1/27. immobilization hypercalcemia crisis.Profound hypercalcemia associated with immobilization is rare. Hypercalcemic crisis occurring as a result of immobilization in which there was not a coexisting, contributing medical condition has not, to our knowledge, been reported previously. Failure to consider hypercalcemia as the source of progressive anorexia, nausea, vomiting, and irritability resulted in a respiratory arrest and nearly fatal outcome in the case of a 13-year-old boy one month after a simple femoral fracture. Therapy consisting of the intravenous administration of fluids and corticosteroids was successful in lowering the serum calcium level until mobilization could be accomplished. review of previously reported cases emphasizes the difficulty in recognition and diagnosis of this unusual condition. Surgeons treating patients with fractures should be aware of this complication and familiar with its appropriate therapy.- - - - - - - - - - ranking = 1keywords = difficulty (Clic here for more details about this article) |
2/27. Teleconsultations in Pohnpei State, Federated States of micronesia.A case report of 6 years old female who sustained a difficult right subtronchanteric fracture of the femur is outlined. She was treated successfully, with local materials, over the internet with assistance of the orthopaedic surgeons at the Tripler Army Medical Center in Honolulu. Pohnpei State spends 10% of the health budget in referring patients off-island for tertiary treatments and this serves less than 1% of the total population. Before the use of the internet, approximately $US1,500 per month was spend on telephone bills, for outside consultations. After connection to the internet and the consult webpage, particularly at Tripler, this cost was reduced to below $US500 per month. To date, fifty consults, via the internet, have been sent to the TAMC Consult Webpage. The introduction of this service has resulted in cost saving in terms of referral communication and perhaps avoided unnecessary off island evacuations. The difficulties so far have been limitation of on-line access and computer illiteracy amongst physicians.- - - - - - - - - - ranking = 4.9503461818707keywords = limitation (Clic here for more details about this article) |
3/27. Supracondylar distal femoral nonunions treated with a megaprosthesis in elderly patients: a report of two cases.The purpose of this paper is to report the use of total knee arthroplasty, a megaprosthesis, as a treatment in elderly patients who have a persistent nonunion of a supracondylar femur fracture. This case report includes two elderly patients who sustained supracondylar femur fractures that failed to unite with standard operative fixation methods. Despite multiple procedures during a long period, patients had a persistent nonunion. Both patients underwent total arthroplasty with a cemented kinematic rotating hinge and had significant clinical improvement. The Hospital for Special Surgery (HSS) knee scores increased from fifty-four points to seventy points in one patient and forty-two points to seventy-three points after surgery in the other patient. Both patients had excellent range of motion after surgery. A cemented megaprosthesis appears to be a viable treatment option for persistent nonunions of supracondylar femur fractures in elderly patients. It is well tolerated and permits early ambulation and return to activities of daily living.- - - - - - - - - - ranking = 593.20936426279keywords = ambulation (Clic here for more details about this article) |
4/27. Temporary vena cava filter placement for pulmonary embolism.Current clinical trials are under way to determine the safety and efficacy of temporary inferior vena cava filters for use in patients who need but have contraindications to anticoagulation medications for a short time (<10 days). To date, no data on these types of filters have been published. The authors describe a 20-year-old male trauma patient in whom a pulmonary embolism developed early in his hospital course and who was appropriately placed on anticoagulation therapy. Surgical intervention, however, was necessary to repair complex facial fractures sustained in a motorcycle collision. A filtering infusion catheter was placed until anticoagulation therapy could be resumed. The patient tolerated the surgery without further embolism and has recovered without difficulty.- - - - - - - - - - ranking = 1keywords = difficulty (Clic here for more details about this article) |
5/27. Recurrent severe haemorrhage from false aneurysm following fracture of the femur.A case of traumatic false aneurysm presenting as recurrent exsanguinating haemorrhage from a surgical wound of the thigh is described. A plate, inserted to maintain reduction of a fracture of the femur, was removed during the third attempt to control the bleeding and only then was the source revealed. Diagnostic difficulty delayed definitive treatment.- - - - - - - - - - ranking = 1keywords = difficulty (Clic here for more details about this article) |
