Arthrodiastasis for Treatment of Avascular Necrosis of Lesser Metatarsal Heads

Total Page:16

File Type:pdf, Size:1020Kb

Arthrodiastasis for Treatment of Avascular Necrosis of Lesser Metatarsal Heads QUICK START GUIDE QUICK START GUIDE (THIS SIDEBAR WILL NOT PRINT) Arthrodiastasis for Treatment of Avascular Necrosis of Lesser Metatarsal Heads (THIS SIDEBAR WILL NOT PRINT) This PowerPoint template produces a 42”x90" presentation poster. You can use it to create your research poster by placing your title, subtitle, text, tables, charts and How to change the template colors photos. You can change the overall template color theme by clicking on the COLORS Stephanie Wu, DPM¹, Jones Thomas, DPM², Hummira Abawi, DPM, FACFAS³ dropdown menu under the DESIGN tab. You can see a tutorial here: We provide a series of online tutorials that will guide you through the poster design ¹ PGY-1, VA Maryland Healthcare System and Sinai Hospital, Baltimore, Rubin Institute for Advanced Orthopedics https://www.posterpresentations.com/how-to-change-the-research-poster-template-colors.h process and answer your poster production questions. For complete template tml tutorials, go online to PosterPresentations.com and click on the HELP DESK tab. ² PGY-2, VA Maryland Healthcare System and Sinai Hospital, Baltimore, Rubin Institute for Advanced Orthopedics You can also manually change the color of individual elements by going to VIEW > ³ Assistant Director, VA Maryland Healthcare System and Sinai Hospital, Baltimore, Rubin Institute for Advanced Orthopedics To print your poster using our same-day professional printing service, go online to SLIDE MASTER. On the left side of your screen select the background master where PosterPresentations.com and click on "Order your poster". you can change the template background, column sizes, etc. After you finish working on the SLIDE MASTER, it is important that you go to VIEW > NORMAL to continue working on your poster. Important: Check the template size Introduction Patient Course Results Discussion/Analysis Conclusion This is a template for a Before you start working on your poster and to presentation poster avoid printing problems check that you have Date Event Details Asymptomatic relief noted at 10 weeks of external fixator application Our patient developed avascular necrosis of 3rd and 4th metatarsals Our case study is limited to one patient. However, the results of downloaded and that you are using the correct There is a paucity of literature describing the use of arthrodiastasis with return to functional baseline at 10 months. Patient had 0/10 pain at 42 inches tall size template for your poster presentation. 05/13/17 Trauma/urgent care Twisted left ankle during patient care. X-ray performed, after a traumatic fall. No resolution of symptoms were noted with the combination of procedures have shown success in symptoms This template can also be printed at the for surgical treatment in avascular necrosis of the lesser How to change the column layout configuration by following sizes without distortion and without Left 4th metatarsal closed nondisplaced fracture 3-year follow-up nonsurgical treatment modalities for 9 months and she was unable to relief and earlier return to functional baseline. Though the surgical You can manually change the configuration on the columns by going to VIEW > SLIDE 90 inches wide any additional formatting: MASTER. You can delete columns, resize them or modify them as needed for your 36 tall x 77.14 wide metatarsals. Arthrodiastasis is used in the setting of avascular 09/14/17 1st clinic visit MRI: angulated fracture of 4th metatarsal neck and return to work due to pain. 4 months after initial surgery, the patient techniques could be limited to patients and pathologies specific, layout. B 44 tall x 94.28 wide collapse of 3rd metatarsal head. A was able to return to daily 4-hour work shift with breaks for icing and they should be applied to current AVN pathologies to explore You can see a tutorial here: necrosis of the hip, Legg-Calves-Perthes disease (1). With similar Tender to palpation of dorsal aspect of 2nd, 3rd and https://www.posterpresentations.com/how-to-change-the-column-configuration.html concept and pathologies, we would expect promising results (2). 4th metatarsals with edema. Not able to return to work. elevating. 6 months after surgery, the patient was able to return to different treatment options. Case series studies in the future would 8-hour shifts requiring breaks. 10 months following surgery, the be essential in comparing core decompression with osteotomies Therefore, we explored the combination of surgical techniques that 11/19/17 2nd clinic visit Ecchymosis along 3rd and 4th. POP along dorsum 3rd How to Zoom in and out and 4th metatarsal. Limited ROM 3rd and 4th MTPJ. patient was able to return to 12-hour shift with no restrictions. 