The role of the greater trochanter pain syndrome in lumbar degenerative disc disease surgery.

PURPOSE: Greater trochanter pain syndrome (GTPS) is highly discussed during spine surgeons, accompanies lumbar pain and complicates differential diagnosis. The aim is to raise awareness among physicians and demonstrate the lumbar spine degenerative diseases (LSDD) association with GTPS. METHODS: A retro-prospective analysis enrolled 172 patients with LSDD with GTPS signs. Group I - retrospective (n = 112), group II - prospective (n = 60). Patients of group II with the confirmed diagnosis clinically and by the ultrasound recieved a GCS injection (Betamethasone 2 mg\ml + 5 mg\ml - 1.0). Also the VAS, X-ray and SPSS Statistics package were used. RESULTS: 112 patients in group I, 89 (79.5%) had increased pain in the hip early postOp to 7.8 points by VAS. All patients required trigger point injections of GCS and 68 (77%) received a repeat injection. 76 from 112 patients were tracked for long-term results, and recurrence of GTPS was detected in five people who treated conservatively for three months without dynamics. They were identified GTPS by ultrasound. During the injection, 39 from 43 (90%) patients noted pain reduction to 2.1 by VAS, but symptoms of radiculopathy or spinal stenosis persisted. Two patients (5%) did not note any changes. Two patients (5%) noted complete pain regression and refused the surgery. CONCLUSION: Timely detection of GTPS among spinal surgeons influences tactics and, in some cases, allows one to avoid unnecessary surgical interventions. In turn, ignoring the symptoms of GTPS in the preoperative period can lead to pain intensification in the greater trochanter after surgery for degenerative diseases of the spine.

Choice of Entry Point Does Not Affect Clinical and Radiological Outcomes in Antegrade Intra-medullary Nailing in Patients with Shaft of Femur Fracture: A Prospective Randomized Controlled Trial.

Purpose: The choice of entry point, Greater trochanter (GT), or Piriformis entry (PE) for antegrade intramedullary nailing (IMN) of the femur is crucial. This study was performed to compare these two entry points in the patients with shaft of femur fractures regarding intra-operative parameters, radiological and functional outcomes. Materials and Methods: Twenty-four patients underwent GT entry nailing, while 25 patients underwent PE nailing. Surgical time, Intra-operative blood units transfused, Intra-operative fluoroscopy exposure by number of C-arm shots taken, mean drop in hemoglobin, and incidence of iatrogenic fracture were recorded. Patients were followed up at 4 weeks, 6 weeks, and 6 months to look for radiological healing and improvements in functional outcome using Modified Harris Hip Score (MHHS). MRI of bilateral hips with pelvis was done in 25 patients at 6 months of follow-up to detect any preliminary signs of AVN. Results: The mean drop in hemoglobin in the GT group was significantly lesser than the PE group (p = 0.02). Mean MHHS at 4 weeks post-op was also significantly higher in the GT group (p = 0.01). There was no significant difference between both the groups regarding surgical duration, fluoroscopy exposure, radiological and functional outcomes in the long term. None of the patients who underwent MRI displayed any preliminary sign of AVN. Conclusion: GT entry nails lead to lesser surgical time, fluoroscopy exposure, and intra-operative blood loss. Both the nailing systems achieve excellent fracture unions and comparable functional outcomes in the long term, and there is a minuscule risk of AVN in adult patients undergoing IMN.

Assessment in location of sciatic nerve between the ischial tuberosity and the greater trochanter of the femur: A cadaveric study.

