Excision of trochanteric bursa during total hip replacement:Does it reduce the incidence of post-operative trochanteric bursitis?

BACKGROUND Trochanteric bursitis is a common complication following total hip replacement(THR),and it is associated with high level of disability and poor quality of life.Excision of the trochanteric bursa prophylactically during THR could reduce the occurrence of post-operative trochanteric bursitis.AIM To evaluate whether synchronous trochanteric bursectomy at the time of THR affects the incidence of post-operative trochanteric bursitis.METHODS This retrospective cohort study was conducted in the secondary care setting at a large district general hospital.Between January 2010 and December 2020,954 patients underwent elective primary THR by two contemporary arthroplasty surgeons,one excising the bursa and the other not(at the time of THR).All patients received the same post-operative rehabilitation and were followed up for 1 year.We reviewed all cases of trochanteric bursitis over this 11-year period to determine the incidence of post-THR bursitis.Two proportion Z-test was used to compare incidences of trochanteric bursitis between groups.RESULTS 554 patients underwent synchronous trochanteric bursectomy at the time of THR whereas 400 patients did not.A total of 5 patients(incidence 0.5%)developed trochanteric bursitis following THR;4 of whom had undergone bursectomy as part of their surgical approach,1 who had not.There was no statistically significant difference between the two groups(Z value 1.00,95%CI:-0.4%to 1.3%,P=0.32).There were also 8 other patients who had both trochanteric bursitis and hip osteoarthritis prior to their THR;all of whom were treated with THR and synchronous trochanteric bursectomy,and 7 had resolution of their lateral buttock pains but 1 did not.CONCLUSION Synchronous trochanteric bursectomy during THR does not materially affect the incidence of post-operative bursitis.However,it is successful at treating patients with known trochanteric bursitis and osteoarthritis requiring THR.

Application of lesser trochanteric reduction fixator in the treatment of unstable intertrochanteric fractures

BACKGROUND Closed reduction and internal fixation with intramedullary nails has been widely accepted for treating intertrochanteric fractures.AIM To focus on how to avoid displacement of the lesser trochanter in unstable intertrochanteric fractures.METHODS We developed a lesser trochanteric reduction fixator for treating intertrochanteric fractures through fixing the lesser trochanter by combining the loop plate through the fixator after reduction by the reducer.Five patients with intertrochanteric fractures treated with the newly developed lesser trochanteric reduction fixator and loop plate combined with intramedullary nails,and 20 patients with intertrochanteric fractures treated with simple intramedullary nails were selected from December 2020 to March 2021.RESULTS The postoperative Harris hip score was significantly higher in patients treated with the lesser trochanteric reduction fixator than in patients treated without the lesser trochanteric reduction fixator,which indicated that this lesser trochanteric reduction fixator had a positive impact on rehabilitation of the hip joint after surgery and could significantly improve the quality of life of patients.CONCLUSION We fully realize the significance of trochanteric reduction and fixation,namely,reconstruction of structures under pressure,in the treatment of intertrochanteric fractures.As long as the general condition of patients is favorable and they are willing to undergo surgery,fixation of the main fracture end should be performed and the lesser trochanter should be reduced and fixed at the same time.

Trochanteric Buttress Plate Combined with Proximal Femoral Nail for Unstable Intertrochanteric Fractures. [Innovative Technique]

