case_images: PMC11045277_01
case_images: Preoperative AP pelvis X-ray and 3D CT scan showing a well-fixed Wagner-type shaft with excessive bone loss at the area of the greater trochanter (Gruen zones 1 and 2) and diffuse bone remodeling around the medial femoral cortex.
case_images: CRIOR2024-7934419.001.jpg
case_images: PMC11045277_01_CRIOR2024-7934419.001.jpg
case_images: fig1
case_images: A radiographic examination revealed a well-fixed shaft with excessive bone loss at the area of the greater trochanter (Gruen zones 1 and 2) and diffuse bone remodeling around the medial femoral cortex (Figure 1).
case_images: Intraoperative image showing the fixation of a polyester patch to the shaft and joint capsule.
case_images: CRIOR2024-7934419.002.jpg
case_images: PMC11045277_01_CRIOR2024-7934419.002.jpg
case_images: fig2
case_images: Tissue Reinforcement, Xiros, Leeds, UK) was first fixed medially to provide the possibility to ensheathe the cement circularly. The patch was therefore partly fixed to the shaft with the help of the mounted Ethibond (Ethicon, Somerville, New Jersey) suture and medially fixed to the joint capsule with two sutures, creating a tent-like structure (Figure 2).
case_images: Intraoperative image showing the attachment of a cement block around the proximal lateral shaft creating a neotrochanter.
case_images: CRIOR2024-7934419.003.jpg
case_images: PMC11045277_01_CRIOR2024-7934419.003.jpg
case_images: fig3
case_images: Bone cement (PALACOS, Heraeus Medical, UK) was molded around the proximal shaft in the shape of a round capsule, creating a trochanter-like shape (Figure 3).
case_images: Intraoperative image showing the fixation of the polyester patch on top of the cement block.
case_images: CRIOR2024-7934419.004.jpg
case_images: PMC11045277_01_CRIOR2024-7934419.004.jpg
case_images: fig4
case_images: This created a cover over the cement in order to smoothen the surface and to allow adherence of soft tissue (Figure 4).
case_images: Intraoperative image of the Z-plasty resulting in lengthening of the iliotibial band.
case_images: CRIOR2024-7934419.005.jpg
case_images: PMC11045277_01_CRIOR2024-7934419.005.jpg
case_images: fig5
case_images: The effect of lengthening of the iliotibial band can be seen in the exposure of the underlying musculature as a result of distending the vertical incisions (Figure 5).
case_images: Postoperative AP pelvis X-ray and 3D CT scan showing a well-fixed cemented neotrochanter around the proximal part of the femoral component protecting the sharp edges of the stem.
case_images: CRIOR2024-7934419.006.jpg
case_images: PMC11045277_01_CRIOR2024-7934419.006.jpg
case_images: fig6
case_images: The sharp edges were now protected by the rounded cement plug (Figure 6).