Although avulsion fractures of greater and lesser trochanters rarely develop in hip fractures, avulsion fracture of short external rotators has not reported still online literature. Moreover, avulsion fracture of short external rotators can simulate the intertrochanteric fracture, and is difficult to differentiate from it on plain radiograph. This study is on the case 74-year old male patient who had avulsion fracture of short external rotators, and had the internal fixation with wire by open reduction under the diagnosis of the intertrochanteric fracture.
Aged ; Diagnosis ; Femur* ; Hip Fractures ; Humans ; Male

PURPOSE: Occult intertrochanteric fractures are misdiagnosed as isolated greater trochanteric fractures in some cases. We investigated the utility of three-dimensional computed tomography (3D-CT) and magnetic resonance imaging (MRI) in the diagnosis and outcome management of occult intertrochanteric fractures. MATERIALS AND METHODS: This study involved 23 cases of greater trochanteric fractures as diagnosed using plain radiographs from January 2004 to July 2013. Until January 2008, 9 cases were examined with 3D-CT only, while 14 cases were screened with both 3D-CT and MRI scans. We analyzed diagnostic accuracy and treatment results following 3D-CT and MRI scanning. RESULTS: Nine cases that underwent 3D-CT only were diagnosed with isolated greater trochanteric fractures without occult intertrochanteric fractures. Of these, a patient with displacement received surgical treatment. Of the 14 patients screened using both CT and MRI, 13 were diagnosed with occult intertrochanteric fractures. Of these, 11 were treated with surgical intervention and 2 with conservative management. CONCLUSION: Three-dimensional CT has very low diagnostic accuracy in diagnosing occult intertrochanteric fractures. For this reason, MRI is recommended to confirm a suspected occult intertrochanteric fracture and to determine the most appropriate mode of treatment.
Diagnosis ; Femur* ; Fractures, Closed ; Hip Fractures ; Humans ; Magnetic Resonance Imaging

Arthroplasty, Replacement, Hip ; Fracture Fixation, Internal ; Hip Fractures ; diagnosis ; surgery ; therapy ; Humans ; Internal Fixators

PURPOSE: The purpose of this study was to retrospectively evaluate the results of modular distal fixation stem for the proximal femoral deficiency in revision total hip arthroplasty. MATERIALS AND METHODS: Thirty five patients (36 hips) were followed for more than 24 months after the revision total hip arthroplasty using modular distal fixation stem between December 1998 and May 2002. The preoperative diagnoses included 27 cases of aseptic loosening, 7 cases of septic loosening, and 2 periprosthetic fractures. The femoral deficiencies classified according to Paprosky classification: Type II 3 cases, Type IIIA 14 cases, Type IIIB 8 cases, and Type IV 11 cases. RESULTS: The average Harris hip score improved from 39.5 points to 89.4 points. The average subsidence of the femoral component was 1.3 mm (range, 0-10 mm). All 36 hips had stable fixations, which were 30 cases by bony ingrowth and 6 cases by stable fibrous ingrowth. Postoperative complications included 3 cases of posterior dislocation, 1 case of heterotopic ossification, 1 case of deep vein thrombosis, and 1 case of reactivated infection. CONCLUSION: Cementless revision total hip arthroplasty using modular distal fixation stem showed good short-term results in the face of the deficient proximal bony support, and it appears to be a effective surgical option in this difficult revisional total hip cases.
Arthroplasty, Replacement, Hip* ; Classification ; Diagnosis ; Dislocations ; Hip ; Humans ; Ossification, Heterotopic ; Periprosthetic Fractures ; Retrospective Studies ; Venous Thrombosis

