1/68. 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.- - - - - - - - - - ranking = 1keywords = bone (Clic here for more details about this article) |
2/68. osteoporosis. An overview of the National osteoporosis Foundation clinical practice guide.During the past decade, numerous organizations and associations have published recommendations for the prevention and treatment of osteoporosis. For the primary care physician, the most applicable of these--due to its reliance on clinical trial data and its scope--is the clinical guide published by the National osteoporosis Foundation. The guide addresses risk assessment, bone mineral density testing, diagnosis, nutritional supplementation, and pharmacologic therapy, including consideration of the newer agents used to slow or manage osteoporosis progression. Reflecting one of the key deficiencies in the clinical trial data, the guide applies predominantly to a patient population of postmenopausal white females. The refined design of new osteoporosis studies will in time allow for recommendations that apply to a more diverse patient population.- - - - - - - - - - ranking = 1keywords = bone (Clic here for more details about this article) |
3/68. Apophyseal fracture of the greater trochanter.Apophyseal fractures about the pelvis and proximal femur are well-described; however, these injuries rarely involve the greater trochanter. We report the case of a 15-year-old boy of large build who appeared to have all signs and symptoms of a left slipped capital femoral epiphysis. No specific inciting event had occurred before the hip pain. Radiographs and bone scan of the capital femoral epiphysis appeared normal, and follow-up radiographs confirmed an apophyseal fracture of the greater trochanter. This case represented a rare occurrence, and its interesting manifestation was similar to that of a slipped capital femoral epiphysis.- - - - - - - - - - ranking = 1keywords = bone (Clic here for more details about this article) |
4/68. Sudden death from pelvic hemorrhage after bilateral central fracture dislocations of the hip due to an epileptic seizure.Fracture and dislocation of major joints may be caused by the forceful tonic muscular contractions of seizure activity. A 77-year-old man who was found dead in bed with no sign of external trauma had bilateral central fracture dislocations of the femoral head through the acetabular floor with fatal pelvic hemorrhage and extensive pulmonary fat and bone marrow embolism. He had epilepsy, but the last seizure was 6 years earlier, and he had long discontinued medication. The fractures were attributed to a new unwitnessed seizure. This is the twentieth case of central fracture dislocation of the hip since 1970, when better anesthesia eliminated convulsive therapy-induced fractures. The authors review these 20 cases. seizures followed inflammation, infarction or neoplasia of the brain, eclampsia, metabolic or iatrogenic causes, or epilepsy (6 cases, 2 of which had no prior seizures for 5 years). There were 11 men (mean age, 64 years) and 9 women (mean age, 47 years). Fractures were unilateral in 13 and bilateral in 7. Additional fractures (in vertebrae, shoulders, or femur) were present in eight. Only eight had prior bone disease. Local symptoms led to diagnosis in most, but two were identified incidentally on imaging. The current patient was the only one to die suddenly, but six other patients presented with shock and three died (one of whom had injuries that led to a suspicion of manslaughter). Central fracture-dislocation of the hip is a rare and little known consequence of seizures, with strong potential for misdiagnosis and lethal complications.- - - - - - - - - - ranking = 2keywords = bone (Clic here for more details about this article) |
5/68. Dealing with post-traumatic arthrosis of the hip.The conversion of the arthritic post-traumatic hip may be more similar to revision surgery than routine primary hip replacement. Careful preoperative planning and templating is essential. Soft-tissue balance to produce stability is challenging, and patients may need bracing with a THR orthosis postoperatively to assure soft-tissue healing and stability. Acetabular bone stock may be significantly compromised, and the preoperative identification of bone stock deficiencies may not always be possible. The surgeon should be prepared with adequate allograft, acetabular reconstruction rings, and alternative procedures such as fusion or resection arthroplasty in these challenging cases.- - - - - - - - - - ranking = 2keywords = bone (Clic here for more details about this article) |
6/68. Endoscopic-assisted, minimally invasive anterior pelvic ring stabilization: a new technique and case report.This report describes the technique of endoscopic-assisted reduction and stabilization of the anterior pelvic ring with endoscopic visualization of all critical bone and soft tissue structures. Compared with the conventional ilioinguinal approach of Letournel, the endoscopic technique facilitates a reliable internal fixation of anterior pelvic ring fractures with minimal soft tissue trauma. Thus, the use of the endoscope enables us to apply the concept of minimal invasive plate osteosynthesis to the pelvis. We recommend the described technique for complex anterior pelvic ring fractures, in which the anterior stabilization has to be achieved with a plate from the symphyseal region to the iliac wing.- - - - - - - - - - ranking = 1keywords = bone (Clic here for more details about this article) |
7/68. Decreased cutaneous vitamin d-synthesis in heavily melanized individuals: a rare cause for pathologic fractures of the hip.Painful pathological fractures of the femoral neck and the subtrochanteric region of the femur are reported in two women originating from india. After exclusion of renal or intestinal causes, laboratory data on bone metabolism, scintigraphic and radiographic examinations were characteristic for the presence of secondary hyperparathyroidism. Based on vitamin deficiency and low calcium absorption, disturbed mineralization of bone and increased osteoclastic resorption have apparently led to osteomalacia and subsequent fracturing. Fracture localization necessitated surgical fixation in one patient; conservative treatment including protected weightbearing was effective in the other women. After supplementation of calcium and vitamin D3, levels of parathyroid hormone and scintigraphic alterations returned to normal in both patients. In these two cases, pathological fractures of the hip could be attributed to the presence of secondary hyperparathyroidism based on decreased cutaneous vitamin d synthesis.- - - - - - - - - - ranking = 2keywords = bone (Clic here for more details about this article) |
8/68. Failure on attempted removal of a Gamma nail in two young patients.We experienced failures in attempting to remove a Gamma nail and a long Gamma nail, both of which were used for fixation of a subtrochanteric fracture in two young patients. We suspect that new bone forms in the notch, which is located beneath the screw thread in the lag screw, and causes jamming of the lag screw in young patients after fracture consolidation.- - - - - - - - - - ranking = 1keywords = bone (Clic here for more details about this article) |
9/68. Retrograde removal of an incarcerated solid titanium femoral nail after subtrochanteric fracture.Intramedullary nailing with a solid titanium nail can result in significant bone ingrowth. Failure of an implant requires removal for replacement with another device. Previous methods have included use of extractors for cannulated nails. When extractors are not available or are inadequate, a simple retrograde push-out method can be used as described here.- - - - - - - - - - ranking = 1keywords = bone (Clic here for more details about this article) |
10/68. Late presentation of a displaced subcapital fracture of the hip in transient osteoporosis of pregnancy.Transient osteoporosis of the hip is rare and has two demographic peaks, one during the third trimester of pregnancy and the other around the fifth to sixth decade of life. During pregnancy, osteoporosis presents with insidious onset of hip pain and antalgic limp with no antecedent infection or trauma. Radiographs show pronounced osteopenia of the femoral head and neck with preservation of the joint space. 1 Bone scan and magnetic resonance imaging are sensitive but not specific for diagnosis, and laboratory studies are typically normal. 2 We present the case of a patient with a displaced, grossly unstable subcapital hip fracture who presented 5 months postpartum and describe successful treatment by open reduction and internal fixation with a muscle-pedicle bone graft.- - - - - - - - - - ranking = 1keywords = bone (Clic here for more details about this article) |
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