ABSTRACT
@#Introduction: The morphology of the proximal femur differs in various populations. Based on our clinical experience, conventional femoral stems used in hip arthroplasty do not fit the Chinese population well. Hence, this study aims to evaluate the suitability of conventional femoral stems in the elderly Chinese hip fracture population requiring hip arthroplasty and to establish if gender and age related differences exist within this population. Materials and methods: We retrospectively analysed radiographic data of 300 patients from a tertiary hospital’s geriatric hip fracture database who underwent either hip hemi-arthroplasties or total hip arthroplasties. Proximal femur morphological measurements were recorded, analysed and compared to that of commonly used femoral stems. Subgroup analysis was performed to compare age and gender related differences. Results: A total of 18.3% of the study population had a medial femoral offset (MFO) of less than 30mm, which is the smallest available offset for the implants studied. 22.6% of female and 3% of male subjects had MFOs that were less than 30mm. In our subgroup analysis, males had significantly larger femoral head diameters, MFO and vertical femoral offsets compared to females. Older subjects (75-90 years old) had significantly smaller femoral head diameters, vertical femoral offsets and neck shaft angles compared to younger subjects (60-75 years old). Conclusion: Commonly used femoral stem implants have measurements that do not suit our Chinese population with small medial femoral offsets. In addition, elderly males have significantly larger femoral head diameters, medial and vertical femoral offsets whereas older subjects have significantly smaller femoral head diameters, vertical femoral offsets and neck shaft angles.
ABSTRACT
Objective:To explore the clinical application of free chimeric medial femoral condyle osteofascial free flap (CMFCOF) in the treatment of traumatic composite bone and soft tissue defect of hand and foot.Methods:Between January, 2015 and March, 2020, 8 patients with traumatic composite bone and soft tissue defect in hand and foot were treated with CMFCOF. Of the 8 patients, there were 6 males and 2 females, with an average age of 41 (range, 24 to 56) years. The causes of injury included 3 of traffic accident, 3 of machine crush and 2 of crush. Two cases had proximal phalanx defect, 3 with metacarpal bone and 3 with metatarsal bone. The time between injury to the flap repair were 2 to 120 (mean, 84) days. The size of bone defect ranged from 2.0 cm×1.2 cm×1.2 cm to 4.4 cm× 3.0 cm×2.3 cm. The soft tissue defect ranged from 2.0 cm×1.4 cm to 5.6 cm×4.5 cm. All bone defects were on the diaphysis, without involvement of joints. Two cases had tendon defect. According to the defect of bone and soft tissue, the CMFCOF was prepared and skin graft was performed on the surface of its fascial flap.Results:The average time of flap harvesting was 53(52-96) minutes. All donor sites were directly closed. All flaps and skin grafts achieved stage I survival. All patients entered 9-16 months of follow-up, with an average of 14.5 months. The average healing time of bone was 7.5 (range, 6-10) weeks. At the last follow-up review, all flaps were not thinned. The function of donor site was restored well, without weight bearing disorder and paraesthesia in the anterior patella area. According to the trial standard of Digit Function Evaluation of the Hand Surgery Society of Chinese Medical Association, 3 patients were rated as excellent, 1 was good and 1 was fair. According to the Maryland foot evaluation criteria, 3 patients were rated as excellent for recovered with normal weight-bearing walking.Conclusion:CMFCOF can achieve satisfactory results in repairing composite bone and soft tissue defect of hand or foot. The flap has the advantages in simple operation, high quality of bone and concealed donor site.
ABSTRACT
Objective:To investigate the clinical effect of the free medial femoral condylar bone flap in treatment of scaphoid nonunion.Methods:From May, 2012 to May, 2016, 15 patients, which were 10 males and 5 females and aged from 18 to 63 (mean 43.5±15.5) years, with scaphoid nonunion were treated with transfer of free medial femoral condyle bone flaps. After debridement of the fractural segment in surgery, the bone flap was transferred to scaphoid and had the bone defect filled. The artery of the bone flap was end-to-side or end-to-end anastomosed to the radial artery. The concomitant vein of the bone flap was end-to-end anastomosed to the concomitant vein of the radial artery. Thirteen patients were treated with the free osteoperiosteal medial femoral condylar graft, and 2 were treated with the free osteochondral medial femoral condylar graft. Fracture healing was evaluated based on X-ray evidence. The clinical effect was evaluated by visual analogue scale (VAS), strength of grip and modified Mayo wrist score. The t-test was used to compare the function between before and after surgery. Results:All patients were entered into a followed-up for an average of 32.5 (8-60) months, 11 of them took the follow-up reviews at the outpatient clinic and 4 via WeChat distanced interviews. All fractures of the 15 patients healed with an average healing time at 12.5 (10-16) weeks. The VAS score decreased from (3.5±1.5) before the surgery to (1.0±1.0) after the surgery. The strength of grip increased from (16.5±4.3) kg before the surgery to (31.5±3.5) kg at the last follow-up review. The modified Mayo wrist score increased from (46.2 ±11.4) before the surgery to (68.5 ±10.8) at the last follow-up review. The wrist function was excellent in 8 patients, good in 6 and fair in 1. There was significant difference in functional evaluation ( P<0.05). Conclusion:The transfer of free medial femoral condylar bone flap is effective in the treatment of scaphoid nonunion. This technique provides both of sufficient blood supply and a structural support for defected scaphoid bone and promotes the healing of fracture. Osteochondral flap transfer may be used as an alternative measure to prevent wrist osteoarthritis and collapse, in the case that there is an avascular necrosis of the proximal pole of the scaphoid. It has an advantage in the treatment of refractory scaphoid nonunion.
