Embedding the lateral end of the lag screw within the lateral wall in the repair of reverse obliquity intertrochanteric femur fracture.

Objective The management of reverse oblique intertrochanteric femoral fractures is difficult because such fractures have unique biomechanical characteristics. This study was performed to review the results of treating reverse oblique intertrochanteric femoral fractures with a long cephalomedullary nail by embedding the lateral end of the lag screw to secure axial compression. Methods We herein report the surgical outcomes in seven patients with reverse oblique intertrochanteric fractures treated with our procedure. Patients whose hip screws obviously had no contact with the distal fragment and whose follow-up time was too short were excluded. The lateral end of the lag screw was embedded within the lateral cortex, and the screws were locked to the nail. All nails were long, and a distal locking screw was inserted in the dynamized position. Results No reoperation, definite leg length discrepancy, or malunion occurred in this study. Conclusions These data suggest that early complications do not seem to increase when the lateral end of the lag screw is embedded and the screw is locked to the nail in the treatment of reverse oblique intertrochanteric fracture at this stage.

The Incidence of Atypical Femoral Fractures in Patients with Rheumatic Disease: Yamagata Prefectural Committee of Atypical Femoral Fractures (YamaCAFe) Study.

Atypical femoral fractures (AFFs) have been reported to occur with minimal or spontaneous subtrochanteric and femoral shaft fractures with a characteristic transverse pattern, compared with typical femoral fractures in young patients with high-energy trauma. AFFs are related to long-term use of bisphosphonates (BPs), glucocorticoids and rheumatic diseases. We have estimated a blind analysis of AFFs in rheumatic patients receiving BPs and glucocorticoids ordinary over a long time in all Yamagata prefectural area through radiographic examination. The 123 AFFs including suspected cases over six years were collected and reviewed by two independent orthopedic surgeons. We found 86 patients with a total of 99 AFFs between 2009 and 2014 (1.43 cases/100,000 person/year). Of these 99 AFFs, 11 were in 8 rheumatic patients including three patients with bilateral AFFs. The incidence of AFFs in rheumatic patients had trend to increase from 2012. The mean age of all 8 patients was 54.9 years. All 8 patients received BPs and 7/8 received prednisolone (PSL). The mean dose of PSL was 14 mg/day. Compared to patients with unilateral AFFs, those with bilateral AFFs in rheumatic patients were on a higher dose of PSL (20 mg/day vs. 7 mg/day) and had less femoral neck-shaft angle (129° vs. 136°, p < 0.05). In conclusion, the incidence of AFFs in rheumatic patients showed a trend to increase from 2012 to 2014 in Yamagata prefecture. Careful management of AFFs is of particular importance in rheumatic patients who have taken high doses of PSL and have small femoral neck-shaft angle.

Early lateral migration of head after bipolar hemiarthoplasty in a cerebral palsy patient.

Migration of the outer head after bipolar hemiarthroplasty within several years after surgery is not a rare complication. We present a patient with cerebral palsy who showed lateral migration of the outer head seven months after bipolar hemiarthroplasty for femoral neck fracture. The patient had no acetabular pathology prior to the fracture, and lacked ambulatory ability in a community setting. She underwent conversion to a total hip arthroplasty and returned to her previous lifestyle.