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Intra-articular migration of broken trochanteric wires
Case reports
201
Discussion
La Follette B. F., Levine M. I. and McNeish L. M. (1986) Bilateral
As this is a very rare injury, there is not yet an established protocol for its treatment. In the literature, treatments vary. In the three patients in whom non-surgical treatment gave a good result, the initial displacement of the sacrum was less than in the present case. Here, the established initial nonsurgical treatment proved inadequate, so we opted for surgical intervention, which led to a good clinical result (Figure 4). Subjectively, the patient was very pleased with the
result.
fracture-dislocation of the sacrum. A case report. 1, Bone Joint Surg. 68A, 1099. Marcus R. E. and Hansen S. T. Jr. (1984) Bilateral fracturedislocation of the sacrum: A case report. 1. Bone ]oinf Surg. 66A, 1297. Schroeder K. E. and Pryor M. (1979) Bilateral sacroiliac dislocation in an adolescent. A case report. C/in. Orthop. 143, 191. Torok G. (1976) Bilateral sacroiliac joint dislocation with intrapelvic intrusion of the intact lumbosacral spine and sacrum. ]. Trauma 16, 930. Paper accepted
References Carl A. and Thomas S. (1990)Bilateral sacroiliac joint fracturedislocation: a case report. 1. Trauma 30, 1402.
Intra-articular wires
30 May
1992.
Requests for reprints should be addressed to: J. C. Silva, Service de Ortopedia, Hospital Geral de Santo Antorio, Largo Abel Salazar, 4000 Porto, Portugal.
migration of broken trochanteric
A. B. K. Lim, S. Parekh and D. N. Smith Arrowe
Park Hospital,
Upton,
Wirral,
Cheshire,
UK
Case report
Discussion
An 80-year-old lady was admitted with a dislocated Charnley total hip replacement after having a fall. She had had the joint replacement for 10 years without problems. Radiographs confirmed the clinical diagnosis and also showed multiple fragments of broken trochanteric wires. There was a suspicion that two fragments were intra-articular (Figure I). She was given an anaesthetic and the prosthesis was reduced. It was very unstable, especially in adduction and internal rotation. Further radiographs showed that the two wires in question had become impacted in the material of the acetabular cup, thus preventing the femoral component from reducing fully (Figure 2). While on light skin traction in abduction, the prosthesis again dislocated when the patient tu.med in bed. The hip was again reduced under a general anaesthetic. The position of the wires remained unchanged. The patient’s condition precluded any major surgery: she had congestive cardiac failure with angina and she developed lobar pneumonia complicated by hyponatraemia postoperatively. When she was considered fit enough, she was taken back to theatre and arthroscopic instruments used. Coincidentally her hip dislocated again 1 day before surgery. Under image intensification, the sharp obturator was introduced percutaneously into the acetabular cup from the anterolateral route to create a track. The tip was shown to move the intra-acetabular fragments of wire. The two pieces of wire (Fi’re3) were removed using the arthroscopic grasping forceps. The small incision was closed and the hip reduced.
Broken trochanteric wires do not usually cause problems. Local symptoms are common but distant symptoms are usually due to the migration of the broken fragments. More problems are encountered from the non-union or malunion and of the greater trochanter (Lazansky, 1970; Amstutz
SC: 1993 Butterworth-Heinemann 0020-1383/93/030201-02
Ltd
Maki, 1978; Browne broken wires.
and
Sheehan,
1986)
than
from
Figure 1. Two wires close to the acetabular cup thought intra-articular.
the
to be
Injury: the British Journal of Accident Surgery (1993) Vol. 24/No.3
202
Figure 3. Two wires removed from the hip joint.
References Arnstutz H. C. and Maki S. (1978) Complications of trochanteric osteotomy in total hip replacement.]. Bone]oint Surg. 60A, 214. Browne A. 0. and Sheehan J. M. (1986) Trochanteric osteotomy in Charnley low friction arthroplasty of the hip. C/in. Ortkop. 211,
128.
Figure 2. Reduced hip but wire loop visible on the medial side of the femoral head.
The two reported papers on the broken trochanteric wires arthroplasty (Brownson, 1986; With this complication in mind patient’s
medical
condition,
intra-articular migration of required revision total hip Ritter and Meding, 1988).
Brownson J. L. (1986) Articular interposition of trochanteric wires in a failed total hip replacement. Cl&z.Orfkop. 121, 50. Hawkins R. (1989) Arthroscopy of the hip. C/in. Otfkop. 249,44. Lazansky M. G. (1970) Complications in total hip replacement with the Charnley technique. Clin. Ortkop. 71,40. Intra-articular trochanteric Ritter M. A. and Meding J. B. (1988) wire migration following bilateral total hip replacement. A case report. Orfkopedics 11,1295.
Paper accepted 5 May 1992.
and the knowledge of the it was decided to remove the
wires with the least possible trauma. This was possible with the use of arthroscopic instruments (Hawkins, 1989).
Requests for reprints shouti be addressed to: A. B. K. Lim, 27 Grangewood, Court Hey, Liverpool L16 3GB, UK.
Subdural haematoma and Factor XII deficiency in a Chinese infant J. Nicholls’, L. C. Char?, Y. M. Koo’, Y. L. Kwong’ and N. S. Tsoi3 ‘Histopathology and ZHaematology Hospital, Hong Kong
Section, Department
of Pathology
Introduction Congenital deficiency of Factor XII (Hageman factor), an autosomally transmitted disorder, is usually asymptomatic despite a prolonged activated partial thromboplastin time (APTT). Deficiency in &ected homozygotes has been 0 1993 Butterworth-Heineman 0020-1383/93/030202-02
Ltd
and 3University
Paediatrics Unit, Queen Mary
associated with arterial or venous thrombosis (Dyerberg and Stufferson, 1980; Hellstem et al., 1983) and a patient with recurrent subarachnoid haemorrhages was found to be Hageman factor deficient (Kovalainen et al., 1979). We report a case of homozygous Factor XII deficiency in a
201
Discussion
La Follette B. F., Levine M. I. and McNeish L. M. (1986) Bilateral
As this is a very rare injury, there is not yet an established protocol for its treatment. In the literature, treatments vary. In the three patients in whom non-surgical treatment gave a good result, the initial displacement of the sacrum was less than in the present case. Here, the established initial nonsurgical treatment proved inadequate, so we opted for surgical intervention, which led to a good clinical result (Figure 4). Subjectively, the patient was very pleased with the
result.
fracture-dislocation of the sacrum. A case report. 1, Bone Joint Surg. 68A, 1099. Marcus R. E. and Hansen S. T. Jr. (1984) Bilateral fracturedislocation of the sacrum: A case report. 1. Bone ]oinf Surg. 66A, 1297. Schroeder K. E. and Pryor M. (1979) Bilateral sacroiliac dislocation in an adolescent. A case report. C/in. Orthop. 143, 191. Torok G. (1976) Bilateral sacroiliac joint dislocation with intrapelvic intrusion of the intact lumbosacral spine and sacrum. ]. Trauma 16, 930. Paper accepted
References Carl A. and Thomas S. (1990)Bilateral sacroiliac joint fracturedislocation: a case report. 1. Trauma 30, 1402.
Intra-articular wires
30 May
1992.
Requests for reprints should be addressed to: J. C. Silva, Service de Ortopedia, Hospital Geral de Santo Antorio, Largo Abel Salazar, 4000 Porto, Portugal.
