Cases reported "Fractures, Spontaneous"

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1/64. Unusual longitudinal stress fractures of the femoral diaphysis: report of five cases.

    We present five cases of a distinctive type of longitudinal stress fracture of the upper femoral shaft in which the fracture line is parallel to the outer surface of the bone, in contrast to the perpendicular orientation to the cortical surface in previously reported cases of diaphyseal stress fractures. In two cases the fracture recurred after 15 and 18 months, respectively.
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2/64. A case of sternal insufficiency fracture.

    We report a case of insufficiency fracture of the sternum in a 70-year-old female patient with a review of the literature. She complained of sudden onset chest pain and aggravating dyspnea. She has been managed with corticosteroid due to chronic obstructive pulmonary disease for 15 years. diagnosis of sternal insufficiency fracture presented with thoracic kyphosis was made on the basis of absence of trauma history, radiologic findings of lateral chest radiograph, bone scintigraphy and chest computed tomography. Thoracic kyphosis and osteoporosis secondary to menopause, corticosteroid therapy and limited mobility due to chronic obstructive pulmonary disease were considered as predisposing factors of the sternal insufficiency fracture in this patient.
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ranking = 9.8884909039495
keywords = chest
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3/64. Post-gastrectomy bone disease undiagnosed for forty years.

    Polya partial gastrectomy was performed for peptic ulcer in a previously healthy woman aged 28 years. She complained afterwards of a variety of non-specific symptoms including weakness, tiredness, debility, slowness of walking, poor appetite and constipation. Within ten years her back became bent. She was treated for intercurrent hypertension and epilepsy. Bone fractures on low-impact trauma occurred in her fifties. At 57 years, she was unable to care for herself and had to be admitted to a nursing home. She could still walk slowly with the aid of a stick. For three months at the age of 65 years, she was unable to rise from her chair. Investigations disclosed severe post-gastrectomy bone disease. At no time had she complained of bone pains.
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ranking = 33.239516238833
keywords = back
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4/64. Estrogen and progesterone receptor-negative T11 vertebral hemangioma presenting as a postpartum compression fracture: case report and management.

    OBJECTIVE AND IMPORTANCE: pregnancy-related vertebral hemangioma compressive myelopathy is a rare occurrence that tends to arise in the upper thoracic and lower cervical spine, peaks during the third trimester, and remits after parturition. Whether corticosteroid receptors play a role in the pathogenesis of these lesions is unknown. Most of these lesions have been managed with posterior decompression. CLINICAL PRESENTATION: A 29-year-old woman presented with acute-onset lower-extremity weakness and sensory loss immediately after parturition. INTERVENTION: We used a retropleural approach for anterior decompression and fusion, followed by radiation therapy. Immunohistochemical analysis of estrogen and progesterone receptor expression was performed. CONCLUSION: We report an unusual case of lower thoracic postpartum vertebral hemangioma compressive myelopathy caused by a parturition-related compression fracture. Results of tests for corticosteroid receptors were negative, which implicated a hemodynamic rather than hormonal cause for disease progression.
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5/64. Vertebral collapse and normal peripheral blood cell count at the onset of acute lymphatic leukemia in childhood.

    Acute lymphatic leukemia presenting with bone pain and spine involvement is a recognized clinicopathologic complex that can mimic a wide range of orthopaedic conditions. Bone pain as the presenting complaint is common, with a reported incidence of 27% to 50%. Radiologic abnormalities associated with leukemia in children has been described previously. In the literature, the incidence of spinal involvement is controversial, but there is agreement that the spine is less commonly involved than are the long bones. At the onset of the disease, only 10% of children have normal peripheral blood counts. If the patient has spinal involvement and a normal leukocyte count, the diagnosis is often unclear. Only three of these patients have been described in the literature; this article adds one more patient with acute lymphatic leukemia with back pain as the main symptom, vertebral collapse, and a normal peripheral blood cell count at the time of initial presentation. It illustrates that delay in diagnosis frequently occurs, with the classic features of the disease being uniformly absent.
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ranking = 502.75408196395
keywords = back pain, back
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6/64. Errors and pitfalls in the diagnosis and treatment of metastatic bone disease.

