1. Aching pain in the thigh, hip or buttock in an elderly person should lead to radiological examination of the hip region. In patients who have been subjected to irradiation for pelvic neoplasms a spontaneous fracture should be strongly suspected and the patient kept under close review, even if the first radiograph is negative. 2. Patients with spontaneous fractures of the femoral neck can be satisfactorily treated by Smith-Petersen nailing even when symptoms have been present for as long as sixteen weeks and displacement for eight weeks. Osteotomy is unnecessary if adequate reduction can be obtained

1. The results of Chiari pelvic osteotomy have been examined two to six years after operation in a group of eighteen patients with persisting acetabular dysplasia in the second and third decades. 2. The analysis suggests that for a good clinical result it is essential to create a relationship of the new outer acetabular lip to the original lip so that the CE angle is between 20 and 40 degrees and the roof angle is between 10 degrees below and 20 degrees above the horizontal. 3. This may be achieved by a pelvic osteotomy immediately above the joint capsule, angled 10 degrees upwards and inwards and displaced by 50 per cent of the pelvic thickness. 4. Details of the operative technique using a Smith-Petersen approach are presented

We have endeavoured to make known the results of a simple type of arthroplasty of the hip which is well tolerated even by elderly patients. It has not been the purpose of this article to compare former operations with our own, a newcomer in the field of surgery of the hip. In particular we do not wish to compare our comparatively recent results with Smith-Petersen's well-established method of cup arthroplasty—a magnificent contribution to the surgery of the region. The results we have already obtained, however, appear sufficiently favourable to merit further study and development of the method. If the future confirms the value of our early results, we shall perhaps be able to suggest operation to patients who suffer more from loss of function than from pain

1. Sixty-five cases of medial fracture of the femoral neck treated by substitution of the head by an acrylic prosthesis have been studied. 2. In general, the long-term clinical results of prosthetic arthroplasty after fresh fractures have been disappointing. The method has given slightly better results in the treatment of old fractures. 3. In view of the almost perfect results obtained after successful Smith-Petersen nailing in the presence of an adequate blood supply to the femoral head, it seems unjustifiable to abandon this principle for immediate substitution with an acrylic femoral head. Nevertheless it is believed that an arthroplasty of this type is justified in fractures seen late, and in fresh subcapital fractures when the fracture is irreducible. If a prosthesis is to be used, more protection for the stump of the neck against the strain of weight bearing is essential; a simple head prosthesis is inadequate, and a head with either a neck extension or an intramedullary prolongation may give better results

Aims

The aims of this study were to characterize the incidence and risk factors associated with stress fractures following periacetabular osteotomy, and to determine their effect on osteotomy union.

This abridged account of a report to the British Medical Research Council describes a long-term investigation of 1,503 subcapital fractures of the femur, almost all of which were treated by reduction and internal fixation. With three exceptions, union occurred in all Garden Stage I and Stage II fractures and in 67% of Stage III and Stage IV fractures, of which only 14-5% were united at six months. In women, late segmental collapse was seen after union had occurred in 16% of Stage I and in 27-6% of Stage III and Stage IV fractures. Delay of up to one week before operation had no significant effect on the incidence of non-union or of late segmental collapse. The incidence of union followed by late segmental collapse was higher in women with normal bone density than in those with osteoporosis. Smith-Petersen nailing was found to be the least effective form of fixation in displaced fractures. The age and physical state of the patient, the accuracy of reduction, and the security of fixation had the greatest influence on union

We adduce the following conclusions from our experience of using this spring-loaded compression screw on completely displaced medial fractures of the femoral neck:. 1. That this method probably eliminates non-union when the head is fully viable. 2. That primary "first-intention" osseous union occurs in approximately 33·3 per cent of cases. 3. That a vascular complication, of varying severity, undetectable by orthodox radiological tests, is revealed by extrusion of the screw in 66·6 per cent of cases. 4. That these observations disprove the idea that the main obstacle to revascularisation of an ischaemic head is the existence of forces so inclined to the axis of the femoral neck as to cause "shear.". 5. That, compared with the Smith-Petersen nail used for completely displaced fractures, continuous spring compression can materially reduce the incidence of utter mechanical failure within the first year after operation. This is the result of "mushroom" impaction which itself can resist shearing strain and so can permit function as a fibrous union. 6. That early and rapid extrusion is a sensitive indication of a vascular complication in the head. Forewarned by this, activity can be restricted, or possibly other measures adopted, to anticipate or permanently postpone serious trouble

