Search

Objective This study was performed to investigate the reliability of the height of pertrochanteric fractures as a predictor of lateral wall fractures after cephalomedullary nailing and provide a simple way to determine the threshold value. Methods We performed a prospective randomized clinical study of 50 consecutive patients who underwent measurement of the height of the pertrochanteric fracture and the tangent line to the superior margin of the contralateral femoral neck. The preoperative and postoperative integrity of the lateral wall was evaluated by computed tomography. Results The pertrochanteric fracture height was significantly lower in patients with than without intraoperative lateral wall fractures (15.6 vs. 28.5 mm, respectively). The threshold value of the fracture height was 20.445 mm, which was not significantly different from the mean height of the tangent line of the superior margin of the contralateral femoral neck (19.4 mm). Conclusions Pertrochanteric fractures with the proximal starting point lower than the mirror position of the tangent line to the superior margin of the contralateral femoral neck have a higher risk of intraoperative lateral wall fractures during cephalomedullary nailing.

To assess the mid-term effectiveness of arthroscopic surgery in treatment of femoroacetabular impingement (FAI).Between July 2014 and December 2015, 131 patients (132 hips) with FAI were enrolled in this study. There were 68 males and 63 females with an average age of 42.5 years (range, 17-68 years). The FAI was located at left hip in 72 cases, right hip in 58 cases, and bilateral hips in 1 case. The mean disease duration was 35 months (range, 3-120 months). Under arthroscopy, the femoral neck osteoplasty and/or acetabular rim trimming were performed, then the torn labrum was repaired. At the same time, the iliopsoas tendon was divided and the torn round ligament was debrided. The effectiveness was assessed by the visual analogue scale (VAS) and the Harris hip score (HHS).After operation, the perineum nerve palsy and numbness of dorsal feet occurred in 2 cases and 3 cases, respectively. There was no other complication. All patients were followed up 20-36 months (mean, 27.7 months). There were significant differences in the VAS scores and HHS scores between pre-operation, post-operative 3 months, and the last follow-up (Arthroscopic labral repair and osteoplasty is an effective and safe management for FAI in the mid-term follow-up.总结关节镜下手术治疗股骨髋臼撞击征（femoroacetabular impingement，FAI）的中期疗效。.回顾分析 2014 年 7 月—2015 年 12 月收治并符合选择标准的 131 例（132 髋）FAI 患者临床资料。男 68 例，女 63 例；年龄 17～68 岁，平均 42.5 岁。左髋 72 例，右髋 58 例；双髋 1 例。病程 3～120 个月，平均 35 个月。关节镜下行髋臼和/或股骨头颈成形、盂唇修补，同时松解粘连的髂腰肌腱、清理撕裂的圆韧带。采用疼痛视觉模拟评分（VAS）及髋关节 Harris 评分（HHS）评价疗效。.术后除 2 例出现阴部神经麻痹、3 例足背麻木外，无其他相关并发症发生。患者均获随访，随访时间 20～36 个月，平均 27.7 个月。术后 3 个月及末次随访时 VAS 评分及 HHS 评分与术前比较，差异均有统计学意义（关节镜下手术治疗 FAI，在行髋臼和/或股骨头颈成形的同时修补撕裂盂唇，中期疗效满意，是一种安全、有效、微创的治疗方法。.

