Primary repair for concurrent bilateral intertrochanteric fracture and femoral head necrosis with prolonged shank biologic total hip replacement: A case report and surgical techniques / 中华创伤杂志(英文版)

For the treatment of an intertrochanteric fracture combined with femoral head necrosis in middle-age patients, it has been controversial whether to perform fracture reduction and fixation first then total hip replacement, or direct total hip replacement. We present a rare case of 53-year-old male patient suffered from bilateral intertrochanteric fracture caused by a road traffic injury. The patient had a history of femoral head necrosis for eight years, and the Harris score was 30. We performed total hip replacement with prolonged biologic shank prostheses for primary repair. One year after the surgery, nearly full range of motion was achieved without instability (active flexion angle of 110°, extension angle of 20°, adduction angle of 40°, abduction angle of 40°, internal rotation angle of 25°, and external rotation angle of 40°). The Harris score was 85. For the middle-aged patient with unstable intertrochanteric fractures and osteonecrosis of the femoral head, we can choose primary repair for concurrent bilateral intertrochanteric fracture and femoral head necrosis with prolonged shank biologic total hip replacement.

A novel lateral classification of osteonecrosis of femoral head based on CT recons-truction of necrotic area and its clinical verification / 中国修复重建外科杂志

OBJECTIVE@#To analyze the femoral head collapse and the operation of osteonecrosis of the femoral head (ONFH) in different Japanese Investigation Commitee (JIC) types, in order to summarize the prognostic rules of each type of ONFH, and explore the clinical significance of CT lateral subtypes based on reconstruction of necrotic area of C1 type and verify their clinical effect.@*METHODS@#A total of 119 patients (155 hips) with ONFH between May 2004 and December 2016 were enrolled in the study. The total hips consisted of 34 hips in type A, 33 in type B, 57 in type C1, and 31 in type C2, respectively. There was no significant difference in age, gender, affected side, or type of ONFH of the patients with differenct JIC types ( P>0.05). The 1-, 2-, and 5-year femoral head collapse and operation of different JIC types were analyzed, as well as the survival rate (with femoral head collapse as the end point) of hip joint between different JIC types, hormonal/non-hormonal ONFH, asymptomatic and symptomatic (pain duration >6 months or ≤6 months), and combined preserved angle (CPA) ≥118.725° and CPA<118.725°. JIC types with significant differences in subgroup surgery and collapse and with research value were selected. According to the location of the necrotic area on the surface of the femoral head, the JIC classification was divided into 5 subtypes in the lateral CT reconstruction, and the contour line of the necrotic area was extracted and matched to the standard femoral head model, and the necrosis of the five subtypes was presented by thermography. The 1-, 2-, and 5-year outcomes of femoral head collapse and operation in different lateral subtypes were analyzed, and the survival rates (with collapse of the femoral head as the end point) between CPA≥118.725° and CPA<118.725° hip in patients with this subtype were compared, as well as the survival rates of different lateral subtypes (with collapse and surgery as the end points, respectively).@*RESULTS@#The femoral head collapse rate and operation rate in the 1-, 2-, and 5-year were significantly higher in patients with JIC C2 type than in patients with other hip types ( P<0.05), while in patients with JIC C1 type than in patients with JIC types A and B ( P<0.05). The survival rate of patients with different JIC types was significantly different ( P<0.05), and the survival rate of patients with JIC types A, B, C1, and C2 decreased gradually. The survival rate of asymptomatic hip was significantly higher than that of symptomatic hip, and the survival rate of CPA≥118.725° was significantly higher than that of CPA<118.725° ( P<0.05). The lateral CT reconstruction of type C1 hip necrosis area was selected for further classification, including type 1 in 12 hips, type 2 in 20 hips, type 3 in 9 hips, type 4 in 9 hips, and type 5 in 7 hips. There were significant differences in the femoral head collapse rate and the operation rate among the subtypes after 5 years of follow-up ( P<0.05). The collapse rate and operation rate of types 4 and 5 were 0; the collapse rate and operation rate of type 3 were the highest; the collapse rate of type 2 was high, but the operation rate was lower than that of type 3; the collapse rate of type 1 was high, but the operation rate was 0. In JIC type C1 patients, the survival rate of the hip joint with CPA≥118.725° was significantly higher than that with CPA<118.725° ( P<0.05). In the follow-up with femoral head collapse as the end point, the survival rates of types 4 and 5 were all 100%, while the survival rates of types 1, 2, and 3 were all 0, and the difference was significant ( P<0.05). The survival rate of types 1, 4, and 5 was 100%, of type 3 was 0, and of type 2 was 60%, showing significant difference ( P<0.05).@*CONCLUSION@#JIC types A and B can be treated by non-surgical treatment, while type C2 can be treated by surgical treatment with hip preservation. Type C1 was classified into 5 subtypes by CT lateral classification, type 3 has the highest risk of femoral head collapse, types 4 and 5 have low risk of femoral head collapse and operation, type 1 has high femoral head collapse rate but low risk of operation; type 2 has high collapse rate, but the operation rate is close to the average of JIC type C1, which still needs to be further studied.