Background: The location description of the sciatic nerve (SN) of adult between the ischial tuberosity (IT) and the greater trochanter of the femur (GT) is inconsistent in publications, this impels us to investigate and measure the distance relationship with SN between IT and GT. Methods: Thirty-one adult cadavers were dissected to investigate the distance relationship of SN with the posterior prominent position of the ischial tuberosity (ppIT), the medial edge of IT (mIT) and the lateral prominent position of GT (lGT). Results: SN passed through the point of the junction of medial one-third and middle one-third of a length from ppIT to lGT, and the midpoint of a length from mIT to lGT from the average data of the total studied cadavers. From average data of female and male, the left SN passed through the point of the junction of the medial two-fifths and the lateral three-fifths of the length between mIT and lGT. Between ppIT and lGT, SN located in a range of proportions from 0.1 to 0.6 from medial to lateral. Between mIT and lGT, SN located in a range of proportions from 0.2 to 0.7 from medial to lateral and all SN passed through the middle third of the length. Conclusions: Different bony landmarks draw different location descriptions of anatomic structure. In anatomic study and clinical practice, the utilized bony landmark should be clearly and accurately identified the reference point, inaccurate bony landmark can result in erroneous localization of the interested anatomic structure and lead to operation failure or iatrogenic injury.

Unrepaired Trochanteric Bursae as a Risk Factor for Deep Gluteal Syndrome After Total Hip Arthroplasty: A Prospective Randomized Controlled Trial.

BACKGROUND: The trochanteric bursae are often left unrepaired after total hip arthroplasty (THA) and they retract posteriorly over the muscle belly of the piriformis. Deep gluteal syndrome (DGS) is a multifactorial condition presenting as buttock pain and is attributed to nondiscogenic sciatic nerve irritation or impingement causes. The purpose of this study was to investigate the relationship between bursal repair and incidence of DGS in patients undergoing THA. METHODS: This prospective randomized trial included patients treated with a THA between January and December 2022 for a diagnosis of primary osteoarthritis. Patients were randomized into 2 groups: group 1 underwent a routine bursal repair, while group 2 did not, leaving the bursae unrepaired. Follow-up was performed on the 15th, 30th, and 90th day postoperatively with clinical scores, physical examinations, and laboratory tests. In this cohort of 104 patients, mean age was 55 years (range, 26 to 88). Demographic variables as well as range of motion and overall clinical results showed no significant difference between the groups. RESULTS: DGS rates were significantly more common in the patients who had an unrepaired bursa (group 2) both on the 30th and 90th postoperative days, while comparison of lateral trochanteric pain on palpation showed similar results between the groups. CONCLUSIONS: DGS is common in individuals who have unrepaired trochanteric bursal tissue following a THA. Despite its higher frequency, these symptoms did not have a substantial impact on the overall clinical scores, which remained consistent across the study groups.

Parameters Governing the Fate of Fracture Fixation With Proximal Femoral Nailing (PFN) for Intertrochanteric Femur Fractures.

INTRODUCTION: A high mortality rate is associated with hip fractures in the elderly. This is because their bones are osteoporotic with implants having less hold and there are more co-morbidities associated with the elderly. Osteosynthesis with the proximal femoral nail (PFN) features the advantages of high rotational stability of the head-neck fragment. However, the use of the nail is technically ambitious and is accompanied by some risks of error, which can lead to failure. This study aims to understand the technical difficulties related to PFN and methods to mitigate them and radiological indicators for successful outcomes of PFN. METHODS: Our study aims to analyze the radiological parameters as indicators for the successful outcome of intertrochanteric fractures fixed using PFN and also the factors responsible for intraoperative conversion to dynamic hip screw (DHS). This is a prospective, observational study conducted from January 2020 to December 2020, on all the patients with intertrochanteric fractures who were planned to be treated by PFN and consented to be part of the study group at our institute. This study includes 99 cases of intertrochanteric fractures classified according to AO (Arbeitsgemeinschaft für Osteosynthesefragen)/Association of the Study of Internal Fixation (ASIF) and Evan's classification systems and followed postoperatively at regular intervals up to one year. Different methods of fracture reduction, intraoperative radiological parameters, and postoperative radiological parameters dictating the fate of PFN along with factors responsible for the intraoperative conversion to DHS were analyzed and discussed. RESULTS:  Out of 99 patients planned for PFN, four were converted to DHS intraoperatively and 15 patients expired within the follow-up period of one year, leaving only 80 patients in the study group. Of them, seven patients (11.4%) had implant-related complications. According to Chang's reduction quality criteria (CRQC), two cases have CRQC 1 (poor reduction), 11 cases have CRQC 2 (acceptable reduction), 39 cases have CRQC 3 (acceptable reduction), and 28 cases have CRQC 4 (excellent reduction). CONCLUSIONS: Though PFN is technically challenging, with proper guidelines and technique, it gives excellent results. Most importantly, a nonvarus reduction, proper nail insertion and accurate placement of lag screws are the crucial factors for a successful outcome. Biomechanically stable reduction, by closed, percutaneous, or open means, is the key to treating unstable intertrochanteric fracture successfully.

Chondroblastoma Affecting the Apophysis of the Greater Trochanter in a Child.

Chondroblastomas are rare primary bone tumours typically affecting the epiphyses and less frequently the apophyses of the growing skeleton. Most cases are treated by intralesional curettage with or without local adjuvants and this technique can produce good long-term outcomes. Herein, we describe a case of chondroblastoma of the greater trochanter in a 12-year-old male child that was treated by intralesional curettage and grafting with calcium phosphate bone cement (Neocement Inject® P, Bioceramed, Loures, Portugal). A brief review of the literature is also presented.

Three-dimensional analysis of functional femoral antetorsion and the position of the greater trochanter in high-grade patellofemoral dysplastic knees.

BACKGROUND: The relationship between functional femoral antetorsion, the greater trochanter (GT) position and anatomical antetorsion has been demonstrated in patients with a primary hip pathology. However, the functional antetorsion and GT position have not been analyzed in patellofemoral dysplastic knees. The aim of this study was to develop a three-dimensional (3D) measurement to quantify the functional femoral antetorsion and position of the GT and to analyze these measurements in a cohort of high-grade patellofemoral dysplastic knees. METHOD: A 3D measurement was developed to analyze functional antetorsion and the axial position of the GT and assessed in 100 cadaveric femora. For validity and repeatability testing, inter- and intra-observer reliability were determined using intraclass correlation coefficients (ICCs). These measurements were then evaluated in a cohort of 19 high-grade patellofemoral dysplastic knees (Dejour type C, D). The relationship between anatomical antetorsion, functional antetorsion and GT position were reported. RESULTS: Inter- and intra-reader reliability for 3D functional antetorsion and axial position of the GT demonstrated a minimum ICC of 0.96 (P < 0.001). Anatomical and functional antetorsion demonstrated a highly linear relationship (R2 = 0.878; P < 0.001) in high-grade patellofemoral dysplastic knees. The mean difference between anatomical and functional antetorsion decreased with increasing anatomical antetorsion (R2 = 0.25; P = 0.031, indicating a more anterior position of the GT relative to the femoral neck axis. CONCLUSION: In high-grade patellofemoral dysplastic knees, the GT is located more anteriorly, relative to the femoral neck axis, with increasing anatomical antetorsion and correction osteotomy may result in an excessively anterior position of the GT.

Outcomes of osteosynthesis of periprosthetic fractures of the greater trochanter with an anatomic claw plate.

Background: The treatment of periprosthetic trochanteric fractures, especially older fractures, is often a challenge. The aim of this study was to investigate the clinical and radiological outcomes of periprosthetic fracture treatment with the anatomic Peri-Plate claw plate. Material and methods: Thirteen new fractures (≤6 weeks after occurrence) and 8 older Vancouver AG fractures (35.4 ± 26.1 weeks after occurrence) were followed radiologically and clinically with a follow-up of 44.6 ± 18.8 (24-81) months. Results: At 6 months, osseous consolidation had occurred in 12 cases and fibrous union in 9 cases. At 12 months one additional osseous consolidation was shown. The Harris hip score (HHS) increased from 37.2 ± 10.3 preoperatively to 87.6 ± 10.3 12 months after surgery. Thirteen patients reported no, 7 mild and one patient significant local trochanteric pain. Conclusions: The Peri-Plate claw plate can achieve reproducibly good outcomes in terms of fracture stabilization and bony consolidation, as well as with regard to clinical outcomes in the treatment of new and older periprosthetic trochanteric fractures.

