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H Ten J Duis - One of the best experts on this subject based on the ideXlab platform.
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Trochanteric Fossa or piriform Fossa of the femur time for standardised terminology
Injury-international Journal of The Care of The Injured, 2013Co-Authors: C Ansari M Moein, P D Gerrits, H Ten J DuisAbstract:Abstract Piriform Fossa, Trochanteric Fossa and greater Trochanteric tip have each been described as entry points for antegrade femoral nailing. However, the terminology used for these entry points is confusing. The accuracy of the entry point nomenclature in published text and illustrations was recorded in this review study. The Trochanteric Fossa, a deep depression at the base of the femoral neck is indicated as ‘piriform Fossa’ in the vast majority of the publications. Other publications indicate the insertion site of the tendon of the piriformis muscle on the greater Trochanteric tip as ‘piriform Fossa’. As a result of recurrent terminology error and consistent reproductions of it, the recommended entry point in literature is confusing and seems to need standardisation. The piriform Fossa does not appear to exist in the femoral region. The Trochanteric Fossa is the standard entry point which most surgeons recommend for facilitating a standard straight intramedullary nail, as is in line with the medullary canal. The greater Trochanteric tip is the lateral entry point for intramedullary nails with a proximal lateral bend.
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intramedullary femoral nailing through the Trochanteric Fossa versus greater trochanter tip a randomized controlled study with in depth functional outcome results
European Journal of Trauma and Emergency Surgery, 2011Co-Authors: C Ansari M Moein, H Ten J Duis, Gerard A P De Kort, Wout J T M Van Der Meulen, Christiaan Van Der WerkenAbstract:Purpose In a level 1 university trauma center, an explorative randomized controlled study was performed to compare soft tissue damage and functional outcome after antegrade femoral nailing through a Trochanteric Fossa (also known as piriform Fossa) entry point to a greater trochanter entry point in patients with a femoral shaft fracture.
C Ansari M Moein - One of the best experts on this subject based on the ideXlab platform.
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Trochanteric Fossa or piriform Fossa of the femur time for standardised terminology
Injury-international Journal of The Care of The Injured, 2013Co-Authors: C Ansari M Moein, P D Gerrits, H Ten J DuisAbstract:Abstract Piriform Fossa, Trochanteric Fossa and greater Trochanteric tip have each been described as entry points for antegrade femoral nailing. However, the terminology used for these entry points is confusing. The accuracy of the entry point nomenclature in published text and illustrations was recorded in this review study. The Trochanteric Fossa, a deep depression at the base of the femoral neck is indicated as ‘piriform Fossa’ in the vast majority of the publications. Other publications indicate the insertion site of the tendon of the piriformis muscle on the greater Trochanteric tip as ‘piriform Fossa’. As a result of recurrent terminology error and consistent reproductions of it, the recommended entry point in literature is confusing and seems to need standardisation. The piriform Fossa does not appear to exist in the femoral region. The Trochanteric Fossa is the standard entry point which most surgeons recommend for facilitating a standard straight intramedullary nail, as is in line with the medullary canal. The greater Trochanteric tip is the lateral entry point for intramedullary nails with a proximal lateral bend.
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intramedullary femoral nailing through the Trochanteric Fossa versus greater trochanter tip a randomized controlled study with in depth functional outcome results
European Journal of Trauma and Emergency Surgery, 2011Co-Authors: C Ansari M Moein, H Ten J Duis, Gerard A P De Kort, Wout J T M Van Der Meulen, Christiaan Van Der WerkenAbstract:Purpose In a level 1 university trauma center, an explorative randomized controlled study was performed to compare soft tissue damage and functional outcome after antegrade femoral nailing through a Trochanteric Fossa (also known as piriform Fossa) entry point to a greater trochanter entry point in patients with a femoral shaft fracture.
Tadashi Tsukeoka - One of the best experts on this subject based on the ideXlab platform.
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COMPUTER SIMULATION OF THE STEM ANTEVERSION USING LANDMARKS ON THE CUT SURFACE OF THE FEMORAL NECK IN TOTAL HIP ARTHROPLASTY
2018Co-Authors: Tadashi TsukeokaAbstract:IntroductionThe midcortical line, the midline between the anterior and the posterior cortical walls has been reported as an intraoperative reference guide for reproducing the true femoral anteversion in cross-sectional computed tomography (CT) image study but we suspected that the version of the midcortical line on the cutting surface is different from that on the axial image. The three-dimensional (3D) CT-based preoperative planning software for THA enabled us to evaluate the cut surface of the femoral neck osteotomy. When we planned the straight non-anatomic stem placement in 20° of anteversion, we noticed that the line connecting the Trochanteric Fossa and the middle of the medial cortex of the femoral neck (T line) was coincident with the component torsion in almost all cases except those involving secondary osteoarthritis of the hip. Therefore we hypothesised that the T-line would provide an accurate reference guide for anteversion of the femoral component in THA. We performed this study to answer th...
