The purpose of this study is to classify the pitfalls, obstacles and complications that occur during distraction histogenesis and also to evaluate the risk factors likely to lead to these problems.

In this study we have retrospectively and prospectively studied the difficulties occurring during distraction histogenesis since 2003. We studied 74 patients (mean age 19,2 years, age range 11–60 yrs) whose 97 limbs segments were lengthened. 21 patients underwent angular correction, 42 patients limb lengthening, 17 patients both angular correction and limb lengthening and 14 non-union correction. In 46 cases, we used the Ilizarov fixator, in 38 the Taylor Spatial Frame and in 10 cases the monolateral external fix-ator Orthofix LRS. Difficulties that occured during limb lengthening were subclassified into pitfalls, obstacles, and complications. For all cases we have recorded the time of appearance of all these difficulties and have associated them with the severity of the initial deformity.

The total number of difficulties in distraction histogenesis was 20%. The number of presenting problems was estimated 5.4% and involved knee subluxation, pin breakage and malalignments. Obstacles presented in 9.5% and included cases with poor bone regeneration, peroneal nerve palsy, premature consolidation and heel cord lengthening. Finally complications were noted in 5.4% of the cases. These consisted of infection, fracture, non-union and loss of range of knee motion.

The problems, obstacles and complications that occur during distraction histogenesis can all impact on the optimal therapeutic target. Extensive surgical experience, and optimal pre-operative planning in conjunction with the type of the original deformity may all contribute in minimising these difficulties

In the peripheral nervous system of rats, a wide-variety of toxins has been studied to selectively target neurons projecting through a particular nerve. We employed 54 adult male rats to create a neuroma-in-continuity and to evaluate the effect of the immunotoxin OX7-saporin to inhibit neuroma-in-continuity formation. Materials and Methods: The left common peroneal, tibial or sciatic nerves were crushed by one 10-second application of a microforceps. At 3 and 6 weeks after nerve crush, the respective nerve was cut distal to the site of nerve crush, and microinjection of 2 μl of natural saline or 2 μl of the OX7-saporin was done.

In all nerve specimens of the control group and the saline-injection experimental subgroups, gross observation showed a thickened area at the site of nerve crush. Histology showed features consistent with a neuroma-in-continuity. In 11 of the 14 nerve specimens of the OX7-saporin injection experimental subgroups, gross observation showed a narrowed area at the site of nerve crush. Histology showed prevention of neuroma-in-continuity formation as seen by wiping out of almost all nerve fibers, leaving an empty tube encasing by connective tissue.

This study supports the hypothesis that intraneural injection of the OX7-saporin may inhibit neuroma-in-continuity formation

Purpose: Fractures of the distal tibia are high energy fractures, associated with marked soft-tissue trauma. Management of these fractures is challenging. The purpose of this study is to present our experience on the treatment of these fractures using hybrid external fixation, with or without open reduction and minimal internal fixation of the fibular fracture.

Patients and Methods: Forty eight patients with a distal tibial fracture were admitted to the authors’ institution since 2005. There were 33 men and 15 women. According to AO there were 24 A, 10 B and 14 C fractures. The mean age of the patients was 45.6 years. Eight patients had an open pilon fracture; according to the Gustilo classification, 1 patient had a grade I, 5 patients had a grade II, and 2 patients had a grade III open fracture. In all patients, the pilon fracture was treated using hybrid external fixation; in 18 patients, open reduction and minimal internal fixation of the fibular fracture using plate and screws was also done.

Results: Mean follow-up was 14 months (range, 9 to 36 months). In all patients, the mean duration of the application of the external fixation was 2.85 months, followed by the application of a below-knee cast. In 42 patients, radiographic evidence of union was observed at 3,6 months (range, 3 to 9 months). Time for union was different between patients with closed and grade I open fractures compared to patients with grade II and grade III open fractures (union at 3.5 and 6 months, respectively). There were 5 non-unions (10,4%) with 3 of them septic (6,25%). All three deep infections were low grade and occurred in open fractures.Delayed union was observed in 3 patients; in these patients, solid union of the fracture was observed at 7 months (range, 6 to 9 months). Pin track infection was observed in 7 patients (14.6%).

