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 aceta...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.展开更多
Tuberculosis of the greater trochanter of the femur is caused by mycobacterium tuberculosis directly or indirectly invading the greater trochanter of the femur.The clinical manifestations are intermittent pain on the ...Tuberculosis of the greater trochanter of the femur is caused by mycobacterium tuberculosis directly or indirectly invading the greater trochanter of the femur.The clinical manifestations are intermittent pain on the side,low fever and night sweat all over the body.The patient was admitted to the Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine on May 27,2020 with the chief complaint of"intermittent pain in the left hip for 2 years,aggravated for more than 1 month".The pre-admission examination was diagnosed as a"bone defect of the left femoral greater trochanter to be investigated."After admission,relevant examinations were actively improved,but the diagnosis could not be clearly made.The diagnosis was left with greater trochanter tuberculosis.The case report,draws the following conclusions:the disease is characterized by insidious onset,low incidence and atypical symptoms,which is prone to misdiagnosis and missed diagnosis in clinical practice.Imaging and laboratory tests can provide more diagnostic evidence before diagnosis,but pathological examination is the main basis for diagnosis.In addition,since the symptoms are not obvious and it is difficult to obtain pathological tissues in the early stage,most patients reach the advanced stage of the disease when they are first diagnosed.The diagnosis and treatment thinking of doctors is relatively fixed when they treat patients.This paper aims to improve the understanding and treatment ideas of the clinical characteristics,laboratory and imaging examination of the disease by reporting this case,which is of great significance to the diagnosis and treatment of the disease.展开更多
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 ...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.展开更多
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 prophylacti...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.展开更多
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 commin...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.展开更多
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 replaceme...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.展开更多
文摘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.
基金was funded by Key Research And Development Project of Science and Technology Department of Shaanxi Province(No.2021SF419)Key Research And Development Program of Social Development of Xianyang Science and Technology Bureau(No.2020K02-109)+1 种基金Discipline Construction Innovation Team of Shaanxi University of Traditional Chinese Medicine(No.2019YL-02)Shaanxi University of Traditional Chinese Medicine Graduate Student Innovation Project of Universal-level scientific Research Project(Study on the mechanism of acupotomy in the treatment of femoral head necrosis 2021CX12)。
文摘Tuberculosis of the greater trochanter of the femur is caused by mycobacterium tuberculosis directly or indirectly invading the greater trochanter of the femur.The clinical manifestations are intermittent pain on the side,low fever and night sweat all over the body.The patient was admitted to the Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine on May 27,2020 with the chief complaint of"intermittent pain in the left hip for 2 years,aggravated for more than 1 month".The pre-admission examination was diagnosed as a"bone defect of the left femoral greater trochanter to be investigated."After admission,relevant examinations were actively improved,but the diagnosis could not be clearly made.The diagnosis was left with greater trochanter tuberculosis.The case report,draws the following conclusions:the disease is characterized by insidious onset,low incidence and atypical symptoms,which is prone to misdiagnosis and missed diagnosis in clinical practice.Imaging and laboratory tests can provide more diagnostic evidence before diagnosis,but pathological examination is the main basis for diagnosis.In addition,since the symptoms are not obvious and it is difficult to obtain pathological tissues in the early stage,most patients reach the advanced stage of the disease when they are first diagnosed.The diagnosis and treatment thinking of doctors is relatively fixed when they treat patients.This paper aims to improve the understanding and treatment ideas of the clinical characteristics,laboratory and imaging examination of the disease by reporting this case,which is of great significance to the diagnosis and treatment of the disease.
文摘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.
文摘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.
文摘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.
文摘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.
文摘目的:评价大转子骨骺阻滞术(greater trochanteric epiphysiodesis,GTE)治疗儿童股骨头缺血性坏死(Legg-Calve-Perthes disease,LCPD)的效果。方法:选择2013年1月至2019年6月在重庆医科大学附属儿童医院采取手术治疗的78例儿童股骨头缺血性坏死患者作为研究对象,根据术前X线是否存在大转子上移(overgrowth of the greater trochanter,OGGT)危象分为危象组与无危象组,危象组中根据术式不同分为阻滞组与未阻滞组。阻滞组给予包容手术联合大转子骨骺阻滞术治疗,共14例16髋,未阻滞组仅给予包容手术治疗,共33例33髋。无危象组共31例31髋。对以上病例进行术后随访,通过调查临床症状和影像学资料,评价手术疗效。结果:患者术后随访时间12~89个月,平均30.6个月。有危象未阻滞组大转子上移率(75.8%)较无危象组(6.5%)明显增加(P<0.001);阻滞组患儿大转子上移率(21.4%)较有危象未阻滞组(75.8%)明显降低(P=0.001)。阻滞组患、健侧大转子发育对比分析,阻滞侧平均每年大转子生长值较健侧减少约1.32 mm,差异有统计学意义(P<0.05),其中空心钉阻滞可达约1.77 mm/年。临床疗效方面,阻滞组术后优良率也高于未阻滞组。结论:大转子上移早期X线危象对大转子上移具有确切的预判意义,可作为实施大转子骨骺阻滞术的手术指征;选择性大转子骨骺阻滞术可有效抑制大转子生长,避免大转子上移的发生,联合传统包容手术,可有效提高患儿的治疗效果。
