Useful Method for Minimizing Leg Length Discrepancies in Hip Arthroplasty: Use of an Intraoperative X-ray

PURPOSE: There are numerous opinions about the methods and usefulness of minimizing leg length discrepancies after hip arthroplasty. In this study, we tried to evaluate the usefulness of an intraoperative x-ray in addition to preoperative templating for minimizing leg length discrepancy. MATERIALS AND METHODS: We reviewed pre- and post-operative pelvis AP x-rays of 46 patients who underwent hip arthroplasty due to a traumatic femoral neck fracture or intertrochanteric fracture between May 2008 and February 2009. A leg length discrepancy is the difference in vertical distance between a horizontal line drawn along the bottom of the ischial tuberosities and the most inferior points of the lesser trochanter. It was measured in a pelvis AP x-ray. In each case, pre-operative templating was performed and an intraoperative pelvis AP x-ray was taken again to assess the accuracy of preoperative planning. Implant positions were readjusted when necessary. RESULTS: The mean post-operative leg-length discrepancy was 0.3 mm (SD, 3.1 mm). The range was from -5.8 mm to +5.9 mm. CONCLUSION: Combining preoperative templating and intraoperative x-rays is a useful method of minimizing leg length discrepancy during hip arthroplasty.

Subtrochanteric Femur Fracture after Multiple Drilling for Treatment of Nontraumatic Osteonecrosis of the Femoral Head: A Case Report

Multiple drilling of the femoral head is a commonly-used surgical technique for the treatment of osteonecrosis. Several holes are drilled into the femoral head using a small-diameter Steinmann pin. This decompression technique promotes revascularization and regeneration of necrotic tissue in the femoral head. Known complications are heterotopic ossification and femoral subtrochanteric fractures, although these have only been rarely reported. Our case study focuses on a subtrochanteric fracture 6 weeks after a multiple drilling operation.

Operative Treatment of the Fracture and Dislocation of the Fourth and Fifth Carpometacarpal Joints Simultaneously: Two Cases Report

Simultaneoulsy carpometacarpal fracture and dislocation is known to be uncommon past days. But Fisher1 reported that it is quite common injury of hand in 1984. Also high energy injury causes carpometacarpal joint fracture and dislocation, the result of treatment has wide spectrum of prognosis, so early diagnosis and treatment is essential. We reported 2 patients who had the fourth and fifth carpometacarpal fracture and dislocation.

Operative Treatment of the Fracture of the Fourth and Fifth Metacarpal Bone Base

PURPOSE: We intend to set up the plan by analyzing the case applying operative treatment for the diagnosis and treatment of the fourth and fifth metacarpal bone base fracture. MATERIALS AND METHODS: Among 15 cases treated operatively from January of 2004 to October of 2009, there were 9 cases being fifth isolated carpometacarpal fracture, 5 cases being the fourth and fifth carpometacarpal comminuted fracture, 2 cases accompanied by hamate body fracture, 10 cases were comminuted fracture of carpal bone or metacarpal bone. RESULTS: The 13 cases of 15 cases which have got operative treatment for the fourth and fifth carpometacarpal fracture were men, average age were 26.3 years old, injury mechanism were direct hit for 9 cases, slip-down for 6 cases. 12 cases were done closed reduction and pinning, 3cases were done open reduction because of comminution or accompanied by hamate fracture. CONCLUSION: Appropriate diagnostic tool such as computed tomography and careful physical examination are essential for good result of the fourth and fifth carpometacarpal fracture treatment.