PURPOSE: The purpose of this study was to evaluate the effectiveness of bipolar hemiarthroplasty for unstable intertrochanteric fracture in patients over the age of 80 years. MATERIALS AND METHODS: Sixty-two patients (62 cases) who had unstable comminuted intertrochanteric fractures between January 2007 and February 2012 were evaluated. All patients were over 80 years old at the time of the diagnosis, and were followed-up for at least 12 months. Patients were divided into two groups: those who received cementless stems (group 1, n=32) and those who received cemented stems (group 2, n=30). Functional results including Harris hip score, thigh pain, Koval's ambulatory classification, postoperative mortality rate, operation time, and the amount of blood loss were evaluated. RESULTS: The operation time and the amount of blood loss were significantly lower in group 1 compared to group 2. The Harris hip score was 82.1+/-8.6 points for group 1 and 83.4+/-7.5 points for group 2 at the final follow-up. One patient with poor cement press-fit level in group 2 experienced thigh pain. Twenty-seven patients (84.4%) in group 1 and 25 patients (83.3%) in group 2 recovered pre-injury ambulatory status. During the follow-up period, overall, 6 patients (18.8%) in group 1 and 8 patients (26.7%) in group 2 died. No significant differences in follow-up mortality rates were observed between the two groups. CONCLUSION: Considering the satisfactory clinical results, cementless bipolar hemiarthroplasty may be a good treatment option for patients over 80 years old with unstable intertrochanteric fracture.
Classification ; Diagnosis ; Femur* ; Follow-Up Studies ; Hemiarthroplasty* ; Hip ; Hip Fractures ; Humans ; Mortality ; Thigh

OBJECTIVES: Osteoporotic hip fractures are associated with high mortality in the older population. Few population studies have reported the long-term trends of incidence and mortality rate of hip fracture among the older in Korea. This study assessed the incidence and mortality rate within 1 year after hip fracture from 2006 to 2015 in South Korea. METHODS: The National Health Information Database was used to identify adults aged 60 years and older with a diagnosis of hip fracture and died within 1 year from hip fracture. Regression analyses were performed to estimate the change of the incidence of hip fracture and the related mortality rate. RESULTS: The events causing hip fracture increased 1.85 times (1.91 times in women and 1.71 times in men), and the incidence of hip fracture increased 1.23 times (1.30 times in women and 1.11 times in men) from 2006 to 2015. The mortality rate after hip fracture decreased by 10% in women; however, it increased by 13% in men. These trends were more prominent in the older population. CONCLUSIONS: Although the mortality rate after hip fracture in women decreased, other parameters associated with hip fracture have worsened during the last decade. Nationwide programs were urgently needed to reduce the future socioeconomic burdens of hip fractures.
Adult ; Cohort Studies ; Diagnosis ; Female ; Hip Fractures ; Hip ; Humans ; Incidence ; Korea ; Male ; Mortality ; Osteoporosis

PURPOSE: This study examined the rate in which a diagnostic workup and treatment for osteoporosis are performed on patients with a hip fracture in Jeju Island, South Korea. MATERIALS AND METHODS: This study reviewed the medical records and radiographs of 174 patients (141 women and 33 men) older than 50 years and diagnosed with femoral neck or intertrochanteric fractures at 8 hospitals in Jeju Island during 2005. The mean age at the time of diagnosis was 78.3 years (range, 50-104 years). The number of patients examined with bone densitometry and treated for osteoporosis after the hip fracture was calculated. RESULTS: DXA was performed on 35 patients (20.1%) diagnosed with osteoporosis (T-score < -2.5). Of these 35 patients, 27 patients were treated for osteoporosis after a hip fracture. Among the 174 patients, only 27 patients (15.5%) had received medication for osteoporosis. CONCLUSION: The detection and treatment of osteoporosis are essential for reducing the incidence of another fracture after a hip fracture. However, a diagnostic study and the treatment for osteoporosis were performed only in a small portion of hip fracture patients.
Densitometry ; Diagnosis ; Female ; Femur Neck ; Hip Fractures* ; Hip* ; Humans ; Incidence ; Korea ; Medical Records ; Osteoporosis*

