Proximal femoral nail anti-rotation (PFNA) with a lag screw that is shaped like a spiral blade shape is an orthopedic implant to fix trochanteric fractures of the proximal femur. In addition the reason of the biomechanical advantages, PFNA widely been used recently. We report an 83-year-old man with excessive sliding of the helical blade and a femoral neck fracture after AO/OTA type A2 intertrochanteric fracture, which was fixed with a PFNA.
Femoral Neck Fractures ; Femur ; Femur Neck ; Hip Fractures ; Nails ; Orthopedics

No abstract available.
Meningitis, Aseptic*

Recently, the use of intramedullary nailing for proximal femoral fractures has increased. Breakage of the nail usually occurs at the un-united fracture site, and it is a rare complication of intramedullary nailing of the femur. However, removal of the distal fragment of a broken nail is a challenging problem. Herein, the authors describe the methods used for removal of relatively fixed or strongly fixed broken intramedullary nails in two different cases.
Femoral Fractures ; Femur ; Fracture Fixation, Intramedullary ; Hip Fractures

No abstract available.
Cholesterol*

PURPOSE: To analyze the effectiveness of inserting beads made of calcium sulfate cement that were also impregnated with Vancomycin after debridement of an acute-immediate stage infected hip arthroplasty. MATERIALS AND METHODS: Between 2002 and 2008, the cases of 13 patients with documented acute-immediate stage infections of hip arthroplasty were reviewed and followed for at least two years postoperatively (average 4.3 years). The preoperative and postoperative clinical and radiologic findings and blood laboratory work of the cases were checked. All cases were performed through retention of the implant and massive debridement and saline irrigation. Next, vancomycin-impregnated calcium sulfate cement beads were inserted. RESULTS: After the first operation, the average interval to wait before performing a second operation was 27.7 days (17~37 days). During the second operation, the erythrocyte sediment rate and C-reactive protein were 150.97 mm/hr (34.6~339.7 mm/hr) and 76.4 mg/L (41~132 mg/L), respectively. Infectious organisms were cultured and isolated. There were 5 cases of Methicillin-resistant Staphylococcus aureus (MRSA). In addition, the results of an antibiotics sensitivity test revealed 8 cases of Vancomycin and 5 cases of 3rd generation Cephalosporin. Radiologic results showed 10 cases with a stable fixation on the last follow-up (femoral stem), and 1 case of hip joint space narrowing, called acetabular erosion. CONCLUSION: Inserting beads made of calcium sulfate cement that were also impregnated with Vancomycin proved to be a useful treatment for an acute immediate infection of hip arthroplasty.
Anti-Bacterial Agents ; Arthroplasty ; C-Reactive Protein ; Calcium ; Calcium Sulfate ; Debridement ; Erythrocytes ; Follow-Up Studies ; Hip ; Hip Joint ; Humans ; Methicillin-Resistant Staphylococcus aureus ; Retention (Psychology) ; Vancomycin

PURPOSE: Cementless total hip arthroplasty was performed to treat primary osteoarthritis of the hip and avascular necrosis of the femoral head. The clinical and radiological results of the acetabular cups and femoral stems were compared. MATERIALS AND METHODS: The subjects were 84 cases who underwent primary cementless total hip arthroplasty from March 1992 to May 2001. The 84 cases were followed up for at least eight years. The patients were divided into the following two groups: group (A), 38 cases of degenerative osteoarthritis of the hip; and group (B), 46 cases of avascular necrosis of the hip. The clinical evaluation was conducted based on the Harris Hip Score (HHS). A radiological assessment was performed to determine if osteolysis or acetabular loosening had occurred. The results were analyzed statistically. RESULTS: The postoperative HHS of groups A and B at the final follow-up were 92.1 and 91.2, respectively (p=0.483). The radiological results revealed 9 and 15 cases of acetabular osteolysis (p=0.671) and 1 and 3 cases of vertical migration of the acetabular cups in the group A and B, respectively. Eight and 7 complications (p=0.572) were encountered in group A and B, respectively. Among these, 4 and 5 cases of revisional total hip arthroplasty were performed in group A and B, respectively. The results of survival analysis were similar in the two groups (p=0.969). CONCLUSION: The clinical and radiological features of the acetabular cups and stems were similar in the two groups. Nevertheless, further studies will be needed due to the high rate of polyethylene liner wear and osteolysis around the acetabular cups or femoral stems.
Arthroplasty ; Follow-Up Studies ; Head ; Hip ; Humans ; Necrosis ; Osteoarthritis ; Osteolysis ; Osteonecrosis ; Polyethylene

