Analysis of effectiveness of greater trochanteric osteotomy approach and K-L posterior approach in patients with type Ⅳ Pipkin fracture / 中国修复重建外科杂志

Objective: To investigate the effectiveness of two surgical approaches in the treatment of type Ⅳ Pipkin fracture. Methods: The clinical data of 15 patients with type Ⅳ Pipkin fracture treated surgically between July 2013 and June 2018 were retrospectively analyzed. According to different surgical approaches, they were divided into group A (8 cases, using K-L posterior approach) and group B (7 cases, using greater trochanter osteotomy approach). There was no significant difference in gender, age, cause of injury, and interval from injury to operation between the two groups ( P>0.05). The incision length, operation time, intraoperative blood loss, hospital stay, fracture healing time, and complications of the two groups were recorded. Hip joint function recovery was evaluated according to Thompson-Epstein functional evaluation system. Results: All the 15 patients were followed up 1-5 years, with an average of 2.5 years. There was no significant difference in operation time between the two groups ( t=14.681, P=0.100); the incision length, intraoperative blood loss, and fracture healing time in group A were all greater than those in group B, and the hospital stay was shorter than that in group B, showing significant differences ( P<0.05). In group A, 1 patient presented hip pain, clasthenia, and limited mobility after operation, 1 patient presented ossifying myositis, 1 patient presented osteonecrosis of the femoral head, 1 patient presented fat liquefaction of incision, and 1 patient presented sciatica, with a complication incidence of 62.5%. Postoperative hip pain occurred in 1 patient and ossifying myositis in 2 patients in group B, with a complication incidence of 42.9%. There was no significant difference in the incidence of complications between the two groups ( χ2=-0.735, P=0.462). At last follow-up, according to Thompson-Epstein functional evaluation system, the results in group A were excellent in 3 cases, good in 2 cases, fair in 2 cases, and poor in 1 case, with an excellent and good rate of 62.5%; in group B, the results were excellent in 4 cases, good in 2 cases, and fair in 1 case, and the excellent and good rate was 85.7%. There was no significant difference in good and fair rate between the two groups ( χ2=-0.990, P=0.322). Conclusion: K-L posterior approach is more convenient in the fracture treatment during operation, but it has greater trauma, greater vascular damage, and more blood loss. The greater trochanter osteotomy approach can better protect the blood supply of femoral head, shorten the operation time, reduce intraoperative blood loss, and reduce postoperative complications. It is an ideal way in the surgical treatment of type Ⅳ Pipkin fracture.

The role of trochanteric flip osteotomy in fixation of certain acetabular fractures / 中华创伤杂志(英文版)

<p><b>PURPOSE</b>Complete visualization of certain acetabular fractures of posterior wall or column with cranial extension involving superior dome from standard surgical exposures is a challenge. Osteotomy of the greater trochanter has been used to enhance fracture visualization, especially the dome, in posterior and lateral exposures of the acetabulum. It also decreases the need for excessive muscle retraction. The purpose of the study was to investigate the outcome associated with trochanteric flip osteotomy in the management of certain acetabulum fractures.</p><p><b>METHODS</b>From January 2011 to December 2013, 25 displaced acetabular fractures were treated by open reduction and internal fixation. The fractures were managed using a Kocher-Langenbeck approach along with trochanteric flip osteotomy. At 3rd, 6th and 24th month follow-up, all patients had radiographic examination and underwent a final clinical evaluation based on the modified Merle d'Aubigne and Postel score. The strength of the abductors was assessed according to the Medical Research Council (MRC) grading system.</p><p><b>RESULTS</b>Congruent reduction was achieved in all patients and all osteotomies healed within an average period of 3.8 months. All our patients were allowed full weight bearing at the end of 3 months and with no abductor lurch at the end of 6 months follow-up. There were no cases of avascular necrosis of femoral head. None of the patients had any neurovascular complication or infection by the end of the follow-up period.</p><p><b>CONCLUSION</b>Trochanteric flip osteotomy is a very effective technique to fix certain acetabular fractures especially those with dome involvement. It is more accurate and associated with no significant complications compared with conventional way.</p>

Treatment of posterior dislocation and acetabular posterior column (wall) fracture with greater trochanteric os-teotomy via Kocher-Langenbeck approach / 局解手术学杂志

