Degradable high purity magnesium screw in fixing the greater trochanter bone flap pedicled with transverse branch of lateral circumflex femoral artery: Treatment of avascular necrosis of femoral head in 12 young and middle-aged patients / 中华显微外科杂志

Objective:To investigate the effect of a degradable high-purity magnesium screw in fixing the greater trochanter bone flap of a lateral circumflex femoral artery transverse branch in the treatment of ischemic necrosis of femoral head in young and middle-aged adults.Methods:From February 2017 to February 2019, 12 cases (15 hips) of young and middle-aged patients with avascular necrosis of femoral head were treated in the Department of Orthopaedic of Affiliated Zhongshan Hospital of Dalian University. The age of patients was 30-53 years old. According to Association Research Circulation Osseous (ARCO), 2 hips were graded in stage II b, 4 in ARCO II c, 1 in ARCO III a, 5 in ARCO III b, 2 in ARCO III c and 1 in ARCO IV. The greater trochanter bone flap with a lateral circumferential vascular branch was used to fill the necrotic area, and fixed by a biodegradable high purity magnesium screw in the bone flap transfer. At 3, 6 and 12 months postoperation, the patient came to the hospital outpatient clinic for follow-up, and then were reviewed once a year. Imaging efficacy was evaluated by comparing preoperative and postoperative imaging. The Harris score and Visual Anoalogue Scale (VAS) score were tested at 12 and 24 months after surgery. The Harris score and VAS score before and after surgery were compared by Friedman test, and P<0.05 was considered statistically significant. Results:All 12 patients (15 hips) were entered in the 24-36 months of follow-up. At 12 and 24 months after surgery, Harris score was found at 87 (86, 92) and 90 (87, 92) respertively, which were both higher than that before surgery [59 (52, 74)] with a significant statistical difference ( Z=-3.743, Z=-4.473, P<0.05). However, there was no significant difference in Harris scores between 12 and 24 months after the surgery ( Z=-0.730, P>0.05). At the 12 and 24 months after surgery, VAS score was found at 3 (2, 3) and 2 (1, 3) respertively, which were both lower than that before surgery [6 (5, 6) ] with a significant statistical difference ( Z=-3.560, Z=-4.656, P<0.05). There was no statistical difference in VAS scores between 12 and 24 months after surgery ( Z=-1.095, P>0.05). X-ray and CT scan showed that the bone flaps healed well and the areas of osteonecrosis were repaired. Thirteen femoral heads were in good shape, and 2 femoral heads had further collapse of hips. No patients underwent joint replacement surgery at the time of last follow-up. Conclusion:Fixation of the greater trochanter flap of lateral circumflex femoral artery transverse branch with a degradable high-purity magnesium screw can ensure the healing of the flap at the implantation site and avoid the displacement and shedding of the flap. It is a new therapeutic option to treat the avascular necrosis of femoral head of young and middle-aged people.

Isolated Apophyseal Avulsion of the Greater Trochanter Treated by Minimally Invasive Osteosynthesis: A Case Report

@#Isolated apophyseal avulsion of the greater trochanter is a rare condition in the paediatric population, frequently related to avascular necrosis of the femoral head. Since there are few cases in the literature, there is no consensus regarding the best treatment of this injury. Our study describes the case of a 9-year-old patient with an avulsion of the right greater trochanter. A minimally invasive osteosynthesis was performed, achieving complete clinical and radiographic healing of the patient and no long-term complications after four years.

