Luxación de cadera asociada a fractura del extremo proximal de fémur: reporte de caso y revisión del tema / Hip dislocation associated with fracture of the proximal end of the femur: case report and literature review / Luxação do quadril associada a fratura da extremidade proximal do fêmur: relato de caso e revisão da literatura

Las luxaciones traumáticas de cadera son poco frecuentes, y es excepcional la asociación lesional con fracturas del extremo proximal de fémur, habitualmente producidas por accidentes de alta energía. Un correcto diagnóstico, y tratamiento adecuado de la fractura, es la conducta ideal para disminuir las complicaciones. Presentamos el caso de un paciente masculino 49 años trabajador de la construcción que, en un accidente de tránsito, sufre una luxación de cadera asociado a fractura de cuello femoral, con excepcional presentación radiológica, con lesión del nervio CPE (ciático poplíteo externo), en que se realizó artroplastia total de cadera, con buena evolución y rehabilitación, retornando a su actividad laboral a los 11 meses del accidente. A propósito de este caso, realizamos una revisión bibliográfica para evaluar el tratamiento propuesto, el ideal, y pronóstico funcional de estas lesiones.

Traumatic hip dislocations are rare, and associated injuries involving fractures of the proximal end of the femur, usually as a result of high-energy accidents, are exceptional. A correct diagnosis and adequate treatment of the fracture is the most appropriate way to reduce complications. We present the case of a 49-year-old male construction worker who, as a result of a traffic accident, suffers from a hip dislocation associated with a femoral neck fracture, with exceptional radiological presentation, with injury to the EPS (External Popliteal Sciatic) nerve. Total hip arthropathy was performed, with good evolution and rehabilitation, and patient returned to work 11 months after the accident. In this particular case, we carried out a bibliographic review to evaluate the proposed treatment, the ideal treatment, and the functional prognosis of these injuries.

As luxações traumáticas do quadril são raras, e a associação de lesão com fraturas da extremidade proximal do fêmur, geralmente causada por acidentes de alta energia, é excepcional. O diagnóstico correto e o tratamento adequado da fratura é a abordagem ideal para reduzir as complicações. Apresentamos o caso de um operário da construção civil, 49 anos, que, em acidente de trânsito, sofre luxação de quadril associada a fratura do colo do fêmur, com apresentação radiológica excepcional, com lesão do nervo ciático poplíteo externo (CPE), em onde foi realizada a artroplastia total do quadril, com boa evolução e reabilitação, retornando ao trabalho 11 meses após o acidente. Em relação a este caso, realizamos uma revisão bibliográfica para avaliar o tratamento proposto, o ideal e o prognóstico funcional dessas lesões.

Fractura por estrés del cuello del fémur en una niña hiperactiva tratada con metilfenidato: Reporte de caso / Femoral neck stress fracture in a hyperactive child taking methylphenidate. Case report

Las fracturas por estrés afectan, con mayor frecuencia, a personas físicamente activas con hueso normal y son infrecuentes en los niños con placa de crecimiento abierta. Aun más infrecuentes son las fracturas por estrés del cuello femoral en la población pediátrica. Sin embargo, constituyen entidades muy importantes debido al riesgo de complicaciones graves, como la necrosis avascular. Se describe el caso de una niña de 7 años medicada con metilfenidato que sufrió una fractura por estrés del cuello del fémur atípica. La paciente consulta por dolor inguinal derecho sin limitaciones en las actividades cotidianas. La radiografía muestra una fractura por estrés del cuello del fémur, que se confirma con tomografía. Se instaura un tratamiento conservador, y la paciente está asintomática a las cuatro semanas. Este caso representa una alerta sobre esta infrecuente entidad en la que podrían presentarse errores diagnósticos. Investigaciones recientes también sugieren la posible participación de fármacos, como el metilfenidato, en la desmineralización ósea, que podría constituir un posible factor de riesgo de fractura. Nivel de Evidencia: IV

Stress fractures most commonly affect physically active individuals with normal bone, and they are rare in children with open growth plates. Even rarer are femoral neck stress fractures in pediatric age. Nevertheless, they constitute a very important entity due to the risk of severe complications, such as avascular necrosis. A seven-year-old girl, treated with methylphenidate, who suffered an atypical femoral neck stress fracture is presented. Patient complained of right inguinal pain without daily life activity limitations. The radiograph showed a stress femoral neck fracture, confirmed by CT imaging. Conservative treatment was instituted and the patient became asymptomatic after 4 weeks. This case report alerts the clinicians about this rare entity that might be misdiagnosed. Recent research also suggests a possible involvement of drugs, such as methylphenidate, in bone demineralization, which might constitute a possible risk factor for fractures. Level of Evidence: IV

Fractura bilateral del cuello femoral por fatiga / Bilateral stress fracture of the femoral neck

Las denominadas fracturas por fatiga o por estrés ocurren en un hueso normal sometido a reiterados episodios de esfuerzo, aunque de menor requerimiento para causar una fractura aguda. Se presenta a una paciente de 63 años de edad, obesa, con antecedentes de salud anterior que comienza a presentar dolor en ambas regiones de la articulación de la cadera, limitando los movimientos e imposibilitando la marcha. Se le realizaron estudios de imagen donde se le diagnosticó una fractura bilateral del cuello femoral, la izquierda de mejor identificación que la derecha. El tratamiento consistió en osteosíntesis de la fractura izquierda con clavo deslizante, y tratamiento conservador mediante reposo de la cadera derecha. La evolución fue satisfactoria, a los 3 meses habían desaparecido los síntomas y a los 6 meses la paciente deambulaba sin dificultad. La asistencia temprana a esta afección es importante para decidir la terapéutica a emplear y de esta manera evitar las complicaciones(AU)

The so called fatigue or stress fractures occur in a normal bone subjected to repeated episodes of stress, albeit of lesser requirement to cause an acute fracture. We present a 63-year-old obese patient with a history of previous health that begins to present pain in both regions of the hip joint, limiting movements and making gait impossible. Imaging studies were performed in which a bilateral fracture of the femoral neck was diagnosed, the left being better identified than the right one. The treatment consisted of osteosynthesis of the left fracture with a sliding nail, and conservative treatment by resting the right hip. The evolution was satisfactory, at 3 months the symptoms had disappeared and at 6 months the patient walked without difficulty. Early care for this condition is important in deciding which therapy to use and thus avoid complications(AU)

Fractura de cuello femoral en trauma de alta energía: ¿podemos confiar en la tomografía computarizada multicorte? caso clínico / High energy femoral neck fracture: can we trust the computerized tomography scan? case report

Las fracturas asociadas de diáfisis y cuello femoral son lesiones infrecuentes. A pesar de ser una asociación conocida, es pasada por alto entre un 19-31% de las veces. A continuación presentamos un caso de una fractura de diáfisis femoral en la cual la tomografía computarizada inicial no evidenció ningún rasgo a nivel del cuello femoral; sin embargo, este rasgo se hizo presente en las imágenes de control. Existen diversos exámenes para reconocer las fracturas de cuello femoral asociadas a diáfisis femoral, como la radiografía y la tomografía computarizada. Sin embargo, a pesar de estas imágenes, pueden no ser diagnosticadas. Con este caso reafirmamos la necesidad del uso de imágenes preoperatorias e intraoperatorias en pacientes con fracturas de diáfisis femoral de alta energía y que la tomografía computarizada multicorte de ingreso puede no evidenciar fracturas mínimamente desplazadas del cuello femoral.

Simultaneous fractures of the neck and shaft of the femur are uncommon injuries. Despite it being a known combination, it is overlooked in between 19 and 31% of cases. This case report describes a femoral shaft fracture in which the initial computed tomography did not show the femoral neck fracture, although it was present in the follow-up images. There are different imaging techniques to recognise femoral neck fractures associated with femoral shaft fractures, such as radiography and computed tomography. However, despite these images, they cannot be diagnosed. This case re-affirms the need for using imaging techniques before and during the operation in patients presenting with high energy femoral shaft fractures, in order to look for an associated femoral neck fracture. Although the use of fine-cut computed tomography scan may improve the diagnostic accuracy of this test, some femoral neck fractures will still go under-diagnosed.

The Targon FN System for the Management of Intracapsular Neck of Femur Fractures: Minimum 2-Year Experience and Outcome in an Independent Hospital

BACKGROUND: The Targon FN implant was developed in 2007 to treat intracapsular neck of femur fractures. Early results from the design centre have shown good results in terms of fracture complications. We wished to see if these results can be reproduced in an independent institution. METHODS: The records of consecutive patients, treated with this implant between 2008 and 2011 at Queen Elizabeth Hospital, were identified and collected for this study. Operations were performed by all grades of surgeons under supervision as appropriate. These patients went on to have both clinical and radiological assessment for fracture healing and function. RESULTS: Fifty-one patients were identified with 43 patients available for final follow-up. The average age was 66 years with a minimum follow-up of 24 months. A non-union rate of 0% in the undisplaced fracture group and 1 in 12 (8%) in the displaced fracture group was observed. An avascular necrosis rate of 6% and 8% was observed for undisplaced and displaced fracture types, respectively. No significant change in premorbid to postoperative ambulation was observed and there was no wound complication. CONCLUSIONS: Our study shows similar results with those of the design centre and which are superior to those currently found in the literature for the more traditional fixation methods. It also shows that the promising results with this new implant as seen from the design institutions can be reproduced by all cadres of surgeons in non-specialist practice.

