Hip firearm injuries are rare injuries that could lead to serious complications,such as posttraumatic hip arthritis and coloarticular fistula.We report a case of a 25-year-old male who sustained a pelvic injury caused...Hip firearm injuries are rare injuries that could lead to serious complications,such as posttraumatic hip arthritis and coloarticular fistula.We report a case of a 25-year-old male who sustained a pelvic injury caused by a single bullet which led to a bilateral acetabular fracture,concomitant with a colon injury treated on an emergency basis by a diverting colostomy;acetabular fractures were treated conservatively by traction.After the patient recovered from the abdominal injury,he was presented with bilateral hip pain and limited motion;plain radiographs showed bilateral hip arthritis with proximal migration of the femoral head and bilateral acetabular defect classified as Paprosky type IIIA.Reconstruction of the hips was performed using the same technique:impaction bone grafting for acetabular defect reconstruction and a reversed hybrid total hip arthroplasty(THA)6 months apart.The patient presented with loosening of the left THA acetabular cup 3 years later,which was revised;then he presented with a discharging sinus from the left THA with suspicion of coloarticular fistula,which was confirmed using CT with contrast material.A temporary colostomy and fistula excision were performed,and a cement spacer was applied to the hip.After clearing the infection,a final revision THA for the left hip was performed.Treating post-firearm hip arthritis by THA is challenging,especially in the situation of neglected cases with the presence of an acetabular defect.Concomitant intestinal injury increases the risk of infection with the possibility of coloarticular fistula formation,which could present later.Working with a multidisciplinary team is paramount.展开更多
Background Giant cell tumors （GCTs） most commonly occur around the knee.The most beneficial procedure for this disease has been extensive curettage with reconstruction.However,since many GCTs may compromise the subc...Background Giant cell tumors （GCTs） most commonly occur around the knee.The most beneficial procedure for this disease has been extensive curettage with reconstruction.However,since many GCTs may compromise the subchondral bone,surgery can further jeopardize the articular cartilage and result in secondary osteoarthritis.In this study,we aimed to determine the factors associated with the development of degenerative arthritis and the effect of bone grafting on the prevention of secondary osteoarthritis.Methods We retrospectively analyzed 76 patients with GCT around the knee.The mean age at first diagnosis was 31.1 years.Surgical treatments included extensive curettage and cementation with or without bone grafting in the subchondral bone.Patient follow-up was a median duration of 35 months,ranging from 18 to 113 months.Results The local recurrence rate was 5.3％ （4/76）.Secondary degenerative changes occurred in 30.3％ （23/76） of the patients.Less than 10 mm of the residual thickness of the remaining subchondral bone was correlated with secondary degenerative changes in 57 patients （P ＜0.001）.Of these 57 patients,56.5％ （13/23） treated with bone cement reconstruction alone developed secondary degenerative changes; following bone grafting,the rate decreased to 29.4％（10/34）,with a statistically significant difference （P=0.041）.Conclusions GCT patients with less residual thickness of the subchondral bone are more likely to develop degenerative arthritis after curettage.Bone grafting in the subchondral bone area is recommended when the residual thickness of the subchondral bone is less than 10 mm.展开更多
文摘Hip firearm injuries are rare injuries that could lead to serious complications,such as posttraumatic hip arthritis and coloarticular fistula.We report a case of a 25-year-old male who sustained a pelvic injury caused by a single bullet which led to a bilateral acetabular fracture,concomitant with a colon injury treated on an emergency basis by a diverting colostomy;acetabular fractures were treated conservatively by traction.After the patient recovered from the abdominal injury,he was presented with bilateral hip pain and limited motion;plain radiographs showed bilateral hip arthritis with proximal migration of the femoral head and bilateral acetabular defect classified as Paprosky type IIIA.Reconstruction of the hips was performed using the same technique:impaction bone grafting for acetabular defect reconstruction and a reversed hybrid total hip arthroplasty(THA)6 months apart.The patient presented with loosening of the left THA acetabular cup 3 years later,which was revised;then he presented with a discharging sinus from the left THA with suspicion of coloarticular fistula,which was confirmed using CT with contrast material.A temporary colostomy and fistula excision were performed,and a cement spacer was applied to the hip.After clearing the infection,a final revision THA for the left hip was performed.Treating post-firearm hip arthritis by THA is challenging,especially in the situation of neglected cases with the presence of an acetabular defect.Concomitant intestinal injury increases the risk of infection with the possibility of coloarticular fistula formation,which could present later.Working with a multidisciplinary team is paramount.
文摘Background Giant cell tumors （GCTs） most commonly occur around the knee.The most beneficial procedure for this disease has been extensive curettage with reconstruction.However,since many GCTs may compromise the subchondral bone,surgery can further jeopardize the articular cartilage and result in secondary osteoarthritis.In this study,we aimed to determine the factors associated with the development of degenerative arthritis and the effect of bone grafting on the prevention of secondary osteoarthritis.Methods We retrospectively analyzed 76 patients with GCT around the knee.The mean age at first diagnosis was 31.1 years.Surgical treatments included extensive curettage and cementation with or without bone grafting in the subchondral bone.Patient follow-up was a median duration of 35 months,ranging from 18 to 113 months.Results The local recurrence rate was 5.3％ （4/76）.Secondary degenerative changes occurred in 30.3％ （23/76） of the patients.Less than 10 mm of the residual thickness of the remaining subchondral bone was correlated with secondary degenerative changes in 57 patients （P ＜0.001）.Of these 57 patients,56.5％ （13/23） treated with bone cement reconstruction alone developed secondary degenerative changes; following bone grafting,the rate decreased to 29.4％（10/34）,with a statistically significant difference （P=0.041）.Conclusions GCT patients with less residual thickness of the subchondral bone are more likely to develop degenerative arthritis after curettage.Bone grafting in the subchondral bone area is recommended when the residual thickness of the subchondral bone is less than 10 mm.