The morphologic relationship of the lesser trochanter with the femoral neck and greater trochanter

Background: The anatomy of the proximal femur comprises important landmarks for many orthopedic surgical procedures. However, this area exhibits morphological differences depending on race, gender and age. Besides being the insertion area of the hip flexor muscles, the lesser trochanter is also used as an angular reference in many orthopedic surgical procedures. The aim of this study is to investigate the morphologic relationship of the lesser trochanter with the femoral neck and greater trochanter.Methods: Around 67 dry femur bones (32 left, 35 right) belonging to humans of unknown gender that belong to the Ankara University Medical Faculty, Department of Anatomy were used in this study. The morphologic relationship of the lesser trochanter (TRMI) with the femoral neck (FN) and greater trochanter (TRMJ) was studied and the results were provided in a table.Results: The measured mean lesser trochanter and greater trochanter tip distance was 67.5±4.9mm (60mm-75mm). The angle between the tip of the lesser trochanter and the center of the femoral neck was measured as 35.050±5.060 (290-420) degrees. The distance between the tip of the lesser trochanter and the center of the femoral neck was measured as 15±2.8mm (10mm-20mm).Conclusions: In addition to the angular relationship of the lesser trochanter with the femoral neck, its relationship in terms of distance with the greater trochanter and femoral neck are the anatomic relationships that are noteworthy for the lesser trochanter, which is used as a landmark during orthopedic surgical procedures.

Comparison of application and curative effects between sternal wire binding and plate fixation of greater trochanter in artificial femoral head replacement of patients with unstable intertrochanteric fracture / 吉林大学学报(医学版)

Objective: To observe the curative effects of artificial femoral head replacement using sternal wire binding and plate fixation in the treatment of the patients with unstable intertrochanteric fracture, and to provide the basis for its treatment. Methods: A total of 52 elderly patients with intertrochanteric fracture treated with artificial femoral head replacement were divided into sternal wire binding group (the patients were given sternal wire binding of greater trochanter, n=28) and plate fixation group (the patients were given plate fixation of greater trochanter, n=24). The operation time, blood loss, the drainage volumes after operation, the time of getting off the bed first, the incidences of early complications, and the Harris scores of hip joint at the discharge time and 1 month, 3 months, 6 months and 12 months after operation of the patients in two groups were recorded. Results: Compared with plate fixation group, the operation time of the patients in sternal wire binding group was decreased (P0. 05). Conclusion: Compared with plate fixation, sternal wire binding of the greater trochanter in femoral head replacement in the treatment of the patients with unstable intertrochanteric fracture has the advantages of shorter operative time, less blood loss volume, better postoperative recovery of hip joint function, which is suitable for the clinical application.

Selecting Arthroplasty Fixation Approach Based on Greater Trochanter Fracture Type in Unstable Intertrochanteric Fractures / 대한고관절학회지

PURPOSE: To evaluate the success rate of fixation approaches for greater trochanter (GT) fracture types in those with unstable intertrochnateric fractures. MATERIALS AND METHODS: Forty-four patients who underwent arthroplasty for unstable intertrochanteric fractures between January 2015 and November 2017 and followed-up more than six months were included in this study. The fractures of GT were classified into one of four types (i.e., A, B, C, and D) and fixed using either figure-8 wiring or cerclage wiring according to fracture type. Fractures were type A (n=7), type B (n=20), type C (n=6), and type D (n=11). Type A and B, which are fractures located above the inferior border of GT were fixed using figure-8 wiring and/or adding cerclage wiring. On the other hand, all type C and D fractures, which were located below the inferior border, were fixed using cerclage wiring. Fixation failure was defined as breakage of wire and progressive migration of GT fragment greater than 5 mm on follow-up radiographs. RESULTS: The most common GT fracture types were B and D, both of which are longitudinal fractures. The success rates of fixation were 85.7% (6 out of 7 cases) for the treatment of type A, 90.0% (18 out of 20 cases) for the treatment of type B, and 100% for the treatment of types C (6 out of 6 cases) and D (11 out of 11 cases). CONCLUSION: We note high success rates following fixation methods were selected based on the GT fracture type.