migration of broken trochanteric
A. B. K. Lim, S. Parekh and D. N. Smith Arrowe
Park Hospital,
Upton,
Wirral,
Cheshire,
UK
Case report
Discussion
An 80-year-old lady was admitted with a dislocated Charnley total hip replacement after having a fall. She had had the joint replacement for 10 years without problems. Radiographs confirmed the clinical diagnosis and also showed multiple fragments of broken trochanteric wires. There was a suspicion that two fragments were intra-articular (Figure I). She was given an anaesthetic and the prosthesis was reduced. It was very unstable, especially in adduction and internal rotation. Further radiographs showed that the two wires in question had become impacted in the material of the acetabular cup, thus preventing the femoral component from reducing fully (Figure 2). While on light skin traction in abduction, the prosthesis again dislocated when the patient tu.med in bed. The hip was again reduced under a general anaesthetic. The position of the wires remained unchanged. The patient’s condition precluded any major surgery: she had congestive cardiac failure with angina and she developed lobar pneumonia complicated by hyponatraemia postoperatively. When she was considered fit enough, she was taken back to theatre and arthroscopic instruments used. Coincidentally her hip dislocated again 1 day before surgery. Under image intensification, the sharp obturator was introduced percutaneously into the acetabular cup from the anterolateral route to create a track. The tip was shown to move the intra-acetabular fragments of wire. The two pieces of wire (Fi’re3) were removed using the arthroscopic grasping forceps. The small incision was closed and the hip reduced.
Broken trochanteric wires do not usually cause problems. Local symptoms are common but distant symptoms are usually due to the migration of the broken fragments. More problems are encountered from the non-union or malunion and of the greater trochanter (Lazansky, 1970; Amstutz
SC: 1993 Butterworth-Heinemann 0020-1383/93/030201-02
Ltd
Maki, 1978; Browne broken wires.
and
Sheehan,
1986)
than
from
Figure 1. Two wires close to the acetabular cup thought intra-articular.
the
to be
Injury: the British Journal of Accident Surgery (1993) Vol. 24/No.3
202
Figure 3. Two wires removed from the hip joint.
References Arnstutz H. C. and Maki S. (1978) Complications of trochanteric osteotomy in total hip replacement.]. Bone]oint Surg. 60A, 214. Browne A. 0. and Sheehan J. M. (1986) Trochanteric osteotomy in Charnley low friction arthroplasty of the hip. C/in. Ortkop. 211,
128.
Figure 2. Reduced hip but wire loop visible on the medial side of the femoral head.
The two reported papers on the broken trochanteric wires arthroplasty (Brownson, 1986; With this complication in mind patient’s
medical
condition,
intra-articular migration of required revision total hip Ritter and Meding, 1988).
Brownson J. L. (1986) Articular interposition of trochanteric wires in a failed total hip replacement. Cl&z.Orfkop. 121, 50. Hawkins R. (1989) Arthroscopy of the hip. C/in. Otfkop. 249,44. Lazansky M. G. (1970) Complications in total hip replacement with the Charnley technique. Clin. Ortkop. 71,40. Intra-articular trochanteric Ritter M. A. and Meding J. B. (1988) wire migration following bilateral total hip replacement. A case report. Orfkopedics 11,1295.
Paper accepted 5 May 1992.
and the knowledge of the it was decided to remove the
wires with the least possible trauma. This was possible with the use of arthroscopic instruments (Hawkins, 1989).
Requests for reprints shouti be addressed to: A. B. K. Lim, 27 Grangewood, Court Hey, Liverpool L16 3GB, UK.
Subdural haematoma and Factor XII deficiency in a Chinese infant J. Nicholls’, L. C. Char?, Y. M. Koo’, Y. L. Kwong’ and N. S. Tsoi3 ‘Histopathology and ZHaematology Hospital, Hong Kong
Section, Department
of Pathology
Introduction Congenital deficiency of Factor XII (Hageman factor), an autosomally transmitted disorder, is usually asymptomatic despite a prolonged activated partial thromboplastin time (APTT). Deficiency in &ected homozygotes has been 0 1993 Butterworth-Heineman 0020-1383/93/030202-02
Ltd
and 3University
Paediatrics Unit, Queen Mary
associated with arterial or venous thrombosis (Dyerberg and Stufferson, 1980; Hellstem et al., 1983) and a patient with recurrent subarachnoid haemorrhages was found to be Hageman factor deficient (Kovalainen et al., 1979). We report a case of homozygous Factor XII deficiency in a