Objective To introduce the operation method and curative effect of posterior dislocation and acetabular posterior column ( wall) fracture with greater trochanteric osteotomy via Kocher-Langenbeck approach. Methods 14 cases of posterior dislocation and ace-tabular posterior column( wall) fracture who were treated by greater trochanteric osteotomy via Kocher-Langenbeck approach were collected, and the surgical methods, intraoperative situation and postoperative recovery were analyzed. Results The mean operating time is 105 min and the mean bleeding volum is 600 mL. After operation, there were 5 cases of anatomical reduction;8 cases of good reduction;1 cases of unsatisfactory reduction. Among the patients, 7 cases were of excellent clinical effect;4 cases were of good clinical effect, 3 cases were of medium clinical effect. Heterotopic ossification occurred in 3 cases and traumatic arthritis occurred in 4 case. Both acetabular posterior col-umn ( wall) and trochanter osteotomy ends were healed, and there was no iatrogenic sciatic nerve and femoral head necrosis injury. Conclu-sion In treatment of posterior dislocation and acetabular posterior column ( wall) fracture, greater trochanteric osteotomy via Kocher-Lange-nbeck approach can provide excellent exposure, and it is conducive to the reduction and fixation of fracture and dislocation.

Osteotomía del trocánter mayor tipo flip en el tratamiento quirúrgico de fracturas de acetábulo / Trochanteric flip osteotomy in the treatment of acetabular fractures

Objective: Analyze a series of patients that underwent surgery for an acetabular fracture in which a trochanteric flip osteotomy was used and discuss the advantages of this surgical procedure. Materials and Method: The clinical files of 8 patients treated of acetabular fractures with this approach is reported. Functional results are evaluated with the Merle d´Aubigne scale. Also, postoperative complications were age of patients was 41 years (range: 28-60 years). Mean follow-up was 13.8 months (range: 4-41 months). Functional results were excellent in 2 patients, good in 4 patients, regular in one patient and poor in one patient. Postoperative complications include two cases of heterotopic ossifications. No loosening of the osteotomy or avascular necrosis of the femoral head was observed. Conclusions: This technique facilitates in selected acetabular fractures, to obtain better visualization and more accurate reduction, by allowing safely dislocation of the femoral head and assessment of the intraarticular reduction.

Objetivo: Revisar los resultados radiológicos y funcionales de una serie de pacientes operados por fractura de acetábulo en que se utilizó un abordaje posterior con osteotomía del trocánter mayor tipo "flip", discutir ventajas y complicaciones potenciales de esta técnica. Material y Método: Se revisaron las fichas clínicas de 8 pacientes operados por fractura de cotilo en que se utilizó la osteotomía del trocánter mayor tipo "flip". Se evaluaron las complicaciones observadas y los resultados clínicos con la escala de Merle d`Aubigne. Resultados: La edad promedio de los pacientes fue de 41 años (rango: 28-60 años). El seguimiento promedio fue de 13,8 meses (rango: 4-41 meses). En cuanto a los resultados funcionales, en 2 pacientes fueron excelentes, en 4 pacientes buenos, en 1 paciente regular y en 1 paciente malo. Las complicaciones fueron 2 casos de osificaciones heterotópicas grado I y II de Broker. No hubo casos de aflojamiento de trocánter mayor o necrosis avascular. Conclusiones: Esta técnica quirúrgica facilita el tratamiento en casos seleccionados de fracturas acetabulares, al permitir luxar la cadera y mejorar la visualización de la reducción intraarticular, sin agregar mayores complicaciones.

Revision Total Hip Replacement using a Cementless Wagner SL Femoral Stem

PURPOSE: To evaluate the clinical and radiological changes of femoral revision with the Wagner SL stem. MATERIALS AND METHODS: 21 femoral revisions were performed in 21 patients (16 males and 5 females; mean age 58.9 years) between June 1997 and July 2005, utilizing the Wagner SL stem. The follow-up period was a mean of 31 months (range 25-84 months). Causes of revision included aseptic loosening (14 cases), periprosthetic fracture (4 cases), recurrent total hip dislocation (2 cases), and neglected bipolar hip dislocation (1 case). Greater trochanteric osteotomy was performed in 10 cases, and extended trochanteric osteotomy was performed in 6 cases. Clinical results were assessed using Harris hip score. Radiographic parameters such as stem subsidence, calcar atrophy, and stressshielding were also assessed. RESULTS: The mean Harris hip score improved from 45.7 to 91.3. There was no removal of the implanted Wagner stem. One case of nonunion of the greater trochanter was treated by fixation with Dall-Miles cables and a trochanteric plate. There was one case of limb shortening of 2 cm. CONCLUSION: The Wagner SL stem provided immediate stability and allowed early weight-bearing. Bony regeneration around the stem was achieved without resorting to a bone graft.