Femoral neck nonunion (FNN) is a potential complication in patients with displaced femoral neck fractures, occurring in 33%. This may lead to early hip dysfunction or arthroplasty. Combination of modified free vascularized fibular grafting (FVFG) and a reverse LISS may provide a reasonable means to salvage a painless, functional and native hip. Between August 2010 and August 2012, sixteen patients with femoral neck nonunion were treated with a combined procedure involving modified free vascularized fibular grafting and a reverse LISS. The average age of them is 20.3 years (range 12.0–28.0 years). After removing old implants, the nonunion site was debrided, reduced and fixed with a LISS. The fibular grafts were compacted into a trough in the femoral neck. The Harris Hip score system was used to assess hip function and anteroposterior and frog-lateral hip roentgenograms were used to evaluate bone healing. All femoral neck nonunion healed without severe complications. The mean follow-up time was 32.9 months (range 23.0–47.0 months) and the average union time was 7.6 months (range 5.0–10.0 months). All coxa vara deformities and retroversions of the femoral head were corrected. The Harris hip scores (HHS) were improved 36.6 points on average (59.6 points preoperatively to 96.2 points postoperatively). No incidences of osteonecrosis of the femoral head were observed. The combined modified FVFG and reverse LISS plating is a suitable procedure for the management of femoral neck nonunion in patients younger than 30 years, especially for those patients with a revision history.

Neglected femoral neck fractures in young adults pose a great challenge to orthopedic surgeons because of the high risks of nonunion and osteonecrosis. We attempted to determine whether free vascularised fibular grafting through an anterior approach could enhance bone union, improve hip function and reduce complications in the treatment of such fractures. Thirteen patients with neglected femoral neck fractures were treated with a free vascularised fibular graft through an anterior approach between 2004 and 2008. The mean age was 30.9 years (range, 17–47 years). The average delay between injury and operation was 6.7 months (range, 1.5–22 months). All 13 cases had ununited fractures but without osteonecrosis of the femoral head on plain radiographs before coming under our care. The average follow-up was 51.2 months (range, 36–75 months). All patients had fracture union within an average of 4.8 months (range, 3–9 months). Postoperatively, 9 patients had coxa vara of 10 to 20 degrees and leg discrepancy between 0.5 to 1.5 cm. One patient had coxa vara deformity of 25 degrees and 2-cm leg discrepancy. No patients developed osteonecrosis of the femoral head or donor-site morbidity. The mean Harris hip score improved from 55.5 points preoperatively to 84.8 points postoperatively (p This procedure may be useful and safe in the treatment of neglected femoral neck fractures in young adults, but further studies with a large number of patients are needed.

The aim of this study was to compare the safety and efficacy of OsteoSet®2 DBM with autologous cancellous bone in free vascularised fibular grafting for the treatment of large osteonecrotic lesions of the femoral head. Twenty-four patients (30 hips) with large osteonecrotic lesions of the femoral head (stage IIC in six hips, stage IIIC in 14, and stage IVC in ten, according to the classification system of Steinberg et al.) underwent free vascularised fibular grafting with OsteoSet®2 DBM. This group was retrospectively matched to a group of 24 patients (30 hips) who underwent free vascularised fibular grafting with autologous cancellous bone during the same time period according to the aetiology, stage, and size of the lesion and the mean preoperative Harris hip score. A prospective case-controlled study was then performed with a mean follow-up duration of 26 months. The results show no statistically significant differences between the two groups in overall clinical outcome or the radiographic assessment. Furthermore, no adverse events related to the use of the OsteoSet®2 DBM were observed. The results demonstrate that OsteoSet®2 DBM combined with autograft bone performs equally as well as that of autologous bone alone. Therefore, OsteoSet®2 DBM can be used as a safe and effective graft extender in free vascularised fibular grafting for large osteonecrotic lesions of the femoral head.

Objective: To evaluate the safety and efficacy of locking plate combined with bone grafting in the treatment of aseptic nonunion following intramedullary nailing fixation of fractures of the long bones. Methods: Thirty-eight consecutive patients treated in our hospital between January 2004 and December 2006 were included in this retrospective study. The nonunions included 20 femurs, 15 tibias, and 3 humeri. The duration of non-union ranged from 6 to 84 months and 21 (55.3%) of them were located around the metaphysis of the affected long bones. There were 12 women and 26 men with a mean age of 39.2 years (range, 9–70 years). Locking plate combined with bone grafting was the procedure chosen to treat every case of nonunion in this series. The clinical outcomes were evaluated. Results: All patients were followed up for 6–20 months (average 11.6 months). After locking plate fixation combined with bone grafting, union was achieved in all cases, the average healing time being 5.3 months (range, 4–8 months). Infection of the superficial incision occurred in three cases (7.9%) and delayed healing of the incision in one case, all of which healed with no further complications. The function of the adjacent joints was excellent to good in 30 patients (78.9%), fair in 7 (18.4%) and poor in 1 (2.6%) after follow-up. Conclusion: Locking plate fixation combined with bone grafting is a highly effective treatment for aseptic nonunions of the long bones after intramedullary nailing fixation, especially in the case of metaphyseal nonunion.