    1. The orthopedist must be sure of the diagnosis and not embark on treatment for the wrong diagnosis. 2. Solitary lesions in patients with a remote history of malignancy require complete investigation and biopsy. This includes blood work, bone scan, magnetic resonance imaging of the bone lesion, and CT scan of the chest and abdomen. 3. Pathologic fractures do not require immediate fixation. They require careful surgical planning and a team approach to the underlying malignancy. 4. Load-sparing devices should not be used. 5. femoral neck fractures should be treated by endoprosthetic replacement, and consideration should be given to long-stemmed femoral components. 6. The orthopedist should assume that the fracture will never heal. 7. Immediate full and unrestricted weight bearing should be planned. 8. Future problems in the surgical site should be anticipated. Often a long-stem cemented femoral component is a better choice than a standard length. 9. The orthopedist must ensure that there are no other lesions that require stabilization in the bone being treated. 10. Methyl methacrylate can be used to augment fixation if needed. 11. If secure fixation cannot be achieved with the use of cement, the bone should be replaced with a tumor endoprosthesis. 12. The orthopedist should not hesitate to call in help. These can be difficult situations to manage and often require the assistance of a tumor surgeon and oncologic team.
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ranking = 3.2961636346498
keywords = chest
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7/64. Glomangiopericytoma causing oncogenic osteomalacia. A case report with immunohistochemical analysis.

    A 47-year-old woman suffered from gait disturbance due to back pain and muscle weakness. Laboratory data showed serum hypophosphatemia, elevated alkaline phosphatase, and a normal level of ionized calcium. Radiological examinations revealed multiple pathologic fractures in the ribs and pubic rami. She had had no episode of familial or any other notable disorder, and so she was initially treated with medication for adult-onset osteomalacia. However, 19 years later (when she was 66 years old), she noticed a soft-tissue tumor in her buttock. The tumor was excised. The histological features were those of glomangiopericytoma characterized by both glomus tumor-like and hemangiopericytoma-like structures. After removal of the tumor, her symptoms disappeared immediately. Laboratory data normalized 8 months later. To our knowledge, this is the first report of oncogenic osteomalacia caused by glomangiopericytoma.
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ranking = 502.75408196395
keywords = back pain, back
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8/64. Clinics in diagnostic imaging (60). Insufficiency fractures of the pelvis.

    An 80-year-old woman presented with severe low back pain of gradual onset. Her walking ability was affected. physical examination was essentially negative. Bone scintiscans showed a butterfly-shaped area of increased sacral uptake as well as focal pubic uptake. The diagnosis of sacral and parasymphyseal insufficiency fractures was confirmed by CT. The patient recovered well with conservative management. The clinical and imaging features, and management of insufficiency fractures of the pelvis are discussed.
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ranking = 502.75408196395
keywords = back pain, back
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9/64. Vertebral compression fractures in acute lymphoblastic leukaemia and remodelling after treatment.

    Three children, aged 7-10 years, with acute lymphoblastic leukaemia presented with back pain, along with a mild kyphosis. Collapse of the vertebral bodies at multiple levels was shown on imaging. Chemotherapy resulted in pain resolution and spontaneous remodelling of the vertebrae.
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ranking = 502.75408196395
keywords = back pain, back
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10/64. Niemann-Pick disease type B: an unusual clinical presentation with multiple vertebral fractures.

    We report here a unique case of a 55-year-old woman presenting with a clinical picture of parkinson disease, severe back pain, splenomegaly, and pronounced dyspnea. Radiographic examination of the spine showed multiple vertebral fractures. Niemann-Pick disease type B was diagnosed by findings of lipid-loaded histiocytes and a strongly reduced sphingomyelinase enzyme activity. She was homozygous for the deletion of codon 608 (delR608), which encodes an arginine residue in the Acid Sphingomyelinase gene. To investigate the cause of the unusual vertebral fractures, we screened for polymorphisms previously described as possibly associated with increased risk for osteoporosis and fractures. Our patient was heterozygous for the polymorphisms of the vitamin d receptor gene, the estrogen receptor gene, and the collagen 1A1gene. Increased physical activity after Parkinson treatment, a genetic predisposition, together with worsening disease due to interfering medications could explain the dramatic presentation of this patient. She was treated with cholesterol lowering drugs such as statins to decrease sphingomyelin synthesis, avoidance of drugs that inhibit sphingomyelinase, and bisphosphonates. No new fractures have occurred, but the interstitial lung disease has progressed.
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ranking = 502.75408196395
keywords = back pain, back
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