Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Mar 2008
Case ReportsExtreme complications of Fixion nail in treatment of long bone fractures.
The authors present their experience related to extreme complications in treatment of diaphyseal fractures of the long bones with application of the Fixion expansion intramedullary nail in a total of 48 surgeries. We have encountered six (12.5%) extreme complications in the management of fractures of 3 humeral, 2 tibial, and 1 femoral bones during its application procedure and postoperative follow-up. Of six cases, two with humeral and tibial fractures developed nonunion and rotational instability because of failure of inflation of the Fixion nail. ⋯ Application may need special training. Since the Fixion has not got rotational stability and rigidity as conventional nailing systems, bending and breaking of the nail may occur during postoperative period in patients with over obesity and hyperactivity. In patients with osteogenesis imperfecta, it may not be the first choice as a nailing system.
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Arch Orthop Trauma Surg · Mar 2008
Case ReportsBilateral non-traumatic acetabular and femoral neck fractures due to pregnancy-associated osteoporosis.
Pregnancy-associated osteoporosis is a rare disorder and its pathophysiology remains unknown. We report a case of pregnancy-associated osteoporosis in a 27-year-old primiparous patient who revealed bilateral hip pain during early postnatal period. The plain radiographs and computerized tomography showed bilateral femoral neck and acetabular fractures. ⋯ The case was treated successfully by bilateral cementless total hip arthroplasty. Bone mineral density increased after 2 years of treatment with calcium-vitamin D, calcitriol and alendronate. Diagnosis of pregnancy-associated osteoporosis should be suspected when hip pain occurs during pregnancy or in the post-partum period as it can lead to acetabular and femoral neck fractures.
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Arch Orthop Trauma Surg · Feb 2008
Case ReportsPulp thumb defect reconstruction using a twin neurovascular island flaps: a case report.
In this report, we present the functional and cosmetic results of a case with complete loss of the thumb pulp for which the Chen and Noordhoof techniques has been chosen for reconstruction. A 33-year-old man, artisan, had his right thumb caught in a machine during the work, resulting in a degloving injury in the entire pulp of the distal phalanx of the thumb with all other digits of the right hand intact. The patient was a young man, in good health and non-smoker. ⋯ The patient turned up to work at 10 weeks after surgery. After 2 years, we obtained a good aesthetic result, a sensitivity in the thumb and at the donor site comparable to the other hand and a complete recovery of normal function of the hand. In focal pulp loss of the thumb, the twin neurovascular island flaps suggested by Chen and Noordhoff could be an easy and efficient method to reconstruct soft tissue coverage and sensibility when microsurgical setting and abilities are not available.
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Arch Orthop Trauma Surg · Feb 2008
Percutaneous antegrade screwing for anterior column fracture of acetabulum with fluoroscopic-based computerized navigation.
Open reduction and internal fixation has been the gold standard for displaced fracture involving weightbearing dome and fractures with intra-articular fragments. However, extensile exposure can lead to complications. Fracture with minimal displacement can be fixed by a minimally invasive method. Percutaneous screwing for an anterior column fracture of acetabulum under conventional 2D fluoroscopy is a demanding technique. With fluoroscopic-based computerized navigation, we can determine the position of a screw real time intra-operatively with less exposure to radiation. We proposed that a fluoroscopy-based computerized navigational system would simplify operation procedures. The purpose of this study is to test the application of the fluoroscopy-based computerized navigational system for anterior column fracture of acetabulum. ⋯ Though the indication for this procedure is limited, we think that there should be potential to apply the screw with less radiation by fluoroscopic-based computerized navigation. Once anatomic reduction can be achieved by the close method in the anterior column fracture of the acetabulum, percutaneous screw fixation under fluoroscopic-based computerized navigation could be a reliable method; however; validating the position of the guide pin and screw by fluoroscopy is suggested.
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Arch Orthop Trauma Surg · Feb 2008
Reconstruction with pasteurized autograft for distal tibial tumor.
Primary malignant tumors of the distal tibia are rare. With advances in various treatment modalities, limb salvage for tumors of the distal tibia has been indicated for selected cases. This study examined whether the results of a pasteurized autologous bone graft are comparable to other reconstruction methods with regard to the graft survival and the functional outcome. ⋯ The reconstruction with a pasteurized autograft is a simple and easily method for treating distal tibial malignancies. Moreover, vascularized fibula transfer might be considered a good ancillary procedure for resolving graft-related complications.