Cases reported "Hip Fractures"

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11/325. ethics in practice.

    H. K. is a ninety-two-year-old woman with Alzheimer's disease and mild hypertension. She resides at a nursing home, where she transfers from bed to chair with maximal assistance. She presents to our emergency department with a painful right hip. physical examination demonstrates a confused, elderly patient with significant right hip pain and shortening and external rotation of the lower extremity. Radiographs demonstrate a displaced intertrochanteric hip fracture. The patient lacks the capacity for informed consent. Her family is contacted to obtain consent for insertion of a compression screw. The family refuses to give consent, stating that the patient is too old and the surgery is too dangerous. ( info)

12/325. 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. ( info)

13/325. 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. ( info)

14/325. 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. ( info)

15/325. 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. ( info)

16/325. Failure of osteosynthesis and prosthetic joint infection due to mycobacterium tuberculosis following a subtrochanteric fracture: a case report and review of the literature.

    We report a patient with a subtrochanteric fracture, for whom internal fixation failed and a prosthetic joint replacement was complicated by a local reactivation of a mycobacterium tuberculosis infection. After hip replacement with revision and adequate medical therapy, a full recovery was attained without the necessity of removing the artificial joint. ( info)

17/325. Asymmetrical bilateral traumatic hip dislocation with ipsilateral acetabular fracture.

    We report a case of simultaneous asymmetrical bilateral traumatic hip dislocation, with one hip dislocated anteriorly and the other posteriorly, with ipsilateral acetabular fracture, suffered in a traffic accident by a 36-year-old man. Closed reduction of both hips was performed, followed by delayed internal fixation of the acetabular fracture. ( info)

18/325. Bilateral trochanteric fractures of the femur in a patient with chronic renal failure.

    We report a spontaneous intertrochanteric fracture with bilateral avulsion of the greater trochanter in a patient with chronic renal failure. ( info)

19/325. Pelvic ring injury with urologic trauma: a report of bladder extravasation into the hip joint.

    A case of blunt trauma is presented with pelvic ring disruption and an extraperitoneal bladder rupture that communicated with the hip joint through an acetabular fracture. Extraperitoneal bladder rupture is usually associated with blunt polytrauma and pelvic ring injuries. Expedient diagnosis and multidisciplinary management are essential to minimize significant early and late complications. ( info)

20/325. Salter-Harris type II fractures of the capital femoral epiphysis.

    Salter-Harris type II fractures of the capital femoral epiphysis have not been previously documented. The authors have treated three patients who sustained four such fractures. One child had a recurrent fracture two years after the first had healed satisfactorily. Two fractures were treated by spica cast immobilization, one fracture by closed reduction and internal fixation, and the other fracture healed without treatment. No patient developed avascular necrosis or other complications. Two of the children had an association with idiopathic slipped capital femoral epiphysis. An etiologic relationship with slipped capital femoral epiphysis, if any, is uncertain. ( info)
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