Non-Union And Resorption Of Extended Trochanteric Osteotomy And Management Using Modular Tapered Stem In Patient With Extensive Surgical History.

Extended trochanteric osteotomy is an invaluable technique for enhancing femoral exposure during revision total hip arthroplasty. Complications are rarely reported but may include non-union. Even rarer is the incidence of extended trochanteric osteotomy resorption. We present our experience using a modular tapered stem in managing a resorbed extended trochanteric osteotomy following revision total hip arthroplasty in a patient with extensive hip surgical history. Good surgical technique is important in the prevention and management of resorption. It is also important to identify high risk patients such as smokers or those with peripheral vascular disease. Long femoral stem prosthesis with diaphyseal fixation may help in dealing with proximal bone loss due to resorption of an extended trochanteric osteotomy, and avoids the need for allogenic bone graft.

Does transepiphyseal drilling and closure of the greater trochanter in early Legg-Calve-Perthes disease improve natural history?

PURPOSE: There is no consensus regarding treatment of Legg-Calve-Perthes disease (LCPD). The most common sequel of the disease is coxa breva and overgrowth of the greater trochanter (GT). Our purpose was to examine the effectiveness of transepiphyseal drilling combined with closure of the GT apophysis in patients with LCPD. METHODS: During 2013-2018, we treated 16 consecutive cases of LCPD. Average age was 7.5 (range 6-10) years; nine patients were in early fragmentation, five in late fragmentation and one in reossification stages. Treatment protocol included hip arthrography, percutaneous drilling of the femoral head epiphysis, percutaneous tenotomy of adductor longus and epiphysiodesis of the GT apophysis. RESULTS: Mean follow-up was 38 months. One patient was lost to follow-up. All patients had a limp prior to surgery. However, at latest follow-up, 10/15 patients had no limp, 11 patients had substantial improvement in hip range of motion. On radiographs, nine patients had Stulberg type 1-2, one type 3 and five type 4-5. There was no change in the epiphysio-trochanteric distance in any patient. Eight out of nine patients treated in the early fragmentation stage had good clinical and radiographic outcome. Most patients treated in late fragmentation stage had Stulberg 4-5 hip and required additional procedures. CONCLUSIONS: Based on our preliminary experience, our protocol can be effective in the treatment of patients with LCPD in the initial or early fragmentation stages by improving the clinical and radiographic outcomes of the disease. This minimally invasive approach does not compromise any future treatment options. LEVEL OF EVIDENCE: IV.

Contemporary Use of Trochanteric Plates in Periprosthetic Femur Fractures: A Displaced Trochanter Will Not Be Tamed.

BACKGROUND: The objective of this study was to evaluate the reoperation and complication rate following trochanteric plate fixation of greater trochanter (GT) periprosthetic femur fractures associated with total hip arthroplasty and to identify risk factors for subsequent reoperation, nonunion, and hardware failure (plate/cable breakage or migration). METHODS: Between 2010 and 2020, 44 patients who had 44 periprosthetic greater trochanter fractures at mean follow up of 2 years were retrospectively reviewed. Initial injury radiographs as well as immediate and final follow-up radiographs were evaluated. Subsequent reoperations, nonunion, and cases of hardware failure were identified. There were 22 (50%) Vancouver B2 fractures and 22 (50%) Vancouver A fractures. RESULTS: The 2-year cumulative probability of any subsequent reoperation was 20%. There were 9 total subsequent reoperations. The trochanteric fracture went on to nonunion in 14 patients (39%), and hardware failure occurred in 10 (28%) patients. A trochanteric bolt was used in addition to the trochanteric plate in 6 patients (14%), of which 4 (67%) patients had trochanteric plate displacement and 3 (50%) patients had trochanteric nonunion. Displacement of the greater trochanter prior to fixation was a predictor of subsequent nonunion (77% versus 23%, P = .02). CONCLUSION: In this large contemporary series, there was a high incidence of reoperation (20%) with in the first 2-years following plating of periprosthetic GT fractures, as well as a high rate of nonunion (39%), and hardware failure (28%). Displacement of the GT prior to plating predicted nonunion. LEVEL OF EVIDENCE: Level IV, retrospective observational study.

