1/7. Medial fibula transport with the Ilizarov frame to treat massive tibial bone loss.Massive segmental tibial bone loss from trauma, tumor, or infection is a limb-threatening situation. It is a considerable surgical challenge, especially when associated with extensive skin and soft tissue damage. amputation was the only solution in the past, but current limb-salvage options include contralateral or ipsilateral microvascularized or free-fibular transfer. However, these methods are not without risks and disadvantages. We report seven patients with massive tibial bone loss treated by gradual medial transport of the ipsilateral fibula using an Ilizarov traction apparatus with olive wires after proximal and distal fibular osteotomies. This method has the advantages of avoiding surgery on the contralateral limb while allowing early weightbearing because of the stability of the Ilizarov frame. hypertrophy of the transported fibula accompanied by full weightbearing and satisfactory joint motion occurred in all patients. All patients were satisfied with the results, and none thought amputation would have been a better treatment. The minimum followup was 5 years. We think the Ilizarov frame for ipsilateral fibular gradual transport is a reasonable alternative for limb salvage in patients with massive tibial bone loss. LEVEL OF EVIDENCE: Therapeutic Study, Level IV (case series). See the Guidelines for Authors for a complete description of levels of evidence.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
2/7. The ghost joint: transient osteoporosis of the hip.Seven adult patients identified as having idiopathic transient osteoporosis of the hip (TOH) are reported. TOH is an uncommon entity, most often seen in women during the third trimester of pregnancy and in middle-aged men. It is characterized by groin pain, limited hip range of motion, nonspecific laboratory findings, localized radiographic evidence of osteopenia, and spontaneous recovery usually within two to nine months. diagnosis remains dependent on clinical recognition and x-ray confirmation. Radioisotope scanning aids in the diagnosis; both bone and synovial biopsies are often less productive. Treatment consists of joint protection with limited weight bearing, range of motion exercise, progressive ambulation, and analgesics. An awareness of TOH facilities appropriate diagnosis and treatment and curtails unnecessary diagnostic procedures.- - - - - - - - - - ranking = 2keywords = motion (Clic here for more details about this article) |
3/7. Transient osteoporosis.Six hips in four patients with hip pain, limited range of motion, no antecedent trauma, and normal laboratory studies demonstrated roentgenographic evidence of periarticular osteoporosis. The subchondral cortex was attenuated. There was little or no cartilage loss. The preliminary diagnosis was transient osteoporosis (migratory osteolysis, regional osteoporosis). This problem is most frequently seen in the hip joint in two population groups: men near 40 and women in the third trimester of pregnancy. Other joints may be involved and the process may regress in one joint but recur in another. diagnosis is based on typical clinical and roentgenographic observations including an aspiration of sterile joint fluid. Radioisotope scanning may be helpful. Bone or synovial biopsy sampling is not necessary. Proper management requires accurate diagnosis and conservative treatment of a cooperative patient. pain may persist for six months or longer. Treatment consists of analgesics, protection against stress fractures, and physical therapy for prevention of contractures.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
4/7. Ender nailing of intertrochanteric and subtrochanteric fractures of the femur.Condylocephalic intramedullary Ender nailing of fractures of the proximal end of the femur offers four advantages. The operation is short and is minimally traumatic, with little blood loss. The patient returns to functional ambulatory status within a few days. infection of the fracture site and at the nail portals is a negligible risk, and the risk of delayed union and non-union is greatly reduced. The method has also introduced a group of new complications such as irritation at the knee, decreased range of knee motion, and distal and proximal migration and penetration of the nails, yet these problems did not cause failures of the method. osteoporosis was found to be a significant factor contributing to complications. External rotation deformity has not been a major problem in the present study and was improved by use of nails that had an anteversion bend. Delayed union was observed in only one patient with an intertrochanteric fracture which eventually healed. All subtrochanteric fractures healed within three months, which represents a favorable result in comparison with other methods.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
5/7. Fracture of the humerus in ball throwers. A consequence of idiopathic juvenile osteoporosis in a female handball player?We report a case of a spontaneous humeral shaft fracture sustained during pitching by a 22-year-old previously healthy female European team handball player. The fracture was treated by closed reposition followed by immobilization in a hanging cast. The fracture healed uneventfully, and normal function and range of motion were reached within 6 months. Between 1 and 2 years after the fracture, bone mineral measurements showed a decreased bone mass (1.43-2.56 SD below mean values of normal women) at all measuring sites; proximal tibia bilaterally (bone mineral content (right) = 2.68 g/cm, bone mineral content (left) = 2.79 g/cm), lumbar spine (bone mineral density (L2-4) = 0.814 g/cm2), and right hip (bone mineral density (neck) = 0.697 g/cm2, bone mineral density (Ward's) = 0.626 g/cm2). A thorough endocrinological examination indicated that a state of bone loss existed, but no specific endocrine disease was found. The unusual fracture presented must be considered the result of the torsional forces transmitted to a severely osteoporotic bone.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
6/7. Operative treatment of the degenerated segment adjacent to a lumbar fusion.Fourteen patients with a previous lumbosacral fusion underwent neural decompression and fusion of degenerated adjacent motion segment. The most common level was L3-L4, and there was an average of 3.2 (range 1-7) previous lumbosacral surgical procedures. The average interval from the first fusion until operative intervention on the degenerated adjacent segment was 11.5 years (range 3-29 years). Five patients had an uninstrumented fusion, of which only one progressed to arthrodesis. Three of these five patients with pseudarthrosis after uninstrumented fusion--and the remaining nine patients--had fusions with instrumentation. Ten of twelve instrumented fusions progressed to solid arthrodesis. The pseudoarthrosis rate of 80% was decreased to 17% with the use of supplemental instrumentation. There was a significant number of complications and poor results, especially in patients with advanced osteoporosis and those with a short interval between adjacent segment degeneration, respectively. Eleven of 14 patients reported some postoperative pain relief.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
7/7. Transient osteoporosis of the hip in pregnancy.A patient is presented with transient osteoporosis of the hip occurring in the third trimester of pregnancy. This syndrome is characterized by hip pain, limited motion, and osteoporosis of the femoral head with preservation of the joint space. The syndrome is self-limited with full recovery in three months to one year. Treatment is symptomatic with bedrest, protected weight-bearing, and analgesics as needed. The cause of this syndrome remains unknown.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |