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1/14. Nonunion of tibial stress fractures in patients with deformed arthritic knees. Treatment using modular total knee arthroplasty.

    In two years we treated four women with ununited stress fractures of their proximal tibial diaphyses. They all had arthritis and valgus deformity. The stress fractures had been treated elsewhere by non-operative means in three patients and by open reduction and internal fixation in one, but had failed to unite. After treatment with a modular total knee prosthesis with a long tibial stem extension, all the fractures united. A modular total knee prosthesis is suitable for the rare and difficult problem of ununited tibial stress fractures in patients with deformed arthritic knees since it corrects the deformity and the adverse biomechanics at the fracture site, stabilises the fracture and treats the arthritis.
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keywords = fracture
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2/14. Spontaneous atlantoaxial rotatory fixation in old age after cerebral infarction: case report.

    STUDY DESIGN: Case report of spontaneous Fielding and Hawkins Type I atlantoaxial rotatory fixation in a 78-year-old man after hemiplegia and homonymous hemianopsia caused by cerebral infarction. OBJECTIVES: To describe a case of spontaneous atlantoaxial rotatory fixation in old age and review previous adult cases of atlantoaxial rotatory fixation without fracture. SUMMARY OF BACKGROUND DATA: Atlantoaxial rotatory fixation in adults is a relatively rare finding and is mainly caused by trauma. To the author's knowledge, there has been no previous report of spontaneous atlantoaxial rotatory fixation in old age. methods: The patient's head was fixed in a 40 degrees left-rotated position. Left hemiplegia and homonymous left-side hemianopsia developed due to cerebral infarction. Computed tomography of the cervical spine clearly showed rotatory fixation of the atlas on the axis. RESULTS: Successful reduction was obtained after 1 day of skull traction. CONCLUSIONS: It was hypothesized that repeated left-rotational stress due to homonymous hemianopsia loaded to the atlantoaxial joint caused abnormal laxity of the joint.
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keywords = fracture
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3/14. Failure of active extension after traumatic cubitus varus. A case report.

    In children cubitus varus is common after malunion of a supracondylar fracture of the humerus. Later problems such as tardy ulnar nerve palsy, snapping of the lateral triceps tendon or ulnar nerve and posterolateral rotatory instability are well documented. We present a case of anteromedial dislocation of the entire triceps tendon with loss of extensor power and describe the method of treatment.
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ranking = 0.1
keywords = fracture
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4/14. arthroplasty in treating knee osteoarthritis and proximal tibia stress fracture.

    The authors describe two cases of severely angulated tibial non-unions after proximal tibia stress fractures associated with ipsilateral osteoarthritis treated with modular knee endoprosthesis with a long tibial stem to stabilize non-union fragments. During the procedure, no additional osteosynthesis or bone grafting was added. Both non-unions healed after 6 months with no post-operative complications. The authors suggest implantation of modular knee endoprosthesis, as a single procedure, in treatment of proximal tibia non-union after a stress fracture as a result of severe varus/valgus deformity. It provides a solution for osteoarthritis treatment, axis correction and non-union osteosynthesis.
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ranking = 0.6
keywords = fracture
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5/14. Progressive cubitus varus due to a bony physeal bar in a 4-year-old girl following a supracondylar fracture: a case report.

    We report a case of progressive cubitus varus deformity caused by a physeal bar following a supracondylar humeral fracture in a 4-year-old girl. Malreduction is thought to be the commonest cause of this deformity, which is nonprogressive. A corrective osteotomy in cases like ours should be deferred until skeletal maturity.
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ranking = 0.5
keywords = fracture
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6/14. Stress fracture of the distal tibia secondary to severe knee osteoarthritis: a case report.

    Stress fracture of the tibia secondary to sports-related activities is relatively common, but rarely occurs secondary to osteoarthritis of the knee. Such fractures usually involve the proximal tibia. We report a 61-year-old woman with osteoarthritis and severe varus deformity of the knee who had a stress fracture of the distal tibial shaft. The patient had declined total knee replacement for severe osteoarthritis. She developed a stress fracture that subsequently malunited. The patient presented late and the diagnosis was not made for several months. The pathomechanics, diagnosis, and management options for this patient are discussed.
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keywords = fracture
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7/14. Premature closure of the distal radial physis after fracture of the distal radial metaphysis.

    Two fractures of the distal radius seemingly with lack of involvement of the distal radial physis are presented. Nevertheless, complete arrest of the adjacent physis occurred, suggesting a Salter-Harris V mechanism of injury to the vulnerable distal radial physis. Ulnar "overgrowth" produced impingement of the carpus and functional complaints sufficient to warrant treatment. In this clinical setting, an ulnar-shortening osteotomy done at skeletal maturity resulted in marked improvement in the range of motion at the radiocarpal joint and corresponding improvement in function for both patients so treated.
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keywords = fracture
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8/14. Bilateral nonunited femoral neck fracture in a child with osteopetrosis.

    We report a case of osteopetrosis with bilateral nonunited femoral neck and coxa vara in a 7-year-old boy. There was a history of traumatic transcervical left femoral neck fracture unsuccessfully treated by internal fixation. We performed a bilateral subtrochanteric valgus osteotomy. K-Wire fixation failed on the right side due to hardness of the bone. Finally, internal fixation with an angular plate after predrilling of the femoral neck offered stability. Bone union was achieved on both sides, resulting in full recovery of normal physical activity.
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keywords = fracture
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9/14. Premature closure of the distal radial physis.

    Two cases of fracture of the radius treated by pinning resulted in severe wrist joint deformity due to premature closure of the epiphysial growth plate. Inappropriate pinning through the physis damaged the growth plate in both cases. They were treated by bone bridge resection with free fat interposition. The bone bar resection was effective in correcting the wrist joint deformity, and bone growth was expected without bone grafting.
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ranking = 0.1
keywords = fracture
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10/14. Secondary forearm deformity due to injury to the distal ulnar physis.

    We present a case of deformity of the forearm with painful functional limitation, after a fracture of the distal third of the radius associated with a nonapparent lesion of the distal physis of the ulna, Salter-Harris type V, suffered by a patient 6 years earlier. This fracture caused premature growth arrest in the bone. It was treated with a plane-oblique corrective osteotomy in the radius together with distal radio-ulnar arthrodesis, following the Sauve-Kapandji technique, with excellent cosmetic and functional results.
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ranking = 0.2
keywords = fracture
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