The clinical effect of trochanteric slide osteotomy combined with a cementless femoral conical stem in total hip replacement for the treatment of Crowe type IV developmental dysplasia of the hip.

BACKGROUND: Total hip replacement (THR) for Crowe type IV developmental dysplasia of the hip (DDH) is still challenging due to specific joint deformities and the high incidence of post-operative complications. OBJECTIVE: This study aimed to evaluate the clinical effect of trochanteric slide osteotomy (TSO) combined with a cementless femoral conical stem in THR for the treatment of Crowe type IV DDH. METHODS: Thirty-one total hip replacements (26 patients) with Crowe type IV DDH were performed using TSO combined with a cementless femoral conical stem. Surgical outcomes were evaluated using leg length discrepancy (LLD), Harris hip score, and post-operative complications. RESULTS: The average pre-operative LLD was 51 mm (range 46-58 mm), decreasing to an average of 10 mm (range 8-12 mm) post-operatively. As a result, the post-operative incidence of the Trendelenburg sign significantly decreased compared with the pre-operative incidence (P< 0.05). Bony union was identified in 26 hips (83.9%), fibrous union in four (12.9%), and non-union in one (3.2%). No acetabular or femoral component loosening, dislocation, or deep infection around the component was found in any of the patients during the follow-up period (27 to 39 months). The average Harris hip score improved from 63.0 ± 3.0 (range 58-69) to 93.3 ± 2.0 (range 91-96). CONCLUSION: TSO combined with a cementless conical stem in THR is an appropriate option for patients with high congenital hip dislocation.

Posterior Protrusion Measures (PPM) for Three-Dimensional (3D) CT Classification of Pertrochanteric Fractures.

Introduction We introduced a novel numerical index known as posterior protrusion measures (PPM), derived from lateral plain radiograph images, which effectively serves to distinguish stable from unstable pertrochanteric fractures. The present study aims to scrutinize PPM values among two classified fracture patterns, stable and unstable, within the three-dimensional (3D) CT classification system, establishing a numeric threshold for PPM to differentiate between these groups; explore the potential relationship between the PPM index and unclassified categories; investigate how groups divided by the PPM threshold value can predict fracture stability based on 3D CT. Materials and methods In this study, three observers were tasked with measuring PPM on a single occasion. The chi-square test assessed the association between each demographic parameter on a categorical scale and stable/unstable groups. Continuous variables were also subject to examination. Receiver operating characteristic (ROC) analysis was employed to determine optimal cut-off points of PPM for predicting the presence of stable versus unstable groups. Additionally, the chi-square test examined the linear relation between separated groups based on the defined threshold PPM value and the stable/unstable groups. Results A total of 106 pertrochanteric fractures were identified using CT scan images and plain radiographs in the 3D CT classification system, revealing the stable group of 35 patients and the unstable group of 71 patients. The PPM values for stable/unstable fractures were, on average (± standard deviation), 0.34±0.25/0.50±0.29 for observer 1, 0.31±0.23/0.57±0.31 for observer 2, and 0.41±0.29/0.57±0.26 for observer 3, respectively (p<0.01). We established 0.3 as the cut-off value for PPM. The average PPM value among three observers represented each patient to assess fracture stability. The group with PPM <0.3 included 27 patients (16 stable and 11 unstable), and the group with PPM ≥0.3 group comprised 79 patients (19 stable and 60 unstable; p<0.005). Conclusion The present study revealed a significant difference in PPM values among stable and unstable 3D CT classification groups. Additionally, a threshold PPM value of 0.3 suggests a pivotal point for differentiating fracture stability. This innovative methodology makes a substantial contribution to clinical endeavors, potentially circumventing the necessity for 3D CT scanning.

