Cases reported "Osteoporosis"

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1/23. Insufficiency fractures of the distal tibiae.

    We describe two patients with uncommon types of insufficiency fractures that occurred at the distal tibiae. In case 1, a 71-year-old man with secondary osteoporosis due to hypogonadism fracture of his left distal tibia was overlooked because initial radiographs had seemed normal. However, bone scintigram obtained 2 months prior to the onset of fracture had already demonstrated abnormally high uptake at the site. In case 2, a 62-year-old woman with postmenopausal osteoporosis sustained an insufficiency fracture of the left distal tibia. Good clinical results were obtained with nonsurgical treatment. Based on the clinical course of case 1, we believe that bone scintigrams may be useful not only for the early diagnosis of insufficiency fracture but also for predicting such fractures.
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keywords = tibia
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2/23. Bilateral tibia and fibula fractures in a patient with rheumatoid arthritis.

    A 52-year-old woman with rheumatoid arthritis treated with low-dose steroids developed bilateral distal tibia and fibula fractures over a 15-month period. Her bone density was within osteopenic levels. Such fractures are an unusual but increasingly recognised complication of rheumatoid disease and its treatment, although there is often diagnostic delay. Bilateral fractures are particularly rare. A high level of clinical suspicion is required for early diagnosis.
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ranking = 0.71428571428571
keywords = tibia
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3/23. Occult bilateral acetabular fractures associated with high-energy trauma and osteoporosis.

    Acetabular fractures that are radiographically occult are associated with osteoporosis, low-energy trauma, and advanced age. We present a case of bilateral occult acetabular fractures in a 65-year-old woman who presented with an open tibia-fibula fracture and compartment syndrome and thoracolumbar spine fractures sustained in a motor vehicle accident. Initial radiographs of the pelvis and a pelvic CT scan did not show any bony injuries when the films were reviewed prospectively. At 6 weeks after injury, a CT scan and plain radiographs showed bilateral healing transverse acetabular fractures with acetabular protrusio on the left. At most recent follow-up, the patient had posttraumatic hip arthritis with moderate protrusio on the left and was ambulating with a cane. Total hip arthroplasty is anticipated in the future.
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ranking = 0.14285714285714
keywords = tibia
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4/23. Longitudinal bone insufficiency fracture of the tibia in a renal transplant recipient.

    We report a case of longitudinal tibial fracture as the first manifestation of bone insufficiency in a 50-year-old patient who had received a renal transplant 12 years earlier. The epidemiological, clinical, and imaging features of these fractures are reviewed. Bone loss occurs in the long term in about half of renal transplant recipients. The main causes are preexisting renal osteodystrophy; glucocorticoid therapy; and hyperparathyroidism, whether residual or secondary to imperfect graft function. The effects of cyclosporine therapy on bone metabolism remain unclear. Identification of patients at very high risk of fracture and available options for early prophylaxis are discussed.
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ranking = 0.71428571428571
keywords = tibia
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5/23. Postpartum osteoporosis associated with proximal tibial stress fracture.

    A 33-year-old woman presented with acute nonspecific knee pain, 6 months postpartum. MR imaging, computed tomography and radiography were performed and a proximal tibia plateau insufficiency fracture was detected. Bone densitometry demonstrated mild postpartum osteoporosis. To our knowledge these findings have not been described in this location and in this clinical setting. The etiology of the atraumatic fracture of the tibia is presumed to be due to a low bone mineral density. The bone loss was probably due to pregnancy, lactation and postpartum hormonal changes. There were no other inciting causes and the patient was normocalcemic. We discuss the presence of a postpartum stress fracture in a hitherto undescribed site in a patient who had lactated following an uncomplicated pregnancy and had no other identifiable cause for a stress fracture.
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ranking = 0.85714285714286
keywords = tibia
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6/23. Shifting bone marrow edema of the knee.

    OBJECTIVE: The purpose of our study is to describe shifting bone marrow edema in the knee as the MR imaging feature of intra-articular regional migratory osteoporosis of the knee. patients AND methods: Five men, aged 45-73 years, were referred by orthopedic surgeons for MR imaging evaluation of knee pain, which had been present for 2 weeks to 6 months. One patient had a prior history of blunt trauma. None had risk factors for osteonecrosis. Four patients had two MR examinations and the patient with prior blunt trauma had four. Plain radiographs were obtained in all patients. RESULTS: In all cases, a large area of marrow edema initially involved a femoral condyle, with migration of the bone marrow edema to the other femoral condyle, tibia, and/or patella occurring over a 2- to 4-month period. Adjacent soft tissue edema was present in all five patients, while none had a joint effusion. Radiographs of two patients showed generalized osteopenia. CONCLUSION: In the absence of acute trauma or clinical suspicion of infection, a large area of bone marrow edema without a zone of demarcation may represent intra-articular regional migratory osteoporosis. Demonstration of shifting bone marrow edema on follow-up examinations suggests this diagnosis.
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ranking = 0.14285714285714
keywords = tibia
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7/23. Effective parenteral clodronate treatment of a child with severe juvenile idiopathic osteoporosis.