PURPOSE: To evaluate the treatment outcome for Type A2 or above intertrochanteric fractures in elderly patients using cementless bipolar hemiarthroplasties incorporating a standard (tapered, rectangular) stem. MATERIALS AND METHODS: We retrospectively reviewed the records of 37 patients who had undergone bipolar hemiarthroplasty between February 2006 and February 2010 in our hospital, and who had received follow up evaluation for more than two years after the surgery. The mean patient age was 73.5 years (range 65-88 years), and 16 patients were male and 21 were female. We evaluated the the results of their treatment by analyzing the operation duration, volume of bleeding, measured results for the recovery of walking capability, and any complications and radiologic findings. RESULTS: The mean operation duration was 75.3 minutes(50-185 minutes). The average total volume of bleeding was of 755.5 cc(75-1,400 cc). Upon the final follow-up visit, 27 patients(72.9%) had recovered more than 80% of their pre-injury Barthel index values(72.8+/-15.1). Complications included one case of deep infection, one case of acetabular erosion, and 3 cases of greater trochanter non-union. There were no cases of revisions due to prosthesis loosening or for other reasons. CONCLUSION: Cementless bipolar hemiarthroplasty using a tapered, rectangular stem is a viable alternative treatment for type A2 intertrochanteric fractures in elderly patients which supports rapid patient mobilization ability.
Aged ; Female ; Femur ; Follow-Up Studies ; Hemiarthroplasty ; Hemorrhage ; Hip ; Hip Fractures ; Humans ; Male ; Osteoporosis ; Prosthesis Failure ; Retrospective Studies ; Treatment Outcome ; Walking

PURPOSE: People with dementia have poor mobility and discharge outcomes following hip fractures. The purpose of this study was to evaluate the clinical and radiological results of internal fixation of undisplaced femur neck fractures (Garden types 1 and 2) by proximal femoral nail antirotation (PFNA) in dementia patients. MATERIALS AND METHODS: We studied retrospectively 19 patients with undisplaced femur neck fracture. All patients were over 70 years of age, walked independently with a cane or crutches and suffered moderate-to-severe dementia. Patients were treated with PFNA and followed-up for more than 2 years. Revision, loss of fixation, complications, and walking ability outcomes were measured. RESULTS: In walking-ability evaluation, patients showed an average decrease of just 0.2 points at the final follow-up. Walking ability was evaluated from before injury to 4 weeks after surgery and decreased by less than 0.5 points. Radiological bone union was achieved in 17 cases; the average time to bone union was 4.14 months (range, 2.5-7 months). Complications included non-union in two cases and femoral head avascular necrosis in one case of non-union. CONCLUSION: We found that for patients with osteoporotic bone tissues in their femoral heads or patients (e.g., those suffering dementia) for whom cooperating with medical workers for postoperative walking control or rehabilitation exercises is difficult, implanting a mechanically stable spiral blade for fixation of femoral neck fractures could facilitate walking after surgery.
Bone and Bones ; Canes ; Crutches ; Dementia* ; Exercise ; Femoral Neck Fractures* ; Femur Neck* ; Femur* ; Follow-Up Studies ; Head ; Hip Fractures ; Humans ; Necrosis ; Rehabilitation ; Retrospective Studies ; Walking

PURPOSE: To compare the clinical and radiological results between internal fixation using the proximal femoral nail system and bipolar hemiarthroplasty (BHA) in reverse oblique intertrochanteric hip fractures in elderly patients. MATERIALS AND METHODS: From January 2005 to July 2012, we reviewed the medical records of 53 patients who had been treated surgically for reverse oblique intertrochanteric fracture and had been followed-up on for a minimum of two years. All patients were > or =70 years of age, and divided into two groups for retrospective evaluation. One group was treated with internal fixation using the proximal femoral nail system (31 cases), and the other group was treated with BHA (22 cases). RESULTS: Early ambulation postoperatively and less pain at postoperative three month were significantly superior in the BHA group. However, by 24 months postoperatively, the internal fixation group exhibited higher Harris scores and correspondingly less pain than the BHA group. There were no significant differences in union rate, duration of hospitalization or lateral wall fracture healing between the two groups. Four patients in the internal fixation group underwent reoperation. CONCLUSION: In the treatment of intertrochanteric fracture of the reverse oblique type, open reduction and internal fixation should be considered to be the better choice for patients with good health and bone quality. However, in cases of severe comminition of fracture and poor bone quality, BHA is an alternative offering advantages including early ambulation, less pain at early stages, and a lower risk of reoperation.
Aged* ; Butylated Hydroxyanisole ; Early Ambulation ; Femoral Fractures* ; Femur ; Fracture Fixation, Intramedullary ; Fracture Healing ; Hemiarthroplasty* ; Hip Fractures ; Hospitalization ; Humans ; Medical Records ; Reoperation ; Retrospective Studies

We experienced one suspected case of chondrodystrophic calcificans congenita of 2 days aged newborn infant. The patient manifested short stature, articular contracture on both lower and upper extremities, moderate jaundice and irritabilities. A brief review of related literature is also presented.
Contracture ; Humans ; Infant, Newborn ; Jaundice ; Upper Extremity