Cases reported "Femoral Neck Fractures"

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1/46. Femoral neck stress fracture presenting as gluteal pain in a marathon runner: case report.

    A case is described of a 50-year-old man with a femoral neck stress fracture presenting as gluteal pain. An operative pinning procedure of the femoral neck was performed for stabilization. Femoral neck stress fractures are often misdiagnosed early in their presentation. The signs and symptoms can mimic those of more commonly seen disorders. Appropriate physiatric history and physical examination, along with indicated studies, will help prevent misdiagnosis and potentially serious complications associated with musculoskeletal pathology.
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ranking = 1
keywords = operative
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2/46. Transient osteoporosis during pregnancy: the perioperative nurse's role.

    Perioperative nurses are confronted with ever changing demands in their daily practice. Perhaps the greatest challenge, however, is in the care of patients with multi-faceted health problems. These patients require the coordination of many multi-disciplinary team members in attempting to achieve optimum health. This paper will describe the case study of a 28 year old, 26 week primip, who presented to a tertiary care centre with spontaneous bilateral hip fractures of unknown origin. It will further discuss the disease process known as Transient osteoporosis during pregnancy, the surgical approach, and finally, the role of the perioperative nurse in coordinating the patient's perioperative care.
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ranking = 7
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3/46. Subcapital femoral neck fracture after closed reduction and internal fixation of an intertrochanteric hip fracture: a case report and review of the literature.

    A subcapital femoral neck fracture in a healed intertrochanteric fracture treated by an open reduction and internal fixation is a rare, but catastrophic, event. We present the case of an 86-year-old woman, a community ambulator, who sustained a displaced right intertrochanteric hip fracture during a fall. She was treated with closed reduction and internal fixation with a dynamic compression hip screw and side plate. Four months later, she was noted to have a displaced subcapital femoral neck fracture and underwent hip screw and side plate hardware removal and cemented bipolar hemiarthroplasty. Both postoperative recoveries were uncomplicated, and she was discharged to a rehabilitation facility able to ambulate with minimal assistance. This devastating complication in patients with osteoporosis may be prevented by deeper placement of the dynamic hip compression lag screw to within 5 mm to 8 mm of the subchondral bone, which may decrease the stress forces in the subcapital femoral neck.
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keywords = operative
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4/46. Femoral neck fracture complicating intramedullary nailing of femoral shaft.

    Intramedullary nailing of the femur is now established as a routine treatment for femoral shaft fractures. A recognised complication of this technique is the occasional jamming of the intramedullary reaming device within the femoral canal although surprisingly we could not find any reports in the literature. We describe a case in which the removal of such a reamer resulted in an iatrogenic intracapsular fracture of the femoral neck, a serious complication of this problem not previously described in the English literature. This resulted in an intraoperative decision to change the fixation device to accommodate this.
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keywords = operative
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5/46. fatigue failure of an AO spiral blade.

    We report an unusual case of a femoral neck stress fracture leading to the fatigue failure of an AO spiral blade. An unreamed femoral nail with a spiral blade was inserted to treat an unstable subtrochanteric femoral fracture. which lead to fracture union at 5 months. Eight months post-operatively the patient started to complain of left hip pain. Serial radiographs revealed progressive osteoporosis of the proximal femur possibly due to the stress sharing effect of a stiff intramedullary device, which continued to bear a significant amount of the transmitted load. The cause of pain was a stress fracture of the femoral neck and the AO spiral blade, which only became radiologically visible 4 months after the start of the symptoms (1 year after the initial operation). The implant was removed and replaced by a cemented hemiarthroplasty. This case reaffirms the difficulty in diagnosing a stress fracture through a metallic implant. The delay in diagnosis may be shortened if stress fracture were included as an expected complication following an intramedullary nailing.
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keywords = operative
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6/46. Stress fracture of the hip and pubic rami after fusion to the sacrum in an adult with scoliosis: a case report.

