Outcome of Pertrochanteric Femur Fractures with Proximal Femur Locking Compression Plate

Background: Fractures of the proximal femur, including fractures affecting the pertrochanteric region, have become a public health problem. Owing to aging of the population, we have to operate on even more elderly patients who sometimes present with significant co-morbidities. Although conventional implants have given good results in stable peritrochanteric fractures, proximal femur locking compression plate (PFLCP) which has been recently introduced is better suited for comminuted, unstable pertrochanteric fractures and osteoporotic bones. In PF-LCP, bone-implantconstruct so formed is mechanically stable and fixation failure due to screw loosening in osteoporotic bone can be reduced. Materials &Methods: This prospective study was conducted in our institute and was approved by local ethical committee. Twenty-five consecutive patients of either sex with age more than 60 years (range, 60-84) having pertrochanteric fractures were operated upon with PFLCP. A.O classification was followed in the study and Singh’s index for osteoporosis was calculated. Operating time, blood loss and any technical difficulty with the implant were recorded. Patients were followed clinically and radiologically for union at fracture site and implant-related complications for a period of 24 months. The Harris Hip Score was used to document hip functions at final follow-up. Observations: Amongst the 25 patients, the average operation time in our study was 66.60±10.57 minutes. The average radiological union was 3.40±0.63 months (13.6 weeks). Average time for full weight bearing was 13.12±1.90 weeks. There were two cases of wound infection, one case of coxa vara and one case of a proximal screw back-out. There was no case of plate lift or screw breakage. There was no case of non-union. Conclusion: The PFLCP can be a feasible alternative to the treatment of peritrochanteric fractures. Treatment with PFLCP can provide good-to-excellent healing in osteoporotic bones having comminuted and unstable peritrochanteric fractures, with a limited occurrence of complications.

Open Surgical Hip Dislocation for an Acetabular Osteoid Osteoma - A Case Report

Osteoid osteoma is a benign tumor that accounts for roughly 10-12% of all benign bone forming tumors. This tumor generally occurs within the first three decades of life and occurs more commonly in males. This lesion is painful and is generally worse at night and has relief of symptoms with the use of NSAIDs. Osteoid osteoma is characterized by the production of osteoid surrounded by a rim of sclerotic bone. These lesions most commonly occur in long bones such as the proximal femur, however they can occur anywhere. Rarely, as with our patient, have these lesions been reported in the acetabulum.

Comparison of diagnostic accuracy of 2D and 3D measurements to determine opportunistic screening of osteoporosis using the proximal femur on abdomen-pelvic CT

Objectives To compare the osteoporosis-predicting ability of computed tomography (CT) indexes in abdomen-pelvic CT using the proximal femur and the reliability of measurements in two- and three-dimensional analyses. Methods Four hundred thirty female patients (age range, 50–96 years) who underwent dual-energy X-ray absorptiometry and abdominal-pelvic CT within 1 month were retrospectively selected. The volumes of interest (VOIs) from the femoral head to the lesser trochanter and the femoral neck were expressed as 3DFemur. Round regions of interest (ROIs) of image plane drawn over the femoral neck touching the outer cortex were determined as 2Dcoronal. In HU histogram analysis (HUHA), the percentages of HU histogram ranges related to the ROI or VOI were classified as HUHAFat (<0 HU) and HUHABone (126 HU≤). Diagnostic performance, correlation analysis and measurement reliability were analyzed by receiver operating characteristic curves, correlation coefficient and interobserver correlation coefficient (ICC), respectively. Results AUCs of each HUHA and mean-HU measurement on 2D-ROI and 3D-VOI were 0.94 or higher (P < 0.001). Both 3DFemur-Mean-HU and 3DFemur-HUHABone showed the highest AUC (0.96). The cut-off value of 3DFemur-Mean-HU was 231HU or less, (sensitivity: 94.8%; specificity: 85.0%; correlation coefficient: −0.65; P <0.001) for diagnosis of osteoporosis. There was no superiority between AUCs in 2D-ROI and 3D-VOI measurements (P > 0.05). Reliability of the 3D-VOI measurement showed perfect agreement (ICC ≥ 0.94), and 2D-ROI showed moderate to good agreement (ICC range: 0.63~0.84). Conclusions CT indexes on 3D-VOI for predicting femoral osteoporosis showed similar diagnostic accuracy with better reproducibility of measurement, compared with 2D-ROI.