Reconstruction of large skeletal defects secondary to osteomyelitis or open fracture is a challenging problem. The purpose of this study was to evaluate the results of using free vascularized fibular graft (FVFG) combined with locking plate in the treatment of large skeletal defects from open fracture and infection. Ten patients with a mean age of 34 years (ranged 13–57 years) and a mean length of 8.7 cm (range 6–17 cm) skeletal defect were treated with FVFG and locking plate. The mean follow-up time was 26 months. Grafting union occurred in all patients, with a mean healing time of 4.5 months. No recurrence of osteomyelitis and stress fractures was observed. The mean time to full weight-bearing was 10 months, and all patients were pain-free and able to walk without supportive devices. FVFG combined with locking plate is a viable option for the management of large skeletal defects from open fracture and infection.

Objective To investigate the prevalence of clinical anxiety and clinical depression in Chinese young and mid-aged patients with osteonecrosis of the femoral head (ONFH) and to analyze their potential risk factors. Methods Two hundred and sixteen Chinese patients with ONFH were consecutively enrolled in this cross-sectional study from January 2010 to December 2010. The Zung self-rating anxiety scale (SAS) and the Zung self-rating depression scale (SDS) were used to assess the prevalence of clinical anxiety and clinical depression. An additional questionnaire containing seventeen items of potential risk factors was completed by all patients. Binary logistic regression analysis was employed to reveal potential risk factors of anxiety and depression. Results The prevalence of clinical anxiety and clinical depression was 20.4% and 21.8% in Chinese young and middle-aged patients with ONFH, respectively. Binary regression analysis showed that independent risk factors correlated with high incidence of clinical anxiety included involved femoral head (OR = 3.168, 95% CI: 1.496 - 6.708) and stages of ONFH (ORIV-V / II = 5.383, 95% CI: 1.664-17.416). Independent risk factors correlated with high incidence of depression included gender (OR = 2.853, 95% CI: 1.467-5.778), comorbid diseases (OR = 4.243, 95% CI: 1.940-9.278) and stages of the disease (OR IV-V/II = 16.963, 95% CI: 4.404-65.331). Conclusions Patients with bilateral ONFH are inclined to have clinical anxiety, while female patients and patients with comorbid diseases might tend to get clinical depression. Advanced stages of ONFH are independent risk factors for both clinical anxiety and clinical depression.

Objective Free vascularised fibular grafting (FVFG) could be a good option for the restoration of massive bone defects in lower limbs when combined with use of a locking plate. The progress of fibular hypertrophy is closely related to regain of function, as well as to prevention of stress fractures. Multiple variables affecting fibular hypertrophy were investigated in the current study to elucidate correlative factors. Methods Eighteen patients with a massive bone defect in a lower limb reconstructed by FVFG combined with a locking plate were retrospectively enrolled in the current study. The degree of fibular hypertrophy was calculated based on the measurements from anteroposterior imaging at regular intervals of 3 months, 6 months, 1, 2 and 3 years postoperatively. Repeated measures analysis of variance was employed to evaluate and compare correlative factors including gender (male vs. female), age distribution ( 30 years), site (femur vs. tibia) and length of bone defect (6–10 cm vs. >10 cm), previous number of operations (once vs. more than twice) and concomitant infection (detected vs. non-detected). Results All defects could be successfully repaired by FVFG and bone union was achieved uneventfully. The degree of fibular hypertrophy was 0.14%, 11.27%, 31.53%, 58.14% and 71.81% retrospectively at the five follow-up time points. Statistical analysis revealed that the above-mentioned factors did not affect the progress of fibular hypertrophy. Conclusions FVFG could be a good choice for the reconstruction of massive bone defects when combined with a locking plate. Factors including gender, age distribution, site and length of bone defects, number of previous operations and infection do not impact the progress of fibular hypertrophy, which implies that intrinsic factors might play an important role in restoration.