6/27. pycnodysostosis presenting with bilateral subtrachanteric fractures: case report.A 50-year-old woman had bilateral subtrochanteric fractures over a period of 9 months; both fractures were found to be in osteosclerotic femora. The patient was multiparous with 5 normal children. Since subtrochanteric fractures represent only 5 per cent of all femoral neck fractures the occurrence of bilateral subtrochanteric fractures in a relatively young woman suggested an unsuspected underlying disease. Clinical and laboratory investigations showed no evidence of systemic, metabolic, infective or malignant disease. The patient's short stature, peculiar facies in association with osteosclerosis in medullated long bones and typical radiographic findings: hypoplastic claviculae, absent ungual tufts of distal phalanges, hypoplastic paranasal sinuses, and obtuse mandibular angles suggested the proposed diagnosis of pycnodysostosis, a rare autosomal recessive osteosclerotic condition, that has been described in less than 50 cases, including only one Jew. Despite 2 technically difficult surgical hip operations, a 3-year follow-up showed good remedullarization of both fractured femora and no limitation in the patient's daily activities.- - - - - - - - - - ranking = 4.9503461818707keywords = limitation (Clic here for more details about this article) |
7/27. Retrograde intramedullary Huckstep nailing for supracondylar fracture of femur after total knee arthroplasty.Supracondylar fracture of femur after total knee arthroplasty (TKA) presents a challenge for orthopedic surgeons. It is controversial to treat such a fracture by using closed method or open method. Nonunion, malunion, knee rigidity and other complications in prolonged immobilization were noted in the closed method. Implant migration, infection, nonunion and malunion were also reported in open reduction treatment because of the difficulty to achieve rigid fixation. In this periprosthetic fracture, retrograde intramedullary Huckstep nailing provides a better chance to get rigid fixation compared with other fixation device, especially in osteopenic bone. We reported 2 cases with supracondylar fracture of femur after total knee arthroplasty that have been successfully treated with retrograde intramedullary nailing.- - - - - - - - - - ranking = 1keywords = difficulty (Clic here for more details about this article) |
8/27. Treatment of pathological fracture of the femur due to diffuse haemangioma in the lower limb.We describe two patients with a diffuse haemangioma of the lower limb complicated by pathological fracture of the femoral shaft, one of whom was treated by a bone graft and immobilisation in a cast, and the other by external fixation and injection of bone marrow. A review of the literature identified difficulty in control of bleeding and obtaining bony union.- - - - - - - - - - ranking = 1keywords = difficulty (Clic here for more details about this article) |
9/27. Differential diagnosis of a femoral neck/head stress fracture.STUDY DESIGN: Resident's case problem. BACKGROUND: Identifying stress fractures of the hip can be a challenging differential diagnosis. pain presentation is not always predictable and radiographs may not show the fracture, especially during its early stages. hip stress fractures left untreated can displace and necessitate open reduction internal fixation or total hip arthroplasty. diagnosis: A 70-year-old woman presented to the physical therapy clinic with complaints of right hip pain. She had been evaluated by a physician and radiographs of the hip, which revealed some arthritic changes, were otherwise normal. Upon examination, the physical therapist observed an antalgic gait, a noncapsular pattern of limitation of hip motion, an empty painful end feel at the end range of motion (ROM) for hip abduction, external rotation, and flexion, and extreme tenderness to palpation over the anterior hip region. The therapist suspected a more pernicious problem than osteoarthritis and discussed his suspicion with the physician. The physician subsequently requested an MRI that revealed a femoral neck and head stress fracture that was later confirmed with a bone scan. The patient was provided with a walker for ambulation with a non-weight-bearing status for 6 weeks, after which she returned to physical therapy for progressive weight bearing and strengthening. She was discharged with a relatively pain-free hip and was ambulating with a cane. A 2-month follow-up examination revealed a pain-free hip and a return to all premorbid activities, including ambulation without an assistive device. DISCUSSION: The presence of a normal radiograph of the hip should not be considered conclusive in ruling out a stress fracture in the hip region. The current case demonstrates how careful evaluation can reveal occult pathologies and prevent potentially catastrophic morbidity.- - - - - - - - - - ranking = 1191.3690747074keywords = ambulation, limitation (Clic here for more details about this article) |
10/27. Early rehabilitation following surgical fixation of a femoral shaft fracture.BACKGROUND AND PURPOSE: The purpose of this case report is to describe the outcome of a patient following fixation of a midshaft femur fracture and an evaluation-based, immediate-weight-bearing approach to rehabilitation. CASE DESCRIPTION: The patient was a 28-year-old male manual laborer whose left femur was fractured in a head-on motor vehicle accident. The patient was treated with internal fixation of the left femur by use of an antegrade intramedullary nail. Following surgery, impairments in range of motion, knee extensor and hip abductor strength, and gait were observed. Intervention focused on immediate weight bearing and early progression of strengthening to address the observed impairments. OUTCOMES: All of the patient's impairments improved, and he was able to return to work as a manual laborer within 6 months. DISCUSSION: Immediate weight bearing with early strengthening activities following surgical correction of a midshaft femur fracture may result in early resolution of impairments and functional limitations and decreased disability.- - - - - - - - - - ranking = 4.9503461818707keywords = limitation (Clic here for more details about this article) |
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