Cases reported "Hip Fractures"

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1/57. 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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2/57. 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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3/57. 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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4/57. magnetic resonance imaging of growth plate injuries: the efficacy and indications for surgical procedures.

    In 23 patients with growth plate injuries, magnetic resonance imaging (MRI) studies were performed a total of 31 times to evaluate the physis which showed plain radiographic evidence of possible damage. Fourteen patients clinically showed growth arrest, and 10 patients required a Langenskiold operation. In 3 patients who underwent this operation, subsequent premature total fusion of the physis adversely affected the postoperative results. We propose that the merging shape of the arrest line with calcification of the provisional zone of the metaphysis shown by MRI indicates poor viability of the physis. MRI provided useful information on the appearance of the growth plate and changes in the metaphysis, both of which affected the prognosis and the results of the surgical procedures.
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ranking = 1
keywords = operative
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5/57. venous thromboembolism after hip fracture surgery in a patient with haemophilia B and factor v Arg506Gln (factor v Leiden).

    We describe a patient with mild haemophilia B who developed symptomatic venous thromboembolism after hip arthroplasty for a traumatic fracture. A deep vein thrombosis developed in the operated leg while he was receiving a high-purity factor ix concentrate. Subsequently, he was determined to be a heterozygous carrier for the factor v Arg506Gln (Leiden) mutation. This case illustrates the importance of providing thromboprophylaxis for all patients with haemophilia receiving coagulation factor replacement and who undergo surgical procedures known to be associated with a high risk of venous thromboembolism. In patients with haemophilia and a family history of venous thromboembolism, preoperative screening for the presence of the factor v Arg506Gln mutation and other thrombophilias may be useful.
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keywords = operative
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6/57. Traumatic unilateral avulsion of the anterior superior and inferior iliac spines with anterior dislocation of the hip: a case report.

    A sixteen-year-old boy involved in a high-speed motor vehicle accident sustained an anterior hip dislocation and avulsion of the anterior ilium extending from the anterior superior iliac spine to the anterior inferior iliac spine. The hip was emergently reduced, and further imaging was obtained to evaluate the bony injury. Computed tomography confirmed the presence of a large displaced bony fragment representing avulsion of the anterior superior and inferior iliac spines and a smaller fragment from the reflected head of the rectus femoris. The patient underwent open reduction and internal fixation of the ilium two days after the initial injury. Postoperatively, he was allowed to bear weight as tolerated with crutches but to avoid active hip flexion. He went on to an uneventful recovery, and at last report (approximately six months after injury), he had returned to full activity. An extensive review of the literature failed to show a similar injury of ipsilateral avulsion of the anterior superior and inferior iliac spines and reflected head of the rectus femoris.
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7/57. Preoperative arterial embolization in heterotopic ossification: a case report.

    We report a case of preoperative embolization in a 64-year-old patient suffering from total stiffness of the right hip joint due to heterotopic ossification following brain injury and pertrochanteric fracture of the right femur. A previous attempt of operative treatment could not be performed successfully due to bleeding complications. After the embolization of the correlating hypervascularisation, the surgical procedure was redone and finished with good result and minimal bleeding complications during the operation and a tolerable drop of the haemoglobin concentration postoperatively.
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ranking = 7
keywords = operative
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8/57. 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.
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ranking = 3
keywords = operative
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9/57. Management of pertrochanteric fractures in the elderly patients with an external fixation.

    One hundred patients above 80 years of age (mean age 88.20 years) with 101 fractures in the area of the trochanters were managed with an external fixation (Orthofix pertrochanteric fixator, OPF) from October 1995 to March 2000. Osteosynthesis was performed under radiology control and especially after a satisfactory closed reduction had been obtained. Accompanying diseases, duration of surgery, the transfused blood units, duration of hospitalization, complications, walking ability, time to union and mortality rate were recorded pre-operatively and post-operatively for a year. The results were: fast operation time (19.6 min at average), minimal blood loss (no blood transfusion was needed for 85 patients whereas for the remaining 15 patients 29 blood units were administrated due to a pre-existing anemia and not to compensate blood loss during surgery) and short duration of post-operative hospitalization (5.27 days at average). The main complications that were recorded were sore wounds in 15%, inflammation in the entrance of the screws in 9%, and aseptic loosening of the femoral screws/loss of reduction in varus >10 degree in 8%. These complications did not prevent the union of the fracture to a satisfactory level (13.91 weeks at average). There were no revisions. Within the first post-operative semester, the majority of the patients (57.69%) returned to the walking condition they had before the fracture. Post-operative mortality during the first month was 15% whereas during the first post-operative semester the rate increased by 7%. Due to the design of the device, the method is simple, fast, does not derange the patients and requires short time of hospitalization. These advantages are especially useful for the treatment of elderly patients with aggravated general condition.
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ranking = 6
keywords = operative
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10/57. 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
keywords = operative
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