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Abstract This study aimed to analyse the treatment and outcomes of traumatic hip dislocation (THD) in children. Clinical data of children with THD were collected at our clinical centre from 1 June 2012 to 1 January 2023. Demographic data, injury mechanism, type of dislocation, combined injuries, reduction time, reduction method, and radiographs were analysed. The Merle d’Aubigné–Postel hip score was used to evaluate hip function and complications at the final follow-up. A total of 19 children with THD were enrolled, including 12 male and seven female patients, with an average age of 8.28 ± 0.99 years. Posterior dislocation was the main type of dislocation (89.47%). Fifteen patients (78.95%) had experienced high-energy injuries and traffic accidents were the main causes of injury (47.37%). Closed reduction was performed as soon as possible, and open reduction was performed if necessary. The hip scores of 18 patients (94.74%) were excellent. One patient had osteonecrosis of the femoral head, with a hip function score of 10 (moderate). High-energy injuries, such as traffic accidents, have gradually become the main cause of injury. The prognosis for THD in children is generally good.

Background and purpose: This prospective observational study aimed to investigate the occurrence of avascular necrosis (AVN) of the femoral head in COVID-19 patients through MRI scans. The study examined the patterns of AVN in 110 individuals who had undergone conventional COVID-19 therapy and reported hip discomfort. This study highlights the importance of considering AVN as a potential complication of COVID-19 therapy, particularly in younger patients who experience hip discomfort. Methods: Individuals who had corticosteroid treatment for COVID-19 and experienced hip discomfort during 6 months between January 2022 and August 2022 were included in this study, and an MRI scan was done to observe changes in the hip joint. Results: The results were classified using the Ficat and Arlet classification system. The analysis revealed that AVN was not present in 91.81% of cases. However, Stage I AVN was detected in 4.54% of cases, Stage II AVN in 2.72% of cases, and Stage III AVN in 1.1% of cases. No cases of Stage IV AVN were observed. Conclusions: The study concludes that AVN occurred in 6% of individuals who underwent conventional therapy for COVID-19 and experienced hip discomfort. In these settings (post COVID-19), normal MRI results were more typical, and mild AVN (Stage I) was a frequent finding in MRI scans that were positive. [ABSTRACT FROM AUTHOR]

Objectives: AVN is the most common in Sickle Cell Disease patients, as SCD is common in the Jazan region of Saudi Arabia. The risk factors, and comorbidity regarding AVN of hip and shoulder joints in SCD patients were investigated in this study. Methods: This retrospective cohort study was conducted at the two biggest hospitals in the Jazan region. A valid data collection sheet was used to collect information of SCD patients admitted to the wards or during follow-up. Staging for HAVN and SAVN was based on FICAT classification guidelines. Descriptive statistics and multivariate logistic regression were utilized. Results: total number of participants is 257, and 99 (38.5%) were under 14 years of age. About half of the participants are (134) females. Regarding participants' hemoglobin type, 78.6% had SCD, while 21.4% had sickle thalassemia. The occurrence of HAVN and SAVN is 14.8% and 5.4%, respectively. Of the 38 HAVN participants, 26.3% had comorbidities, and 5.3% had hypertension. The SAVN participants didn't report diabetes or hypertension. The vascular occlusive crisis is the most significant complication associated with SCD. Multivariate logistic regression determined some risk factors for SAVN and HAVN. Conclusion: AVN is a frequent consequence of SCD, where the incidence rises with age. The vascular necrosis is the most significant complications. Continuing research on the prevention and non-surgical treatments of AVN caused by SCD must remain a top focus.

Introduction: Despite having a substantial impact on survivors' mobility and leading to morbidity, musculoskeletal involvement was the post-COVID-19 infection sequelae area that received the least attention in the literature. Reviewing the COVID-19 histories of patients who visited a tertiary health center, the research is aimed at finding an association between COVID-19 infection and avascular femoral head necrosis, a condition brought on by insufficient blood flow. Avascular necrosis of the femoral head is a condition characterized by a restricted range of motion, pain, and disturbance of gait. It is brought on by insufficient blood flow. Case reports: We discussed several examples in which COVID-19 caused individuals to develop bilateral femoral head necrosis. When COVID-19 infection is the only factor present, and corticosteroids are used to treat it, avascular necrosis of the femoral head may become more prevalent. Detecting avascular necrosis of the femoral head in its early stages, hip MRI might reduce the patient's disability and need for continuous treatment. Conclusion: Early identification and treatment of AVN patients reduce the need for surgery and the chance of disabilities.

