Femoral Shaft Fracture After Hip Arthroplasty: A System for Classification and Treatment--Mark H. Gonzalez, MD ; Riad Barmada, MD; Daniel Fabiano, MD; William Meltzer, MD

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Twenty-one consecutive cases of femoral shaft fracture after hip arthroplasty treated at the University of Illinois affiliated hospitals were reviewed. Adequate follow-up and radiographs were available for 19 patients. The length of follow-up after fracture ranged from 2 to 13 years, with a mean of 3.1 years. The time from index procedure to fracture averaged 2.6 years, with a range of 10 days to 11 years. The primary femoral stem was cemented in 11 hips and cementless in 8 hips. Six patients were treated nonoperatively and 13 operatively. Three had fracture fixation with retention of a well-fixed prosthesis and 10 had prosthetic revision. Cortical allograft was used in 5 cases. Sixteen of the 19 patients returned to their prefracture level of function and ambulation. The factors important to treatment are fracture stability, implant stability, and adequacy of bone stock. A classification system based on these factors and recommendations for treatment are proposed.

Bipolar Arthroplasty for Recurrent Total Hip Instability--David E. Attarian, MD

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Bipolar arthroplasty has been reported as a method for correction of recurrent dislocations of total hip replacements. This retrospective review of six patients with multiple dislocations of total hip replacements treated by conversion to simple bipolar hip arthroplasty confirms a 100% success rate in eliminating hip instability during a follow-up period of 21/2 to 5 years. However, given the high rate of postoperative discomfort and abnormal gait associated with this procedure, it should be used only when other revision techniques prove to be unsuitable.

Effects of Kyphosis and Lordosis on the Remaining Lumbar Vertebral Levels Within a Thoracolumbar Fusion:--Fred J. Molz, MS John S. Kirkpatrick, MD S. M. Reza Moeini, PhD; Jason I. Partin, BS; Martha Warren Bidez, PhD

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This study was done to determine the motion of the whole lumbar spine after internal fixation and the effect of kyphosis and lordosis on the remaining vertebral levels. Baseline motion analysis of sagittal, frontal, and transverse planes was done to determine the intact range of motion. Three fusion configurations were tested: neutral position (0°), 4.6° ± 2.0 kyphosis, and –6.2° ± 3.6 lordosis. The sagittal and frontal plane relative rotation of the instrumented segments (T12/L2) decreased an average of 74% and 60%, respectively, as compared with intact testing. Sagittal plane motion at the remaining segments increased for all fusion configurations when compared with intact motion and reached statistical significance at the L4/L5 level. No significant differences were found between fusion configurations (ie, fused neutral, kyphosis, and lordosis).

Intramedullary Fixation of Unstable Forearm Fractures in Children--Douglas W. Lundy, MD Michael T. Busch, MD

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Although most forearm fractures in children are appropriately treated with closed reduction and cast immobilization, certain unstable fractures of the radius and ulna are best treated operatively. We present our technique of using flexible intramedullary fixation to stabilize these fractures. Retrograde fixation of the radius is obtained with a 5/64th or 3/32nd Steinmann pin, and stabilization of the ulna is achieved with a 1/8th inch Rush rod. Complications from this technique are few. The rods are usually removed after fracture union to avoid painful hardware.

Giant Cell Tumor and the Skeletally Immature Patient--Jeffrey D. Morgan, MD John L. Eady, MD

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Conventional wisdom suggests that giant cell tumor (GCT) does not occur in the skeletally immature individual; however, we believe that GCTs of bone, though rare, do occur in children. We are reporting the occurrence of GCT of bone in three patients who were skeletally immature at the time of their initial presentation. In our review of the reports since 1954 that document this condition, we were also able to find a total of 318 patients, of whom 130 were skeletally immature at the time of their tumor presentation. From the data compiled, we found a 7.5% incidence of GCT of bone in skeletally immature individuals at a mean age of 10.5 years. Based on our review and the experience with our three patients, we believe the diagnosis of GCT of bone should be considered in the differential diagnosis of a destructive lesion of bone in skeletally immature individuals. Giant cell tumor in the skeletally immature is being reported here to better define its incidence and increase awareness of its occurrence. Management options will also be discussed.

In Pursuit of Excellence: Personal Reflections--Chitranjan S. Ranawat, MD

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I thank the board members and attendees of the annual meeting of the Eastern Orthopaedic Association. It has been a great honor and privilege to be your President. I am going to present my “Personal Reflections on the Pursuit of Excellence” to the members and guests of the Eastern Orthopaedic Association.

Episodic Snapping of the Medial Head of the Triceps Due to Weightlifting--Robert J. Spinner, MD; Doris E. Wenger, MD; Christopher J. Barry, MD; Richard D. Goldner, MD

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We describe two patients who had episodic elbow snapping and ulnar nerve dysesthesias only after weightlifting. These symptoms would disappear soon afterward. The episodic nature of their complaints and findings led to misdiagnosis. We documented by repeated clinical examinations and magnetic resonance imaging that the presence of these symptoms correlated directly with the finding of intermittent, activity-related snapping of the medial triceps. In both patients, the symptoms disappeared when the medial portion of the triceps migrated medially but did not dislocate over the medial epicondyle with elbow flexion. Thus, a minor change in the configuration of the medial portion of the triceps (fluid accumulation) in the same individual at different times can cause intermittent dislocation of the medial triceps. Previous papers dealing with patients with snapping of the medial triceps describe symptoms exacerbated by athletic activities, but the constant finding of snapping on sequential examinations.

Atraumatic Floating Clavicle and Total Claviculectomy--David E. Attarian

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We describe a patient with a floating clavicle of atraumatic origin treated by total claviculectomy. Clavicular function and anatomy are summarized relative to complete excision. Other treatment options for panclavicular instability are also discussed.

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