1/790. Femoral fracture at the proximal end of an intramedullary supracondylar nail: a case report. Retrograde intramedullary supracondylar nails have been added to the orthopedic armamentarium for treatment of distal femoral fractures. Major complications of this new technique have not been noted. We report a case of a femoral fracture at the proximal end of a retrograde intramedullary supracondylar nail. We hypothesize that this complication may be due to the proximal end of the nail acting as a stress riser, with the cortical holes drilled for the interlocking screws compounding this effect. ( info) |
2/790. Remission of idiopathic thrombocytopenic purpura after femoral lengthening. Clinical case followed for 5 years. We report on a patient with chronic idiopathic thrombocytopenic purpura (ITP) who went into remission after femoral lengthening. Although it is possible that spontaneous remission (frequency 5%-10%) of chronic ITP coincided with the femoral lengthening, limb lengthening could also have caused the thrombocytosis. This case suggests a close relationship between osteogenesis and hematopoiesis during regenerate bone formation. Limb lengthening can therefore be defined as the formation not only of bone and soft tissue but also of hematopoietic tissue. ( info) |
3/790. sciatic nerve injury associated with fracture of the femoral shaft. The sciatic nerve escapes injury in most fractures of the femoral shaft. We report a case of sciatic nerve palsy associated with a fracture at the distal shaft of the femur. The common peroneal division of the sciatic nerve was lacerated by a bone fragment at the fracture site. Despite the delay in treatment, a satisfactory result was obtained. ( info) |
4/790. Pseudoaneurysm of the superficial femoral artery following accidental trauma: result of treatment by percutaneous stent-graft placement. Accidental trauma frequently involves the extremities, and can extend to involve their blood supply, causing exsanguinating hemorrhage and pseudoaneurysm in the involved blood vessel. This is traditionally managed by surgical repair. We report a case in which control of life-threatening hemorrhage and exclusion of a large, post-traumatic pseudoaneurysm in the superficial femoral artery was performed by a commercially available stent-graft, without complication. This treatment method may be a safe and effective alternative to surgery in selected patients. ( info) |
| Two patients thought to have distal femur fractures presented to the emergency department (ED) of a level 1 trauma center with traction splints applied to their lower extremities. Both patients had varying degrees of peroneal nerve palsies. Neither patient sustained a fracture, but both had a lateral collateral ligament injury and one an associated anterior cruciate ligament tear. One patient had a sensory and motor block, while the other had loss of sensation on the dorsum of his foot. After removal of the traction splint both regained peroneal nerve function within 6 hours. Although assessment of ligamentous knee injuries are not a priority in the trauma setting, clinicians should be aware of this possible complication in a patient with a lateral soft tissue injury to the knee who is placed in a traction splint that is not indicated for immobilization of this type of injury. ( info) |
6/790. Primary resection total knee arthroplasty for complicated fracture of the distal femur with an arthritic knee joint. Treatment of fractures of the distal end of the femur in an elderly patient is difficult. If the knee joint is arthritic, the problem is even greater. The reports of two patients with rheumatoid arthritis who sustained fractures of the distal end of the femur and underwent unconventional treatment with a resection total knee arthroplasty are presented. ( info) |
7/790. Management of supracondylar fractures of the femur with the GSH intramedullary nail: preliminary report. The GSH supracondylar nail is a closed section rigid intramedullary device that combines the biomechanical advantages of intramedullary fixation with the stability of rigid internal fixation for the management of supracondylar fractures of the femur. The use of this implant is indicated in the management of distal comminuted nonarticular fractures and fractures with intraarticular extension. Intramedullary fixation provides improved fracture stabilization in both elderly patients with osteoporotic metaphyseal bone and in younger patients with extensively comminuted fractures. The experience with the GSH supracondylar nail has shown that it provides better results than supracondylar plating for the stabilization of acute fractures or revision of failed internal fixation. ( info) |
8/790. Unusual longitudinal stress fractures of the femoral diaphysis: report of five cases. We present five cases of a distinctive type of longitudinal stress fracture of the upper femoral shaft in which the fracture line is parallel to the outer surface of the bone, in contrast to the perpendicular orientation to the cortical surface in previously reported cases of diaphyseal stress fractures. In two cases the fracture recurred after 15 and 18 months, respectively. ( info) |
9/790. Ewing's sarcoma recurrence vs radiation necrosis in dynamic contrast-enhanced MR imaging: a case report. PURPOSE: We report a case of Ewing's sarcoma in the right distal femur in a 6-year-old male to demonstrate how dynamic contrast-enhanced magnetic resonance imaging (DEMRI) findings predicted histopathology. MATERIALS AND methods: DEMRI was performed at presentation and during and after completion of chemotherapy and radiation therapy. Histopathologic studies were done at presentation, at 77 weeks (20 weeks after a pathological fracture), and from the en bloc resection at 104 weeks. RESULTS: DEMRI predicted the early tumor response, absence of tumor recurrence, presence of necrosis and lack of fracture healing, confirmed by histopathology. CONCLUSION: DEMRI is a clinically useful tool in managing Ewing's sarcoma. ( info) |
10/790. Severe anorexia nervosa associated with osteoporotic-linked femural neck fracture and pulmonary tuberculosis: a case report. We report a case study of a 38-year-old woman who had been suffering from anorexia nervosa (AN) since the age of 26. Before admittance to our clinic, she weighed 23.8 kg (at a height of 164 cm, 8.8 body mass index [BMI]) but still carried out strenuous physical activities. After good psychotherapeutic response and weight gain (34.4 kg), she accidentally fell and broke her femoral neck-favored as it was by osteoporosis. The X-ray taken before dynamic hip screw implantation coincidentally showed signs of pulmonary tuberculosis (TB), which could then be proven by computed tomography (CT) scans and cultures from a bronchoscopy. Other than lack of appetite and loss of weight, which we attributed to AN, there were no other clinical or biochemical indicators which could have pointed to an earlier TB diagnosis. As a result, the need for screening procedures is discussed. The manifestation of TB during the first weight gain after 12 years of severe malnutrition, during which there were no serious infections, seems to endorse former observations that AN patients appear to be "resistant" to some extent against infectious diseases, a "protection" which may be lost with convalescence and weight gain. ( info) |