The Extended Trochanteric Osteotomythrough the Lateral Approachin Revision Hip Arthroplasty / 대한정형외과학회잡지

PURPOSE: To review the results and discuss the technique for an extended trochanteric osteotomy through the lateral approach in revision total hip arthroplasty. MATERIALS AND METHODS: Twenty patients were reviewed after an average follow-up of 30.4 months (range, 24-56 months) between 1999 and 2003. The indications for the extended trochanteric osteotomy included the removal of a well-fixed cemented or cementless stem in 12 hips, varus remodeling of the femur in 3 hips and trochanteric malposition in 5 hips. The length of the osteotomy, the proximal migration of the osteotomized fragment, the fixation status of the femoral stem, the union status of the osteotomy site and complications were evaluated at the last follow-up. RESULTS: The mean length of the osteotomy was 12 cm (range, 8-20 cm). Radiographic union of the osteotomy site was noted in all cases after an average of 3.8 months (range, 2.5-6.0 months). The mean migration of the osteotomized fragment was 2.4 mm (range, 0-8 mm). The complications included postoperative dislocation in 3 hips and fractures of the osteotomy fragment in 2 hips, which were treated at the last follow up. Fixation of the stem with bone ingrowth was noted in all patients. CONCLUSION: An extended trochanteric osteotomy through the lateral approach can be performed safely in complex revision total hip arthroplasty.

Preoperative Planning of Oblique Femoral Trochanteric Osteotomy by Geometric Analysis / 대한정형외과학회잡지

Oblique single-plane trochanteric osteotomy, in which an oblique cut is made through the femoral trochanteric area and the bony fragments are rotated at the face of the cut in direct contact with each other, allows simulatenous correction of the femoral neck-shaft angle, femoral anteversion as well as flexion/extension effect. Only approximate methods of calculating the correction effects of this procedure have been introduced. Considering unique spatial orientation of femoral neck, we developed a rigorous method to calculate preoperatively the obliquity of the single-plane osteotomy and the amount of rotation required to achieve the target femoral conformation, through geometric analysis. The correction effect by oblique trochanteric osteotomy on the geometry of proximal femur was dependent not only on the amount of change of the neck-shaft angle and femoral anteversion but also on the preoperative neck-shaft angle and femoral anteversion themselves. The flexion/extesion effect was determined by the direction of the correction and the preoperative neck orientation. Computer graphic simulation study confirmed the validity of this method. A program written in QBASIC was introduced to make this complex calculation method more useful in the clinical practice.

The Changes of the Intra-Osseous Venographic Findings of the Proximal Femur before and after Intertrochanteric Varus Osteotomy in Legg-Calve-Perthes' Disease: Comparision of Venographic Changes between Normal and Affected Hip / 대한정형외과학회잡지

In order to clarify the changes of the venous circulation in normal and affected hip with Legg-Ca1ve-Perthes' disease(L.C.P.D.) and to assess the effect of intertrochanteric varus osteotomy on the venous circulation around the proximal femur in L.C.P.D., intra-osseous venography(I.O.V.) was performed before osteotomy and also 8 weeks later when K-wires or staples used at the time of osteotomy were removed. Results obtained were as follows: 1. The material was consisted of 13 normal and 17 hips with L.C.P.D.. There were 14 boys and one girl, with a mean age of 6.1 years ranged from 5 to 9 years; in two patients the disease was bilateral. 2. When the hips with L.C.P.D. were divided into four groups by the method described by Catterall, three hips were included in group II, ten in III and four in IV. 3. In I.O.V. of the proximal femoral metaphysis on 13 normal hips, the opaque medium disappeard rapidly through the local venous system around the proximal femur, and no regurgitation into diaphysis were noted. But gluteal and medial circumflex vein in each one case was not visualized. 4. Of 17 hips with L.C.P.D., an I.O.V. was carried out before and after the intertrochanteric osteotomy. The ligamentum teres and gluteal vein appeared in only 4(24%) and 7 hips (41%) before and after osteotomy. And the lateral and medial circumflex vein visualized in 12(71%) and 15 hips before osteotomy and in 17 hips, both after osteotomy. The diaphyesal regurgitation in 35 % and trochanteric venous pooling of the opaque medium in 47%, indicating venous congestion on the trochanteric region of femur, disappeared after the osteotomy. But no significant differences in their age and group of L.C.P.D. were found. All of these findings suggest that the impaired venous system around the proximal femur and increased intra-osseous pressure on proximal femur may act as one of the important role in pathophysiology of the L.C.P.D., and the intertrochanteric osteotomy might have some positive effect for the normalization of venous circulation and intra-osseous pressure in L.C.P.D..