. They had an aver- age Harris hip score of 47 points preoperatively and 90 points postoperatively. Roentgenographic measurements showed that the mean change in the height of the center of the hip postoperatively was only +6.6 millimeters and the mean change of horizontal location of them was 10 millimeters medial to the preoperative position. Postoperative complications included calcar fracture(1 case), trochanteric bursitis(1 case), postop- erative dislocation(1 case) and one case of radiological loosening of the acetabular component. The center of the hip in THR is not a crucial parameter with regard to the long-term stability of acetabular component, so our recommendation is to place the acetabular component at a more proximal but not lateral position if strong bone stock is available. But future studies of high hip center need to address femoral component longevity.
Subject(s)
Adult , Humans , Acetabulum , Arthroplasty, Replacement, Hip , Contracture , Femur , Follow-Up Studies , Hip Joint , Hip , Longevity , Osteoarthritis , Postoperative Complications , Transplants , Weight-BearingABSTRACT
The femoral neck fracture in children are extremely rare and occur secondary to severe trauma. Many authors recommend early anatomical reduction and firm internal fixation because of many complications after treatment. Eleven displaced femoral neck fractures in children who were treated at the Keimyung University Dong San Medical Center from February, 1989 to February, 1993. Following results were obtained, after clinical and radiological evaluations. 1. Fractures of the femoral neck in children occurred from five to sixteen years, the highest inci dence was between ten and thirteen years of age. 2. The main causes of the fracture were traffic accident in 9 cases. 3. 10 cases were treated by arthrotomy, open reduction and internal fixation and one by closed reduction and internal fixation. 4. Operation were performed within 24 hrs after trauma in 5 cases, within 5 days in 4 cases, and 2 cases were performed within 10 days after trauma. 5. According to the classification of Delbet and Colonna(12), cervicotrochanteric fracture(type III) was the most common type(7 cases). 6. The degrees of displacement were 4 cases totally displaced, one case more than two third dis placed, 4 cases 1/3 to 2/3 displaced, and 2 cases less than one third displaced. 7. Complications were transient AVN confirmed by bone scan(1 case) and coxa vara due to nonunion(1 case). 8. According to the Ratliffs assessment(22) the results were good in 9 cases, fair in one, and poor in one.
Subject(s)
Child , Humans , Accidents, Traffic , Classification , Coxa Vara , Decompression , Femoral Neck Fractures , Femur NeckABSTRACT
False aneurysm has been recognized for many years. Incomplete severance of an artery as the result of trauma is thought to be the precipitating factors in the formation of false aneurysm. False aneurysm of the peripheral artery is presented with pulsating mass and may show extrinsic indentations of the adjacent bone with or without neurovascular symptoms, mimicking a malignant tumor. But careful history taking can reveal a proceeding deep penetrating injury variable period prior to development of symptoms. We are reporting two cases of false aneurysm of the superior gluteal artery and superficial femoral artery in each after trauma.
Subject(s)
Aneurysm, False , Arteries , Femoral Artery , Precipitating FactorsABSTRACT
Pronation-external rotation ankle fractures are divided into four stages by Lauge-Hansen who placed the individual components of an ankle injury in their correct sequence in time so that, when the end point is represented by a fracture, the presence of intermediary ligament injuries may be inferred. Pronation-external rotation stages 3 and 4 injuries have severe soft tissue injuries and may be too difficult to reduce with closed method and to maintain with plaster immobilization. They also require attention because of a high level fraeture of the fibula and rupture of all ligaments of the syndesmosis or a avulsion fracture of their bone insertion. If anatomical reductions and rigid internal fixations were not performed. the results were worse than other types of ankle injuries. We reviewed the results of 31 patients with pronation external rotation ankle fractures who were followed from 18 months to 7 years. All cases were managed with open reduction and internal fixation with a plate, a screw or screws, a tension band wiring and multiple K-wires. All patients were treated and followed at the Department of Orthopaedic Surgery, Keimyung University, School of Medicine, Daegu, Korea and their results were rated on a clinical and roentgenological basis. The results obtained from this study were as followings:1. Most of the patients were in the age range between 20 and 39 (64.7% ) and 58.1% of the injuries occured in traffic accidents. 2. A plating considered as an effective method to obtain maintenance of appropriate anatomical reduction and rigid internal fixation of the distal fibula was used. 3. The accuracy of the reduction affected the degree of the arthrosis in long term follow-up. 4. A degree of initial displacement is considered as one of the important factors affecting the clinical results. 5. 80.7% were rated good to excellent.
Subject(s)
Humans , Accidents, Traffic , Ankle Fractures , Ankle Injuries , Ankle , Fibula , Follow-Up Studies , Immobilization , Korea , Ligaments , Methods , Pronation , Rupture , Soft Tissue InjuriesABSTRACT
Osteonecrosis of the femoral head seems to be due to circulatory disturbance of the femoral head, usually idiopathic in origin, but also associated with chronic alcoholism, gout, prolonged treatment with corticosteroids, sickle cell disease, Caisson's disease and surface and degenerative changes in the hip joint. Aims of this procedure are to decompress the femoral head hence allowing better circulation, to revitalize the dead head by insertion of vascularized pedicle bone and to give a mechanical support preventing further collapse of the femoral head. Authors reviewed 19 cases of the vessel pedicled iliac bone graft performed for the idiopathic osteonecrosis of femoral head from January, 1984 to April, 1988 with follow-up periods from 23 months to 66 months, average 37.5 months. The purpose of this follow-up note is to report the long term follow-up result and to show the critical points of this technique.
Subject(s)
Adrenal Cortex Hormones , Alcoholism , Anemia, Sickle Cell , Bone Transplantation , Follow-Up Studies , Gout , Head , Hip Joint , Osteonecrosis , TransplantsABSTRACT
In osteoarthritis of the knee with varus deformity, abnormal stress is concentrated in the medial compartment of the knee joint. A logical treatment must decrease and recenter the force acting on the knee in order to distribute the compressive stresses evenly over the largest possible weight-bearing articular surfaces. This can be attained by an overcorrection of the deformity. The technique of a Barrel-Vault osteotomy is the correction of severe angular deformity of the knee and the reduction of the patellofemoral joint pressure simultaneously by an anterior displacement of the distal fragment. From 1986 to 1989, the authors studied the preoperative clinical status and lpostoperative results in twelve knees(nine patients) who had had a Barrel-Vault osteotomy for combined medial and patellofemoral disease. The total Insall Knee Rating Score improved from a preoperative mean 54.1 to 85.4 Points at the last assessment. The pain component score improved from a preoperative mean 6.6 to 26.2 points at the last assessment. Eleven kness had either no pain or occasional mild pain. The tibiofemoral angle was corrected from a preoperative mean of 4.4 degrees of varus to a mean of 11.2 degrees of valgus at the last assessment.