The Effect of Screw Apophysiodesis of Greater Trochanter in Legg-Calve-Perthes Disease / 대한정형외과학회잡지

PURPOSE: To evaluate the interstitial and appositional growth of greater trochanter post-screw apophysiodesis in Legg-Calve-Perthes (LCP) disease. MATERIALS AND METHODS: A total of 17 patients, who were diagnosed with LCP and underwent greater trochanter screw apophysiodesis and metal removal between December 2003 and December 2012, and were followed-up for at least 4 years, were selected. Anterioposterior radiologic images were taken in each process of apophysiodesis, metal removal, and last follow-up. From such images, articulotrochanter tip distance (ATD), trochanter tip-screw distance (TSD), trochanter tip-trochanter lower margin distance (TLD), and screw-trochanter lower margin distance (SLD) were measured. Appositional growth and greater trochanter growth rates were compared using paired t-test, independent t-test, and correlation analysis. RESULTS: The average ATD of the affected and unaffected sides was 14.2 and 16.8 mm, respectively at apophysiodesis and 9.2 and 14.8 mm at the last follow-up, with a significantly greater decrease observed on the affected side the unaffected side (p=0.030). TLD of the affected side during the follow-up increased 11.0 mm, from an average of 30.8 to 41.8 mm, while the un-affected side increased 14.3 mm, from an average of 26.7 to 41.0 mm. The growth of greater trochanter after the operation in the affected side was 76.7% of that in unaffected side. The ratio of TLD of the affected side to the unaffected side was significantly reduced, from 1.15 to 1.02 (p=0.014) at the final follow-up. TSD was significantly increased from 4.5 to 14.4 mm at metal removal (p < 0.001) and increased to 17.0 mm at the last follow-up. Moreover, the ratio of TSD to SLD was significantly increased from 0.20 to 0.74 at metal removal (p < 0.001) and increased to 0.84 at the final follow-up. CONCLUSION: The results of this study showed that screw apophysiodesis can suppress the overall growth, but not the appositional growth of the greater trochanter. Therefore, screw apophysiodesis may not be a good procedure to inhibit the growth of greater trochanter.

Incidence of Varus Malalignment Post Interlocking Nail in Proximal Femur Shaft Fractures Comparing Two Types of Entry Points

Introduction: Osteosynthesis of the femur using an interlocking nail is the gold standard for treating diaphyseal fractures of the femur. There are two established entry points for the antegrade interlocking nails which is the piriformis fossa or the greater trochanter. It has been reported that varus malalignment was frequently seen in proximal femur fracture which were treated with interlocking nail utilizing the greater trochanter entry point. The study was done to find out if the problem was of significance. Materials and Methods: This was a retrospective study which included 179 patients with femur fractures which were treated from January 2013 till September 2015 in one Hospital. They were treated with interlocking nail either by utilizing the piriformis fossa (PF) or the greater trochanter (GT) entry points. Post-operative radiographs of the femur were used to measure the varus deformity. Results: Out of 179 patients, there were 5 patients who were reported to have unacceptable varus malalignment (2.79%). These 5 patients were out of the 88 (5.68%) patients utilizing the greater trochanter as the entry point. The same 5 patients were out 90 patients that were diagnosed with proximal femur shaft fractures (5.55%). Analysis with logistic regression was statistically not significant. Conclusion: There was higher rate of varus malalignment seen in proximal femur shaft fractures treated with interlocking nails utilizing the greater trochanter entry point. The incidence of varus malalignment was not significant statistically. Key Words: interlocking nail; greater trochanter entry point; varus deformity; femur shaft fracture

The Fixation Method according to the Fracture Type of the Greater Trochanter in Unstable Intertrochanteric Fractures Undergoing Arthroplasty / 대한고관절학회지

