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S P Mohanty, K A Singh, R Kundangar, V Shankar
BACKGROUND: The purpose of this study was to compare the clinical and radiological outcomes of multiple small diameter drilling and core decompression with fibular strut grafting in the management of non-traumatic avascular necrosis (AVN) of the femoral head. MATERIALS AND METHODS: Outcomes of patients with AVN treated by multiple small diameter drilling (group 1) were compared retrospectively with patients treated by core decompression and fibular grafting (group 2)...
October 18, 2016: Musculoskeletal Surgery
Brice Ilharreborde, Vincent Cunin, Saad Abu-Amara
BACKGROUND: There is growing evidence that symptomatic femoroacetabular impingement (FAI) can develop after severe slipped capital femoral epiphysis (SCFE) fixed in situ. Realignment procedures have therefore gained popularity, but complication rates remain controversial. Among them, the subcapital shortening osteotomy without hip dislocation has been progressively adopted in France, but results have never been assessed to date. METHODS: All cases performed in 23 French university hospitals between January 2010 and March 2014 were reviewed to (1) describe the surgical procedure, (2) assess the radiologic and functional outcomes, and (3) report complications and more specifically the avascular necrosis rate (AVN) according to initial stability...
September 3, 2016: Journal of Pediatric Orthopedics
M Olsen, P M Lewis, Z Morrison, M D McKee, J P Waddell, E H Schemitsch
AIMS: One method of femoral head preservation following avascular necrosis (AVN) is core decompression and insertion of a tantalum rod. However, there may be a high failure rate associated with this procedure. The purpose of this study was to document the clinical and radiological outcomes following total hip arthroplasty (THA) subsequent to failed tantalum rod insertion. PATIENTS AND METHODS: A total of 37 failed tantalum rods requiring total hip arthroplasty were identified from a prospective database...
September 2016: Bone & Joint Journal
Raju Vaishya, Amit Kumar Agarwal, Nishint Gupta, Vipul Vijay
Avascular necrosis (AVN) of femoral head needs to be addressed early in the course of the disease, to prevent progression to osteoarthritis. A revascularizing procedure which can help preserve the head should be considered in young adults to alleviate the need for total hip arthroplasty. We included 40 cases (53 hips) of AVN of femoral head operated with Sartorius muscle pedicle iliac bone grafting, done by the senior author. Early post-operative rehabilitation was done. The weight bearing was delayed for 6 weeks...
August 2016: Journal of Hip Preservation Surgery
Mayank Gupta, R-K Arya, Satish Kumar, Vijay-Kumar Jain, Skand Sinha, Ananta-Kumar Naik
PURPOSE: Both cannulated cancellous screw (CCS) and sliding hip screw (SHS) are used in femoral neck fracture fixations, but which is superior is yet to be determined. This study was aimed to compare the clinicoradiological outcome of femoral neck fracture treated with SHS or CCS in young adults. METHODS: Adults (16e60 years) with femoral neck fracture were divided into Group 1 fixed with SHS and Group 2 fixed with three CCS after closed reduction. Pain relief, functional recovery and postoperative radiographs at 6 weeks, 3 months, 6 months and then yearly for upto 4 years were analyzed...
August 1, 2016: Chinese Journal of Traumatology, Zhonghua Chuang Shang za Zhi
D D Baksi, A K Pal, D P Baksi
BACKGROUND: Ununited femoral neck fracture is seen commonly in developing countries due to delayed presentation or failure of primary internal fixation. Such fractures, commonly present with partial or total absorption of femoral neck, osteonecrosis of femoral head in 8-30% cases with upward migration of trochanter posing problem for osteosynthesis, especially in younger individuals. Several techniques for treatment of such conditions are described like osteotomies or nonvascularied cortical or cancellous bone grafting provided varying degrees of success in terms of fracture union but unsatisfactory long term results occurred due to varying incidence of avascular necrosis (AVN) of femoral head...
July 2016: Indian Journal of Orthopaedics
Ming-Yue Xiong, Li-Qiang Liu, Shi-Qiong Liu, Zhen-Hui Liu, Hang-Fei Gao
Avascular necrosis of femoral head (AVFH) is a clinically recalcitrant disease of hip that leads to joint destruction. Osteoprotegerin (OPG), receptor activator of nuclear factor kappa-B (RANK) and RANK ligand (RANKL) regulates the balance, maturation and function of osteoclast and bone remodeling. This study aims to investigate molecular pathways which leads to AVN by studying expression profile of OPG, RANK and RANKL genes. Quantitative Real Time-PCR is used to evaluate mRNA expression of OPG, RANK and RANKL...
