1/13. Oncogenic osteomalacia presenting as bilateral stress fractures of the tibia.We report on a patient with bilateral stress fractures of the tibia who subsequently showed classic biochemical features of oncogenic osteomalacia. Conventional radiographs were normal. MR imaging revealed symmetric, bilateral, band-like low-signal lesions perpendicular to the medial cortex of the tibiae and corresponding to the only lesions subsequently seen on the bone scan. A maxillary sinus lesion was subsequently detected and surgically removed resulting in prompt alleviation of symptoms and normalization of hypophosphatemia and low 1,25-(OH)2 vitamin D3. The lesion was pathologically diagnosed as a hemangiopericytoma-like tumor. patients with oncogenic osteomalacia may present with stress fractures limited to the tibia, as seen in athletes. The clue to the real diagnosis lies in paying close attention to the serum phosphate levels, especially in patients suffering generalized symptoms of weakness and not given to unusual physical activity.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/13. cementoplasty and the oncologic population.The first and only description of percutaneous cementoplasty, to date, has been described in the French medical literature in 1994. In this series of 12 cases, radiologists successfully instilled a cement derivative into the acetabulum under fluoroscopic control. As in these cases, the major indication for cementoplasty is to provide pain control and stabilization of an osteolytic lesion. Potential complications include physical or thermal damage to the adjacent neurovascular structures, either during needle positioning or from cement leakage, respectively. Although no absolute contraindications exist, one should proceed cautiously in patients with coagulopathies. Results may be suboptimal as well in patients with pathologic fractures.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/13. 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.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/13. Four-year review of burns as an etiologic factor in the development of long bone fractures in pediatric patients.Reduced bone density has been documented in children after burns. This loss of bone may place children at heightened risk for fractures. The medical records of all acutely injured patients with burns in excess of 40% TBSA burn admitted to our institution between January 1, 1997, through December 31, 2000, were reviewed for fracture incidence. patients with fractures sustained during the course of initial trauma were not included in the review. One hundred four records were reviewed. These patients had a mean age of 6.7 /- 0.51 years, (range, 0.2 to 18.0) and a mean %TBSA burn of 59.9 /- 1.60 (range, 40 to 98) with a mean full-thickness %burn of 51.7 /- 2.16 (range, 0 to 95). Fifteen long bone fractures were documented in six patients during the review time frame. All fractures were initially suspected by physical therapy personnel upon regularly scheduled therapy sessions and subsequently verified by x-ray. All fractures identified by this review occurred in children less than 3 years of age. Most fractures were noted during the rehabilitation phase of injury (range, 73 to 283 days after burn) once wounds were more than 95% healed, except for one child, who sustained multiple fractures during the acute recovery phase at a referring hospital. A 5.8% incidence of fractures was noted in patients with burns in excess of 40% (6 of 104 admissions). The etiology of the fractures is unknown, although the hormonal milieu postburn, depressed vitamin d status, inadequate protein intake, and decreased weight-bearing activity are potential contributory factors. In addition, infants and toddlers tend to provide more resistance to therapy because of an inherent lack of cognition. This may account for the increased breaks in this population.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/13. Fracture of bone with an aneurysmal bone cyst during lactation.A case is presented of a 28-year-old lactating Nigerian mother who developed a pathological fracture of the left humerus following inapparent physical stress. There was radiographical and histological evidence of aneurysmal bone cyst disease involving both humerus. A possible pathogenetic role of bone-calcium dyshomeostasis during pregnancy and, indeed, lactation is entertained. A strong case is made for calcium supplementation in the pregnant and/or lactating mother, especially in the developing countries with an increased probability of marginal nutrition status.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
6/13. Pathologic fractures associated with idiopathic amyloidosis of bone in chronic hemodialysis patients.Amyloid bone lesions were found in 2 chronic hemodialysis patients presenting with pathologic hip fractures. These amyloid deposits were noted as lytic defects on plain skeletal radiographs. No evidence for disseminated amyloidosis was discovered on physical examination, skin biopsy, or bone marrow biopsy. Myeloma, other plasma cell dyscrasia, and preceding chronic inflammatory states were not found in either patient. The amyloid deposits had staining characteristics suggestive of secondary amyloid based on the potassium permanganate reaction. Isolated amyloid bone deposits should be included in the differential diagnosis of lytic bone lesions or pathologic fractures in chronic dialysis patients.- - - - - - - - - - ranking = 4.1713610861553keywords = physical examination, physical (Clic here for more details about this article) |
7/13. Spontaneous fracture of the odontoid process in a patient with ankylosing spondylitis. Nonunion responsible for compression of the upper cervical cord.Tetraparesis due to a spontaneous fracture of the base of the odontoid process occurred in a patient with undiagnosed, advanced ankylosing spondylitis. Few cases of insufficiency fractures of the proximal cervical spine in patients with loss of spinal mobility have been reported in the literature. The pathologic lesions that can cause severe neurologic compromise are reviewed. Because functional impairment and neurologic loss are common even after surgical decompression and stabilization, these lesions should be looked for during a careful physical evaluation followed by appropriate investigations.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
8/13. Fracture of costochondral graft in temporomandibular joint reconstructive surgery: an unexpected complication.The case of a 35-year-old woman with a history of several temporomandibular joint (TMJ) operations, including condylectomy, is reported. She presented with myofacial pain and partial fibrous ankylosis of her right TMJ. The ankylosis was released and an autogenous costochondral graft was used to restore the vertical dimension of the ramus. About 3 months after surgery, a fracture of the graft occurred during physical therapy. The cause of this complication is discussed with reference to the literature.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
9/13. Unusual site of spontaneous first-rib fracture: case report.Spontaneous fractures of the first rib are uncommon and are usually thought to be associated with a malignant process. However, fatigue fractures of the first rib are being encountered increasingly in association with various physical activities. Typically, the fractures occur at the subclavian groove, but in the 48-year-old woman described in this report the fracture was unexpectedly situated in the posterior portion of the rib and was the result of snow shovelling, which was a new activity for the patient.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
10/13. Syphilitic osteitis in a patient with secondary syphilis and concurrent human immunodeficiency virus infection.Destructive bone disease is a well-recognized complication of congenital and tertiary syphilis. Clinically significant osteitis and osteomyelitis are rare complications of primary or secondary syphilis in patients who are not infected with human immunodeficiency virus (hiv). We report a case of an hiv-infected man who presented with symptomatic, left ulnar osteitis as the initial manifestation of secondary syphilis. The patient's clinical course was complicated by a pathological fracture, but he responded to high-dose intravenous penicillin g therapy and surgical intervention. Results of physical examination on follow-up at 15 months were normal, and a serofast (rapid plasma reagin [RPR]) titer of 1:4 and a markedly decreased uptake on bone scintigraphy were observed. Our case report suggests that bone disease can represent an atypical manifestation of early acquired syphilis and that hiv-positive patients who present with orthopedic complaints or bone lesions should be evaluated for the presence of syphilitic bone disease.- - - - - - - - - - ranking = 4.1713610861553keywords = physical examination, physical (Clic here for more details about this article) |
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