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A Useful Anatomical Reference Guide for Stem Anteversion during Total Hip Arthroplasty in the Dysplastic Hip
Journal of Arthroplasty, 2015Co-Authors: Tadashi Tsukeoka, Yoshikazu TsuneizumiAbstract:Abstract Computed tomography scans of 50 dysplastic hips were obtained and reconstructed using preoperative planning software for total hip arthroplasty. The anteversion of the stem implanted parallel to the line connecting the Trochanteric Fossa and the middle of the medial cortex of the femoral neck (T line) was measured. The cutting heights of 5mm and 10mm above the lesser trochanter were simulated. The mean difference of the anteversion of the stem using the T line and the native femoral anteversion was 2.7° (95% CI: 1.0°–4.5°) and 3.5° (95% CI: 1.5°–5.5°) at cutting heights of 5mm and 10mm respectively. An anteversion using a T line is compatible with native femoral anteversion even in developmental dysplasia of the hip.
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The T-line as an intraoperative landmark for reproducing the native femoral anteversion during hip arthroplasty
Archives of Orthopaedic and Trauma Surgery, 2014Co-Authors: Tadashi Tsukeoka, Yoshikazu TsuneizumiAbstract:Introduction Three-dimensional computed tomographic (CT)-based preoperative planning for total hip arthroplasty (THA) enabled us to evaluate the cut surface of the femoral neck osteotomy. When we planned the stem placement in 20° of anteversion, we noticed that the line connecting the Trochanteric Fossa and the middle of the medial cortex of the femoral neck (T line) was coincident with the component torsion in many cases. We attempted to evaluate the accuracy of the T line for reproducing the native femoral anteversion during THA comparing it with the midcortical line, the reference guide previously reported by Suh. Materials and methods The institutional review board allowed a retrospective review of CT images of 100 normal hip joints. We performed virtual THA using the non-anatomic straight stem at three different cutting heights of 5, 10, or 15 mm above the lesser trochanter. The anteversion of the stem implanted parallel to the T line or midcortical line was measured. Results The mean difference of the stem anteversion using the T line and the native femoral anteversion was −0.77º (95 % CI: −1.92º to 0.38º), 0.69º (95 % CI: −0.42º to 1.79º) and 3.38º (95 % CI: 2.29º–4.46º) at cutting heights of 5, 10 and 15 mm, respectively. Using the midcortical line, stems tended to retroversion. Conclusions Aligning the stem parallel to the T line on the cut surface provides a good reproduction of the femoral anteversion. The T line can be an useful intraoperative reference guide for the anteversion of the femoral component in THA for patients without severe hip deformity.
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The T-line as an intraoperative landmark for reproducing the native femoral anteversion during hip arthroplasty
Archives of Orthopaedic and Trauma Surgery, 2014Co-Authors: Tadashi Tsukeoka, Yoshikazu TsuneizumiAbstract:Introduction Three-dimensional computed tomographic (CT)-based preoperative planning for total hip arthroplasty (THA) enabled us to evaluate the cut surface of the femoral neck osteotomy. When we planned the stem placement in 20° of anteversion, we noticed that the line connecting the Trochanteric Fossa and the middle of the medial cortex of the femoral neck (T line) was coincident with the component torsion in many cases. We attempted to evaluate the accuracy of the T line for reproducing the native femoral anteversion during THA comparing it with the midcortical line, the reference guide previously reported by Suh.
