1.
Successful treatment for bilateral femoral neck insufficiency fractures: a rare lesion case report and an updated review of the literature.
Tan, XY, Lei, T, Wu, GB, Luo, HE, Huang, G, He, CY, Lu, M, Lei, PF
BMC musculoskeletal disorders. 2020;(1):102
Abstract
BACKGROUND The incidence of insufficiency fracture (IF) at femoral neck is low, accounting for about 5% of all insufficiency fractures, and IF at bilateral femoral neck is less common with more occurrence in athlete or serviceman. With the aging of populations, more cases of bilateral femoral neck IF have occurred recently, while the standard clinical treatment still remains lacking due to the complexity of these patients. CASE PRESENTATION A 55-year-old male patient complained pain in his bilateral hip, with no history of trauma, glucocorticoid hormone consumption or radiotherapy, and imaging examination revealed fracture nonunion and shortening in his left femoral neck, and double fracture line on the right femoral neck. The patient received a cementless THA for the left femoral neck fracture and conservative treatment for the right side, followed by Elcatonin injection and oral administration of Carbonate D3 Granules. After 4 months of fellow-up, the patient presented improved functional scorings in bilateral hip joints, with no signs of prothesis infection or loosening. CONCLUSION We present a rare case of bilateral femoral neck IF in a middle-aged male and the treatment is successful. The timely CT and MRI examinations of bilateral hip joints for patients was necessary for orthopedists to select proper therapeutic regimen. In addition, the choice for therapeutic regimen of bilateral femoral IF should not only be based on the professional judgement of orthopedists, but also on the wishes of patients.
2.
Pseudotumour formation and subsequent resolution in metal-on-metal total hip arthroplasty following revision: Instructional review and an illustrative case report with revision using a dual mobility design.
Sassoon, AA, Barrack, RL
The bone & joint journal. 2016;(6):736-40
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Abstract
The use of large-diameter metal-on-metal (MoM) components in total hip arthroplasty (THA) is associated with an increased risk of early failure due to adverse local tissue reaction to metal debris (ARMD) in response to the release of metal ions from the bearing couple and/or head-neck taper corrosion. The aim of this paper was to present a review of the incidence and natural history of ARMD and the forms of treatment, with a focus on the need for and extent of resection or debulking of the pseudotumour. An illustrative case report is presented of a patient with an intra-pelvic pseudotumour associated with a large diameter MoM THA, which was treated successfully with revision of the bearing surface to a dual mobility couple and retention of the well-fixed acetabular and femoral components. The pseudotumour was left in situ Resolution of the intra-pelvic mass and normalisation of metal ion levels was observed seven months post-operatively. Cite this article: Bone Joint J 2016;98-B:736-40.
3.
[Chronic cobalt poisoning in endoprosthetic replacement].
Steens, W, Loehr, JF, von Foerster, G, Katzer, A
Der Orthopade. 2006;(8):860-4
Abstract
This article outlines symptoms and therapeutic options in chronic cobalt poisoning including a case report in which metallosis caused by a ceramic-metal articular pairing led to almost complete loss of sight and hearing after revision of a total hip prosthesis. At primary revision the firmly incorporated stem was left in place. For a better offset only the head was exchanged from a ceramic to a metal model which articulated with a socket containing a ceramic inlay. Postoperatively, movement of the hip joint became increasingly uncomfortable and painful. After 2 years, the patient started complaining about increasing impairment of his eyesight followed by a gradual loss of hearing. In a second revision, examination of the explanted material showed almost complete deterioration of the metal femoral head and a partially fractured ceramic inlay with extensive contamination of the bone and surrounding soft tissue by metal debris. At the time of revision increasing concentrations of the alloy elements cobalt, chromium, and molybdenum were measured in the serum and liquor. The concentration of cobalt, in particular, was remarkably high. Treatment options in cases with chronic cobalt poisoning include chelation therapy with EDTA or BAL/DMPS.
4.
[Heparin induced thrombocytopenia. A frequently unrecognised complication after major orthopedic surgery].
Picker, SM, Gathof, BS
Der Orthopade. 2004;(11):1300-8
Abstract
The application of unfractioned (UFH) and low molecular weight heparins (LMH) has reduced the incidence of thromboembolic events. However, the frequency of heparin-induced thrombocytopenia (HIT II) in orthopedic patients, particularly susceptible for both thromboembolic complications and HIT II with potentially life threatening complications, is about 0.5% for LMW and 3% UFH. Induced by an immune response, the excessive activation of platelets and endothelial cells causes massive thrombin generation and, as a result, thrombotic vessel occlusion. The rates of mortality and amputation in HIT II are estimated to be 30% and 20%, respectively. The clinical course is highly dependent on early therapeutic intervention, consisting of compatible and adequately dosed anticoagulation drugs. Vitamin K antagonists as well as platelet substitution may lead to disastrous sequelae. We summarize the current state of the pathophysiology, diagnosis and therapy of HIT II and illustrate therapeutic mistakes in a case report.