21/138. Effect of treatment with alendronate in osteogenesis imperfecta type I: a case report.A case of osteogenesis imperfecta (OI), which was successfully treated with alendronate is reported. A 41-year-old premenopausal woman with OI type I, who had frequently been experiencing fragile fractures, consulted our clinic because of back pain associated with spinal osteoporosis. She had experienced heart surgery (aortic valve replacement) due to aortic regurgitation 5 years before her first consultation with our clinic. After the surgery, she had been taking warfarin 3 mg/day, and this treatment was continued during our follow-up period. She was treated with alendronate (5 mg/day, daily) for 18 months. The bone mineral density of the lumbar spine (L2-L4) measured by dual energy X-ray absorptiometry (Norland XR-36) increased for 18 months, and back pain markedly decreased. The urinary cross-linked N-terminal telopeptides of type I collagen and serum bone-specific alkaline phosphatase, osteocalcin, and undercarboxylated osteocalcin levels also markedly decreased. No new fragile vertebral or non-vertebral fractures were observed during the 18 months of treatment. This report provides evidence indicating that treatment with oral alendronate may have the potential to decrease bone turnover, improve the lumbar BMD, reduce back pain, and prevent new fragile fractures in premenopausal women with OI type I.- - - - - - - - - - ranking = 1keywords = ray (Clic here for more details about this article) |
22/138. osteogenesis imperfecta: a case with hand deformities.In a 51-year-old woman with a history of fractures and dislocations after low intensity trauma in childhood, intensive blue sclera, short stature, and hearing loss, the diagnosis of osteogenesis imperfecta (OI) was suspected. She was referred to our clinic with hand deformities and left knee pain and stiffness. She had difficulty in walking and reported a history of immobilization for 6 months because of knee pain. She had bilateral flexion contracture of the elbows which occurred following dislocations of the elbows in childhood. She had Z deformity of the first phalanges, reducible swan-neck deformity of the third finger of the left and the second finger of the right hand, flexion contracture of the proximal interphalangeal joint of the fifth finger of the left hand, and syndactyly of the third and fourth fingers of the right hand. Flexion contractures of both knees were observed. Pes planus and short toes were the deformities of the feet. Acute phase reactants of the patient were normal. She had no history of arthritis or morning stiffness. Bone mineral density evaluated by dual-energy X-ray absorptiometry (DEXA) showed severe osteoporosis of the femur and lumbar vertebrae. She had radiographic evidence of healed fractures of the left fibula, the third metacarpal, and the fourth and fifth middle phalanges of the right hand. OI, affecting the type I collagen tissue of the sclera, skin, ligaments, and skeleton, presenting with ligament laxity resulting in subluxations and hand deformities may be misdiagnosed as hand deformities of rheumatoid arthritis.- - - - - - - - - - ranking = 1keywords = ray (Clic here for more details about this article) |
23/138. intracranial hypotension and recurrent pleural effusion after snow-boarding injury: a manifestation of cerebrospinal fluid-pleural fistula.BACKGROUND DATA: intracranial hypotension causing postural headaches has been described after occult and postsurgical cerebrospinal fluid (CSF) leaks and rarely isolated lumbar punctures. The occurrence of a CSF-pleural communication is much rarer, and a high level of suspicion aids in prompt recognition. PURPOSE: Early detection and anatomic delineation of the site of CSF-pleural fistula allows prompt intervention, results in resolution of symptoms and prevents the complication of meningitis. STUDY DESIGN: A case of intracranial hypotension with postural headaches is described after spinal surgery, with demonstration on computed tomography (CT) myelography of a rare CSF-pleural fistula. methods: The clinical presentation, postoperative intervention and imaging as well as laboratory data are presented. RESULTS: Chest X-ray showed recurrent pleural effusion after placement of chest tube, and serial head CT studies revealed decreasing ventricular size with development of severe headaches. Myelogram and CT postmyelogram demonstrate the CSF-pleural communication, allowing appropriate surgical repair. CONCLUSION: Severe headaches with a recurrent pleural effusion after thoracic spinal surgery may indicate presence of a CSF-pleural fistula, an unusual complication of thoracic spinal surgery.- - - - - - - - - - ranking = 1keywords = ray (Clic here for more details about this article) |
24/138. Hawkins type III fracture-dislocation of the talus and diastasis of the tibiofibular joint without concomitant fracture of the malleolei. A case report.A 23-year-old man injured his foot in a motorcycle accident. Roentgenograms and computed tomography scans demonstrated a Hawkins Type III fracture-dislocation of the talus with a suspected disruption of the anterior tibiofibular ligament. Prompt anatomic reduction of the talus with rigid internal fixation was performed. Intraoperative stress roentgenograms confirmed the presence of a syndesmotic disruption. No cases of this injury have been reported in the literature. When no obvious fracture of the ankle mortise is present in a Hawkins Type III or IV talar fracture-dislocation, care must be taken to fully evaluate the osseous and ligamentous structures of the ankle to rule out an occult injury. Computed tomography scans, stress roentgenograms, intraoperative clinical examination, and direct visual inspection can all be used to aid in this evaluation.- - - - - - - - - - ranking = 919.92328714043keywords = roentgen (Clic here for more details about this article) |
