Early Clinical and Radiographic Results of Minimally Invasive Anterior Approach Hip Arthroplasty

We present a retrospective review of the early results and complications in a series of 35 consecutive patients with 43 total hip arthroplasties performed through an anterior muscle sparing minimally invasive approach. We found the early complication rates and radiographic outcomes comparable to those reported from arthroplasties performed via traditional approaches. Complications included dislocation (2%), femur fracture (2%), greater trochanteric fracture (12%), postoperative periprosthetic intertrochanteric fracture (2%), femoral nerve palsy (5%), hematoma (2%), and postoperative iliopsoas avulsion (2%). Radiographic analysis revealed average cup anteversion of 19.6°±6.6, average cup abduction angle of 48.4°±7, stem varus of 0.9°±2, and a mean leg length discrepancy of 0.7 mm. The anterior approach to the hip is an attractive alternative to the more traditional approaches. Acceptable component placement with comparable complication rates is possible using a muscle sparing technique which may lead to faster overall recovery

A Rare Case Report of Extensive Polyostotic Gorham's Disappearing Bone Disease Involving the Upper Extremity

Gorham's disease is a rare disorder involving the proliferation of endothelial channels resulting in resorption and disappearance of bone. An unusual case of polyostotic Gorham's disease affecting the scapula, humerus, radius, and ulna in a 39-year-old woman is described. The patient had extensive disease spreading across both the glenohumeral and humeroulnar joints. This is the first report of Gorham's disease spreading across multiple joints in the upper extremity

Analysis of Contoured Anatomic Plate Fixation versus Intramedullary Rod Fixation for Acute Midshaft Clavicle Fractures

The recent trend has been toward surgical fixation of displaced clavicle fractures. Several fixation techniques have been reported yet it is unclear which is preferable. We retrospectively reviewed one hundred one consecutive patients with acute midshaft clavicle fractures treated operatively at a level-1 trauma center. Thirty-four patients underwent intramedullary pin fixation and 67 had anatomic plate fixation. The outcomes we assessed were operative time, complications, infection, implant failure, fracture union, range of motion, and reoperation rate. There were 92 males and 9 females with an average age of 30 years (range: 14–68 years). All patients were followed to healing with an average followup of 20 months (range: 15–32 months). While fracture union by six months (P=0.8729) and range of motion at three months (P=0.6139) were similar, the overall healing time for pin fixation was shorter (P=0.0380). The pin group had more infections (P=0.0335) and implant failures (P=0.0245) than the plate group. Intramedullary pin fixation may have improved early results, but there was no long term difference in overall rate of union and achievement of full shoulder motion. The higher rate of implant failure with pin fixation may indicate that not all fracture patterns are amenable to fixation using this device

A Meta-Analysis of Osteosarcoma Outcomes in the Modern Medical Era

Four decades ago, specialized chemotherapy regimens turned osteosarcoma, once considered a uniformly fatal disease, into a disease in which a majority of patients survive. Though significant survival gains were made from the 1960s to the 1980s, further outcome improvements appear to have plateaued. This study aims to comprehensively review all significant, published data regarding osteosarcoma and outcome in the modern medical era in order to gauge treatment progress. Our results indicate that published survival improved dramatically from 1960s to 1980s and then leveled, or in some measures decreased. Recurrence rates decreased in the 1970s and then leveled. In contrast, published limb salvage rates have increased significantly every recent decade until the present. Though significant gains have been made in the past, no improvement in published osteosarcoma survival has been seen since 1980, highlighting the importance of a new strategy in the systemic management of this still very lethal condition

Hip Disarticulation for Severe Lower Extremity Infections

Hip disarticulation is rarely performed for infections and variable mortality rates have been reported. We determined the number of deaths following hip disarticulation for severe lower extremity infections in 15 patients. Indications for hip disarticulation were necrotizing soft tissue infections in seven patients and persistent infections of the proximal thigh in eight patients. The most common microorganism was Staphylococcus aureus, present in eight patients. Hip disarticulation was performed emergently in seven patients and electively in eight patients. All patients survived the operation and at 1 month postoperatively 14 of 15 patients were alive. Hip disarticulation for these severe infections had high survival, even when performed emergently for life-threatening infections. We believe hip disarticulation is a reasonable option treating severe infections of the lower extremity and should be part of the armamentarium of the orthopaedic surgeon