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This study aims to examine the trends and demographics of periacetabular osteotomy (PAO) in the United States from 2016 to 2020 using a large healthcare database analysis. The PearlDiver database was queried for patients who underwent a PAO procedure starting with current procedural terminology (CPT) codes 27299, S2115 and 27146. Subsequently, the population was filtered for patients being ages 12-50, having an inpatient charge-type and those having a length of stay of at least 1 day. Patients with total hip arthroplasty were filtered out, and the resulting population was filtered by ICD-10 diagnosis codes. The providers of each patient were also examined to ensure their history of treating hip dysplasia. Student t and multiple regression analysis tests were used for statistical comparisons and trends analysis (P < 0.05 reported as significant). A total of 535 consecutive patients were analyzed over the study period. There was a higher incidence of PAO in females compared with males (P < 0.001) and a higher incidence of PAO in patients aged 15-19 years compared with older age groups (P = 0.017). Within the first year after the index PAO, 171 of the 535 patients, almost one-third (32%), received a reoperation. Of the 171 reoperations, 115 were deep removal of implant, 55 were a hip arthroscopy and 1 patient had a bone excision for heterotopic ossification. Similar studies should be carried out using other large health databases to confirm the external validity of these trends and rates across the United States.
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BACKGROUND: A periacetabular osteotomy (PAO) is often sufficient to treat the symptoms and improve quality of life for symptomatic hip dysplasia. However, acetabular cartilage and labral pathologies are very commonly present, and there is a lack of evidence examining the benefits of adjunct arthroscopy to treat these. The goal of this study was to compare the clinical outcome of patients undergoing PAO with and without arthroscopy, with the primary end point being the International Hip Outcome Tool-33 at 1 year. METHODS: In a multicenter study, 203 patients who had symptomatic hip dysplasia were randomized: 97 patients undergoing an isolated PAO (mean age 27 years [range, 16 to 44]; mean body mass index of 25.1 [range, 18.3 to 37.2]; 86% women) and 91 patients undergoing PAO who had an arthroscopy (mean age 27 years [range, 16 to 49]; mean body mass index of 25.1 [17.5 to 25.1]; 90% women). RESULTS: At a mean follow-up of 2.3 years (range, 1 to 5), all patients exhibited improvements in their functional score, with no significant differences between PAO plus arthroscopy versus PAO alone at 12 months postsurgery on all scores: preoperative International Hip Outcome Tool-33 score of 31.2 (standard deviation [SD] 16.0) versus 36.4 (SD 15.9), and 12 months postoperative score of 72.4 (SD 23.4) versus 73.7 (SD 22.6). The preoperative Hip disability and Osteoarthritis Outcome pain score was 60.3 (SD 19.6) versus 66.1 (SD 20.0) and 12 months postoperative 88.2 (SD 15.8) versus 88.4 (SD 18.3). The mean preoperative physical health Patient-Reported Outcomes Measurement Information System score was 42.5 (SD 8.0) versus 44.2 (SD 8.8) and 12 months postoperative 48.7 (SD 8.5) versus 52.0 (SD 10.6). There were 4 patients with PAO without arthroscopy who required an arthroscopy later to resolve persistent symptoms, and 1 patient from the PAO plus arthroscopy group required an additional arthroscopy. CONCLUSIONS: This randomized controlled trial has failed to show any significant clinical benefit in performing hip arthroscopy at the time of the PAO at 1-year follow-up. Longer follow-up will be required to determine if hip arthroscopy provides added value to a PAO for symptomatic hip dysplasia.