Conclusion: Based on the present study, hybrid external is associated with satisfactory results for the management of distal tibial fractures with acceptable complications.

The purpose of this study was to evaluate the clinical and radiological findings in patients with avascular necrosis of the femoral head after implantation of a porous tantalum implant combined with autologous growth factors (AGF).

The study included 40 hips in 30 patients. Of the 40 hips, 1 hip was stage I, 9 hips were stage II, 22 hips were stage III, and 8 hips were stage IV, according to the Steinberg classification system. Follow-up was 2 to 4 years. The porous tantalum (diameter of 10 mm, length ranging from 70 –110 mm) was implanted in the center of the necrotic area under fluoroscopic control.

Clinical evaluation using the Harris hip score showed an increase from 66 to 96 points preoperatively to postoperatively in hips with stage II disease, from 60 to 85 points in hips with stage III, and from 60 to 80 points in hips with stage IV (p< 0,001). Of the 40 hips, the radiological stage in 20 hips (50%) remained stable, 17 (42.5%) progressed to an advanced stage and 3 hips (7.5%) underwent total hip arthroplasty (p< 0,001). Of the 17 hips that progressed, 7 were stage II, 7 were stage III, and 3 were stage IV. No material damage or implant migration was observed.

Although failures are still observed with the use of porous tantalum, the minimal invasive technique and short operative time make tantalum a reasonable alternative in the treatment of AVN of the femoral head.

The purpose of this study was to compare the clinical and radiological findings in patients with avascular necrosis of the femoral head after management with vascularized fibular graft (VFG) compared to porous tantalum implant.

The study included 60 hips in 50 patients, who were followed prospectively for 2–4 years. 28 patients (30 hips) were treated with VFG and 22 patients (30 hips) were treated with a porous tantalum implant. The two patient groups were matched for age, gender, etiology, pre-operative stage and Harris Hip Score (HHS). Of the VFG group, 14 hips were stage II and 16 were stage III, while of the tantalum group, 1 hip was stage I, 11 hips were stage II and 18 hips were stage III, according to Steinberg classification system. Mean operative time was 3 hours for VFG and 30 min for porous tantalum.

At final follow-up, there was no significant statistical difference in the radiological stage (p=0.246), and radiological progression of the disease (p=0.329) was observed between these two groups. Using HHS, the mean clinical results improved in the VFG group from 61 points preoperatively to 90 points at final follow-up, while in tantalum group HHS improved from 63 to 81 points (p=0.022). Three hips from each group underwent total hip arthroplasty.

The results of the present study suggest that although the management of AVN with VFG appears to show better results compared to the use of porous tantalum using clinical evaluation Methods: (eg HHS), further controlled studies with larger patient groups and longer follow-up are required.

The incidence of periprosthetic knee infection is generally low (0.5%–2%) but the economic impact is great. The rates are higher for rheumatoid arthritis and revision knee surgery. Treatment of periprosthetic knee infection takes into account the acuteness of the infection, the overall immune/medical status of the patient, and the local factors at the site of infection.

Evaluate the results of two-phase exchange arthroplasty with the use of articulating spacer in III-A-1 and III-B-1 periprosthetic knee infection.

From 1990–2005, 24 patients with minimum (< 2) systemic and no local compromising factors were treated for chronic periprosthetic knee infection. These patients staged as III-A-1 or III-B-1 according to MSIS staging system. Diagnosis was clinical, radiological, laboratory and from knee aspiration cultures. Two-phase exchange arthroplasty was performed. Initially, there was removal of the prosthesis, surgical debridement and placement of a PMMA spacer impregnated with antibiotic. The spacer was shaped as a knee joint permitting motion. In 6 cases a hybrid spacer was used (PMMA and TECRES® spacer). Intravenous antibiotic therapy according to intraoperative cultures followed for 6–8 weeks. Re-implantation was always done after the completion of the antibiotic therapy and on the ground of normal CRP, ESR and negative aspiration cultures. All patients received antibiotics after the re-implantation.

