Orthopedics
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Femoral neck fractures account for 46% of the proximal femur fractures in children; however, the overall incidence of proximal femur fractures in children is <1%. Pathologic causes for proximal femur fractures include local or global causes of bone weakness, such as metabolic bone conditions or neoplastic causes. Nonpathologic causes of femur fractures are caused almost exclusively by high-energy trauma and are readily identified. ⋯ If neither condition is readily identified, the possibility of nonaccidental injury should be considered. This article presents a case of nonaccidental injury with an atypical presentation in a 3-year-old girl with a femoral neck fracture and discusses the diagnostic rationale for a diagnosis of nonaccidental injury. This case report highlights the magnitude of child abuse and its early recognition in the orthopedic community.
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Gas gangrene or clostridial myonecrosis is a rare, life threatening infection of the muscle that is typically associated with recent surgery or trauma. It usually affects older individuals who suffer from vascular insufficiency or who are immunocompromised. The typical pathogen is Clostridium perfringens. ⋯ A team approach to managing these patients postoperatively is necessary. The use of hyperbaric oxygen can be considered, however, it may not be readily available and its use is unproven in human studies. Due to its high mortality, one should err on the side of more aggressive resective/ablative surgery.
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Case Reports
Acute fracture of the acetabulum secondary to a convulsive seizure 3 years after total hip arthroplasty.
While aseptic loosening, osteolysis, and infection are the most common causes of failure after total hip arthroplasty (THA), late hip pain can also be the result of acetabular fracture related to trauma and resultant prosthetic failure. However, atraumatic fracture of the acetabulum around a well-fixed acetabular component is unusual. We present a patient with an acetabular fracture resulting from a generalized convulsive attack 3 years after an uncomplicated primary THA. ⋯ Severe muscle spasms during generalized seizures are known to lead to various musculoskeletal injuries (fractures of the proximal humerus, femur, acetabulum, and dislocation of the shoulder). Seizures could also lead to acute periprosthetic fracture of the acetabulum in patients with osteopenia. Therefore careful reaming is required to avoid overmedialization of the acetabular component in those patients.
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Controlled Clinical Trial
One-stage bilateral total joint arthroplasty: a prospective, comparative study of total hip and total knee replacement.
This prospective study compared the incidence of minor and major complications in 50 patients (100 joints) undergoing bilateral total knee arthroplasty (TKA) with 50 patients (100 joints) undergoing bilateral total hip arthroplasty (THA). Gender, comorbidities, American Society of Anesthesiologists scores, and body mass indices were similar in both groups. ⋯ Bilateral THA patients had lower rates of total major and minor complications than bilateral TKA patients. Although cementless bilateral THA and cemented bilateral TKA can be performed efficiently and with relative safety in a select group of patients, the high rate of minor complications and in particular the need for allogenic transfusion in both groups is concerning and should be discussed with patients before surgery.
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We report a case of a skeletally immature achondroplastic adolescent with significant thoracolumbar lordosis who presented with neurogenic claudication and urinary incontinence progressing over a 1-year period. She underwent decompressive lumbar laminectomy from T12 to L5 with preservation of the facet joints. ⋯ Because of the severity and progression of her deformity, a combined anterior and posterior fusion and stabilization was required. We present this case and a review of the literature on spinal stenosis in achondroplasia and the complication of post-laminectomy kyphosis.