1/68. Patellar stress fracture: a complication of knee joint arthroplasty without patellar resurfacing.A case of patellar stress fracture after total knee arthroplasty in a man with gout and previous osteonecrosis of the tali is reported. The combination of fat pad excision and lateral release causing disruption to the patellar blood supply during primary total knee arthroplasty resulted in the development of a patellar fracture. Avascular necrosis, caused by gout, may form part of the pathogenesis.- - - - - - - - - - ranking = 1keywords = fracture (Clic here for more details about this article) |
2/68. Heat-induced segmental necrosis after reaming of one humeral and two tibial fractures with a narrow medullary canal.In three cases referred to our clinic (a simple fracture of the humeral shaft, a simple, closed fracture, and a wedge fracture of the mid-third of the tibia), bone necrosis had resulted from excessive heat produced by reaming extremely narrow medullary cavities (5-5.5 mm diameter) with the 9 mm front-cutting reamer as part of a reamed nailing procedure. In any one case, different degrees of damage can occur from the metaphysis to the diaphysis. Based on the clinical course and the histological evaluation, we postulate that heat-induced damage can be divided into four degrees of severity (0-3): Grade 0: no damage; no devascularization, no heat-induced damage. Grade 1: The heat damaged zone is cut away during subsequent reaming, the only damage is devascularization. Grade 2: The damaged zones are not eliminated by subsequent reaming. The bone is devascularized and heat damaged. Grade 3: The entire cross section of the bone including the periosteum is devitalized by exposure to excessive heat. Depending on the severity of additional damage to the soft tissues, grave consequences are to be expected and further operations are unavoidable. The effects of heat-induced damage are particularly critical in the presence of infection (cases 2 and 3). The fundamental aspects and the extent of heat necrosis will be discussed. After discussion with the AO Technical Commission on the cause of heat-induced necrosis, we would recommend the following preventive measures: 1. preoperative measurement of the smallest diameter of the medullary cavity in two planes. 2. reaming with the standard instrumentation (9 mm) only if the medullary cavity has a diameter of at least 8 mm at its narrowest point. 3. Extremely narrow cavities should first be reamed manually or an alternative to nailing should be sought. 4. It is strongly recommended that only sharp reamers be used in such cases and blunt or damaged reamers replaced.- - - - - - - - - - ranking = 1.1666666666667keywords = fracture (Clic here for more details about this article) |
3/68. Avascular necrosis of the distal phalangeal epiphysis following physeal fracture: a case report.Avascular necrosis of the distal phalangeal epiphysis following an unrecognized angulated Salter II fracture of the distal phalanx treated by open reduction and internal fixation resulted in premature closure of the growth plate and mild shortening. The epiphysis itself revascularized and good function of the distal interphalangeal joint was maintained.- - - - - - - - - - ranking = 0.83333333333333keywords = fracture (Clic here for more details about this article) |
4/68. Unusual complications in an inflammatory abdominal aortic aneurysm.An unusual case of an inflammatory abdominal aortic aneurysm (IAAA) associated with coronary aneurysms and pathological fracture of the adjacent lumbar vertebrae. The associated coronary lesions in cases of IAAA are usually occlusions. In the present case, it was concluded that a possible cause of the coronary aneurysm was coronary arteritis and the etiology of the pathological fracture of the lumbar vertebrae was occlusion of the lumbar penetrating arteries due to vasculitis resulting in aseptic necrosis. Inflammatory AAA can be associated with aneurysms in addition to occlusive disease in systemic arteries. The preoperative evaluation of systemic arterial lesions and the function of systemic organs is essential.- - - - - - - - - - ranking = 0.33333333333333keywords = fracture (Clic here for more details about this article) |
5/68. Subchondral insufficiency fracture of the femoral head and medial femoral condyle.This case report documents the clinical, radiographic, and histologic findings in a 69-year-old obese man, who had subchondral insufficiency fracture both in the femoral head and medial femoral condyle. On plain radiographs, both lesions underwent subchondral collapse. Magnetic resonance images of the left hip showed a bone marrow edema pattern with associated low-intensity band on T1-weighted images, which was convex to the articular surface. The histopathologic findings in the hip and knee were characterized by the presence of a subchondral fracture with associated callus and granulation tissue along both sides of a fracture line. There was no evidence of antecedent osteonecrosis. To our knowledge, this is the first case report to describe the multiple occurrence of collapsed subchondral insufficiency fracture.- - - - - - - - - - ranking = 1.3333333333333keywords = fracture (Clic here for more details about this article) |