Staphylococcus aureus was the most common pathogen followed by Staphylococcus epidermidis and Pseudomonas aeruginosa. No infection recurrence was noted over a 2–15 years follow-up. All patients returned to normal everyday activity. A custom-made prosthesis was placed in one patient and there was a rupture of the extensor mechanism in another.

Patients with periprosthetic knee infection, staged as III-A-1 and III-B-1, when treated with two-stage exchange arthroplasty combined with antibiotic impregnated articulating spacer and i.v. antibiotics can have excellent results.

The management of localized soft tissue sarcomas remains complex. This is a retrospective review of a single institution experience with manual afterloaded brachytherapy following intra-operative implantation of the tumor bed during surgery.

Ten patients over a 4-year period had resection for localized soft-tissue sarcomas and desmoids with insertion of intra-operative brachytherapy implants combined with resection for localized soft-tissue sarcomas. Manual afterloading of the implant with iridium wires was done postoperatively in all patients. The low dose rate brachytherapy dose varied from 13 to 20 Gy. Supplementary external beam radiation was administered pre-operatively or postoperatively to bring the total dose of adjuvant irradiation to 60–65 Gy.

After a median follow-up period of 30 months, the 4-year local disease-free survival rate was 80%. The 4-year actuarial survival rate was 85%. There were no failures within the high-dose region of the implant. No patients had locoregional failures. One patient developed distant metastases. No serious side effects were noticed. Pro-phylactic intramedullary nailing was done in 1 patient. Pathological fractures occurred in 2 patients. All patients had good cosmetic and functional outcomes.

Intra-operative implantation of the tumor bed in combination with tumor resection for soft-tissue sarcomas results in a high degree of local control with acceptable complications. This modality offers the patient a high chance of avoiding a more radical surgical procedure such as limb amputation.

Introduction: Objective of study is to provide a quantitative description of the amount of RLN irritation during ACDF and to correlate the amount of irritation with operative parameters.

Methods: In a series of 98 patients undergoing ACDF continuous IEMG monitoring of the vocal cords was performed with a specially designed, commercially available Endotracheal Tube. The amount of irritation was described as irritation score (IS) by use of our proposed formula IS=log( ∑ (AxD)/B ), where A is the amplitude of irritation, D the duration of irritation and B the baseline irritation

Results: The amount of RLN irritation as described by our formula was statistically higher in patients that had undergone previous surgery compared to de novo cases (p= 0.024), and in cases where self retained retractors were used compared to handheld retractors (p= 0.020). Although results were not statistically significant, the irritation score was higher in patients presented with postoperative hoarseness.

Conclusions: The use of our proposed scale may be a useful adjunct in the prevention of RLN injury in patients undergoing ACD with or without fusion.

Objective: The purpose of this communication was to evaluate the long-term outcome of patients with type II odontoid fractures treated with anterior screw fixation.

Material and Methods: In our prospective clinical study 34 patients, 21 males and 13 females (with mean age 35.4 + 0.8 years) with type II odontoid fractures of traumatic etiology, underwent anterior cannulated screw fixation, during a period of 36 months. All patients had radiologicaly confirmed intact transverse ligament and a reducible odontoid fracture. All patients were immobilized in a Miami J cervical collar for 4 weeks postoperatively. Radiological examination of the cervical spine with plain X rays and cervical spine CT was performed at 6 weeks and two, six and 12 and 24 months postoperatively. Follow-up time ranged between 36 and 80 months (mean follow-up 54.3+ months).