Introduction: Proximal femoral nail is a better choice of implant for the treatment of an unstable trochanteric fracture, however it is associated with screw migration and cutout because of greater trochanteric comminution and coronal split. This study is to evaluate the results of Trochanteric Buttress Plate (TBP) combined with PFN in an unstable IT fractures for buttressing lateral wall and reinforcing fixation. Materials and Methods: We carried out a consecutive study of 32 patients of Unstable intertrochanteric fracture femur with lateral wall comminution. It was studied at Ashwini Sahakari Rugnalaya and Sanshodhan Kendra Solapur India and Government medical college Chandrapur India from April-2015 to December-2017 using innovative Trochanteric buttress plate along with PFN. Eighteen male and fourteen female in the age group of 55 to 80 years were included in the study. There were 26 cases of A3 and six cases of A2 were fixed by PFN combined with trochanteric buttress plate to augment the comminuted lateral wall. Results: The bone healing is observed in all the cases in the mean period of 12.6 weeks. Four patients developed complications, including lateral migration of neck screws (n = 2), superficial infection (n = 2). Patients were followed up for a mean of 10.6 months. At the end of follow-up the Salvati and Wilson hip function was 36 (out of 40) in 87.5% of patients [twenty eight patients]. The clinical, radiological and functional outcomes were found to be satisfactory. Conclusion: The stabilization of lateral trochanteric wall with trochanteric buttress plate restores anatomy, increases the stability of construct and prevents inherent complication of screw migration and cutout.

Proximal Femoral Nailing: Technical Difficulties and Results in Trochanteric Fractures

Background: Proximal femoral nailing in communited intertrochanteric fractures is increasingly becoming popular in view of superior biomechanics and prevention of varus collapse associated with Dynamic hip screw. However, technical difficulties and implant related complications have been described with this technique, thus we need more studies to address these issues. Our study aims to understand technical difficulties involved in proximal femoral nailing, and specifically analyses neck shaft angle at follow-up indicating varus collapse and also to compare results of stable and unstable fractures. Materials and Methods: In this study, patients who presented to the Orthopedic Unit of Dr. TMA Pai Hospital (An associated hospital of Manipal University, Manipal) with trochanteric fractures included and treated with proximal femoral nailing. The technical difficulties involved with surgical procedure and techniques adapted to overcome such difficulties were recorded. All patients were followed up for a period of 2 years and final outcome assessment included the number of shortening, neck shaft angle and harris hip score. Results: 41 patients (mean age 71) who underwent proximal femoral nailing from January 2004 to December 2009 were included in the study, 38 patients completed 2-year follow-up. The technical difficulties we faced were divided into 3 categories, difficulties in securing entry point and guide wire placement especially when greater trochanter and piriform fossa were gathered, reduction was lost while passing nail, and finally difficulties faced during placement of hip screws. In all except one, neck shaft angle of more than 130 degrees was achieved, and this was also maintained in the final follow-up (Mean 131.9 degrees). All fractures were united, with mean shortening of 2 mm. Conclusions: Although PFN is technically required, with a proper technique PFN gives excellent clinical results with almost negligible varus collapse even in unstable trochanteric fractures. Regarding the techniques, reaming the proximal part of femur adequately and observing the nail passage with image carefully are important in placing the nail correctly, while, placement of lag screw in the inferior part of neck in anterior posterior projection and central in lateral projection reduces risk of implant failure.

Trochanteric Fracture of a Congenital/Developmental Dislocation of the Hip in an Elderly Woman: A Case Report

An 87-year-old woman with a residual dislocated hip suffered a trochanteric fracture on the ipsilateral side. The fracture was treated by open reduction and internal fixation surgery with good results. To treat a proximal femoral fracture of the residual dislocated hip in an elderly patient, the patient’s overall status, pre-fracture ability, hip joint configuration, and fracture pattern should be considered.

A Comparative Study between Hyaluronic Acid and Corticosteroids for the Treatment of the Greater Trochanteric Pain Syndrome

Objective: To date, there are no studies addressing the efficacy of hyaluronic acid (HA) injections at the trochanteric bursa in patients with greater trochanteric pain syndrome (GTPS). The objective of the study was to compare the efficacy and safety of HA to corticosteroid injections for the treatment of the GTPS. Methods: This prospective, randomized, two-arm trial involved 47 patients with unilateral or bilateral GTPS. Patients received an intra-bursal injection of 40 mg triamcinolone acetonide plus 1mL lidocaine, or of 60 mg HA. Patients completed visual analog scales (VAS) and Likert scales to evaluate interference of pain with daily activity, recovery from pain, and treatment satisfaction. A non-inferiority analysis was also performed. Results: Mean VAS score for pain significantly decreased comparing baseline with 1, 3 and 6 months in both treatment groups. VAS score for pain on palpation was also significantly lower than baseline in both arms. No significant differences were found between groups. Analysis of Likert scales at the sixth month didn’t detect statistically significant differences between treatment groups. The non-inferiority analysis showed that the treatment with HA was non-inferior to corticosteroids. No secondary adverse effects were found among the patients of both groups during the follow-up. Conclusions: The treatment with HA has demonstrated to be non-inferior to corticosteroids after 6 months of follow-up in patients with GTPS. Therefore, the treatment with HA may be considered an effective alternative therapeutic strategy to reduce pain in patients in whom the treatment with corticosteroids, or other therapies, have been unsuccessful or contraindicated.

Treatment of Hip Trochanteric Bursitis Using Hyaluronate Injections

Trochanteric bursitis is a common cause of musculoskeletal pain and often requires medical intervention and should be distinguished from sciatica and irradiating pain of pelvic and spinal origin. Previously, the etiology of the trochanteric pain syndrome was thought to be caused by inflammation. The current study was performed in order to assess the efficacy of trochanteric injections. Methods: 158 patients were treated for trochanteric bursitis (132 females/26 males, range 22 - 88 years). 59b were treated with corticosteroid injection, 60 with hyaluronate and 39 were injected using a combination of both. Patients were followed by the HOOS score for a minimum of 12 months. Results: Pre-operative HOOS scores were similar in all groups. Following injection, the HOOS score increased from 27 ± 4 to 66 ± 2 after six months and 77 ± 4 after a year. At 12-month follow-up, the average score of patients treated by corticosteroids injection was 44 ± 7 compared with 62 ± 8 for the hyaluronate injected group and 64 ± 6 for the combination injection group. Discussion: It appears that injection therapy is highly efficacious for treating trochanteric bursitis. The effect of hyaluronate or hyaluronate and steroid combination appears to be longer lasting than that of steroid alone.

Irreducible Posterior Hip Dislocation with Associated Isolated Comminuted Greater Trochanter Avulsion Fracture Treated with Universal Locking Trochanteric Stabilization Plate: A Rare Combination of Hip Injury

Posterior hip dislocation with greater trochanter fracture is an uncommon injury pattern in the acute trauma patient. Frequently associated injury includes a combination of hip dislocation with posterior wall of acetabulum, head of femur fracture, intertrochanteric fracture and even the most severe type of combined acetabular fracture. We report a 42-year-old man post traumatic bilateral hip injuries with irreducible posterior hip dislocation and associated isolated greater trochanteric fracture successfully managed with open reduction and fixation of greater trochanter with universal locking trochanteric stabilization plate.

Trochanteric area pain,the result of a quartet of bursal inflammation

Bursitis is quite responsive to therapeutic intervention, once the afflicted area is accurately identified. This is especially notable for some hip complaints. Patients' use of the term "hip" can relate to anything from the low back to groin to lateral thigh pain. Trochanteric area surface localization of "hip" pain may afford an opportunity for immediate cure. Effectiveness of therapeutic intervention is predicated upon injection of not one or two, but all four peri-trochanteric bursa with a depot(minimally water-soluble) corticosteroid. The term trochanteric bursitis suggests that the inflammation is more focal than what is clinically observed. While easier to express, perhaps it is time to refer to inflammation in this area, naming all four affected bursae.