Femoral head necrosis rate and risk factors after internal fixation of femoral neck fracture:a Meta-analysis / 中国骨伤

OBJECTIVE@#To study the incidence and risk factors of osteonecrosis of the femoral head (ONFH) after internal fixation in adult patients with femoral neck fracture (FNF) after 2000, and identify high-risk population of ONFH.@*METHODS@#PubMed, Medline, The Cochrane Library, CNKI, Wanfang and VIP Database were searched to collect all the literatures on ONFH and related risk factors after internal fixation of FNF from January 1th 2000 to July 1th 2020. Study extraction was performed according to inclusion and exclusion criteria. Endnote X9 and Excel 2019 were used for literatures extraction, management and data entry, and R Studio 3.6.5 software was used for Meta-analysis. Subgroup analysis, sensitivity analysis and publication bias detection were used to explore the sources of heterogeneity and the reliability of the evaluation results.@*RESULTS@#A total of 16 studies with 5521 patients were included. Meta-analysis showed that the incidence of ONFH after internal fixation for adult FNF was 14.5% [95% CI(0.126-0.165)]. Fracture displacement[OR=0.27, 95%CI(0.21-0.35)] and reduction quality [OR=0.15, 95%CI(0.09-0.27)] were related risk factors for ONFH. The results of subgroup rate analysis showed that the non-displaced fracture necrosis rate was 6.2%[95%CI(0.051-0.077)] and the displaced fracture necrosis rate was 20.4% [95%CI(0.166-0.249)];the good reduction fracture necrosis rate was 8.3%[95%CI(0.072-0.095)] and the poor reduction fracture necrosis rate was 35.5%[95%CI(0.233-0.500)]. The included literatures have good consistency and no publication bias.@*CONCLUSION@#After 2000, the total incidence of ONFH after internal fixation of adult FNF has decreased, while the necrosis rates of patients with displaced fracture and poor reduction are still at a high level. The interval between injury and surgery was not analyzed in this study because of the inconstant division in the original literature.

Case-control study on robot-assisted core decompression and conventional core decompression for early necrosis of femoral head / 中国骨伤

OBJECTIVE@#To compare clinical effect of robot-assisted core decompression and conventional core decompression in treating ARCO Ⅰ stage necrosis of femoral head.@*METHODS@#A retrospective analysis was performed on 60(unilateral operation) patients who underwent core decompression for femoral head necrosis from February 2018 to February 2020. Among them, 30 patients(30 hips) were underwent robot-assisted core decompression (RCD group), including 19 males and 11 females, aged from 17 to 58 years old with an average of(38.50±10.61) years old;30 patients(30 hips) were underwent traditional core decompression surgery (CCD group), including 20 males and 10 females, aged from 20 to 55 years old with an average of (40.63±10.63) years old. Intraoperative fluoroscopy times, intraoperative blood loss and operation time between two groups, and Harris score, visual analogue scale (VAS) before opertaion and 24 months after operation were compared.@*RESULTS@#All patients were followed up, RCD group followed up from 21 to 26 months with an average of(23.40±1.65) months, CCD group followed up from 21 to 26 months with an average of (23.30±1.66) months, and had no difference between two groups(P>0.05). The number of intraoperative X-ray fluoroscopy, intraoperative blood loss and operative time in RCD group were (9.43±1.14) times, (153.80±22.04) ml, (33.40±1.87) min, respectively;while(19.67±1.32) times, (165.04±20.41) ml and (54.75±3.46) min in CCD group respectively;and there were statistical difference between two groups(P<0.05). In addition, there were no statistical difference between two groups in Harris score and VAS at 24 months after operation(P>0.05).@*CONCLUSION@#Compared with conventional core decompression, robot-assisted core decompression could reduce the number of intraoperative fluoroscopy, shorten operation time, and reduce risk of surgery.

