In these series of cases including patients with pre-collapse osteonecrosis, we observed non-significant results regarding rate of conversion to THA with CD, CDBG or CDSC at an average of 5.5 years.

There are very few therapeutic alternatives for patients with proximal femoral epiphyseal bone deficit combined with a fracture at another level and signs of infection. This combination can be successfully managed with a proximal femur megaspacer. This article is intended to review our variation of this technique and to show the initial results obtained from 11 cases. Of these 11 cases, there were 6 women and 5 men. The mean age was 66 years. The average number of previous surgeries was 3. Definitive prosthetic reconstructive treatment was achieved in 7 of these 11 subjects. The average time to reimplantation was 11.7 months. Fractures or nonunion healed uneventfully. Bone union and infection control were achieved in 10 of the 11 patients.

BACKGROUND Between 43% and 75% of patients who undergo primary anterior cruciate ligament (ACL) surgery return to sport activity. However, after a revision ACL reconstruction (ACLR) the rate of return to sports is variable. A few publications have reported returns to sports incidence between 56% to 100% after revision ACLR. AIM To determine return to sports and functional outcomes after a single-stage revision ACLR with a 5-year minimum follow-up at a single institution. METHODS All patients operated between 2010 and 2016 with a minimum 5 years of follow-up were included. Type of sport, intensity, frequency, expectation, time to return to sport and failure rate were recorded. Lysholm, Tegner and International Knee Documentation Committee forms were evaluated prior to the first ACLR surgery, at 6 mo after primary surgery and after revision ACLR at 5 years minimum of follow-up. Objective stability was tested with the knee arthrometer test (KT-1000 knee arthrometer, Medmetric Corp). RESULTS A total of 41 patients who underwent revision ACLR during that period of time were contacted and available for follow-up. Median patient age at time of revision was 29 years old [interquartile range (IQR): 24.0-36.0], and 39 (95.0%) were male. The median time from revision procedure to follow-up was 70 mo (IQR: 58.0-81.0). Regarding return to sports, 16 (39.0%) were at the same level compared to preinjury period, and 25 patients (61.0%) returned at a lower level. Sixty-three percent categorized the sport as very important and 37.0% as important. One patient (2.4%) failed with a recurrent ACL torn. Mean preoperative Lysholm and subjective International Knee Documentation Committee scores were 58.8 [standard deviation (SD) 16] and 50 (SD 11), respectively. At follow-up, mean Lysholm and subjective International Knee Documentation Committee scores were 89 (SD 8) and 82 (SD 9) ( P = 0.0001). Mean Tegner score prior to primary ACLR was 6.7 (SD 1.3), 5.1 (1.5 SD) prior to revision ACLR and 5.6 (1.6 SD) at follow-up ( P = 0.0002). Overall, knee arthrometer test measurement showed an average of 6 mm (IQR: 4.0-6.0) side-to-side difference of displacement prior to revision ACLR and 3mm (IQR: 1.5-4.0) after revision. CONCLUSION Almost 40.0% of patients returned to preinjury sports level and 60.0% to a lower level. These may be useful when counseling a patient regarding sports expectations after a revision ACLR.

Mujer de 69 años de edad, sin antecedentes de relevancia, quien luego de una caída de propia altura, sufrió una fractura intertrocantérica de fémur izquierdo (Figura 1A) (Clasificación AO 3.1 A.2). Fue tratada mediante reducción y osteosíntesis con clavo endomedular cervicodiafisario (TFN, Synthes®) de 235 mm de largo. Permaneció internada por 72 horas hasta que fue dada de alta con internación domiciliaria, sin intercurrencias. Desde el posoperatorio inmediato, se cumplió el protocolo de rehabilitación de la marcha con andador según la tolerancia. La paciente tuvo una buena evolución clínica y radiológica (Figuras 1B y C) en el control al mes de la cirugía. En el segundo mes posoperatorio, comenzó a sentir, durante la marcha, un dolor en la cara anterior del muslo, de intensidad progresiva, el cual evolucionó con impotencia funcional en el transcurso del tercer mes.Penetración de la cortical anterolateral en fracturas de fémur proximal tratadas con clavos endomedulares cortos PRESENTACIÓN DE CASOSFigura 1. A. Radiografía de la paciente al ingresar: se observa una fractura intertrocantérica de cadera izquierda. B y C. Radiografías de frente y de perfil al mes de la cirugía.