Cases reported "Osteonecrosis"

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1/492. Assessment of bone viability by scintiscanning in frostbite injuries.

    Radionuclide bone imaging with a radiotechnetium-labeled phosphate (99mTc-methylene diphosphonate) has been employed to study the extremities injured by frostbite. The degree of accretion of the radiopharmaceutical in bone is dependent on the integrity of the vascular supply. This property has been used successfully to distinguish viable and nonviable bone. ( info)

2/492. Does avascular necrosis cause collapse of the dome of the talus in severe haemophilia?

    Arthropathy of the ankle joint is commonly observed in people with severe haemophilia. A review of the radiological appearance of ankle arthropathy provides evidence that the changes in the talar bone of the ankle joint are probably due to avascular necrosis. This may arise due to impairment to the arterial supply, as it enters the talar neck, secondary to the increased pressure at the time of haemarthroses. ( info)

3/492. Patellar stress fracture: a complication of knee joint arthroplasty without patellar resurfacing.

    A case of patellar stress fracture after total knee arthroplasty in a man with gout and previous osteonecrosis of the tali is reported. The combination of fat pad excision and lateral release causing disruption to the patellar blood supply during primary total knee arthroplasty resulted in the development of a patellar fracture. Avascular necrosis, caused by gout, may form part of the pathogenesis. ( info)

4/492. Thiemann's disease: a case report.

    In this case report, we describe a patient with the diagnosis of Thiemann's disease, which is a genetically determined rare form of idiopathic avascular necrosis of the proximal interphalangeal joints of the hands. ( info)

5/492. Heat-induced segmental necrosis after reaming of one humeral and two tibial fractures with a narrow medullary canal.

    In three cases referred to our clinic (a simple fracture of the humeral shaft, a simple, closed fracture, and a wedge fracture of the mid-third of the tibia), bone necrosis had resulted from excessive heat produced by reaming extremely narrow medullary cavities (5-5.5 mm diameter) with the 9 mm front-cutting reamer as part of a reamed nailing procedure. In any one case, different degrees of damage can occur from the metaphysis to the diaphysis. Based on the clinical course and the histological evaluation, we postulate that heat-induced damage can be divided into four degrees of severity (0-3): Grade 0: no damage; no devascularization, no heat-induced damage. Grade 1: The heat damaged zone is cut away during subsequent reaming, the only damage is devascularization. Grade 2: The damaged zones are not eliminated by subsequent reaming. The bone is devascularized and heat damaged. Grade 3: The entire cross section of the bone including the periosteum is devitalized by exposure to excessive heat. Depending on the severity of additional damage to the soft tissues, grave consequences are to be expected and further operations are unavoidable. The effects of heat-induced damage are particularly critical in the presence of infection (cases 2 and 3). The fundamental aspects and the extent of heat necrosis will be discussed. After discussion with the AO Technical Commission on the cause of heat-induced necrosis, we would recommend the following preventive measures: 1. preoperative measurement of the smallest diameter of the medullary cavity in two planes. 2. reaming with the standard instrumentation (9 mm) only if the medullary cavity has a diameter of at least 8 mm at its narrowest point. 3. Extremely narrow cavities should first be reamed manually or an alternative to nailing should be sought. 4. It is strongly recommended that only sharp reamers be used in such cases and blunt or damaged reamers replaced. ( info)

6/492. A novel surgical procedure for osteonecrosis of the humeral head: reposition of the joint surface and bone engraftment.

    A novel surgical procedure was performed on a 33-year-old woman with idiopathic osteonecrosis of the head of the left humerus. The operation involved repositioning of the joint cartilage and bone engraftment through her humeral head from under the greater tuberosity with shoulder arthroscopy. The patient wore an abduction brace for 8 weeks after the operation to hold the joint surface in its new position. This surgical procedure resulted in considerable improvement of the functional status of the shoulder by relieving pain and increasing range-of-motion. A preoperative radiograph showed stage IV osteonecrosis of the humeral head. However, at follow-up, repositioning of the joint surface and improvement of the necrotic bone were observed by radiography and magnetic resonance imaging. ( info)

7/492. Avascular necrosis of the distal phalangeal epiphysis following physeal fracture: a case report.

    Avascular necrosis of the distal phalangeal epiphysis following an unrecognized angulated Salter II fracture of the distal phalanx treated by open reduction and internal fixation resulted in premature closure of the growth plate and mild shortening. The epiphysis itself revascularized and good function of the distal interphalangeal joint was maintained. ( info)

8/492. An operative procedure for advanced Kienbock's disease. Excision of the lunate and subsequent replacement with a tendon-ball implant.

    Excision of the lunate and subsequent replacement with a tendon implant was performed in 22 patients with Kienbock's disease between 1971 and 1985. This procedure was indicated mainly for those with advanced Kienbock's disease, i.e., stage III or IV according to the Lichtman classification. After the collapsed lunate is removed, a tendon-ball implant, made of the palmaris longus and plantaris tendons is placed in the resultant space in the carpus. A forearm distractor is applied during the operation, and distraction is continued for 4 weeks postoperatively. We report the long-term results in 15 patients, whose average follow-up period was 16 years and 3 months. One patient with infection was excluded from the study because the implanted tendon was removed 2 weeks after the operation, and 6 patients were lost to follow-up. All patients were free of pain after the surgery. The flexion-extension range of the wrist increased by 14.2 degrees, on average, after the surgery. The average grip power of the operated hand was 90.2% of that in the non-operated hand. Calcification and ossification were frequent in the implanted tendons a few months postoperatively. The average carpal height ratio (defined as carpal height/length of the third metacarpal) was 0.53 before the operation and 0.49 at the time of follow-up. According to Dornan's classification of clinical results, 9 of the 15 patients were classified as having excellent results and 6 as good. ( info)

9/492. Treatment of autoimmune premature ovarian failure.

    There is no known immunosuppressive therapy for autoimmune premature ovarian failure that has been proven safe and effective by prospective randomized placebo-controlled study. Nevertheless, immunosuppression using corticosteroids has been used on an empirical basis for this condition. Here we present two cases of young women with premature ovarian failure who were treated with glucocorticoids in the hopes of restoring fertility. The first case illustrates the potential benefit of such therapy, and the second case illustrates a potential risk. The first patient with histologically proven autoimmune oophoritis was treated with alternate day glucocorticoid treatment. She had return of menstrual bleeding six times and ovulatory progesterone concentrations four times over a 16 week period. The second patient with presumed but unconfirmed autoimmune ovarian failure was referred to us after having been treated with a 9 month course of corticosteroids. During that treatment her menses did not resume. The corticosteroid treatment was complicated by iatrogenic cushing syndrome and osteonecrosis of the knee. Identifying patients with autoimmune premature ovarian failure presents the opportunity to restore ovarian function by treating these patients with the proper immune modulation therapy. On the other hand, potent immune modulation therapy can have major complications. Corticosteroid therapy for autoimmune premature ovarian failure should be limited to use in placebo-controlled trials designed to evaluate the safety and efficacy of such treatment. ( info)

10/492. osteonecrosis of the base of the second metacarpal: a case report.

    osteonecrosis of the metacarpal is rare. Previously reported cases have only involved the metacarpal heads, with the long finger being the most commonly affected. We present a patient with avascular necrosis involving the base of the second metacarpal. ( info)
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