Questions: Does surgical hip dislocation with drilling or bone grafting, cartilage treatment and femoral osteotomy in avascular necrosis of the femoral head (AVN) result in: (1) progression of osteonecrosis or osteoarthritis; (2) pain relief and improved function; and (3) subsequent surgery and complications? Methods: We retrospectively reviewed 12 patients (13 hips, mean age 29 ± 9 years) undergoing surgical hip dislocation for AVN. Preoperative ARCO stages were: 1 hip ARCO II, 8 hips ARCO III early, 4 hips ARCO III late. Drilling was performed in 4 hips, 9 hips underwent curettage, drilling and autologous bone grafting. Cartilage was sutured in 5 hips, autologous matrix-induced chondrogenesis was performed in 3 hips, an osteochondral autograft was used in 1 hip. Femoral osteotomy was performed in 10 hips. Mean follow-up was 3 ± 2 years. Progression of AVN and osteoarthritis was assessed preoperatively and at latest follow-up using Tönnis and ARCO staging. Pain and function were assessed with the Merle d’Aubigné-Postel score. Complications were graded according to Sink et al. Results: 1 hip had AVN progression and converted to THA. 9 hips showed no AVN- or advanced osteoarthritis progression and 3 hips improved at least 1 ARCO stage. The Merle d’Aubigné-Postel score increased from preoperatively 14.1 ± 3.2 to 16.6 ± 1.2 ( p = 0.012). Subsequent surgery were performed in 3 hips, complications occurred in 3 hips. Conclusion: Although the first results are promising a longer follow-up with more patients is needed to draw a definite conclusion regarding the joint preserving potential in AVN.
Compartment syndrome of the upper and the lower extremities is a well-known entity in emergency medicine and traumatology. However, compartment syndrome of the paraspinal musculature is a very rare cause of acute back pain and may be missed at presentation despite its clinical importance. Therefore, we present a case of paraspinal compartment syndrome embedded in an overview of the actual literature. A 21- year-old woman presented with acute back pain refractory to analgesia with opiates after a tug of war match. A CT-scan of the abdomen demonstrated paraspinal swelling and an MRI ruled out intra-spinal pathologies. A compartment measurement yielded a pressure of 135mmHg. Even though conservative treatment attempts are often described, an emergency fasciotomy was carried out. Further rehabilitation was uneventful. Nevertheless, the timing of fasciotomy in the paraspinal region is under discussion, especially due to very rare experiences. Even if surgery is delayed by more than 24 hours following symptom onset, favourable postoperative outcomes have been observed.
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