ABSTRACT
Maxillary defects result in esthetic and functional defects in patients. Several techniques are available for ma-xillary reconstruction. Herein, we present a case of maxillary reconstruction with medial femoral condyle periosteal flap by intraoral anastomosis. The characteristics of medial femoral condyle periosteal flap and the advantages of intraoral anasto-mosis are introduced.
Subject(s)
Humans , Anastomosis, Surgical , Esthetics, Dental , Femur , Maxilla , Plastic Surgery Procedures , Surgical FlapsABSTRACT
Objective To evaluate the outcomes of the free bone flap of medial femoral condyle for treatment of old scaphoid fracture with bone necrosis and review the utility of this procedure.Methods Eleven cases of old scaphoid fracture with bone necrosis were treated with the free medical femoral condyle bone grafting between Feburay,2013 and May,2015(9 males and 2 females).The average age was 34 years ranged from 27 to 55 years.Six cases were in left wrist,and other 5 cases were in right.Six cases were in waist area,and the other 5 cases were proximal pole nonunion.All cases were evaluated with 3D-CT scan,while humpback deformity were occurred in 6 cases,and avascular necrosis at the proximal pole were occurred in 3 cases.After refreshing the fracture,the free medical femoral condyle bone was transferred to the scaphoid,reduct the scaphoid and fix with the Kirschner wire.An endto-side anastomosis was performed with the bone flap artery and the radial artery,accompanied by the end to end anastomosis of the flap vein and the vein with the radial artery.The plaster was used for 8 weeks.Bone healing was evaluated with X-ray and 3D CT scan.A functional review was performed after the operation and a Mayo wrist scoring test was taken 6 months after the treatment.Results The average followed-up period was 13.1 months(ranged from 9 to 24 months).Bone union were demonstrated in all cases at 13.4 weeks after the operation (ranged from 11 to 18 weeks).Mayo wrist scoring testing showed excellent in 5 cases,good in 4 cases,and fair in 2 cases.Conclusion Free bone flap of medial femoral condyle is constant in vascular anatomy,and is easy to perform with plenty bone graft and less morbidity at donor site.Medial femoral condyle bone flap transplantation based on the descending gennicular vessels is an effective method for treatment of old scaphoid fracture with bone necrosis.
ABSTRACT
Objective To evaluate the efficacy of medial femoral tubed skin flap combined with penile elongation for repairing long-segment penile defects.Methods From June 2009 to January 2015,13 cases of long-segment penile defects were treated by medial femoral tubed skin flap with pe nile elongation.Results All cases were followed up for 0.5 to 5.0 years.All flaps survived and all patients had the minor scar in donor areas,with good appearance and feeling of penis.The length of pe nis in flaccid state was 6.3±1.6 cm.The length of penis in erection state was 8.5±1.2 cm;The circumference of penis was 5.3±1.9 cm.1.0 cm × 0.7 cm of necrosis at distal parts occurred in one case early after operation,and healed after dressing changes.Two cases had tumid appearance which influenced penile appearance and sexual intercourse.It was improved by local liposuction.No feeling and e rectile dysfunction developed during the following-up.Except 5 cases who did not married,the other married patients and their partners were satisfied or quite satisfied with sexual intercourse activity.Conclusions Medial femoral tubed skin flap combined with penile elongation is a good method for the treatment of long-segment penile defects.The prosthetic penis could have suitable length,good ap pearance,good feeling and erectile function.
ABSTRACT
PURPOSE: The object of this study was to evaluate entrance angle effects on femoral tunnel length and cartilage damage during anteromedial portal drilling using three-dimensional computer simulation. MATERIALS AND METHODS: Data was obtained from an anatomic study performed using 16 cadaveric knees. The anterior cruciate ligament femoral insertion was dissected and the knees were scanned by computer tomography. Tunnels with different of three-dimensional entrance angles were identified using a computer simulation. The effects of different entrance angles on the femoral tunnel length and medial femoral cartilage damage were evaluated. Specifically, tunnel length and distance from the medial femoral condyle to a virtual cylinder of the femoral tunnel were measured. RESULTS: In tunnels drilled at a coronal angle of 45degrees, an axial angle of 45degrees, and a sagittal angle of 45degrees, the mean femoral tunnel length was 39.5+/-3.7 mm and the distance between the virtual cylinder of the femoral tunnel and the medial femoral condyle was 9.4+/-2.6 mm. The tunnel length at a coronal angle of 30degrees, an axial angle of 60degrees, and a sagittal angle of 45degrees, was 34.0+/-2.9 mm and the distance between the virtual cylinder of the tunnel and the medial femoral condyle was 0.7+/-1.3 mm, which was significantly shorter than the standard angle (p<0.001). CONCLUSION: Extremely low and high entrance angles in both of axial plane and coronal plane produced inappropriate tunnel angles, lengths and higher incidence of cartilage damage. We recommend that angles in proximity to standard angles be chosen during femoral tunnel drilling through the anteromedial portal.