Periprosthetic acetabular fracture (PAF) is an uncommon complication following hip arthroplasty. However, as the number of people needing hip prostheses continues to rise, the absolute number of PAF is expected to increase as well. These fractures may occur either intraoperatively or postoperatively. Postoperative fractures can be caused by traumatic events or by pathologic conditions related to periacetabular osteolysis. The management of PAF usually depends on the degree of displacement and the stability of the acetabular component. While most of non-displaced fractures can be managed nonoperatively by protected weight bearing, displaced fractures with unstable implants require surgical intervention, which is often technically challenging. This review summarized the latest findings on the epidemiology, the diagnosis, the classification, and the treatment of PAF.
Acetabulum ; Arthroplasty ; Classification ; Diagnosis ; Epidemiology ; Hip Prosthesis ; Hip ; Osteolysis ; Periprosthetic Fractures ; Weight-Bearing

A case of chordoma occurred in the right femoral head and gluteus maximus muscle is reported. The case was a 61 year old female who complained of severe painful limitation of motion of the hip and radiating pain to the posterior aspect of right thigh for ten months. Roentgenological study revealed pathological fracture of femoral neck with osteoporotic change. For the treatment of femoral neck fracture, Moore type prosthetic femoral head replacement was performed. The cut surface of the resected femoral head showed multiple necrotic foci here and there, whitishgrey in color and gellatinous in consistency. The diagnosis was confirmed as a chordoma by microscopic examination. Femoral head and gluteus maximus muscle is one of very rare site of chordoma in the previous literature.
Chordoma ; Diagnosis ; Female ; Femoral Neck Fractures ; Femur Neck ; Fractures, Spontaneous ; Head ; Hip ; Humans ; Thigh

Purpose: The goal of study was to evaluate the clinical and radiographic performance of the proximal modular cementless femoral stem for use in revision total hip arthroplasty. Material and method: Fifty seven patients (57 hips) were followed for longer than 24 months or up to 8.4 years after performing revision total hip arthroplasty with using the proximal modular cementless femoral stem between January 1997 and December 2002. The preoperative diagnosis included 45 cases of aseptic loosening, 5 cases of septic loosening (re-revision operation), 6 cases of periprosthetic fracture and 1 case of recurrent dislocation. The bone deficiencies were classified according to the Paprosky classification: there were 27 cases of Type I and II, 19 cases of Type IIIA, 9 cases of Type IIIB and 2 cases of Type IV. Results: The average Harris hip score improved from 47 to 87.6. Clinically satisfactory results were noted in 50 patients (87.7%). Radiographically, distal stable fixation was observed in 54 patients (94.7%). Intraoperative complications included two greater trochanteric fractures and two proximal femur fractures. Postoperative complications included 5 femoral stem subsidences (2hips< 5mm, 3 hips>20mm), 4 deep infections, 2 non-unions of the greater trochanter and the osteotomy site and set screw dissociation was noted in 1 case. 5 proximal component changes were done due to progressive subsidence in two cases, non-union at the osteotomy site and trochanteric displacement in two cases and set screw dissociation in one hip. For the infection cases, the proximal segment was removed and re-revised with a 2nd stage operation. (Ed note: check this.) The subsidence of the femoral stems was showed in 3 Paprosky grade IIIA cases and in 2 cases of grade IIIB or more. There was no postoperative periprosthetic fracture observed at the last follow-up. Conclusion: Revision total hip arthroplasty using the proximal modular cementless femoral stem showed good results in the face of the infection of the proximal component and deficient proximal bony support. This procedure appears to be convenient for the surgeon to correct anteversion of the femoral head and leg length discrepancy.
Arthroplasty, Replacement, Hip ; Classification ; Diagnosis ; Dislocations ; Femur ; Follow-Up Studies ; Head ; Hip ; Hip Fractures ; Humans ; Intraoperative Complications ; Leg ; Osteotomy ; Periprosthetic Fractures ; Postoperative Complications ; Prostheses and Implants*