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COMPUTER SIMULATION OF THE STEM ANTEVERSION USING LANDMARKS ON THE CUT SURFACE OF THE FEMORAL NECK IN TOTAL HIP ARTHROPLASTY
Journal of Bone and Joint Surgery-british Volume, 2013Co-Authors: Tadashi TsukeokaAbstract:Introduction The midcortical line, the midline between the anterior and the posterior cortical walls has been reported as an intraoperative reference guide for reproducing the true femoral anteversion in cross-sectional computed tomography (CT) image study but we suspected that the version of the midcortical line on the cutting surface is different from that on the axial image. The three-dimensional (3D) CT-based preoperative planning software for THA enabled us to evaluate the cut surface of the femoral neck osteotomy. When we planned the straight non-anatomic stem placement in 20° of anteversion, we noticed that the line connecting the Trochanteric Fossa and the middle of the medial cortex of the femoral neck (T line) was coincident with the component torsion in almost all cases except those involving secondary osteoarthritis of the hip. Therefore we hypothesised that the T-line would provide an accurate reference guide for anteversion of the femoral component in THA. We performed this study to answer the question: which is the better intraoperative reference guide for reproducing the true femoral anteversion, the midcortical line or the T line? Materials and methods The institutional review board allowed a retrospective review of CT images of 33 normal femora (33 patients) in our CT database. We performed virtual THA using the non-anatomic straight stem on the 3D CT-based preoperative planning software at the two different cutting heights of 10mm or 15mm above the lesser trochanter. The anteversion of the stem implanted parallel to the T line or the midcortical line was measured. The true femoral neck anteversion was measured using the single CT slice method reported by Sugano. Results The mean true femoral anteversion was 16.9°±10.7°. We found strong positive correlations between the anteversion of the stem and the true femoral anteversion using the T-line at each cutting height (r=0.85 and r=0.92 in 10mm and 15mm cutting height respectively). The mean differences between the anteversion of the stem parallel to the T line and the true femoral anteversion were 3.5° (95% confidence interval; 1.38°–5.59°) and 2.7° (95% confidence interval; 1.15°–4.15°) in 10mm and 15mm cutting height respectively. The mean anteversion of the stem parallel to the midcortical line on the cut surface were −2.0° and −1.9° in 10mm and 15mm cutting height respectively and we could not implant the stem in some cases. Discussion Theoretically, the anteversion of the stem using the T line is close to the true femoral anteversion because the Trochanteric Fossa is in line with the femoral canal, and the center of the medial cortex of the cutting surface faces the center of the femoral head, if the cutting height is not too low. Conclusion The T line was a useful intraoperative reference guide for reproducing the true femoral anteversion and the midcortical line on the cut surface of the femoral neck was not a good intraoperative reference guide.
Yoshikazu Tsuneizumi - One of the best experts on this subject based on the ideXlab platform.
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A Useful Anatomical Reference Guide for Stem Anteversion during Total Hip Arthroplasty in the Dysplastic Hip
Journal of Arthroplasty, 2015Co-Authors: Tadashi Tsukeoka, Yoshikazu TsuneizumiAbstract:Abstract Computed tomography scans of 50 dysplastic hips were obtained and reconstructed using preoperative planning software for total hip arthroplasty. The anteversion of the stem implanted parallel to the line connecting the Trochanteric Fossa and the middle of the medial cortex of the femoral neck (T line) was measured. The cutting heights of 5mm and 10mm above the lesser trochanter were simulated. The mean difference of the anteversion of the stem using the T line and the native femoral anteversion was 2.7° (95% CI: 1.0°–4.5°) and 3.5° (95% CI: 1.5°–5.5°) at cutting heights of 5mm and 10mm respectively. An anteversion using a T line is compatible with native femoral anteversion even in developmental dysplasia of the hip.
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The T-line as an intraoperative landmark for reproducing the native femoral anteversion during hip arthroplasty
Archives of Orthopaedic and Trauma Surgery, 2014Co-Authors: Tadashi Tsukeoka, Yoshikazu TsuneizumiAbstract:Introduction Three-dimensional computed tomographic (CT)-based preoperative planning for total hip arthroplasty (THA) enabled us to evaluate the cut surface of the femoral neck osteotomy. When we planned the stem placement in 20° of anteversion, we noticed that the line connecting the Trochanteric Fossa and the middle of the medial cortex of the femoral neck (T line) was coincident with the component torsion in many cases. We attempted to evaluate the accuracy of the T line for reproducing the native femoral anteversion during THA comparing it with the midcortical line, the reference guide previously reported by Suh. Materials and methods The institutional review board allowed a retrospective review of CT images of 100 normal hip joints. We performed virtual THA using the non-anatomic straight stem at three different cutting heights of 5, 10, or 15 mm above the lesser trochanter. The anteversion of the stem implanted parallel to the T line or midcortical line was measured. Results The mean difference of the stem anteversion using the T line and the native femoral anteversion was −0.77º (95 % CI: −1.92º to 0.38º), 0.69º (95 % CI: −0.42º to 1.79º) and 3.38º (95 % CI: 2.29º–4.46º) at cutting heights of 5, 10 and 15 mm, respectively. Using the midcortical line, stems tended to retroversion. Conclusions Aligning the stem parallel to the T line on the cut surface provides a good reproduction of the femoral anteversion. The T line can be an useful intraoperative reference guide for the anteversion of the femoral component in THA for patients without severe hip deformity.
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The T-line as an intraoperative landmark for reproducing the native femoral anteversion during hip arthroplasty
Archives of Orthopaedic and Trauma Surgery, 2014Co-Authors: Tadashi Tsukeoka, Yoshikazu TsuneizumiAbstract:Introduction Three-dimensional computed tomographic (CT)-based preoperative planning for total hip arthroplasty (THA) enabled us to evaluate the cut surface of the femoral neck osteotomy. When we planned the stem placement in 20° of anteversion, we noticed that the line connecting the Trochanteric Fossa and the middle of the medial cortex of the femoral neck (T line) was coincident with the component torsion in many cases. We attempted to evaluate the accuracy of the T line for reproducing the native femoral anteversion during THA comparing it with the midcortical line, the reference guide previously reported by Suh.