Results: 32 patients had an uneventful postoperative course, while one patient developed pulmonary atelectasis, which resolved without any significant sequelae and another one developed a superficial wound infection, which resolved without removing the implanted hardware. Radiographic evaluation showed satisfactory bony fusion and no evidence of abnormal movement at the fracture site in 31 patients (91.1%). In two patients (5.8%), the radiographic studies showed pseudo-arthrosis and instability while in one patient (2.9%) the implanted cannulated screw was broken but there was no instability shown.

Conclusions: In our series anterior odontoid screw fixation constituted a safe therapeutic modality with high stability and low mechanical failure rates in short and long term follow-up period.

Aim: Adequate length is an important prerequisite for a functional digit. Over the last 20 years small external fixators have been developed allowing the principles of distraction osteogenesis to be applied to the small bones of the hand. We present our experience in digital lengthening with the contemporary designs of external fixators. Methods: From 1998 to 2001, 20 patients (26 rays) were treated with metacarpal or phalangeal lengthening through distraction osteogenesis using a monolateral frame with two half-pins on each site of the osteotomy. The mean age of the patients was 21 years (6–48) and indications included traumatic amputation in 13 and congenital amputation (transverse deficiency, brachydactyly, constriction band syndrome) in 7. The mean distraction period was 3 weeks and the mean consolidation period 7 weeks. No protective splinting or additional bone grafting was necessary. Results: The distraction callus consolidated in all patients. The mean total length gained was 17,5 mm (68% of the original length). The mean treatment time was 2,8 days for every mm of length gained. One patient suffered angulation at the distraction site and the fixator had to be revised. No infection, fracture or half pin loosening were observed. Conclusions: Callotasis is a reliable technique for digital ray lengthening. Meticulous surgical technique and close observation of the patient during the distraction phase are necessary in order to avoid complications. Over 2 cm of lengthening can be achieved without bone grafting

Aim: To describe a new technique, the Ç Ioannina method È, which aims to improve the precision of targeting the lesion of the femoral head, thus increasing the survival of the femoral head in patients with osteonecrosis treated with a free vascularized þbular graft. Material: Twenty-seven patients (30 hips) with femoral head osteonecrosis were treated with this technique in our Orthopaedic Department during the last four years.

With use of CAD-CAM the lesion is located and a custom-made metallic aiming device is manufactured. This aiming device is then used to place the graft in its optimal position in the center of the lesion. This group was compared with 20 patients with conventional targeting. Results: Outcome was evaluated both clinically and radiologically. The short-term results showed precision of targeting in 89% of the patients, compared to 55% with the conventional method. X-ray exposure and operative time were also signiþcantly reduced.

Conclusions: This technique is the result of more than 12 years of experience in the treatment of osteonecrosis with transfer of free vascularized þbular graft. It was designed and developed by the þrst of the authors and expresses the contemporary trend for precision in location and description of the lesion. It decreases X-ray exposure, minimizes operative time and optimizes the placement of the graft.

Aim: Although primary ßexor tendon repair in children yields satisfactory results, some children end up with poor function because of delay in diagnosis, technical difþculties and the inability to follow a structured rehabilitation program. The aim of this study is to evaluate the functional outcome after two stage reconstruction with the modiþed Paneva technique (which includes creating a loop between the proximal stumps of Flexor Digitorum Profundus and Superþcialis in the þrst stage and reßecting the latter as a Ç pedicled È graft through the pseudosheath created around the silicone rod, in the second stage) in children. Methods: Nine patients (9 digits) with a mean age of 8,2 years (range 3 Ð15) were treated for zone II lesions. Their pre-operative status in the Boyes and Hunter scale was grade two in 3, grade three in 3, grade four in 1 and grade þve in 2 patients. Results: After a mean of 42 months of follow-up (minimum 12 months), according to the Buck-Gramco scale there were 4 excellent, 4 good and 1 poor result and according to the revised Strickland scale 3 excellent, 5 good and 1 poor. Children over the age of 10 had slightly improved Total Active Motion (mean +350) compared to younger ones. No signiþcant length discrepancies were noted. Two postoperative infections were treated and one graft-related re-operation was necessary. Conclusions: Staged ßexor tendon reconstruction in children is technically feasible and efþcient. Delaying such a reconstruction in younger children does not seem justi-þed.

