No abstract

Femoral neck fractures in young patients are usually caused by a high-energy trauma, which results in a perpendicular fracture. Although efforts are focused on preserving the femoral head in young patients, vertical femoral neck fracture is a problematic orthopedic injury due to the domination of shear forces. Due to controversy regarding which fixation method is the best choice, the purpose of this study was to find the most stable fixation method for this kind of fracture. This study includes experimental testing on cadaveric bone samples and finite element analysis (FEA) for three fracture fixation techniques, namely cannulated screws (CSs), dynamic hip screw with derotational screw (DHS + DS), and proximal femoral locking plate (PFLP). Experimental results of bone-implant stiffness, average femoral head displacement, failure load, failure energy, and relative position of the fractured fragments indicate that DHS + DS offers the strongest structure for stabilizing a vertical femoral neck fracture. Experimental data and FEA results both indicate that under static loading, the DHS + DS method of fixation produces the lowest femoral head displacement and interfragmentary movement, followed by PFLP and then CSs. The results of this research suggest that, based on the clinical assumption that a restricted weight-bearing regimen is recommended in the postoperative rehabilitation protocol, the DHS + DS method of fixation is a better choice compared to CSs and PFLP for a vertical femoral neck fracture fixation in young adults.

Based on the clinical assumption that restricted weight-bearing regimen is recommended in the postoperative rehabilitation protocol, the results of this study suggest that the priority order of selection for the stable fixation implant of vertical femoral neck fracture in young patients is DHS+DS, then PFLP, and finally CSs.

Osteoblastoma is an uncommon benign bone tumor most commonly located in the vertebral column or metaphysis of a long bone. Periosteal location is rare. We report a periosteal-based osteoblastoma, arising from the proximal tibia, in a 20-year-old woman who presented with knee swelling and pain of 2-year duration. Imaging studies showed a metaphyseal surface-based lesion with patchy radiodensities. The cortico-medullary junction was intact. The lesion was totally excised. Histopathologic evaluation disclosed immature bone and osteoid deposition in a vascularized stroma, associated with numerous osteoblasts and osteoclasts rimming the bony trabeculae. Plate-like arrangements of cartilage in the margin of the neoplastic tissue were also identified. At 16 months postoperatively, the patient was well without recurrence. Although extremely unusual, the presence of cartilage does not necessarily exclude the diagnosis of osteoblastoma.