Total Hip Arthroplasty With Subtrochanteric Osteotomy for Crowe IV Dysplasia Using an Extensile Direct Anterior Approach: A Surgical Technique.

The direct anterior approach (DAA) has been increasing in popularity for primary total hip arthroplasty (THA). Despite previously documented anatomic limitations to its direct distal extension, alternative exposure methods have been described to safely access the femoral diaphysis and facilitate increasingly complex primary and revision THA scenarios. The DAA has several purported advantages compared to alternative approaches (eg, posterior and lateral-based), including its muscle-sparing nature, use of an internervous plane, and preservation of posterior stabilizing structures.

Synthetic Mesh Reconstruction of Chronic, Native Quadriceps Tendon Disruptions following Failed Primary Repair.

Case: Two patients presented with chronic knee extensor mechanism disruption after failed primary repairs. Both patients had minimal ambulatory knee function prior to surgical intervention and were treated with a synthetic mesh reconstruction of their extensor mechanism. Our technique has been modified from previously described techniques used in revision knee arthroplasty.

Outcomes of periprosthetic distal femur fractures following total knee arthroplasty: Intramedullary nailing versus plating.

Background: Periprosthetic distal femur fractures (PPDFFs) present a challenge in terms of optimizing fixation in patients with poor bone quality and limited bone stock. The main treatment options include laterally based plating and intramedullary nailing. We hypothesized that treatment of PPDFFs with intramedullary nails would result in improved union rate, fewer complications, and an equivalent rate of malalignment compared to plating.

Improving the Diagnosis of Ipsilateral Femoral Neck and Shaft Fractures: A New Imaging Protocol.

Background: Despite increased awareness of ipsilateral femoral neck fractures in patients with high-energy femoral shaft fractures and advanced imaging with thin-cut high-resolution computed tomography (CT), failure of diagnosis remains problematic. The purpose of the present study was to determine if the preoperative diagnosis of ipsilateral femoral neck fractures in patients with high-energy femoral shaft fractures can be improved with magnetic resonance imaging (MRI) compared with radiographic and CT imaging.

Methods: In response to delayed diagnoses of femoral neck fractures despite thin-cut high-resolution CT, our institutional imaging protocol for acute, high-energy femoral shaft fractures was altered to include rapid limited-sequence MRI to evaluate for occult femoral neck fractures.

Use of the 95-degree Angled Blade Plate to Treat a Proximal Femur Fracture.

There are a variety of ways to treat high-energy proximal femur fractures, including intramedullary nails and laterally based plates. Although each have distinct advantages and disadvantages, fracture reduction and avoiding varus alignment are critical. For some fractures, the blade plate is a reliable, straightforward implant to treat these injuries.