Lower body bone fractures have high mortality rates and poor prognosis in the patients with hemodialysis.

INTRODUCTION: The objective of the current study was to investigate the association between lower body bone fractures occurring during maintenance hemodialysis and prognosis. METHODS: This study included 151 hemodialysis patients at the dialysis center of our hospital as of December 2017, and data were systematically gathered from medical records over a period of 5 years, concluding in December 2022. RESULTS: Fourteen patients, 3.0 per 100 person-years, in 151 hemodialysis patients suffered from lower body bone fractures. The ratio of males was significantly lower, and age was significantly higher in the lower body bone fracture group than in the no lower body bone fracture group. Duration of hemodialysis prior to entry into this study was significantly shorter in the lower body bone fracture group than in the no lower body bone fracture group. Serum albumin was significantly lower and alkaline phosphatase was significantly higher in the lower body bone fracture group than in the no lower body bone fracture group. Mortality rate was significantly higher in the lower body bone fracture group (85.7%) compared to no lower body bone fracture group (28.5%) (p = 0.01). Kaplan-Meier survival curves for mortality showed that lower body bone fracture group had poor prognosis compared to no lower body bone fracture group. Multivariable-adjusted odds ratio for mortality were significantly higher for cases with lower body bone fractures. CONCLUSION: Lower body bone fractures have high mortality rates and poor prognosis in the patients with hemodialysis.

Acetabular cysts heal after successful periacetabular osteotomy.

The presence of subchondral bone cysts reflects degeneration or defects of the articular cartilage and elevated local stresses in the subchondral bone. We asked whether the presence of acetabular cysts deleteriously influenced the clinical and radiographic results of periacetabular osteotomy for treatment of dysplastic hips. We retrospectively reviewed 46 hips in 43 patients with cartilage narrowing who had periacetabular osteotomies. Of the 46 hips, 21 had acetabular cysts (cyst group) and 25 did not (control group). The average followups were 5.8 and 5.4 years in the cyst and control groups, respectively. We compared the Harris hip score and coverage of the femoral head between the two groups. The clinical results were similar between the two groups. There were no differences in radiographic evaluations between the two groups at the latest followup. In the cyst group, complete or partial healing of the cysts was observed in 17 of the 21 hips. A postoperative increase in the center-edge angle of 20 degrees or greater was found in 14 of the 17 hips. The preoperative presence of acetabular cysts did not influence the results of periacetabular osteotomy. Adequate rotation of the acetabular fragment induced cyst remodeling.

Partial physeal growth arrest treated by bridge resection and artificial dura substitute interposition.

We treated four cases of partial physeal growth arrest by resecting the bone bridge and interposing an expanded polytetrafluoroethylene membrane, which has minimal tissue response. We evaluated three cases with sufficiently long follow-up. No apparent recurrence of the bone bridge and no limb length discrepancy occurred in any of the cases. No remodeling after the operation occurred. In one case, which underwent this operation and corrective osteotomy of the proximal tibia, slight recurrence of the varus deformity occurred which was detected only by radiographs, and did not compromise the alignment of the leg. There were no complications.

Curved periacetabular osteotomy for treatment of dysplastic hip.

UNLABELLED: The Bernese periacetabular osteotomy has a considerable rate of postoperative complications such as reflex sympathetic dystrophy, motor nerve palsy, heterotopic ossification, and delayed union of the ilium, which are assumed to be caused by extensive exposure or asphericity of the osteotomy surfaces. To address these issues, we developed the curved periacetabular osteotomy, a modification of the Bernese periacetabular osteotomy which limits dissection, prevents the outside of the ilium from being exposed, and produces osteotomy surfaces with the same curvature. Curved periacetabular osteotomies were done on 128 hips in 118 patients whose average age at the time of surgery was 35.2 years (range, 16-59 years). The average followup was 46 months (range, 24-99 months). The average center-edge angles were 4 degrees (range, -15 degrees -5 degrees ) preoperatively and 35 degrees (20 degrees -55 degrees ) postoperatively, and union of the iliac osteotomy was achieved in all hips. We experienced three asymptomatic pubic nonunions. Dysesthesias occurred in 27 patients along the lateral femoral cutaneous nerve and symptoms resolved in 23 patients within 1 year. The average Harris hip score improved from 72 to 93 points. There were no major complications such as sciatic nerve palsy, abductor dysfunction, or heterotopic ossification. LEVEL OF EVIDENCE: Therapeutic study, Level IV (case series--no, or historical control group). See the Guidelines for Authors for a complete description of levels of evidence.

Intraoperative pelvic motion in total hip arthroplasty.

In total hip arthroplasty (THA) in which the posterolateral approach is used, the pelvis can be easily inclined to roll both backward or forward on the operating table during the procedure. We prospectively studied 30 posterolateral-approach primary THA cases in which the surgeon used a specially devised goniometer that measured motions of the pelvis in the horizontal, frontal, and sagittal planes. We found that the pelvis primarily tilted forward during surgery, averaging 14.57 degrees of anterior tilt in the horizontal plane. The pelvic motion primarily occurred while the Hohman retractor was being applied to the femur to expose the acetabulum. Assessment of pelvic motion during surgery is an important component for successful positioning and placement of the acetabular cup with the posterolateral-approach THA.

Acute effects of hip and knee positions on motor-evoked potentials of the sciatic nerve in total hip arthroplasty.

In 23 patients, motor-evoked potentials (MEP) of the sciatic nerve were elicited during total hip arthroplasty by using a stimulating electrode at the level of the acetabulum and recording from the middle portion of the tibialis anterior. The distal motor latencies were determined before dislocation (control), during dislocation, and after reduction with the trial prosthesis. While the hip was dislocated, recording was performed at varying angles of the hip and knee joints. During dislocation, the distal motor latencies were significantly increased in all positions except at hip flexion of 60 degrees and internal rotation of 60 degrees with the knee joint in maximum flexion. No significant correlations were found between the latency increase and limb lengthening. No patient had sciatic nerve palsy or causalgia after operation.

In vivo study of acute effects of hip and knee positions on blood flow in canine sciatic nerve.

We studied blood flow in the canine sciatic nerve using a laser Doppler flowmeter. Blood flow was measured in 20 hind limbs of ten adult dogs at varying angles of hip flexion, hip rotation and knee flexion. Blood flow decreased as flexion and internal rotation of the hip increased and also with only slight flexion of the knee. With 90 degrees knee flexion, the mean blood flow did not change significantly when the hip was internally rotated from 0 degrees to 30 degrees. When the knee was straight, the blood flow changed significantly during the same procedure. To prevent sciatic nerve palsy, attention should be paid to the positioning of the hip and knee during total hip arthroplasty.