Is There Still a Place for the Staca Nail Plate in the Osteosynthesis of Trochanteric Fractures? Results from 52 Cases in a Regional Hospital in a Developing Country

The synthesis of trochanteric fractures has evolved considerably since the use of the Staca nail-plate in 1964. This implant, despite its age, remains a solid and reliable material for the synthesis of this type of fracture. Objective: To evaluate the anatomo-clinical and functional results of Staca nail-plate osteosynthesis of trochanteric fractures at the Regional University Hospital of Ouahigouya in Burkina Faso. Methods: We performed a retrospective study of 52 trochanteric fractures treated by Staca nail-plate in the regional university hospital of Ouahigouya between June 2007 and June 2017. There were 10 women and 42 men with a mean age of 61 years (range 17 years to 89 years). Ten stable type I and II of Ender classification fractures and 42 unstable fractures were recorded, including four pseudarthrosis and six vicious calluses. The anterolateral approach was used in all cases. In the absence of an image intensifier, we performed an arthrotomy to identify the femoral neck and set up a guide pin. Results: The reduction was satisfactory with stable synthesis in 39 cases. At last follow-up, consolidation was effective in all patients, except one. Two cases of acetabular protrusion were noted, requiring early removal of equipment. Fifty-one patients were autonomous. The overall results were considered satisfactory. Conclusion: The Staca nail-plate remains a means of solid osteosynthesis. Although it is no longer relevant in industrialized countries, it provides comparable results to new implants for the osteosynthesis of trochanteric fractures. Because of its low cost, its abandonment is not justified in low-income countries.

Treatment of Trochanteric Mass Fractures by Dynamic Screw-Plate (DHS) in the Orthopedic-Traumatology Department of the Donka National Hospital: 25 Cases

Objective: To evaluate the radiological and functional results of patients treated with dynamic screw plates (DHS) for trochanteric fractures in the Orthopedics-Traumatology Department of the Donka National Hospital. Methodology: This was a five (05)-year continuous retrospective study from January 1, 2019, to December 31, 2023. We used the Watson-Jones pathway without an image intensifier. Patients were evaluated according to the Postel-Merle D’Aubigné evaluation criteria. Results: A total of 25 trochanteric fractures were recorded. The patients were 16 men and 9 women, with a sex ratio of 1.77 and an average age of 63.5 years, with extremes of 31 and 96 years. The average fracture management time was 4.04 days. Etiologies were dominated by road traffic accidents (52.00%), followed by domestic accidents (falls) (44.00%). Merchants and housewives were the most affected (32.00%). According to the Ender classification, type III fractures (n = 15;60.00%) were the most common, followed by type VII (n = 4;16.00%). The procedure was performed 23 times (92.00%) under spinal anesthesia, 2 times (8.00%) under general anesthesia. The average hospital stay was 9.6 days. The mean operative time was 105.6 min, with extremes ranging from 90 to 120 min. The mean time to consolidation was 14.88 weeks, with extremes of twelve and twenty weeks. Comorbidities included hypertension and diabetes. The majority of patients (76.00%) had good anterior autonomy according to the Parker index. The mean index was 8.2 [standard deviation ±1.8]. We noted three cases of post-operative death (12.00%). We evaluated nineteen patients with a mean follow-up of 24 months, and the functional results according to Postel and Merle d’Aubigné scores were excellent in 42.10% (n = 8), good in 52.63% (n = 10), and fair in 5.2% (n = 1). Conclusion: The DHS dynamic screw-plate has enabled us to achieve good radiological and functional results, enabling us to resume daily activities as quickly as possible. It appears to be a reliable solution for trochanteric fractures. It can be performed without an image intensifier, provided we are aware of its limitations.

Outcome of buttress plate-nail construct used for reconstruction of broken lateral wall in intertrochanteric fractures

