Incidence and Risk Factors of Osteonecrosis of the Femoral Head after Cephalomedullary Nailing for Pertrochanteric Fractures: Observational Single-Center Study

Background@#The objective of this study was to investigate the incidence of osteonecrosis of the femoral head (ONFH) after cephalomedullary nailing in elderly patients with pertrochanteric fractures and to analyze the risk factors related to ONFH. @*Methods@#A total of 689 consecutive patients with cephalomedullary nailing for pertrochanteric fractures at our hospital were recruited. Of these, 368 patients who met the inclusion criteria were finally enrolled. ONFH after cephalomedullary nailing was identified by reviewing patients’ electronic charts and serial radiographs. The ONFH group was then compared with the non-ONFH group. @*Results@#ONFH was identified in 9 of 368 patients (2.4%). The time to diagnosis of ONFH averaged 23.8 months (range, 5–54 months) after index surgery. The mean age, body mass index, and bone mineral density (T-score in femur neck) were 84.1 ± 7.1 years, 23.7 ± 3.6 kg/m2, and −3.1 ± 0.7 kg/m2, respectively. The times from injury to surgery, from admission to surgery, and operation time averaged 4.2 ± 2.7 days, 3.6 ± 2.6 days, and 87.2 ± 30.0 minutes, respectively. Among 9 patients, 3 underwent conversion arthroplasty. The ONFH group had advanced age (p = 0.029), more basicervical fracture components (p= 0.002), and inadequate reduction (p = 0.045) compared to the non-ONFH group. On multivariate analysis, advanced age (odds ratio [OR], 1.61;, p = 0.022), basicervical fracture components (OR, 24.58; p = 0.001), and inadequate reduction (OR, 4.11; p = 0.039) were identified as risk factors of ONFH. @*Conclusions@#Although ONFH is relatively rare after cephalomedullary nailing for pertrochanteric fractures in elderly patients, its risk may increase with advanced age, basicervical fracture components, and inadequate reduction. Therefore, in patients with these risk factors, meticulous and longer follow-up is needed even after bone union.

Is an Anatomical Suprapectineal Quadrilateral Surface Plate Superior to Previous Fixation Methods for Anterior Column-Posterior Hemitransverse Acetabular Fractures Typical in the Elderly?: A Biomechanical Study

Background@#This study aimed to compare the mechanical characteristics of four fixation methods including an anatomical suprapectineal quadrilateral surface (QLS) plate in hemipelvic models of anterior column–posterior hemitransverse acetabular fractures typical in elderly patients. @*Methods@#In total, 24 composite hemipelvic models were used and allocated to four groups: group 1, pre-contoured anatomical suprapectineal QLS plate; group 2, suprapectineal reconstruction plate with two periarticular long screws; group 3, suprapectineal reconstruction plate with a buttress reconstruction plate; group 4, suprapectineal reconstruction plate with a buttress T-plate. Axial structural stiffness and displacement of each column fragment in four different fixation constructs were compared. @*Results@#Multiple group comparisons of axial structural stiffness demonstrated significant difference (p = 0.001). Although there was no significant difference between groups 1 and 2 (p = 0.699), group 1 showed greater stiffness than groups 3 and 4 (p = 0.002 and 0.002, respectively). Group 1 showed less displacement in the anterior region of the anterior fragment than group 4 (p = 0.009) and in the posterior region than groups 3 and 4 (p = 0.015 and p = 0.015, respectively). However, group 1 demonstrated greater displacement than group 2 in the posterior region of the posterior fragment (p = 0.004), while showing similar displacement to groups 3 and 4. @*Conclusions@#The anatomical suprapectineal QLS plate provided the mechanical stability comparable or superior to other existing fixations in osteoporotic models of anterior column–posterior hemitransverse acetabular fractures typical in the elderly. However, additional plate modification would be needed for better stability and outcomes.

Utility of False Profile View for Screening of Ischiofemoral Impingement / 대한고관절학회지

PURPOSE: Ischiofemoral impingement (IFI)-primarily diagnosed by magnetic resonance imaging (MRI)-is an easily overlooked disease due to its low incidence. The purpose of this study was to evaluate the usefulness of false profile view as a screening test for IFI. MATERIALS AND METHODS: Fifty-eight patients diagnosed with IFI between June 2013 and July 2017 were enrolled in this retrospective study. A control group (n=58) with matching propensity scores (age, gender, and body mass index) were also included. Ischiofemoral space (IFS) was measured as the shortest distance between the lateral cortex of the ischium and the medial cortex of lesser trochanter in weight bearing hip anteroposterior (AP) view and false profile view. MRI was used to measure IFS and quadratus femoris space (QFS). The receiver operating characteristics (ROC), area under the ROC curve (AUC) and cutoff point of the IFS were measured by false profile images, and the correlation between the IFS and QFS was analyzed using the MRI scans. RESULTS: In the false profile view and hip AP view, patients with IFI had significantly decreased IFS (P < 0.01). In the false profile view, ROC AUC (0.967) was higher than in the hip AP view (0.841). Cutoff value for differential diagnosis of IFI in the false profile view was 10.3 mm (sensitivity, 88.2%; specificity, 88.4%). IFS correlated with IFS (r=0.744) QFS (0.740) in MRI and IFS (0.621) in hip AP view (P < 0.01). CONCLUSION: IFS on false profile view can be used as a screening tool for potential IFI.

Delayed Pseudoaneurysm of the Femoral Artery after Intramedullary Nailing of a Femur Shaft Fracture / 대한정형외과학회잡지

Interlocked intramedullary nailing is widely accepted for treatment of closed femoral shaft fractures. An interlocking screw is inserted percutaneously, and especially the distal screw is inserted without use of a guide. Vascular complications associated with an interlocking screw in intramedullary nailing are rare. No case of delayed pseudoaneurysm caused by a distal interlocking screw has yet been reported in Korea. We present two cases of delayed pseudoaneurysm caused by a distal interlocking screw several months after intramedullary nailing.

Patient Safety in Spine Surgery: Regarding the Wrong-Site Surgery

Patient safety regarding wrong site surgery has been one of the priority issues in surgical fields including that of spine care. Since the wrong-side surgery in the DM foot patient was reported on a public mass media in 1996, the wrong-site surgery issue has attracted wide public interest as regarding patient safety. Despite the many wrong-site surgery prevention campaigns in spine care such as the operate through your initial program by the Canadian Orthopaedic Association, the sign your site program by the American Academy of Orthopedic Surgeon, the sign, mark and X-ray program by the North American Spine Society, and the Universal Protocol program by the Joint Commission, the incidence of wrong-site surgery has not decreased. To prevent wrong-site surgery in spine surgeries, the spine surgeons must put patient safety first, complying with the hospital policies regarding patient safety. In the operating rooms, the surgeons need to do their best to level the hierarchy, enabling all to speak up if any patient safety concerns are noted. Changing the operating room culture is the essential part of the patient safety concerning spine surgery.