37 and core decompression with joint distraction. Use the PowerPoint zoom tool to adjust the involved core decompression with autologous bone marrow discussed surgery How to hide the QUICK START screen magnification to view comfortably. months after injury and 28 months after initial surgery, patient GUIDE bars from the sides of PowerPoint provides 2 ways to zoom: aspirate concentrate (BMAC). In conjunction with BMAC, 2/20/18 Surgery #1 Left application of ex-fix monorail 3rd and 4th continues to report no pain as rated on Visual analog scale. the template 1. On the top menu bar click on the VIEW tab metatarsophalangeal joint. Core decompression of 3rd The Quick Start Guides are outside the and then click on ZOOM. Choose the zoom template’s printable area and they will percentage that works best for you. offloading harmful stresses to a compromised articular surface with and 4th metatarsals. Bone marrow aspirate from calcaneus not be on the printed poster. 2. For better zoom flexibility, use the zoom The literature is rife with surgical treatment options for avascular Acknowledgement slider at the bottom right of the window. external fixation allows one to maintain full weight bearing to the If you create a PDF file from your 3/8/18 Post-op visit #1 Blister to distal 4th digit. Hardware intact. 4th monorail necrosis of the lesser metatarsal heads. Typical surgical treatment template, the guides will not be included. foot, while improving the synovial circulation to the joint. This adjusted/loosened up Thank you John Miller, DPM and Emily Chau, DPM for providing includes osteotomies, debridement, core decompression, autografts, To hide the guides click on the Home tab Ruler and Guides case study documents a patient with avascular necrosis of the lesser 3/15/18 ED visit Possible DVT. Readjusted proximal monorails allografts, and arthroplasties. Alhadhoud et al. performed a systematic patient care. (top of the screen) and then click on the The dotted lines on his poster template are guides. The horizontal and vertical guides Layout button below to see the available will help you align your poster elements accurately. Text boxes and other elements will metatarsal heads treated successfully with core decompression, 4/10/18 Surgery #2 Removed external fixator, manipulation under review of surgical interventions for AVN of metatarsal heads and layouts. Choose the Without Guides ”snap” to the guides and stay within the boundaries of the columns. To hide the guides anesthesia layout. go to VIEW and uncheck the Guides box. BMAC and multiple monorail external fixators. found that all interventions had weak support in the literature in 5/3/18 Post-op visit #1 Pin sites clean, no infection concerns. Xray - metatarsal C D regards to demonstrating their efficacy (3). To our knowledge, only Headers and text containers heads 3 and 4 have bony consolidation. No signs of Included in this template are commonly used lytic lesions except at lateral 3rd metatarsal head. Dorsal one article in the literature mentions the use of arthrodiastasis for References section headers such as Abstract, Objectives, Case Presentation pain on palpation to left foot 4th metatarsal head, no AVN of the lesser metatarsal heads (4). In the foot and ankle, Methods, Results, etc. plantar pain, no pain with ROM - Click inside a section header to add its text. arthrodiastasis is often used for treatment of arthritis of both the first 1.Maxwell, S. L., et al. “Arthrodiastasis in Perthes’ Disease.” The Journal of Bone - To add another header, click on edge of the Forty-nine-year-old female with past medical history of diabetes 7/5/18 Post-op visit #2 Incision all healed. Xray - pin sites healed. Joint space and Joint Surgery. British Volume Crossref section box so that it is outlined. Copy and metatarsophalangeal joint and ankle joint. , vol. 86-B, no. 2, 2004, pp. 244–50. , paste it. mellitus type 1 with cheiroarthropathy, graves disease, within lesser digits 2-4 maintained space. No further doi:10.1302/0301-620x.86b2.14284. How to preview your poster prior - To increase its size, click on the white circles avn changes. Contour of metatarsal heads acceptable. to printing and expand to the the desired size. hypothyroidism, psoriatic arthritis, hyperlipidemia, aortic Able to return to 4-hour work shift with breaks for 2.Luzo, Carlos Augusto Malheiros, et al. “Initial Experience of Use of an You can preview your poster at any time Arthrodiastasis has been used in the treatment of avascular necrosis by pressing the F5 key on your insufficiency, pericarditis and bilateral carpal tunnel syndrome who ice/elevation Articulated External Fixator in Treating Legg-Calvé-Perthes Disease by keyboard. You will see on the screen Adding content to the poster of the femoral head as early as 1979. By creating a space between the what's on your poster and how it should presented to clinic after suffering a fall during work a month ago. 8/2/18 Clinic visit Able to perform 8-hour shift with several breaks for Means of Arthrodiastasis during the Active Phase of the Disease.” Revista Start by adding your text to each section without spending too much time with articular surfaces, minimizing mechanical stress, and maintaining look when printed.
