Acetabular osteochondroplasty and simultaneous reorientation: background and validation of concept.

Most hips with femoroacetabular impingement (FAI) have combinations of femoral and acetabular abnormalities, including acetabular deficiency in some cases. Other impinging hips have large acetabular hyaline cartilage lesions that, when treated by resection, lead to acetabular deficiency and the need for a subsequent reorientation to improve coverage. Ideally, large cartilage lesions could be identified preoperatively and treated with 1 procedure. Therefore, a single operative approach that allows for both femoral and acetabular osteochondroplasty where needed, as well as simultaneous acetabular reorientation, is advantageous. We hypothesized that the addition of traction and dry arthroscopy via the Smith-Petersen approach at the time of periacetabular osteotomy could allow for the diagnosis and treatment of intra-articular labral and hyaline cartilage lesions and simultaneous acetabular reorientation. To validate this concept, we performed the procedure on cadaveric hips and subsequently treated a series of patients successfully (4 hips with limited anterior debridement and dry arthroscopy and 1 hip with a simultaneous periacetabular osteotomy). There were no intra- or postoperative complications in the series of 5 hips. The addition of traction and dry arthroscopy can permit the diagnosis and treatment of intra-articular lesions in reorienting periacetabular osteotomy. This enables the surgeon to address both acetabular cartilage and labral lesions, as well as idealizing acetabular orientation and coverage in 1 setting with less morbidity.

Intrafocal pinning for juxtaarticular phalanx fractures.

Juxtaarticular phalanx fractures can present a challenge to the treating physician. Because they are not a common occurrence, we wanted to discuss our treatment protocol for this entity. Goals of treatment include anatomic realignment, fracture stability, and early range of motion. Improper treatment can lead to malunion resulting in deformity or loss of function as well as joint stiffness. Other treatment modalities can also result in unsatisfactory results including decreased range of motion. Intrafocal pinning provides a treatment alternative for the irreducible fracture normally requiring open intervention while satisfying the requirements of fracture stabilization and early range of motion. This technique has been used in 5 patients over the past 3 years without significant complications. Two patients had fractures involving their proximal phalanx, and 3 had middle phalangeal injuries. All patients healed their fractures and maintained functional range of motion (PIPJ 90 degrees, DIPJ 65 degrees).