Cases reported "Fractures, Spontaneous"

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1/10. Neurological complications in insufficiency fractures of the sacrum. Three case-reports.

    Three cases of nerve root compromise in elderly women with insufficiency fractures of the sacrum are reported. Neurological compromise is generally felt to be exceedingly rare in this setting. A review of 493 cases of sacral insufficiency fractures reported in the literature suggested an incidence of about 2%. The true incidence is probably higher since many case-reports provided only scant information on symptoms; furthermore, sphincter dysfunction and lower limb paresthesia were the most common symptoms and can readily be overlooked or misinterpreted in elderly patients with multiple health problems. The neurological manifestations were delayed in some cases. A full recovery was the rule. The characteristics of the sacral fracture were not consistently related with the risk of neurological compromise. In most cases there was no displacement and in many the foramina were not involved. The pathophysiology of the neurological manifestations remains unclear. We suggest that patients with sacral insufficiency fractures should be carefully monitored for neurological manifestations.
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2/10. Multisystem involvement in congenital insensitivity to pain with anhidrosis (CIPA), a nerve growth factor receptor(Trk A)-related disorder.

    Congenital insensitivity to pain with anhidrosis (CIPA), a rare autosomal recessive disorder, is characterized by insensitivity to pain, self-mutilating behaviour, anhidrosis and recurrent hyperpyrexia. It is a hereditary sensory and autonomic neuropathy, also classified as HSAN, due to a defect of the receptor for nerve growth factor. CIPA is the first human genetic disorder caused by a defect in the neurotrophin signal transduction system. This is the first clinical report of CIPA patients characterized on molecular grounds. The clinical phenotypes of our patients show that CIPA is characterized by a multisystem involvement besides the nervous system, including bone fracture with slow healing, immunologic abnormalities, such as low response to specific stimuli, chronic inflammatory state ending in systemic amyloidosis. The molecular characterization allows a better understanding of most of the clinical features.
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ranking = 5
keywords = nerve
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3/10. Simple bone cyst with pathologic lumbar pedicle fracture: a case report.

    STUDY DESIGN: A case report and review of the literature are presented. OBJECTIVE: To describe an unusual simple bone cyst involving the pedicle of lumbar spine. SUMMARY OF BACKGROUND DATA: To the authors' knowledge, only nine cases of a simple bone cyst involving the spine have been reported. Most of these reports have described mild back or neck pain because the presenting symptoms or cysts were found incidentally. In the reported case, acute severe back pain with radiating pain developed. Therefore, the study focus was on the unusual location, the presenting symptoms, and its spinal involvement. methods: A cystic lesion involving the left pedicle of the first lumber vertebra was identified in a 53-year-old woman with sudden-onset severe back pain with pain radiating to the left leg. Surgical resection was undertaken along with review of the patient's medical record, imaging studies, microscopic findings of the lesion, and the related literature. RESULTS: Microscopic examination of the cystic lesion corresponded with the findings of a simple bone cyst. A thin fibrous membrane with reactive bone formation was identified without evidence of hemorrhage. A favorable result was achieved by surgical resection. CONCLUSIONS: This case study suggests that a simple bone cyst may be found in any portion of the spine, including the pedicle. Severe resting pain would be elicited by a pathologic fracture of the pedicle. Direct nerve compression by the fractured fragment and chemical irritation by cystic fluid would be compatible with the observed clinical manifestations.
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keywords = nerve
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4/10. paraplegia complicating percutaneous vertebroplasty for osteoporotic vertebral fracture: case report.

    We report a case of spinal cord and root compression during percutaneous transpedicular polymethylmethacrylate vertebroplasty (PTPV) for a compression fracture due to osteoporosis. Sudden onset of excruciating pain in the distribution of the right sixth intercostal nerve with hyperemia along its path, prompted the interruption of the procedure. Under narcotic sedation the patient was taken to the ICU and 10mg of dexamethasone was administered intravenously. Few hours later she developed paraplegia with preservation of light touch and a CT scan and MRI showed epidural extravasation of polymethylmethacrylate with spinal cord and root compression. Surgical decompression was followed by neurological recovery. The cement could be removed after been thinned out by high speed drill, with microsurgical technique, through a wide three level laminectomy of D5 to D7. Extravasation of cement is commonly encountered in PTPV and most of the time it is asymptomatic. Root compression may require surgical intervention if nonresponsive to steroid treatment. Cord compression is less often seen and requires emergency surgery. The cement does not adhere to the duramater and it can be removed easily.
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keywords = nerve
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5/10. Deep venous thrombosis revealed during ultrasound-guided femoral nerve block.