Background: Avascular necrosis (AVN) of the metacarpal head is a rare disease that may lead to progressive destruction of the metacarpophalangeal joint and hand function. This study aimed to describe the epidemiology, possible risk factors, clinical presentation, diagnostic workup, and treatment of the rare condition of avascular necrosis of the metacarpal head. Methods: Articles were searched using the subject words "Dieterich disease","Mauclaire's disease", and "avascular necrosis of metacarpal head" in the PubMed and Scopus databases. Studies were retained for review after meeting the inclusion criteria. Those outcomes relevant to diagnose and assessing AVN of the metacarpal head and those related to curative management were extracted. Results: The literature search revealed 45 studies with 55 patients. Although the aetiology of osteonecrosis has not been clearly delineated, AVN of the metacarpal head most commonly arises from trauma but other risk factors may also be involved. Plain radiographs are often negative and therefore likely to be missed. Early-stage osteonecrosis of the metacarpal head was best assessed using MRI. Given the rarity of this condition, there is no clear consensus on the treatment. Conclusions: Avascular necrosis of the metacarpal head should be considered in the differential diagnosis of painful metacarpophalangeal joints. An early understanding of this unusual disease will provide an optimal clinical outcome, restoring joint activity, and resolving pain. Nonoperative treatment cannot cure all patients. Surgical management is based on the patient and lesion characteristics. [ABSTRACT FROM AUTHOR]

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Abstract Background Historical papers on the treatment of congenital dislocation of the hip suggest the use of preliminary traction to facilitate closed reduction or to decrease the risk of avascular necrosis (AVN) of the femoral head. In the 1980s, some authors questioned the role of preliminary traction and suspended its use, yielding satisfactory results. Since then, several studies called into question this method, and some authors have continued to recommend preliminary traction while other authors have discouraged its use. Materials and methods We reanalysed the full set of radiographs of 71 hips (52 patients) surgically treated by a medial approach after 4 weeks of preoperative longitudinal traction. The mean age at operation was 16 months. Before and after traction, the height of the dislocation was graded according to the Gage and Winter method. The hips were divided into two groups: group 1, in which the traction was effective, and group 2, in which the traction was not effective. These two groups were statistically analysed regarding the severity of the dislocation, the age of the patient at surgery and the incidence of AVN. Results Preliminary traction was effective in 48 hips (68%, group 1), while it was not effective in the remaining 23 (32%, group 2). The effectiveness of preliminary traction was statistically related to the height of the dislocation and to the age of the patient at surgery, with traction being less effective in more severe dislocations and in older children. The incidence of AVN was statistically lower in group 1 than in group 2. Conclusions In our study population, despite not having a control group, preliminary traction—when effective—seemed to reduce the incidence of AVN in patients surgically treated for congenital dislocation of the hip. The effectiveness of the traction was influenced by the severity of the dislocation and the age of the patient; it worked better for less severe dislocations and in younger children. To reduce hospital costs, traction should be applied at home. Level of evidence 3.

Avascular necrosis of the hip (AVN) is one of the most severe complications of surgical reduction when treating developmental dysplasia of the hip (DDH). The current study identified the differences in the balance control during walking in terms of the inclination angle (IA) of the center of pressure (COP) to the center of mass (COM), and the rate of change of IA (RCIA) between female juveniles with and without secondary AVN at the hip who were treated for unilateral DDH during toddlerhood as compared to their healthy peers. When compared to female healthy controls, the non-AVN group showed bilaterally similar compromised balance control with significantly decreased IA (p < 0.05) but increased RCIA (p < 0.04) in the sagittal plane during single-limb support (SLS) of the unaffected side, and in the frontal plane during terminal double-limb support (DLS) of the affected side. In contrast, the AVN increased between-side differences in the sagittal IA (p = 0.01), and sagittal and frontal RCIA during DLS (p < 0.04), leading to bilaterally asymmetrical balance control. Secondary AVN significantly reduced IA and RCIA in the sagittal plane (p < 0.05), and reduced range of RCIA in the frontal plane during initial DLS (p < 0.05). The trend reversed during terminal DLS, indicating a conservative COM-COP control in the sagittal plane and a compromised control in the frontal plane during body weight acceptance, with a compromised COM-COP control in the frontal plane during weight release. The current results suggest that increased between-side differences in the sagittal IA, and sagittal and frontal RCIA during DLS are a sign of AVN secondary to treated unilateral DDH in female juveniles, and should be monitored regularly for early identification of the disease.

