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Animal Models for Investigations of Biomaterial Debris
Published in Yuehuei H. An, Richard J. Friedman, Animal Models in Orthopaedic Research, 2020
Martin Lind, Yong Song, Stuart B. Goodman
After sacrifice the proximal femur with implant was harvested as well as synovial tissue from the contralateral hip joint. Part of the membrane was used for histology and graded semiquantita-tively with respect to macrophage density. Another part of the membrane was harvested aseptically and used for biochemistry. This was accomplished by dicing the membrane and synovial tissue and subsequently culturing the tissue in organ culture for 72 hours. Conditioned media were assayed for collagenase, gelatinase, PGE2 and IL-1 activity.
Management of osteoporotic proximal intertrochanteric/subtrochanteric femoral fractures
Published in Peter V. Giannoudis, Thomas A. Einhorn, Surgical and Medical Treatment of Osteoporosis, 2020
Avadhoot Kantak, George Tselentakis
The proximal femur is surrounded by large and powerful muscles. These together with the interplay of gravity result in characteristic deformities in the case of subtrochanteric fractures. The iliopsoas flexes, abducts, and externally rotates the proximal fragment. The adductors lead to adduction of the shaft. This deformity complicates attempts at closed reduction. Shortening, of course, occurs as a result of the contraction of all the long muscles that span the length of the shaft. Thus, the characteristic deformity is an anterior and lateral bowing of the femoral shaft combined with considerable shortening (Figure 22.2). The angle formed by the axis of femoral neck and femoral shaft is 130 ± 7. If the angle is reduced as would occur with varus reduction of fracture, the distance between the head and shaft is increased, with the increased moment arm and the bending forces across the fracture, and may produce varus collapse (77).
Musculoskeletal trauma
Published in Ian Greaves, Keith Porter, Chris Wright, Trauma Care Pre-Hospital Manual, 2018
Ian Greaves, Keith Porter, Chris Wright
Injury to the hip usually results in the patient complaining of pain in the joint itself, the proximal femur or the groin. Elderly patients and those with osteoporosis are particularly prone to fragility fractures of the neck of the femur. The exact location of the fracture within the femoral neck determines the surgical treatment, but cannot be determined by the pre-hospital clinician. This is an injury with significant long-term morbidity, particularly in older patients. Patients usually complain of pain associated with a fall, often onto the hip itself. The affected leg may be externally rotated and shortened when the patient is in the supine position. A history of minimal or no trauma and signs suggestive of proximal femur fracture should raise the possibility of a pathological fracture. Analgesia will be required for extrication and transfer. Intravenous opiates are appropriate. Where skill and expertise are available, a femoral nerve block offers good analgesia of the hip, which usually lasts for several hours. In the elderly, femoral neck fractures may appear to be associated with surprisingly little discomfort until the patient is moved.
Computational prediction of the long-term behavior of the femoral density after THR using the Silent Hip stem
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2023
Zainab Al-Hajaj, Pouria Tavakkoli Avval, Habiba Bougherara
The conventional cementless hip prosthesis has a serious issue of stress shielding of the proximal femur, periprosthetic fractures, thigh pain and removal during revision (Kumar 2012; Kim et al. 2016). In an effort to overcome the limitations of the traditional prostheses, Silent Hip prosthesis was introduced. The present study revealed significant results in demonstrating less bone resorption using Silent Hip prosthesis compared to the conventional hip stem design. The sophisticated design of the Silent short stem allows to preserve more bone stock and soft tissue, during the prosthesis inserting procedure (i.e. incision) and following the THR, than of the traditional design (Kumar 2012). Waller and McTighe (2013) confirmed that the Silent Hip transfers the load to the femur bone, throughout the neck to the femoral shaft in movement a more physiological fashion than other conventional stems. Silent Hip provides stability and does not show continuing patterns movement over time (Waller and McTighe 2013). Studies (Chen et al. 2009; Dabirrahmani et al. 2010) confirmed that the short stem shows less stress shielding with no cortical hypertrophy compared to the traditional long stem implant, as it acts as a shorter cantilever.
A three-dimensional measurement based on CT for the posterior tilt with ideal inter-and intra-observer reliability in non-displaced femoral neck fractures
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2021
Shenghui Wu, Wei Wang, Binbin Zhang, Haowei Zhang, Xinsheng Xu, Guangyi Li, Huipeng Shi, Jiong Mei
Our results highlighted the robust reliability and more realistic approach based on CT imaging to depict posterior tilt. An almost perfect inter- and intra-observer reliability for the 3D measurement was shown in our study. Zamora et al. (2019) reported that the posterior tilt evaluation of non-displaced FNFs was not altered using CT. However, in Zamora et al. (2019), only one of the 2D sectional CT images axial oblique was used. This implies that the determined angle might have been affected by selection bias and hip position. In our study, CT scan images were fully used through 3D reconstruction. In the process of mirror and registration, the bilateral femurs were over lapped except two sides of the femoral head. Two sides can eliminate the influence of hip positions or anatomical variations of the proximal femur. Therefore, our method describes a more realistic angle of the posterior tilt of femoral head. Besides, this work is based on CT imaging, which is widely applied in many parts of the world. Thus, our method resonates with a wider audience and can be adapted across the globe.
The elastoplastic numerical model and verification by macroindentation experiment of femoral head
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2021
Jun Wang, Chen Yi, Sufang Wang, Ling Wang, Haiyou Jia, Bo Chen, Yong Huan
Worldwide, proximal femoral fracture is a common occurring trauma (Cumming et al. 1997), and the number of patients with proximal femoral fracture will continue to increase as the population ages—by 2050, the number of over 60 s will exceed a fifth of the global population according to WTO. Femoral head fractures, femoral neck fractures, and intertrochanteric fractures are all classified as fractures of the proximal femur. Open reduction and internal fixation is one of the most common operative treatments for these fractures (Giannoudis et al. 2009; Yang et al. 2013; Ostrum et al. 2014; Arslan et al. 2016; Filipov et al. 2017), and the typical method of internal fixation is to drive the screw into the femoral head (Oransky et al. 2012; Elgeidi et al. 2017; Blitz et al. 2018); therefore, the ability of the femoral head to hold the screw is very important. Mechanical matching of the femoral head and fixation should be verified before surgery.