Pressure side and tension side comminution of femoral neck cortex are independent risk factors for aseptic necrosis after femoral neck fracture surgery / 中国骨伤

OBJECTIVE@#To investigate the related factors of aseptic necrosis of femoral head after closed reduction and internal fixation of femoral neck fracture.@*METHODS@#From January 2009 to January 2016, 236 patients with femoral neck fracture were treated with closed reduction and internal fixation with 3 hollow lag screws, including 111 males and 125 females, aged from 19 to 89 (50.17±12.88) years. According to the follow-up results, the correlation of aseptic necrosis of femoral head was analyzed. Univariate analysis of age, gender, injured side, body weight, injury mechanism, preoperative waiting time, Garden classification and whether there was comminution of femoral neck cortex was conducted to obtain the independent variables with significant difference. Then binary logistic regression analysis was conducted to explore the independent risk factors of avascular necrosis of femoral head.@*RESULTS@#The average follow-up period of 236 cases was 4.58 years. There were significant differences in the range of injury (24.69% vs. 5.16%, @*CONCLUSION@#High energy injury, preoperative waiting time (>48 h) and comminution of femoral neck cortex were independent risk factors for aseptic necrosis of femoral head. In addition, cortical comminution on the pressure side and tension side of the femoral neck is a strong prognostic risk factor for aseptic necrosis of the femoral head, because it indicates a more serious and complex injury mechanism.

Epidemiología, resultados clínicos y tasa de éxito en cirugía preservadora de cadera en la necrosis avascular de cabeza femoral / Epidemiology, clinical results and success rate in hip preservation surgery in avascular osteonecrosis of the femoral head

Resumen: Introducción: La necrosis avascular de cabeza femoral (NACF) es una patología frecuente que en sus inicios es asintomática y se manifiesta de forma insidiosa, por lo que a menudo el diagnóstico se realiza en estadios avanzados, donde la única solución eficaz es la artroplastía total de cadera (ATC). El diagnóstico en fases precoces permitirá utilizar opciones terapéuticas que eviten o retrasen la ATC. Nuestro objetivo es valorar los resultados demográficos, clínicos y la tasa de éxito en nuestro centro de pacientes con diagnóstico de NACF y que han sido subsidiarios de cirugía de preservación de cadera. Material y métodos: Estudio clínico unicéntrico, prospectivo, no controlado de pacientes con diagnóstico de NACF entre Enero de 2012 y Septiembre de 2017 con un estadio Steinberg ≤ IIIA. La técnica quirúrgica utilizada es el forage descompresivo, asociado a relleno con aloinjerto y aspirado de médula ósea. Resultados: Se intervinieron 26 caderas con nuestra técnica quirúrgica. La tasa de éxito obtenida es de 61.54%, ya que 10 casos han precisado ATC durante el estudio (38.46%). Conclusión: El éxito terapéutico en la NACF está directamente relacionado con el grado de la enfermedad, por lo que es importante el diagnóstico precoz. El forage descompresivo con relleno de aloinjerto que asocia aspirado de médula ósea es una opción a tener en cuenta, ya que en estadios iniciales muestra una elevada tasa de éxito.

