Anterior hip dislocation in conjunction with a stroke: a diagnosis not to miss.

Anterior dislocation of the native hip joint is an uncommon presentation accounting for around 15% of all hip dislocations. It is usually the result of a high-energy impact in circumstances such as a motor vehicle accident or a fall from a significant height. A delay in relocation of more than 6 h has been associated with a high risk of avascular necrosis of the femoral head. We report the case of a 75-year-old man who suffered an anterior dislocation of his native hip following a fall from a standing height, associated with an acute cerebrovascular stroke. There was significant delay in the recognition of the dislocation due to the coexistent signs of the stroke. This case illustrates that hip dislocation can occur following a low-energy mechanism of injury with the possibility of serious long-term consequences if it is not promptly recognised and treated.

Leg length discrepancy in total hip arthroplasty with the use of cemented and uncemented femoral stems. A prospective radiological study.

Leg length discrepancy may occur following total hip arthroplasty, with a potentially impaired functional outcome as a result. The aim of this study was to compare the leg length discrepancy between both cemented and uncemented femoral stems when used in total hip arthroplasty. A prospective radiological study of 200 consecutive primary total hip arthroplasties was performed between June 2005 and December 2006. Pre and post-operative radiographs were analysed. 56 (56%) of the total hip arthroplasties where an uncemented femoral stem was used had a leg length discrepancy over 1 cm. However only 23 (23%) of the total hip arthroplasties with a cemented femoral stem had a leg length discrepancy over 1 cm. The use of cemented femoral stems in total hip arthroplasty results in a lower incidence of leg length discrepancy, with a potentially better functional outcome.

Acetabular cement mantles and component position: are we achieving "ideal" results?

Radiographs of 100 primary cemented total hip arthroplasties were studied. Acetabular component positioning and cement mantles were assessed with respect to implant type, grade of surgeon, and operated side. Seventy-eight percent of the components were eccentrically placed, with increasing cement mantle thickness from zone 1 to zone 3. Concentricity occurred in only 13% of the Charnley Ogee and in 28% of the IP Lubinus components. The Charnley Ogee was more superiorly placed than the IP Lubinus (P < .001). Surgical grade affected neither cement mantle thickness nor opening angle. In vitro studies ideally recommend concentric placement of the acetabular component. This appears difficult to achieve consistently in vivo in most patients using the components in this study.

Recombinant human bone morphogenetic protein-2 for treatment of open tibial fractures: a prospective, controlled, randomized study of four hundred and fifty patients.

BACKGROUND: The treatment of open fractures of the tibial shaft is often complicated by delayed union and nonunion. The objective of this study was to evaluate the safety and efficacy of the use of recombinant human bone morphogenetic protein-2 (rhBMP-2; dibotermin alfa) to accelerate healing of open tibial shaft fractures and to reduce the need for secondary intervention. METHODS: In a prospective, randomized, controlled, single-blind study, 450 patients with an open tibial fracture were randomized to receive either the standard of care (intramedullary nail fixation and routine soft-tissue management [the control group]), the standard of care and an implant containing 0.75 mg/mL of rhBMP-2 (total dose of 6 mg), or the standard of care and an implant containing 1.50 mg/mL of rhBMP-2 (total dose of 12 mg). The rhBMP-2 implant (rhBMP-2 applied to an absorbable collagen sponge) was placed over the fracture at the time of definitive wound closure. Randomization was stratified by the severity of the open wound. The primary outcome measure was the proportion of patients requiring secondary intervention because of delayed union or nonunion within twelve months postoperatively. RESULTS: Four hundred and twenty-one (94%) of the patients were available for the twelve-month follow-up. The 1.50-mg/mL rhBMP-2 group had a 44% reduction in the risk of failure (i.e., secondary intervention because of delayed union; relative risk = 0.56; 95% confidence interval = 0.40 to 0.78; pairwise p = 0.0005), significantly fewer invasive interventions (e.g., bone-grafting and nail exchange; p = 0.0264), and significantly faster fracture-healing (p = 0.0022) than did the control patients. Significantly more patients treated with 1.50 mg/mL of rhBMP-2 had healing of the fracture at the postoperative visits from ten weeks through twelve months (p = 0.0008). Compared with the control patients, those treated with 1.50 mg/mL of rhBMP-2 also had significantly fewer hardware failures (p = 0.0174), fewer infections (in association with Gustilo-Anderson type-III injuries; p = 0.0219), and faster wound-healing (83% compared with 65% had wound-healing at six weeks; p =0.0010). CONCLUSIONS: The rhBMP-2 implant was safe and, when 1.50 mg/mL was used, significantly superior to the standard of care in reducing the frequency of secondary interventions and the overall invasiveness of the procedures, accelerating fracture and wound-healing, and reducing the infection rate in patients with an open fracture of the tibia.