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Acetábulo , Artroscopía , Osteotomía , Humanos , Femenino , Osteotomía/métodos , Masculino , Artroscopía/métodos , Adulto , Adolescente , Adulto Joven , Acetábulo/cirugía , Resultado del Tratamiento , Persona de Mediana Edad , Distinciones y Premios , Articulación de la Cadera/cirugía , Luxación de la Cadera/cirugía , Calidad de Vida , Estudios de SeguimientoRESUMEN
Heterotopic ossification (HO) following acetabular fracture surgery is relatively common. The purpose of this study was to perform a systematic review of the literature regarding HO rates following acetabular surgery and the effectiveness of the various prophylactic measures taken to prevent its occurrence. A search of PubMed, MEDLINE, and Cochrane Database of Systematic Reviews was performed using the search terms ("Acetabular" OR "Acetabulum") AND ("Heterotopic Ossification" OR "HO" OR "Ectopic Ossification"). Inclusion criteria included articles published in English reporting on HO in acetabular fracture surgery. Descriptive statistics were calculated with categorical data presented as frequency with percentages and continuous data as means. Standard weighted means were calculated for all parameters. Sixty-six articles were included in this study with a total of 5,028 patients. HO was identified in 1,511 (30%) of fractures. Indomethacin (27%) and radiation therapy (24%) demonstrated decreased rates of HO formation versus no prophylaxis (36%). In particular, rates of severe HO formation were substantially decreased with radiation therapy (3%) and indomethacin (7%) compared to no prophylaxis (18%). Indomethacin and radiation therapy both appear to decrease HO formation and severity without substantially increasing surgical morbidity. (Journal of Surgical Orthopaedic Advances 32(4):217-224, 2023).
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Acetábulo , Fracturas Óseas , Indometacina , Osificación Heterotópica , Humanos , Osificación Heterotópica/prevención & control , Osificación Heterotópica/etiología , Acetábulo/lesiones , Acetábulo/cirugía , Fracturas Óseas/cirugía , Indometacina/uso terapéutico , Complicaciones Posoperatorias/prevención & control , Complicaciones Posoperatorias/epidemiología , Antiinflamatorios no Esteroideos/uso terapéuticoRESUMEN
CASE: A 19-year-old woman presented with bilateral mangled upper extremities after jumping in front of a moving train. After revascularization, osteocutaneous free vascularized fibula flap was performed to reconstruct the right humerus. The left forearm required transradial amputation with acute targeted muscle reinnervation. Finally, staged bilateral bipolar latissimus dorsi functional muscle flaps were performed to restore elbow flexion. CONCLUSION: Staged orthoplastic reconstruction of the upper extremities is an effective treatment approach for traumatic bone and soft-tissue defects. This patient's recovery demonstrates improved quality of life after severe upper extremity trauma.
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Colgajos Tisulares Libres , Procedimientos de Cirugía Plástica , Adulto , Codo , Femenino , Humanos , Calidad de Vida , Extremidad Superior , Adulto JovenRESUMEN
INTRODUCTION: Pelvic and acetabular fracture incidence is increasing worldwide for more than four decades. There is currently no evidence examining risk factors for loss to follow up in patients with these injuries. METHODS: Patients presenting with pelvic and/or acetabular fractures at our institution between 2015 and 2020 were included. Demographic, injury, treatment, and follow up information was included. Excluded patients were those who sustained a pathologic fracture, has a course of treatment prior to transfer to our centre, or expired prior to discharge. RESULTS: 446 patients, 263 with a pelvic ring injury, 172 with an acetabular fracture, and 11 with combined injuries were identified. 271 (61%) of patients in our cohort followed up in Orthopaedic clinic (p = 0.016). With an odds ratio of 2.134, gunshot wound mechanism of injury was the largest risk factor for loss to follow up (p = 0.031) followed by male sex (OR= 1.859) and surgery with general trauma surgery (OR=1.841). The most protective risk factors for follow up with Orthopaedic surgery were operatively treated pelvic and acetabular fractures (OR=0.239) and Orthopaedic Surgery as the discharging service (OR=0.372). DISCUSSION: Numerous risk factors exist for loss to follow up including male sex, ballistic mechanism, and discharging service. Investigation into interventions to improve follow up in these patients are warranted.