A simple method for restoring the femoral head center in hip arthroplasty: a 3-dimensional analysis in the Chinese population.

BACKGROUND: Various authors have successfully demonstrated that the distance from the greater trochanter to the femoral head center (GTFHC) and the distance from the lesser trochanter to the femoral head center (LTFHC) can be used as parameters to determine the recovery of the femoral head center (FHC) during hip arthroplasty. It is necessary to undertake an anatomical study concerning the correlations between the greater trochanter (GT), the lesser trochanter (LT), and the FHC using data obtained from the 3D-CT reconstruction method. METHODS: The study comprised 293 patients (151 males and 142 females), with an average age of 65.06 years. The femoral head diameter(FHD), the linear distance from FHC to GT (GTFHC), and the linear distance from FHC to LT(LTFHC) were all measured and recorded data. The correlation between FHD with LTFHC and GTFHC was assessed using Pearson correlation coefficients, and the ratio of LTFHC and GTFHC to FHD was calculated from this ratio. All measured parameters were compared between the left and right sides and the sexes of the participants. RESULTS: The average ratios of GTFHC/FHD and LTFHC/FHD were 0.99 and 0.95, respectively .96% of the LTFHC had absolute lateral differences of < 4 mm . 92% of the GTFHC had absolute lateral differences of < 4 mm. CONCLUSION: LTFHC and GTFHC are reliable reference parameters for preoperative planning and reconstruction of FHC of hip arthroplasty. The ratio displayed in this research may yield insight into a practical and straightforward method for orthopedic surgeons to perform hip arthroplasty in patients with femoral neck fractures. Ratios from studies based on the same race may be desirable for future work.

A new understanding of radiographic landmarks of the greater trochanter that indicate correct femoral rotation for measurement of femoral offset.

OBJECTIVES: To establish and validate a novel method for aligning femoral rotation to accurately measure femoral offset for preoperative templating and component sizing, and to identify the physical location of two radiographic lines utilized in the described method. MATERIALS AND METHODS: Cadaveric proximal femurs were skeletonized and mounted to a biaxial load frame. Two radiographic lines along the greater trochanter were identified fluoroscopically. The femurs were rotated, and images were taken when the lines appeared superimposed, then in 2-degree increments to 10° of internal and external rotation, and at 30°. Radiographic femoral offset was calculated at each angle, and the maximum and aligned offsets were compared. Bone was removed until the radiographic lines disappeared, then a metal wire was inserted in place of the bone to confirm that the lines reappeared. RESULTS: The physical locations of the radiographic landmarks were on the anterior and posterior aspects of the greater trochanter. The mean true femoral offset was 38.2 mm (range, 30.5-46.3 mm). The mean aligned femoral offset was 37.3 mm (range, 29.3-46.3 mm), a 2.4% underestimation. The mean angle between aligned and true offset was 3.6° of external rotation (range, 10°ER-8°IR). Intra-rater intraclass correlation coefficient was 0.991. CONCLUSION: Alignment of the radiographic lines created by the anterior and posterior aspects of the greater trochanter is a reliable and accurate rotational positioning method for measuring true femoral offset when using plain films or fluoroscopy, which can aid surgeons with preoperative templating and intraoperative component placement for total hip arthroplasty.

