Particulate bone grafting of osteolytic femoral lesions around stable cementless stems.

The purpose of the current study was to evaluate the effect of particulate grafting for proximal femoral osteolysis in the presence of a well-fixed cementless femoral stem at the time of acetabular liner change or revision. Sixteen patients (17 hips) who averaged 51 years of age underwent curettage and packing of proximal femoral osteolytic lesions with cancellous allograft. Modular acetabular liners were changed in 11 patients, acetabular revisions were performed in six patients, and femoral heads were exchanged in all patients. The femoral component was retained in all patients. The majority of patients were asymptomatic before revision surgery. The size of the femoral osteolytic lesions was measured preoperatively and postoperatively with anteroposterior and Lauenstein lateral radiographs of the hip. Preoperatively, the average lesion was 41 x 16 mm on the anteroposterior view and 18 x 7 mm on the lateral view. The average clinical and radiographic followup was 39 and 32 months, respectively, with a minimum followup of 24 months. All but one patient remained asymptomatic during the followup period and no femoral stem showed evidence of loosening. The size of the femoral osteolytic lesion averaged 16 x 6 mm on the anteroposterior view and 6 x 2 mm on the lateral view at most recent followup. In 15 of 17 patients, the size of the femoral lesion had regressed. This technique seems to be a viable means of preventing progressive osteolysis and femoral loosening while preserving bone stock for future reconstruction.

Isolated avulsion fracture of the lesser tuberosity of the humerus: A case report.

Isolated avulsion fracture of the lesser tuberosity of the humerus is extremely rare. Only 75 cases have been reported in the literature since Hartigan's report in 7895. In all of the previously reported cases, these injuries seriously impaired the patients' ability to function. However, the case reported here involves chronic pain after an avulsion fracture of a fragment of the lesser tuberosity of the humerus in a young male athlete. This patient continued to participate in competitive athletics for over a year after his injury before he sought definitive treatment. Eventually, surgical excision of the fragment of lesser tuberosity relieved the patient's symptoms.