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Anterior Cruciate Ligament/surgery , Anterior Cruciate Ligament Reconstruction/instrumentation , Cadaver , Computer Simulation , Femur/anatomy & histology , Imaging, Three-Dimensional , Knee Joint/diagnostic imaging , Osteotomy/methods , Outcome and Process Assessment, Health Care , Patient Positioning , Surgical Instruments , Tomography, X-Ray ComputedABSTRACT
Background: The femur is thighbone. The angle of femoral torsion is the angle obtaining between the transverse axes of the neck and head that of the lower end of the bone. In the adult, the angle measures about 12 to 15 degrees, but it is considerably greater in the fetus and at birth averages 40 degrees. In postnatal development a reduction of the FNA angle usually occurs during growth. Aim: to evaluate femoral torsion value on dried femora and to find the difference between Japanese, Caucasian and Indian femoral torsion. Method: The present study was carried out on 200 dry normal adult human femora. The bones studied were free of any pathological condition. The male bones were 117 and 83 were female femora out of 200 dried femora. Out of 111 were left and 89 were right femora. The gender of each specimen was determined by the recognized established practice. The angle of anteversion as measured by placing the femur on the osteometric board, the horizontal surface represents the retrocondylar axis and the plane of reference against which the anteversion is measured with the help of the axis of head and neck of the femur. Results: The average anteversion is 16.1 and 15.65 on the right and left sides respectively in male, 18.17 and 17.95 on the right and left sides respectively in female. Statistical analysis using ‘z’ test revealed significant (p<0.05), greater average anteversion in female bones and right-left variations, being greater on the right side. Conclusion: The objective measurement of this angle is of paramount importance in orthopedic surgery for total replacement to attain a normal activity of the replaced joint.
ABSTRACT
PURPOSE: To evaluate the efficacy of sagittal fat-suppressed 3D SPGR MR imaging of the osteoarthritic medial femoral condyle in terms of extent and degree of a focal articular cartilage defect of the knee. MATERIALS AND METHODS: The MRI findings (Disler scale) of normal and osteoarthritic medial femoral condyles from 112 knees were prospectively compared with the arthroscopic findings (Jackson staging). The arthroscopic findings were normal in 10 cases, stage I in 26 cases, stage II in 36 cases, stage III in 21 cases and stage IV in 19 cases on arthroscopy. RESULTS: All 10 cases arthroscopy findings were grade 0 in MRI. Among the 26 knees in arthroscopic stage I, only 11 knees (42.3%) showed surface irregularities on MRI that were consistent with grade 1, otherwise grade 2. All cases of arthroscopic stage II showed grade 2 or grade 3. Stage III was grade 3 in all cases on MRI. Among the 19 knees in arthroscopic stage IV, 16 knees (84.2%) with a large defect showed grade 4 on MRI. The sensitivity, specificity and accuracy of the MRI compared with the arthroscopic findings was 97%, 100% and 97.3%, respectively. The weighted kappa index was 0.7194 and the SE (standard error) was 0.053, suggesting significant consistency. CONCLUSION: The sagittal fat-suppressed 3D SPGR MR imaging is valuable for determining the extent and degree of the articular cartilage lesion of the medial femoral condyle in an osteoarthritic knee.
Subject(s)
Arthroscopy , Cartilage, Articular , Knee , Magnetic Resonance Imaging , Prospective Studies , Sensitivity and SpecificityABSTRACT
Medial femoral cutaneous nerve(MFCN), a sensory branch of the femoral nerve, supplies the skin over the anteromedial aspect of the thigh and knee. Posterior femoral cutaneous nerve(PFCN), comprised of fibers originating from the anterior and posterior divisions of the first three sacral segments, supplies the skin over the posterior aspect of the thigh. Forty nerves of twenty healthy adults, ages from 20 to 58, were tested. The onset and peak latencies of MFCN were 2.3+/-0.2 ms and 2.9+/-0.2 ms respectively. The baseline to peak amplitude was 6.5+/-2.3 V. The onset and peak latencies of PFCN were 2.4+/-0.2 ms and 2.9+/-0.2 ms respectively. The baseline to peak amplitude was 7.1+/-1.7 V.