Background: Delayed presenting Fracture neck of femur is one of the complex and challenging fracture to treat. Multiple treatment options are available with varying results. This study was conducted to assess the functional outcome of fracture neck of femur seeking medical attention several days after injury that are managed by cannulated screw and fibular. Methods: A total of 35 patients were included in the cross-sectional study performed at orthopaedic surgery department of United Medical & dental college Karachi. Adults aged 18 years and over both male and female with fracture neck of femur presenting 14 days after the injury for medical treatment were included in the study. Ethical approval was obtained from the ethical review committee and patients who provided written informed consent were included in study. Data analysis was performed through SPSS version 20. Results: Thirty-five patients with fracture neck of femur of both sexes 25 (71.4%) male and 10 (28.6%) females were included in study. out of which 14 (40%) of the patients had sub-capital fracture and 21 (60%) patients had trans-cervical fracture neck of femur. Mean age of patients was 32.14±10.20 years. Twenty-eight (80%) patients out of 35 had excellent and good outcome, 4 (11.4%) cases had fair and 3 (8.5%) had poor outcome Conclusion: Cannulated screw fixation along with non-vascularized fibular graft is effective technique to management of delayed presenting fracture neck of femur as it is easy, inexpensive and does not require any special instrumentation or expertise [ABSTRACT FROM AUTHOR]

Abstract Background The modified Dunn procedure has rapidly gained popularity as a treatment for slipped capital femoral epiphysis (SCFE) during the past few years. However, there is limited information regarding its safety and efficacy in severe slips with this procedure. The purpose of this study is to present clinical results and incidence of complications associated with the modified Dunn osteotomy in a consecutive series of severe SCFE cohort. Patients and methods We retrospectively assessed the outcomes of all twenty patients who had been treated with the modified Dunn procedure in our tertiary-care institution. According to the Loder and Fahey criteria, all cases were classified as severe slips; nineteen cases were stable, and one case was an unstable slip. All surgical procedures were performed by one senior orthopedic surgeon who had specific training in the modified Dunn procedure. Operative reports, outpatient records, follow-up radiographs, and the intraoperative findings were reviewed to determine the demographic information, type of fixation, final slip angle, presence of avascular necrosis (AVN), and any additional complications. The mean age of the patients was 13.2 ± 1.6 years (range, 10 to 17 years). Twenty patients (twenty-one hips) with a mean of 31.2 ± 14 months (range, 12 to 57 months) follow-up met the inclusion criteria. Pain and function were assessed by the modified Harris score and WOMAC score. Radiographic anatomy was measured using the slip angle and α-angle. The radiographic findings related to the anatomy of the femoral head-neck junction, as well as signs of early-onset of osteoarthritis (OA) and AVN, were evaluated pre- and postoperatively. Results Overall, nineteen patients had excellent clinical and radiographic outcomes with respect to hip function and radiographic parameters. One patient (5%) who developed implant failure at 3 months postoperatively had a poor outcome. The mean preoperative slip angle was corrected from 63.2 ± 8.1° (range, 51 to 84°) to a normal value of 7.5 ± 3.5° (range, 2 to 15°) (p < 0.01). The mean α-angle was improved from an average of 94.5 ± 21.1° (range, 61 to 123°) to postoperative 42 ± 6.4° (range, 25 to 55°) (p < 0.01). The mean modified Harris hip and WOMAC scores postoperatively were 96.7 ± 13.4 (range, 40 to 100) and 95.4 ± 10.6 (range, 38 to 100), respectively. There were no cases of the development of femoroacetabular impingement (FAI) and the progression of OA. We did not record any case of AVN, closure of the growth plate, heterotopic ossification (HO), trochanteric nonunion, or limb length discrepancy that occurred postoperatively either at the most recent follow-up. Conclusions Our series of severe SCFEs treated with the modified Dunn osteotomy demonstrated that the procedure is safe and capable of restoring more normal proximal femoral anatomy by maximum correction of the slip angle, minimizing probability of secondary FAI and early onset of OA. However, despite its lower surgical complication rate compared with alternative treatment described in the literature for SCFE, AVN can and do occur postoperatively which should always be concerned in every hip.

