[Treatment of open fracture of the tibia and femur, including intramedullary nailing].
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Femoral Fractures↗
Biomedical subjects
M Liebergall
Publications and source records attributed to M Liebergall.
Osteomyelitis of the pelvis.
Four cases of osteomyelitis of the pelvis are reported to demonstrate the several clinical syndromes to which this disease can give rise. Extensive surgical drainage and antibiotic treatment led to recovery in all cases.
Adolescent↗
Avascular necrosis of the femoral head following intertrochanteric fracture.
Two cases are reported of avascular necrosis of the femoral head occurring as a late complication of an intertrochanteric fracture. The cases are presented to emphasize the importance of including this condition in the differential diagnosis of any late clinical deterioration following such an injury.
Aged↗
The floating hip. Ipsilateral pelvic and femoral fractures.
A consecutive series is reported of 17 patients who underwent early surgical treatment for acetabular or unstable pelvic fractures associated with ipsilateral fractures of the femur. Treatment included external and internal fixation, and required careful consideration of the surgical approach and the positioning of the patient. The multiple injuries sustained by these patients required simultaneous procedures by several surgical teams. All the femoral fractures were internally fixed at the initial operation and eight patients had primary definitive treatment of all their other fractures as well. In nine patients the definitive treatment of their other fractures was delayed for an average of 11 days. There were no deaths, and no serious infections. The long-term morbidity resulted from the associated injuries and not from the pelvic or femoral fractures.
Acetabulum↗
Complications of suppurative arthritis and osteomyelitis in children.
Three children with suppurative arthritis and osteomyelitis are described to emphasise that delayed or incorrect diagnosis may lead to serious cardiopulmonary complications. In two patients, bilateral bronchopneumonia developed with pneumatocoeles, pneumothorax and empyema. The other had cardiac failure from septic pericarditis. In one case, disarticulation of the knee was needed as a life-saving measure, and the other leg developed an infected pseudarthrosis of the tibia. The causative organism in each case was staphylococcus aureus and no evidence of immunodeficiency was demonstrated.
Acute Disease↗
CT of adult lumbar disc herniations mimicking posterior apophyseal ring fractures.
This report concerns 35 adult patients with lumbar or sciatic pain and axial CT findings reportedly associated with posterior apophyseal ring fractures. Review of the CT images suggested two pathophysiologic categories. (1) Posterior Schmorl--A posterior intravertebral disc herniation with posterior displacement of a fractured or remodelled vertebral margin. (2) Calcified subligamentous--Reactive annular and or posterior longitudinal ligament calcification at the periphery of a herniated disc with or without remodelling and anterior displacement of the posterior vertebral margin.
Adult↗
Surgical treatment of fractures of the capitellum in adults: a modified technique.
Five adults with fractures of the capitellum (Hahn-Steinthal type) were treated by a modified improved technique of open reduction and internal fixation in 1988 and 1989. Full range of motion was achieved in all cases at 4 months.
Adult↗
Pyogenic vertebral osteomyelitis with paralysis. Prognosis and treatment.
In the interval between 1983 and 1988, 14 patients were treated for pyogenic spondylitis complicated by neurologic compromise. There were nine males and five females aged 39-80 years. The average time between onset of symptoms and diagnosis was 2.8 months. Predisposing factors were diabetes mellitus in four patients and urinary tract infections in five patients. The infection was blood borne in all 14 patients. In two patients, the infection was superimposed on a recent vertebral fracture. The cervical spine was involved in one patient; the thoracic spine in seven; and the lumbar spine in six patients. Six patients presented with a Frankel B paralysis, six with a Frankel C paralysis, and two with grade D paralysis. The neurologic symptoms lasted between one day and six weeks before surgery. Twelve patients had anterolateral decompression. Two of the 12 patients had a second stage posterior stabilization. Two patients were deemed inoperable. All surviving patients were managed by parenteral antibiotics for three to six weeks followed by enteral route for a total of three to six months. All 12 operated patients had a significant neurologic improvement (one grade or more on the Frankel scale) with solid interbody fusion.
Adult↗
Osteoid osteoma of the scapula. A case report and review of the literature.
The scapula is a rare location for osteoid osteoma, which in most cases does not involve the flat bones. The en bloc excision in this uncommon location can be problematic since the surgical exposure is difficult, and shoulder joint function can be affected if the lesion is subchondral. In an 18-year-old man, an osteoid osteoma was located in the subchondral area of the glenoid. A guided needle biopsy of the nidus resulted in complete healing. This mode of treatment, with proper follow-up examination, is acceptable for a benign lesion situated in a problematic location.
Adolescent↗
[Cauda equina syndrome in lumbar disc herniation].
During the past 5 years 10 patients suffering from cauda equina syndrome as a result of prolapsed disc were treated surgically. Although considerable time had elapsed between the onset of symptoms and the operation, most of the patients improved, at least partially. The syndrome is a rare complication of a common condition of the lower spine. Awareness of its possibility and identification of the early clinical picture are essential. An accurate history and detailed physical examination are the most important factors in early diagnosis. In 5 women and 4 men, who ranged in age from 28-60 and averaged 41 years, the disks involved were L5-S1 in 6, L4-L5 in 2 and L1-T12 in 1 case. Persistent disability was found in most of the patients, including 4 with bladder and 4 with sexual dysfunction. In 7 there was residual sensory loss and in 5 some degree of motor weakness. Earlier surgical treatment seems to be the most effective method for improving the results of treatment.