Christiaan Van Der Werken - One of the best experts on this subject based on the ideXlab platform.
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Intramedullary femoral nailing through the Trochanteric Fossa versus greater trochanter tip: a randomized controlled study with in-depth functional outcome results
European Journal of Trauma and Emergency Surgery, 2011Co-Authors: C. M. Ansari Moein, Henkjan Ten Duis, Gerard A P De Kort, Wout J T M Van Der Meulen, Christiaan Van Der WerkenAbstract:Purpose In a level 1 university trauma center, an explorative randomized controlled study was performed to compare soft tissue damage and functional outcome after antegrade femoral nailing through a Trochanteric Fossa (also known as piriform Fossa) entry point to a greater trochanter entry point in patients with a femoral shaft fracture. Materials and methods Nineteen patients were enrolled and randomly assigned to two nail insertion groups; ten patients were treated with an Unreamed Femoral Nail^® (UFN, Synthes^®, Solothurn, Switzerland) inserted at the Trochanteric Fossa and nine patients were treated with an Antegrade Femoral Nail^® (AFN, Synthes^®, Solothurn, Switzerland) inserted at the tip of the greater trochanter. The main outcome measures were pain, gait, nerve and muscle function, along with endurance. Magnetic resonance imaging (MRI), electromyography (EMG), and Cybex isokinetic testings were performed at, respectively, 2 and 6 weeks and at a minimum of 12 months after surgery. Results The MRI and EMG showed, in both groups, signs of iatrogenic abductor musculature lesions (four in the UFN group and four in the AFN group) and superior gluteal nerve injury (five in the UFN group and four in the AFN group). The isokinetic measurements and the patient-reported outcomes showed moderate reduction in abduction strength and endurance, as well as functional impairment with slight to moderate interference with daily life in both groups, with no appreciable differences between the groups. Conclusions Anatomical localization of the entry point seems to be important for per-operative soft tissue damage and subsequent functional impairment. However, the results of this study did not show appreciable differences between femoral nailing through the greater trochanter tip and nailing through the Trochanteric Fossa.
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functional outcome after antegrade femoral nailing a comparison of Trochanteric Fossa versus tip of greater trochanter entry point
Journal of Orthopaedic Trauma, 2011Co-Authors: Chloe Ansari Moein, Henkjan Ten Duis, Gerard A P De Kort, Wout J T M Van Der Meulen, Karin Vermeulen, Christiaan Van Der WerkenAbstract:OBJECTIVES: This study was performed to explore the relationship between entry point-related soft tissue damage in antegrade femoral nailing and the functional outcome in patients with a proximal third femoral shaft fracture. DESIGN: Retrospective clinical trial. SETTING: Level I university trauma center. PATIENTS: Seventeen patients with a high femoral shaft fracture treated with an antegrade femoral nail joined the study. INTERVENTION: Nine patients with an Unreamed Femoral Nail (UFN; Synthes, Bettlach, Switzerland) inserted at the Trochanteric Fossa and eight patients with a long Proximal Femoral Nail (PFN; Synthes) inserted at the tip of the greater trochanter. MAIN OUTCOME MEASUREMENTS: Pain, gait, nerve, and muscle function along with endurance. RESULTS: Five patients with a UFN had a positive Trendelenburg sign and a reinnervated superior gluteal nerve after initial injury of the nerve at operation. None of these findings occurred in the long PFN group (P = 0.01). Isokinetic measurements showed diminished abduction as well as external rotator function in the UFN group rather than in the long PFN group. Leg endurance was significantly lower in patients with a UFN. CONCLUSIONS: Compared with the Trochanteric Fossa, femoral nailing through the greater trochanter tip may decrease the risk of damage to the superior gluteal nerve and intraoperative damage to the muscular apparatus of the hip region, resulting in some improved muscle function. Therefore, a lateral entry point may be a rational alternative for conventional nailing through the Trochanteric Fossa.
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intramedullary femoral nailing through the Trochanteric Fossa versus greater trochanter tip a randomized controlled study with in depth functional outcome results
European Journal of Trauma and Emergency Surgery, 2011Co-Authors: C Ansari M Moein, H Ten J Duis, Gerard A P De Kort, Wout J T M Van Der Meulen, Christiaan Van Der WerkenAbstract:Purpose In a level 1 university trauma center, an explorative randomized controlled study was performed to compare soft tissue damage and functional outcome after antegrade femoral nailing through a Trochanteric Fossa (also known as piriform Fossa) entry point to a greater trochanter entry point in patients with a femoral shaft fracture.