The introduction of the Femoral Neck System (FNS) represents a promising alternative to traditional cancellous cannulated (CC) screw fixation for managing intra-capsular neck of femur (ICNF) fractures. This case report aims to validate its safety and report the outcomes in a young patient. The findings demonstrate that the FNS possesses excellent biomechanical properties and provides significantly greater overall construct stability bearing in mind, that it was used in a Pauwels Classification Grade 3 ICNF fracture., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Solunke et al.)

Optimal reduction methods for late-detected developmental dysplasia of the hip (DDH) remain debatable. Gradual reduction (GR) using traction is a safer and more reliable option for late-detected DDH than closed reduction or open reduction with or without preliminary traction. GR using overhead traction, one of the current GR methods, has been indicated for children of walking age up to four years of age, whereas the upper age limit of this method has not yet been determined. We present three cases of late-detected DDH whose hips were treated between four and six years of age with this method. Stable reduction without subsequent redislocation was technically accomplished for all patients, albeit the duration of horizontal traction became longer than usual. Clinically significant avascular necrosis (AVN) has developed in children aged ≥5 years, indicating the need for some modifications to the conventional protocol to prevent AVN., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Mishima et al.)

Background: Historical papers on the treatment of congenital dislocation of the hip suggest the use of preliminary traction to facilitate closed reduction or to decrease the risk of avascular necrosis (AVN) of the femoral head. In the 1980s, some authors questioned the role of preliminary traction and suspended its use, yielding satisfactory results. Since then, several studies called into question this method, and some authors have continued to recommend preliminary traction while other authors have discouraged its use.Materials and Methods: We reanalysed the full set of radiographs of 71 hips (52 patients) surgically treated by a medial approach after 4 weeks of preoperative longitudinal traction. The mean age at operation was 16 months. Before and after traction, the height of the dislocation was graded according to the Gage and Winter method. The hips were divided into two groups: group 1, in which the traction was effective, and group 2, in which the traction was not effective. These two groups were statistically analysed regarding the severity of the dislocation, the age of the patient at surgery and the incidence of AVN.Results: Preliminary traction was effective in 48 hips (68%, group 1), while it was not effective in the remaining 23 (32%, group 2). The effectiveness of preliminary traction was statistically related to the height of the dislocation and to the age of the patient at surgery, with traction being less effective in more severe dislocations and in older children. The incidence of AVN was statistically lower in group 1 than in group 2.Conclusions: In our study population, despite not having a control group, preliminary traction-when effective-seemed to reduce the incidence of AVN in patients surgically treated for congenital dislocation of the hip. The effectiveness of the traction was influenced by the severity of the dislocation and the age of the patient; it worked better for less severe dislocations and in younger children. To reduce hospital costs, traction should be applied at home.Level Of Evidence: 3. [ABSTRACT FROM AUTHOR]

Aim The present study aims to look at the long-term clinical and radiological outcomes of surgically treated talus fractures. We have compared the outcomes and complications between simple and complex talar fracture patterns. Additionally, patients' ability to return to activity following surgical treatment of these fractures was also analysed. Materials and methods Retrospective analysis of surgically treated talus fractures at the PSG Institute of Medical Sciences and Research from 2012 to 2015. The fractures were classified as neck and body fractures. The fractures were classified anatomically (neck and body) based on their severity (simple and complex) fracture patterns. A radiological assessment was done at follow-up to assess for complications of malunion, avascular necrosis (AVN), and arthritis. The outcomes were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) score and the Maryland foot score (MFS). Results Twenty patients were included in the analysis. There were 12 talar neck and eight body fractures, subclassified into simple (10) and complex fracture patterns (10). The surgical approach involved either a medial malleolus osteotomy/via fractured medial malleolus (55%) or a non-osteotomy-based approach (anteromedial (AM)/anterolateral (AL)/combined AM and AL) (45%). The average AOFAS score was 71.34, while the MFS was 74.35. The outcomes were consistently unfavourable for patients with complex fractures with a higher propensity for complications, but no difference was observed when comparing neck and body fractures. There was a 10% incidence of malreduction in the non-osteotomy-based approach group. AVN was found in 35% of cases, and post-traumatic arthritis occurred in 75% of cases during the five-year follow-up period. Conclusion The findings of the present study consistently reiterate the propensity for complex talus fractures to develop complications like AVN and post-traumatic arthritis in the long term. This study serves to help predict talus fractures based on their severity, with poor outcomes noted with more complex fracture types. We also advocate a more extensile medial malleolus osteotomy-based approach to better visualise complex body fractures of the talus and obtain more anatomical reduction., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Vincent et al.)