Recommended publications
  • Blount, Anteversion and Torsion: What's It All About?
    Blount, Anteversion and Torsion: What’s it all about? Arthur B. Meyers, MD Assistant Professor of Radiology Children’s Hospital of WisConsin/ MediCal College of WisConsin Disclosures • Author for Amirsys/Elsevier, reCeiving royalGes Lower Extremity Alignment in Children • Lower extremity rotaGon – Femoral version / Gbial torsion – Normal values & CliniCal indiCaGons – Imaging • Blount disease – Physiologic bowing – Blount disease Lower Extremity RotaGonal Alignment Primarily determined by: 1. Femoral version 2. Tibial torsion 3. PosiGon of the foot Rosenfeld SB. Approach to the Child with in-toeing. Up-to-date. 2/2014 Lower Extremity RotaGonal Alignment Primarily determined by: 1. Femoral version 2. Tibial torsion 3. PosiGon of the foot Rosenfeld SB. Approach to the Child with in-toeing. Up-to-date. 2/2014 Femoral Version The rotaGon of the femoral neCk in relaGon to the long axis of the femur (posterior Condylar axis of the distal femur) Femoral Version The rotaGon of the femoral neCk in relaGon to the long axis of the femur (posterior Condylar axis of the distal femur) Femoral Version The rotaGon of the femoral neCk in relaGon to the long axis of the femur (posterior Condylar axis of the distal femur) Femoral Version The rotaGon of the femoral neCk in relaGon to the long axis of the femur (posterior Condylar axis of the distal femur) Femoral Version The rotaGon of the femoral neCk in relaGon to the long axis of the femur (posterior Condylar axis of the distal femur) Femoral Version The rotaGon of the femoral neCk in relaGon to the long
    [Show full text]
  • Arthroscopic and Open Anatomy of the Hip 11
    CHAPTER Arthroscopic and o'pen Anatomy of the Hip Michael B. Gerhardt, Kartik Logishetty, Morteza lV1eftah, and Anil S. Ranawat INTRODUCTION movements that they induce at the joint: 1) flexors; 2) extensors; 3) abductors; 4) adductors; 5) external rotators; and 6) interI12 I The hip joint is defined by the articulation between the head rotators. Although some muscles have dual roles, their primary of the femur and the aeetahulum of the pelvis. It is covered by functions define their group placem(:)nt, and they all have ullique :l large soft-tissue envelope and a complex array of neurovascu- neurovascular supplies (TIt ble 2-1). lar and musculotendinous structures. The joint's morphology The vascular supply of tbe hip stems from the external and anu orientation are complex, and there are wide anatomi c varia- internal iLiac ancries. An understanding of the course of these tions seen among individuals. The joint's deep location makes vessels is critical fo r ,lVo iding catasu"ophic vascular injury. fn both arthroscopic and open access challenging. To avoid iatro- addition, the blood supply to the fel11()ra l head is vulnerahle to genic injury while establishing functional and efficient access, both traumatic and iatrogenic injury; the disruption of this sup- the hip surgeon should possess a sound ana tomic knowledge of ply can result in avascular necrosis (Figure 2-2). the hip. T he human "hip" can be subdivided into three categories: I) the superficial surface anatomy; 2) the deep femoroacetabu- la r Joint and capsule; and 3) the associated structures, including the muscles, nerves, and vasculature, all of which directly affeet HIP MUSCULATURE its function.