Aim: To investigate the natural history and the impact of reconstruction in shoulder deformities due to obstetrical brachial plexus palsy. Methods: Pre and postoperative CT scans of bilateral upper extremities of 28 patients with obstetrical palsy were studied. The age during the preoperative CT scan ranged from 1.5 months to 10 years (average: 4 ± 3 years). 17 patients had Erbñs palsy and 11 global plexus involvement. Eighteen had primary shoulder reanimation mainly via intraplexus neurotization. Palliative surgery in 25 patients included trapezius transfer for shoulder abduction, adductors release and rerouting of the latissimus dorsi and terres major for external rotation, scapula stabilization and rotational osteotomy of the humerus. The CT measurements included: humeral head retroversion, spinoscapular angle, glenoid fossa inclination, congruence of the humeral head to the glenoid and distance of the lower angle of the scapula from the midline. Results: Preoperatively the humeral head was subluxated or dislocated posteriorly and had decreased retroversion. The hypoplastic scapula had winging and increased distance from the midline, while the glenoid fossa was more retroverted. Postoperatively all the above measurements were improved. Conclusions: Novel measurements on CT scans of bilateral shoulders provide valuable information. Surgical intervention signiþcantly improves the functional anatomy and the dynamics of the shoulder joint.

Aim: To study the functional outcome ofmusculocutaneous nerve neurotization in brachial plexus palsy patients. Methods: From 1998 to 2001, 51 adult patients (mean age 24,6 years) with posttraumatic brachial plexus palsy were operated. Exploration of the brachial plexus was performed in 39 patients with a mean denervation time of 6 months (1 to 14 months). Seven patients had an extended infraclavicular lesion, while from the 32 supraclavicular lesions, 21 had the element of avulsion (4 global, 10 four-root and 7 three-roots avulsions). Neurotization of the musculocutaneous was performed in 25 via nerve grafts from intraplexus donors (C5, C6, C7)and from extraplexus donors in 14. In 7 patients, the phrenic was used alone or with intraplexus donor (5), in 3 cases the accessory nerve, in one patient the accessory and cervical plexus motor branches and þnally in 3 patients 3 intercostal nerves were used. Results: All intraplexus neurotizations of the musculocutaneous nerve, but two, regained useful biceps function (M3+ to M4+). From the extraplexus neurotizations the phrenic n. as a conjunctant donor gave functional result, when used alone gave M3 and M3−; the accessory n. gave M3+ in combination with cervical motors and M3− when used alone. The intercostal neurotizations gave M2+ and M3−. Conclusions: In brachial plexus paralysis, when avulsion is present the reconstruction often is based in extraplexus donors. The return of biceps function is greater and faster when intraplexus donors are used. Extraplexus neurotizations yield satisfactory results used in combinations Vertebral osteoporosis and fracture

