The avascular necrosis (AVN) of the FEMUR HEAD due to the death of the osteocytes of the bone marrow occurs because the organ is not supplied with sufficient blood. The prevalence of the problem is 10%-50% in adults. The etiology of the disease includes various factors such as trauma, cigarette smoking, drinking spirits, taking corticosteroids, genetics, metabolic disorders, human immunodeficiency virus, pregnancy, and the like. The treatment of necrosis can be conducted regarding the degree of the problem. In the present paper, a case was reported whose FEMUR HEAD necrosis was treated by applying Iranian Medicine without using common drugs in modem Medicine. The patient was a 46-year-old man who had felt severe pain in his left hip since a month before referring. The pain had gradually increased and the AVN of the FEMUR HEAD was diagnosed after magnetic resonance imaging. Finally, the surgery and arthroplasty of the FEMUR HEAD were recommended in this regard. In general, surgery and arthroplasty were recommended regarding the hard medicinal and complicated treatment of the AVN of the FEMUR HEAD. However, it is noteworthy that applying Iranian medicine capacities is possible for curing the disease.

Background: Some skeletal criteria especially for bones of lower limbs are considerably different between men and women that may help in identifying the gender. We studied two lower limbs parameters, i.e. bicondylar width and vertical diameter of the femoral HEAD based on radiographic assessment in gender identification.Methods: Bicondylar width and vertical diameter of the femoral HEAD of 280 radiographs taken from people aged 30 to 75 years were measured. Additionally, gender and age subgroups were recorded and added to the measured anthropometric parameters in the checklist of the study.Results: The mean width of both left and right bicondylar bones as well as vertical diameter of both left and right femoral HEADs were significantly different between men and women. Considering two parameters of bicondylar width and vertical diameter of femoral HEAD, the measurements could differentiate gender, with 96.7% sensitivity, 72.2% specificity, and 96.0% accuracy.Conclusion: By measuring bicondylar width and vertical diameter of the FEMUR HEAD, it is possible to determine gender with a high discriminative capability.

Introduction: Traumati c anterior dislocation of the hip is not common and open perineal variant of the inferior type of anterior dislocation is an even rare event. Case Presentation: We report a case of open perineal variant of the inferior type of anterior hip dislocation, with concomitant fracture of the femoral HEAD and greater trochanter, in a 17-year-old male patient. Closed reduction of dislocation and later open reduction and fixation of the greater trochanter were performed. Eighteen months after the injury, the femoral HEAD resorption, due to infection and avascular necrosis, led to a poor functional outcome. Conclusions: Open perineal variant of anterior hip dislocation can lead to very poor outcome when performed with closed reduction.

Background: Avascular necrosis (AVN) of femoral HEAD, with resultant joint destruction, is a common disabling disease of fourth and fifth decades of life. Metal-on-metal resurfacing is a relatively newer treatment modality for this disease. The aim of this study is to compare the result of resurfacing for osteonecrosis with that of resurfacing for other causes.Methods: Twenty eight patients with stage III or IV (Ficat & Arlet) osteonecrosis who underwent metal-onmetal hip resurfacing were compared with 24 cases of grade IV or V (Croft’s) osteoarthritis (OA) who had undergone the same kind of arthroplasty during a 2 year period in Akhtar hospital in Tehran. These cases were matched in terms of gender and age, and were assessed by Harris hip score with 41(±22) months follow-up.Results: The AVN cases had 30.86 (±7.5) and OA cases 47.88 (±12.6) years at surgery. Three patients from each of the above groups had sustained complications of either femoral neck or acetabular cup fracture and had required revision surgery. The average Harris hip score was 94(±7.2) in AVN and 91.2(±9.4) in OA group. The collective hip range of motion was 216(±6.2) in AVN and 196±(5.6) in AO patients. Conclusions: Metal-on-metal hip resurfacing gives similar satisfactory results in avascular necrosis and in osteoarthritis of hip joint in short-term, with no statistically significant difference.

Introduction: Distal FEMUR fractures are a common fracture seen in both high and low-energy traumas in young and elderly patients. The standard of care in healthy, mobile, younger patients remains open reduction and internal fixation (ORIF) through various fixation devices. However, the standard of care for comorbid and elderly patients remains unclear. In these patients, rates of nonunion vary between 6% and 20%, requiring revision surgery. Our study sought to identify patients who have gone endoprosthesis conversion to a distal FEMUR replacement following failed ORIF. Methods: This descriptive study includes a total of eight patients who underwent a revision distal femoral replacement (DFR) following failure of primary distal FEMUR ORIF and data were gathered through chart review. Patient comorbidities, demographic characteristics, hospital disposition, complications, and mortality were collected and described. Results: The average age of this cohort was 52. 1 years, with 6 being female, and with a follow-up mean of 3. 02 years. The most common medical comorbidities present in these patients at the time of ORIF were diabetes, hypertension, obesity, smoking, and renal insufficiency. 87. 5% of patients were able to tolerate weight bearing following DFR conversion, compared to 62. 5% tolerating weight bearing before revision. Complications requiring revision surgery occurred in 3/8 patients, which included: aseptic loosening, prosthetic joint infection, and patellar maltracking. Conclusion: DFR in a revision setting following acute distal FEMUR ORIF can be an acceptable treatment options with outcomes similar to primary DFR. Further investigation is warranted to determine optimal timing and indications for primary DFR in a fracture setting.

Background: Femoral shaft fracture is one of the most common fractures in high energy trauma patients and can be associated with soft tissue injuries of knee joint. Recognition of ligamentous and meniscal injuries of knee in acute phase is essential for optimum treatment and prognosis. Polytraumatized patients with FEMUR fracture and knee ligament or meniscus damage present a difficult diagnosis challenge.Methods: Twenty two adult patients with closed or open, displaced, diaphyseal femoral fractures and no previous knee injury were prospectively studied to look for possible concomitant ipsilateral knee injury. In all cases the mechanism of injury was high energy car accident. Trauma following open reduction and fixation with nail or plate. All patients had an examination under anaesthesia followed by knee arthroscopy. Results: The results of physical examination showed instability of grade 1 or more in six patients; two positive valgus stress test, one isolated and another with positive anterior drawer test, one positive varus stress test, two positive isolated anterior drawer tests, one isolated positive posterior drawer test. There were also knee effusions in 8 patients. Significant arthroscopic findings consisted of three cases of hemarthrosis; one complete and two partial anterior cruciate ligaments tears and two lateral meniscuses tears. In general, upon physical examination, 6 cases of ligamentous injury were suspected and in knee arthroscopy five patients had positive findings; and similar findings were confirmed by both tests. Therefore high incidences of ipsilatersal knee injuries (36.3%), including those that were occult, occurred in conjunction with femoral shaft fractures. Conclusions: Based on the above findings, it is recommended to have a high index of suspicion for coexisting knee injury with ipsilateral fracture of FEMUR.