    [Show full text]
  • Femur Pelvis HIP JOINT Femoral Head in Acetabulum Acetabular
    Anatomy of the Hip Joint Overview The hip joint is one of the largest weight-bearing HIP JOINT joints in the body. This ball-and-socket joint allows the leg to move and rotate while keeping the body Femoral head in stable and balanced. Let's take a closer look at the acetabulum main parts of the hip joint's anatomy. Pelvis Bones Two bones meet at the hip joint, the femur and the pelvis. The femur, commonly called the "thighbone," is the longest and heaviest bone of the body. At the top of the femur, positioned on the femoral neck, is the femoral head. This is the "ball" of the hip joint. The other part of the joint – the Femur "socket" – is found in the pelvis. The pelvis is a bone made of three sections: the ilium, the ischium and the pubis. The socket is located where these three sections fuse. The proper name of the socket is the "acetabulum." The head of the femur fits tightly into this cup-shaped cavity. Articular Cartilage The femoral head and the acetabulum are covered Acetabular with a layer of articular cartilage. This tough, smooth tissue protects the bones. It allows them to labrum glide smoothly against each other as the ball moves in the socket. Soft Tissues Several soft tissue structures work together to hold the femoral head securely in place. The acetabulum is surrounded by a ring of cartilage called the "acetabular labrum." This deepens the socket and helps keep the ball from slipping out of alignment. It also acts as a shock absorber.
    [Show full text]
  • Osteonecrosis of the Femoral Head. Surgical Technique Free
    This is an enhanced PDF from The Journal of Bone and Joint Surgery The PDF of the article you requested follows this cover page. Free Vascularized Fibular Grafting for the Treatment of Postcollapse Osteonecrosis of the Femoral Head. Surgical Technique J. Mack Aldridge, III, Keith R. Berend, Eunice E. Gunneson and James R. Urbaniak J Bone Joint Surg Am. 2004;86:87-101. This information is current as of August 9, 2009 Reprints and Permissions Click here to order reprints or request permission to use material from this article, or locate the article citation on jbjs.org and click on the [Reprints and Permissions] link. Publisher Information The Journal of Bone and Joint Surgery 20 Pickering Street, Needham, MA 02492-3157 www.jbjs.org COPYRIGHT © 2004 BY THE JOURNAL OF BONE AND JOINT SURGERY, INCORPORATED Free Vascularized Fibular Grafting for the Treatment of Postcollapse Osteonecrosis of the Femoral Head Surgical Technique By J. Mack Aldridge III, MD, Keith R. Berend, MD, Eunice E. Gunneson, PA-C, and James R. Urbaniak, MD Investigation performed at Duke University Medical Center, Durham, North Carolina The original scientific article in which the surgical technique was presented was published in JBJS Vol. 85-A, pp. 987-993, June 2003 SURGICAL TECHNIQUE ABSTRACT Overview In its early stages, free vascularized fibular grafting of the femoral BACKGROUND: head required two teams of surgeons and an operative time of six Osteonecrosis of the femoral hours or more. Today, thanks in large part to the development of tech- head, a disease primarily affect- nical shortcuts, customized instrumentation, and an operative sup- ing young adults, is often associ- port staff familiar with the nuances of the surgery, free vascularized ated with collapse of the articular fibular grafting of the femoral head can easily be performed in be- surface and subsequent arthro- tween two and one-half and three hours, with two surgeons and one sis.
