Michael C. Moran

Supracondylar femoral fracture following total knee arthroplasty.

Twenty-nine supracondylar femoral fractures above total knee arthroplasty were studied retrospectively. Group 1 consisted of 5 nondisplaced fractures managed with closed treatment, yielding 5 satisfactory results. Group 2 consisted of 9 displaced fractures managed with closed treatment. There were no satisfactory results in Group 2; there were 8 malunions and 2 knees requiring revision. Group 3 consisted of 15 displaced fractures managed with open reduction and internal fixation. There were 10 satisfactory results in Group 3; there were 2 malunions and 3 knees requiring revision or repeat fixation. On the basis of these results, closed treatment for nondisplaced fractures is recommended. If displacement exists, early open reduction and internal fixation yields the greatest chance for a satisfactory result, though it has a significant complication rate.

Magnetic resonance imaging in diagnosis of transient osteoporosis of the hip.

The results of magnetic resonance (MR) imaging in six patients with transient osteoporosis of the hip were reviewed. Short TR/TE (repetition time/echo time) images demonstrated diffusely decreased signal intensity in the femoral head and intracapsular region of the femoral neck. Increased signal intensity was noted with progressive T2 weighting. Bone biopsies were performed in four patients. Histologic findings were nonspecific and included fat necrosis, marrow edema, increased bone resorption, and reactive bone formation. Repeat MR scans in two patients, performed six and eight months after the initial scans, showed an almost complete return to normal marrow signal. All patients became asymptomatic without bony deformity. In the appropriate clinical setting, MR scanning can aid in the diagnosis of transient osteoporosis as the cause of a painful hip.

Total hip arthroplasty in sickle cell hemoglobinopathy

Twenty-two arthroplasties were performed in 14 patients with sickle cell hemoglobinopathy (SCH). There were 15 primary and seven revision procedures; none were lost to follow-up evaluation. In the primary arthroplasty group, there were two deaths in patients whose implants were functioning well. The remaining 13 hips had a mean follow-up period of 4.8 years. Failure occurred in five of these 13 hips (38%), four due to aseptic acetabular loosening and one due to sepsis. In the revision arthroplasty group, at a mean follow-up period of 5.3 years, failure occurred in three hips (43%), one due to acetabular loosening, one due to femoral loosening, and one due to sepsis. Perioperative complication rates were high in both groups. Femoral intramedullary sclerosis and bone altered by marrow hyperplasia were associated with intraoperative technical difficulties as well as problems with achieving long-term component fixation. Though total hip arthroplasty provides the most reliable measure of effective treatment in SCH, it carries a high risk of complications and failure.

Modified lateral approach to the distal humerus for internal fixation.

Internal fixation of fractures of the most distal portion of the humeral shaft is problematic. A modified lateral approach was assessed to determine its role in the surgical management of these injuries. Posterior plating of the lateral column was performed in each case. Eight patients with eight fractures (seven acute, one nonunion) were treated. All fractures united. There were no complications. On the basis of these results, displaced fractures of the most distal portion of the humeral shaft can be managed successfully via a modified lateral approach to the distal humerus.

Functional loss after total knee arthroplasty for poliomyelitis.

Recurvatum deformity secondary to poliomyelitis was corrected during total knee arthroplasty. Modular distal augmentation of the femoral component was successful in achieving and maintaining correction. This case also shows the potential functional disadvantages of correcting recurvatum in patients with quadriceps weakness.

Iatrogenic femoral neck fracture in transient osteoporosis of the hip : a case report

The diagnostic evaluation of suspected cases of transient osteoporosis of the hip does not typically include biopsy. Presented herein is a case in which an open biopsy procedure was undertaken in the presence of severe osteopenia. An iatrogenic fracture occurred during the surgical exposure. The fracture healed and the condition subsequently resolved. This complication suggests the importance of noninvasive diagnostic modalities in the assessment of this condition. The fragility of the proximal femur also suggests a potential role for a period of protected weight bearing in the management of transient osteoporosis of the hip.