Cases reported "Hip Fractures"

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1/9. Percutaneous radiofrequency lesioning of sensory branches of the obturator and femoral nerves for the treatment of hip joint pain.

    BACKGROUND AND OBJECTIVES: The sensory innervation of the hip joint includes the sensory articular branches of the obturator and femoral nerves. In this report, we retrospectively evaluated 14 cases in which hip joint pain was treated by percutaneous radiofrequency lesioning of sensory branches of obturator and/or femoral nerves. methods: Fourteen patients who had hip joint pain and underwent percutaneous radiofrequency lesioning of sensory branches of obturator and/or femoral nerves were studied. In all cases, intra-articular hip joint block or articular branch block of obturator nerve with local anesthesia was transiently effective. Radiofrequency lesioning was performed at 75 degrees C to 80 degrees C for 90 seconds using an RFG-3B generator and Sluijter-Mehta cannulae kit (Radionics, Burlington, MA) for the obturator nerve in 9 patients and for both the obturator and femoral nerves in 5 patients. To assess pain intensity, a visual analog scale (VAS) was used. RESULTS: The VAS scores before and after the radiofrequency lesioning were 6.8 /- 0.9 and 2.7 /- 1.3, respectively. Twelve patients (86%) reported at least 50% relief of pain for 1 to 11 months. There were no side effects or motor weakness observed. CONCLUSIONS: Percutaneous radiofrequency lesioning of sensory branches of the obturator and femoral nerves is an alternative treatment in patients with hip joint pain, especially in those where operation is not applicable.
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keywords = block, nerve
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2/9. Combined paravertebral lumbar plexus and parasacral sciatic nerve block for reduction of hip fracture in a patient with severe aortic stenosis.

    PURPOSE: To report the use of a combined paravertebral lumbar plexus and parasacral sciatic nerve block for reduction of hip fracture in an elderly patient with severe aortic stenosis. Clinical features: In an 87-yr-old lady with severe aortic stenosis and fracture of the right trochanter due to a fall, a combined right-sided paravertebral lumbar plexus and parasacral sciatic nerve block was used successfully for operative reduction of the fracture. A moderate amount of phenylephrine was required to maintain adequate systemic blood pressure despite the largely unilateral nature of the blocks. CONCLUSION: Combined paravertebral lumbar plexus and parasacral sciatic nerve block can be a viable alternative to general anesthesia and epidural or spinal block for hip surgery in patients with severe aortic stenosis.
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ranking = 1.7386584829332
keywords = block, nerve
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3/9. Hip and pelvic fractures and sciatic nerve injury.

    OBJECTIVE: To investigate the influence of hip and pelvic fracture, especially acetabular fracture complicated by sciatic nerve injury on clinical features and prognosis of sciatic nerve injury. methods: From January 1987 to January 2000, 17 patients (14 male and 3 female) who had hip and pelvic fractures complicated by sciatic nerve injury were treated with operative reduction and internal fixation and followed up from 10 months to 5 years. The average age was 38 years (ranging 23-56 years). The left extremities were involved in 11 patients and the right in 6. Twelve patients underwent primary exploration and neurolysis and 5 patients underwent secondary operation. RESULTS: Preoperatively, 8 patients were treated with large doses of oral narcotics to control their severe sciatic pain. Three of the 8 patients underwent patient-controlled analgesia and epidural analgesia. After operation, excellent and good rates of reduction and functional recovery of sciatic nerve were 94.1% and 88% respectively. Four patients still had sciatic pain and 2 patients failed to recover. sciatic nerve function improved within 3-6 months after surgery in 11 patients. CONCLUSIONS: Hip and pelvic fractures can result in sciatic nerve injury, especially common peroneal nerve injury and prognosis is poor. Open reduction and internal fixation combined with nerve exploration and neurolysis should be used as early as possible for severe sciatic pain.
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ranking = 0.77967289893652
keywords = nerve
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4/9. Successful open reduction of a 5-month-old hip dislocation associated with a femoral head fracture.

    The long-term prognosis after open reduction of neglected posterior hip dislocations is poor; as such, primary arthroplasty is recommended by a number of authors. We present a patient with a 5-month-old posterior hip dislocation with concomitant paralysis of the sciatic nerve who had an open reduction. At a follow-up of 3.5 years, the patient has normal function with no signs of arthrosis. magnetic resonance imaging scans, however, revealed partial avascular necrosis of the femoral head. A discussion based on the literature shows the uniqueness of this case.
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ranking = 0.064972741578043
keywords = nerve
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5/9. hyperkalemia-induced residual neuromuscular blockade: a case report.