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Fracturas de Cadera , Traumatismos del Cuello , Huesos Pélvicos , Fracturas de la Columna Vertebral , Heridas por Arma de Fuego , Humanos , Masculino , Huesos Pélvicos/cirugía , Huesos Pélvicos/lesiones , Acetábulo/cirugía , Acetábulo/lesiones , Heridas por Arma de Fuego/epidemiología , Heridas por Arma de Fuego/cirugía , Estudios de Seguimiento , Estudios Retrospectivos , Fracturas de Cadera/cirugía , Pelvis/lesiones , Factores de RiesgoRESUMEN
Purpose: The aim of this study is to identify highly cited articles and examine trends and characteristics in research on periacetabular osteotomy. Materials and Methods: The 50 most highly cited articles on periacetabular osteotomy research were identified using Scopus. Data regarding article demographics and publication were collected from each article and an analysis was performed. Results: The mean citation count was 125±37. The article with the highest total citation count (796), five-year citation count (327), and five-year citation density (65/year) was reported by Reinhold Ganz. The five-year citation density showed strong correlation with total citation density (r=0.930, P<0.001). Reinhold Ganz, the most productive author, was listed on 13 articles in the cohort with 455 weighted citation points. Conclusion: This study provides a collection of articles examining periacetabular osteotomies and demonstrates that citation count can be regarded as an acceptable measure of the contemporary academic influence of an article.
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Acetabular fractures are often first evaluated in the emergency department, where physicians with little experience reading pelvic radiographs may be required to make an accurate diagnosis and early management decisions. In this study, medical students classified radiographs of 20 acetabular fractures and repeated the exercise three weeks later with the aid of a previously described algorithm; half the students were given a lesson prior to using the algorithm. The pre-algorithm accuracy was 4/20 and the post-algorithm accuracy was 8.3/20 (p<0.01). The lesson provided no difference (p=0.5). This algorithm is therefore a useful reference to help classify and triage acetabular fractures.
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The quadrilateral plate (QP) is the relatively flat surface of bone in the true pelvis lying directly medial to the acetabulum. This surface is frequently involved in acetabular fractures. Elderly individuals, in particular, commonly sustain anterior column fractures with incomplete or complete posterior hemitransverse fracture lines with associated QP comminution. If QP fracture lines propagate through the superior weight-bearing surface of the acetabulum, the femoral head may displace medially, leading to poor outcomes if not addressed. Fortunately, the collective work of many orthopaedic surgeons has resulted in numerous effective methods for approaching, reducing, and stabilizing the QP and the diverse family of fractures which affect it. A thorough understanding of the QP, its anatomy, radiology, and techniques for fixation, is required to optimize patient outcomes.
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Fracturas Óseas , Fracturas de Cadera , Fracturas de la Columna Vertebral , Acetábulo/diagnóstico por imagen , Acetábulo/lesiones , Acetábulo/cirugía , Anciano , Placas Óseas , Fijación Interna de Fracturas , Fracturas Óseas/diagnóstico por imagen , Fracturas Óseas/cirugía , HumanosRESUMEN
BACKGROUND: Several variables are known to correlate with the successful completion of short-stay total hip arthroplasty (THA) protocols. The role of psychological factors remains unclear. We investigated the interaction between patient-reported measures of psychological fitness and successful completion of a short-stay THA protocol. METHODS: We performed a prospective cohort study of patients undergoing elective anterior total hip arthroplasty enrolled in a short-stay protocol (success defined as LOS ≤1 midnight versus failed, LOS >1 midnight). Psychological fitness was measured using the Patient-Reported Outcomes Measurement Information System (PROMIS) domains for self-efficacy, depression, anxiety, emotional support, and the ability to participate in social roles. PROMIS scores, patient demographics, and surgical factors were assessed for a relationship with failure to complete short-stay protocol. RESULTS: Patients that failed to complete the short-stay protocol had higher mean pre-operative PROMIS depression scores (50.8 vs 47.1, P = .025) and anxiety scores (53.6 vs 49.2, P = .008) and higher postoperative PROMIS depression (48.19 vs 43.49, P = .003) and anxiety scores (51.7 vs 47.1, P = .01). Demographic and surgical variables did not correlate with the successful completion of the short-stay protocol. That seventy-six percent of the patients did not adhere to the short-stay protocol was due to the inability to complete a physical therapy standardized safety assessment. CONCLUSION: Higher levels of preoperative and postoperative anxiety and depression in otherwise psychologically healthy patients, is associated with an increased risk of failure to complete a short-stay protocol following THA. Targeted interventions are needed to facilitate rapid recovery in patients with psychological barriers to early mobilization.