    Ultrasound imaging used to facilitate performance of a femoral nerve block also affords imaging of adjacent anatomical structures. Following a fracture of the femur, an ultrasound guided femoral nerve block (UGFNB) was performed to provide analgesia; this led to the incidental finding of a previously undiagnosed femoral vein thrombosis (DVT), resulting in a change in patient management before surgery. An inferior vena cava (IVC) filter was placed before intramedullary nailing of the fracture.
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ranking = 4370.7488533333
keywords = nerve block, block, nerve
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6/10. Bone metastasis in hepatocellular carcinoma. A report of five cases and a review of the literature.

    Hepatocarcinoma occurs frequently throughout the world. Bone metastases are rare although incidence has increased because of progress in diagnosis and treatment. The authors report 5 cases of bone metastases and review the literature. The spine is the most frequent localization of bone metastases. radiotherapy is the treatment of choice for this lesion. Surgery should be used to prevent and treat complications such as nerve compression and pathologic fracture, only if the coagulative pattern and the conditions of the patient allow it. The authors recommend the use of long intramedullary nailing when localization of the disease is in the femur, with prophylactic stabilization of the neck in diaphyseal metastasis.
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ranking = 1
keywords = nerve
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7/10. Spontaneous fractures of uninvolved bones in patients with Paget's disease during unduly prolonged treatment with disodium etidronate (EHDP).

    Three patients with Paget's disease of bone were treated by disodium etidronate (EHDP) without interruption during periods of 18 to 30 months. In one case the daily dose was also unduly high (approximately equal to 18 mg/kg/day). A moderate to conspicuous diminution of the renal function was observed in all cases. The three patients developed skeletal pain in a gradual but progressively severe pattern. Seven nontraumatic fractures in nonpagetic bones were encountered. EHDP produces blockage of bone mineralization and excessive suppression of bone remodeling, therefore increasing the risks of fracture. EHDP affects not only pagetic bones but normal skeleton. A baseline evaluation of the renal function might help to identify those patients with greater risk to develop skeletal side effects during EHDP treatment.
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ranking = 1.5508551111111
keywords = block
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8/10. Ablation of the brachial plexus. Control of intractable pain, due to a pathological fracture of the humerus.

    A case report is presented which illustrates the difficulties in providing control of intractable pain from pathological fractures of the humerus. Relief from large and frequent doses of systemic analgesics was found to be inadequate. Control was achieved using brachial plexus block with bupivacaine combined with absolute alcohol. The decision to partially ablate the plexus is considered to be justified by the improved quality of life which the patient enjoyed.
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ranking = 1.5508551111111
keywords = block
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9/10. MR of myelomatous meningitis.

    In a 56-year-old woman with multiple myeloma involving the leptomeninges diffusely, MR of the spine showed multiple vertebral compression fractures and marked enhancement of the cauda equina region. Intracranial MR showed pathologic enhancement of the left third and fifth cranial nerves.
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ranking = 1
keywords = nerve
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10/10. Mandibular fracture after endosseous implant placement in conjunction with inferior alveolar nerve transposition: a patient treatment report.

    A patient with a severely atrophic right posterior mandible had three endosseous implants placed in conjunction with transposition of the inferior alveolar nerve. Three weeks following implant placement surgery, the patient experienced a spontaneous fracture of the mandible involving the two anterior implants. The two implants were removed, and the fracture was treated with open reduction and fixation with titanium mesh. The fracture healed, and the posterior implant integrated. This report suggests that the buccolingual and superior-inferior position of the mandibular canal can increase the possibility of mandibular fracture by increasing the size of the buccal cortical plate that is removed to expose the nerve during surgery.
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ranking = 6
keywords = nerve
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