Bruce T Cohn

Clinical experience with a triradiate exposure of the hip for difficult total hip arthroplasty

A triradiate exposure of the hip was developed to facilitate the performance of certain difficult primary and revision total hip arthroplasties. Using this triradiate skin and fascial incision, complete anterior and posterior exposure of the hip capsule can be performed with relative ease. Between October 1980 and January 1985, this exposure was used 50 times in selected cases, including 9 of 320 (3%) primary total hip arthroplasties. All of these cases involved obesity, acetabular protrusion, and/or fragile femoral bone, conditions that would have made safe, adequate exposure without trochanteric osteotomy considerably more difficult through a routine anterolateral or posterior approach. Over this period, the majority of revision hip arthroplasties were performed using triradiate exposure; trochanteric osteotomy was routinely performed in these revision cases. Excellent wound healing was observed in every case, despite unfavorable factors such as advanced age, prednisone therapy, and the presence of prior incisional scars. The triradiate incision offers safe, controlled, and improved exposure in selected primary and revision total hip arthroplasties. It has become nearly the routine incision for the senior author for revision cases.

Soft tissue interposition following dislocation of a total hip replacement. A case report and introduction of a new technique.

Dislocation following total hip arthroplasty is an uncommon event. Soft tissue interposition following reduction is extremely rare. The following is a case report of this unusual problem handled in a unique fashion in that the interposed soft tissue was removed percutaneously.

Fatigue Fracture of a Tibial Interlocking Nail

The interlocking system has recently become a popular mode of treatment for unstable fractures of the tibia. Metal fatigue is an extremely rare complication of the system; this article presents a case of metal failure, and the possible mechanisms.

Case Report of a Rare Mallet Finger Injury

Mallet finger injuries are commonly seen in the emergency room and the treatment is usually simple, consisting of extension splinting of the DIP joint. The hyperextension mallet finger is a rare variant. The diagnosis can be made if the fracture fragment involves more than 50% of the joint surface. For this injury splinting is inadequate and open reduction is the treatment of choice.