ABSTRACT
OBJECTIVE: To compare minimally invasive dynamic hip screw (MIDHS) fixation with conventional dynamic hip screw (CDHS) fixation for treatment of intertrochanteric femoral fracture. METHODS: Of the 66 participants in this double-blind study, 35 were randomised to MIDHS and 31 to CDHS fixation. Main outcome measurements were wound size, haemoglobin decrease, blood transfusion rate, pain score, analgesic consumption, Elderly Mobility Scale score, hip screw position, tip-apex distance, union rate, time to healing and complication rate. RESULTS: The groups had similar preoperative clinical data. Postoperatively the MIDHS group had significantly smaller wound size, less blood loss, lower blood transfusion rates, pain scores and rates of analgesic consumption, and higher early Elderly Mobility Scale scores. There were no significant differences in fracture alignment, hip screw position, tip-apex distance, union rate, time to healing or complication rate. CONCLUSION: MIDHS fixation of intertrochanteric fractures is effective and safe and significantly reduces blood loss, pain and rehabilitation period, without sacrificing reduction alignment, screw position, fixation stability or bone healing.
Subject(s)
Bone Screws , Fracture Fixation, Internal/methods , Hip Fractures/surgery , Aged , Aged, 80 and over , Blood Loss, Surgical/prevention & control , Blood Transfusion , Double-Blind Method , Female , Fracture Fixation, Internal/rehabilitation , Hemoglobins/metabolism , Hip Fractures/rehabilitation , Humans , Male , Middle Aged , Minimally Invasive Surgical Procedures/methods , Minimally Invasive Surgical Procedures/rehabilitation , Prospective Studies , Recovery of Function , Treatment Outcome , WalkingABSTRACT
Atypical mycobacterium infection after total hip arthroplasty is a very rare but a potential cause of implant failure. We present the first report of Mycobacterium farcinogenes infection in human beings. Although the treatment of atypical mycobacterium infection after total hip arthroplasty is controversial, we successfully treated the infection in this case, after consultation with a microbiologist regarding infection management, with both surgery and chemotherapy. It is important to maintain a high index of suspicion for atypical mycobacterium infection, particularly when standard culture findings are negative despite strong clinical evidence of prosthesis infection.
Subject(s)
Arthroplasty, Replacement, Hip , Mycobacterium Infections, Nontuberculous , Prosthesis-Related Infections , Aged , Female , Hip Joint/diagnostic imaging , Humans , Mycobacterium Infections, Nontuberculous/diagnosis , Mycobacterium Infections, Nontuberculous/drug therapy , Nontuberculous Mycobacteria/isolation & purification , Prosthesis-Related Infections/diagnosis , Prosthesis-Related Infections/drug therapy , Radiography , ReoperationABSTRACT
A definitive diagnosis of clear-cell sarcoma of soft parts (CCSSP) is possible by fine-needle aspiration (FNA) biopsy alone. The aspirates are markedly cellular, consisting predominantly of discohesive cells but also of cohesive cells. The cytoplasm is eosinophilic and eccentric. The nuclei are round and contain macronucleoli. CCSSP should be considered when FNA of a soft-tissue tumor shows uncharacteristically high cellularity and relatively uniform cells with macronucleoli. Cohesion of some tumor cells does not rule out CCSSP. Melanin pigment and cytoplasmic clearing are infrequent and not necessary for the diagnosis. Sufficient material should always be procured for immunohistochemical studies on the cell block. Seven other cases are found in the literature, all correctly diagnosed by FNA. Although it is rare, CCSSP is a highly malignant tumor that can be diagnosed readily by FNA without resorting to incisional biopsy.
