1/9. Simultaneous bilateral trochanteric fractures during squatting in a patient with multiple myeloma.Pathologic bone fractures are usually confined to the trunk in multiple myeloma (MM). But bilateral trochanteric fractures have not been reported in patients with MM before. Radiographic, histological and immunoelectrophoresis revealed typical features of MM. This report points out the importance of physical rehabilitation of patients in addition to chemotherapy in adaptation to the activities of daily living.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/9. thigh compartment syndrome secondary to intertrochanteric hip fracture in a quadriplegic patient: case report.compartment syndromes in the thigh are rare and the diagnosis may be difficult in the light of subtle early physical findings in the patient with spinal cord injury. Clinical awareness of the impending compartment syndrome is important to provide timely proper treatment and avoid disabling deformities. A compartment syndrome should not be ignored in the paraplegic, because the potential for late fibrosis and contractures may limit the independence of such patients. Greater awareness and index of suspicion are needed to successfully recognize and promptly treat the compartment syndrome in this patient population.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/9. exercise prescription for a patient 3 months after hip fracture.BACKGROUND AND PURPOSE: Most patients with hip fracture do not return to prefracture functional status 1 year after surgery. The literature describing interventions, however, does not use classic overload and specificity principles. The purpose of this case report is to describe the use of resistance training to improve functional outcomes in a patient following hip fracture. CASE DESCRIPTION: The patient was a 68-year-old woman who had a comminuted intertrochanteric fracture of the left hip 3 months previously. She used a cane for ambulation, and her walking was limited. The patient received 16 sessions of lower-extremity strengthening exercises, aerobic training on a stationary bicycle, functional training supervised by a physical therapist, and a home stretching program. OUTCOME: The patient's isometric muscle force for involved hip extension, hip abduction, and knee extension improved by 86%, 138%, and 33%, respectively; walking endurance increased by 22.5%; balance improved by 400%; balance confidence increased by 41%; and self-reported ability to perform lower-extremity functional activities increased by 20%. DISCUSSION: The authors believe that some patients can perform comprehensive exercise programs after hip fracture and that properly designed programs can affect patient outcomes beyond observed impairments.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/9. Occult acetabular fracture in an elderly runner.STUDY DESIGN: Resident's case problem. BACKGROUND: A 79-year-old African American male runner sustained a left hip injury while jogging on a running track. Initial radiographs did not show any bony injuries and the patient was diagnosed with hip tendonitis. The patient was initially treated conservatively with medications and referred to a local physical therapy clinic for thermal modalities and therapeutic exercises. The patient failed to show any improvement despite a period of conservative treatment. The author examined the patient 6 months postinjury at a university physical therapy department. diagnosis: The author suspected the presence of a possible fracture and the patient was referred to an orthopaedic surgeon. Subsequent radiographic imaging studies including a CT scan revealed a supra-acetabular fracture. The patient underwent a total hip arthroplasty approximately 1 year after the initial injury and has since recovered well. DISCUSSION: It is not uncommon for runners or joggers to develop hip or pelvic pain, but there has been no prior report in the literature of the occurrence of an acetabular hip fracture while jogging. This resident's case problem illustrates the challenges of arriving at an accurate diagnosis in the presence of a rare fracture and the need for careful follow-up, especially among elderly individuals with cognitive deficits.- - - - - - - - - - ranking = 2keywords = physical (Clic here for more details about this article) |
5/9. Unmasking delirium.The authors use a case study to illustrate the risks of delirium in older adult patients and discuss ways to prevent, identify and manage its occurrence. An estimated 60 to 80 per cent of hospitalized frail older adults experience at least one preventable episode of delirium, often leading to prolonged hospitalization, functional decline, increased morbidity and eventual nursing home placement or death. delirium is a medical emergency, characterized by acute onset and a fluctuating course that is demonstrated by abrupt changes in mental status and function. It has three categories: hyperactive, hypoactive and mixed. Although delirium is amenable to expert nursing care, it is unrecognized or misdiagnosed in up to 70 per cent of older patients. delirium results from the interplay of multiple forces associated with illness in the older adult, including drugs, substance abuse, metabolic disturbances, nutritional deficiencies, fluid disturbances, acute trauma or illness, infection and impaired physical or functional ability A proactive strategy for delirium prevention and treatment targets defined risk factors and the management of physiologic factors that precipitate delirium. It includes assessment, therapeutic environmental modification, standardized protocols for physiological interventions and staff education.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
6/9. Central fracture-dislocation of the hip with ipsilateral femoral neck fracture: case report.Central fracture dislocation of the hip with associated fracture of the femoral neck is rare. Treatment of choice consists of open reduction of the displacement and internal fixation of both fractures. Nevertheless, inadequate reduction of the burst fracture of the acetabulum may lead to hip arthritis, and the surgical approach to the femoral neck jeopardizes its vitality. In elderly patients early full motion and prompt physical rehabilitation can be achieved by total hip arthroplasty after fusion of the displaced femoral head to the acetabular wall.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
7/9. Replacement of femoral head endoprosthesis with total hip prosthesis. A report of five cases with problems of management.Five cases who had endoprosthesis implanted for medial fracture of the neck of the femur are reported. All of them developed late complications that required replacements of endoprosthesis with total hip prosthesis. Complications included wearing of both joint cartilage and subchondral bone of the acetabulum, osteoporosis of the proximal end of the femur and fracture of the femur and the level of the endoprosthesis. Several problems of surgical management ensued. This experience strengthens the author's opinion that other forms of treatment--reduction in traction and nailing or total hip prosthesis--should be tried first also in particular cases of chronologically aged, but physically healthy patients with medial fractures of the neck of the femur.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
8/9. Radiological and histological improvement of oxalate osteopathy after combined liver-kidney transplantation in primary hyperoxaluria type 1.A 15-year-old patient with severe bone disease (with bilateral fractures of hips and shoulders) due to primary hyperoxaluria type 1 (PH1) was treated with combined liver-kidney transplantation after a 4-year hemodialysis period. Normalization of excessive oxalate synthesis brought in by the liver graft combined with the slow excretion of skeletal oxalate stores by the renal graft led to progressive improvement of clinical, radiological, and histological evidence of oxalate osteopathy. This allowed bilateral hip replacement 3 years after transplantation, which led to complete physical rehabilitation of the crippled patient. Combined liver-kidney transplantation constitutes the treatment of choice for end-stage renal failure due to PH1, even in the face of severe oxalate bone disease.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
9/9. A ballet dancer with chronic hip pain due to a lesser trochanter bony avulsion: the challenge of a differential diagnosis.Physical therapy assessment involves confirmation of a medical diagnosis. To help discuss this process, this case report is presented regarding a ballet dancer who experienced 6 years of chronic hip pain and dysfunction. Many diagnostic tests and surgical procedures were performed by various physicians in search of a diagnosis. Physical therapy assessments did not support the working diagnoses, and treatment given according to evaluation findings was not effective. Initial hip radiographs revealed a bony ossicle at the lesser trochanter, which was overlooked. Hip radiographs taken 5 years later revealed the same bony ossicle. Ultimately, surgical removal of the ossicle eliminated the hip pain, and the patient returned to full activity and dance again. With the attempt to confirm the patient's diagnosis, the physical therapy approach to problem solving is discussed. This case gives an example where it is important to question the physician's diagnosis when the physical therapy assessment and treatment response do not support it. it is also evident that an in-depth physical therapy assessment may be self-limiting if pathology has not been ruled out properly by the physician.- - - - - - - - - - ranking = 3keywords = physical (Clic here for more details about this article) |