    [Show full text]
  • Normative Values for Femoral Length, Tibial Length, Andthe Femorotibial
    Article Normative Values for Femoral Length, Tibial Length, and the Femorotibial Ratio in Adults Using Standing Full-Length Radiography Stuart A Aitken MaineGeneral Medical Center, 35 Medical Center Parkway, Augusta, ME 04330, USA; [email protected] Abstract: Knowledge of the normal length and skeletal proportions of the lower limb is required as part of the evaluation of limb length discrepancy. When measuring limb length, modern standing full-length digital radiographs confer a level of clinical accuracy interchangeable with that of CT imaging. This study reports a set of normative values for lower limb length using the standing full-length radiographs of 753 patients (61% male). Lower limb length, femoral length, tibial length, and the femorotibial ratio were measured in 1077 limbs. The reliability of the measurement method was tested using the intra-class correlation (ICC) of agreement between three observers. The mean length of 1077 lower limbs was 89.0 cm (range 70.2 to 103.9 cm). Mean femoral length was 50.0 cm (39.3 to 58.4 cm) and tibial length was 39.0 cm (30.8 to 46.5 cm). The median side-to-side difference was 0.4 cm (0.2 to 0.7, max 1.8 cm) between 324 paired limbs. The mean ratio of femoral length to tibial length for the study population was 1.28:1 (range 1.16 to 1.39). A moderately strong inverse linear relationship (r = −0.35, p < 0.001, Pearson’s) was identified between tibial length and the Citation: Aitken, S.A. Normative corresponding femorotibial ratio.
    [Show full text]
  • Free Vascularized Fibula Grafting: Principles, Techniques, and Applications in Pediatric Orthopaedics
    FREE VASCULARIZED FIBULA GRAFTING: PRINCIPLES, TECHNIQUES, AND APPLICATIONS IN PEDIATRIC ORTHOPAEDICS DONALD S. BAE, MD AND PETER M. WATERS, MD CHILDREN’S HOSPITAL INTRODUCTION refers to the formation of new bone from either the host or graft Bone grafts are commonly used in all specialties of ortho- tissue. In addition to these three properties, it is important to paedic surgery, and an understanding of the principles and consider the mechanical strength and vascularity of the bone techniques of bone grafting is critical to the care of traumatic, graft material. developmental, and reconstructive musculoskeletal conditions. Autogenous and allogenic cortical and cancellous bone While most orthopaedic surgeons are familiar with the utiliza- grafts are all, to varying degrees, osteoconductive, osteoin- tion of non-vascularized bone graft and bone graft substitutes, ductive, and osteogenic. For these reasons, non-vascularized the applications of vascularized bone grafts --and free vascular bone grafts are effective in facilitating bony healing. When fibula grafts in particular—are often less well understood. The appropriately utilized, non-vascularized bone grafts may be purpose of this article is to review the principles and technique incorporated into the adjacent host bone through the process of free vascularized fibula grafting, with particular attention to of “creeping substitution.” The bone graft material, through its applications in pediatric orthopaedic surgery. the invasion of capillaries, perivascular tissue, and inflamma- tory
    [Show full text]
  • Anatomical Axes of the Proximal and Distal Halves of the Femur in A
    Yazdi et al. Journal of Orthopaedic Surgery and Research (2018) 13:21 DOI 10.1186/s13018-017-0710-0 RESEARCH ARTICLE Open Access Anatomical axes of the proximal and distal halves of the femur in a normally aligned healthy population: implications for surgery Hamidreza Yazdi1, Ara Nazarian2, John Y. Kwon3, Mary G. Hochman4, Reza Pakdaman5, Poopak Hafezi6, Morteza Ghahremani7, Samad Joudi8 and Mohammad Ghorbanhoseini3* Abstract Background: The anatomical axis of the femur is crucial for determining the correct alignment in corrective osteotomies of the knee, total knee arthroplasty (TKA), and retrograde and antegrade femoral intramedullary nailing (IMN). The aim of this study was to propose the concept of different anatomical axes for the proximal and distal parts of the femur; compare these axes in normally aligned subjects and also to propose the clinical application of these axes. Methods: In this cross-sectional study, the horizontal distances between the anatomical axis of the proximal and distal halves of the femur and the center of the intercondylar notch were measured in 100 normally aligned femurs using standard full length alignment view X-rays. Results: The average age was 34.44 ± 11.14 years. The average distance from the proximal anatomical axis to the center of the intercondylar notch was 6.68 ± 5.23 mm. The proximal anatomical axis of femur passed lateral to the center of the intercondylar notch in 12 cases (12%), medial in 84 cases (84%) and exactly central in 4 cases (4%). The average distance from the distal anatomical axis to the center of the intercondylar notch was 3.63 ± 2.09 mm.