Abstract: Introduction: Avascular osteonecrosis of the femoral head (ONFH) is a frequent pathology with an insidious and asymptomatic presentation in early stages, so the diagnosis is often made in advanced stages, where the only effective solution is total hip arthroplasty (THA). Diagnosis in early stages will allow the use of therapeutic options that avoid or delay ATC. Our objective is to evaluate the demographic, clinical results and the success rate in our center of patients diagnosed with ONFH and who have been subsidiary of hip preservation surgery. Material and methods: Unicentric, prospective, uncontrolled clinical study of patients diagnosed with ONFH between January 2012 and September 2017 with a Steinberg ≤ IIIA stage. The surgical technique used is decompressive forage, associated with bone allograft and bone marrow aspiration. Results: 26 hips were operated on with our surgical technique. The success rate obtained is 61.54%, since 10 cases have required THA during the study (38.46%). Conclusions: The therapeutic success in ONFH is directly related to the degree of the disease, which is why early diagnosis is important. The decompressive forage with bone allograft that associates bone marrow aspiration is an option to be taken into account, since in early stages it shows a high success rate.

Platelet-rich plasma combined with core decompression and bone grafting in the treatment of non traumatic necrosis of femoral head in ARCO stageⅡ / 中国骨伤

OBJECTIVE@#To observe the clinical effect of platelet rich plasma (PRP) combined with β tricalcium phosphate bioceramic bone in the treatment of non traumatic necrosis of the femoral head in ARCO stageⅡ.@*METHODS@#From January 2017 to December 2018, 100 patients (160 hips) with ARCO stageⅡnon traumatic necrosis of the femoral head were divided into PRP group and control group. In PRP group, 50 patients (80 hips), 22 males and 28 females, aged from 18 to 65 (43.47± 7.23) years, with a course of 4 to 18 (15.8±2.9) months, underwent core decompression and bone grafting combined with PRP implantation. There were 50 cases (80 hips) in the control group, including 27 males and 23 females, aged 20 to 63 (45.72± 7.43) years, and the course of disease was 6 to 19 (14.9±3.8) months. Hip X-ay film was followed up after operation. Harris score and VAS score were used to evaluate the curative effect, and the survival rate of hip joint was recorded.@*RESULTS@#All patients had good wound healing, no infection, thrombosis and other complications. All patients were followed up for 12 to 14 (12.0±0.4) months. Twelve months after operation, the image expression of PRP group was better than that of control group(@*CONCLUSION@#Platelet-rich plasma(PRP) combined with artificialbone for core decompression and bone grafting can change the situation of simple artificial bone implantation and uncertain curative effect, improve the success rate of this operation, effectively reduce the collapse rate of femoral head necrosis in the early and middle stage, delay or even avoid hip replacement.

Clinical outcomes of osteonecrosis of the femoral head after autologous bone marrow stem cell implantation: a meta-analysis of seven case-control studies

The purpose of this study was to evaluate the clinical outcomes of osteonecrosis of the femoral head after autologous bone marrow stem cell implantation. We searched the PubMed, Embase and Web of Science databases and included all case-control trials that reported on the clinical outcomes of osteonecrosis progression, incidence of total hip arthroplasty and improvement in Harris hip scores. Overall, seven case-control trials were included. Compared with the controls, patients treated with the bone marrow stem cells implantation treatment showed improved clinical outcomes with delayed osteonecrosis progression (odds ratio = 0.17, 95% CI: 0.09 - 0.32; p <0.001), a lower total hip arthroplasty incidence (odds ratio = 0.30, 95% CI: 0.12 - 0.72; p <0.01) and increased Harris hip scores (mean difference = 4.76, 95% CI: 1.24 - 8.28; p<0.01). The heterogeneity, publication bias, and sensitivity analyses showed no statistical difference significant differences between studies. Thus, our study suggests that autologous bone marrow stem cells implantation has a good therapeutic effect on osteonecrosis of the femoral, resulting in beneficial clinical outcomes. However, trials with larger sample sizes are needed to confirm these findings.

Stem Cell Therapy for the Treatment of Hip Osteonecrosis: A 30-Year Review of Progress

Avascular necrosis of the femoral head is caused by a multitude of etiologic factors and is associated with collapse with a risk of hip arthroplasty in younger populations. A focus on early disease management with the use of stem cells was proposed as early as 1985 by the senior author (PH). We undertook a systematic review of the medical literature to examine the progress in cell therapy during the last 30 years for the treatment of early stage osteonecrosis.

