1/16. An unusual extraspinal cause of bilateral leg pain.low back pain with pain radiating to the lower extremities is common in patients referred to a spine center. Lumbar spine pathology is commonly the etiology of such symptoms, but extraspinal causes of back and leg pain can manifest as a radicular disorder. Extraspinal etiologies must be considered in the workup of back and leg pain. This report describes an unusual case of spontaneously occurring bilateral femoral neck stress fractures presenting as low back pain with seemingly bilateral L4 radicular symptoms.- - - - - - - - - - ranking = 1keywords = spine, spinal (Clic here for more details about this article) |
2/16. Stress fracture of the hip and pubic rami after fusion to the sacrum in an adult with scoliosis: a case report.Correction of adult scoliosis frequently involves long segmental fusions, but controversy still exists whether these fusions should include the sacrum. It has been suggested that forces associated with activities of daily living transfer the stresses to the remaining levels of the spine and to the pelvis. The case described here was a 43-year-old woman with scoliosis and chronic back pain refractory to non-surgical modalities. Radiographically, the patient had a 110 degree lumbar curve. An anterior and posterior fusion with Luque-Galveston instrumentation was performed. Six months postoperatively the patient returned with a 2-week history of right hip pain with no history of trauma. There was radiographic evidence of a displaced femoral neck fracture and pubic rami fractures. The femoral neck fracture was treated with a total hip replacement. Further surgeries were required to correct a lumbar pseudoarthrosis and hardware failure. We believe that this case provides evidence that fusion into the lumbosacral junction may distribute forces through the pelvic bones and hip resulting in stress and potential hardware complications, especially in patients at risk due to osteopenic conditions.- - - - - - - - - - ranking = 0.15290590075033keywords = spine (Clic here for more details about this article) |
3/16. Kirschner wires caused unexpected complications of femoral neck fracture.OBJECTIVE: To report a unique complication of the surgical treatment of femoral neck fractures. CLINICAL PRESENTATION AND INTERVENTION: A young adult presented with lower abdominal pain and bleeding per rectum caused by rectal transfixion by Kirschner wires (K wires). The wires were used to fix a fracture on the neck of the femur during the Iraqi occupation of kuwait. A plain X-ray showed an old united fracture of the neck of the left femur with coxa magna, mild coxa vara and mild secondary osteoarthritis of the left hip joint. Limited barium enema disclosed transfixion of the rectum by two radiopaque K wires in the pelvis with rectal track formation around them. The complication necessitated a laparotomy and a major dissection to remove the K wires. CONCLUSION: The K wire provided an immediate solution during a difficult period. However, since it is not normally used for this purpose, it caused subsequent complications that were resolved by laparotomy and a major dissection.- - - - - - - - - - ranking = 3480.1372826692keywords = osteoarthritis (Clic here for more details about this article) |
4/16. Acute toxicity of local anesthetic ropivacaine and mepivacaine during a combined lumbar plexus and sciatic block for hip surgery.Hip fracture is a common pathology in elderly patients. Intercurrent diseases, mainly cardiac and respiratory, often result in significant morbidity and mortality. anesthesia for hip fracture can be provided by general or regional techniques. The combination of a lumbar plexus and posterior sciatic nerve block represents an alternative to neuraxial technique of anaesthesia such as spinal anesthesia (4, 6). We report a case of acute toxicity resulting in the injection of local anesthetics Ropivacaine and mepivacaine in elderly patient. An elderly woman was scheduled for surgical repair of a fractured femur neck by dynamic hip screw synthesis. anesthesia was realized by peripheral nerve bi-block (lumbar plexus and posterior sciatic block) (7). The patient experienced seizures and dysrhythmias twenty minutes after block completion and injection of the anesthetic solution [Ropivacaine 0.75%, administered for lumbar plexus block performed via the posterior approach (WINNIE) and mepivacaine 1.5%, administered for posterior sciatic nerve block (LABAT)]. cardiopulmonary resuscitation was successful. All signs of toxicity disappeared after injection of midazolam and atropine, intubation and 100% oxygen ventilation. We decided to proceed with surgery. The postoperative course was uncomplicated and made a full recovery.- - - - - - - - - - ranking = 0.11569803308322keywords = spinal (Clic here for more details about this article) |
5/16. Non-operative management of a peri-prosthetic subcapital fracture after metal-on-metal Birmingham hip resurfacing.We describe a patient who sustained a peri-prosthetic fracture of the femoral neck two weeks after undergoing a resurfacing procedure for osteoarthritis of the hip. The fracture was minimally displaced and a satisfactory outcome was obtained following conservative treatment.- - - - - - - - - - ranking = 3480.1372826692keywords = osteoarthritis (Clic here for more details about this article) |
