Surgical Hip Dislocation Is a Reliable Approach for Treatment of Femoral Head Fractures

BACKGROUND: Femoral head fractures are rare injuries; incongruency and instability are indications for surgical intervention. Anterior, posterior, and transtrochanteric surgical approaches have been proposed, but the exposure is limited with classical approaches. Surgical hip dislocation allows for a 360° view of the head and may facilitate a reduction in selected head fractures, but to our knowledge, few studies have reported on the results with this technique. We therefore report on the (1) quality of fracture reduction; (2) modified Harris hip score at a minimum of 2 years (mean, 6 years, range, 26–122 months); and (3) frequency of complications, including avascular necrosis (AVN), arthritis development, and heterotopic ossification, in a case series of patients with femoral head fractures treated with this approach. DESCRIPTION OF TECHNIQUE: The procedure involves digastric trochanteric flip osteotomy and safe dislocation of the femoral head, preserving its vessels. Using this technique we are able to reduce all displaced femoral head fractures under direct view. Definitive fixation is performed through this approach with 2.7-mm nonabsorbable screws. The same technique may be used also for Pipkin IV fractures to fix transverse, T-type, posterior wall, or posterior column acetabular fracture. METHODS: Between 2004 and 2011, we used this approach to manage all displaced femoral head fractures in patients younger than 55 years old. A total of 17 patients were thus treated; of those three were lost to followup before 2 years, and one was excluded from study because of severe preoperative neurological impairment, leaving 13 for analysis here. Patient demographic, injury, and surgical variables as well as complications were recorded and retrospectively evaluated. Radiographic outcome was scored according to Matta’s criteria on postoperative radiographs. Outcomes were evaluated with the modified Harris hip score. Minimum followup was 24 months (mean, 77 months; SD, 32.8 months). RESULTS: Fracture reduction was anatomic in eight hips and imperfect in five. Mean clinical score was 82 points (SD, 7.7). One patient developed symptomatic femoral head AVN and underwent total hip arthroplasty 4 years after the index procedure; no other patient underwent arthroplasty. Besides this patient, signs of arthritis (Grade I according to Tönnis classification) were found in one patient and heterotopic ossification was recorded in two patients, but neither was symptomatic. CONCLUSIONS: Our experience with surgical dislocation shows clinical results comparable to previously reported outcomes in femoral head fractures treated with common approaches; we also present a similar rate of AVN and a lower rate of posttraumatic arthritis, but a higher risk of heterotopic ossification. Further case-control studies are necessary to confirm these statements. LEVEL OF EVIDENCE: Level IV, therapeutic study. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s11999-015-4352-4) contains supplementary material, which is available to authorized users

Computer-Aided Diagnosis System for Bone Fracture Detection and Classification: A Review on Deep Learning Techniques

Bone fracture detection and classification was a large discussed topic over the last few years and many researchers proposed different technological solutions to tackle this task. Despite this, a universal approach able to support the classification of fractures in the human body still does not exist today. We aim to provide a first discussion concerning a selection of research works done in the technological domain, with a specific focus on Deep Learning. The objective was to underline a picture on the most promising studies for stimulating a knowledge improvement in the specific focus of bone fracture classification, necessary to start the development of an optimal shared framework. The evaluation has been made involving a first qualitative assessment based on strengths and weaknesses, providing a usage scenario evaluation. This could support the development of a helpful Computer Aided Diagnosis (CAD) system able to drive doctors in diagnosis tasks reducing diagnosis time, especially in the most complex tasks, and supporting the reduction of wrong diagnosis issues, especially during stressful working conditions, as what frequently happens in many emergency departments

Algo-Functional Indexes and Spatiotemporal Parameters of Gait after Sacroiliac Joint Arthrodesis

Aims of the study were to evaluate the reliability and validity of the Italian version of the Majeed and Iowa questionnaires and to investigate the long-term surgical outcomes following sacroiliac joint arthrodesis. Twenty one patients who underwent a sacroiliac joint arthrodesis and 21 healthy subjects were evaluated. The experimental procedure consisted of gait analysis and a physical activity assessment (in both groups) and of administration of outcome questionnaires and pain assessment (in the patient group). The Majeed and Iowa questionnaires showed excellent reliability, excellent (for the Majeed questionnaire) and good (for the Iowa questionnaire) construct validity, and poor convergent validity (for both questionnaires) relative to walking speed. Most of the patients reported no pain and minimum pain-related disability and their physical activity profile was comparable to healthy controls. Patients showed an impaired walking performance (i.e., they walked slower and using shorter steps) compared with healthy controls. Long-term walking pattern abnormalities following sacroiliac joint arthrodesis may occur despite excellent clinical results. Given their excellent reliability and construct validity, the Majeed and Iowa questionnaires can be used in combination with the assessment of spatiotemporal gait parameters for the prognostic assessment and/or follow-up of surgical patients

Pelvic ring fractures: External fixation comparative numerical structural analysis

