Magnetic resonance imaging [MRI] and core decompression in the early management of acute unilateral adult hip pain secondary to osteonecrosis of the femoral head

The objective of our study was to evaluate the efficacy of diagnosis and treatment of early cases of adult AVN of the femoral head, using an early sensitive and specific modality as MRI, coupled with the use of a simple surgical intervention capable of stopping the vicious circle of complications due to the ischemia and ending by necrosis and collapse of the femoral head. Our patients were six, five males and one female. Their age ranged between 30-60 years [mean=45.7 SD of 12.8 years]. Five patients attended the OPD with minimal hip pain, one of them associated with mild limping. The one female patient was accidentally discovered during MR examination of the pelvis. The possible etiological factors were steroids in three patients [50%], alcohol in two patients, and two patients were considered as idiopathic. On plain radiographs, classified according to the Ficat and Arlet staging, five patients were preradiological, one patient preclinical and one patient radiological [minimal osteoporosis]. MRI 1.5T was used in the following sequences T1 TSE, T2 TSE and SPIR. The most valuable early MR sign of AVN, bone marrow oedema, was present in all patients [100%]. Double subchondral line was elicited in only five patients [83.3%]. Surgery was planned according to the MR stage of AVN which ranged in our selected patients between 0-1 according to Ficat. Modified core decompression surgery was performed in all patients. Clinical and MR follow up examinations three and six months were performed. All the patients rendered free from pain or limping by six months. At three months MRI follow-up, bone oedema persisted in all patients, while the vascularized core appeared in 50% of them. However, at six months, bone oedema disappeared with appearance of the vascularized core in all patients. In conclusion, a high level of clinical awareness about AVN should be present while dealing with adult hip pain. MRI is a sensitive and specific modality in the early diagnosis, staging, and sole modality for operative planning for AVN. Modified core decompression technique; in early stages of AVN, is an easy, reliable, and quick intervention that is available to most of orthopaedic surgeons, to stop the vicious cycle of ischemia and necrosis

Functional outcome of calcaneal fractures treated either conservatively or operatively; a comparative study

The aim of this paper is to compare the functional results of treatment of displaced intracalcaneal fractures after operative and conservative management. Thirty seven patients with 42 feet having displaced intra-articular calcaneal fractures were included in this study. These were divided into two groups. Cases in group I were treated by open reduction and internal fixation, while those in group II were treated conservatively. In both groups, the injury was common in males, in the 3rd and 4th decades of life. Most of them were heavy manual workers. Falling from a height was the commonest mode of injury. All patients were assessed by stndard plain radiographs and CT scans. In group I, surgery was done after an average of 4.3 days. The extended lateral approach was used with calcaneal or 3.5mm reconstruction plates. In group II, intensive rehabilitation program started as soon as pain and swelling allowed. Only non-weight bearing ambulation was allowed in both groups till the fractire has healed rodiologically. The results were assessed using a 15-question patient-surgeon visual analogue scale. By the end of the follow up period, which exceeded 24 months in both groups, the overall results were significantly more satisfactory in group I [86%] than in group II [40%]. The rate of complications with the operative group was also low. The conclusion is; CT scans have improved the managementt of intraarticular calcaneal frractures. The results of conservative treatment can not be accepted in the modern era of orthopaedic practice. On the other hand, the results of open reduction and internal fixation are accepted, being more or less satisfactory by the patient, and reproducible