1/82. Severe protein c deficiency and aseptic osteonecrosis of the hip joint: a case report.Homozygous congenital protein c deficiency is accompanied by severe thrombophilia. Thrombotic events can be reduced in number and severity by lifelong oral anticoagulation therapy. A 4-year-old boy was first diagnosed as having severe congenital homozygous protein c deficiency during the neonatal period when purpura fulminans occurred as the first manifestation of thrombosis. From this time he had been treated with phenprocoumon (INR 3.5-4.5). During an infection of the upper respiratory tract he developed signs of a new episode of purpura fulminans (INR 2.6). Additional anticoagulation therapy with LMW heparin (Clexane) and protein C concentrate was given while the oral anticoagulation therapy was continued. On the third day of this episode the boy suffered from pain of unknown origin. MRI of the abdomen and of the pelvis revealed nontraumatic osteonecrosis of the hip joint. After a few weeks of immobilisation no special treatment was necessary. One year later he was able to walk with no problem. CONCLUSION: Aseptic osteonecrosis of the hip joint is associated with a variety of disorders including vascular thrombosis and haemorrhage. Especially young children and handicapped patients with thrombophilia and pain of unknown origin are suspected to have thrombosis in atypical regions.- - - - - - - - - - ranking = 1keywords = trauma (Clic here for more details about this article) |
2/82. Avascular necrosis. A case history and literature review.We describe a patient with avascular necrosis in both shoulders. Confirmatory testing in making the diagnosis included plain radiography, bone scan, and magnetic resonance imaging. The pathogenesis and staging of the disease by radiography are presented in the article. Treatment options include a conservative regimen of shoulder range of motion exercises and nonsteroidal anti-inflammatory agents or surgery (arthroplasty or core decompression). The patient's risk factors include long-term corticosteroid use, smoking, and alcohol consumption. Other known risk factors include sickle cell disease, gaucher disease, chemotherapy, lymphoma, dysbaric conditions, and trauma. This literature search shows that prevention and early diagnosis lend the best outcomes for the diagnosis of avascular necrosis.- - - - - - - - - - ranking = 1keywords = trauma (Clic here for more details about this article) |
3/82. osteonecrosis after treatment for heterotopic ossification in spinal cord injury with the combination of surgery, irradiation, and an NSAID.STUDY DESIGN: Case report. OBJECTIVE: Heterotopic ossification (HO) is a frequent complication in spinal cord injury (SCI) that is often difficult to treat. Although surgery may become necessary, operative resection has been associated with complications and poor outcome due to a high recurrence rate. Additional methods of treatment to reduce the recurrence rate have been developed, including post operative irradiation and NSAIDs. This article presents three patients, who developed an osteonecrosis of the femoral head after the combined treatment for HO of surgery, irradiation, and an NSAID.- - - - - - - - - - ranking = 33.05754499012keywords = injury (Clic here for more details about this article) |
4/82. Avascular necrosis after minimally displaced talus fracture in a child.This is a case report of a delayed diagnosis in a 5 year old child who sustained a minimally displaced fracture of the proximal or posterior aspect of the talar neck of the left foot with no subluxation at the subtalar or ankle joint of his left talus. Avascular necrosis (AVN) appeared 6 months after the injury. The further course was protracted with another 12 months of non-weight bearing. The case was followed until 36 months after the injury with nearly full functional recovery. An extensive literature review revealed a calculated incidence of AVN after reportedly non-displaced talus fractures in children of 16 per cent which is considerably more than is reported in adults. Nearly half of all reported cases occurred after the fracture had been missed initially. 8 of 11 cases with reported age occurred between 1 and 5 years. No child was older than 9 years, which indicates that the immature talus may be more prone to AVN. Some possible causes for the higher incidence of AVN in children with non-displaced talus fractures are discussed. Prolonged non weight-bearing cannot be recommended, since it reportedly does not alter the course of the disease.- - - - - - - - - - ranking = 13.223017996048keywords = injury (Clic here for more details about this article) |