In case of surgical procedures in sickle cell disease (SCD), patients are associated with high risk of perioperative complications like vaso-occlusive crisis, chest syndrome, post-operative infections, congestive heart failure, cerebrovascular accident and acute kidney injury. Preoperative assessment and stabilization like control of sepsis, blood transfusion, correction of hypoxia, hypothermia, dehydration and acidosis is needed to reduce peri-operative complications. Blood transfusion (Simple, manual exchange and automated exchange) remains an important therapeutic intervention in patients with SCD. The case study below shows the perioperative management of patients posted for bipolar prosthesis due to AVN (avascular necrosis). Adequate analgesia, incentive spirometry, early mobilisation and oxygen supplementation is the mainstay of post-operative management. [ABSTRACT FROM AUTHOR]

Purpose: Role of heritable blood clotting disorders, both thrombophilias and hypofibrinolysis in causing avascular necrosis (AVN) of femoral head have been studied in regions like Europe and U.S.A. This study was done to investigate the role of heritable thrombophilias in ethnic Indian population. Materials and Methods: A case control study of 150 patients (100 cases and 50 age and sex matched controls) of Indian Ethnicity with clinico-radiographically documented idiopathic AVN of femoral head was done after ethics committee approval. DNA was extracted from the blood and PCR analysis was used to study heritable thrombophilic gene mutation (G1691A Factor V Leiden). Enzyme-linked immunosorbent assay (ELISA)-based assays, were utilized to measure antigen levels of protein C, antithrombin III levels and protein S. Results: Nine cases out of 100 showed deficiency of Protein C (9%) while no control showed deficiency of Protein C (p value: 0.028—significant, Odds ratio: 9.791) Ten cases showed deficiency of Protein S (10%) in study population as compared to one case (2%) in control population (p value: 0.038—significant, Odds ratio: 5.44). ATIII deficiency was more prevalent in control group i.e. 22% compared to 11% in study group. Factor V mutation was present in 3% cases as compared to one (2%) in control group. (p value is 0.393—not significant). Conclusion: Difference in thrombophilic mutations in various populations indicates possible effect of ethnicity on genetic profile in the development of AVN. This risk stratification will enable in near future early diagnosis and possible role of antithrombotics in disease prevention. [ABSTRACT FROM AUTHOR]

Introduction: Proximal humeral fracture is a common cause of morbidity in the elderly and poses a challenge for the orthopedic surgeon. Open reduction and internal fixation (ORIF) with a locking plate is associated with high rate of secondary implant-related complications (IRC). Early implant removal could potentially reduce the risk of IRC and further improve the outcome in relatively asymptomatic patients. The purpose of this study was to evaluate the clinical and radiologic outcomes following implant removal. Methods: A total of 56 patients with an average age of 63 ± 13 years and a mean follow-up of 29 months were evaluated retrospectively following removal of a locking plate in the proximal humerus. Postoperative functional outcomes were evaluated with the Constant-Score, Subjective shoulder value and Quick-DASH score. Results: Early implant removal resulted in high functional outcomes with 96% of the patients reporting an improvement of their shoulder function following implant removal. No intraoperative complications were reported. Avascular necrosis (AVN) of the humeral head occurred in 12.5% of the patients, but no secondary screw cut-out was reported. Conclusion: Early implant removal might be a safe option to avoid secondary IRC with significant subjective functional improvement also in asymptomatic patients. Although early implant removal cannot reverse the process of AVN, it could potentially prevent secondary IRC and subsequent glenohumeral cartilage destruction. [ABSTRACT FROM AUTHOR]