2016: American Journal of Translational Research
Hüseyin Yorgancıgil, Ahmet Aslan
OBJECTIVES: This study aims to investigate the effects of surgical approach on the clinical and radiological outcomes, the incidence of avascular necrosis (AVN), and the need for revision surgery in children undergoing open reduction via medial or anterior approach for developmental dysplasia of the hip (DDH). PATIENTS AND METHODS: Forty-three hips of 36 patients (9 males, 27 females; mean age 13.8 month; range 6 to 18 months) treated for DDH, followed-up regularly for at least four years between January 1997 and December 2010, and who were aged five or above in the final control were included in this retrospective study...
August 2016: Eklem Hastalıkları Ve Cerrahisi, Joint Diseases & related Surgery
Yasuharu Nakashima, Takuaki Yamamoto, Jun-Ichi Fukushi, Goro Motomura, Satoshi Hamai, Yusuke Kohno, Yukihide Iwamoto
BACKGROUND: Avascular necrosis of the femoral head (AVN) is the most serious complication after unstable slipped capital femoral epiphysis (SCFE), and is often unsalvageable. We report a minimum 10 years of clinical results for transtrochanteric rotational osteotomy of the femoral head (TRO) for AVN. METHODS: This study included 7 patients (7 hips) with a mean age at surgery of 13.3 years, and the follow-up period was 15.8 years. All patients had prior treatment via closed reduction and pinning of the unstable SCFE, and showed severely collapsed femoral heads...
July 22, 2016: Journal of Orthopaedic Science: Official Journal of the Japanese Orthopaedic Association
Ya-Jie Wang, Fan Yang, Qi-Jun Wu, Shi-Nong Pan, Lian-Yong Li
BACKGROUND: The risk of avascular necrosis of the femoral head (AVN) after treatment of developmental dysplasia of the hip is associated with the method of reduction. Some authors have suggested that open reduction is a risk factor for AVN; however, this is controversial. To our knowledge, a quantitative comparison of the incidence of AVN between closed and open reduction has not been conducted. METHODS: Published studies were identified by searching PubMed, EMBASE, and the Cochrane Library up to May, 2015, focusing on the incidence of AVN after closed or open reduction for developmental dysplasia of the hip in children aged <3 years...
July 2016: Medicine (Baltimore)
Gabriela Ciapetti, Donatella Granchi, Caterina Fotia, Lucia Savarino, Dante Dallari, Nicola Del Piccolo, Davide Maria Donati, Nicola Baldini
BACKGROUND AIMS: Avascular necrosis of the femoral head (AVN) occurs as common result of various conditions or develops as a primary entity, with a high freqency in young adults. Because of its tendency toward osteoarthritis requiring total hip arthroplasty, alternative treatments are being advocated, including cell therapy with mesenchymal stromal cells (MSCs). Because osteonecrotic bone is a severely hypoxic tissue, with a 1-3% oxygen tension, the survival and function of multipotent cells is questionable...
September 2016: Cytotherapy
Frank M Chang, Allison May, Leonard W Faulk, Katherine Flynn, Nancy H Miller, Jason T Rhodes, Pan Zhaoxing, Eduardo N Novais
BACKGROUND: The appropriate intervention for hip subluxation or dislocation in children affected by cerebral palsy (CP) remains controversial. The purpose of this retrospective study was to report radiographic and clinical outcomes following isolated femoral varus derotational osteotomy (VDRO) in children with CP hip dysplasia. Risk factors for resubluxation and avascular necrosis (AVN) were also examined. METHODS: A cohort of 100 patients (199 hips) with CP treated with isolated VDRO between 2003 and 2009 was reviewed...
June 8, 2016: Journal of Pediatric Orthopedics
Joshua K Napora, Allison Gilmore, Jochen P Son-Hing, Dominic C Grimberg, George H Thompson, Raymond W Liu
BACKGROUND: Unstable slipped capital femoral epiphysis (SCFE) has an increased incidence of avascular necrosis (AVN). Early identification and surgical intervention for AVN may help preserve the femoral head. METHODS: We retrospectively reviewed 48 patients (50 hips) with unstable SCFE managed between 2000 and 2014. AVN was diagnosed based on 2 different postoperative protocols. Seventeen patients (17 hips) had a scheduled magnetic resonance imaging (MRI) between 1 and 6 months from initial surgery, and the remaining 31 patients (33 hips) were evaluated by plain radiographs alone...