The effect of corticosteroid injection in the treatment of greater trochanter pain syndrome: a systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: corticosteroid injection (CSI) has been used to treat greater trochanter pain syndrome (GTPS) for many years. However, so far, the efficacy of CSI in the treatment of GTPS is still controversial. Therefore, the aim of this review is to evaluate the effectiveness of CSI in comparison with sham intervention, nature history, usual care, platelet-rich plasma (PRP), physiotherapy/exercise therapy, dry needling, or other nonsurgical treatment for improvements in pain and function in GTPS. METHODS: PubMed (Medline), Embase, Cochrane Library were searched from their inception until April 2021. Randomized controlled trails (RCTs) comparing CSI to nonsurgical treatment were included. Data on the effect of CSI on pain and function were extracted and checked by two review authors independently. The treatment effect was analyzed in the short term, medium term, and long term. RESULTS: Eight RCTs (764 patients) were included. This review suggests CSI may be superior to usual care and 'wait and see,' ESWT, but may not be superior to exercise, PRP, dry needling, and sham intervention in short-term pain or function improvement. In terms of medium-term pain or function improvement, CSI may be superior to usual care and 'wait and see,' but may not be superior to PRP. In terms of long-term pain or function improvement, CSI may be inferior to PRP and ESWT, but it may be superior to usual care and 'wait and see' at 12 months. CONCLUSIONS: Due to the small sample size and lack of sufficient clinical studies, current evidence is equivocal regarding the efficacy of CSI in the treatment of GTPS. Considering the limitations, more large-sample and high-quality RCTs are needed to prove the therapeutic effect of CSI on GTPS. TRIAL REGISTRATION: PROSPERO registration number: CRD42021247991. Registered 09 May 2021.

Isolated greater trochanter fracture may impose a comparable risk on older patients' survival as a conventional hip fracture: a population-wide cohort study.

BACKGROUND: Isolated greater trochanter fracture (IGT) and conventional hip fracture (HF) affect the same anatomical area but are usually researched separately. HF is associated with high mortality, and its management is well established. In contrast, IGT's effect on mortality is unknown, and its best management strategies are unclear. This study aims to compare these patient populations, their acute- and post-acute care, physical and occupational therapy use, and up to three-year mortality. METHODS: This retrospective cohort study is based on population-wide data of Estonia, where routine IGT management is non-operative and includes immediate weight-bearing as tolerated. The study included patients aged ≥ 50 years with a validated index HF or IGT diagnosis between 2009-2017. The fracture populations' acute- and post-acute care, one-year physical and occupational therapy use and three-year mortality were compared. RESULTS: A total of 0.4% (50/11,541) of included patients had an IGT. The baseline characteristics of the fracture cohorts showed a close resemblance, but the IGT patients received substantially less care. Adjusted analyses showed that the IGT patients' acute care was 4.5 days [3.4; 5.3] shorter they had 39.2 percentage points [25.5; 52.8] lower probability for receiving post-acute care, and they had 50 percentage points [5.5: 36]] lower probability for receiving physical and occupational therapy. The IGT and HF patients' mortality rates were comparable, being 4% and 9% for one month, 28% and 31% for one year, and 46% and 49% for three years, respectively. Crude and adjusted analyses could not find significant differences in their three-year mortality, showing a p-value of 0.6 and a hazard ratio of 0.9 [0.6; 1.3] for the IGT patients, retrospectively. CONCLUSIONS: Despite IGT being a relatively minor injury, the evidence from this study suggests that it may impose a comparable risk on older patients' survival, as does HF due to the close resemblance of the two fracture populations. Therefore, IGT in older patients may signify an underlying need for broad-based medical attention, ensuring need-based, ongoing, coordinated care. TRIAL REGISTRATION: Retrospectively registered.

[A new measurement method of offset in total hip arthroplasty].