The primary objective of this study was to juxtapose the union rate and incidence of complications in paediatric patients presenting early (≤ 7 days) following injury with children presenting later (> 7 days) with femoral neck fractures. This critical appraisal evaluated 15 patients according to their timing of presentation and surgery from the initial day of injury (Group A: operated ≤ 7 days or Group B: > 7 days of injury). Patients with traumatic femoral neck fractures with Delbet 1 to 4 subtypes who were skeletally immature (age ≤ 16 years) were included in the study. Pathological fractures and post-infective fractures were not included. Each patient's secondary loss of reduction was calculated by measuring the Neck shaft angle (NSA) on the immediate post-operative radiograph and at the union. A change in NSA of ≥ 5 degrees was considered a significant loss of reduction. Ratliff's Criteria was used to analyze the final result, and a thorough record of complications was kept. There were no significant variations in the two groups' with respect to distributions of age, sex, injury mechanism, or fracture pattern. The most frequent injury culprit in both groups was falling from a height. Type II fracture pattern (54.54%) was more common in group A, while Type III and Type II fracture pattern was equally distributed in group B. In group A, the mean operation time was 55 ± 8.25 minutes, whereas in group B, it was 65 ± 15 minutes ( p -value > 0.05). In group A, 90.9% of patients underwent CCS fixation, and in group B, 75% underwent fixation by CCS. The quality of reduction in post-operative radiographs was anatomical in 10 (90.9%) patients and unacceptable in 1 (9.1%) patient. In group B, 2 (50%) patients had an anatomical reduction, while 2 (50%) patients had an unacceptable reduction. Timing of reduction and its association with complications showed that early stable reduction and fixation decrease the occurrence of complications in femoral neck fractures ( p -value = 0.033). Fracture union was seen in all our patients in both groups and none of our patients underwent non-union. The mean union time was 11.11 ± 7.06 weeks in group A and 16.5 ± 2.59 weeks in group B ( p -value = 0.0189). In group A, only 1 (9.1%) patient developed coxa vara. In group B, out of 4 patients, the femoral head of one patient underwent avascular necrosis, one patient exhibited coxa vara, and 1 patient developed premature physeal closure with limb length inequality. Management of femoral neck fractures in children is challenging because of the paediatric bone's peculiar anatomic and physiological considerations. In our study, patients operated within 7 days developed fewer complications as compared to patients who were operated after 7 days, which was statistically significant. Although AVN is a frequent adverse consequence of pediatric femoral neck fractures, early reduction and stable fixation lowers AVN rates, as observed in our study. Our short-term functional and radiological results using the Ratliff scoring system were comparable to previous studies owing to stable anatomic reduction. Based on our findings and the existing literature, we emphasize long-term follow-up and recommend an early stable anatomic reduction in the treatment of paediatric femoral neck fractures., Competing Interests: None., (IJBT Copyright © 2024.)

Introduction Avascular necrosis (AVN) of the femoral head is a type of osteonecrosis, which is caused by the disruption of blood flow to the proximal femur, resulting in osteocyte death. Regression of the disease is rare, and most patients will ultimately progress to having a total hip arthroplasty performed. Early diagnosis of AVN allows treatment options beyond total hip arthroplasty. One such procedure described is core decompression of the femoral head. Health literacy is defined as the ability to make health decisions in the context of everyday life. It has been shown that lower levels of health literacy are associated with higher complication rates. It has been recommended that patient information documents are written at a reading grade level (RGL) no higher that the sixth grade to help with health literacy. Methods Twenty-nine websites containing information on core decompression were identified, and the online readability software WebFX (Pennsylvania, USA) was used to carry out analysis on readability. This software was able to generate a Flesch reading ease score (FRES) and an RGL for each website. The search was carried out in the Republic of Ireland. Results The mean FRES score was 48.8 (standard deviation (SD) +/-15.3), which categorizes the data as "difficult to read." The mean RGL was 8.46 (SD +/-2.34), which is higher than the recommended target. Conclusion This study has shown that the material on the Internet regarding core decompression is above the recommended readability levels for the majority of patients. This aligns with results from similar studies that have assessed the readability of online patient information. Given these outcomes, it is imperative for physicians to take an active role in curating and delivering information to their patients, ensuring that it is comprehensible. This approach aims to empower patients with a clearer understanding of core decompression, enabling them to make more informed decisions about their health., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Ahmed et al.)

Avascular necrosis (AVN) is a devastating condition that is rarely reported in patients with immune thrombocytopenia (ITP). Treatment with steroids remains a major risk factor for developing AVN. However, the incidence of AVN in patients with ITP requiring corticosteroid therapy is much less than that observed with other clinical conditions requiring corticosteroids. ITP is a bleeding disorder but can be also be a pro-thrombotic state via different mechanisms and thus could result in AVN. Among the possible causes of this pro-thrombotic state is the presence of antiphospholipid antibodies (aPLs). In this case, we report a patient with refractory ITP who developed multifocal AVN around the time she acquired new aPLs. We also discuss different mechanisms by which risk of thrombosis is increased in ITP and the relationship between ITP, aPLs and antiphospholipid syndrome. [ABSTRACT FROM AUTHOR]

Developmental dysplasia of the hip (DDH) is a developmental pathology of the hip which may be encountered in different clinical manifestations after birth. Avascular necrosis (AVN) is the most critical complication leading to several problems in the long-term period after the treatment of DDH. It is a commonly found complication secondary to treatment and also follow-up period of the dysplastic hip joint. Development of AVN in the normal hip in treatment and follow-up process of the cases with unilateral DDH has been reported in a very limited number of studies in the literature. This paper has presented a case of AVN encountered in the normal hip by radiography performed the fifth follow-up month of the patient who previously received the treatment of unilateral DDH.