Purpose:Intramedullary implants are well accepted fixation of all types of intertrochanteric(IT)frac-tures,both stable and unstable types.Intramedullary nails have an ability to effectively support the posteromedial part,but fail to buttress the broken lateral wall requiring lateral augmentation.The aim of this study was to evaluate the outcome of proximal femoral nail augmented with trochanteric buttress plate for broken lateral wall with IT fractures,which was fixed to the femur through hip screw and anti-rotation screw nail.Methods:Of 30 patients,20 had Jensen-Evan typeⅢand 10 had type V fractures.Patients with IT fracture of broken lateral wall and aged more than 18 years,in whom satisfactory reduction was achieved by closed methods,were included in the study.Patients with pathologic or open fractures,polytrauma,prior hip surgery,non-ambulatory prior to surgery,and those who refused to participate were excluded.The operative time,blood loss,radiation exposure,quality of reduction,functional outcome,and union time were evaluated.All data were coded and recorded in Microsoft Excel spread sheet program.SPSS 20.0 was used for data analysis and normality of the continuous data was checked using Kolmogorv Smirnov test.Results:The mean age of patients in the study was 60.3 years.The mean duration of surgery(min),mean intra-operative blood loss(mL)and mean number of exposures were 91.86±12.8(range 70-122),144.8±3.6(range 116-208),and 56.6(range 38-112),respectively.The mean union time was 11.6 weeks and the mean Harris hip score was 94.1.Conclusion:Lateral trochanteric wall in IT fractures is significantly important,and needs to be recon-structed adequately.Nail-plate construct of trochanteric buttress plate fixed with hip screw and anti-rotation screw of proximal femoral nail can be successfully used to augment,fix or buttress the lateral trochanteric wall giving excellent to good results of early union and reduction.

Lateral migration with telescoping of a trochanteric fixation nail in the treatment of an intertrochanteric hip fracture

Background The trochanteric fixation nail （TFN） can be used to treat stable and unstable fractures of intertrochanteric hip fractures.We study the common lateral migration that occurs with telescoping of intertrochanteric hip fractures treated with TFN and identify the predictors and relationships to clinical outcomes.Methods Patient demographic information,fracture type （Arbeitsgemeinschaft f＆#252;r Osteosynthesefragen （AO）/Orthopaedic Trauma Association （OTA） classification）,radiographic data,and clinical data were collected.Lateral migration with telescoping was measured.Statistical analyses were performed to determine which variables predicted lateral migration with telescoping.Patient outcome scores were recorded using the Modified Harris Hip Score （MHHS）,Hip Outcome Score-Activity of Daily Living （HOS-ADL）,and Visual Analog Scale for pain.Results Two hundred and twenty-three patients （67 males,156 females） fitted the radiographic and follow-up （average 24.6 months） criteria.The average age was 77.2 years.The average lateral migration with telescoping was 4.8 mm.Twenty-one patients （9.4%） had excessive lateral migration with telescoping （≥10 mm）.The quality of calcar reduction （P=0.01） and unstable fracture patterns （P=0.006） were significant predictive factors of lateral migration with telescoping.The mean outcome scores （MHHS and HOS-ADL） were 80.1 points and 78.7 points,respectively.All subjects had no significant relationship to lateral migration with telescoping （P 〉0.05）.Of all the patients who developed lateral migration with telescoping,only one required removal of the blade for hip pain and all patients went on to uneventful union at an average time of 4.5 months.Conclusions Lateral migration with telescoping is a common mechanical complication of intertrochanteric hip fracture treated with the TFN procedure.It was predicted by the quality of calcar reduction and fracture type.However,this did not affect stable fixation and fracture healing,so rarely leads to clinical problems.

Primary repair for concurrent bilateral intertrochanteric fracture and femoral head necrosis with prolonged shank biologic total hip replacement: A case report and surgical techniques

For the treatment of an intertrochanteric fracture combined with femoral head necrosis in middle-age patients,it has been controversial whether to perform fracture reduction and fixation first then total hip replacement,or direct total hip replacement.We present a rare case of 53-year-old male patient suffered from bilateral intertrochanteric fracture caused by a road traffic injury.The patient had a history of femoral head necrosis for eight years,and the Harris score was 30.We performed total hip replacement with prolonged biologic shank prostheses for primary repair.One year after the surgery,nearly full range of motion was achieved without instability(active flexion angle of 110°,extension angle of 20°,adduction angle of 40°,abduction angle of 40°,internal rotation angle of 25°,and external rotation angle of 40°).The Harris score was 85.For the middle-aged patient with unstable intertrochanteric fractures and osteonecrosis of the femoral head,we can choose primary repair for concurrent bilateral intertrochanteric fracture and femoral head necrosis with prolonged shank biologic total hip replacement.