    [Show full text]
  • Coronal and Transverse Malalignment in Pediatric Patellofemoral Instability
    Journal of Clinical Medicine Article Coronal and Transverse Malalignment in Pediatric Patellofemoral Instability Robert C. Palmer 1, David A. Podeszwa 1,2, Philip L. Wilson 1,2 and Henry B. Ellis 1,2,* 1 Scottish Rite for Children, Dallas, TX 75219, USA; [email protected] (R.C.P.); [email protected] (D.A.P.); [email protected] (P.L.W.) 2 Department of Orthopeadics, University of Texas Southwestern Medical Center, Dallas, TX 75033, USA * Correspondence: [email protected] Abstract: Patellofemoral instability (PFI) encompasses symptomatic patellar instability, patella subluxations, and frank dislocations. Previous studies have estimated the incidence of acute patellar dislocation at 43 per 100,000 children younger than age 16 years. The medial patellofemoral ligament (MPFL) complex is a static soft tissue constraint that stabilizes the patellofemoral joint serving as a checkrein to prevent lateral displacement. The causes of PFI are multifactorial and not attributed solely to anatomic features within the knee joint proper. Specific anatomic features to consider include patella alta, increased tibial tubercle–trochlear groove distance, genu valgum, external tibial torsion, femoral anteversion, and ligamentous laxity. The purpose of this paper is to provide a review of the evaluation of PFI in the pediatric and adolescent patient with a specific focus on the contributions of coronal and transverse plane deformities. Moreover, a framework will be provided for the incorporation of bony procedures to address these issues. Keywords: pediatric patellar instability; coronal malalignment; genu valgum; rotational malalignment; Citation: Palmer, R.C.; Podeszwa, D.A.; femoral anteversion; tibial torsion Wilson, P.L.; Ellis, H.B. Coronal and Transverse Malalignment in Pediatric Patellofemoral Instability.
    [Show full text]
  • Avascular Necrosis of the Talus Following Arthroscopic Classification
    CHAPTER 24 AVASCUIAR NECROSIS OF THE TALUS ./oel W. Brook, D.P.M. Micbael S. Douney, D.P.M. Avascular necrosis (A\,T{) of the talus is a topic that extravascular compromise considers bone, in this should be understood by any practitioner treating instance the talus, as a closed compartment. An pathology of the foot and ankle. Its pathogenesis is increase in marrow pressure causes a decrease in such that if it is not diagnosed early and treated perfusion to the osteoc),tes and creates a "marrow properly, it may result in sequelae with a high compaftment syndrome." This can occur in degree of morbidity. The literature on A\N is infectious processes where the infectious by-prod- extensive, and illustrates the fact that it is a ucts increase the intraosseous pressure. complex, progressive disease that defies simple Vascular disruption is another etiologic categorization. It is most easily defined as the death mechanism. Traumatic vascular disruption is self- of bone cells secondary to complete interruption or explanatory, and occurs most frequently with a significant decrease in the vascular supply to talar neck fractures. Disruption due to vascular bone.' Synonyms for the process include ischemic compression refers to an increase in soft tissue necrosis, osteonecrosis and aseptic necrosis."3 The volume and/or pressure which may occur either latter is actually a misnomer, and will subsequently intraosseously or extraosseously, and again, is most be discussed in the section on etiology. commonly a sequela of infection. Intraluminal It is important to discern between the etiology obstruction occurs with any embolic process. and pathogenesis of A\N in that a working The majority of literature dealing with A\N knowledge of both contribute to the diagnosis of reflects the disease process as it effects the femoral the disease.