Aims: In the present study we reviewed 105 patients who had had Galeazzi fractures with particular emphasis on classiþcation (þve types according to the fracture patterns), treatment, and þnal results. Methods: One hundred and þve cases (75 males and 30 females) were included in this study. Most of the fractures (70 cases) occurred in the distal third of radial shaft (Type I). Seventeen fractures were in the middle third (Type II), and 11 fractures were in the proximal third of the shaft of the radius (Type III). In four cases disruption of the distal radio-ulnar joint associated with fractures of both bones (Type IV). Finally three cases considered as Galeazzi-equivalent lesions (Type V). Results: The mean follow-up time was 7 years. The overall results were good in 81% of the patients, fair in 14% and poor in the 5% of the patients. Union achieved in 102 cases and non union in three cases (two had had primary conservative treatment and one case was treated surgically). Supination ranged from 40 to 90 degrees (average 77.5 degrees), and pronation from 50 to 90 degrees (average 81.6 degrees). Conclusions: The Galeazzi fracture is uncommon injury with an incidence varying from 3% to 6% of all forearm fractures. The key to satisfactory results in the treatment of the Galeazzi lesion is anatomic restoration of the length of the radius, with application of rigid internal þxation to maintain the reduction. Although most of the reports do not recommend exposing the distal radioulnar joint, we suggest that once the anatomic reduction is secured, anteroposterior and true lateral x-rays planes to control the distal radioulnar joint.

Aim: To present our experience concerning late infections in operated scoliosis. Methods: 118 patients were treated surgically using multiple hook and screw instrumentation systems over the last 10 years. 103 patients had idiopathic (mean age 22.1) and 15 had neuromuscular scoliosis (mean age 12.2 years). All patients were instrumented posteriorly. Bovine xenografts were used were used in all cases where fusion was the goal. Additional anterior fusion was necessary in 8 patients. To date 10 patients (7 idiopathic and 3 neuromuscular) presented late deep wound postoperative infections. None of these patients had signs of generalized septic condition. The latent period of the infection varied from 1 to 5 years. Two patients presented rod failure. Initial pus cultures were negative in 5 patients. A common þnding was pus lining on the instrumentation surface with increased concentration under the cross-links. All patients had at least one loose cross-link nut. Local corrosion of the hardware and metal inþltration of the surrounding tissues was also present. The instrumentation was removed in all cases. All patients but one had satisfactory bony fusion. A variety of pathogens were cultured from intra-operative specimens (5 CNS, 2 A. baumannii, 1 peptostreptococcus, 2 St. epidermidis). A continuous irrigation system was used for 5 days in all patients, combined with antibiotics IV for 7 days and po for 45 days. Results: Protocol treatment was successful in all patients. No recurrence of the infection was observed after the removal of the instrumentation. Conclusions: The exact etiology of those infections seems to be an interesting subject for investigation. The extended surface and bulky nature of the construct are a probable predisposing factor, as is instrumentation failure and loosening. No bone involvement was noticed. Removal of instrumentation appears to be effective treatment.

Aims: The purpose of this study is to to assess the surgical results, complications, and long-term results of vascularized fibula in the treatment of congenital pseudarthrosis of the tibia. Methods: Seven patients who had congenital pseudarthrosis of the tibia were treated consecutively at our clinic between 1992 and 2000 with free vascularized fibular graft. There were four females and three males. The mean age at the time of operation averaged 6.5 years (range 1–12 years). Four left tibias and 3 right tibias were involved. Stability was maintained with internal fixation in four patients, external fixation in two patients and intramedullary pin in one patient. Results: The average follow-up was 2.6 years (range 6 months to 8 years). In five patients, both ends of the graft healed primarily within 2.7 months (range 1.5 to 3 months), and hypertrophy of the fibular graft occurred rapidly with a well-formed medullary canal. In one patient the distal junction did not unite and although required three subsequent operations still not healed. Stress fracture occurred in one patient underwent four additional operations before union achieved. Conclusions: Despiting the continuing problems and the relatively high complication rate, the ultimate results with free vascularized fibula transplant are generally good specially as compared with published series in whom conventional grafting techniques had failed. However, even achieving union of pseudarthrosis is not enough for the resolution of this disease and is only half of the problem; the other half is to maintaining