The role of trochanteric flip osteotomy in fixation of certain acetabular fractures

Purpose： Complete visualization of certain acetabular fractures of posterior wall or column with cranial extension involving superior dome from standard surgical exposures is a challenge. Osteotomy of the greater trochanter has been used to enhance fracture visualization, especially the dome, in posterior and lateral exposures of the acetabulum, it also decreases the need for excessive muscle retraction. The purpose of the study was to investigate the outcome associated with trochanteric flip osteotomy in the management of certain acetahulum fractures. Methods： From January 2011 to December 2013, 25 displaced acetabular fractures were treated by open reduction and internal fixation. The fractures were managed using a Kocher-Langenbeck approach along with trochanteric flip osteotomy. At 3rd, 6th and 24th month follow-up, all patients had radiographic examination and underwent a final clinical evaluation based on the modified Merle d＇Auhigne and Postei score. The strength of the abductors was assessed according to the Medical Research Council （MRC） grading system. Results： Congruent reduction was achieved in all patients and all osteotomies healed within an average period of 3.8 months. All our patients were allowed full weight bearing at the end of 3 months and with no abductor lurch at the end of 6 months follow-up. There were no cases of avascular necrosis of femoral head. None of the patients had any neurovascular complication or infection by the end of the follow-up period. Conclusion： Truchanteric flip osteotomy is a very effective technique to fix certain acetabular fractures especially those with dome involvement. It is more accurate and associated with no significant com- plications compared with conventional way.

Z-effect after intramedullary nailing systems for trochanteric femur fractures

Purpose： The aim of this study was to investigate the incidence of Z-effect after dual lag screw intramedullary nailing systems and risk factors contributing to this effect. We hypothesized that long nails provide more neck strength due to a longer lever than short nails and are therefore less likely to develop a misbalance of a higher head compressive strength than neck compressive strength, Methods： In this retrospective cohort study 103 patients treated operatively with a dual lag screw intramedullary nailing device for （sub）trochanteric hip fracture were included, We analysed patient charts regarding patient and operation characteristics. Furthermore we conducted radiologic mea- surements within the 2-year follow-up period to investigate the quality of fracture fixation, implant failure and predictors for Z-effect. The re-operation risk was investigated with multivariate regression analysis, Results： The incidence of （reversed） Z-effect in this study was 9% （n 80）; 6 out of 7 Z-effects occurred in the short nail group, which was not significant. Patients who were treated with a long nail had a significant larger number of complications in comparison with the short nail group （median 2 vs 0,5, p = 0.001）. The long nail group received more often erythrocytes blood transfusions （82% vs 31%, p 〈 0.01） and had a longer hospital stay （13 vs 21 days, p 〈 0.05）. Migration of lag screws （p 〈0.05） and unstable fracture type （p 〈 0.05）, were risk factors for re-operation. The re-operation rate within 2 year after surgery was 21%, of which one fourth was due to a Z-effect. Conclusion： The nail length was not associated with the development of a Z-effect. Migration of lag screws after intramedullary nailing is common and a risk factor for re-operation.

Treatment of comminuted trochanteric fractures and non-union of trochanteric osteotomy in revision total hip arthroplasty

