Cases reported "Femoral Fractures"

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11/790. femur osteomyelitis due to a mixed fungal infection in a previously healthy man.

    We describe a previously healthy, 22-year-old man who, after a closed fracture of the femur and subsequent operation, developed chronic osteomyelitis. Within a few days, infected bone fragments, bone, and wound drainage repeatedly yielded three different filamentous fungi: aspergillus fumigatus, aspergillus flavus, and Chalara ellisii. Histologic examination of the bone revealed septate hyphae. After sequential necrotomies of the femur and irrigation-suction drainage with added antimycotic therapy, the infection ceased and the fracture healed. This case is unique in that it is the only known instance in which a long bone was affected in an immunocompetent individual, with no evidence of any systemic infection, by a mixed population of two different Aspergillus spp. and the rare filamentous fungus C. ellisii. Environmental factors that could potentiate the infection include blood and edema fluid resulting from the surgical procedure and the presence of the osteosynthetic plate. ( info)

12/790. Histopathology of a well-functioning hydroxyapatite-coated femoral prosthesis after 52 months.

    A fully hydroxyapatite-coated femoral implant was retrieved during autopsy. This component, provided with a bipolar femoral head, had been inserted for a displaced fracture of the femoral neck 52 months before. osseointegration of the implant was evident, without any formation of fibrous tissue :39.9% of the perimeter of the prosthesis at the level of its proximal third was interfaced with bone (62.8% at the mid-third and 65.2% at the distal third). Remodeling of bone had ensued. Deposition of bone was most prominent in the calcar zone, along the medial and lateral aspects and around the tip. Proximally, cortical porosity was found to be increased by 73%, whereas medullary bone porosity was increased by a factor of 2. Cell-mediated resorption of the coating was systematically present in these bone remodeling areas. The average thickness of the coating was respectively 10.8, 50.2 and 151.2 microns in the proximal, mid- and distal thirds of the implant. Formation of new bone was often coupled with resorption. No debris from the coating was found in the joint tissues or in the articulating surface of the polyethylene insert. These overall histopathological features support mechanical stability of the implant and active remodelling of bone along with focal removal of HA coating associated with osteoclastic activity. No side effects from coating degradation could be demonstrated. ( info)

13/790. Complications of Kuntscher intramedullary nailing in a child: a case report.

    A fracture of the femur in a 7-year-old boy who was treated with retrograde Kuntscher nailing is described. The follow-up period was 8 1/2 years. Deep infection, physeal injury of the femoral head, and trochanteric epiphysiodesis were serious consequences of the surgery. ( info)

14/790. The abdominal compartment syndrome: a report of 3 cases including instance of endocrine induction.

    Three patients with the abdominal compartment syndrome are presented and discussed. In one of the patients the condition was induced in an endocrine fashion, since trauma was sustained exclusively by the middle third of the left leg. The development of the syndrome as a remote effect of local trauma has never been reported previously. In all three instances only insignificant amounts of intraperitoneal fluid was found and the increase in abdominal pressure was due to severe edema of the mesentery and retroperitoneum. Since the condition is highly lethal, early diagnosis is imperative, and this starts by carrying a high index of suspicion. Measurement of the intraperitoneal pressure easily confirms this diagnosis. It is emphasized that measurements at various sites, like bladder and stomach, in each patient is essential to confirm the diagnosis, since one of the sites may be rendered unreliable due to intraperitoneal processes impinging on the affected site and affecting its distensibility. ( info)

15/790. Use of the fork plate for internal fixation of periprosthetic fractures and osteotomies in connection with total knee replacement.

    Six cases of periprosthetic fractures of the distal femur following total knee arthroplasty were treated with a newly developed fork plate. Instead of the blade of the condylar plate, this implant features two prongs that are adaptable in length. Because of the space between the prongs, the distal femoral fragment surrounds the anchorage pegs of the prosthesis and can be gripped near the joint line. The average patient age was 74 years. Follow-up ranged between 2 and 54 months. All patients were mobilized immediately postoperatively. Full weight bearing and bone consolidation was achieved by 9 weeks postoperatively. ( info)

16/790. Use of a custom retrograde intramedullary rod for the management of distal femoral nonunion: a report of two cases.

    Nonunion of the distal femur is a rare injury that is difficult to manage. A variety of surgical implants and techniques are available. We present an alternative mode of treatment for supracondylar femoral nonunion using a custom retrograde titanium femoral nail (Biomet; Warsaw, IN) to successfully achieve union in two cases. We believe the added length, custom modifications, and enhanced stability allowed better fixation in an osteopenic distal femur. ( info)

17/790. Intraarticular heterotopic ossification in the knee following intramedullary nailing of the fractured femur using a retrograde method.

    The cases of a forty-five-year-old woman and a twenty-year-old man who developed severe intraarticular and periarticular heterotopic ossification around the knee following intramedullary nailing of a femur fracture using a retrograde technique. The association of musculoskeletal heterotopic ossification with closed head injuries seems well established and can occur in and around the knee following retrograde intramedullary nailing. This complication may occur more often than has been reported. ( info)

18/790. Repair of supracondylar femur fracture and unilateral knee replacement at the same surgery.

    In patients who are candidates for a total knee arthroplasty and suffer a periarticular fracture of the femur, the arthroplasty may be performed after bony union of the fracture or immediately, in conjunction with the fracture repair. Herein we present the case of a sixty-year-old female with rheumatoid arthritis and a supracondylar fracture of the right femur in whom total knee arthroplasty and retrograde nail insertion were addressed at one surgery; the outcome was favorable. The transverse extraarticular fracture pattern in this patient was advantageous for simultaneous procedures; had the fracture been more comminuted or intraarticular, it might not have been possible to perform both procedures at the same time. ( info)

19/790. 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. ( info)

20/790. Spontaneous healing of an atrophic pseudoarthrosis during femoral lengthening. A case report with six-year follow-up.

    A seven-year old girl developed an atrophic pseudoarthrosis at the midshaft of the femur with 8.5 cm of femoral shortening after an open type II fracture. During a femoral lengthening procedure, the pseudoarthrosis filled with spontaneous callus formation and bone union was obtained. ( info)
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