Avascular necrosis of the femoral head in Kirkuk

Osteonecrosis of the head of femur is of serious consequences. The aetiology is of vascular origin, medications like corticosteroid can contribute in to the aetiology. Management depends on the stage of the disease. In the current study we explore the associated factors and the management of this disease in a well-defined population. Between October 2009 and December 2010, a retrospective study was carried out on patients with osteonecrosis of the hip [28 hips] in twenty three patients [8 female, 15 male], with mean age of 43 years. Three patients underwent core decompression, and three underwent total hip replacement, one of them was bilateral. corticosteroid was the main associated factor, the indications for the administration of this medication were not appropriate, yet it was given by the health professionals for musculoskeletal pain. Those patients who underwent core decompression had limited benefit, those treated with conservative treatment, continued to suffer from pain, two of those who underwent hip replacement, were satisfied, however they were concerned about the long term effect of the operation, one patient had periprosthetic infection and required revision. The outcome of the management of osteonecrosis is poor and the incidence in the city of Kirkuk is rather high. The department of health has to impose regulations and stop the practice of prescribing corticosteroid for pain relief

Successful transplant of mesenchymal stem cells in induced osteonecrosis of the ovine femoral head: preliminary results / Sucesso no transplante de células tronco mesenquimais em ovinos com osteonecrose induzida da cabeça do fêmur: resultados preliminares

PURPOSE: Evaluate the bone tissue recovery following transplantation of ovine mesenchymal stem cells (MSC) from bone marrow and human immature dental-pulp stem cells (hIDPSC) in ovine model of induced osteonecrosis of femoral head (ONFH). METHODS: Eight sheep were divided in three experimental groups. First group was composed by four animals with ONFH induced by ethanol through central decompression (CD), for control group without any treatment. The second and third group were compose by two animals, six weeks after ONFH induction received transplantation of heterologous ovine MSC (CD + oMSC), and hIDPSC (CD + hIDPSC), respectively. In both experiments the cells were transplanted without application of any type of immunosupression protocol. RESULTS: Our data indicate that both cell types used in experiments were able to proliferate within injured site providing bone tissue recovery. The histological results obtained from CD+hIDPSC suggested that the bone regeneration in such animals was better than that observed in CD animals. CONCLUSION: Mesenchymal stem cell transplant in induced ovine osteonecrosis of femoral head by central decompression technique is safe, and apparently favors bone regeneration of damaged tissues.

OBJETIVO: Verificar os efeitos das células-tronco mesenquimais da medula óssea de ovinos e da polpa dentária imatura humana em ovinos com osteonecrose induzida, da cabeça do fêmur. MÉTODOS: Oito ovelhas foram distribuídas em três grupos experimentais. O primeiro grupo foi composto por quatro animais com osteonecrose da cabeça do fêmur induzida por etanol através da descompressão central, que não receberam nenhum tratamento. O segundo e o terceiro grupo, cada um composto por dois animais, receberam transplante heterólogo de células tronco mesenquimais de ovinos e polpa dentária imatura humana seis semanas após a indução da osteonecrose da cabeça do fêmur, respectivamente. Em ambos os grupos experimentais as células foram transplantadas sem o uso de drogas imunossupressoras. RESULTADOS: Os achados demonstram que as células-tronco mesenquimais injetadas na cabeça do fêmur se encontravam viáveis após o transplante no novo sítio e proliferaram em pouco tempo. Os dados histológicos sugerem que a regeneração óssea nos animais transplantados com polpa dentária imatura humana foi mais rápida do que nos animais submetidos somente a descompressão central. CONCLUSÃO: O transplante de células tronco mesenquimais na osteonecrose da cabeça do fêmur induzida em ovinos através da técnica de descompressão central é um procedimento seguro, e aparentemente favorece a regeneração óssea de tecidos lesados.