6/16. Cerebral fat embolism diagnosed by magnetic resonance imaging at one, eight, and 50 days after hip arthroplasty: a case report.PURPOSE: To describe cardiovascular collapse during a cemented hip hemiarthroplasty in a patient who, despite a successful cardiopulmonary resuscitation, remained in a persistent vegetative state due to cerebral fat embolism diagnosed by magnetic resonance imaging (MRI). CLINICAL FEATURES: A 75-yr-old woman with no medical history underwent cemented hip hemiarthroplasty under spinal anesthesia for a right femoral neck fracture. Shortly after insertion of the prosthesis, a sudden oxygen desaturation, hypotension, bradycardia, and cardiac arrest occurred. The patient was successfully resuscitated, but did not regain consciousness. The patient developed high-grade fever, thrombocytopenia, anemia, and oliguria. MRI scans of the brain revealed multiple high intensity signals throughout the white matter, the basal ganglia, the cerebellum, and the brain stem. The diagnosis of fat embolism was made on the basis of clinical findings and MRI images. Although her cardiorespiratory status improved over the next week, the patient remained in a persistent vegetative state. CONCLUSION: When fat embolism is suspected, serial MRI scans of the brain should be performed to diagnose the etiology of cerebral embolism as well as to evaluate the severity of brain damage.- - - - - - - - - - ranking = 0.11569803308322keywords = spinal (Clic here for more details about this article) |
7/16. Unusual stress fracture of the femoral neck in a young adult not caused by excessive stress: a case report.A 30-year-old man complained of a 10-day history of gradual onset of severe left leg pain. He did not have any history of trauma or excessive training. Routine laboratory data showed no abnormal findings. He was able to perform passive motions of the hip joint without pain, but active motion of the left hip joint was impossible due to anterolateral thigh pain. Plain radiographs of the hip showed no abnormal findings. However, bone scintigraphy indicated trace accumulation in the left femoral neck, and T(1)-weighted magnetic resonance imaging showed a linear low signal on the inferomedial aspect of the femoral neck. Bone mineral density of the lumbar spine was 1.053 g/cm(2), which ruled out osteoporosis. The thigh pain was resolved 2 months after onset with conservative treatment, when plain radiographs showed sclerotic change and a reduction in the intensity of the low signal of T(1)-weighted magnetic resonance imaging. Our diagnosis of unusual stress fracture indicates that the possibility of stress fractures without bone fragility should be kept in mind when young adults complain of atypical pain even without evidence of unusual activities.- - - - - - - - - - ranking = 0.15290590075033keywords = spine (Clic here for more details about this article) |
8/16. osteoporosis and hip fracture in a young woman with anorexia nervosa.A 35-year-old woman with a 17-year history of anorexia nervosa (AN) sustained a pathologic fracture of the hip. osteoporosis was confirmed by quantitative computed tomography of the lumbar spine and transiliac bone biopsy. Severe bone disease may exist in the anorexia nervosa syndrome and may to some extent be reversible on treatment of the underlying condition. AN could have profound effects on the peak bone mass achieved in the lifetime of the individual. Asymptomatic and symptomatic osteoporosis in young women may be based upon AN. patients should be informed that osteoporosis can cause pathologic fractures as a sequela of self-imposed chronic malnutrition.- - - - - - - - - - ranking = 0.15290590075033keywords = spine (Clic here for more details about this article) |
9/16. hemorrhage into a spinal ependymoma after peridural anesthesia.The authors present a case of the accidental puncture of a spinal ependymoma causing bleeding and an increase in the preexisting neurological deficits.- - - - - - - - - - ranking = 0.57849016541612keywords = spinal (Clic here for more details about this article) |
10/16. Anatomico-radiological study of an ununited intracapsular fracture of the femoral neck dating back 47 years. Data relevant to osteoarthritis, bone infarct, and Paget's disease of the bone.This is the anatomico-radiological study of a 47-year-old ununited intracapsular fracture of the hip. The femoral head was osteoporotic but its center contained a zone of osteomedullary necrosis in the form of a bone infarct. Its contour was reshaped and remnants of articular cartilage were covered by osteophyte-like bone formations; furthermore, an acetabular osteophyte was observed. Histological signs of Paget's disease of the bone were observed in the medial part of the femoral stump. The findings in this case provide the basis for a discussion of the pathogenesis of osteophytes in osteoarthritis, the pathogenesis of bone infarcts (and the distinction between this condition and another form of aseptic osteonecrosis), and the role of mechanical stresses in the development of Paget's disease of the bone.- - - - - - - - - - ranking = 17400.686413346keywords = osteoarthritis (Clic here for more details about this article) |
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