1/63. Changes on magnetic resonance images after traumatic avascular necrosis of the femoral head.SUMMARY: We describe two cases of avascular necrosis after traumatic fracture of the femoral neck. The size and signal intensity of the necrotic areas changed on follow-up magnetic resonance images. magnetic resonance imaging is suitable for showing resolvable changes that radiographic study cannot demonstrate during the clinical course.- - - - - - - - - - ranking = 1keywords = fracture (Clic here for more details about this article) |
2/63. Concomitant sickle cell disease and skeletal fluorosis.Skeletal fluorosis typically manifests as a diffuse increase in bone density, whereas avascular necrosis of the epiphyses and diaphyseal marrow are the main skeletal manifestations of sickle cell disease. The diagnostic and therapeutic challenges raised when both disorders are present are illustrated by two cases in Senegalese patients from an area characterized by high fluoride contents in the water and soil. Both had SS sickle cell disease. Skeletal fluorosis was diagnosed during evaluation for avascular necrosis in one patient and in the wake of septic arthritis in the other. Femoral head necrosis is difficult to identify in a patient with skeletal fluorosis. The bone lesions due to sickle cell disease and those due to fluorosis can mimic other bone diseases, most notably metastases. The combination of sickle cell disease and fluorosis results in significant medullary canal narrowing due to cortical thickening and to accumulation of necrotic bone. When performing hip replacement surgery, careful reaming of the medullary canal may reduce the risk of iatrogenic femoral fracture and inappropriate stem placement.- - - - - - - - - - ranking = 1keywords = fracture (Clic here for more details about this article) |
3/63. Pathological fracture of the femoral neck as the first manifestation of osteonecrosis of the femoral head.We describe two cases of pathological fracture of the femoral neck occurring as the first manifestation of osteonecrosis of the femoral head (ONFH). No abnormal findings suggestive of ONFH were identified on the radiographs for either of the patients, and the fractures occurred like spontaneous fractures without any trauma or unusually increased activity. The patients' medical history, age, and good bone quality suggested ONFH as a possible underlying cause of the fractures. If we had not suspected ONFH as a predisposing condition, these minimally displaced fractures might have been fixed internally with multiple pins, and this would have led to nonunion or collapse of the femoral head. To avoid inappropriate treatment, ONFH should be considered as a predisposing factor in pathological fractures of the femoral neck.- - - - - - - - - - ranking = 10keywords = fracture (Clic here for more details about this article) |
4/63. fatigue subcapital fracture of the femur after the removal of the hip plate in transtrochanteric rotational osteotomy.We report two cases of fatigue subcapital fracture of the femur after the removal of the hip plate used for fixation in transtrochanteric rotational osteotomy for osteonecrosis. Two patients, a 42-year-old man and a 43-year-old man, underwent transtrochanteric rotational osteotomy, and bony union was achieved in both patients. However, fatigue subcapital fracture of the femur occurred in both patients 15 months after the removal of the hip plate. Transtrochanteric rotational osteotomy greatly changes the trabecular bone structure in the proximal femur, thus affecting the strength of the femoral neck. Therefore, for the trabecular bone to be remodeled and for the proximal femur to achieve sufficient strength, a sufficient period is necessary after complete bony union has occurred in the transtrochanteric lesion, before removal of the plate.- - - - - - - - - - ranking = 6keywords = fracture (Clic here for more details about this article) |
5/63. Can ischemic hip disease cause rapidly destructive hip osteoarthritis? A case report.Avascular osteonecrosis of the femoral head (AONFH) usually goes through the four stages described by Arlet and Ficat: normal radiographs, heterogeneity and sclerosis of the femoral head, subchondral fracture with an individualized sequestrum, and secondary osteoarthritis. Arlet and Ficat individualized a specific pattern of AONFH which they called ischemic hip disease, in which cartilage damage seen as concentric joint space loss precedes the bony alterations. Although radiological and pathological studies of ischemic hip disease have been published, no clinical data are available. We report the case of a 65-year-old man admitted for a 1-month history of severe hip symptoms with concentric joint space loss but no osteophytes. Laboratory tests and examination of fluid aspirated from the hip ruled out septic arthritis and inflammatory hip disease. Two magnetic resonance imaging (MRI) studies done 1 month apart showed diffuse edema involving not only the femoral head but also the neck and trochanter, as well as major synovial hypertrophy. This atypical MRI appearance prompted synovial membrane and pertrochanteric core biopsies, which showed reactive synovitis and stage IV osteonecrosis, respectively. The pain, disability, and joint space loss worsened. Total hip arthroplasty was performed 1 month after the biopsy. Histological examination of the femoral head showed diffuse necrosis; no evidence of another condition was found on histological sections of the entire synovial membrane. This case corroborates the hypotheses put forward by Lequesne that some cases of rapidly destructive hip osteoarthritis may be ascribable to ischemia.- - - - - - - - - - ranking = 1keywords = fracture (Clic here for more details about this article) |
