Orthopedics
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Although hip dislocation combined with acetabular fracture is not an uncommon injury, anterior acetabular wall fractures rarely occur in patients who have posterior fracture-dislocations of the hip. This article presents a unique case of anterior and posterior wall fractures of the ipsilateral acetabulum in a patient who sustained traumatic posterior hip dislocation that resulted from a high-speed motor vehicle accident. The initial imaging evaluation, which did not include the obturator oblique view, revealed no concomitant anterior acetabular wall fracture. ⋯ Intraoperatively, the major anterior wall fragment was used to reconstruct the defected posterior wall. This case highlights the necessity of suspicion and pre- and postoperative monitoring of the obturator oblique view and CT scans to detect the potentially existing anterior acetabular wall fracture. Early surgical intervention is important to guarantee satisfactory outcomes of such complex fracture-dislocation injuries.
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Comparative Study
Dynamic compression plate and cancellous bone graft for aseptic nonunion after intramedullary nailing of femoral fracture.
We evaluated the effect of revision with dynamic compression plate and cancellous bone graft for aseptic nonunion after intramedullary nailing of femoral shaft fracture. Fifty patients with aseptic nonunion of femoral shaft fracture after intramedullary nailing were reviewed and analyzed retrospectively between 1996 and 2007. There were 40 men and 10 women with an average age of 44 years (range, 19-76 years). ⋯ One superficial wound infection occurred. At follow-up, each patient was evaluated to have satisfactory function results, with near normal hip/knee functions without noticeable pain, and full return to preinjury activities/work without pain. Augmentative dynamic compression plate with cancellous bone graft is a reliable and effective treatment for revision of aseptic nonunion of femoral shaft fracture after intramedullary nailing.
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Case Reports
Multi-level total en bloc spondylectomy for solitary lumbar metastasis of myxoid liposarcoma.
This article reports a case of solitary lumbar metastasis of myxoid liposarcoma treated by multi-level total en bloc spondylectomy. Myxoid liposarcoma has a predisposition to initial metastasis at an extrapulmonary site including bone. However a bone scan and FDG-PET, which are generally used for a whole-body screening of metastasis, are not sensitive to bone metastasis from myxoid liposarcoma. ⋯ The lumbar nerves were dissected and preserved. The vertebral bodies of L2, 3 and the upper half of L4, which had been invaded by the tumor, were removed en bloc using an anterolateral extraperitoneal approach. He had no local recurrence or further metastasis until he died of ischemic cardiac disease 14 months postoperatively.
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Randomized Controlled Trial Comparative Study
Pulmonary gas exchange impairment following tourniquet deflation: a prospective, single-blind clinical trial.
The tourniquet has been considered as a recognized cause of limb ischemia/reperfusion injury in orthopedic surgery resulting in a transient neutrophil, monocyte activation, and enhanced neutrophil transendothelial migration with potential remote tissue injury. This study investigated the effect of unilateral tourniquet application within a safe time limit on pulmonary function and the roles of lipid peroxidation and systemic inflammatory response. Thirty patients undergoing unilateral lower extremity surgery with or without tourniquet were equally divided into a control group with no tourniquet (Group C) and a tourniquet (Group T). ⋯ The results represented no significant changes in Group C with regard to either blood gas variables or levels of circulating mediators, while blood gas variable changes of greater A-aDO(2) and respiratory index and lower PaO2 and a/A ratio were shown at 6 hours following tourniquet deflation. The levels of malondialdehyde, IL-6, and IL-8 were increased over baseline values from 2 to 24 hours following tourniquet deflation in Group T. We concluded that tourniquet application within a safe time limit may cause pulmonary gas exchange impairment several hours after tourniquet deflation, where lipid peroxidation and systemic inflammatory response may be involved.