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Artroplastia de Reemplazo de Cadera , Artroplastia de Reemplazo de Cadera/efectos adversos , Procedimientos Quirúrgicos Electivos , Humanos , Tiempo de Internación , Complicaciones Posoperatorias , Periodo Posoperatorio , Estudios Prospectivos , Factores de RiesgoRESUMEN
PURPOSE: To determine the 3-dimensional (3D) in vivo hip translation in patients with symptomatic femoroacetabular impingement syndrome (FAIS) using 3D computed tomography (CT) models with the hip in neutral and FABER (flexion, abduction, and the external rotation) positions and to identify patient predictors associated with the degree of hip translation. METHODS: Seventy-eight patients with FAIS and cam lesions underwent CT scans in neutral and FABER positions. Demographics including age, sex, and body mass index (BMI) were recorded for each patient. The cam deformity was characterized both in plain x-ray film and 3D. Translation between both positions was calculated using a validated high-precision 3D-3D registration technique. Univariate and multivariate regression analyses sought factors correlated with translation. RESULTS: The mean age of the patients included in the analysis was 36.3 ± 9.2 years, with 51% of the study group being female. The mean 3D femoral head center translation was 0.84 ± 0.37 mm, decomposed into vectors on standard anatomical directions as 0.13 ± 0.58 mm medial, 0.10 ± 0.54 mm posterior, and 0.08 ± 0.46 mm inferior. Multivariate analysis demonstrated that total translation was associated with larger alpha angles (ß = 0.014; 95% confidence interval [CI] 0.003-0.024; P = .013), and greater BMI (ß = 0.033; 95% CI 0.001-0.065; P = .042). Furthermore, posterior-inferior translation was associated with BMI (ß = 0.032; 95% CI 0.003-0.061; P = .031), whereas medial-lateral translation is associated with the female sex (ß = 0.388; 95% CI 0.124-0.634; P = .002), and smaller head radius (ß = -0.068; 95% CI -0.128 to -0.007; P = .029). CONCLUSIONS: As a provocative maneuver, FABER positioning in patients with FAIS resulted in an average measurable translation of the femoral head center in the posterior, medial, and inferior direction. Factors including sex, BMI, and alpha angle predicted the degree of translation. CLINICAL RELEVANCE: The current study demonstrates that there is measurable hip translation between the neutral and FABER positions in patients with symptomatic FAIS, which may cause hip microinstability. Furthermore, the study found an association between hip translation and both modifiable and nonmodifiable factors. This may indicate the need for more comprehensive preoperative surgical planning, intraoperative dynamic examination of the hip, and consideration of capsular plication in certain patients.
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BACKGROUND: Scapular neck and body fractures are typically treated nonoperatively, with operative treatment traditionally focused on intraarticular fractures or double disruptions of the shoulder suspensory complex. The objective of this study was to systematically examine and compile the existing literature in regard to operative and conservative treatment of extraarticular fractures of the scapula. METHODS: A comprehensive search of multiple electronic databases was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement to find outcome data on fractures of the scapular neck and body. All studies from 1988 to 2018 that met inclusion criteria were reviewed independently and graded based on the modified Coleman Methodology Score. Outcomes of interest were compiled and analyzed for adjusted means. RESULTS: 42 manuscripts with a total of 669 patients were included for analysis from an initial search of 335 results. There was an average age of 41.2 years, 78.1% were male, 98.8% had a blunt force mechanism, and 66.7% had other injures outside the scapula at time of presentation. In total, there were 120 patients with scapular body fractures, 95 with scapular neck fractures, 130 with floating shoulder injuries including a scapular neck or body fracture, and 324 with an unspecified extraarticular scapular fracture. 464 patients were treated operatively, with a mean union rate of 99.4%, Constant score of 84.4, and end forward elevation of 158°. 205 total patients were treated non-operatively, with a mean union rate of 85.1%, Constant score of 79.0, and end forward elevation of 153°. CONCLUSION: Patients with extraarticular fractures of the scapula have excellent outcomes following either nonoperative or operative management. There is a need for high quality comparative studies to determine the optimal treatment strategy for these injuries.
