Results after revision of the stem in periprosthetic fractures of the hip.

Periprosthetic femoral fractures following primary total hip arthroplasty (THA) represent an emerging challenge for the orthopaedic surgeon, because of their increasing incidence and negative impact on clinical and functional patient outcome. For these reasons, in the last decade, many efforts were made to prevent and manage  this complication  and a large number of studies were focused on finding out the best treatment. The type of treatment depends on several factors such as morphology and location of the fracture, implant stability, quality and quantity of bone stock, patient's age and clinical conditions. Fractures that cause loosening of the stem always require its revision, with a contextual assessment of the quality and quantity of remaining bone stock, which is generally good in type B2 and poor in type B3 according to Vancouver's classification. The latter may require the use of bone grafts. In this context, the  authors performed the following study and analyzed the results of 45 patients treated surgically for periprosthetic femoral fractures with revision of the femoral stem during a fourteen years period, between June 1999 and June 2013.

Quadriceps tendon tear rupture in healthy patients treated with patellar drilling holes: clinical and ultrasonographic analysis after 36 months of follow-up.

BACKGROUND: quadriceps tendon subcutaneous rupture is an uncommon injury affecting predominantly middle-aged men as a result of direct or indirect trauma; aim of this work is to evaluate clinical outcome and tendon morphology in patients treated surgically with transpatellar drilling suture. METHODS: 20 patients (20 male) with an average age of 54 (42-59) were evaluated with a mean follow-up of 36 months. Measurements of range of motion (ROM) and of tight circumference were collected. Lysholm and Rougraff Score were also performed. All the patients underwent a US evaluation the morphologic changes of the repaired tendon. RESULTS: mean active ROM was 1°-117°; average difference in the circumference of the quadriceps was 2.6% 10 C and 3.3% 15 C. The mean Lysholm Score calculated was 88/100; the mean Rougraff Score 17/25. At ultrasonographic evaluation all tendons were continuous; heterotopic ossification was present in 18 quadriceps tendons. Thickness was augmented in 18 quadriceps tendons and in 5 patellar tendons. Vascularization was always conserved. Lateral subluxation of patella was reported in 1 case. CONCLUSIONS: patellar drilling holes repair is a non-demanding procedure, inexpensive and technically uncomplicated. US evaluation confirms tendon healing; tendon remodeling does not affect patient's clinical outcome and quality of life. LEVEL OF INCIDENCE: IV.