June 2, 2016: Journal of Pediatric Orthopedics
A Pazderska, S Crowther, P Govender, K C Conlon, M Sherlock, J Gibney
UNLABELLED: Avascular necrosis (AVN) is a rare presenting feature of endogenous hypercortisolism. If left untreated, complete collapse of the femoral head may ensue, necessitating hip replacement in up to 70% of patients. The majority of the described patients with AVN due to endogenous hypercortisolaemia required surgical intervention. A 36-year-old female, investigated for right leg pain, reported rapid weight gain, bruising and secondary amenorrhoea. She had abdominal adiposity with violaceous striae, facial plethora and hirsutism, atrophic skin, ecchymosis and proximal myopathy...
2016: Endocrinology, Diabetes & Metabolism Case Reports
Joon Soon Kang, Kyoung Ho Moon, Joong Sup Shin, Eun Ho Shin, Chi Hoon Ahn, Geon Hong Choi
BACKGROUND: Subcapital femoral neck is known to cause many complications, such as avascular necrosis (AVN) of the femoral head or nonunion, compared with other femoral neck fractures. The purpose of this study was to analyze the incidence of AVN and fixation failures in patients treated with internal fixation using cannulated screws for the subcapital femoral neck fractures. METHODS: This study targeted a total of 84 cases of subcapital femoral neck fractures that underwent internal fixation using cannulated screws...
June 2016: Clinics in Orthopedic Surgery
Perajit Eamsobhana, Kamolporn Keawpornsawan
OBJECTIVES: Fractures of the proximal femur account for less than 1% of all children's fractures. Because of this, most orthopaedic surgeons lack enough experience in treating them. This adds to the rather high incidence of complications especially nonunion. At the time of this review there is no consensus on which method of treatment of the nonunion is the best. The objective of this study is to present our method of treatment to correct the nonunion without open reduction of the nonunion sites...
May 23, 2016: Hip International: the Journal of Clinical and Experimental Research on Hip Pathology and Therapy
Mathew D Schur, Christopher Lee, Alexandre Arkader, Anthony Catalano, Paul D Choi
PURPOSE: The purpose of this study was to identify and evaluate risk factors of avascular necrosis (AVN) after closed treatment for developmental dysplasia of the hip (DDH). METHODS: A retrospective review of children diagnosed with DDH at a tertiary-care children's hospital between 1986 and 2009 was performed. The presence of AVN was assessed according to Salter's classification system. RESULTS: Eighty-two affected hips in 70 children with an average age of 10 months at closed reduction (range 1-31 months) and 5 years (range 2-19 years) of follow-up met the inclusion criteria...
June 2016: Journal of Children's Orthopaedics
Jesús Palencia, Saud Alfayez, Firas Serro, Jamal Alqahtani, Hani Alharbi, Hamed Alhinai
INTRODUCTION: Femoral head and neck fractures in children are uncommon, accounting for fewer than 1% of all pediatric fractures and fewer than 8% of all hip fractures. Furthermore, traumatic transphyseal hip fracture is rare to present in daily practice especially when associated with an acetabular fracture. PRESENTATION OF THE CASE: A twelve years old boy, not known to have any chronic illnesses, presented to the emergency department as a case of polytrauma after a road traffic accident...
2016: International Journal of Surgery Case Reports
Travis Murray, Melanie A Morscher, Amy M Krahe, Mark J Adamczyk, Dennis S Weiner
Previous studies documented the use of fibular allograft in the treatment of slipped capital femoral epiphysis (SCFE) with bone graft epiphysiodesis (BGE). This study describes the results of using a 10-mm diameter premilled fibular allograft packed with demineralized bone matrix placed across the physis in an open surgical approach under image intensification. A review identified 45 cases of BGE using fibular allograft and demineralized bone matrix in 34 patients with a diagnosis of SCFE performed by a single surgeon during an 8-year period...
May 1, 2016: Orthopedics
Lalit Maini, Santosh Kumar, Sahil Batra, Rajat Gupta, Sumit Arora
Avascular necrosis (AVN) of femoral head is a recognised complication of fracture dislocation of the hip joint but is not studied frequently in relation to acetabulum fractures. The aim was to establish the relationship between obturator externus and piriformis muscle morphology in acetabulum fractures and potenital development of AVN of the femoral head. Twenty-five fractures were included in this prospective study and were subjected to radiological assessment and computed tomography of the pelvis. Magnetic resonance imaging (MRI) of the hip was performed to assess the morphology of obturator externus and piriformis, and findings were compared intraoperatively (in 15 cases)...
August 2016: Strategies in Trauma and Limb Reconstruction
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