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Fijación de Fractura/métodos , Fracturas Óseas/cirugía , Escápula/lesiones , Hombro/cirugía , Tratamiento Conservador , Humanos , Rango del Movimiento Articular , Lesiones del Hombro/cirugía , Resultado del TratamientoRESUMEN
PURPOSE: Supine positioning and the use of fluoroscopy during direct anterior approach total hip arthroplasty (DAA THA) have been reported to improve acetabular component positioning. This study aims to compare 2-dimensional intraoperative radiographic RadLink measurements of acetabular component position with 3-dimensional postoperative 3D SterEOS measurements. METHODS: Intraoperative fluoroscopy and RadLink (El Segundo, CA, USA) were used to measure acetabular cup position intraoperatively in 48 consecutive patients undergoing DAA THA. Cup position was measured on 6-week postoperative standing EOS images using 3D SterEOS software (EOS Imaging, SA, Paris, France) and compared to RadLink findings using Student's t-test. Safe-zone outliers were identified. We evaluated for measurement difference of > +/- 5°. RESULTS: RadLink acetabular cup abduction measurement (mean 43.0°) was not significantly different than 3D SterEOS in the anatomic plane (mean 42.6°, p = 0.50) or in the functional plane (mean 42.7°, p = 0.61). RadLink acetabular cup anteversion measurement (mean 17.9°) was significantly different than 3D SterEOS in both the anatomic plane (mean 20.6°, p = 0.022) and the functional plane (mean 21.2°, p = 0.002). RadLink identified 2 cups outside of the safe-zone. However, SterEOS identified 12 (anatomic plane) and 10 (functional plane) outside of the safe-zone. In the functional plane, 58% of anteversion and 92% of abduction RadLink measurements were within +/- 5° of 3D SterEOS. CONCLUSIONS: Intraoperative fluoroscopic RadLink acetabular anteversion measurements are significantly different than 3D SterEOS measurements, while abduction measurements are similar. Significantly more acetabular cups were noted to be outside of the safe-zone when evaluated with 3D SterEOS versus RadLink.
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Acetábulo/diagnóstico por imagen , Artroplastia de Reemplazo de Cadera , Prótesis de Cadera , Cuidados Intraoperatorios , Acetábulo/cirugía , Anciano , Estudios de Cohortes , Femenino , Fluoroscopía , Francia , Humanos , Masculino , Persona de Mediana EdadRESUMEN
INTRODUCTION: Intraoperative radiographic evaluation during total hip arthroplasty (THA) has shown to improve the accuracy of acetabular component placement, however, differences in interpretation based on radiographic technique has not been established. This study aims to determine if differences exist in the interpretation of acetabular component abduction and anteversion between different radiographic projections. METHODS: 55 consecutive direct anterior THAs in 49 patients were prospectively enrolled. Target anteversion and abduction was defined by the Lewinnek zone. Fluoroscopy was used to direct acetabular component placement intraoperatively. After final cup implantation, fluoroscopic posterior-anterior hip and pelvis images were obtained for analysis. After completion of the procedure, an anterior-posterior plain pelvis radiograph was obtained in the operating room. Acetabulum component abduction and anteversion were postoperatively determined using specialised software on each of the 3 image acquisition methods. RESULTS: Average acetabular cup abduction for intraoperative fluoroscopic posterior-anterior hip (FH), intraoperative fluoroscopic posterior-anterior pelvis (FP), and postoperative, standard, anteroposterior pelvis radiographs (PP) was 40.95° ± 2.87°, 38.87° ± 3.82° and 41.73° ± 2.96° respectively. The fluoroscopic hip and fluoroscopic pelvis tended to underestimate acetabular cup abduction compared to the postoperative pelvis (p < 0.001). Average acetabular cup anteversion for FH, FP, and PP was 19.89° ± 4.87°, 24.38° ± 5.31° and 13.36° ± 3.52° respectively. Both the fluoroscopic hip and fluoroscopic pelvis overestimated anteversion compared to the AP pelvis, with a 6.38° greater mean value measurement for FH (p < 0.001), and an 11° greater mean value measurement for FP (p < 0.001). CONCLUSIONS: Fluoroscopic technique and differences between radiographic projections may result in discrepancies in component position interpretation. Our results support the use of the fluoroscopic posterior-anterior hip as the choice fluoroscopic imaging technique.
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Acetábulo/cirugía , Artroplastia de Reemplazo de Cadera/métodos , Fluoroscopía/métodos , Articulación de la Cadera/cirugía , Prótesis de Cadera , Cirugía Asistida por Computador/métodos , Acetábulo/diagnóstico por imagen , Femenino , Articulación de la Cadera/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Periodo Posoperatorio , Radiografía , Reproducibilidad de los Resultados , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
CASE: A 26-year-old woman sustained a traumatic right hip dislocation with posterior wall component in a motor vehicle collision. Initial treatment consisted of open reduction internal fixation of her posterior wall fracture. Six years later, she developed low-energy recurrent hip instability. Imaging demonstrated posterior capsular insufficiency and femoral retrotorsion. The patient underwent intertrochanteric femoral rotational osteotomy. Nine years postoperatively, the patient has returned to activity without restriction or subsequent dislocations. CONCLUSIONS: Recurrent posttraumatic hip instability requires careful identification of the etiology of instability. This case provides long-term follow-up after successful treatment with intertrochanteric femoral rotational osteotomy.
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Fémur/cirugía , Luxación de la Cadera/cirugía , Articulación de la Cadera/cirugía , Inestabilidad de la Articulación/cirugía , Osteotomía/métodos , Accidentes de Tránsito , Adulto , Femenino , Humanos , RecurrenciaRESUMEN
Preoperative expectations impact shared decision making and patient satisfaction. Surgeon views of patient selection, expected outcomes and patient expectations after periacetabular osteotomy (PAO) for treatment of acetabular dysplasia have not been defined. We assessed surgeon views of patient selection and expected outcomes after PAO. A sample of experienced PAO surgeons participated in semi-structured phone interviews assessing: (i) factors that determine patient candidacy for PAO; (ii) surgeon expectations for PAO outcomes; (iii) surgeon perceptions of patient expectations for PAO outcomes and (iv) surgeon perceptions of discrepancies in surgeon and patient expectations and approaches for reconciling these discrepancies. Twelve surgeons (77% of PAO-performing ANCHOR surgeons) participated. The factors most commonly mentioned in determining patient candidacy for PAO were: symptoms, radiographic findings, absence of arthritis and age. Only one-quarter of the sample mentioned patient expectations as a factor in determining patient candidacy for PAO. The most common surgeon expectations were: pain reduction, joint preservation, function with activities of daily living and return to desired activities. 58% of surgeons felt that surgeon and patient expectations align most of the time. Common expectation discrepancies included return to unrestricted activities and complete pain relief. Detailed discussion was the most commonly employed strategy to resolve expectation discrepancies. PAO surgeons felt that patient expectations of complete pain relief and return to unrestricted activities were misaligned with their own expectations. Development of an expectations survey may facilitate shared decision making.
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OBJECTIVE: The Accreditation Council for Graduate Medical Education (ACGME) has published orthopedic case log data since the 2006/2007 academic year. Here, we use this data to analyze the variability in orthopedic trauma case experience reported by orthopedic trainees and to better understand the impact of an orthopedic trauma fellowship on orthopedic surgical training. DESIGN, SETTING, AND PARTICIPANTS: Data were gathered from ACGME case log reports for orthopedic residents (reporting the cumulative case experience of graduating residents) and orthopedic trauma fellows (reporting the case experience of their fellowship year only) for all available years. RESULTS: The average orthopedic trauma fellow reported significantly more trauma cases in multiple body regions ("Pelvis/Hip", "Femur/Knee", and "Foot/Toes") and "Open Complex" reductions (as defined by the ACGME) in their 1 year of fellowship than the average resident reported in their 5 years of residency. CONCLUSION: On average, orthopedic trauma fellowships substantially increase the trauma case volumes of orthopedic trainees, especially with respect to lower extremity trauma.
