A hip arthroscopy technique for the reduction and internal fixation of a displaced femoral head fracture is presented. Open treatment is often required for femoral head fractures. However, it is shown below how large fragments of a femoral head fracture-dislocation were reduced and internally fixated using hip arthroscopy. This was performed in the supine position using skeletal traction. The accessory distal anterior portal was used for internal fixation when a hip was positioned in abduction with external rotation. A satisfactory outcome was reported. Recovery was immediate and cosmetics were excellent. We conclude that hip arthroscopy is a valuable option for managing femoral head fracture-dislocations (Pipkin I).

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PurposeThis study was performed to characterize the natural history of squeaking sounds that occur following total hip arthroplasty (THA) using ceramic-on-ceramic bearing surfaces and its potential correlation with clinical and/or radiological results.Materials and MethodsThis study included 47 patients who underwent THA between April 1999 and April 2005, and had at least 10 years of follow up from the time of the operation. Squeaking sounds were detected in 10 out of the 47 cases (21.3%). Squeaking-associated factors (i.e., cause, time of onset, inducing motions, and continuity of the sound) were assessed.ResultsSqueaking sounds: i) were detected an average of 46.2 months after operation, ii) occurred more frequently in patients with a high body mass index (BMI) compared to those with low BMI, and iii) most frequently detected when deep flexion of hip joint followed extension. In all 10 cases, the squeaking sound remained through the follow up period; 6 cases experienced no change in frequency and pitch, 4 cases experienced a decrease in frequency and pitch over time. The cause(s) of changes to squeaking sounds could not be determined.ConclusionThe frequency and pitch of the squeaking sounds changed over time in a subset of patients. The squeaking sound did not appear to correlate with clinical results or survival of the prosthesis.

골수강 금속정 고정술 후 발생한 대퇴골 간부 불유합의 치료 정현균ㆍ김대중ㆍ김병학ㆍ정영율 광주기독병원 정형외과Purpose: To evaluate of efficacy of the treatment options for a femoral shaft nonunion occurring after intramedullary nailing. Material and Methods: Thirty-one patients with nonunion of a femoral shaft fracture, who had been treated with interlocking intramedullary nailing from January 1996 to December 2000, were examined. Twenty-six had oligotrophic nonunion and five were hypervascular. Forty-five procedures were performed for 31 nonunions; bone grafting for 14, exchange nailing for 13, plate augmentation and bone grafting for 14 and dynamization for 4 cases. Results: The success rate after a single procedure was only 58%. The four dynamization cases failed to unite. Seven of the 13 (54%) nonunion cases treated with nail exchange healed satisfactorily. All cases treated with plate augmentation and bone grafting achieved successful union. The mean period from fracture to union was 20 months. Conclusion: Exchange nailing is not always a reliable procedure for treating nonunion of a femoral shaft fracture. Plate augmentation and bone grafting were found to be a successful mode of therapy for the femoral shaft nonunion without complications.

The Prodigy femoral component was extensively coated along its entire length, except for a smooth bullet-shaped distal tip. At a minimum 5 year followup we compared the results of that stem to those of a proximally coated first generation femoral component at comparable followup to address the question of which design performed better. For the extensively coated cohort, 86 patients (100 hips) underwent total hip arthroplasty by a single surgeon. At final followup, no patients were lost to followup and no hips were revised for aseptic loosening. Clinically, 3% of patients reported thigh pain (versus 15% in the proximally coated group). Radiographically, all hips had evidence of bone ingrowth (versus 94% in the PCA group). As expected with an extensively coated device there were fewer radiolucencies around the lower half of the prosthesis as well as less distal femoral lysis compared to the proximally coated stem.