This study attempts to establish the factors on which the prognosis of an intracapsular fracture of the femoral neck depends, and to draw attention to certain causes of non-union and ischaemic necrosis. These factors are of two kinds: those inherent in the fracture, and those produced by the surgeon. The prognosis depends largely on the nature of the fracture. Original displacement and comminution are the factors which have most influence. Fractures of Type IV with severe comminution have mainly contributed to the bad reputation of intracapsular fractures. Accurate reduction and firm fixation are necessary if the best results for the type of fracture are to be expected. Accurate reduction does not mean merely accurate apposition of the fragments. Fixation of the fracture in certain rotational malpositions such as valgus of over 20 degrees and rotation round the long axis of the neck may occlude the only remaining source of blood supply, the vessels of the ligamentum teres. If these vessels remain open they may produce revascularisation in a femoral head deprived of its blood supply. The degree of valgus can easily be measured but it is impossible to detect rotation round the long axis of the neck. In this analysis only two methods of fixation were studied. It is clear that rigid fixation is of great significance, and a nail-plate, though it may not be the ideal method of fixation, is greatly superior to a Smith-Petersen nail introduced in the usual way. From the results of this survey there is no justification for continuing the use of this method except perhaps in Type II fractures. The greater the risk of non-union the more important is the fixation, and this is true of all fractures. This study also has a bearing on the indications for primary prosthetic replacement. If the nature of the fracture and the result of the reduction make it likely that replacement by a prosthesis is going to be the ultimate solution, and if the patient is over seventy years old, it is wiser to do it as a primary measure. Finally it was shown that condensation and collapse of the femoral head are not the only radiological signs of ischaemic necrosis. An earlier sign is flattening of the weight-bearing area, which appears on an average six and a half months after injury, as compared to condensation, which may not be apparent until eighteen months after injury

Aims

Giant cell tumours (GCTs) of the proximal femur are rare, and there is no consensus about the best method of filling the defect left by curettage. In this study, we compared the outcome of using a fibular strut allograft and bone cement to reconstruct the bone defect after extended curettage of a GCT of the proximal femur.

Aims

Femoroacetabular impingement (FAI) describes abnormal bony contact of the proximal femur against the acetabulum. The term was first coined in 1999; however what is often overlooked is that descriptions of the morphology have existed in the literature for centuries. The aim of this paper is to delineate its origins and provide further clarity on FAI to shape future research.

Aims

It has been suggested that the direct anterior approach (DAA) should be used for total hip arthroplasty (THA) instead of the posterior approach (PA) for better early functional outcomes. We conducted a value-based analysis of the functional outcome and associated perioperative costs, to determine which surgical approach gives the better short-term outcomes and lower costs.

Aims

Injury to the lateral femoral cutaneous nerve (LFCN) is one of the known complications after periacetabular osteotomy (PAO) performed using the anterior approach, reported to occur in between 1.5% and 65% of cases. In this study, we performed a prospective study on the incidence of LFCN injury as well as its clinical outcomes based on the Harris Hip Score (HHS), Short-Form 36 Health Survey (SF-36), and Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ).

Aims

Whether a combined anteroposterior fusion or a posterior-only fusion is more effective in the management of patients with Scheuermann’s kyphosis remains controversial. The aim of this study was to compare the radiological and clinical outcomes of these surgical approaches, and to evaluate the postoperative complications with the hypothesis that proximal junctional kyphosis would be more common in one-stage posterior-only fusion.

Aims

Tranexamic acid (TXA) has been shown to reduce blood loss and transfusion requirements in patients undergoing orthopaedic surgery. There remains a lack of prospective evidence for the use of TXA in patients undergoing periacetabular osteotomy (PAO). The purpose of this study was to determine if intravenous (IV) TXA is effective in reducing calculated blood loss and transfusions after PAO.

Aims

The aim of this randomized trial was to compare the functional outcome of two different surgical approaches to the hip in patients with a femoral neck fracture treated with a hemiarthroplasty.

Aims

The surgical treatment of tuberculosis (TB) of the spine consists of debridement and reconstruction of the anterior column. Loss of correction is the most significant challenge. Our aim was to report the outcome of single-stage posterior surgery using bone allografts in the management of this condition.

Aims

The aim of this study is to introduce and investigate the efficacy and feasibility of a new vertebral osteotomy technique, vertebral column decancellation (VCD), for rigid thoracolumbar kyphotic deformity (TLKD) secondary to ankylosing spondylitis (AS).

Stress fractures occurring in the pubis and ischium after peri-acetabular osteotomy (PAO) are not well recognised, with a reported incidence of 2% to 3%. The purpose of this study was to analyse the incidence of stress fracture after Bernese PAO under the care of two high-volume surgeons. The study included 359 patients (48 men, 311 women) operated on at a mean age of 31.1 years (15 to 56), with a mean follow-up of 26 months (6 to 64). Complete follow-up radiographs were available for 348 patients, 64 of whom (18.4%) developed a stress fracture of the inferior pubic ramus, which was noted at a mean of 9.1 weeks (5 to 55) after surgery. Most (58; 91%) healed. In 40 of the patients with a stress fracture (62.5%), pubic nonunion also occurred. Those with a stress fracture were significantly older (mean 33.9 years (16 to 50) vs 30.5 years (15 to 56), p = 0.002) and had significantly more mean pre-operative deformity: mean centre–edge angle (9.8° (-9.5 to 35) vs 12.4° (-33 to 28), p = 0.04) and mean Tönnis angle (22.8° (0 to 45) vs 18.7° (-2 to 38), p < 0.001). The pubic nonunion rate was significantly higher in those with a stress fracture (62.5% vs 7%, p < 0.001), with regression analysis revealing that these patients had 11.8 times higher risk than those without nonunion.

Cite this article: Bone Joint J 2015; 97-B:24–8.

Aims

There is a paucity of information on the pre-operative coronal imbalance in patients with degenerative lumbar scoliosis (DLS) and its influence on surgical outcomes.