Necrosis aseptica no traumatica de la cabeza femoral. Descompresion del nucleo cefalico como tratamiento en estadios iniciales / Aseptic non-traumatic femoral head necrosis. Core decompression as treatment in initial stages

Introduccion: El presente trabajo es un estudio prospectivo, no comparativo, que tiene por objeto evaluar los resultados obtenidos empleando la descompresión del núcleo cefálico con técnica de perforacion-forage aislada en los estadios iniciales de la necrosis aséptica (NA) de la cabeza femoral no traumatica y determinar su eficacia a largo plazo. Materiales y métodos: Desde junio de 1997 hasta junio de 2002 se trataron 56 caderas en 47 pacientes con NA de la cabeza femoral, agrupados por la clasificacion de Arlet y Ficat, modificada por Steinberg. Se incluyeron 32 varones y 15 mujeres, con una edad promedio de 39,6 años. Dieciocho pacientes presentaron enfermedad bilateral (11 eran asintomaticos). La tecnica quirurgica empleada, en todos los casos, fue la descompresion del núcleo cefalico aislada. Resultados: El seguimiento minimo fue de 30 meses (rango, 85-30 meses). Los pacientes fueron evaluados segun el puntaje de Harris (preoperatorio: 53 ± 14; posoperatorio: 79 ± 15). Se considero exito del tratamiento descompresivo cuando el paciente durante el seguimiento no requirió un segundo procedimiento terapeutico, conservo su cadera y realiza su actividad habitual sin dolor o con minimas molestias. Se obtuvo un resultado exitoso en 19 caderas del estadio I (82,61 por ciento), en 8 del estadio IIA (72,73 por ciento), en 5 del estadio IIB (55,56 por ciento), en 2 del estadio IIC (28,57 por ciento) y solo en 1 del estadio IIIA (16,66 por ciento). Conclusiones: La descompresion del nucleo cefalico es un procedimiento seguro, simple y de baja morbilidad que permite obtener un resultado significativo cuando se la utiliza en estadios iniciales del tratamiento de la NA no traumatica. Por lo tanto, para optimizar sus resultados es indispensable su pronto diagnostico y tratamiento, ya que su pronóstico es ostensiblemente mejor cuando se tratan lesiones pequeñas y en estadios precolapso de la cabeza femoral.

Free vascularized fibula graft for a cystic femoral head and neck lesion in the West Indies

A case is presented of an 18-year-old athlete with fibrous dysplasia of the femoral neck and head. The approach was by joint plastic and orthopaedic teams, which minimized operating time and allowed the option of vascular bone grafting. The lesion was curetted through a greater trochanteric window and the defect reconstructed with a free vascularized fibula graft with excellent result. Weight bearing was achieved in six months and there was minimal donor site morbidity. We believe the free vascularized fibula graft to be a reconstructive option, in difficult orthopaedic problems, facilitated by microsurgery and there is immense benefit of a joint effort between the orthopaedic and plastic surgical teams

Osteonecrosis del cóndilo femoral: informe de 32 casos / Osteonechrosis of femoral condyle: report of 32 cases

Se revisaron 32 casos de osteonecrosis idiopática espontánea del cóndilo femoral medial en 29 pacientes, 18 mujeres y 11 hombres, con una edad entre 60 y 73 años, tratados entre 1986 y 1992 con un seguimiento medio de 85 meses, presentándose a consulta entre uno y 36 meses (media cuatro meses) después del inicio de los síntomas. En el primer examen se tuvieron siete casos en el estadio I de Koshino, ocho casos en el estadio II, 11 en el estadio III y seis en el estadio IV. Cinco casos del estadio I pasaron al estadio II dentro de los tres meses después de la primera observación, mientras que en los otros dos los cóndilos se aplastaron y desarrollaron un modelo artrósico moderado del compartimiento interno en los cinco años sucesivos. De estos cinco casos y los ocho casos del estadio II del inicio, nueve casos evolucionaron hacia un estadio III dentro del año siguiente, con una degradación artrósica con el tiempo en todos los casos. En el estadio IV se presentó un deterioro artrósico y un aumento del varo de la rodilla. Los siete casos del estadio I y cuatro casos del estadio II (15 por ciento) con lesiones de menos de 3.5 cm2, se trataron inicialmente en forma no quirúrgica evolucionando satisfactoriamente. En los tres casos del estadio II de superficie entre 3.5 cm2 y 5 cm2 tratados por artroscopia y perforaciones, se fracasó en dos casos, mientras que el tercer caso continúa en estadio II. Una osteotomía tibial valgizante de descarga se practicó en 20 rodillas en el estadio III, seis se relacionaron con injerto osteocondral autólogo fresco, siete (35 por ciento) presentaron un resultado aceptable. El agregar el injerto no mejoró el resultado. En 19 casos (60 por ciento) se realizó la colocación de prótesis total de la rodilla como tratamiento definitivo. Estos resultados y sus porcentajes son hechos comparables de la indicación de las prótesis en el tratamiento de las artrosis de rodilla.