Objective: To explore the clinical efficacy of the treatment of comminuted trochanteric fractures and trochanteric osteotomy non union in revision total hip arthroplasty with tension band fixation. Methods: A retrospective review of 295 revision total hip operations performed between 1992 and 1998 was undertaken. Twenty hips of 19 patients with comminuted fractures or nonunion of the greater trochanter were stabilized with tension band technique. Multiple 2.0 mm k wires and tension band wires were placed through the intact cortex distally and the abductor tendon proximally in the pattern "8". Results: The average follow up was 30 months. The Harris Hip Score improved on average from 45 preoperatively to 89 at follow up. Sixteen hips with intra operative trochanteric fracture through osteolytic bone and four hips with symptomatic trochanteric nonunion were approached with tension band fixation. Perioperative loss of fixation in one patient required a repeated surgery. The same fixation at the second operation achieved an uneventful healing. Two patients had a 2 cm proximal migration of one K wire without loss of bony fixation. The trochanteric fractures healed with no further proximal wire migration. One patient had loss of fixation with trochanteric escape at 6 weeks post operatively. The patient has abductor weakness with Trendleburg limp but without pain. On average, radiographic examination showed that healing occurred at 16.6 weeks postoperatively. Six patients developed grade 1 heterotopic ossification and two patients grade 3. All were asymptomatic. None of the 19 patients experienced a dislocation during the follow up. Conclusions: Tension band fixation for greater trochanter can enhance the success rate of revision total hip arthroplasty without a deficient abductor mechanism.

Lessons learned from study of congenital hip disease in adults

Orthopaedic surgeons specialising in adult hip reconstruction surgery often face the problem of osteoarthritis secondary to congenital hip disease(CHD). To achieve better communication among physicians,better treatment planning and evaluation of the results of various treatment options,an agreed terminology is needed to describe the entire pathology. Furthermore,a generally accepted classification of the deformities is necessary. Herein,the authors propose the use of the term "congenital hip disease" and its classification as dysplasia,low dislocation and high dislocation. Knowledge of the CHD natural history facilitates comprehension of the potential development and progression of the disease,which differs among the aforementioned types. This can lead to better understanding of the anatomical abnormalities found in the different CHD types and thus facilitate preoperative planning and choice of the most appropriate management for adult patients. The basic principles for improved results of total hip replacement in patients with CHD,especially those with low and high dislocation,are: Wide exposure,restoration of the normal centre of rotation and the use of special techniques and implants for the reconstruction of the acetabulum and femur. Application of these principles during total hip replacement in young female patients born with severe deformities of the hip joint has led to radical improvement of their quality of life.

Trabecular bone deterioration at the greater trochanter ol mice with unilateral obstructive nephropathy

Our previous study showed the early molecular responses of bone in response to obstructive nephropathy in a unilateral ureteral obstruction （UUO） mouse model. Here, we addressed the changes in trabecular bone properties at greater trochanter, the proximal and the distal metaphysis of femur in UUO mice. The male mice were subjected to UUO （n= 10） or sham operation （n= 10）. All mice were killed on day 7 after the surgical operation. The micro-computed tomography （micro-CT） analysis for different femoral trabecular bone sites demonstrated pathological alterations of trabecular bone mass and micro-networks at greater trochanter as shown by decreases in bone mineral density/bone volume （P〈O.05） and trabecular number （P〈O.05） and increases in trabecular separation （P〈O.01） and bone surface/bone volume （P〈O.05） in UUO mice. The present study demonstrates that UUO-induced unilateral obstructivenephropathy has markedly detrimental effects on the trabecular trochanter of the femur.

Reattachment of the Osteotomized Greater Trochanter in Hip Surgery Using an Ultrahigh Molecular Weight Polyethylene Fiber Cable: A Multi-Institutional Study

The purpose of this multicenter study was to evaluate the clinical performance of an ultrahigh molecular weight polyethylene (UHMWPE) fiber cable for re-attachment of the osteotomized greater trochanter in hip surgery. Included in the study were 85 hips that had undergone surgery with greater trochanter osteotomy, including 50 hip arthroplasty procedures and 35 hip osteotomies. The osteotomized greater trochanter was reattached using one or more UHMWPE fiber cables. The bone union and displacement of the greater trochanter were assessed in radiographs for up to 12 months after surgery. Non-union of the osteotomy site occurred in 4.7% of the cases. In approximately 90% of the cases, displacement was less than 2 mm at up to 12 months after surgery. The UHMWPE fiber cable was a good biomaterial for reattaching the osteotomized greater trochanter and may also be an option for osteosynthesis procedures.