Long-Term Follow-Up Results of a Second-Generation Cementless Femoral Prosthesis with a Collar and Straight Distal Fixation Channels

PURPOSE: We evaluated the results of more than 10 years of follow-up of total hip arthroplasty using a second-generation cementless femoral prosthesis with a collar and straight distal fixation channels. MATERIALS AND METHODS: One hundred five patients (129 hips) who underwent surgery between 1991 and 1996 for primary total hip arthroplasty using cementless straight distal fluted femoral stems were followed for more than 10 years. Ninety-four hips in 80 patients were available for clinical and radiologic analysis. The mean age at the time of surgery was 47 years, and the mean duration of follow-up was 14.3 years. RESULTS: The mean Harris hip scores had improved from 58 points to 88 points at the time of the 10-year follow-up. Activity-related thigh pain was reported in nine hips (10%). At the last follow-up, 93 stems (99%) were biologically stable and one stem (1%) was revised because of loosening. No hip had distal diaphyseal osteolysis. Proximal femoral stress-shielding was reported in 86 hips (91%). We found no significant relationship between collar-calcar contact and thigh pain, stem fixation status, or stress-shielding. The cumulative survival of the femoral stem was 99% (95% confidence interval, 98-100%) after 10 years. CONCLUSION: The long-term results of total hip arthroplasty using a second-generation cementless femoral prosthesis with a collar and straight distal fixation channels were satisfactory; however, the high rate of proximal stress-shielding and the minimal effect of the collar indicate the need for some changes in the stem design.

[Stress fracture of femoral neck [Report of 3 observations]]

Authors bring back 5 cases of fractures of stress of the femoral collar respectively at 3 patient aged of 26, 36 and 47 years with bilateral reach in 2 cases. The diagnosis of stress fracture has kept before a bundle of arguments to know: the traumatic absence and the existence of an obvious intense physical activity in case, the pathological antecedent absence, the normality of the biologic balance well as the reminiscent radiological aspect. The treatment consisted in a vissage in 4 cases total arthroplastie of the hip in a case. To the light of these 3 observations and a magazie of the literature, authors analyze epidemiologic, etiopathogenic and physiopathologic aspects aspects as well as the therapeutic possibilities of the fractures of stress of the femoral collar. They also underline especially the gravity of this pathology and the interest of data of the imagery to the precocious stadiums of the illness the scintigraphie and the IRM, the key of the treatment being the precocious

New implant and technique for valgus osteotomy with dynamic osteotomy plate

With the increased rate of orthopedic trauma especially proximal femur, neck femur fractures, non-union, malunion and hip osteoarthritis; and the increased production of instrumentation, we designed a new implant for valgus osteotomy with dynamic osteotomy plate. This implant overcomes a lot disadvantages occurred with the other implants. The aim of this work is to present this implant and its results in treating union problems [nonunion and malunion] in proximal femur and neck femur fractures. 30 patients with different hip problems were included in this study. From April 2000 to May 2005. 12 females and 18 males. Their age ranged from 21 to 68 years old. All patients submitted to a period of follow up [x-rays and clinical evaluation]. This study reported a significant results in early union, correction of the deformity and good hip range of movement with the use of the valgus osteotomy dynamic plate. In conclusion there is a marvelous results and better outcomes with use of this implant. This paper had been presented in: The 1st SGH group international orthopedic conference Riyadh, KSA in sept. 2002. The annual international congress of the EOA in nov. 2001 Heliopolis Sheraton Cairo Egypt. And the author was awarded

Results of Austin Moore replacement.

Forty cases of Austin Moore Replacement done for transcervical fractures of the femur in patients were reviewed after a period of 12 to 48 months postoperatively (mean 26 mth). 30 cases (75%) had mild to severe pain of non-infective origin, starting as early as 6 months postoperatively. This was irrespective of the make, size or position (varus/valgus) of the prosthesis. Though the Aufranc and Sweet clinical scoring was satisfactory in 65% cases, radiological evidence of complications like sinking, protrusion, etc. were seen in majority of the cases. Calcar resorption was seen in 34 cases (85%) as early as 4 months postoperatively. Results of THR and bipolar replacement done for transcervical fractures in recent literature show 85% pain-free cases at 5 years. We feel that Austin Moore Replacement should be reserved for patients more than 65 years of age and those who are less active or debilitated because of other factors, because of increased acetabular wear with time in the younger individual. This is corroborated by unsatisfactory results in patients less than 65 years of age (p < 0.05).

Is McMurray's osteotomy obsolete?

A review of the method of performing, advantages, disadvantages of McMurray's displacement osteotomy with regard to treatment of nonunion of transcervical fracture neck femur with viable femoral head was carried out in this study of ten cases, in view of the abandonment of the procedure in favour of angulation osteotomy. Good results obtained in the series attest to the usefulness of McMurray's osteotomy in the difficult problem of nonunion of transcervical fracture neck femur in well selected cases with certain advantages over the angulation osteotomy due to the 'Armchair effect'.

Ipsilateral simultaneous femoral shaft and femoral neck fracture: valuable diagnostic signs

When fractures of both shaft and neck occur in the same femur the neck fracture is often missed; this may lead to complications such as avascular necrosis and non-union. Management of this fracture combination can be successful provided the diagnosis is made early. This paper is presented to demonstrate valuable diagnostic signs to avoid missing the femoral neck fracture; it is based on a clinical and radiological study of 8 patients with this fracture combination. The presence of an associated femoral neck fracture should be suspected if there is fullness and tenderness in the groin or over the greater trochanter of the affected limb. Radiologically, medial displacement of the proximal fragment of a transverse fracture of the shaft is almost always diagnostic of the associated hip injury