25/138. An unusual case of segmental clavicle fracture.Fracture of the clavicle is a common traumatic injury and comprises 4% of all fractures in adults. Amongst these, midshaft injuries account for the majority and medial fractures are uncommon. Whilst segmental fractures have been reported in the literature, concurrent lateral and medial injuries are very rare. These injuries are, therefore, susceptible to being missed, due to failure to look for a second injury after the initial diagnosis, and difficult X-ray interpretation around the area of the medial clavicle. The nature of segmental fractures can pose a difficult management problem for numerous reasons, and initial operative fixation is usually indicated. early diagnosis is therefore imperative, and as such, clinical examination is essential even if an obvious mid or lateral shaft fracture is seen on X-ray. This unusual case of combined lateral and medial fractures was initially missed and the presentation and management is discussed.- - - - - - - - - - ranking = 2keywords = ray (Clic here for more details about this article) |
26/138. Fractures of the proximal phalanx of the hallux: the use of plates with displaced multifragment fractures.Fractures of the proximal phalanx of the hallux are a common injury. Due to the important biomechanical function of the first ray, these injuries must be treated properly. Incorrectly treated, a fracture of the hallux can be debilitating. These injuries will be discussed, and several illustrative cases will be presented with the use of plate fixation.- - - - - - - - - - ranking = 1keywords = ray (Clic here for more details about this article) |
27/138. Trans-carpal injuries associated with distal radial fractures in children: a series of three cases.Isolated trans-carpal injuries in children are rare. This paper presents three cases of trans-carpal injury associated with an ipsilateral distal radial fracture. Two cases involved simultaneous fractures of the scaphoid and the capitate. The third case involved the scaphoid and the triquetrum. The full extent of these injuries was not recognized on the initial x-rays. If a child presents with a displaced fracture of one carpal bone it may not be an isolated injury.- - - - - - - - - - ranking = 1keywords = ray (Clic here for more details about this article) |
28/138. Fracture of the anterior iliac crest following autogenous bone grafting.Anterior iliac crest is the most common donor site for anterior cervical spine surgeries. We searched the literature to summarize the reported fractures of the anterior iliac crest following bone graft harvesting for anterior cervical fusion and documented our experience with such complication. In this account, we report 3 new patients with this rare complication of fracture of the anterior iliac crest following bone graft for anterior cervical fusion. The dual energy x-ray absorptiometry scan was performed in all our patients to assess bone mineral density and all patients had osteoporosis. Non-operative treatment was the method of treatment in our patients. A better understanding of surgical technique and complications of iliac crest bone grafting is important to minimize graft site morbidity, and even more important is identification of risk factors that are involved in fracture of the iliac crest.- - - - - - - - - - ranking = 1.0980983989664keywords = ray, x-ray (Clic here for more details about this article) |
29/138. Effects of 3 years of intravenous pamidronate treatment on bone markers and bone mineral density in a patient with osteoporosis-pseudoglioma syndrome (OPPG).We present a 21 year-old woman with osteoporosis-pseudoglioma syndrome (OPPG) suffering from bone pain and frequent long bone fractures (approximately 1 or 2 fractures/year) who was treated with i.v. pamidronate for 3 years. OPPG is a rare autosomal recessive disorder characterized by severe widespread osteoporosis leading to pathological fractures and congenital or early onset blindness. Bone mineral density (BMD) (g/cm2) was determined at lumbar spine and femur neck by dual energy X-ray absorptiometry. BMD studies were also performed in her parents and 18 year-old brother who were phenotypically normal. Within 2 months of the first pamidronate treatment the patient reported considerable decrease in bone pain and improved mobility. During the treatment period no important side effects and no recurrent bone fracture were reported. There were substantial increases in BMD, T score and z-score at both lumbar spine and femoral neck during therapy. Baseline lumbar spine BMD increased from 0.416 to 0.489 g/cm2 and femoral neck BMD increased from 0.455 to 0.532 g/cm2 after 3 years. Although her parents and brother did not have any history of fracture, BMD measurements revealed that her parents were osteopenic and her brother was osteoporotic. We demonstrated that pamidronate therapy seems to be safe and beneficial in both spinal and peripheral skeleton osteoporosis in patients with OPPG. Moreover, the present study clearly indicates that bone density studies and LRPS gene screening for mutations should be performed in phenotypically normal family members of patients with OPPG.- - - - - - - - - - ranking = 1keywords = ray (Clic here for more details about this article) |
30/138. Diagnosis and management of posttraumatic piriformis syndrome: a case study.OBJECTIVE: The aim of this study is to describe the clinical management of a young male patient with sciatica symptoms that developed after an avulsion of the ischial tuberosity. This is a rare injury, but complications may occur. CLINICAL FEATURE: A 19-year-old patient developed sciatica 6 months after a football injury. The patient described his symptoms as a shooting pain from the buttock to the lateral part of the foot, along the back of his thigh and calf, sometimes accompanied by paresthesia. physical examination showed restricted hip range of motion and a positive Bonnet's test. X-ray analysis revealed a bony overgrowth of the right ischial tuberosity. INTERVENTION AND OUTCOME: A treatment plan was designed to decrease the pain level, increase sacroiliac and lumbar joint mobility, and augment muscular extensibility. The patient received 20 treatments over a period of approximately 3 months. Complete recovery was observed 5 months later. CONCLUSION: Although many differential diagnoses were contemplated, it is most likely that changes in muscular tension and gait pattern, resulting from the ischial tuberosity avulsion, contributed to overuse of the piriformis muscle leading to a piriformis syndrome.- - - - - - - - - - ranking = 1keywords = ray (Clic here for more details about this article) |
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