Orthopedics
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Review Case Reports
Intrapelvic migration of a gamma nail lag screw: review of the possible mechanisms.
This article presents a case of intrapelvic migration of a Gamma nail lag screw (Stryker, Mahwah, New Jersey) in an 82-year-old woman 7 months after fixation of an unstable pertrochanteric fracture. Two of the most common complications associated with the use of the Gamma nail and other sliding intramedullary devices, as well as lag screw and side plate devices, relate to the lag screw: cut out and medial migration in the femoral head. ⋯ Several risk factors can be associated with Gamma nail failure, most importantly damage to femoral head leading to lag screw migration, plate/lag or nail/lag screw interface dysfunction, technical mistakes, and additional subsequent trauma. This article reviews the literature and the theories for such device failures.
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In the United States, total hip arthroplasty (THA) is typically performed with the patient in the lateral decubitus position. Positioning of the morbidly obese patient can be technically challenging and may require special positioning equipment. Although the increased incidence of complications after THA in obese patients has been well documented, neurologic complications in the contralateral limb are rare. ⋯ Meralgia paresthetica is an uncommon, but known, complication of THA. To our knowledge, it has been reported only in the operative limb. This report reinforces the need for careful positioning to avoid pressure over the anterior superior iliac spine intraoperatively.
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We examined the variation in the origin of the tibialis anterior muscle from the lateral aspect of the tibial shaft and interosseous membrane as well as the variation in the morphology of its musculotendinous junction. Forty cadaveric lower leg specimens (20 right and 20 left) were dissected to reveal the anterior compartment. The origin of the tibialis anterior muscle and its relation to the lateral tibial shaft and interosseous membrane were determined. ⋯ There was no statistical correlation between tibial length and muscle morphology. This variation warrants consideration in the percutaneous insertion of screws in the distal end of long plates, as the neurovascular bundle may be injured in patients with a shorter muscle belly. We advocate an open distal approach to protect the neurovascular bundle during insertion of the plate and distal screws.