The Iowa orthopaedic journal
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Treatment of Crowe IV developmental dysplasia of the hip (DDH) with total hip arthroplasty (THA) reconstructs the true acetabulum, which improves hip biomechanics and function. However, restoration of the native acetabulum may lead to limb lengthening and traction neuropraxia. The purpose of this study is to describe the short term results of a retrospectively reviewed series of patients with Crowe IV DDH treated with THA using a titanium mesh cup, cemented liner, and subtrochanteric femoral shortening osteotomy. ⋯ THA of Crowe IV DDH by reconstructing the acetabulum with bone graft, a titanium mesh cup, cemented liner, and subtrochanteric femoral shortening osteotomy demonstrated no osteolysis or subsidence and improved function with a low incidence of sciatic nerve palsy at short term follow up.Level of evidence: IV.
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Recent estimates suggest an annual incidence of greater than 125,000 femoral neck fractures. Surgical treatment is indicated for the majority of these fractures, which are estimated to double by the year 2050. Most displaced femoral neck fractures in elderly patients are treated with arthroplasty secondary to high complication rates associated with internal fixation. ⋯ The Targon Femoral Neck Plate (Aesculap, Tuttlinger, Germany) has been used in Europe for the treatment of both displaced and nondisplaced femoral neck fractures by combining a side plate and multiple cancellous lag screws. Multiple studies have shown superior rates of both nonunion and osteonecrosis when compared to the SHS and multiple cancellous screws in both displaced and nondisplaced femoral neck fractures. This article details the design rationale, surgical technique and early postoperative results of a new hybrid implant used for the treatment of both displaced and nondisplaced femoral neck fractures.
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The residency match is increasingly competitive. The interview is an essential component, yet little has been documented about the costs applicants incur during the interview process and it is unclear how they manage these expenses. ⋯ Senior medical students incur substantial costs to participate in residency interviews, often adding to already burdensome educational debt. We encourage residency programs, especially those in competitive specialty fields, to pursue cost reduction strategies. Additionally, medical schools should provide financial counseling to allow students to anticipate interview costs.
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Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are among the most common orthopaedic procedures performed in the United States annually. As the number of patients undergoing these procedures increases so too does the incidence of periprosthetic femur fractures. A number of these periprosthetic fractures occur between two ipsilateral implants, so-called interprosthetic fractures. Recent biomechanical data has challenged the importance of these interprosthetic distances, relating that cortical width and osteoporotic bone are more closely correlated with fracture than interprosthetic distance. The purpose of the current study is to further define the presence of osteoporosis, cortical width (CW) and medullary diameter (MD) as potential predictive factors for interprosthetic femur fractures. ⋯ Current Procedural Terminology (CPT) codes were used to identify a cohort of patients undergoing operative treatment for periprosthetic femur fractures. A review of the medical records identified 23 patients (5 male / 18 female) with a femur fracture between two intramedullary implants. CPT codes were also used to identify a second cohort of 25 patients (8 male / 17 female) having undergone ipsilateral THA and TKA. The intact femoral isthmus was identified radiographically and the MD and CW (mm) were measured. A ratio of MD to CW was also determined. Chart review was undertaken and any diagnosis of osteoporosis was recorded. An independent sample T-test was performed comparing the mean MD, CW, and the ratio of MD:CW for these groups. Significance was set at p.
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Observational Study
Dynamic Fixation of Humeral Shaft Fractures Using Active Locking Plates: A Prospective Observational Study.
Rigid locked plating constructs can suppress fracture healing by inhibiting interfragmentary motion required to stimulate natural bone healing by callus formation. Dynamic fixation with active locking plates reduces construct stiffness, enables controlled interfragmentary motion, and has been shown to induce faster and stronger bone healing in vivo compared to rigid locking plates. This prospective observational study represents the first clinical use of active locking plates. It documents our early clinical experience with active plates for stabilization of humeral shaft fractures to assess their durability and understand potential complications. ⋯ Absence of failure of the plate and locking holes suggests that dynamic fixation of humeral shaft fractures with active plates provides safe and effective fixation. Moreover, early callus bridging and excellent functional outcome scores suggest that dynamic fixation with active locking plates may promote increased fracture healing over standard locked plating.