PURPOSE: We conducted a study on patients who underwent hip joint arthroplasty because of unstable femur intertrochanteric fractures with greater trochanter bony fragments. After dividing patients into three groups depending on their fracture patterns, we evaluated the clinical and radiological outcomes of different operation methods applied to each of these groups. MATERIALS AND METHODS: Using Evan's classification, we defined an unstable intertrochanteric fracture as those characterized as stage 4 or 5. Of the 137 patients presenting with an intertrochanteric fracture with osteoporosis (bone mineral density, <−2.5) between March 2014 and October 2015, 63 met the eligibility criteria and were included in this study. Next, patients were divided into three groups based on their greater trochanter fracture patterns (discerned with three-dimensional computed tomography images); different fixation methods were applied to each group by a single orthopaedic surgeon. RESULTS: Taken as a whole, 50 out of 63 patients experienced no reduction in walking distance in their daily lives. Harris hip score increased from 74.8 to 85.7 point and we considered this a relatively good result. Radiologically, we observed complete bone union in 62 cases (98.4%); the lone exception was in a patient who experienced osteolysis. There were also 3 cases who removed greater trochanter reattachment device due to broken implant and 1 case of dislocation. CONCLUSION: The different fixation methods applied to three distinct groups with varying fractures patterns were successful in achieving proper reduction and fixation of greater trochanteric fractures. We also observed reduced bone union periods when arthroplasty was performed in patients with unstable intertrochanteric fractures. Lastly, we believe these approaches may also aid in achieving early ambulation and early rehabilitations.

Clinical followed-up study of greater trochanter bone flap with the lateral femoral circumflex artery reconstruct femoral head / 中华显微外科杂志

Objective To analyze retrospectively the clinical efficacy that the application with vascularized greater trochanter to reconstruct the collapse of femoral head necrosis.Methods Followed-up the data of 21 patients who underwent reconstruction of the femoral head from January,2008 to December,2012,by this we made the clinical and radiological assess,Harris hip scoring system was used to evaluate the situation of hip function.All patients were followed up regularly for X-ray film (after 3 months,6 months and then be reviewed once a year),by the film we assessed the bone healing and repair of the femoral head,and determined whether had the progress in phases.The clinical survival was decided by receiving or not the arthroplasty.Results All 21 patients were followed up for 24-72 months,with an average of 47 months.The postoperative Harris hip score was 82.8 ± 7.1 points,compared with the preoperative,the score improved significantly (average 52.4 ± 4.3 points for preoperative),the difference was statistically significant (P ＜ 0.05).Based on Ficat stage for osteonecrosis,8 patients in this group had progress after 24 to 48 months (mean 33 months),whose femoral heads got collapse worsened.The radiographic success rate was 61.9％.Six cases received arthroplasty in 18 to 48 months (mean 34 months) due to progressive collapse of the femoral head or severe hip pain,or both.FicatⅢ contained 25％ (4 hips),and Ⅳ had 40％ (2 hips),the clinical survival rate was 71.4％.Conclusion The application with vascularized greate.r trochanter transfer coverage to rebuild the collapse of the femoral head in patients with osteonecrosis is a good way.It' s worthy to be applied.

Comparison of Greater Trochanter Versus Piriformis Entry Nail for Treatment of Femur Shaft Fracture

PURPOSE: The purpose of this study was to compare the clinical outcome of femoral shaft fracture treatment with intramedullary nailing performed using a greater trochanter and a piriformis entry nail. MATERIALS AND METHODS: A total of 57 patients treated by antegrade nailing for a femoral shaft fracture between January 2008 and April 2013 were included in this study. We evaluated postoperative radiographs of 57 femoral shaft fractures stabilized with femoral intramedullary nailing at a single institutional center. The cases included 25 piriformis fossa entry nails and 32 greater trochanter entry nails. Outcome measures included the alignment, union rate and duration of union, complications, operation time, intra-operative bleeding, and a pain rating scale. RESULTS: The alignment, union rate, and duration of union did not differ significantly between the groups with piriformis fossa and trochanteric nailing. In addition, no significant differences regarding complications and operation time were observed between the two groups. Less intra-operative bleeding was observed in the trochanteric nailing group. This difference was statistically significant (p=0.044). CONCLUSION: Use of a femoral nail specially designed for the trochanteric insertion resulted in equally high union rates, duration of union, and low complication rates. Thus, greater trochanter entry nails were similar to conventional antegrade femoral nailing through the piriformis fossa.

Fracture of the Greater Trochanter during Closed Reduction of Obturator Type Hip Dislocation / 대한고관절학회지

Obturator (Inferior) type dislocation of the hip joint is a rare and the fracture of greater trochanter during closed reduction for it has never been reported in literature. In this report, we present a case of a fracture of greater trochanter during difficult closed reduction which required operative fixation. Surgeons need to be aware of this complication and excessive force for reduction should be avoided when treating of this type dislocation.