Background: Developmental dysplasia of the hip (DDH) is a very common congenital disorder, and late-presenting cases often require surgical treatment. Surgical reduction of the hip may be complicated by avascular necrosis (AVN), which occurs as a result of interruption to the femoral head blood supply during treatment and can result in long-term problems. Some surgeons delay surgical treatment until the ossific nucleus (ON) has developed, whereas others believe that the earlier the reduction is performed, the better the result. Currently there is no definitive evidence to support either strategy. Objectives: To determine, in children aged 12 weeks to 13 months, whether or not delayed surgical treatment of a congenitally dislocated hip reduces the incidence of AVN at 5 years of age. The main clinical outcome measures were incidence of AVN and the need for a secondary surgical procedure during 5 years’ follow-up. In addition, to perform (1) a qualitative evaluation of the adopted strategy and (2) a health economic analysis based on NHS and societal costs. Design: Phase III, unmasked, randomised controlled trial with qualitative and health economics analyses. Participants were randomised 1 : 1 to undergo either early or delayed surgery. Setting: Paediatric orthopaedic surgical centres in the UK. Participants: Children aged 12 weeks to 13 months with DDH, either newly diagnosed or following failed splintage, and who required surgery. We had a target recruitment of 636 children. Interventions: Surgical reduction of the hip performed as per the timing allocated at randomisation. Main outcome measures: Primary outcome – incidence of AVN at 5 years of age (according to the Kalamchi and MacEwen classification). Secondary outcomes – need for secondary surgery, presence or absence of the ON at the time of primary treatment, quality of life for the main carer and child, and a health economics and qualitative analysis. Results: The trial closed early after reaching

Background Fractures of the proximal femur are amongst the most common injuries in the elderly population. While there is a clear consensus regarding the management of displaced femoral neck fractures, the management of non-displaced fractures is less clear. Both fixation and arthroplasty are valid treatment options. Internal fixation is a less invasive procedure, but it carries the risks of non-union and avascular necrosis (AVN) of the femoral head. The literature describes varying complication rates associated with these risks. We aim to describe a series of elderly patients above the age of 65 years with non-displaced fractures of the femoral neck who were treated with internal fixation. Our objectives are to determine the union rate and complications in this group and to elucidate the factors that influence these outcomes. Methods We conducted a retrospective review of all patients aged 65 years and older who presented with femoral neck fractures at our level 1 trauma unit between 2018 and 2020. Fractures were classified using the Garden classification system, and only those with Garden 1 or 2 fractures (non-displaced) were included. Preoperative radiographs or intraoperative fluoroscopy images were used to classify fractures using the Pauwels classification. Serial postoperative radiographs and clinical notes (up to 24 months postoperatively) were reviewed to assess the union rate and the development of complications. Both non-union and AVN were analysed for their associations with age, sex, Pauwels grade and comorbidities. A subgroup analysis of the complications was performed to elucidate their association with age groups (<80 and >80 years) and types of fixations (dynamic hip screws {DHS} and cannulated screws). Results A total of 148 patients, consisting of 60 males and 88 females, were included in the analysis. The patients had a mean age of 78.5 years (ranging from 65 to 98 years). The union rate without any degree of AVN was 90.7%, with six non-unions (4.05%) and six patients experiencing AVN (4.05%). No difference in outcome was detected between the two groups based on age. High (type 2 or 3) Pauwels grade (p = 0.05) and treatment with cannulated screws (p = 0.02) were indicated as significant factors for non-union. All patients who developed AVN were noted to have a comorbidity that is known to predispose them to AVN. Conclusion Our series shows a union rate of 90.7%, which is comparable to the union rates reported in other published literature. Our results suggest that age does not independently influence the outcome of fixation for these fractures. We conclude that fractures with vertical orientation (Pauwels grade 2 or 3), when treated with cannulated screws, are more likely to result in non-union. AVN is the second most common complication after non-union, which is also associated with other risk factors for AVN., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Abdallatif et al.)