6/63. Stem fracture after hemiresurfacing for femoral head osteonecrosis.The ideal treatment of the young patient with a large necrotic segment in the femoral head remains controversial. Hemiresurfacing is a reasonable option in the young patient with a large osteonecrotic lesion that has collapsed. Complications reported after hemiresurfacing include implant loosening, femoral neck fracture, acetabular wear, and persistent pain. We present a case of stem fracture after hemiresurfacing in a young patient with femoral head osteonecrosis.- - - - - - - - - - ranking = 6keywords = fracture (Clic here for more details about this article) |
7/63. Traumatic dislocation of hip joint with fracture of shaft of femur on the same side.Four cases of traumatic dislocation of the hip joint with fracture of the shaft of femur on the same side, and one case of bilateral hip joint dislocation with a fracture of shaft of femur on one side are reported. Pitfalls in diagnosis and hazards of delayed treatment are emphasized. methods of treatment are outlined. Complications such as avascular necrosis of the head of the femur and sciatic nerve palsy are discussed. Avascular necrosis of the head of the femur is not inevitable even after reduction of the joint has been delayed for several days.- - - - - - - - - - ranking = 6keywords = fracture (Clic here for more details about this article) |
8/63. femoral neck fractures in young adults.In 17 patients with femoral neck fractures who were between 15 and 40 years old the incidence of aseptic necrosis in patients followed more than 2 years was 18.7 per cent. The fracture was associated with other severe injuries in 40 per cent of the cases, probably reflecting the level of violence necessary to induce the fracture in young adults. Two of the 7 fractures treated with large-bore internal fixatives required secondary procedures to correct fracture displacement (this was not a complication with threaded devices). While the incidence of aseptic necrosis is no higher than that in other adult series, subsequent degenerative changes may supervene in many femoral neck fractures in this age group.- - - - - - - - - - ranking = 10keywords = fracture (Clic here for more details about this article) |
9/63. Unusual osteonecrosis of the femoral head misdiagnosed as a stress fracture.We report a case of femoral head osteonecrosis that originally was misdiagnosed as a femoral neck stress fracture by plain radiography and magnetic resonance imaging. The correct diagnosis was made using pinhole bone scintigraphy, which revealed a completely cold lesion of the entire femoral head, confirmed by histologic examination. The patient was treated with muscle pedicle bone grafting, and 3 months postoperatively, pinhole bone scintigraphy showed improved vascularity of the femoral head.- - - - - - - - - - ranking = 5keywords = fracture (Clic here for more details about this article) |
10/63. Femoral head preservation in non-united femoral neck fracture and head osteonecrosis in Cushing's disease.There have been few reports associating avascular necrosis of bone with Cushing's disease. patients with Cushing's disease and avascular necrosis of the femoral head usually receive total hip arthroplasty. However, hip prosthetic replacement in younger patients has been criticized due to a high incidence of component loosening. We report a case of successful femoral head preservation in non-united femoral neck fracture and head osteonecrosis in a 14-year-old girl with Cushing's disease (adrenocorticotropic hormone-secreting pituitary adenoma) who developed avascular necrosis of the right femoral head and pathologic fracture of the right femoral neck 2 years after the onset of hypercortisolism. Subtrochanteric valgus osteotomy was performed to preserve the femoral head after successful transsphenoidal surgery to remove pituitary microadenoma. At follow-up 10 years after the osteotomy, the femoral head had revascularized and the femoral neck fracture were united with much improvement of hip function. Dual energy X-ray absorptiometry scan of the right hip showed 0.86 SD from the normal bone densitometry. Aggressive femoral head preservation may be an effective alternative to treat this rare situation in a teenager.- - - - - - - - - - ranking = 7keywords = fracture (Clic here for more details about this article) |
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