Fixation of the Greater Trochanter in Arthroplasty for Unstable Intertrochnateric Fracture

PURPOSE: We classified fractures of the greater trochanter (GT) and evaluated fracture fragment stability according to GT type. MATERIALS AND METHODS: A total of 43 patients with an unstable intertrochanteric fracture treated between January 2007 and July 2009 with bipolar hemiarthroplasty were included in this study. GT fractures were classified as type A, B, C, or D and fixed using either cerclage wiring alone, cerclage wiring and non-absorbable suture or a greater trochanteric reattachment (GTR) plate. RESULTS: Type A fractures were fixed using cerclage wiring with non-absorbable suture in two cases, cerclage wiring in six cases and GTR plate in seven cases. Failure occurred in three cases of type A fractures treated with cerclage wiring alone. A total of 11 type B fractures were fixed with cerclage wiring (7), cerclage wiring and non-absorbable suture (3) and GTR plate (1). There was no failure of type B fractures. Type C fractures were fixed using cerclage wiring with non-absorbable suture in one case and GTR plate in three. There was no fixation in three cases. Of 10 type D fractures, six were treated with cerclage wiring and one with GTR plate. Fixation was not performed in three patients. There was no failure in type C and D type fractures. CONCLUSION: Fracture fragment stability differed according to fracture types. Cerclage wiring alone was insufficient to fix type A fractures, so type A fracture required a stronger fixation method.

Treatment of Femoral Shaft Fracture with an Interlocking Humeral Nail in Older Children and Adolescents

PURPOSE: Rigid interlocking nailing for femoral shaft fracture is ideal for use in adolescents in terms of stability of the fracture and convenience for the patient. However, numerous authors have reported that rigid interlocking nailing has some limitations in this age group due to the risk of complications. We evaluated the results of intramedullary nailing for femoral shaft fractures with an interlocking humeral nail in older children and adolescents. MATERIALS AND METHODS: We retrospectively reviewed records of patients treated with an interlocking humeral nail. Radiographs were examined for proximal femoral change and evidence of osteonecrosis. Outcomes were assessed by major or minor complications that occurred after operative treatment. RESULTS: Twenty-four femoral shaft fractures in 23 patients were enrolled. The mean age at the time of operation was 12 years and 8 months and the mean follow-up period was 21 months. Bony union was achieved in all patients without any complications related to the procedure such as infection, nonunion, malalignment and limb length discrepancy. All fractures were clinically and radiographically united within an average eight weeks. No patients developed avascular necrosis of the femoral head and coxa valga. CONCLUSION: Intramedullary nailing through the greater trochanter using a rigid interlocking humeral nail is effective and safe for the treatment of femoral shaft fractures in older children and adolescents.

Bipolar Hemiarthroplasty Using the Greater Trochanter Reattachment Device (GTRD) for Comminuted Intertrochanteric Femur Fracture in Elderly Patients

PURPOSE: To evaluate the clinical and radiological outcome of the greater trochanter reattachment device (GTRD) as firm fixation method for displaced greater trochanter fragment in bipolar hemiarthroplasty for comminuted intertrochanteric femur fracture in elderly patients. MATERIALS AND METHODS: From January 2006 to January 2008, 32 patients above 70 years old treated with bipolar hemiarthroplasty using the GTRD as fixation method for comminuted intertrochanteric femur fracture with greater trochanter bone fragment displaced above 1 cm. They were followed up for more than one year. Clinically, the postoperative Harris hip score (HHS) and daily activities of life of Johnston et al were evaluated, and radiological, any displacement of greater trocharter bone fragments and/or GTRD. RESULTS: The mean postoperative HHS was 71.6 (range, 53~82) points. In rating the daily activity of life, twenty seven (84.4%) patients` postoperative results were above fair. Two patients (6.3%) had displacement of the greater trochanter bone fragment above 1 cm. One patient had a deep infection, so we removed the bipolar head and inserted antibiotics-loaded cement block instead, and after the infection was controlled, conversion to total hip arthroplasty was done. CONCLUSION: In bipolar hemiarthroplasty for comminuted intertrochanteric femur fracture with displaced greater trochanter bone fragment, GTRD produced satisfactory results and early rehabilitation.