6/68. Avascular necrosis after minimally displaced talus fracture in a child.This is a case report of a delayed diagnosis in a 5 year old child who sustained a minimally displaced fracture of the proximal or posterior aspect of the talar neck of the left foot with no subluxation at the subtalar or ankle joint of his left talus. Avascular necrosis (AVN) appeared 6 months after the injury. The further course was protracted with another 12 months of non-weight bearing. The case was followed until 36 months after the injury with nearly full functional recovery. An extensive literature review revealed a calculated incidence of AVN after reportedly non-displaced talus fractures in children of 16 per cent which is considerably more than is reported in adults. Nearly half of all reported cases occurred after the fracture had been missed initially. 8 of 11 cases with reported age occurred between 1 and 5 years. No child was older than 9 years, which indicates that the immature talus may be more prone to AVN. Some possible causes for the higher incidence of AVN in children with non-displaced talus fractures are discussed. Prolonged non weight-bearing cannot be recommended, since it reportedly does not alter the course of the disease.- - - - - - - - - - ranking = 1.3333333333333keywords = fracture (Clic here for more details about this article) |
7/68. Fishtail deformity following fracture of the distal humerus in children: historical review, case presentations, discussion of etiology, and thoughts on treatment.Fishtail deformity is an uncommon complication of distal humeral fractures in children. This article reports four cases accompanied by premature closure of a portion of the distal humeral physis with resultant deformity, length retardation, decreased elbow motion, and functional impairment. The ages of the patients at time of injury ranged from 4 years 2 months to 6 years 1 month (average 5 years 4 months). The average length of follow-up was 9 years 9 months (range, 3 years 5 months to 18 years 10 months). The cause of the arrest is multifactorial and may be due to a gap in reduction of an intracondylar fracture, avascular necrosis of the epiphysis, or central premature physeal arrest (bar formation) without a fracture gap or avascular necrosis. If identified in a young child, surgical closure of the medial and lateral portion of the physis may prevent the deformity from progressing and would not cause significant additional humeral length discrepancy.- - - - - - - - - - ranking = 1.1666666666667keywords = fracture (Clic here for more details about this article) |
8/68. Spontaneous osteonecrosis of the knee associated with ipsilateral tibial plateau stress fracture: report of two patients and review of the literature.Two cases are presented of spontaneous osteonecrosis of the knee (SONK) associated with stress fractures of the tibial plateau. This association lends further credence to the postulate that SONK has a traumatic etiology.- - - - - - - - - - ranking = 0.83333333333333keywords = fracture (Clic here for more details about this article) |
9/68. Prediction of osteonecrosis by magnetic resonance imaging after femoral neck fractures.Thirty-one patients undergoing internal fixation for femoral neck fractures who were examined by magnetic resonance imaging at 2, 6, and 12 months after surgery and who could be followed up more than 2 years were enrolled in the current study. The items investigated were timing of the appearance of the band image on T1 weighted images, magnetic resonance imaging classification, and plain radiographs. Band images were observed 2 months after surgery in eight patients and 6 months in 12 patients (39% of all patients). According to the location and extent of the band image on magnetic resonance imaging, one patient was classified in the B1 Group (lateral type), four patients in the B2 Group (surface type), three patients in the B3 Group (intermediate type), and four patients in the B4 Group (extended type). Band images appeared in all patients in the B4 Group 6 months after surgery. Femoral heads of the patients in the B3 and B4 Groups by magnetic resonance imaging classification all were collapsed. On plain radiographs, osteonecrosis of the femoral head could be diagnosed in eight patients between 11 and 24 months after injury. The interval giving the greatest sensitivity, specificity, and accuracy of the diagnosis of osteonecrosis of the femoral head by magnetic resonance imaging was 6 months after surgery.- - - - - - - - - - ranking = 0.83333333333333keywords = fracture (Clic here for more details about this article) |
10/68. Scapho-capitate fracture syndrome. A case report.A rare injury of the wrist, scapho-capitate fracture syndrome, in a young patient is reported. Despite early recognition of the injury and surgical intervention, the scaphoid fracture did not unite and another attempt to achieve union with bone grafting and internal fixation also failed. The wrist continued to be painful and stiff. Radiographs of the wrist, 18 months after the injury, showed nonunion of the scaphoid, avascular necrosis of the scaphoid and the lunate and carpal collapse with midcarpal joint arthritis. Due to persistent and disabling symptoms arthrodesis of the wrist had to be carried out. Possible causes for the bad outcome after this injury are discussed. We recommend open reduction for the fracture of the capitate and open reduction and internal fixation with primary bone grafting for a displaced comminuted scaphoid fracture.- - - - - - - - - - ranking = 1.3333333333333keywords = fracture (Clic here for more details about this article) |
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