Discusión entre pares / 36 yrs. Male having pain for 5 months in rt hip

Indian-Orthopaedic Research-Group

DrAkhilesh Singh

36 yrs. Male having pain for 5 months in rt hip . Felt by itself and presented with this picture.
I did curatage and filled cancellous bone graft and fixed.
Curated material send for biopsy.
Opinion please regarding my attempt.

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  Ali Zaki Need ORIF

  12 de mayo a la(s) 9:27 · Me gusta
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  Drmhreddy Moola Leads to AVN

  12 de mayo a la(s) 9:39 · Me gusta · 1
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  Kir Pat Fibular cortical sturt would have given better strength and osteoinduction

  12 de mayo a la(s) 9:40 · Me gusta · 6
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  Kurniawan Silalahi Better biopsy first...

  12 de mayo a la(s) 9:46 · Me gusta · 1
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  Rebar Khaffaf Better to do THR

  12 de mayo a la(s) 9:52 · Me gusta · 2
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  Mohammed Ahmed Refay Your attempt is very good. But I want to know what was the pathology, curettage done through window in the trochanter or you opened the capsule and did direct curettage and what approach you used?

  12 de mayo a la(s) 9:52 · Me gusta · 3
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  Munir Ahmed Good job,poor prognosis.THR

  12 de mayo a la(s) 9:57 · Me gusta · 2
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  Raghuraj Kundangar may come as chondrosarcoma

  12 de mayo a la(s) 9:59 · Me gusta
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  Sanjay Ganorkar attempt good ..but for the patient leaves behind a feeling that something is missing ..if your curettage shows a benign lesion you are through with your effort but what about the vascularity of the head and the ultimate healing ..good procedure anyway

  12 de mayo a la(s) 10:01 · Me gusta · 1
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  Karwan Ahmed Raouf good job ....hope for success ....

  12 de mayo a la(s) 10:12 · Me gusta
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  Ashish Agarwal fibula would make ur attempt more logical.

  12 de mayo a la(s) 10:27 · Me gusta · 1
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  Baher Samy If the biospy came out with a malignant lesion then this is a catastrophy, and if it's benign then non-union or fixation failure is likely to occur. Better have well investigated and biposied first then manage accordingly

  12 de mayo a la(s) 10:41 · Me gusta · 2
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  Ranjit Sah If its not mets then bipolar with modular head would have been better

  12 de mayo a la(s) 10:42 · Me gusta
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  Anup Msf Lesion extendin well into the head
  Osteosynthesis chances r very less
  Uncemented thr wud b btr option with excissiin biopsy

  12 de mayo a la(s) 10:49 · Me gusta
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  Yogesh Gaikwad Most probably benign lesion like ABC.You should be proceed after biopsy report.You preserved his own head I think is good but fibula r strut graft in addition to DHS is better.

  12 de mayo a la(s) 10:55 · Me gusta
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  Golam Mahmud Suhash This is bad for patient

  12 de mayo a la(s) 10:58 · Me gusta
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  DrBahaa Yahya Total hip

  12 de mayo a la(s) 11:13 · Me gusta
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  Santosh Singh In this whatever lesion it will collapse& derot screw is going to prevent, this chances of osteosynthes is less

  12 de mayo a la(s) 11:48 · Me gusta
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  DrAkhilesh Singh I curated it through trochanter(reamed hole made for Richard screw) and filled the graft through same.

  12 de mayo a la(s) 11:59 · Me gusta · 2
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  DrDilawar Khan Mahsud How was the hold of the screws ?? It may loose (back) or cut out into the joint

  12 de mayo a la(s) 12:39 · Me gusta
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  Harish Makker dear ur intention of saving neck and attempt is good but graft is insfficient,it could be benign is my gut feeling but if pt.could afford-mri could have made some clearity-/

  12 de mayo a la(s) 12:59 · Me gusta
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  Shyamlal Mukhi Graft is insufficient iliac and fibula and dhs u can pull on for 6 to 10 years this is benign bone cyst later one can do THR COC

  12 de mayo a la(s) 14:26 · Me gusta · 1
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  Hamadtoh Hasan it was better if you added a fibular graft

  12 de mayo a la(s) 16:24 · Me gusta
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  Hany Khalil Ask for ca .p. alk p and parathrmone level to exclude hyperpara

  12 de mayo a la(s) 16:38 · Me gusta
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  Sikthireak Kluesik It is better to make clear diagnosis of pathology first by MRI and Biopsy, then management accordingly.

  12 de mayo a la(s) 19:56 · Me gusta
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  Abhijit Khade If u hav cureted through trochanter then it is insuficient ... U hav to 1st do mri then needle biopsy and then anterior aproach curetage wth lateral dhs plate wth bone graft... V had done same kind of case wth sp aproach

  12 de mayo a la(s) 22:43 · Me gusta · 1
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  Ravi Shankar Good attempt. Curettage&bg through the dhs entry hole is good enough. It really works. Additional Valgus osteotomy would improve the outcome

  12 de mayo a la(s) 22:55 · Me gusta · 5
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  Ramesh Kumar Gupta Very nice job, u have done. Almost same I have done 6- 7 yrs before, I got very good result. Biopsy report was benign lesion.

  hace 17 horas · Me gusta · 1
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  Yogesh Gaikwad Good job, at least you try to preserve normal head.
  Done similar case 4 yr back .Turn out ABC.Keep non wt bearing till at least 3 month.Thomos splint for earlier post op period.
  Attaching similar case.will post follow up x ray.

  

  hace 17 horas · Me gusta · 2
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  Ashish Gupta Many of us are saying fibula . & most likely non vascularized ( nagi's) .one of my friend frm PGI chd told me they followed these pt by CT & these fibula were not incorporated even after 2-3 years . so believing that non vascularized fibula is a good option may not be very wise

  hace 15 horas · Me gusta · 1
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  Ashish Gupta Regarding this case there r few issues as mentioned earlier , preop biopsy, quantity of graft , and quality of purchase lag screw is having as there is not much bone present in head. But a decent attempt. If succeed ,then nothing better . i did 3 cases like this ( non of them were this big lesions ). 2 healed & one is just 2 months follow up.

  hace 14 horas · Editado · Me gusta · 1
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  Shyamlal Mukhi Good attempt done

  6 horas · Me gusta