Vascularised iliac graft as a method of acetabular augmentation in subluxed hip in adolescents.

This article presents the clinical experience of patients with a dysplasic subluxated hip treated with the same procedure involving a vascularised graft of iliac crest by sartorius muscle. This study was performed in three different centres, in two different countries, and in 31 patients with 37 hips (9 bilateral). All patients were clinically evaluated according to the Merle d Aubigne scale and radiological measuring of acetabular coverage, Sharp angle, and CE angle. Walking ability preoperatively was 4.87 and postoperatively 5.12, which was not statistically significant. Preoperative inclination acetabular angle was 59.0 degrees +/- 6.23 and postoperatively 37.5 degrees +/- 6.08 (P < 0.00001). Preoperative CE angle was -2.03 degrees +/- 13.5 and postoperatively was 41.0 degrees +/- 12.3 ( P < 0.00001). Index head acetabulum had a preoperative coverage of 48.3% +/- 13.0 and postoperatively 100.8% +/- 19.5. The head sphericity did not show any statistically significant difference in relation to the results. The results obtained were satisfactory from every point of view, making this the procedure of choice in the armamentarium to delay the need for a total joint as treatment of early osteoarthritis in young adults.

Faulty design increases the risk of neck fracture in a hip prosthesis.

From October 1993 to May 1994, we performed 35 total hip arthroplasties (20 women) using a Charnley type modular 28 head manufactured by Medical Tee Brazil. 9 fractures through the neck of the stem prostheses occurred, all but 1 in men, after mean 4 (0.3-6) years. All fractures were due to an inadequate confluent radius causing abnormal transmission forces through the neck. The higher the load (men, heavy body weight), the greater the risk of fracture. The metallographic, chemical and microhardness analyses showed no abnormalities. We ascribe these fractures to faulty design of the stem prosthesis.

Classification and diagnosis of intracapsular fractures of the proximal femur.

Intracapsular fractures of the hip have been classified by different authors with a basis on various concepts. Pauwels classified these fractures according to the angle of inclination; Linton used trabecular disposition among the fractural fragments, and Garden described four types according to the order of displacement. The AO group used the comprehensive classification of fractures of the long bones and divided them among types, groups, and subgroups. However, the presence of posterior comminution of the femoral neck in intracapsular fractures as a factor foretelling instability was overlooked by each of the aforementioned classifications. With a basis on the factors previously described, the current authors developed a classification in which the criteria of instability in intracapsular fractures are given priority. Consequently, the characteristics of full or partial lines, angulation, displacement, and the presence of posterior comminution have been considered. Radiology is the first complementary study for diagnosis; it enables observation of the fracture line or trabecular changes in most cases and fragmental displacement and posterior comminution of the neck. In patients with stress fractures, radiographs often fail to show alterations, so a different diagnostic methodology is required. A diagnosis algorithm is presented. Differential diagnoses are focused toward diseases that may reveal images of pseudofractures.