Cases reported "Fractures, Spontaneous"

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1/61. hip fracture and bone histomorphometry in a young adult with cystic fibrosis.

    A 25-yr-old male with cystic fibrosis sustained a fragility fracture of the left femoral neck, which required surgical correction. He had several risk factors for the development of low bone density and despite treatment with an oral bisphosphonate, his bone mineral density reduced further. The patient died 2 yrs after sustaining the fracture. Bone specimens obtained at post mortem demonstrated severe cortical and trabecular osteopenia, but the histological features were not typical of osteoporosis or osteomalacia. osteoporosis is thought to be a common complication of cystic fibrosis. The novel histomorphometric appearances reported here suggest that the bone disease of cystic fibrosis may be more complex and possibly unique. Labelled bone biopsies are required to clarify the bone defect leading to low bone density in cystic fibrosis patients so that appropriate therapeutic strategies can be developed.
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2/61. Progressive bone resorption after pathological fracture of the femoral neck in Hunter's syndrome.

    We report a case of Hunter's syndrome associated with a transverse fracture of the left femoral neck after minor trauma, followed by progressive resorption of the femoral head at 12 years of age and a stress fracture of the right femoral neck at 16 years of age. MRI performed at 15 years of age revealed intra-articular low intensity on T1-weighted and T2-weighted images of both hip joints. The MR finding may represent fibrous synovial thickening, which caused pressure erosion of the femoral neck, resultant pathological and/or stress fractures, and subsequent osteonecrosis with rapid absorption of the femoral head.
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3/61. Spontaneous fracture of an ossified stylohyoid ligament.

    The stylohyoid ligament extends from the styloid process to the hyoid bone. For an unknown reason it occasionally ossifies and forms a solid structure which can break because of trauma or even spontaneously. Symptoms of the fracture may mimic tumours, foreign bodies, infections or neuralgia. In our cases a spontaneous fracture of totally ossified stylohyoid ligaments presented as a painful neck swelling. The diagnosis was achieved by an ortopantomographic radiograph. In both cases the healing was spontaneous and complete.
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4/61. trisomy iop.

    A stillborn male fetus having a trisomy of the short arm of chromosome No 10 is described. The father is a carrier of the reciprocal translocation 46XY,t(10;21) (10pter leads to 10p11::21p11 leads to 21qter). The clinical picture included growth retardation, bilateral cleft lip and palate, micrognathia, short neck, microphalus and bilateral clubbed feet. The long bones were markedly thinned with spontaneous fractures. autopsy findings included pulmonary hypoplasia and renal dysplasia. Previous reports of trisomy 10 and trisomy of the short arm of chromosome 10 are discussed.
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5/61. Errors and pitfalls in the diagnosis and treatment of metastatic bone disease.

    1. The orthopedist must be sure of the diagnosis and not embark on treatment for the wrong diagnosis. 2. Solitary lesions in patients with a remote history of malignancy require complete investigation and biopsy. This includes blood work, bone scan, magnetic resonance imaging of the bone lesion, and CT scan of the chest and abdomen. 3. Pathologic fractures do not require immediate fixation. They require careful surgical planning and a team approach to the underlying malignancy. 4. Load-sparing devices should not be used. 5. femoral neck fractures should be treated by endoprosthetic replacement, and consideration should be given to long-stemmed femoral components. 6. The orthopedist should assume that the fracture will never heal. 7. Immediate full and unrestricted weight bearing should be planned. 8. Future problems in the surgical site should be anticipated. Often a long-stem cemented femoral component is a better choice than a standard length. 9. The orthopedist must ensure that there are no other lesions that require stabilization in the bone being treated. 10. Methyl methacrylate can be used to augment fixation if needed. 11. If secure fixation cannot be achieved with the use of cement, the bone should be replaced with a tumor endoprosthesis. 12. The orthopedist should not hesitate to call in help. These can be difficult situations to manage and often require the assistance of a tumor surgeon and oncologic team.
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6/61. Early fracture of clavicle following neck dissection.

    Fracture of the clavicle as a late complication following radical neck dissection is rare, with an incidence of approximately 0.4-0.5 per cent. We report a case where fracture occurred early following a selective neck dissection.
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7/61. Pathological fracture of the femoral neck as the first manifestation of osteonecrosis of the femoral head.

    We describe two cases of pathological fracture of the femoral neck occurring as the first manifestation of osteonecrosis of the femoral head (ONFH). No abnormal findings suggestive of ONFH were identified on the radiographs for either of the patients, and the fractures occurred like spontaneous fractures without any trauma or unusually increased activity. The patients' medical history, age, and good bone quality suggested ONFH as a possible underlying cause of the fractures. If we had not suspected ONFH as a predisposing condition, these minimally displaced fractures might have been fixed internally with multiple pins, and this would have led to nonunion or collapse of the femoral head. To avoid inappropriate treatment, ONFH should be considered as a predisposing factor in pathological fractures of the femoral neck.
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8/61. Congenital bilateral short femur complicated by stress fracture. A case report.

    Congenital malformation of the femur is an uncommon but complex problem. Short femur with proximal deficiency (Kalamchi type III) is part of this congenital anomaly. If the precautions associated with progressive coxa vara and bowing in the femoral shaft are not taken, stress fractures may occur in the femoral neck and the femoral shaft. We report on a 38-year-old female with type III-A congenital malformation of both femurs who presented the complications mentioned and had not been treated before. This case is instructive because it illustrates the complications developed in patients who have not been treated.
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9/61. Stress fracture of the femoral neck in young adult: report of four cases.

    Stress fracture of the femoral neck is an uncommon injury. If the diagnosis is missed or delayed and fracture displacement results, serious complications such as avascular necrosis of the femoral head, nonunion or varus deformity may occur. Treatment depends on the type of stress fracture. Compression and tension stress fractures can be successfully treated with conservative management or prophylactic internal fixation using multiple screws. Displaced stress fractures are an orthopedic emergency, requiring prompt surgical intervention. Poor outcomes after fracture displacement have been reported by many authors. We present four cases demonstrating three types of stress fracture of the femoral neck. It is hoped that these case reports will serve to increase practitioner awareness of this injury and emphasize the need for careful diagnosis and treatment of this potentially problematic injury.
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ranking = 6
keywords = neck
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10/61. fatigue subcapital fracture of the femur after the removal of the hip plate in transtrochanteric rotational osteotomy.

    We report two cases of fatigue subcapital fracture of the femur after the removal of the hip plate used for fixation in transtrochanteric rotational osteotomy for osteonecrosis. Two patients, a 42-year-old man and a 43-year-old man, underwent transtrochanteric rotational osteotomy, and bony union was achieved in both patients. However, fatigue subcapital fracture of the femur occurred in both patients 15 months after the removal of the hip plate. Transtrochanteric rotational osteotomy greatly changes the trabecular bone structure in the proximal femur, thus affecting the strength of the femoral neck. Therefore, for the trabecular bone to be remodeled and for the proximal femur to achieve sufficient strength, a sufficient period is necessary after complete bony union has occurred in the transtrochanteric lesion, before removal of the plate.
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