BACKGROUND The injury degree of the femoral head is a significant predictor of femoral neck fracture (FNF) incidence in patients with femoral head fractures (FHFs). However, the exact measurement methods have yet been clearly defined. OBJECTIVE To design a new measurement for the injury degree of the femoral head and investigate its association with FHFs with FNF. METHODS A consecutive series of 209 patients with FHFs was assessed regarding patient characteristics, computed tomography images, and rate of FNF. New parameters for injury degree of femoral head, including percentage of maximum defect length (PMDL) in 2D parameter and percentage of fracture area (PFA) in 3D parameter, were respectively measured. Reliability tests for all parameters were evaluated in 100 randomly selected patients. The sensitivity, specificity, likelihood ratios, and positive and negative predictive values for different parameter cut-off values were employed to test the diagnostic accuracy for FNF prediction. RESULTS Intra- and inter-class coefficients for all parameters were ≥ 0.887. The results of logistic regression analysis showed that average PMDL across all three planes and PFA were the significant predictors of FNF (p < 0.05). Areas under curves (AUCs) of all parameters were ≥ 0.719 (p < 0.05). The cutoff values of the average PMDL across all three planes and PFA were 91.65% and 29.68%. The sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, predictive positive value and negative predictive value of 2D (3D) parameters were 91.7% (83.3%), 93.4% (58.4%), 13.8 (2.0), 0.09 (0.29), 45.83% (10.87%) and 99.46% (98.29%). CONCLUSIONS The new measurement for injury degree of femoral head appears to be reliable and indicates strong emergence of femoral neck fracture in patients with femoral head fractures. 2D and 3D parameters in FHFs have been proposed in this study, which were a feasible adjunctive diagnostic tool in identifying FNFs. CLINICALTRIAL N/A.
Background Kashin–Beck disease (KBD) is an endemic, chronic osteoarthropathy that seriously affects joint function and can lead to severe knee deformity. Osteotomy is considered to be one of the effective methods for the treatment of this disease. Therefore, we designed a novel type of osteotomy named combined proximal tibial osteotomy (CPTO), which combines the characteristics of opening‐wedge high tibial osteotomy and tibial condylar valgus osteotomy. Case presentation We report the case of a 48‐year‐old male with knee pain and varus deformity who was diagnosed with KBD and varus knee osteoarthritis (Kellgren–Lawrence stage IV). Considering the patient's relatively young age, a varus deformity of the right knee of 16.79°, and an intra‐articular instability, we performed a CPTO treatment. In this procedure, we performed an L‐shaped osteotomy from the medial edge of the proximal tibia to the intercondylar eminence and an osteotomy from the medial side of the proximal tibia to the lateral side through the same incision, to adjust the leg alignment and the congruity of the joint by valgus correction. At 29 months follow‐up, this patient achieved satisfactory results, with a varus right knee of 2.87°. There was significant improvement in his right knee function, pain, and joint stability. Conclusions CPTO may be an acceptable treatment for KBD patients with severe knee varus deformity and intra‐articular instability. It can be considered as an alternative treatment, especially for patients with advanced osteoarthritis needing knee preservation.
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