Between June 2007 and May 2008, 21 patients with bilateral osteonecrosis of the femoral head were surgically treated with implantation of free vascularized fibula obtained from the unilateral donor site. All patients were followed up clinically and radiographically for an average of 3.5 years. The evaluation included operative duration, blood loss, Harris hip score, incidence of complications, and radiological examinations. The time for fibular harvesting was 20min on average. Total operative duration was 100–240min, with an average of 150min. Blood loss averaged 300ml. All transplanted fibula integrated well to the femoral head 3.5years postoperatively with no severe complications observed. The results revealed that unilateral free vascularized fibula is effective for the treatment of bilateral osteonecrosis of the femoral head.

To investigate the effectiveness of free vascularized fibula grafting with unilateral fibula as donor in treatment of bilateral avascular necrosis of femoral head (ANFH).Between June 2007 and January 2008, 14 patients with bilateral ANFH were treated with free vascularized fibula grafting with unilateral fibula as donor. There were 12 males and 2 females with an average age of 36.6 years (range, 17-57 years). The necrosis was caused by use of steroids in 3 cases, consumption of alcohol in 4 cases, and idiopathic condition in 7 cases. According to Steinberg system, 16 hips were classified as stage II, 10 hips as stage III, and 2 hips as stage IV. The preoperative Harris hip scores were 77.50 +/- 4.19, 69.70 +/- 2.76, 59.50 +/- 0.50 in patients at stages II, III, and IV, respectively. The duration of operation and the bleeding volume were recorded. The X-ray examination, the Harris hip score, and the complications were used to evaluate the effectiveness.The duration of the fibula osteotomy was 10-32 minutes (mean, 20 minutes). The duration of the total operation was 100-240 minutes (mean, 140 minutes). The bleeding volume was 200-500 mL (mean, 280 mL). All patients achieved healing of incision by first intention. The patients were followed up 12-40 months (mean, 24 months). One case had numbness and hypesthesia of the anterolateral thigh; 1 case had abnormal sensation of the dorsal foot; 1 case had discomfort of the ankle; and they restored to normal at 1 year after operation. According to X-ray films 1 year after operation, the improvement was achieved in 23 hips (82.1%) and no deterioration in 5 hips (17.9%). At 1 year after operation, the Harris hip scores were 93.90 +/- 4.84, 88.50 +/- 8.13, and 78.00 +/- 0.00 in patients at stages II, III, and IV, respectively, showing significant differences when compared with preoperative ones (P0.05).Unilateral free vascularized fibula grafting has lots of virtues, such as short surgical time, less bleeding volume, little injury, and good results of function recovery. It could be an effective and safe method in treating bilateral ANFH.

Although a large skeletal defect secondary to osteomyelitis in children is not an uncommon problem, there are no descriptions of the management of such a defect with a free vascularized fibular graft in combination with a locking plate. We performed such a technique, after radical debridement and systemic antibiotic treatment, on a 13-year-old boy suffering from a large 10 cm tibial defect secondary to osteomyelitis. Primary union of the graft was achieved at 6 months. No recurrence of osteomyelitis occurred in the 29-month follow-up period, and limb salvage and eradication of the infection were achieved successfully.

