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Transfixation pin removal: a new twist.

veil has been lifted. Consequently, if avascular necrosis is suspected, as in the head of the femur, loss of the fine trabeculae and relative coarsening of the main supporting trabeculae indicate viability. Atrophy due to disuse often occurs in the femoral head of the normal side after a few weeks, as it does at the base of the neck and intertrochanteric area of the involved hip, permitting comparison with the head in an intracapsular fracture. In assessing incorporation of bone grafts, loss of the fine trabeculae and coarsening of the pattern within a necrotic graft are indications of osteoclasis and ingrowth of nonosieogenic granulation. Early incorporation is evidenced by the appearance of homogeneity and increased roentgenographic density as invading new bone creeps along the graft trabecular scaffolding to fill the intertrabecular spaces. Osteoporosis of a graft, therefore, indicates absorption rather than viability, the opposite of the observation in an intercapsular fracture of the hip. Finally, following a phase of bone atrophy and roentgenographic trabecular coarsening, healing occurs by osteoblastic activity creeping along the remaining trabeculae, similar to incorporation of a bone graft. The result is thickening of the longitudinal stress trabeculae rather than reconstructing the former cross-bracing pattern of fine trabeculae as a permanent document of a former stage of bone atrophy (Fig. 1C).