External fixation (EF) is commonly practiced for pelvic ring fractures management. Many parameters influence mechanical performances of external fixators. Our virtual 3D model of the pelvic ring introduces the advantage of differentiating the mechanical properties of cortical and cancellous bone along with the complex boundary conditions of major ligaments. We assessed stiffness variations by increasing fixator pins depth and we evaluated dislocation related to load intensity and sitting angle

The additional labour of a disabled PhD student

This is a personal account of the challenges I have faced during the first year and a half of my PhD, solely due to my identity as a disabled student. I address issues such as a lack of representation when researching PhD life, the impact of the services which are meant to be there to help and the complexities of juggling the additional time-consuming events which occur when you are disabled, with PhD time, a home life and work. This is especially relevant in the United Kingdom at this time as the Disabled Students Allowance has recently been cut back, meaning there is less support available for disabled students, and with the increased marketisation of higher education it could be argued that there is less impetus for universities to support those who have non-standard needs

Low-dose prophylaxis protocol for heterotopic ossification after hip preservation surgery in a sport participants cohort

Background: Heterotopic ossification (HO) is a well-known complication of arthroscopic and open surgical treatment of femoroacetabular impingement (FAI). Incidence of heterotopic ossification has been reported in the literature between 0% and 44% after hip arthroscopy and between 18.2% and 25% after anterior mini-open surgery. Currently, pharmacological prophylaxis with NSAIDs and selective COX-2 inhibitors are commonly used and their effectiveness is well documented in literature. Hypothesis: We hypothesized that the low-dose prophylaxis protocol with selective cox-2 inhibitors decreases the risk of heterotopic ossification in open or arthroscopic hip preservation surgery in athletes. Methods: This study is an analysis of prospectively gathered data on 98 sport participant patients who underwent arthroscopic or anterior mini-open treatment for FAI between April 2008 and April 2018. All the patients received postoperative oral prophylaxis with 60 mg etoricoxib once daily for two weeks. Post-operative X-rays were performed at 1, 3, and 12 months after surgery and reviewed by two orthopedic surgeons blinded to the type and side of surgery. HO were graded according to the Brooker classification. Descriptive statistics was used to analyze demographic data. Bivariate analysis was performed to analyze the association of HO with each of the following variables: type of surgery, physical activity, time of evolution of symptoms, age at surgery, and sex. Finally, a regression model analysis was performed to determine the presence of confounding effects between variables. Results: The study cohort was composed of 54 patients in the arthroscopic treatment group and 44 patients in the anterior mini-open group. HO was identified in 6 (13.6%) patients in the mini-open group. No HO was identified in the arthroscopic group. In the bivariate analysis, “type of surgery” was the only variable that showed a statistically significant association with HO (p = 0.007). Conclusion: Results of this study suggest that anterior mini-open treatment was characterized by a higher risk of HO development compared to hip arthroscopy for femoroacetabular impingement treatment regardless of pharmacological prophylaxis. The treatment regimen of 60 mg etoricoxib daily for two weeks was an effective prophylaxis for HO formation in sport participant patients compared with data available in the literature

Ceftriaxone bone penetration in patients with septic non-union of the tibia

SummaryObjectivesA main determinant of clinical response to antibiotic treatment is drug concentration at the infected site. Data on ceftriaxone (CFX) bone penetration are lacking. We measured CFX concentrations in infected bone to verify their relationship with pharmacodynamic microbiological markers.MethodsEleven patients undergoing debridement for septic non-union of the tibia and receiving intravenous CFX were studied. Plasma and bone specimens were collected intraoperatively at a variable interval after CFX administration. Drug concentrations were measured by high-performance liquid chromatography with ultraviolet detection (HPLC-UV) method.ResultsBone samples were extracted at a mean of 3.3h (range 1.5–8.0h) since the start of CFX infusion. The mean±standard deviation intraoperative CFX plasma concentration was 128.4±30.8mg/l; the corresponding bone concentrations were 9.6±3.4mg/l (7.8%) in the cortical compartment and 30.8±8.6mg/l (24.3%) in the cancellous compartment. The mean 24-h area under the concentration–time curve (AUC24) values were 176.8±62.2 h*mg/l in cortical bone and 461.5±106.8 h*mg/l in cancellous bone. The time above the minimum inhibitory concentration (T>MIC) was 24h in all compartments. The estimated mean free AUC/MIC ratios and T>MIC were 140 and 24.4h, respectively, in cancellous bone and 42.4 and 21h, respectively, in cortical bone.ConclusionsCFX bone penetration was poor (<15%) in the cortical compartment and satisfactory in the more vascularized cancellous bone. The T>MIC and AUC/MIC ratios suggest that CFX achieves a satisfactory pharmacokinetic exposure in cancellous bone as far as pathogens with a MIC of <0.5 are concerned. However, considering free drug concentrations, pharmacokinetic/pharmacodynamic targets may not be fully achieved in cortical bone. As antibiotic exposure can be suboptimal in the infected cortical compartment, and drug penetration may be impaired into necrotic bone and sequesters, a radical surgical removal of purulent and necrotic tissues appears essential to shorten treatment duration and to prevent treatment failures