Avascular osteonecrosis (AVN) of the femoral head is one of the most common skeletal complications of kidney transplantation. Patients with hip joint avascular necrosis usually undergo joint arthroplasty. However, if a patient is unfit for surgery due to some comorbidities, hip joint articular branches denervation can be done to control pain and improve functional life. There is a large variation in the contribution as well in the position of the articular branches to hip joint by obturator, femoral, and sciatic nerves. Several authors have proposed percutaneous radio frequency denervation of the hip joint to eliminate pain.In our case, the patient was having an intractable hip joint pain which was not responding to conservative drug therapy as well physiotherapy. In our patient, hip arthroplasty was contraindicated because of the high risk of infection and anticoagulants. After diagnostic block, the pain in his groin and hip disappeared immediately. The patient noted a decrease in pain (Visual Analog Scale, VAS 9-10 to 1-2) and an improvement in the ability to walk. Then we performed percutaneous radio frequency ablation of the articular branches of the obturator nerve and the femoral nerve. Nerve blocks were performed via a combined approach using fluoroscopy and nerve stimulation to identify the obturator nerve. Because optimal coagulation requires electrodes to lie parallel to the nerves, a perpendicular approach probably produced only a minimal lesion. A perpendicular approach is likely to puncture femoral vessels. Vessel puncture can be avoided if an oblique pass is used. The patient had improved ability to ambulate and the patient can carry out his daily routine activites at home without much pain and can sleep comfortably. There were no complications like motor deficit, neuritis, bleeding, or infection. Our case report gives few impressions. First, it shows that if radio contrast agent (omnipaque dye) use is restricted or contraindicated, a combined approach using fluoroscopy and nerve stimulation to identify the obturator nerve and articular branch of femoral nerve. Second, it confirms the radiological anatomy of articular branches of hip joint. Third, oblique approach is safe and gives optimum lesion.

Background and objective Sickle cell disease (SCD) can predispose patients to avascular necrosis (AVN) of the femoral head, resulting in severe disabling pain. Total hip arthroplasty (THA) is the leading treatment choice for end-stage arthritis caused by AVN. In this study, we aimed to compare complications associated with implant fixation with and without cement. Materials and methods We retrospectively analyzed 95 total hip implants in which 26 patients had staged bilateral THA. These surgeries were performed by four senior arthroplasty consultants between 2007 and 2018. Data were collected from the surgical logbook, physical files, and the electronic patient database (I-Seha, National Health Information System, Ministry of Health, Kingdom of Bahrain). Results The study included 95 hip implants in 69 patients. Forty-five (47%) were in males, and 50 (53%) were in females. Of these, 22 implants underwent revision (23%), two implants had periprosthetic infections (0.2%), two implants had periprosthetic fractures (0.2%), and 18 implants had implant loosening. We found that cemented THA was significantly associated with the development of implant loosening (p<0.001), small particle disease (p<0.001), and a higher revision rate (p<0.001). Conclusion We found that cemented THA in SCD patients led to a higher rate of aseptic implant loosening, mainly caused by osteolysis. Based on our findings, we recommend uncemented THA in SCD patients., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Almarzooq et al.)

OBJECTIVE: Osteonecrosis of the femoral head (ONFH) is a multifactorial disease, with unclear pathogenesis. The collapse of the femoral head is an important turning point in ONFH, especially for young patients. Many methods have been proposed, but the best treatment lacks consensus among orthopedic surgeons. Thus, understanding the collapse mechanism of the femoral head in ONFH is the key to a successful outcome of joint preservation. This review aims to provide an update of the collapse mechanism of the femoral head in ONFH and to focus on the most appropriate therapeutic strategies to adopt in clinical practice. MATERIALS AND METHODS: We reviewed the international literature to identify studies focusing on ONFH and therapeutic options. PubMed, Medline and Cochrane Library databases were searched for English language papers. RESULTS: An imbalance between bone resorption and bone formation as well as stress distribution on insufficient trabecular bone may be the most important collapse mechanism in ONFH. CONCLUSIONS: Treatment to avoid femoral head collapse should focus on local effective mechanical support with modification of bone remodeling in the femoral head. [ABSTRACT FROM AUTHOR]

Outside of Preiser and Kienbock disease, avascular necrosis (AVN) of the remaining carpal bones is a rare cause of wrist pain and disability with a natural history that is incompletely understood. At present, much of the available clinical information exists in the form of isolated case reports or small case series. Although reported surgical treatment options are numerous, there is a dearth of comparative studies and long-term outcomes data with which to guide management., (Copyright © 2022 Elsevier Inc. All rights reserved.)