The purpose of this study was to review the radiographs of symptomatic femoral head osteonecrosis in patients with systemic lupus erythematosus (SLE) and to assess the results of treatment using free vascularised fibular grafting. We retrospectively reviewed 50 patients (80 hips) with SLE who underwent free vascularised fibular grafting for osteonecrosis of the femoral head. All patients were followed up for at least 2 or more years (average, 4.3 years). The mean Harris hip score improved from 72 to 88. At the latest follow-up, we found improved or unchanged radiographs in 12 of initially Stage II hips and in 60 of 64 Stage III or IV hips. No hips failed treatment and underwent total hip arthroplasty. The data suggest that free vascularised fibular grafting was successful in maintaining joint function and in delaying the need for joint replacement procedure.

Treatment of skeletal defects secondary to osteomyelitis is a challenging problem. The purpose of this study was to present our experience of the use of free vascularised fibular grafts to treat such defects. Ten patients with a mean age of 31 years (range 16–50 years) and a skeletal defect with a mean length of 9.5 cm (range 6–17 cm) were managed with a protocol which included radical debridement of the lesion and a vascularised fibular graft. The mean follow-up time was 26 months. Union of the graft occurred in all patients, at a mean of 4.5 months. No recurrence of osteomyelitis was observed. The mean time to full weight bearing was ten months, and all patients were pain-free and able to walk without supportive devices. A free vascularised fibular graft is a viable option for the management of large skeletal defects resulting from osteomyelitis.

Osteonecrosis of the femoral head is a common and severe complication after renal transplantation. It is characterized by deterioration of hip joint function, which impairs quality of life. We present 3 renal transplant case reports of patients with osteonecrosis of the femoral head who underwent free vascularized fibular grafting at our hospital. Follow-up was from 1½ to 2 years. All 3 patients exhibited good recovery with substantial improvement in joint function. Intraoperative and postoperative findings demonstrated the safety of this surgical procedure.

To evaluate the effect of the treatment of necrosis of femoral head with the free vascularized fibula grafting.From October 2000 to February 2002, 31 hips in 26 patients with ischemic necrosis of the femoral head were treated with free vascularized fibula graft. Among these patients, 21 patients (25 hips) were followed up for 6-18 months (12 months on average). According to Steinberg stage: II period, 5 hips; III period, 8 hips; IV period, 12 hips.Among 25 hips, their Harris Hip Score at all satges were improved during the follow-up. The symptom of pain diminished or disappeared after operation. The patient's ability to work and live was not limited or only slightly limited during the follow-up. Radiographic evaluation showed that most femoral heads improved (18 hips) or unchanged (6 hips) and only one worsened.The free vascularized fibular grafting is a valuable method for femoral head necrosis. With this method, we can prevent or delay the process of the disease.

Background Fractures of the intertrochanteric hip are common and the treatment of unstable fractures generally requires an operative approach. In elderly patients, osteoporosis makes internal fixation problematic and frequently contributes to failed fixation and poor clinical results. We have attempted to apply the Less Invasive Stabilization System (LISS) in reverse position for the repair of intertrochanteric hip fractures in elderly patients with osteoporotic bones. A retrospective review is presented of the cases of 28 elderly patients with stable and unstable fractures of the intertrochanteric hip treated using the reverse LISS. Methods We treated 28 elderly patients with a mean age of 82.3 years. According to the Evens classification, there were 2 Type I fractures, 2 Type II fractures, 3 Type III fractures, 13 Type IV fractures, 6 Type V fractures and 2 Type R fractures. All fractures were treated using the reverse LISS. Radiographic and clinical evidence of functional outcome and complications were evaluated. Results Mean perioperative blood loss was 92.4 milliliters (range 35 to 245 milliliters), and the mean postoperative hospital stay was 8.7 days (range 3 to 14 days). Complications included one minor wound hematoma. Radiographically, no collapses, screw cutouts, or head penetrations were seen. All surviving patients (28 of 28; 100 percent) had uneventful fracture healing with union achieved by six months in all patients. Conclusions Use of the Reverse LISS plating for intertrochanteric hip fractures resulted in event-free fracture healing.