Mid-term results of an uncemented tapered femoral stem and various factors affecting survivorship.

OBJECTIVE: CLS stem is commonly used today in primary hip arthroplasty, but only a few studies have evaluated their outcome in young high demanding patients. In Indian scenario, many patients require squatting and sitting cross-legged as part of their daily activities placing excessive load on the joint. We evaluated (I) Mid-long term functional and radiological results (II) Influence of age, gender, diagnosis, stem alignment, Canal fill index (CFI) on the outcome (III) Kaplan-Meier survivorship using revision for any reason or for aseptic loosening as an endpoint. METHODS: Retrospective evaluation of 64 THA in 54 patients operated between July 2000 to July 2011 using CLS stem was done. Mean follow-up was 10.3 years (5-14.9 years) with 5 patients lost to follow-up and 4 patients died. Mean age at surgery was 46.8 years (18-78 years). RESULTS: Mean Harris hip score was 89.4 (72-100). Thigh pain was present in 4 hips which were not associated with the sizing of the stem (p = .489). Stable fixation by bony ingrowth was seen in 53 hips (96.4%) and by fibrous ingrowth in 2 cases (3.6%) with no case of loosening seen. Stress shielding was seen as Grade II in 17 hips (30.9%), Grade III in 3 hips (5.4%). Pedestal formation was seen in 9 hips (16.4%) which were statistically associated with varus alignment and CFI < 80. No stem revision was performed with stem survivorship of 100%. CONCLUSION: The mid-term survival rates and good clinical-radiological outcomes of CLS stem in high demanding Indian population were excellent.

A rare case of bilateral central subluxation of the hip joint with associated bilateral quadrilateral plate fracture in an elderly male due to seizure activity / Um caso raro de subluxação central bilateral da articulação do quadril associada a fratura bilateral da lâmina quadrilátera em um homem idoso devido a convulsões

ABSTRACT Musculoskeletal injuries such as dislocation of the shoulder and hip joints and fractures of the femoral neck are known complications of seizures. Bilateral central subluxation of the hip joint with associated bilateral quadrilateral plate fracture is a rare entity and is prone to delayed diagnosis, even more so in patients who experience post-seizure disorientation. The authors report the case of a 74-year-old male patient with bilateral central subluxation of the hip joint with associated bilateral quadrilateral plate fracture due to seizure activity. Bilateral open reconstruction and fixation of the quadrilateral plate with a 3.5-mm pre-bent reconstruction plate reinforced with 3.5-mm pelvic brim reconstruction plate was performed. In conclusion, this case is an example of rare bilateral quadrilateral plate fracture caused due to seizure activity, a fracture for which a high level of suspicion should be kept in mind while evaluating the patient post-seizure episode.

RESUMO Lesões musculoesqueléticas, tais como luxação das articulações do ombro e quadril e fraturas do colo do fêmur, são complicações conhecidas de convulsões. A subluxação central bilateral da articulação do quadril associada a fratura bilateral da lâmina quadrilátera do acetábulo é uma entidade rara e propensa ao diagnóstico tardio, ainda mais em pacientes que experimentam desorientação pós-convulsão. Os autores relatam o caso de um paciente masculino de 74 anos com subluxação central bilateral da articulação do quadril associada a fratura bilateral da lâmina quadrilátera decorrente de atividade convulsiva. Foi feita reconstrução bilateral aberta e a lâmina quadrilátera foi fixada com uma placa de reconstrução pré-dobrada de 3,5 mm, reforçada com uma placa de reconstrução da borda pélvica de 3,5 mm. Conclui-se que este caso é um raro exemplo de fratura bilateral das lâminas quadriláteras causada pela atividade convulsiva. Os profissionais de saúde devem manter um alto nível de suspeita para esse tipo de fratura ao avaliar pacientes após um episódio convulsivo.

A rare case of bilateral central subluxation of the hip joint with associated bilateral quadrilateral plate fracture in an elderly male due to seizure activity.

Musculoskeletal injuries such as dislocation of the shoulder and hip joints and fractures of the femoral neck are known complications of seizures. Bilateral central subluxation of the hip joint with associated bilateral quadrilateral plate fracture is a rare entity and is prone to delayed diagnosis, even more so in patients who experience post-seizure disorientation. The authors report the case of a 74-year-old male patient with bilateral central subluxation of the hip joint with associated bilateral quadrilateral plate fracture due to seizure activity. Bilateral open reconstruction and fixation of the quadrilateral plate with a 3.5-mm pre-bent reconstruction plate reinforced with 3.5-mm pelvic brim reconstruction plate was performed. In conclusion, this case is an example of rare bilateral quadrilateral plate fracture caused due to seizure activity, a fracture for which a high level of suspicion should be kept in mind while evaluating the patient post-seizure episode.

Lesões musculoesqueléticas, tais como luxação das articulações do ombro e quadril e fraturas do colo do fêmur, são complicações conhecidas de convulsões. A subluxação central bilateral da articulação do quadril associada a fratura bilateral da alâmina quadrilátera do acetábulo é uma entidade rara e propensa ao diagnóstico tardio, ainda mais em pacientes que experimentam desorientação pós-convulsão. Os autores relatam o caso de um paciente masculino de 74 anos de idade com subluxação central bilateral da articulação do quadril associada a fratura bilateral da lâmina quadrilátera decorrente de atividade convulsiva. Foi feita reconstrução bilateral aberta e a lâmina quadrilátera foi fixada com uma placa de reconstrução pré-dobrada de 3.5 mm, reforçada com uma placa de reconstrução da borda pélvica de 3,5 mm. Conclui-se que este caso é um raro exemplo de fratura bilateral das lâminas quadriláteras causada pela atividade convulsiva. Os profissionais de saúde devem manter um alto nível de suspeita para esse tipo de fratura ao avaliar pacientes após um episódio convulsivo.

Bilateral simultaneous neck femur fracture following domestic fall in an elderly patient: a rare case report.

Simultaneous bilateral neck femur fracture is a rare entity that has been associated with underlying bone disease, various metabolic diseases, high-energy trauma, and seizure disorders. Its occurrence following minimal trauma is very rare. This article presents the case of a 66-year-old female who sustained bilateral intracapsular fracture neck femur following a slip and fall at home. Single-stage bilateral cemented total hip replacement was done using a direct lateral approach with alternate right and left lateral positions. The authors report a satisfactory outcome, with Harris hip score of 98 at one year, which persisted until her last follow-up at 30 months.

A fratura simultânea bilateral do colo do fêmur é uma entidade rara que tem sido associada a doenças ósseas, diversas doenças metabólicas, traumas de alta energia e distúrbios convulsivos. Sua ocorrência após trauma mínimo é muito rara. Este artigo apresenta o caso de uma mulher de 66 anos de idade que sofreu fratura intracapsular bilateral do colo do fêmur após um deslize e queda em casa. Uma artroplastia total do quadril, bilateral e cimentada foi feita em um único momento, usando uma abordagem lateral direta, alternando as posições laterais direita e esquerda. Os autores relatam um resultado satisfatório, com Harris Hip Score de 98 após um ano, que persistiu até o último seguimento, aos 30 meses.

Bilateral simultaneous neck femur fracture following domestic fall in an elderly patient: a rare case report / Fratura simultânea bilateral do colo do fêmur após queda doméstica em uma paciente idosa: relato de um caso raro

ABSTRACT Simultaneous bilateral neck femur fracture is a rare entity that has been associated with underlying bone disease, various metabolic diseases, high-energy trauma, and seizure disorders. Its occurrence following minimal trauma is very rare. This article presents the case of a 66-year-old female who sustained bilateral intracapsular fracture neck femur following a slip and fall at home. Single-stage bilateral cemented total hip replacement was done using a direct lateral approach with alternate right and left lateral positions. The authors report a satisfactory outcome, with Harris hip score of 98 at one year, which persisted until her last follow-up at 30 months.

RESUMO A fratura simultânea bilateral do colo do fêmur é uma entidade rara que tem sido associada a doenças ósseas, diversas doenças metabólicas, traumas de alta energia e distúrbios convulsivos. Sua ocorrência após trauma mínimo é muito rara. Este artigo apresenta o caso de uma mulher de 66 anos que sofreu fratura intracapsular bilateral do colo do fêmur após um deslize e queda em casa. Uma artroplastia total do quadril, bilateral e cimentada foi feita em um único momento, com o uso de uma abordagem lateral direta, em que se alternaram as posições lateral direita e esquerda. Os autores relatam um resultado satisfatório, com Harris Hip Score de 98 após um ano, que persistiu até o último seguimento, aos 30 meses.

Fracture Diaphyseal Femur in a Case of Ipsilateral Excision Arthroplasty of Hip: Report of Two Cases with Description of an Unusual Injury Pattern, Mechanism, and Clinical Decision-making in Management.

INTRODUCTION: Although fracture diaphyseal femur is commonly seen in orthopedic practice, its association with ipsilateral resection arthroplasty of hip/pseudarthrosis of neck is rare. The technique of excision arthroplasty has undergone modification with emphasis on preserving as much bone as possible. However, it is not always possible to preserve bone while removing the earlier prosthesis and cement. This often leads to extensive proximal bone loss. Associated ipsilateral fracture femur presents a unique scenario. Till date, only one case report is published highlighting its surgical management. CASE REPORT: We report two cases of diaphyseal fracture femur associated with resection arthroplasty of hip at subtrochanteric level with greater trochanter as a separate fragment (Case 1) and other with pseudarthrosis of the neck of femur with intact greater trochanter (Case 2). The first case was operated with surface fixation, whereas the second was operated with closed antegrade intramedullary nail. CONCLUSION: Decision-making and formulating treatment plan includes taking various factors into account such as level of resection arthroplasty of hip/pseudarthrosis of neck, status of greater trochanter (intact or separate fragment), osteoporosis, and post-operative ambulation and rehabilitation. In this report, we highlight the unusual occurrence, probable mechanism of injury, risk factors for fracture, and decision-making in the surgical management of such a condition.