Conservative Treatment of a Nondisplaced Intertrochanteric Femur Fracture: A Case Report and Review of the Literature.

A 21-year-old otherwise healthy male sustained a nondisplaced, intertrochanteric fracture of the left femur after being "rear-ended" by a motor vehicle while riding his bicycle. His fracture was managed with protected weight-bearing and progressive mobilization. No traction was utilized. The patient had an excellent clinical outcome at two-year follow-up, reporting modified Harris Hip Score 85, Hip Outcome Score-Activities of Daily Living 88, Hip Outcome Score-Sport Specific 89, and International Hip Outcome Tool-33 of 77. Conclusion: Nonsurgical treatment, consisting of restricted weight-bearing, for non-displaced intertrochanteric femur fracture in young, healthy patients can provide a successful result.Level of Evidence: V.

Fluoroscopy-Guided Suture Anchor Placement Yields Excellent Accuracy for Arthroscopic Acetabular Labral Repair: A Cadaveric Study.

PURPOSE: To determine the accuracy of fluoroscopy-guided suture anchor placement for arthroscopic acetabular labral repair in cadaveric hip specimens. METHODS: Two sports medicine fellowship-trained surgeons performed arthroscopic hip surgery on 6 cadaveric specimens each. Suture anchors were placed at the 11-, 12-, 1-, 2-, 3-, and 4-o'clock positions of the acetabulum in each specimen using a previously described fluoroscopically guided technique. Gross dissection and thin-cut computed tomography scans were performed to assess for accuracy. The insertion angle between the subchondral bone and the drill bit immediately prior to suture anchor insertion was measured, and fluoroscopic visualization of the subchondral bone at each clock-face position was qualitatively graded as good, fair, or poor by 2 independent reviewers. RESULTS: Overall, 90.3% of attempts (65 of 72) were entirely intraosseous, 5.5% (4 of 72) perforated the articular cartilage, and 4.2% (3 of 72) perforated the far cortex, rates that are comparable with those in previous cadaveric studies. There was no statistically significant difference in accuracy between the surgeons (P = .42) or between the various clock-face positions (P = .63). Neither the insertion angle (P = .26) nor visualization of the subchondral bone (P = .35) was significantly correlated with accuracy by gross dissection. CONCLUSIONS: In a cadaveric hip arthroscopy model, fluoroscopy-guided suture anchor placement yields excellent accuracy rates, similar to non-image-guided techniques. CLINICAL RELEVANCE: Intra-articular suture anchor placement and intrapelvic suture anchor placement are known complications of arthroscopic acetabular labral repair. Fluoroscopically guided suture anchor placement can be a useful tool for hip arthroscopy surgeons performing acetabular labral repair and reconstruction, potentially reducing the risk of these complications.

The gothic arch: a reliable measurement for developmental dysplasia of the hip.

BACKGROUND: The "Gothic Arch" is a radio-graphic finding on AP pelvis x-rays postulated to be predictive of hip osteoarthritis. PURPOSE: The purpose of this study was to determine the reliability of measurement of the Gothic Arch in patients with no known hip pathology and patients with unilateral developmental dysplasia of the hip (DDH). PATIENTS AND METHODS: After obtaining IRB approval, nine skeletally mature patients (18 hips) with no known hip pathology were selected to serve as the control group. The AP pelvis x-rays at skeletal maturity of eight patients (16 hips) with unilateral DDH treated with closed reduction and casting comprised the comparison group. A digitizing program was designed to measure the Gothic Arch based on landmarks identified by the user. Two pediatric orthopaedic surgeons and two orthopaedic residents completed the program on two separate occasions. Intra-and interobserver reliability were determined using intraclass cor-relation coefficients (ICC) for continuous variables. RESULTS: Both the unilateral DDH group and the control group demonstrated excellent inter- and intraobserver reliability (ICC >0.70) for base, height, area, and orientation of the Gothic Arch, but poor reliability (ICC <0.40) for medial and lateral sharpness. CONCLUSION: The Gothic Arch can be reliably measured on AP pelvis x-rays of patients with normal and dysplastic hips. LEVEL OF EVIDENCE: III, Diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.

Primary hip and knee replacement: "are we all operating on the same patients, even at the same institution?".

BACKGROUND: Survey studies have concluded that a lack of consensus exists between orthopaedic surgeons on indications for total hip and knee arthroplasty. Geographic variation in the rates of these operations has raised concerns that some surgeons inappropriately indicate healthier patients for surgery than others. The objective of this study was to compare primary hip and knee arthroplasty patients'pre-operative validated outcome scores between four orthopaedic surgeons operating at a single academic institution from 2003 to 2007. METHODS: A retrospective chart review was performed using CPT-4 codes to identify patients who underwent primary total hip or knee arthroplasty at our institution between June 2003 and June 2007. Pre-operative SF-36 and WOMAC scores were recorded for each patient Patient demographics including age, gender, body mass index (BMI), number of co-morbidities, life orientation score (a measure of patient optimism), smoking and alcohol use, education level, and occupation were also recorded. Statistical analysis using unbalanced analysis of variance (ANOVA) and Chi-Square test were used to compare data between the surgeons, with statistical significance set at P < 0.05. RESULTS: There was no statistically significant difference in SF-36 or WOMAC stiffness and function scores between the surgeons. There was a small difference in WOMAC pain scores between the surgeons'total knee patients, but not total hip patients. The number of primary hip and total knee replacements performed by each surgeon ranged from 151 to 955, with a total of 1896 primary joint replacements by the four surgeons during the study period. CONCLUSIONS: Patients undergoing primary total joint arthroplasty at our institution were equally disabled between four surgeons, despite the surgeons performing variable numbers of the procedures. Further comparative effectiveness research using validated outcome measures is warranted.