Subtrochanteric Femoral Fracture during Trochanteric Nailing for the Treatment of Femoral Shaft Fracture

We report on three cases of subtrochanteric femoral fractures during trochanteric intramedullary nailing for the treatment of femoral shaft fractures. Trochanteric intramedullary nails, which have a proximal lateral bend, are specifically designed for trochanteric insertion. When combined with the modified insertion technique, trochanteric intramedullary nails reduce iatrogenic fracture comminution and varus malalignment. We herein describe technical aspects of trochanteric intramedullary nailing for femoral shaft fractures to improve its application and prevent implant-derived complications.

Reliability of the Radiologic Measurement Methods for Assessment of Osteoporosis Using the Digital Hip Radiograph

PURPOSE: We evaluated the usefulness of radiographic parameters for osteoporosis by analyzing the results of radiographic parameters determined by digital hip radiographs and bone mineral density T-scores, as assessed by Dual Energy X-ray Absorptiometry (DEXA). MATERIALS AND METHODS: The authors reviewed 100 subjects in the hip fracture group and 50 in the non-fracture control group. Digital hip radiographs were assessed to determine the values of Singh index, Canal-to-Calcar Ratio, and Cortical Thickness Index (CTI). Bone mineral density was assessed by DEXA. RESULTS: Intraclass Correlation Coefficient (ICC) results of the CTI were above 0.8 in the fracture group. Compared to the control group, the fracture group showed higher ICCs. Interobserver ICCs were especially lower in the control group. There were statistically significant correlations between CTI and DEXA (r=0.50~0.58, p<0.05). In the analysis of ROC curves, a mean threshold for CTI set a value of 0.54 (0.53~0.55), and mean sensitivity and specificity were 75.5% (69~79%) and 67.8% (65~78%), respectively. CONCLUSION: CTI showed reasonable reliability and correlation with DEXA results. CTI was a useful radiographic parameter to alert the surgeon to recommend referral for osteoporosis evaluation in elderly hip fracture patients.

Follow-up Study of the Cemented Polished Femoral Stem for More than Five Years

PURPOSE: Surface finishing of a cemented femoral stem is a subject of controversy even though the contemporary cementing techniques have improved results. Using the Versys Heritage femoral stem, we evaluated the outcome of using a polished surface. MATERIALS AND METHODS: The subjects of this study were 95 hip arthroplasties in 82 patients and we used a cemented polished femoral stem with the 3rd generation cement technique and all the surgeries were done between October 2000 and August 2003. There were 58 male patients (64 hips) and 24 female patients (31 hips). The mean age at the time of the index arthroplasty was 52.3 years (26~74 years), and the average body mass index was 24.2+/-2.75 (19.1~29.8). The average follow up period was 80.7 months (64~109 months). All the hips were evaluated clinically by the Harris hip score and the thigh pain, and they were radiologically assessed by the cement grade and the presence of osteolysis around the femoral stem, as well as the presence of stress shielding of the proximal femur. RESULTS: At the final follow up, the Harris hip score for all the patients had improved from preoperative 58.9 (17-83) to post operative 91.7 (72~100). The cement grade was measured using Barrack's method. Of the 95 hips, 45 (47.3%) cases were grade A, 48 (50.5%) cases were grade B and 2 (2.1%) cases were grade C1 at the final follow up. There was 1 case of definite loosening. Stress shielding was noted in 65 (68.4%) cases of the zero grade and 19 (20.0%) cases of the 1st grade. CONCLUSION: In this study, the cemented polished femoral stem showed excellent results at the mid term with a minimum follow up of 5 years. But a longer-term follow-up study will be needed for further understanding the implications of cemented polished femoral stem.

Rapidly Destructive Coxarthrosis in Patients with Rheumatoid Arthritis: Report on 3 Cases

Rapidly destructive coxarthrosis may be caused by osteoarthritis, osteonecrosis of the femoral head and rheumatoid arthritis, but its etiology has not been clarified. Rapidly destructive coxarthrosis generally occurs in old age patients and the patients clinically show severe pain, but a relatively preserved range of motion. Rapidly destructive coxarthrosis is characterized by a rapid destruction, resorption and subluxation of the femoral head, destruction of the articular area in the acetabulum, above 50% or 2 mm/year loss of the joint space and minimal osteophyte formation. The radiologic changes are dramatic and they may mimic neuropathic or septic arthritis. We report here on three cases of rheumatoid arthritis that had acute destruction of the hip joint and rapid resorption of the femoral head, and we also review the relevant medical literature. We recommend taking repetitive radiographs for rheumatoid arthritis patients who suffer with continuing severe hip pain.