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Issa M, Naja A, Sultanem S, Elias C, Saghieh S. Dual medial and anterior approach for excision of extraosseous synovial hip osteochondroma: a case report. J Med Case Rep 2022; 16:489. [PMID: 36585715 PMCID: PMC9805212 DOI: 10.1186/s13256-022-03724-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 12/12/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Osteochondromas are the most common benign bone tumors occurring near the end of long bones. In this case report, we demonstrate the successful treatment of a proximal femoral osteochondroma in a pediatric patient excised through a dual medial and anterior approach with no hip dislocation. CASE PRESENTATION We present the case of a white Arab 14-year-old boy with chronic hip pain and inability to ambulate. He failed conservative treatment and was referred to us after X-rays revealed two osseous masses. He was diagnosed with an intra-articular hip osteochondroma confirmed on magnetic resonance imaging and computed tomography scan. He was treated surgically with excision using two incisions: Smith-Petersen approach and Ferguson approach. CONCLUSION This case presents the successful resection of a symptomatic pediatric proximal femoral osteochondroma, using dual medial and anterior approaches without the need for hip dislocation. This was optimal for both the safety and accessibility of this unusual condition.
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Affiliation(s)
- Mohamad Issa
- grid.411654.30000 0004 0581 3406Orthopaedic Surgery Department, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ahmad Naja
- grid.411654.30000 0004 0581 3406Orthopaedic Surgery Department, American University of Beirut Medical Center, Beirut, Lebanon
| | - Serge Sultanem
- grid.411654.30000 0004 0581 3406Orthopaedic Surgery Department, American University of Beirut Medical Center, Beirut, Lebanon
| | - Charbel Elias
- grid.411654.30000 0004 0581 3406Orthopaedic Surgery Department, American University of Beirut Medical Center, Beirut, Lebanon
| | - Said Saghieh
- grid.411654.30000 0004 0581 3406Orthopaedic Surgery Department, American University of Beirut Medical Center, Beirut, Lebanon
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王 照, 官 建, 吴 敏, 朱 仲, 周 平, 刘 亚, 徐 陈, 赵 宇. [Comparison of effectiveness of two cannulated screw configurations in the treatment of femoral neck fractures in young adults]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:318-322. [PMID: 33719240 PMCID: PMC8171766 DOI: 10.7507/1002-1892.202009103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 12/24/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To investigate and analyze the effectiveness of internal fixation with the two different cannulated screw implanting methods of rhomboid and inverted triangle in the treatment of femoral neck fracture in young adults. METHODS The clinical data of 38 young adults with femoral neck fracture who met the selection criteria between January 2018 and August 2019 were retrospectively analyzed. According to the different methods of cannulated screw implanting, the patients were divided into two groups, 19 cases in each group. The trial group was treated with closed reduction and cannulated screw rhombic distribution internal fixation, while the control group was treated with closed reduction and cannulated screw inverted triangular distribution internal fixation. There was no significant differences in patients' gender, age, cause of injury, Garden classification of fracture, and time from injury to operation between the two groups ( P>0.05). The fracture healing time, the incidence of nonunion, femoral neck shortening, and femoral head necrosis were recorded and compared between the two groups; the effectiveness was evaluated by Harris score and visual analogue scale (VAS) score at last follow-up. RESULTS The incisions of the two groups healed by first intention. All patients were followed up 12-24 months with an average of 15.5 months. There were 1 case of fracture nonunion and 2 cases of shortening of femoral neck in the trial group; while there were 2 cases of fracture nonunion, 1 case of necrosis of femoral head, and 6 cases of femoral neck shortening in the control group; the difference in the incidence of complications (15.8% vs. 47.4%) between the two groups was significant ( χ 2=4.385, P=0.036). The remaining 18 cases in the trial group and 17 cases in the control group all achieved osteonal union, and the healing time was (14.8±1.6) weeks and (15.9±1.3) weeks, respectively, showing no significant difference between the two groups ( t=1.265, P=0.214). At last follow-up, Harris score and VAS score of the trial group were 88.9±4.3 and 1.1±0.7, respectively, while those of the control group were 86.9±5.9 and 1.3±0.9, respectively, showing no significant difference ( t=0.603, P=0.550; t=1.152, P=0.257). Hip function was evaluated in accordance with Harris score, the results were excellent in 12 cases, good in 6 cases, and fair in 1 case in the trial group, the excellent and good rate was 94.74%; the results were excellent in 10 cases, good in 7 cases, and fair in 2 cases in the control group, the excellent and good rate was 89.47%; there was no significant difference in the excellent and good rate between the two groups ( χ 2=0.368, P=0.544). CONCLUSION The short-term effectiveness of the two kinds of cannulated screw implanting methods is clear, rhomboid fixation of 4 screws has strong stability with stress distribution, which can effectively reduce the incidence of femoral neck shortening, fracture nonunion, femoral head necrosis, and other complications.
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Affiliation(s)
- 照东 王
- 蚌埠医学院第一附属医院骨科 组织移植安徽省重点实验室(安徽蚌埠 233000)Department of Orthopaedics, the First Affiliated Hospital of Bengbu Medical College, Anhui Key Laboratory of Tissue Transplantation, Bengbu Medical College, Bengbu Anhui, 233000, P.R.China
| | - 建中 官
- 蚌埠医学院第一附属医院骨科 组织移植安徽省重点实验室(安徽蚌埠 233000)Department of Orthopaedics, the First Affiliated Hospital of Bengbu Medical College, Anhui Key Laboratory of Tissue Transplantation, Bengbu Medical College, Bengbu Anhui, 233000, P.R.China
| | - 敏 吴
- 蚌埠医学院第一附属医院骨科 组织移植安徽省重点实验室(安徽蚌埠 233000)Department of Orthopaedics, the First Affiliated Hospital of Bengbu Medical College, Anhui Key Laboratory of Tissue Transplantation, Bengbu Medical College, Bengbu Anhui, 233000, P.R.China
| | - 仲廉 朱
- 蚌埠医学院第一附属医院骨科 组织移植安徽省重点实验室(安徽蚌埠 233000)Department of Orthopaedics, the First Affiliated Hospital of Bengbu Medical College, Anhui Key Laboratory of Tissue Transplantation, Bengbu Medical College, Bengbu Anhui, 233000, P.R.China
| | - 平辉 周
- 蚌埠医学院第一附属医院骨科 组织移植安徽省重点实验室(安徽蚌埠 233000)Department of Orthopaedics, the First Affiliated Hospital of Bengbu Medical College, Anhui Key Laboratory of Tissue Transplantation, Bengbu Medical College, Bengbu Anhui, 233000, P.R.China
| | - 亚军 刘
- 蚌埠医学院第一附属医院骨科 组织移植安徽省重点实验室(安徽蚌埠 233000)Department of Orthopaedics, the First Affiliated Hospital of Bengbu Medical College, Anhui Key Laboratory of Tissue Transplantation, Bengbu Medical College, Bengbu Anhui, 233000, P.R.China
| | - 陈 徐
- 蚌埠医学院第一附属医院骨科 组织移植安徽省重点实验室(安徽蚌埠 233000)Department of Orthopaedics, the First Affiliated Hospital of Bengbu Medical College, Anhui Key Laboratory of Tissue Transplantation, Bengbu Medical College, Bengbu Anhui, 233000, P.R.China
| | - 宇朋 赵
- 蚌埠医学院第一附属医院骨科 组织移植安徽省重点实验室(安徽蚌埠 233000)Department of Orthopaedics, the First Affiliated Hospital of Bengbu Medical College, Anhui Key Laboratory of Tissue Transplantation, Bengbu Medical College, Bengbu Anhui, 233000, P.R.China
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Halawi MJ, Brigati DP, Brooks PJ. Surgical hip dislocation through a modified direct lateral approach: real-time perfusion monitoring. Arthroplast Today 2019; 5:316-319. [PMID: 31516974 PMCID: PMC6728437 DOI: 10.1016/j.artd.2019.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 03/19/2019] [Accepted: 03/20/2019] [Indexed: 11/25/2022] Open
Abstract
This study aimed to measure femoral head perfusion during hip resurfacing arthroplasty through a trochanter-sparing modified direct lateral approach. High-power laser Doppler probes were inserted into the femoral heads of 26 patients (26 hips, age range 35-70 years). Changes in blood flow were recorded (1) pre-capsulectomy (reference), (2) post-capsulectomy, and (3) following femoral head dislocation and reduction. There were no statistically significant changes in perfusion amplitudes post-capsulectomy and following femoral head dislocation and reduction (mean −10%, P = .134 and +27%, P = .166, respectively). Prolonged dislocation with the hip maximally flexed and externally rotated resulted in significantly decreased perfusion (mean −28%, P = .002). This study provides in vivo evidence that surgical hip dislocation is feasible using a modified direct lateral approach.
