Medial femoral circumflex artery pseudoaneurysm following intramedullary nailing for intertrochanteric fracture

Abstract Objective：Intertrochanteric fracture is a common senile disease, which is mainly treated by surgery. The evaluation of postoperative healing of such fractures has always been based on qualitative evaluation of clinical and radiological indicators. Currently, there are no quantitative evaluations of hip fracture union other than the Radiographic Union Score or Hip (RUSH) score. The aim of this study was to evaluate fracture healing of intertrochanteric fractures treated with intramedullary nailing and plates using RUSH and the modified RUSH score we developed. Methods：We collected a total of 96 patients with surgically treated intertrochanteric fractures, including 46 with lateral plate fixation and 50 with intramedullary nailing. Six orthopedic surgeons assessed the overall impression of fracture union on more than 200 postoperative X-rays without knowing any information, followed by the use of RUSH and modified RUSH to evaluate the x-rays separately to see if the two methods improved the consistency of intertrochanteric fracture union. Results：the consistency of overall fracture healing impression was moderate（ICC=0.487）, RUSH and modified RUSH improved the consistency to substantial（ICC=0.80）and basically perfect（ICC=0.81）, respectively. In addition, for the evaluation of union of all intertrochanteric fractures, the overall score of plate was always higher than that of intramedullary nail. When the lateral plate and intramedullary nail were separately scored, the RUSH score of plate was basically the same as modified RUSH, while the modified RUSH of intramedullary nail was higher than modified RUSH. Ultimately,the medial (r=0.54 and R =0.53) and anterior (r=0.55 and R =0.54) and the global score (R =0.68 and R =0.68) in the single cortex showed a high correlation with the overall fracture healing impression in both RUSH and modified RUSH scores. Ultimately,medial (r=0.54 and r =0.53) and anterior (r=0.55 and r=0.54) in individual cortices and overall scores (r=0.68 and r =0.68) showed a high correlation with overall fracture healing impressions in both RUSH and modified RUSH scores. Conclusions：we developed a new hip fracture score comparable to the RUSH score that significantly improves the consistency of radiographic assessment of intertrochanteric fracture union. Most importantly, modified RUSH filled the callus formation gap in RUSH scores between cortical bridging and no cortical bridging. Therefore, we recommend the use of RUSH or a modified RUSH score to improve orthopedic surgeons' assessment of intertrochanteric fracture union.

Download Full-text

Access to the Ischium: A Simple Extension of the Posterior Approach in Revision Hip Arthroplasty

The Journal of Hip Surgery ◽

10.1055/s-0038-1646938 ◽

2018 ◽

Vol 02 (01) ◽

pp. 054-058

Author(s):

Kilian Rueckl ◽

Friedrich Boettner

Keyword(s):

Hip Arthroplasty ◽

Surgical Approach ◽

Posterior Approach ◽

Posterior Column ◽

Simple Extension ◽

Circumflex Artery ◽

Obturator Externus ◽

Medial Femoral Circumflex Artery ◽

Revision Tha ◽

Acetabular Defects

AbstractReconstruction of acetabular defects in revision total hip arthroplasty (THA) requires excellent exposure. Most extensile approaches to the acetabulum were described in the trauma literature and are not beneficial for revision THA. This article describes a modification of the standard posterior surgical approach to improve visualization of the ischium as required for acetabular defect reconstruction, insertion of standard and custom triflange cages as well as posterior column plating. The current surgical technique utilizes an intermuscular plane between the gemellus inferior muscle and the obturator externus muscle. This intermuscular plane leads the surgeon directly to the ischium and facilitates easy extension toward the insertion of the hamstring muscles without compromising the insertion of the external rotator muscles along the ischium. This article describes a novel surgical approach to the posterior column and ischium under special consideration of the sciatic nerve, superior gluteal vessels, and medial femoral circumflex artery. This simple extension of the standard posterior approach optimizes exposure of the posterior column during revision THA using a posterior approach.

Download Full-text