    [Show full text]
  • Restoration of the Femoral Head After Collapse in Osteoarthrosis
    Ann. rheum. Dis. (1971), 30, 406 Ann Rheum Dis: first published as 10.1136/ard.30.4.406 on 1 July 1971. Downloaded from Restoration of the femoral head after collapse in osteoarthrosis G. 0. STOREY AND J. W. LANDELLS Hackney Hospital, London E.9, and Department of Morbid Anatomy, Institute of Pathology, The London Hospital It has often been said that osteoarthrosis of the hip is a relatively static condition, the radiological appearance remaining unchanged over a number of years. It is now recognized, however, that in some cases destructive changes occur (Isdale, 1962; Storey, 1968); some of these may be the result of avascular necrosis. In a proportion of these patients, 'healing' may bring about re-formation of the femoral head and reappearance of the radiological 'joint space'. In the following report this course was observed clinically and radiologically during the last years of the patient's life and correlated with the findings at the postmortem examination. copyright. Case Report The patient was first seen in 1966, when he was 76 years old. He gave a history that 8 years previously, in 1958, he had fallen on his right hip. He attended the Casualty Department, where a radiograph (Fig. 1) was thought to http://ard.bmj.com/ be normal. The pain in the hips disappeared, but returned in 1964, especially on walking, about 18 months before his attendance. He also noticed that his leg had become shorter. Examination The shortening of the right lower limb was confirmed (1 in.; 2 5 cm.) with limitation of the movements of the on September 23, 2021 by guest.
    [Show full text]
  • The Pros and Cons of Using Larger Femoral Heads in Total Hip Arthroplasty
    A Review Paper The Pros and Cons of Using Larger Femoral Heads in Total Hip Arthroplasty Pranav Rathi, MBBS, MS, Gavin C. Pereira, MBBS, FRCS (Eng), FRCS (T&O), Mauro Giordani, MD, and Paul E. Di Cesare, MD Twenty-five percent of all revisions are performed for instabil- Abstract ity or dislocation.3 With the introduction of improved bearing sur- faces for total hip arthroplasty (THA) has come Total Hip Arthroplasty Stability a reintroduction of larger femoral heads with the and Jump Distance promise of reducing the rate of hip instability Jump distance (JD) is the femoral head center translation dis- and increasing hip range of motion (ROM). The tance required for a head to dislocate from a socket (Figure 1). size of femoral heads used for THA ranges from Prosthetic hips with less JD are more likely to dislocate than 22 to 40 mm, and even larger heads are used hips with more JD. Sariali and colleagues5 found that JD varies for hip resurfacing. With accurately positioned according to cup abduction angle (angle of rotation around components, larger heads reduce the hip insta- anterior-posterior axis of pelvis), cup anteversion angle (angle bility rate and theoretically increase hip ROM. of rotation around cranial-caudal axis of pelvis), femoral head However, for any given bearing surface, the vol- diameter, and cup center offset. umetric wear rate is higher for larger heads than Cup center offset is the shortest distance from the center of for smaller heads, which potentially jeopardizes the head to the opening plane of the cup (Figures 2A-C).
    [Show full text]
  • Free Fibula Graft to the Hip Fori Avascular Necrosis ARTICLE by GAIL S
    Free Fibula Graft to the Hip fori Avascular Necrosis ARTICLE BY GAIL S. BOYD, CST/CFA ree fibula grafting additional equipment, medications continued his alcohol intake postop- to the hip is contem- used in the procedure, instrumenta- eratively, which was the probable plated as treatment tion, sutures, etc. I gave inservices contributing cause for his disease). for avascular necro- to all OR personnel and hospital We have also had one major postop- sis (AVN) of the staff nurses who would be assisting erative complication. Our patient femoral head. AVN in the patients' postoperative care in was on his crutches 2 weeks postop- is a condition in which blood flow the hospital. eratively when he got one of his to the bone is restricted, causing During Dr Urbaniak's first 5 years crutches tangled up in something, that portion of the bone to die. doing free fibula grafts on 50 causing him to fall. He fractured his Pain and decreased range of patients, he reported having three femur just distal to the graft inser- motion (ROM) may result. patients whose disease progressed tion site. We reduced the fracture Although there are several meth- enough to warrant total hip arthro- and placed a cobra-type plate and ods of treatment for AVN, none is plasty, and three more patients with screws for fixation to try to preserve completely satisfactory or progressive or further collapse of the the graft. Time and future x-ray constantly successful. The purpose femoral head. films will reveal the success or fail- of this surgery is to decompress the Since we began free fibula grafts ure.
    [Show full text]