    Correction of adult scoliosis frequently involves long segmental fusions, but controversy still exists whether these fusions should include the sacrum. It has been suggested that forces associated with activities of daily living transfer the stresses to the remaining levels of the spine and to the pelvis. The case described here was a 43-year-old woman with scoliosis and chronic back pain refractory to non-surgical modalities. Radiographically, the patient had a 110 degree lumbar curve. An anterior and posterior fusion with Luque-Galveston instrumentation was performed. Six months postoperatively the patient returned with a 2-week history of right hip pain with no history of trauma. There was radiographic evidence of a displaced femoral neck fracture and pubic rami fractures. The femoral neck fracture was treated with a total hip replacement. Further surgeries were required to correct a lumbar pseudoarthrosis and hardware failure. We believe that this case provides evidence that fusion into the lumbosacral junction may distribute forces through the pelvic bones and hip resulting in stress and potential hardware complications, especially in patients at risk due to osteopenic conditions.
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keywords = operative
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7/46. Primary prosthetic replacement in acute femoral neck fractures.

    This paper reports a retrospective study of acute femoral neck fractures in 123 patients treated by primary prosthetic replacement. The average age in our patient population was 80-5 years. A Christiansen trunnion-bearing hip prosthesis (Christiansen, 1969 and 1974) was used in all patients except one. The prosthesis was cemented to the femoral shaft. The postoperative mortality rate was low, and the mortality rate was 8-7 per cent. The patients were examined between 6 months and 3 1/2 years after operation. Excellent or good results according to Stinchfield's hip assessment system (Stinchfield et al., 1957) were obtained in 82 per cent of the patients. We suggest that primary prosthetic replacement in acute femoral neck fractures in elderly patients is a safe and valuable procedure. However, a definite conclusion concerning this therapy cannot be drawn before a prospective study comparing the results of internal fixation and primary prosthetic replacement is made.
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ranking = 1
keywords = operative
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8/46. Intraoperative stroke under epidural anesthesia for bipolar hemiarthroplasty in a patient with multiple myeloma: a case report.

    A 56-yr-old, 58-kg woman with right femoral neck fracture underwent right bipolar hemiarthroplasty. Her medical problems included diabetes mellitus and multiple myeloma. Epidural anesthesia was performed uneventfully. No other drug except for local anesthetic (2% lidocaine) was administered during the procedure. Unfortunately, we "witnessed" the dramatically hemodynamic change of an intraoperative stroke, which was preceded by a hypotensive episode and followed by sustained hypertension. The stroke was presented with decreased level of consciousness initially and confirmed by the brain CT, which revealed acute infarction at the right middle cerebral artery territory, four days after the procedure. Multiple mechanisms such as intraoperative hypotensive episode and vascular atherosclerotic change due to poor controlled diabetes mellitus might be involved in the event. In the meanwhile, hyperviscosity (3.7 centipoise units of the patient v.s. 1.4-1.8 centipoise units of normal range) caused by multiple myeloma might also have contributed to the intraoperative stroke. Clinical presentation of this case will be discussed.
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ranking = 7
keywords = operative
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9/46. Continuous intra-articular patient-controlled analgesia in a cancer patient with a pathological hip fracture. A case report.

    pain management is one of the major goals to achieve in treating terminal patients. Managing severe pain with drug therapy by using a combination of narcotics, non-narcotics, and adjuvant drugs provides the best results for most patients. In patients with fractures due to bone metastases there is a relative indication for operative treatment if the patient is expected to survive the operation and to recover in the postoperative period. In this case report a terminal 48 year-old female with a pathological femoral neck fracture is presented. No operative treatment was offered because of her bad general status. Pain control was maintained by continuous administration of local analgesics directly into the intra-articular femoral space, through a system of patient-controlled analgesia (PCA). The visual-analogue pain scale (VAS), which was maximal before beginning of this treatment, was markedly reduced during the treatment, and was again elevated to maximum after the intra-articular catheter was removed. Although continuous regional analgesia to a fractured bone which involves the joint is not a generally acceptable method and carries some risks it has a role in a selected group of patients.
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ranking = 3
keywords = operative
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10/46. Epidural anaesthesia for insertion of a femoral neck prosthesis in a patient with phaeochromocytoma.

    A hemiarthroplasty for femoral neck fracture was successfully performed under combined epidural anaesthesia and light general anaesthesia before phaeochromocytoma removal. Pre-operative therapy was managed with doxazosin, enalapril and diltiazem. Peri-operative management facilitated maintenance of stable haemodynamic conditions. Post-operative pain management was provided with continuous 1% lignocaine infusion via an epidural catheter. The phaeochromocytoma was finally removed uneventfully 7 weeks after hemiarthroplasty.
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ranking = 3
keywords = operative
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