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Affiliation(s)
- Mohamad J Halawi
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
| | - David P Brigati
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Peter J Brooks
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
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Gadinsky NE, Klinger CE, Sculco PK, Helfet DL, Lorich DG, Lazaro LE. Femoral Head Vascularity: Implications Following Trauma and Surgery About the Hip. Orthopedics 2019; 42:250-257. [PMID: 31355905 DOI: 10.3928/01477447-20190723-03] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 05/28/2019] [Indexed: 02/03/2023]
Abstract
Traumatic injury and surgical intervention about the hip joint place the arterial supply to the femoral head (FH) at risk. Compromised perfusion may lead to FH ischemia, cell death, and osteonecrosis. Progression to FH collapse may lead to pain, functional impairment, and decreased quality of life, especially in younger patients. This review describes the arterial supply to the FH, analyzes the impact of femoral neck fractures on FH vascularity, and explores the vascular implications of various surgical interventions about the hip, offering specific techniques to minimize iatrogenic damage to the vessels supplying the FH. [Orthopedics. 2019; 42(5):250-257.].
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Vuksanović-Božarić A, Abramović M, Vučković L, Golubović M, Vukčević B, Radunović M. Clinical significance of understanding lateral and medial circumflex femoral artery origin variability. Anat Sci Int 2018; 93:449-455. [PMID: 29500659 DOI: 10.1007/s12565-018-0434-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 02/21/2018] [Indexed: 11/30/2022]
Abstract
The common femoral artery (CFA) divides into the superficial femoral artery (SFA) and deep femoral artery (DFA). The lateral circumflex femoral artery (LCFA) and medial circumflex femoral artery (MCFA) are most often branches of the DFA, although a large number of different variations in their origin has been described. We performed microdissection on both lower limbs of 30 fetuses, gestational age from 7 to 10 lunar months. Our results show that the LCFA and MCFA usually arise from the DFA. In 78.3% of cases, the MCFA originated from the DFA. In 11.7% of cases, the MCFA originated from the CFA, and in 5% of cases from the SFA. One case showed a common trunk with the DFA. Also, the MCFA was missing in one case, and it had a common trunk with the LCFA in one case. In 83.3% of cases, the LCFA arose from the DFA and in 6.7% of cases from the CFA. In one case, it had a common trunk with the DFA, and in one case with the MCFA. In 3.3% of cases, the LCFA was missing. In 66.7% of cases, both arteries originated from the DFA, in 15% of cases one originated from the DFA and the other from the CFA or SFA. Our results are in accordance with some published studies but also differ from the outcomes of other studies. Comprehensive knowledge of different variation types is imperative in order to prevent complications during surgical and orthopedic interventions.
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Affiliation(s)
| | - Marija Abramović
- Department of Anatomy, Faculty of Medicine, University of Montenegro, Ljubljanska 1, 20000, Podgorica, Montenegro
| | - Ljiljana Vučković
- Department of Pathology, Faculty of Medicine, University of Montenegro, Podgorica, Montenegro
| | - Mileta Golubović
- Department of Pathology, Faculty of Medicine, University of Montenegro, Podgorica, Montenegro
| | - Batrić Vukčević
- Department of Anatomy, Faculty of Medicine, University of Montenegro, Ljubljanska 1, 20000, Podgorica, Montenegro
| | - Miroslav Radunović
- Department of Anatomy, Faculty of Medicine, University of Montenegro, Ljubljanska 1, 20000, Podgorica, Montenegro
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