Greater trochanteric pain syndrome and gluteus medius and minimus tendinosis: nonsurgical treatment.

Greater trochanteric pain syndrome (GTPS) affects 10-25% of people in developed countries. The underlying etiology for GTPS is most commonly the tendinosis or a tendon tear of the gluteus medius, minimus or both at the greater trochanter; the inflammation of the tendon is not a major feature. We critically evaluated conservative treatment, for which we reviewed 76 publications, grading them according to four levels of evidence. We identified a wide variety of conservative treatment options: home therapy (insoles, walking sticks/crutches, orthotic devices, stretching exercises and preventive measures); physiotherapy (massage and stretching exercises); infiltrations (corticosteroids and local anesthetics); image-guided infiltrations (fluoroscopy and ultrasound); shockwave therapy; platelet-rich plasma injection; and drug therapy. Severe complications associated with infiltrations are extremely rare, as are those associated with shockwave therapy. The most effective treatments were infiltrations with corticosteroids and shockwave therapy. We propose a graded treatment schedule for patients with GTPS.

Is cannulated-screw fixation an alternative to plate osteosynthesis in open book fractures? A biomechanical analysis.

OBJECTIVES: The current biomechanical work compares the symphyseal and sacroiliac stability obtained with two systems of bone osteosynthesis. The two methods of fixation compared were the 6-hole suprapubic non-locked plate and pubic fixation with two cannulated screws, a novel technique that can be applied percutaneously in the clinical practice. The aim of this study was to examine the validity of the use of two-cannulated-screws osteosynthesis in order to minimize the secondary effects of open fixation, especially in patients in whom an open reduction is contraindicated. MATERIALS AND METHODS: A biomechanical study was designed in 9 fresh, human pelvis specimens, simulating an AO B1.1 type injury, using both fixation systems sequentially in each specimen. In both parts of the test, the specimens were subjected to an axial load of 300N. Displacements and rotations between the different pelvic elements were studied by means of a discrete set of points. The absence of differences between the two systems has been set as the null hypothesis. RESULTS: There were significant differences in favor of the cross-cannulated screws in most of the displacements measured at the pubic symphysis and sacroiliac joint. CONCLUSIONS: Fixation of the AO B1.1 type fractures with cross cannulated screws restores the biomechanical behavior of the pubic symphysis, obtaining better stability than fixation with the 6-hole non-locked plate. To date, no comparative, biomechanical studies have been conducted with these two systems of osteosynthesis. This study demonstrates that cross-cannulated screws fixation of the pubic symphysis in AO B1.1 pelvic fractures should be considered as an alternative to the conventional plating system.

Trabecular Metal buttress augment and the Trabecular Metal cup-cage construct in revision hip arthroplasty for severe acetabular bone loss and pelvic discontinuity.

Large acetabular defects can be reconstructed using a tantalum Trabecular Metal acetabular component with Trabecular Metal buttress augments. We asked if these reconstructions survived at short-term follow-up. Of 35 patients undergoing acetabular reconstruction with a Trabecular Metal acetabular revision system from 2006, 19 acetabular revisions associated with major bone loss in which we reconstructed the acetabulum with buttress tantalum augments or cup-cage construct combined with a Trabecular Metal shell, were available for evaluation. Mean follow-up was 26 months (range 18-43 months). Mean patient age was 63 years, and 12 patients were women. All defects were classified according to Paprosky and Saleh classifications; there were 13 type IIIA and 6 type IIIB acetabular defects. Five chronic pelvic discontinuities were preoperatively or intraoperatively assessed (Saleh type 5) and a cup-cage construction was employed. No mechanical failure has occurred in any hip, and all patients have radiographically stable cups. Radiographic assessment showed an improvement in the position of the rotation centre of the hip, from a vertical position a mean of 3.5 cm (range 1.6-5.5 cm), to 1.4 cm (range 0.5-2.7 cm) postoperatively. The centre of the femoral head was relocated from a mean of 1.4 cm (range, -3 to 2.6 cm) lateral from the vertical at the teardrop to 3 cm (range 0.2-4 cm). Our early results suggest that buttress tantalum augments, with cup-cage construct for severe bone defects, may be an alternative to other treatment options, but a longer follow-up is necessary.