Reconstruction of Greater Trochanteric defect using Lumbar Artery Perforator Free Flap: A Case Report

There could be several methods for trochanteric reconstruction including local flap, pedicled perforator flaps, free flap, etc. We performed greater trochanteric reconstruction with lumbar artery perforator free flap in some aberrant method. So we report this experience with review of literatures. A 42-year-old man visited our hospital with a large soft tissue defect in his left greater trochanteric area by traffic accident. The patient had wide skin and soft tissue defect combined with open femur fracture. During one month period of admission, he underwent femur open reduction and wound debridement four times. After that we planned thoracodorsal perforator free flap reconstruction. The flap was outlined as large as 20x15 cm and elevated in a suprafascial plane from the lateral border. During intramuscular perforator dissection, we found that two 1.5 mm diametered perforator vessels coursed inferomedially toward second lumbar region. Finally the flap became lumbar artery perforator flap based on second lumbar artery perforator as a main pedicle. After flap transfer, the perforator vessels were connected with inferior gluteal artery and vein microsurgically. The operation was successful without uneventful course. We found no significant postoperative complication and donor site morbidity during six months follow up periods. Lumbar artery perforator flap could be an alternative procedure for thoracodorsal perforator flap in some patients with anatomic variant features.

Distal Transfer of Greater Trochanter in Patients with High-Standing Greater Trochanter by Legg-Calve-Perthes (LCP) Sequelae

PURPOSE: To evaluate the clinical and radiological results of distal transfer of the greater trochanter in patients with a high-standing greater trochanter as a sequela of LCP disease. MATERIALS AND METHODS: Between 1994 and 2005, ten cases (nine patients) underwent distal transfer of a highstanding greater trochanter and were followed up for more than 2 years after surgery. The clinical findings, such as the abduction of the hip, VAS score, and Trendelenburg sign, were evaluated. In addition, the centrotrochanteric distance (CTD) and Lever arm ratio (LAR) were used for the radiographic assessment. RESULTS: The mean range of abduction improved from 27.5degrees to 40degrees , and the VAS score improved from 4.1 to 1.2. Seven cases with positive Trendelenburg sign before surgery showed negative Trendelenburg sign after the surgery. At the last follow-up, the CTD improved from -1.52 cm to -0.2 cm and the LAR decreased from 2.2 to 1.8. CONCLUSION: The distal transfer of the greater trochanter in patients with a high standing greater trochanter as a consequence of LCP is an effective procedure that can reduce the level of hip pain and improve the hip abduction if careful patient selection is performed.

Methods to Increase the Effectiveness of Trochanteric Stabilizing Plate for Unstable Femoral Intertrochanteric Fractures with Gtreater Trochanteric Fracture: Fixation of Greater Trochanter with Wire and Screw

PURPOSE: The clinical outcome is favorable for the treatment of unstable femoral intertrochanteric fractures using both dynamic hip screw (DHS) and trochanter stabilizing plate (TSP) in elderly patients. However, there are sometimes complications related to excessive sliding. Therefore, the aim of this study was to evaluate the value of additional fixation of greater trochanter using wires and screw in the unstable femoral intertrochanteric fractures with a greater trochanter fracture. MATERIALS AND METHODS: From March 2004 through December 2005, thirty-seven patients, who were more than sixty-five years of age and were diagnosed with osteoporosis, were treated with DHS and TSP in unstable femoral intertrochanteric fractures with a follow-up of more than 6 months (mean duration, 13.5 months). The patients were divided into two groups. One group (group A: 20 patients) was treated with DHS and TSP only, whereas the other (group B: 17 patients) was treated with DHS and TSP augmented by a wire and screw. The average age was 80.9 (range 68 to 89) and 83.2 years (range 72 to 91) in groups A and B, respectively. All the patients in both groups were assessed radiographically immediately after surgery and at the last follow-up. The level of sliding of the lag screw and displacement of the greater trochanter were evaluated statistically. RESULTS: Bony union was achieved in all cases except for two cases in group A. At the last follow-up, the average of lag screw sliding in groups A and B was 8.96+/-5.98mm and 4.80+/-3.68, respectively, showing a statistical difference (P value0.05). CONCLUSION: Unstable femoral intertrochanteric fractures can be treated successfully using a hip screw and TSP alone. However, the addition of wires and screws in the greater trochanter can prevent excessive sliding that occurs after displacing the greater trochanteric fragments out of the plate in the presence of a greater trochanteric fracture line or severe bone defect in the lateral aspect.