The correlation between volumetric bone mineral density and morphological parameters of the proximal femur and clinical outcomes in ankylosing spondylitis patients with hip involvement

Background To measure volumetric bone mineral density (vBMD) with quantitative computed tomography (QCT) in the proximal femur of ankylosing spondylitis (AS) patients with hip involvement and analyze their correlations with radiographic and clinical parameters. Methods Sixty-five AS inpatients were enrolled in this study. The bone mineral density was measured by QCT and dual-energy x-ray absorptiometry (DXA), respectively. The morphological parameters of the proximal femur were measured on digital anteroposterior (AP) radiographs of the pelvis. The correlations between them were analyzed by SPSS software. Results The average trabecular vBMD measured at the femoral neck was 136.38 ± 25.58 mg/cm3. According to the BASRI-Hip score, group A consisted of 39 hips (0–2 score) and group B consisted of 26 hips (3–4 score). There were significant differences regarding trabecular CTXA equivalent T-score between group A and B at the femoral neck (p = 0.004); intertrochanteric region (p < 0.001) and greater trochanter (p = 0.001). The trabecular CTXA equivalent T-score at femoral neck had a negative correlation with disease duration (r = − 0.311, p = 0.012) and with CBR (r = − 0.319, p = 0.010). Conclusions The low trabecular bone density at the site of the hip was associated with the duration of disease progression and degree of hip involvement. Meanwhile, it had a correlation with hip function status although we failed to confirm a significant relationship between hip vBMD and disease activity.

Peculiarities of Reparative Osteogenesis in Fractures of the Proximal Femur in Patients with Concomitant Arterial Hypertension

Treatment of patients with fractures of the proximal femur is an important problem in modern traumatology. Hip fractures are more commonly associated with osteoporosis. Elderly and senile people make up a significant proportion of patients with fractures. Arterial hypertension (AH) in the elderly population is a disease with a high prevalence. When treating fractures of the proximal femur, it is necessary to take into account the features of reparative osteogenesis characteristics of patients with concomitant arterial hypertension. Medicines used to treat hypertension have a beneficial effect on bone tissue. Pharmacological correction of hypertension in these patients is essential to optimize fracture healing.

Experimental Validation of a Voxel-Based Finite Element Model Simulating Femoroplasty of Lytic Lesions in the Proximal Femur

Femoroplasty is a procedure where bone cement is injected percutaneously into a weakened proximal femur. Uncertainty exists whether femoroplasty provides sufficient mechanical strengthening to prevent fractures in patients with femoral bone metastases. Finite element models are promising tools to evaluate the mechanical effectiveness of femoroplasty, but a thorough validation is required. This study validated a voxel-based finite element model against experimental data from eight pairs of human cadaver femurs with artificial metastatic lesions. One femur from each pair was left untreated, while the contralateral femur was augmented with bone cement. Finite element models accurately predicted the femoral strength in the defect (R² = 0.96) and augmented (R² = 0.93) femurs. The modelled surface strain distributions showed a good qualitative match with results from digital image correlation; yet, quantitatively, only moderate correlation coefficients were found for the defect (mean R² = 0.78) and augmented (mean R² = 0.76) femurs. This was attributed to the presence of vessel holes in the femurs and the jagged surface representation of our voxel-based models. Despite some inaccuracies in the surface measurements, the FE models accurately predicted the global bone strength and qualitative deformation behavior, both before and after femoroplasty. Hence, they can offer a useful biomechanical tool to assist clinicians in assessing the need for prophylactic augmentation in patients with metastatic bone disease, as well as in identifying suitable patients for femoroplasty.