Osteonecrosis del cóndilo medial de la rodilla en pacientes jóvenes: tratamiento mediante artroscopía y osteotomía tibial / Osteonechrosis of the medial femoral condyle in youngsters: treatment by arthroscopy and tibial osteotomy

Se trataron 11 pacientes de 18 a 50 años con osteonecrosis del cóndilo femoral medial, mediante perforaciones y rasurado intra-articular por artroscopía. Cuando hubo enfermedad angular se hizo osteotomía fijada con fijador externo. Todos tuvieron exudado en el trayecto de los clavos y uno infección de partes blandas. Las osteotomías consolidaron en promedio en 3 meses y el resultado del tratamiento de las lesiones condrales fue satisfactorio en el 90 por ciento de los casos.

Artroplastía total de cadera en fracturas acetabulares / Total hip arthroplasty following acetabular fracture

Se revisaron 14 pacientes con artropastía total de cadera (ATC) secundaria a fractura de acetábulo entre 1988-1997. Se indicó la ATC en 13 artrosis postraumática y en una necrosis avascular, con un seguimiento promedio de 8,4 años. Se colocaron 10 ATC cementadas, 3 híbridas y 1 no cementada: se comprobó aflojamiento aséptico en 3 casos: 1 cotilo al año, 1 a los 2 años y 1 de ambos componentes a los 11 años. Los resultados a 5 años fueron excelentes y buenos en 86 por ciento y regulares y malos en 14 por ciento asociados a dolor crónico y aflojamiento precoz. Las fracturas acetabulares son un factor adversos en la sobrevida protésica, con aflojamiento a 2 años de 15 por ciento y a los 11 de 68 por ciento, mayores cuando se compara a la ATC en lesiones de tipo degenerativas. Además, la cirugía protésica es más compleja aumentando la incidencia de complicaciones

A etiologia na osteonecrose da cabeça femoral / Etiology of the femoral head osteonecrosis

O objetivo deste trabalho é analisar o desenvolvimento do conhecimento sobre a etiologia da osteonecrose da cabeça femoral e suas implicaçoes clínicas. Baseado em 91 quadris tratados com descompressao e enxerto ósseo em 77 pacientes, procura-se estabelecer uma associaçao entre esse tratamento e a citologia dos casos. Sao estudados os fatores prognósticos e os achados sao submetidos a análise estatística e confrontados com a leteratura. Os resultados do tratamento sao satisfatórios em 74,7 por cento dos casos e a citologia nao é considerada como fator prognóstico significante.

Fatores prognóstico no tratamento da osteonecrose da cabeça femoral / Prognosis factors in the treatment of osteonecrotic femoral heads

Este estudo foi feito a partir de 91 quadris em 77 pacientes portadores de osteonecrose nao traumática da cabeça femoral. O tratamento consistiu na descompressäo e enxerto ilíaco, sendo os resultados avaliados clinicamente pelo Método de Merle D'Aubigné-Postel. Os possíveis fatores prognósticos foram analisados estatisticamente em relaçäo aos seguintes parâmetros: estagiamento, idade, sexo, etnia, etiologia e bilateralidade. As associaçöes significantes foram encontradas em relaçäo ao estagiamento e idade, que foram considerados fatores prognósticos.

Tratamiento quirúrgico de la enfermedad de Perthes mediante el Sistema AO / Surgical treatment of Perthe's disease by the AO system

Se realizó un estudio descriptivo preliminar sobre la aplicación del tratamiento quirúrgico mediante el sistema AO a 12 pacientes con enfermedad de Perthes (necrosis avascular de la cabeza del fémur). Se analizaron las variables propuestas con el objetivo de demostrar la eficacia de esta técnica y determinar otros aspectos de indole particular de nuestra serie, edad y sexo, elementos radiológicos e incidencias de complicaciones. Los resultados obtenidos se evaluaron como adecuados