Objective: To report a new offset parameter for total hip arthroplasty (THA)-greater trochanter offset (GTO), and analyze the effectiveness and feasibility of this parameter based on clinical data. Methods: The 47 patients who met the selection criteria and admitted between January 2016 and May 2020 were selected as the research object. The global offset (GO) was used as the offset parameter in preoperative design. Firstly, the test-retest reliability and inter-rater reliability of GTO were analyzed based on pelvic X-ray films. The GTO reconstruction was defined as the difference between the operative side and the healthy side within ±5 mm, and 47 patients were divided into the reconstruction group and the non-reconstruction group. General data (age, gender, type and side of fracture, the interval between injury and operation), visual analogue scale (VAS) score, Harris score, gait score, and leg length discrepancy (LLD) were recorded and compared between two groups. Then, the GTO was used as the offset parameter in preoperative design of 21 patients (GTO group) admitted between June 2020 and December 2020. The pre- and post-operative clinical data were compared between GTO group and GO group to explore the feasibility of GTO for THA. Results: Statistical analysis showed that GTO had good test-retest reliability (P<0.001) and inter-rater reliability (P<0.001). There was no significant difference in gender, age, type and side of fracture, the interval between injury and operation, preoperative VAS score, and LLD at 1 year after operation between the GTO reconstruction group and the non-reconstruction group, as well as between the GO and GTO groups (P>0.05). The Harris score and gait score at 1 year after operation, and difference of VAS score between pre- and post- operation in the reconstruction group and GTO group were significantly better than those in the non-reconstruction group and GO group, respectively (P<0.05). There were 23 cases (48.9%) in the GO group and 19 cases (90.5%) in the GTO group with GTO reconstruction, and the difference was significant (χ2=10.606, P=0.001). There were 25 cases (53.2%) in the GO group and 13 cases (61.9%) in the GTO group with GO reconstruction, and the difference was not significant (χ2=0.447, P=0.504). There were 34 cases (72.3%) in the GO group and 19 cases (90.5%) in the GTO group with LLD reconstruction, and the difference was not significant (χ2=2.777, P=0.096). Conclusion: GTO has reliable test-retest reliability and inter-rater reliability. GTO as a parameter of preoperative offset reconstruction plan of THA can obtain good reconstruction of offset and limb length, and obtain a good effectiveness.

Large and Intermediate Joint Injections: Olecranon Bursa, Greater Trochanteric Bursa, Medial and Lateral Epicondyle Peritendinous Injections.

Olecranon bursitis, greater trochanteric bursitis, medial epicondylosis, and lateral epicondylosis are common diagnoses encountered in primary care and sports medicine clinics. This section explores the anatomy, clinical presentation, evaluation, procedural techniques, and management to effectively treat these common conditions.

Multivariable Analysis of Risk Factors Affecting Dislocation After Bipolar Hemiarthroplasty in Patients with Femoral Neck Fracture.

OBJECTIVE: This study aimed to investigate the risk factors associated with dislocation and dissociation following bipolar hemiarthroplasty (HA) for the treatment of patients with femoral neck fractures. METHODS: We retrospectively reviewed 462 patients (479 hips) treated with bipolar HA from January 2010 to January 2020. All patients received posterolateral approaches and a minimum follow-up of at least 2 years regularly. A case-control study was performed to analyze the risk factors of dislocation regarding patient demographics, coexisting diseases, surgical and morphologic features. Multivariable logistic regression analysis for independent risk factors affecting dislocation and dissociation was also performed. RESULTS: The dislocation rate was 5.01%, and the mean time from HA to the first incident of dislocation was 38.75 days. Patient-related factors, including operation side, prosthesis type, and neuromuscular disease, did not differ significantly. Regarding the morphological factors, a significant difference was observed in center-edge (CE) angle, abduction angle, acetabular depth, depth/width ratio, rotation center (RC) to greater trochanter tip (GTT) vertical distance, RC to GTT vertical distance difference, RC to GTT horizontal distance, RC to GTT horizontal distance difference, offset difference, and offset discrepancy. Further, decreased CE angle, increased abduction angle, decreased RC to GTT vertical distance, decreased offset difference and increased offset discrepancy were determined to be independent risk factors of dislocation. The proportion of patients experiencing dissociation was 1.04%. All the implanted femoral heads were smaller than 43 mm, which was determined to be the risk factor of dissociation. CONCLUSION: Decreased CE angle, RC to GTT vertical distance, offset difference, and increased abduction angle, offset discrepancy were determined to be independent risk factors of HA dislocation. Once dislocation risk was detected by simulated templating, THA or changing surgical approach should be considered to avoid evitable perioperative complications.