Adult↗
Altered structural and functional properties of myosins, from platelets of idiopathic scoliosis patients.
Platelets of patients with idiopathic scoliosis (IS) have been shown to have decreased capacity to aggregate and secrete in response to certain agonists. Similarities between the contractile protein system of platelets and muscle have made the platelets a popular model for muscle disease. We attempted to characterize the function and structure of myosin in platelets of IS patients. Blood was obtained from seven IS patients and seven matched non-scoliotic healthy controls. The mean Cobb angle measurement of the IS patients was 35.4 degrees with a mean Risser sign of 2.2. Washed platelets were isolated from the blood, and the contractile proteins from the membrane and the cytosol compartments were isolated and analyzed by two-dimensional peptide mapping. As previously reported (J Biol Chem 258:9290, 1983), peptide maps of normal platelets revealed that the heavy chain of myosin located in the platelet membrane lacks one major spot relative to the cytoplasmic myosin. In IS patients the cytoplasmic myosin lacks the same peptide that is missing in the membrane myosin of normal individuals. In addition, the ATPase specific activity of the cytoplasmic myosin from IS platelets was significantly lower compared with the activity of the cytoplasmic myosin from normal platelets. These results suggest the presence of a fundamental abnormality of IS platelet contractile proteins.
Adenosine Triphosphatases↗
Serratia osteomyelitis causing neurological deterioration after spine fracture. A report of two cases.
We report two cases of Serratia marcescens infection at the sites of spinal fractures and emphasise the fact that neurological deterioration soon after spinal fracture may be due to acute vertebral osteomyelitis.
Adult↗
Dural penetration by interspinous process segmental spine instrumentation: case report.
A case of pseudo-meningocele complicating posterior spine fusion with interspinous process segmental spinal instrumentation is presented. The L rod rotated postoperatively 90 degrees and penetrated the dura. The presenting symptoms were pain accompanied by fixed lumbar and hip flexion contractures that improved dramatically after removal of the penetrating part. The unusual course as well as the treatment and recommendation for prevention are discussed.
Adolescent↗
Functional, biochemical, and structural anomalies in platelets of patients with idiopathic scoliosis.
Idiopathic scoliosis (IS) is the most common type of lateral curvature of the spine, the etiology of which is unknown. Among the various pathological changes that have been reported in IS are platelet anomalies. Since the platelets are not involved mechanically in the spinal deformity, platelet disorders may reflect a basic cellular pathology and not a secondary change attributed to the spinal curvature. In the present review, a summary of the platelet anomalies in idiopathic scoliosis is presented. The accumulated data indicate the existence of profound functional anomalies in platelets of patients with IS. An attempt is made to clarify the different anomalies and to try to link them together.
Blood Platelets↗
Bone scintigraphic findings in recruits after short periods of nonweight-bearing ambulation. A report of two cases.
Two military recruits with suspected stress fractures underwent scintigraphy after brief periods of nonweight-bearing ambulation. Their scans showed a dramatic, diffuse increase of activity over the asymptomatic weight-bearing foot, with areas of increased focal activity. Our reported cases illustrate how gait changes can be reflected in scintigraphy and the difficulty in evaluating areas of increased focal scintigraphic activity in the feet. The physician should see the bone scan and not rely on a written report when evaluating a trainee for possible stress fracture.
Achilles Tendon↗
Simultaneous bilateral fractures of the femoral necks and the proximal humeral heads during convulsion.
Simultaneous bilateral fractures of either the femoral necks or the humeral heads are rare injuries. Four simultaneous fractures of both femoral necks and humeral heads have not been previously described. The case reported occurred after an epileptic convulsion in a woman with multiple metastases from breast cancer.
Breast Neoplasms↗
NSAID induced avascular necrosis and arthropathy of femoral head.
The authors present the case of an 81-year-old woman with pain in her left hip. X-ray showed moderate osteoarthritic changes. The patient was prescribed diclofenal sodium (Voltaren), a nonsteroidal anti-inflammatory drug (NSAID). The patient continued use of the drug and returned 18 months later complaining of severe hip pain and difficulty in walking. X-ray, at that time, showed necrosis of the femoral head with subluxation and formation of a pseudoacetabulum. Total hip replacement was performed and the patient resumed normal daily activity. The authors point out that avascular necrosis of the femoral head, a known complication of steroid therapy, can also be caused by NSAID therapy and urge physicians to be aware of this complication.
Aged↗
Streptococcal osteomyelitis associated with varicella virus infection: a case report and review of the literature.
A case in a child with varicella associated with osteomyelitis caused by Streptococcus hemolyticus group B is reported. The complication of bacterial osteomyelitis in varicella is rare, and only three cases have been reported in the English literature.
Chickenpox↗