A systematic review of the causes of failure of Revision Total Hip Arthroplasty.

This study reviewed literature published in the last 10 years to investigate the reasons for revision failure. A total of 9952 revisions were identified and it was determined that the number one cause of failure was aseptic loosening (23.19%), followed by instability (22.43%) and infection (22.13%). Further analysis of applicable revisions investigated BMI and age at the failure rates. The rate of rerevision in obese patients was markedly higher (p < 0.01) compared to non-obese patients and individuals receiving a revision THA under the age of 55 are at a higher risk of rerevision (p < 0.01).

Severity of ulnar deficiency and its relationship with lower extremity deficiencies.

To assess the characteristics of ulnar deficiency (UD) and their relationship to lower extremity deficiencies, we retrospectively classified 82 limbs with UD in 62 patients, 55% of whom had femoral, fibular, or combined deficiencies. In general, UD severity classification at one level (elbow, ulna, fingers, thumb/first web space) statistically correlated with similar severity at another. Ours is the first study to show that presence of a lower limb deficiency is associated with less severe UD on the basis of elbow, ulnar, and thumb/first web parameters. This is consistent with the embryological timing of proximal upper extremities developing before the lower extremities.

Case report: irreducible medial subtalar dislocation with incarcerated anterior talar head fracture in a young patient.

Subtalar dislocations are rare injuries that typically occur from high-energy injuries. All subtalar dislocations should be attempted to be closed reduced, however, ~32% are irreducible requiring open reduction. We present an irreducible medial subtalar dislocation following a motor vehicle accident with no associated fractures demonstrated on radiograph. However, open reduction revealed an incarcerated anterior talar head fracture that was reduced and stabilized with retrograde K-wires.

A Case Report of an Isolated Dislocation of the Scaphoid in a Lesser Arc Injury and a Review of the Literature.

Isolated dislocations of the scaphoid are extremely uncommon injuries and are often associated with significant ligamentous failures. Since scaphoid dislocations typically present with associated carpal fractures, few cases of isolated dislocations of the scaphoid exist in the literature. The proposed treatment options in the literature range from closed reduction and casting to open reduction and internal fixation. We present the case of a 41-year-old male with an isolated scaphoid dislocation in whom open reduction and internal fixation was performed with K-wires. At five months follow-up, the patient had returned to work and all desired activities.

Hemorrhagic lumbar synovial facet cyst secondary to transforaminal epidural injection: A case report and review of the literature.

A 64-year-old-female presented with progressive left foot weakness, low back and radicular pain after a left sided S1 transforaminal epidural steroid injection (ESI). Magnetic resonance imaging revealed left side L5-S1 large extradural heterogeneous mass with layering areas suggesting different stages of hematoma formation. Past medical history was significant for peripheral vascular disease and transient ischemic attacks, for which she took aspirin and clopidogrel (antiplatelet agent). These medications were discontinued one week prior to ESI. Although synovial cysts associated with facet arthropathy are common, hemorrhagic cyst is not. To the best of the authors' knowledge, this is the first reported case of symptomatic hemorrhagic lumbar facet synovial cyst following ESI on a patient taking anti-platelet medications.

Interprosthetic femoral fractures treated with locking plate.

PURPOSE: Interprosthetic fractures are challenging to manage. Although treatment of femoral fractures around a single implant has been described, there is little literature for treatment of interprosthetic femoral fractures. This study analyses the management and outcomes of 15 patients with interprosthetic femoral fractures treated with locking plates. METHODS: A retrospective chart review was conducted of 17 patients with interprosthetic femur fracture treated with locking plates from 2002 to 2013. Patient demographics and comorbidities were collected. Preoperatively, patients were classified with the Vancouver or Su classification system. Intraoperative use of bone graft and/or cerclage cables was also examined. Clinical and radiographic outcomes were evaluated for union, time to full weight bearing, return to preinjury level of activity, and pain assessed with visual analog scale (VAS). RESULTS: There were 15 patients with interprosthetic fractures meeting criteria for this study. Average patient age was 80.53 (range, 61-92) years. Bone grafting was used in 23.5% (four of 17) and cerclage cables in 29.4% (five of 17). Patients achieved complete union and return to full weight bearing an average of 4.02 (range, two to six) months later. Average VAS pain score was 1.00 (range, zero to six). All patients returned to their preoperative ambulatory status. CONCLUSION: Locking plates could achieve satisfactory results for interprosthetic fractures. Considering an individual's fracture type, bone quality and protheses to determine the appropriate plate length and optional use of cerclage and/or bone graft was essential. In this limited sample size, interprosthetic fractures occurred at similar rates at the supracondylar region and diaphysis.