1/76. Fracture of the femoral component associated with polyethylene wear and osteolysis after total knee arthroplasty.Fracture of the femoral component associated with polyethylene wear and osteolysis after total knee arthroplasty (TKA) has not been well reported before. A 63-year-old man with osteoarthritis of the right knee underwent TKA with a New Jersey LCS knee, with cementing on the tibia and patella but not on the femoral component. After 42 months, in addition to wearing of polyethylene of the tibia and patella, severe osteonecrosis of the medial femoral condyle was noted. osteonecrosis caused loss of osseous support of the medial flange of the femoral component, and the bone ingrowth of the central and lateral flange to the distal femur was so good that it overcame the yield stress of the metal of the femoral component and caused fracture of the femoral component. The osteolytic area was filled with autogenous iliac bone, and a new femoral component was inserted and cemented. The patient's condition became satisfactory with relief of pain. Although uncommon, fracture of the femoral component does occur associated with polyethylene wear and osteolysis.- - - - - - - - - - ranking = 1keywords = fracture (Clic here for more details about this article) |
2/76. Severe osteoporosis in familial hajdu-cheney syndrome: progression of acro-osteolysis and osteoporosis during long-term follow-up.hajdu-cheney syndrome is an autosomal dominant inherited osteodysplastic bone disease with the hallmarks of acro-osteolysis, skull deformations, and generalized osteoporosis. Very few patients have been followed long-term with respect to the prognosis of acro-osteolysis and osteoporosis. Here we describe a 39-year-old woman and her 19-year-old daughter who are both affected with the hajdu-cheney syndrome. Skeletal lesions were followed in the mother between the ages of 22 and 39 years. The acro-osteolytic lesions progressed markedly and caused shortening of several fingers; some end phalanges had completely disappeared. Severe spinal osteoporosis with serial vertebral fractures was found at the age of 22 years. New vertebral fractures developed until the age of 33 years, but did not progress afterward. High turnover osteoporosis was found in the bone histology of iliac crest biopsies performed at the ages of 22 and 34 years. Bone mineral content (BMC) was strikingly decreased at the age of 34 years (T score -5.1 SD) and did not significantly change during further follow-up. In the daughter, BMC failed to increase between the ages of 12 and 19 years and was also markedly decreased (T score -4.4 SD). This suggests that osteoporosis in hajdu-cheney syndrome is related to a low peak bone mass and a high bone turnover, leading to insufficient bone formation compared with the increased bone resorption.- - - - - - - - - - ranking = 1keywords = fracture (Clic here for more details about this article) |
3/76. Acute periprosthetic fracture of the acetabulum associated with osteolytic pelvic lesions: a report of 3 cases.Three cases of acute acetabular fracture around uncemented porous-coated acetabular components associated with osteolytic lesions of the pelvis are reported. In each case, the fracture occurred through an area of severe osteolysis that contributed to the structural failure of the pelvis. None of the fractures were associated with significant trauma, and none of the implants demonstrated evidence of loosening before the fracture. When marked pelvic osteolysis develops around the acetabular component of a total hip arthroplasty, the possibility of pelvic fracture must be considered. Total hip arthroplasty patients with osteolysis should be followed with radiographs at regular and frequent intervals. When osteolysis progresses, early intervention should be strongly considered because appropriate treatment may prevent fracture occurrence.- - - - - - - - - - ranking = 5keywords = fracture (Clic here for more details about this article) |
4/76. Osteolysis of the pelvis presenting as insufficiency fracture in a patient with rheumatoid arthritis.Physician awareness of the risk of osteoporosis and subsequent fractures in a patient with a history of long-term steroid treatment is high. The tendency to assume that a fracture is owing to steroid-induced osteoporosis may result in an unnecessarily intense antiresorptive treatment regimen for a patient who may not have osteoporosis. I report here about a patient with rheumatoid arthritis who presented with bone fracture despite antiresorptive therapy and without evidence of osteoporosis by bone mineral density testing.- - - - - - - - - - ranking = 3.5keywords = fracture (Clic here for more details about this article) |
5/76. cementoplasty and the oncologic population.The first and only description of percutaneous cementoplasty, to date, has been described in the French medical literature in 1994. In this series of 12 cases, radiologists successfully instilled a cement derivative into the acetabulum under fluoroscopic control. As in these cases, the major indication for cementoplasty is to provide pain control and stabilization of an osteolytic lesion. Potential complications include physical or thermal damage to the adjacent neurovascular structures, either during needle positioning or from cement leakage, respectively. Although no absolute contraindications exist, one should proceed cautiously in patients with coagulopathies. Results may be suboptimal as well in patients with pathologic fractures.- - - - - - - - - - ranking = 0.5keywords = fracture (Clic here for more details about this article) |
