Cases reported "Femoral Fractures"

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1/75. Lower limb exsanguination and embolism.

    We report a case of fatal pulmonary embolism during lower limb exsanguination in orthopaedic surgery. A 76-year-old woman underwent an open fixation of an external femoral condyle fracture one day after injury. Subarachnoidal anaesthesia was performed and Esmarch compression bandages were applied in preparation for tourniquet ischaemia. At this time, the patient lost consciousness, became apneic and collapsed. resuscitation procedures were instituted and transoesophageal echocardiography revealed pulmonary embolism. In spite of haemodynamic support and thrombolytic therapy, the patient died. Postmortem examination revealed multiple thromboemboli of recent origin in the right heart cavities, in the pulmonary arteries and in the popliteal and tibial veins of the injured leg. Preventive, diagnostic and therapeutic options of this catastrophic event and indications of pulmonary embolectomy are discussed.
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keywords = tibia
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2/75. Occult fractures of tibial plateau detected employing magnetic resonance imaging.

    We describe two cases of spontaneous fracture at the tibial metaphysis not diagnosed by standard X-ray. In both cases, only magnetic resonance imaging supplied a precise diagnosis and allowed us to follow the evolution of the pathology. Scintigraphy is equally sensitive but unspecific. osteoporosis was noted in all cases. Hypothetically, similar pathological situations could be present without being diagnosed since they are not always detected by standard x-rays.
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keywords = tibia
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3/75. Distal femoral fracture through the screw hole of a ligament augmentation device fixation.

    SUMMARY: Complications associated with fixation of artificial ligaments in augmented repair of the anterior cruciate ligament (ACL) have been reported throughout the literature. However, fractures following ligament augmentation device (LAD) fixation appear to be rare. We report the case of a 43-year-old woman, injured in a road accident, who sustained a depressed fracture of the tibial plateau and knee instability. The fracture was reduced and the medial collateral ligament and the menisci were sutured. The torn ACL was repaired using the Marshall technique and augmented with an LAD in an over-the-top technique. Twenty-five months postoperatively, the patient sustained a distal femoral fracture through the screw hole of the former LAD fixation after a simple fall on the street.
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ranking = 1
keywords = tibia
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4/75. Multiple fracture of medullary tube during intramedullary nailing of long bone fractures.

    Intramedullary nailing is an accepted treatment for the fixation of femoral and tibial shaft fractures. There is a low but significant incidence of intraoperative complications during intramedullary nailing. During this procedure, a medullary tube may be used to exchange the bent olive-tipped reaming guidewire for the straight guidewire. A review of the literature found only one report of a fracture of the medullary tube. Two cases in which the medullary tube fractured into multiple pieces are presented.
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keywords = tibia
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5/75. Removal of the retained fragment of broken solid nails by the intra-medullary route.

    The development of solid nails has not eliminated the risk of occasional nail failure. It has been suggested that subsequent intra-medullary removal of solid nail fragment may be virtually impossible and thus major surgery is required for their revision. We report two cases of hardware failure of a solid intra-medullary nail (Synthes solid femoral and tibial nail) and describe their successful intra-medullary removal using the Synthes extraction kit.
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ranking = 1
keywords = tibia
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6/75. Medulloscopy for sepsis or nonunion: Early clinical experience with the tibia and femur.

    We report the clinical use of "medulloscopy" for the visualization and irrigation of sepsis or nonunion of the tibia and femur in 7 cases. Included were 2 cases of aseptic femoral nonunion, 1 infected femoral nonunion with chronic osteomyelitis, 2 cases of healed tibia fracture with chronic osteomyelitis, 1 aseptic nonunion of the tibia, and 1 case of tibial osteomyelitis secondary to intravenous drug use. Visualization of the nonunion site or pathologic lesion was achieved in 86% of cases (6 of 7) and additional diagnostic information was obtained by medulloscopy in 86% of cases (6 of 7). A representative case is presented. Medulloscopy appears to be clinically useful for the treatment of sepsis or nonunion of the tibia and femur when access to the intramedullary canal is necessary.
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ranking = 9
keywords = tibia
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7/75. Intra-articular fracture of the knee with spondyloepiphyseal dysplasia congenita: successful result of open reduction and internal fixation.

    In spondyloepiphyseal dysplasia congenita (SEDC), since the cartilage is congenitally abnormal, functional recovery of an intra-articular fracture is uncertain even with surgical treatment. We report a 29-year-old Japanese woman with SEDC whose left knee injury (intercondylar femur fracture and tibial plateau fracture) was surgically reduced and fixed. Although special care was required during the operation for associated atlantoaxial instability and cardiopulmonary suppression due to severe thoracolumbar kyphoscoliosis as well as osteopenia, she had neither restriction of knee motion nor pain at follow-up 2 years and 4 months after surgery. Therefore, although the situation involving fractures in a patient with SEDC is complicated, we believe the main problem to be solved is whether the risk-related kyphoscoliosis and atlantoaxial instability can be managed or not. Fractures themselves can be treated based on the principles used for patients without SEDC.
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ranking = 1
keywords = tibia
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8/75. Spontaneous fractures in the differential diagnosis of fractures in children.

    A four-year-old male with cerebral palsy and spasticity, as a result of a non-accidental head injury sustained when he was two years old, died of pneumonia. Postmortem full body x-rays revealed fractures of varying ages of the left humerus and both femora, tibiae, and fibulae. This led to a thorough investigation of the case by the Office of the Chief Medical Examiner. child abuse, accidents, metabolic bone disorders, other primary or secondary diseases of the bones, and pathological fractures were ruled out. The final diagnosis was spontaneous fractures secondary to osteopenia. The term spontaneous fractures is used to define fractures that occur without any known external cause, especially in cerebral palsy patients with spasticity.
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ranking = 1
keywords = tibia
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9/75. Unimuscular neuromuscular insult of the leg in partial anterior compartment syndrome in a patient with combined fractures.

    A complicated case of ipsilateral fractures of the left femur and tibia after a road traffic accident is reported. The patient presented with numbness of the first web of his left foot and contracture of the extensor hallucis longus muscle, with fixed length deformity after intramedullary nailing of the femur and tibia. The extensor digitorum longus and tibialis anterior muscles were spared. Tinel's sign could be elicited at the mid-portion of the anterior compartment of the injured leg. This indicated that the distal half of the anterior tibial nerve (deep peroneal nerve), together with the extensor hallucis muscle of the anterior compartment of the leg, had been damaged. The subsequent management of this patient is described.
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ranking = 4
keywords = tibia
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10/75. Three different stages of bone stress reactions of long bones in one patient: case report and review of the literature.

    INTRODUCTION: The similar clinical and radiological early course of stress fractures and bone tumors can lead to diagnostic misinterpretation. MATERIALS AND methods: A patient is presented who was admitted to our clinic with the diagnosis of similar bone tumors in the distal femur and the proximal tibia. We found an additional localization with high bone turnover in the contralateral proximal tibia; including this lesion, the patient presented with three different types of stress reaction of bone. The final diagnostic decision-making was based on MRI and bone scintigraphy as well as the consideration of localization, age of occurrence, and behavior of malignant bone diseases. Therefore, bone biopsy was not performed. RESULTS: After 8 weeks of partial weight-bearing, the symptoms disappeared, and the patient could return to normal activity.
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ranking = 2
keywords = tibia
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