Citations

Objectives: To analyze the radiographic outcomes of intertrochanteric osteotomy for the treatment of femoral neck nonunion with “undercorrection” of the Pauwels angle and relative preservation of the proximal femoral anatomy. Design: Retrospective cohort study. Setting: Level-1 trauma center. Patients: Thirty-two patients with established femoral neck nonunions that had been treated with intertrochanteric osteotomy were retrospectively identified through Current Procedural Terminology codes. Seven patients were treated with 30 degree closing wedge osteotomy and 25 with a 20 degree or smaller osteotomy. Intervention: Valgus-producing intertrochanteric osteotomy with a blade plate. Main Outcome Measurements: Femoral neck and intertrochanteric osteotomy osseous union. Results: Thirty-one of 32 patients (97%) went on to osseous union of the femoral neck and all intertrochanteric osteotomies healed. There was no significant difference in the rate of union of the femoral neck between those patients treated with 30 versus 20 degree or less osteotomies. After osteotomy, the mean Pauwels angle decreased from 71 degrees (range 52–95 degrees) to 47 degrees (range 23–67 degrees) and the mean proximal femoral offset decreased by 11 mm (range 0–23 mm). Seven patients developed radiographic signs of avascular necrosis after osteotomy (22%). Three patients of these patients were converted to total hip arthroplasty (9%). Patients treated with a 30 degree osteotomy were more likely to develop avascular necrosis (67% vs. 12%, P-value = 0.014). Conclusions: Valgus-producing intertrochanteric osteotomy with a smaller degree of correction than has been traditionally described leads to an excellent rate of radiographic union while preserving more of the native proximal femoral anatomy. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Background Radiocarpal dislocations are rare, high-energy injuries. High morbidity and poor functional outcomes are common. Currently, there is limited data on functional outcomes following treatment of this injury. Methods A retrospective review was conducted analyzing the radiographic and clinical outcome of patients treated for a radiocarpal dislocation from 1979 to 2010. Outcome assessments included wrist range of motion, grip strength, Mayo wrist score, patient-rated wrist evaluation (PRWE), and disabilities of the arm, shoulder and hand (DASH) score. Statistical analysis was performed with the Student's t test. Results Twenty-six patients (26 wrists) were treated for a radiocarpal dislocation during the study period; 23 wrists were treated acutely (within 4 weeks of injury), and 3 were treated after a delayed presentation (>4 weeks). Clinical follow-up of more than 6 months was available in 17 patients. Three patients (12 %) underwent primary fusion as initial treatment (two radioscapholunate fusion; one total wrist fusion). Four wrists (24 %) failed initial treatment and were salvaged with scapholunate ligament reconstruction (one wrist) or partial wrist fusion (three wrists). Seventeen patients completed PRWE and DASH questionnaires with a mean of 14.6 years following surgery (range 2–32 years). Subjective outcomes tended to be superior in those patients treated with ligament reconstruction versus partial or complete wrist fusion; however, comparisons were not statistically significant. Conclusion Radiocarpal dislocations result in significant osseous and ligamentous injury to the distal radius and carpus. Early recognition and treatment of radiocarpal dislocations with open reduction, internal fixation, and repair of ligaments may result in improved long-term functional outcomes when compared to acute partial or complete wrist arthrodesis.

Background: Decreased hip range of motion (ROM) is a common finding in patients with femoroacetabular impingement (FAI). Purpose: To report the prevalence of decreased hip ROM in asymptomatic adolescent athletes and to correlate examination findings to signs of FAI on radiographs and magnetic resonance imaging (MRI). Study Design: Cross-sectional study (prevalence); Level of evidence, 3. Methods: A total of 226 adolescent athletes presenting for state-mandated preparticipation physical examinations were assessed. Hip internal rotation was measured with the participant supine and the hip flexed to 90°. All participants with ≤10° of internal rotation were invited to return for standard radiographs and MRI of both hips. An age-matched control group, with >10° of internal rotation, underwent MRI examination only. Twenty-six athletes (13 study and 13 control) returned for clinical and radiographic examinations. Results: Nineteen athletes (34 hips, 8%) were found to have <10° of internal rotation. Eight athletes (13 hips, 3%) also had a positive anterior impingement sign. Thirteen of 19 athletes participated in the radiographic portion of the study. Of these 13 participants, 4 had limited internal rotation unilaterally, leaving 22 hips in the study group. Eight of 13 participants (15 hips, 68%) had a cam-type deformity evident on plain radiographs, and 4 participants (7 hips, 32%) had a positive radiographic crossover sign. The average α angle measured from radial MRI sequences was 58.1° in the study group versus 44.3° in the control group ( P < .001). Fifteen hips (68%) in the study group had abnormal MRI findings within the acetabular labrum or cartilage compared with 10 of 26 hips (38%) in the control group (odds ratio, 3.4; P = .078). Conclusion: Eight percent of asymptomatic teenagers had limited internal rotation on examination; 68% of these had radiographic findings suggestive of FAI. More than two thirds of these participants had evidence of asymptomatic hip pathological lesions on MRI.