6/76. Increased T2 signal intensity in the distal clavicle: incidence and clinical implications.OBJECTIVE: The objectives of the current study were (1) to quantify the incidence of increased T2 signal in the distal clavicle and (2) to assess the clinical significance of this finding in patients with chronic acromioclavicular (AC) joint pain. DESIGN AND patients: Eight patients (five male and three female, 15-41 years of age) with disabling shoulder pain localized to the AC joint and marked increased T2 signal in the distal clavicle are presented. These eight patients underwent MR examination over a 25 month period (August 1996 to September 1998). The dictated reports of all shoulder MR examinations conducted over this same time period were reviewed retrospectively for the presence of signal abnormality in the distal clavicle. Clinical data and, in five patients, findings at shoulder arthroscopy or open surgery, were correlated with the results of MR imaging. One patient underwent arthroscopy on both shoulders. RESULTS: The selected eight patients each presented clinically with disabling shoulder pain localized to the AC joint. One patient is presented twice, as both shoulders were symptomatic (n=9). Plain film examination (9/9) failed to indicate a structural cause of shoulder pain in any of the patients. MR examination demonstrated abnormally increased T2 signal in the distal clavicle in all nine cases and no other cause for AC joint pain. Three patients responded to a course of conservative therapy. Six experienced refractory pain despite conservative therapy. Resection of the distal clavicle was performed in five of the six cases. All patients who underwent resection of the distal clavicle experienced complete resolution of AC joint pain. A retrospective review of the dictated reports for all shoulder MR imaging examinations performed at out institution over a 25 month period (August 1996 to September 1998; n=761) demonstrated a 12.5% incidence of abnormally increased T2 signal in the distal clavicle. CONCLUSIONS: Increased T2 signal in the distal clavicle is a relatively common finding (12.5%) on MR imaging examinations of the shoulder and in most cases is of no clinical significance. However, in patients with chronic AC joint pain and no other abnormality on plain film or MR imaging, increased T2 signal may represent an early manifestation of, or a process similar to, osteolysis of the distal clavicle. patients with this presentation who continue to suffer from disabling pain following conservative therapy may benefit from surgical resection of the distal clavicle.- - - - - - - - - - ranking = 0.00040922909411947keywords = open (Clic here for more details about this article) |
7/76. Progressive erosive arthropathy with contractures, multicentric osteolysis-like changes, characteristic craniofacial appearance, and dermatological abnormalities: a new syndrome?We report a 27-year-old man with an apparently new syndromic form of progressive erosive arthropathy and contractures of small and large joints associated with mild epiphyseal changes, normal vertebrae, and generalized osteopenia. The patient had a characteristic craniofacial appearance, dermatological abnormalities, and normal intelligence. The head was large with frontal bossing. The face was elongated with malar hypoplasia, thin upper lip, prominent lower jaw, high arched palate, dental malocclusion, and prominent ears with absent ear lobules. Dermatological abnormalities included malar erythema and facial telangiectasia together with multiple nevi and lentigenes all over the body. Pseudorheumatoid arthropathy, spondyloarthropathy, and Borrone dermatocardioskeletal syndrome were considered in the differential diagnosis and were excluded. Also, no similar cases have been found in POSSUM or the london Dysmorphology databases.- - - - - - - - - - ranking = 0.00040922909411947keywords = open (Clic here for more details about this article) |
8/76. Massive osteolysis of the humerus with spontaneous recovery.An elderly woman presented with a pathological fracture of the right humerus. Progressive dissolution of the shaft of this bone took place over six months. No cause could be established and the patient refused biopsy. With only simple splintage for treatment the humeral shaft gradually reformed and re-ossified over a period of two years. The patient has been under review for four and a half years and no further pathology has come to light. The cause of the osteolysis remains obscure.- - - - - - - - - - ranking = 0.5keywords = fracture (Clic here for more details about this article) |
9/76. eosinophilic granuloma masquerading as fracture of the orbital roof: case report.Orbital involvement of eosinophilic granuloma accounts for less than 1% of all orbital tumors. The most common presenting sign of eosinophilic granuloma is bilateral or unilateral proptosis; rarely, neural parenchyma involvement is observed. This article features a case report of a 16-year-old male patient who presented to the authors after minor trauma that simulated a fracture near the orbital apex. The authors conclude that the diagnosis of eosinophilic granuloma should be considered if there is unusual location of apparent "fracture," a mass in the region of the fracture, lysis of bone, and recurrence of inflammation after the initial injury has subsided. Timely intervention with appropriate excision, histologic confirmation, and reconstruction with proper follow-up are the cornerstones of therapy for this rare disorder.- - - - - - - - - - ranking = 3.5keywords = fracture (Clic here for more details about this article) |
10/76. Percutaneous vertebroplasty in the management of a patient with malignant pain and associated osteolytic compression fractures.Percutaneous vertebroplasty is a minimally invasive procedure that is effective in the treatment of pain resulting from pathologic compression fractures, osteolytic bone metastases from solid tumors, myeloma, vertebral hemangioma, and osteoporotic compression fractures. A discussion of a patient with severe, aggressive metastatic breast cancer to the spine with compression and osteolysis of multiple lumbar vertebral bodies is presented. Despite treatment with opiates, chemotherapy, radiation therapy, and the implantation of a morphine pump, her pain was not adequately treated until she underwent multilevel vertebroplasty. The clinical and technical application of vertebroplasty in the context of the management of vertebral pain of malignant origin is presented as an integral part of multidisciplinary pain management.- - - - - - - - - - ranking = 3keywords = fracture (Clic here for more details about this article) |
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