INFLUENCE OF DIFFERENCE IN BUOYANCY ON PHYSIOLOGICAL RESPONSES DURING TREADMILL WALKING IN WATER / 体力科学

The aim of this study was to clarify the influence of buoyancy on physiological responses during treadmill walking. Six subjects participated in this experiment. The water level was adjusted to the greater trochanter. Normal water (NW) and 1.135 kg/<i>l</i> of specific gravity (high buoyancy ; HB) were set. Oxygen uptake (VO₂), heart rate (HR), and rating of perceived exertion were measured during exercise. VO₂ in HB at all walking speeds were higher than those in NW significantly. HR enhanced in HB over the walking speed of 70 m/min significantly. It was clear that the workload of walking in HB increased remarkably over the walking speed of 70 m/min. This suggested that the water resistance acted on the phenomenon of increase of the workload in HB. Furthermore, it was suggested that walking in HB was useful for rehabilitation and therapeutic exercise in the low-speed and for physical training in the high-speed.

ARTHROPLASTY OF HIP WITH TRANSPOSITION OF GREATER TROCHANTER AND FASCIAL FLAP WITH VASCULAR PEDICLE / 解放军医学杂志

Objective To evaluate a new method of arthroplasty by transposing the greater trochanter together with a fascia flap pedicled by a branch of transverse lateral circumflex femoral artery. Methods On the basis of anatomical study, arthroplasty of the hip by transposition of the greater trochanter with fascia flap pedicled by a branch of transverse lateral circumflex femoral artery was performed in 17 patients (18hip). All the patients were followed up for six years and two months to eight years and two months. Results Pain vanished in 10 cases, slight pain remained in 1 patient, walking was nearly normal in 5 patients, and 2 patients were still limping with fast walk. Range of movement of the hip joint was as follows: flexion and extension 60?-120?, adduction 5?-15?, abduction 5?-10?, internal rotation 0?-5?, and external rotation 0?-5?. As shown by radiography, the joint space was obviously enlarged, the configuration of the femoral head was sharp, and the union between the greater trochanter and the femoral head was good. Conclusion Transposition of the greater trochanter with fascia flap pedicled by a branch of transverse lateral circurmflex artery to femoral head could result in a solid union with cartilagenous ossification and satisfactory recovery of function of the hip joint.

Isolated Fractures of the Greater Trochanter Report of 6 Cases

Isolated fractures of the greater trochanter are unusual injuries. Because of their relative rarity and the unsettled controversy regarding their etiology and pathogenesis, several methods of treatment have been advocated. Furthermore, the reports on this particular type of injury are not plentiful and the average textook coverage afforded to this entiry is limited. These fractures are seen as two distinctly different types which occur in different age groups. The first type are epiphyseal separations which are found in the adolescent population, ususlly from seven to seventeen years of age. In this type, the mechanism of injury is muscle contraction that results in avulsion of the entire trochanteric apophysis and it can be displaced up to 6 cm. The second type is a comminuted fracture of the greater trochanter seen in adults. In this type, the mechanism of injury is usually a direct blow to the greater trochanter that results in a comminuted fracture, and only a part of the greater trochanter is generally involved.