    Muscle relaxants are routinely administered during anesthesia. The residual effects of nondepolarizing muscle relaxants must be reversed by the anesthesia provider prior to extubation of the trachea to ensure that patients can safely protect their own airways and maintain adequate ventilation. Many factors can potentiate the effects of muscle relaxants, and each of these factors must be taken into consideration when postoperative muscle weakness is encountered. Only after the cause of residual neuromuscular weakness is discerned can the appropriate treatment be determined. This article describes the anesthetic management of a patient who experienced postoperative residual muscle weakness secondary to unsuspected hyperkalemia. A discussion of potassium's role in membrane excitability and factors that must be considered in the differential diagnosis of residual neuromuscular weakness is included.
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ranking = 0.57059968528305
keywords = block
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6/9. Triplicate post-traumatic sciatic nerve palsy: evoked potentials in the diagnosis.

    Three episodes of sciatic nerve palsy occurred after open reduction and internal fixation of a fracture-dislocation of the left hip and pelvis in a 20-year-old female injured in a motor cycle accident. There were also ipsilateral open fractures of the tibia and fibula and an open knee injury. When the palsy first developed the patient was in a hip spica plaster cast extending from the costal margin to encase the whole left lower limb. At the time of the second and third episodes of palsy she was in a left below-knee cast and it was not possible to fully assess the function of involved muscles clinically or electromyographically. Psychological factors due to prolonged disability and hospitalization were suspected as a possible cause of weakness. Therefore evoked potentials obtained by stimulation of the peroneal nerves were used to aid diagnosis. There was no response from lumbar and cerebral recording sites on stimulation of the peroneal nerve on the affected side. diagnosis of a conduction block in the sciatic nerve was thus established. The patient recovered clinically and on repeated testing after motor recovery the cortical potential was attenuated and delayed by 15ms. Recurrent sciatic nerve palsy, occurring three times after hip trauma and with heterotopic bone formation and diagnostic application of evoked potential techniques, has not been previously reported.
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ranking = 0.72740459552315
keywords = block, nerve
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7/9. Undiagnosed phaeochromocytoma in the perioperative period. case reports.

    Phaeochromocytomas appear as frequently as one in 1000-2000 patients. Release of catecholamines may be triggered by events in the perioperative period. patients whose phaeochromocytomas are diagnosed in this period, have a mortality of about 80%. Three patients with perioperative debut of symptoms of a phaeochromocytoma are presented. A possible drug-induced release of catecholamines from the tumour is suggested for two of the patients. The first symptoms of a phaeochromocytoma may be arrhythmias and shock, which favours the use of adrenergic blockade prior to elective removal of phaeochromocytomas. Therapeutic approaches to the treatment of catecholamine-induced heart failure may be potassium and magnesium supplements and possibly drugs reducing circulating angiotensin ii activities. Caution is advised in the use of digitalis.
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ranking = 0.14264992132076
keywords = block
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8/9. Late superior gluteal nerve palsy following posterior fracture-dislocation of the hip.

    An unusual case of late superior gluteal nerve palsy complicating posterior fracture-dislocation of the hip is reported. Posterior fracture-dislocation of the hip was Grade V according to the classification of Thompson and Epstein, and Type IV according to the subclassification of Pipkin. The palsy resulted from traction by scar tissue formation. Excision of the scar tissue and decompression of the superior gluteal nerve led to complete recovery.
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ranking = 0.38983644946826
keywords = nerve
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9/9. Bilateral brachial plexus compressive neuropathy (crutch palsy).

    brachial plexus compressive neuropathy following the use of axillary crutches (crutch palsy) is a rare but well-recognized entity. Most reported cases involve the posterior cord of the brachial plexus in children and have resolved spontaneously within 8-12 weeks. We recently treated a 36-year-old man who was using axillary crutches for mobilization after a supracondylar femoral fracture. Bilateral posterior cord (predominantly radial nerve) compressive neuropathy subsequently developed, with lesser involvement of the ulnar and median nerves. The patient had little to no improvement clinically 8 weeks after the estimated onset of the palsy, and an electromyogram at that time confirmed the presence of a severe axonotmesis lesion of the radial, median, and ulnar nerves bilaterally. The patient was treated with static cock-up wrist splinting and discontinuation of the axillary crutches. Return of sensory and motor function was delayed but occurred within 9 months.
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ranking = 0.19491822473413
keywords = nerve
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