Cases reported "Fractures, Stress"

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1/32. 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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keywords = operative
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2/32. Nonunion of tibial stress fractures in patients with deformed arthritic knees. Treatment using modular total knee arthroplasty.

    In two years we treated four women with ununited stress fractures of their proximal tibial diaphyses. They all had arthritis and valgus deformity. The stress fractures had been treated elsewhere by non-operative means in three patients and by open reduction and internal fixation in one, but had failed to unite. After treatment with a modular total knee prosthesis with a long tibial stem extension, all the fractures united. A modular total knee prosthesis is suitable for the rare and difficult problem of ununited tibial stress fractures in patients with deformed arthritic knees since it corrects the deformity and the adverse biomechanics at the fracture site, stabilises the fracture and treats the arthritis.
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ranking = 1
keywords = operative
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3/32. 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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ranking = 1
keywords = operative
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4/32. Lateral insufficiency fractures of the femur caused by osteopenia and varus angulation: a complication of total hip arthroplasty.

    Lateral femoral insufficiency fractures in total hip arthroplasty occur due to osteopenia and varus positioning of the femoral component, the femur itself, or both. The presentation of these fractures can be unclear but usually involves the insidious onset of unexplained thigh or groin pain. The patients are likely to have significant comorbidities as well. Characteristic radiographic findings may be present, depending on when the patient presents. The insufficiency fractures generally occur at the level of the femoral stem tip on the lateral cortex of the femur. If left untreated, pain and loss of function continue. Eventually an insufficiency fracture can progress to a displaced periprosthetic fracture. Nonsurgical treatment is not successful. Recommended treatment involves revision to a long-stem femoral component. The risk of postoperative complications is significant.
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ranking = 1
keywords = operative
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5/32. 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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ranking = 1
keywords = operative
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6/32. 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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ranking = 1
keywords = operative
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7/32. Early fracture of the sacrum or pelvis: an unusual complication after multilevel instrumented lumbosacral fusion.

    STUDY DESIGN: A retrospective review of a series of cases with a complication of instrumented lumbosacral fusion. OBJECTIVES: To present a previously undescribed complication, early sacral or pelvic stress fracture, after instrumented lumbosacral fusion and to identify the risk factors associated with this complication. BACKGROUND: There are a number of well-described complications of instrumented lumbosacral fusion, including delayed stress fracture of the pelvis. Early sacral or pelvic stress fracture after instrumented lumbosacral fusion has not been previously reported, to the authors' knowledge. methods: The authors present three cases of early stress fracture occurring at 2-4 weeks after surgery in patients who underwent instrumented multilevel lumbosacral fusions for degenerative lumbosacral disease. RESULTS: Two patients had sacral fracture, which to the authors' knowledge, has not been previously reported. risk factors included lumbosacral instrumentation and fusion, osteoporosis in elderly women, and iliac crest bone graft procurement. All patients were treated conservatively, with restricted ambulation and gradual return to activity. CONCLUSION: This complication can cause significant morbidity and a delay in the patient's return to function. A better understanding of the related biomechanical forces and preoperative risk factors may identify patients at risk and may aid in surgical planning and in expectations of postoperative recovery.
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ranking = 2
keywords = operative
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8/32. Periprosthetic tibial fractures after cementless low contact stress total knee arthroplasty.

    periprosthetic fractures are a recognized complication of total knee arthroplasty. Fractures may occur intraoperatively or postoperatively, and risk factors have been identified that may predispose an individual to such a complication. We report 7 cases of periprosthetic tibial fractures after low contact stress total knee arthroplasty, a complication encountered by the senior author (D.E.B.) only after a change in practice from a cemented implant to a cementless one. In light of this previously unreported complication in our unit, we attempted to identify common features within this group of patients that may have contributed to fracture occurrence. Statistical analysis revealed a highly significant (P<.005) risk of periprosthetic tibial fracture in patients with a preoperative neutral or valgus knee. Age, gender, and diagnosis did not appear to increase the risk of fracture significantly. All patients displayed evidence of reduced bone mineral density in the lumbar spine and femoral neck regions on dual-energy x-ray absorptiometry scanning. patients with a preoperative neutral or valgus knee and local evidence of osteopenia represent a high-risk group, in whom particular care in alignment should be taken. In this group, it may be preferable to have the tibial component inserted with cement fixation.
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ranking = 4
keywords = operative
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9/32. Serious consequences of the wrong diagnosis of meniscal lesion in a case of stress fracture of the distal femur.

    We report on a 42-year-old runner who developed pain on weight bearing during his training in his right femur that radiated to the knee. A pulled muscle was suspected and treatment with nonsteroidal anti-inflammatory drugs initiated. Because of persisting pain, radiological diagnosis was started and a lesion of the meniscus suspected. The radiograph of the knee was negative and magnetic resonance imaging (MRI) showed a mild degeneration of the meniscus. Six weeks after the symptoms started, the patient underwent arthroscopy based on the MRI findings. Intraoperatively, while his leg was being fixed in the leg-holder, a supracondylar fracture of the left femur occurred. A pathologic fracture was suspected and the patient was admitted to our hospital. Another MRI and a biopsy examination were performed. Histopathologic findings were normal concerning malignancy, and osteosynthesis was performed. The subsequent analysis of the first MRI showed intramedullary and periosteal edema with high signal intensity, which led to the suspicion of a pre-existing stress fracture. After 6 months, the patient returned to sports. Because of insufficient initial anamnesis and clinical examination, a diagnostic algorithm of the stress fracture had not been kept. Additionally, in these cases, biopsy must be performed to obtain a reliable diagnosis. This mistake led to a fracture of the femur and a long rehabilitation for this patient.
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ranking = 1
keywords = operative
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10/32. Medial malleolar stress fractures. literature review, diagnosis, and treatment.

    Medial malleolar stress fractures are relatively uncommon injuries that can be quite debilitating and disabling. This article discusses the symptoms, diagnostic aids, pathomechanics, and management of medial malleolar stress fractures. Using three cases, the authors illustrate nonoperative versus operative treatments in an athlete and the influence of an in-season versus an off-season injury. A percutaneous cannulated screw fixation procedure is described that allowed an athlete to return to competition 24 days after sustaining a displaced medial malleolar stress fracture.
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ranking = 2
keywords = operative
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