    We report on an 8 years and 3 months old boy with severe idiopathic juvenile osteoporosis (IJO). Clinical features included multiple fractures, especially of the vertebrae, and neurological symptoms. Biological studies showed non-parathyroid hormone-mediated excessive bone resorption and massive urinary calcium loss. Although IJO is usually a self-limiting condition after puberty, the severity of our patient's manifestations required therapeutic intervention. Clodronate (dichloromethylene-bisphosphonate) was administered parenterally every 3 months for a period of 2 years. Dramatic clinical and biochemical improvement was noted within 2 weeks. All parameters of bone resorption normalised and no new fractures occurred. After 6 months of treatment, radiological improvement with healing of fractures and rebuilding of the vertebral plates was documented. Bone mineral density increased to normal within 1 year and growth velocity was accelerated. After 2 years, treatment was stopped at the age of 10 years and 3 months. One year later, back pain and increasing pain in the knee region recurred. A tibial fracture was evident and, again, bone mineral density was far below normal. Bisphosphonate medication was reinstituted leading to rapid improvement. No side-effects were observed. CONCLUSION: Parenteral clodronate therapy is effective in managing severe idiopathic juvenile osteoporosis.
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ranking = 0.14285714285714
keywords = tibia
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8/23. Bone death in transient regional osteoporosis.

    A 48-year-old man developed transient regional osteoporosis, with hip and later knee pain. He responded well to lumbar sympathectomy. The femur and tibia adjacent to the painful knee were osteoporotic, while the medial femoral condyle showed increased uptake in a bone scan. In the femoral condyle, bone histology showed areas of dead bone undergoing osteoclastic resorption, and increased bone formation. The tibial bone was histologically normal. The partial bone death in the distal femur suggests that the disorder may be related to both avascular necrosis of bone and reflex sympathetic dystrophy.
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ranking = 0.28571428571429
keywords = tibia
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9/23. Medial fibula transport with the Ilizarov frame to treat massive tibial bone loss.

    Massive segmental tibial bone loss from trauma, tumor, or infection is a limb-threatening situation. It is a considerable surgical challenge, especially when associated with extensive skin and soft tissue damage. amputation was the only solution in the past, but current limb-salvage options include contralateral or ipsilateral microvascularized or free-fibular transfer. However, these methods are not without risks and disadvantages. We report seven patients with massive tibial bone loss treated by gradual medial transport of the ipsilateral fibula using an Ilizarov traction apparatus with olive wires after proximal and distal fibular osteotomies. This method has the advantages of avoiding surgery on the contralateral limb while allowing early weightbearing because of the stability of the Ilizarov frame. hypertrophy of the transported fibula accompanied by full weightbearing and satisfactory joint motion occurred in all patients. All patients were satisfied with the results, and none thought amputation would have been a better treatment. The minimum followup was 5 years. We think the Ilizarov frame for ipsilateral fibular gradual transport is a reasonable alternative for limb salvage in patients with massive tibial bone loss. LEVEL OF EVIDENCE: Therapeutic Study, Level IV (case series). See the Guidelines for Authors for a complete description of levels of evidence.
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keywords = tibia
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10/23. Bilateral tibial stress fracture presenting as painful edemas in lower limbs.

    Bilateral stress fracture of the tibia is infrequent. This paper presents an unusual case of a 73-year-old man who sustained a bilateral stress fracture of the tibia presenting as painful edemas in lower limbs. The radiographic and scintigraphic examination confirmed the diagnosis of the fractures. In addition, the patient was receiving androgen deprivation therapy with GnRH analogs for the treatment of prostate cancer and the bone density measurements confirmed the presence of osteoporosis. Treatment with restricted weight bearing was associated with improvement of clinical symptoms. Early recognition and diagnosis of this injury is essential for treating the underlying osteoporosis as well as the fracture.
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ranking = 0.85714285714286
keywords = tibia
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