This study describes the clinical features and treatment of the 53 patients with primary tumors of the hand. A review of primary tumors of the small bones of the hand during a 9 year period (1991–2001) was done. There were 14 enchondromas, 1 malignant fibrous histiocytoma, 15 ganglions, 5 haemangiomas, 1 haemangioma of median nerve, 4 giant cell tumors of tendon sheath, 4 osteoid osteomas, 1 lymphangioma, 1 exostosis, 1 dermatofibrosarcoma, 1 neurilemoma, 2 neurinomas, 1 glomus tumor, 1 benign fibrous histiocytomas and 1 papillary endothelial hyperplasia. There were 34 males and 19 females with an average age 37.7 years. The mean follow-up was 6y (1–8y). There were 33 lesions in the fingers, 3 in the metacarpals, 13 in the carpus and 4 in the palm. Swelling and localized tenderness were the most common presenting complaints. One patient died of metastatic disease. 3 patients were seen initially with locally reccurent lesion. All the patients were treated surgically. The material was analyzed in terms of diagnosis, localization, surgical management and post-operative complications. Primary tumors of the hand are rare. The cases in these series are similar to that of other reports. As in other musculoskeletal neoplasms, a treatment plan must be formulated based on the location, size and biologic behaviour of the lesion.

Purpose: Vascular injuries occur in approximately 3% of all patients with major civilian trauma and peripheral vascular injuries account for 80% of all cases of vascular trauma. Upper extremity arterial injuries represents about 30% of all cases arterial trauma. The present study was designed to document and analyze the respective role of arterial damage and associated injuries on functional outcomes after upper extremity arterial trauma.

Material and Methods: Excluding the arterial injuries resulting in immediate amputation there were 57 patients who sustained arterial trauma of the upper extremity. Their mean age was 33 years (range 4–68 years), and 40 were males and 19 were females. The most frequently injured vessel was the ulnar artery (42%) followed by the brachial artery (29.8%), radial artery (26.3%) and axillary artery (1.7%). Concomitant fractures or nerve injuries were present in 54% and 45% respectively.

Results: An average of 5.6 hours elapsed between the time of injury and the time of vessel reconstruction. The most common method of surgical management was end to end anastomosis. Twenty one autogenous vein grafts were employed. Primary nerve repair was carried out in 29 patients and in another 18 secondary repair was performed. None of patients had any residual compromise from the arterial injury.

Discussion: Vascular injuries are potentially limb threatening. Improvements in the technical ability to revascularize injured extremities and advances in microsurgery, resulting in the low present day limb loss rate associated with attempted vascular repairs. Associated injuries, rather than vascular injuries, cause long-term disability in the trauma of the upper extremity. Persistent nerve deficits, joint contractures and pain are principal reasons for functional impairment

Purpose: Although transient osteoporosis of the hip was initially described in pregnant women, now most frequently identified in middle-age and older men. Has also been reported to occur in either hip and in both successively. This condition is referred as migratory transient osteoporosis of the hip. In this study the authors describe five cases of migratory hip osteoporosis and the differential diagnosis with osteonecrosis is also discussed.

Material and Methods: Thirty-four patients with transient osteoporosis were presented. Of the 34 patients five had a similar episode of severe pain in the contralateral hip 14 months mean time later. Early bone scans and MRI of the hips had been carried out in all of the patients. After the evaluation of these findings and thorough exclusion of other conditions diagnosis of migratory transient osteoporosis was demonstrated, and confirmed by the natural course of the disease.

Results: All cases were treated with nonsteroidal anti-inflammatory medications and protected weight-bearing. The course of the disease has not been appreciably altered by medical treatment, and the mean time interval from the onset of symptoms to clinical recovery was 4.6 months (range 3 to 6 months). Imaging findings on MR confirmed the diagnosis during both episodes and paralleled the reduction of pain.

Conclusions: Migratory transient osteoporosis of the hip is a rare self-limited condition of uncertain etiology and pathogenesis, which “migrate” from one hip to the other. Magnetic resonance imaging is highly sensitive in the early detection of this condition and moreover is helpful in the exclusion of other entities. Although the diagnosis is one of exclusion, it must be considered and contrasted with hip osteonecrosis.