Chronic locked posterior gleno-humeral dislocation: technical note on fibular grafting for restoration of humeral head sphericity

Background Reconstruction of reverse Hill-Sachs defect using osteo-chondral allograft has the advantages of spherical re-contouring and provision of smooth biological articular surface of the reconstructed humeral head. However, worldwide availability and risk of disease transmission of osteo-chondral allograft remain points of increasing concerns. As an alternative to lacking osteo-chondral allograft, the current technical note describes a reconstructive technique of reverse Hill-Sachs defect using autologous fibular grafting. Methods Following open reduction of the dislocated humeral head, reverse Hill-Sachs defect was reconstructed using 3–4 autologous fibular pieces (each is of 10 mm in length) fixed in flush with the articular cartilage using 4-mm cancellous screws. Defect reconstruction was then followed by modified McLaughlin’s transfer and posterior capsulorrhaphy. Results Spherical contour of the humeral head and gleno-humeral range of motion were restored. Intra-operative dynamic testing of the reconstruct revealed no residual posterior gleno-humeral instability. Conclusion Currently reported technique might offer advantages of graft availability, technical simplicity, familiarity and reproducibility, safety (i.e. no disease transmission) and bone preservation facilitating future revision management (if needed). Nevertheless, long-term outcomes of this technique should be investigated via further cohort clinical studies.

Mid- to long-term results of modified avascular fibular grafting for ONFH

Free vascularized fibular grafting was reported a favorable method to prevent the collapse of the femoral head. This study analyzed the mid- to long-term outcomes of avascular fibular grafting (AVFG) for osteonecrosis of the femoral head (ONFH) with 6- to 8-year follow-up. From March 2009 to March 2012, 34 patients (48 hips) were diagnosed with ONFH operated with AVFG in Jiangsu Province Hospital of traditional Chinese Medicine. We retrospectively reviewed the clinic outcomes of these patients and evaluated the differences in outcomes by diverse stages [Association Research Circulation Osseous (ARCO)] and types [China–Japan Friendship Hospital (CJFH) classification] annually. The hip survival rate, Harris hip score (HHS), activity level and imaging stability were calculated. The average follow-up time was 6.7 years. At the last follow-up, 34 of 48 hips survived totally. According to the ARCO stage, the overall clinical success rate for hip preserving were 76.0% (19/25) in II stage, 85.7% (12/14) in IIIA stage and 33.3% (3/9) in IIIB stage. Referring to the CJFH classification system, the hip survival rate were 100% (2/2) in M type, 90.9% (10/11) in C type, 77.8% (14/18) in L1 type, 57.1% (8/14) in L2 type and 0% (0/3) in L3 type. The mean visual analog scale (VAS) score, HHS and Western Ontario McMaster Osteoarthritis index (WOMAC) were significantly improved at the final follow-up compared with pre-operative values (P < 0.001). The AVFG operation can increase the hip function and improve patients’ lives quality. The mid- to long-term efficacy can satisfy fundamental life requirements, especially for those early-stage and small-scale patients who suffer ONFH to avoid or put off the time of total hip arthroplasty surgery.

Bilateral Congenital Pseudarthrosis of the Tibia with Neurofibromatosis Type 1: Case Report and Literature Review

Congenital pseudoarthrosis of the tibia (CTP) is a pathology characterized by dysplasia and pathological fractures in the tibia which fail to heal on its own. Its relationship with neurofibromatosis type 1 is already known. A very rare case; an 13 year old child diagnosed with NF1, accompanying bilateral CTP was presented in this article. She also had occasional blood pressure attacks and café au lait spots. She was diagnosed with NF, by gene mutation analysis and the BT results reported that pseudoarthrosis affected both tibiae. The patient was successfully treated by performing fibular grafting and external fixation operation of the tibia with internal and Ilizarov technique. Correction osteotomy was performed and grafted with 20 cc synthetic bone graft on the part of the right tibia where the bowing deformity was observed; the left tibia was not osteotomized as the bowing deformity was slighter. As a result of the 13-month follow-up,

A Mid- to Long-Term Results of The Avascular Fibular Grafting in ONFH With 6 to 8-Year Follow-Up

Background: Free vascularized fibular grafting was reported a favorable method to prevent the collapse of the femoral head. Nevertheless, this operation is traumatic and expensive. This study analyzed the long-term outcomes of avascular fibular grafting for osteonecrosis of the femoral head(ONFH) with 6 to 8 year follow-up.Methods: From March 2009 to March 2012, 34 patients(48 hips) were diagnosed the ONFH with Association Research Circulation Osseous(ARCO) stage of Ⅱ to Ⅲb and operated with avascular fibular grafting in Jiangsu Province Hospital of traditional Chinese Medicine. We retrospectively reviewed the clinic effects of these patients and assessed the difference effects with diverse stages(ARCO) and types(China-Japan Friendship Hospital classification, CJFH) annually. The hip survival rate, Harris hip score, activity level and imaging stability were calculated. The average follow-up time was 6.7 years.Results: At the last follow-up,34 of 48 hips survived totally. Depending on the ARCO stage, The overall clinical success rate for hip preserving were 76.0% (19/25) in Ⅱ stage ,85.7%(12/14) in ⅢA stage and 33.3%(3/9) in ⅢB stage. Referring to the CJFH classification system, the hip survival rate were 100%(2/2) in M type,90.9%(10/11) in C type,77.8%(14/18) in L1 type,57.1%(8/14) in L2 type and 0%(0/3) in L3 type. The mean VAS score, HHS, and WOMAC were significantly improved at the final follow-up compared with preoperative values (p < 0.001).Conclusion: The avascular fibular grafting operation can increase the hip function and improve patients’ lives quality. It possesses vast clinical as well as practical significance, because the long-term efficacy can satisfy fundamental life requirements, especially for those early-stage and small-scale patients who suffer ONFH to avoid or put off the time of total hip arthroplasty(THA) surgery.