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Acreditación , Educación de Postgrado en Medicina , Becas , Sistema Musculoesquelético/lesiones , Sistema Musculoesquelético/cirugía , Procedimientos Ortopédicos/estadística & datos numéricos , Ortopedia/educación , Traumatología/educación , Humanos , Factores de TiempoRESUMEN
The Judet and Letournel acetabular fracture classification system, based on the idea of bicolumnar support of the acetabulum, was first described in a landmark article published in the 1960s. It has stood the test of time and continues to be the preferred method for describing acetabular fractures for the majority of orthopaedic trauma surgeons. Still, there have been attempts to modify or replace Letournel system since its introduction for a variety of reasons, chief among them a perceived inability of the classification system to account for a number of transitional fracture patterns and injury modifiers that may affect surgical decision making and patient outcomes. In this review, we present the literature related to the Judet and Letournel acetabular fracture classification system, over 50 years after its first formal description. We summarize its strengths, weaknesses, and its place in our current understanding of acetabular fractures and their recommended management.
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Acetábulo/lesiones , Fracturas Óseas/clasificación , HumanosRESUMEN
CASE: We describe 2 cases of proximal femoral deformity due to fibrous dysplasia that were corrected with osteotomies and a novel combined construct with a blade plate and a retrograde intramedullary nail. CONCLUSION: A single-stage procedure using a combined construct with a blade plate and a retrograde intramedullary nail is a viable option for correcting and subsequently preventing proximal femoral deformities due to fibrous dysplasia.
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Fémur/cirugía , Displasia Fibrosa Monostótica/cirugía , Osteotomía/métodos , Femenino , Humanos , Osteotomía/instrumentación , Adulto JovenRESUMEN
OBJECTIVES: Septic arthritis results in rapid joint destruction if not properly diagnosed and treated. A work up for septic arthritis includes a peripheral white blood cell count, inflammatory markers, and a joint aspiration. In the general population, the interpretation of these labs has been well-defined by prior studies. To this point, no study has determined how immunosuppressive states affect this work up. METHODS: Patients with immunosuppressive conditions who received a joint aspiration for a painful joint were retrospectively identified. Laboratory results from their work up were gathered and analyzed. RESULTS: 216 patients were included in the study, 21 of whom were diagnosed with septic arthritis. The average aspiration WBC count was 74,190 with 88% PMNs. 81% had a positive gram stain. DISCUSSION: Laboratory values for immunosuppressed patients with septic arthritis were similar to those associated with septic arthritis in historical general population controls.
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Artritis Infecciosa/diagnóstico , Artritis Infecciosa/inmunología , Huésped Inmunocomprometido , Artritis Infecciosa/sangre , Sedimentación Sanguínea , Proteína C-Reactiva/metabolismo , Diagnóstico Precoz , Humanos , Recuento de Leucocitos , Estudios Retrospectivos , Sensibilidad y Especificidad , Líquido Sinovial/metabolismo , Líquido Sinovial/microbiologíaRESUMEN
BACKGROUND: Intraoperative fluoroscopy aims to improve component position in total hip arthroplasty. Measurement bias related to image quality, however, has not been quantified. We aim to quantify measurement bias in the interpretation of acetabular component position as a function of pelvis and fluoroscopic beam position in a simulated supine total hip arthroplasty model. METHODS: Posterior-anterior pelvis and hip images were obtained using a previously described pelvic model with known acetabular component position. Pelvic position was varied in 5° increments of pelvis rotation (iliac-obturator) and tilt (inlet-outlet), and in 1 cm increments from beam center in cranial-caudal and medial-lateral planes. Multiple regression analyses were conducted to evaluate the relationship between the resulting bias in interpretation of component position relative to pelvis position. RESULTS: Anteversion and abduction measurement bias increased exponentially with increasing deviation in rotation and tilt. Greater bias occurred for anteversion than for abduction. Hip centered images were less affected by pelvis malposition than pelvis centered images. Deviations of beam center within 5 cm in the coronal plane did not introduce measurement bias greater than 5°. An arbitrarily defined acceptable bias of ±5° for both abduction and anteversion was used to identify a range of optimum pelvic positioning each for hip and pelvis centered imaging. CONCLUSION: Accurate measurement of acetabular component abduction and anteversion, especially anteversion, is sensitive to proper pelvic position relative to the chosen radiographic plane. An acceptable measurement bias of ±5° is achieved when the pelvis is oriented within a newly identified range of optimum pelvic positioning.