5/82. Fishtail deformity following fracture of the distal humerus in children: historical review, case presentations, discussion of etiology, and thoughts on treatment.Fishtail deformity is an uncommon complication of distal humeral fractures in children. This article reports four cases accompanied by premature closure of a portion of the distal humeral physis with resultant deformity, length retardation, decreased elbow motion, and functional impairment. The ages of the patients at time of injury ranged from 4 years 2 months to 6 years 1 month (average 5 years 4 months). The average length of follow-up was 9 years 9 months (range, 3 years 5 months to 18 years 10 months). The cause of the arrest is multifactorial and may be due to a gap in reduction of an intracondylar fracture, avascular necrosis of the epiphysis, or central premature physeal arrest (bar formation) without a fracture gap or avascular necrosis. If identified in a young child, surgical closure of the medial and lateral portion of the physis may prevent the deformity from progressing and would not cause significant additional humeral length discrepancy.- - - - - - - - - - ranking = 6.611508998024keywords = injury (Clic here for more details about this article) |
6/82. Histological findings of bone marrow edema pattern on MRI in osteonecrosis of the femoral head.Sequential magnetic resonance imaging (MRI) was performed on a 38-year-old woman with systemic lupus erythematosus who had received corticosteroid and had developed non-traumatic osteonecrosis of the femoral head. The initial MR finding was a band lesion on the T1-weighted image, which had been present before the onset of symptoms. At the onset of symptoms, a diffuse bone marrow edema pattern, with a low signal intensity on T1 and high signal intensity on T2-weighted images, was noted around the band lesion, extending to the femoral neck. Histopathologically, this region was found to consist of serous exudate, focal interstitial hemorrhage, and mild fibrosis, without any evidence of extension of osteonecrosis. It should be noted that extension of a low signal intensity area on MRI after the onset of hip pain may not be the result of the extension of osteonecrosis, but may represent concomitant edema due to collapse.- - - - - - - - - - ranking = 1keywords = trauma (Clic here for more details about this article) |
7/82. Spontaneous osteonecrosis of the knee associated with ipsilateral tibial plateau stress fracture: report of two patients and review of the literature.Two cases are presented of spontaneous osteonecrosis of the knee (SONK) associated with stress fractures of the tibial plateau. This association lends further credence to the postulate that SONK has a traumatic etiology.- - - - - - - - - - ranking = 1keywords = trauma (Clic here for more details about this article) |
8/82. Prediction of osteonecrosis by magnetic resonance imaging after femoral neck fractures.Thirty-one patients undergoing internal fixation for femoral neck fractures who were examined by magnetic resonance imaging at 2, 6, and 12 months after surgery and who could be followed up more than 2 years were enrolled in the current study. The items investigated were timing of the appearance of the band image on T1 weighted images, magnetic resonance imaging classification, and plain radiographs. Band images were observed 2 months after surgery in eight patients and 6 months in 12 patients (39% of all patients). According to the location and extent of the band image on magnetic resonance imaging, one patient was classified in the B1 Group (lateral type), four patients in the B2 Group (surface type), three patients in the B3 Group (intermediate type), and four patients in the B4 Group (extended type). Band images appeared in all patients in the B4 Group 6 months after surgery. Femoral heads of the patients in the B3 and B4 Groups by magnetic resonance imaging classification all were collapsed. On plain radiographs, osteonecrosis of the femoral head could be diagnosed in eight patients between 11 and 24 months after injury. The interval giving the greatest sensitivity, specificity, and accuracy of the diagnosis of osteonecrosis of the femoral head by magnetic resonance imaging was 6 months after surgery.- - - - - - - - - - ranking = 6.611508998024keywords = injury (Clic here for more details about this article) |
9/82. Salvage of avascular bone from frostbite with free tissue transfer.Traditional management of frostbite injury of the hands and fingers has been to allow demarcation to occur between viable and nonviable tissues, corresponding to the level of amputation required. In this case report, phalangeal length in mummified digits was maintained with free tissue transfer followed by evidence of bony revascularization on bone scan. Rather than waiting for tissue demarcation to occur, the authors propose that consideration be given to debridement of soft tissues in the frostbitten fingers followed by free tissue transfer to salvage length and function in the digital bony skeleton.- - - - - - - - - - ranking = 6.611508998024keywords = injury (Clic here for more details about this article) |
10/82. Dieterich's disease: avascular necrosis of the metacarpal head: a case report.The authors report a case of non-traumatic avascular necrosis of the third metacarpal head. This very rare condition is known as Dieterich's disease and has been associated with trauma, systemic lupus erythematosus and steroid use.- - - - - - - - - - ranking = 2keywords = trauma (Clic here for more details about this article) |
| | Next -> |