A pseudo-iatrogenic case of medial clavicular fracture.
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ABSTRACT:
SUBMITTER: Poelmann TA
PROVIDER: S-EPMC2291476 | biostudies-other | 2008 Apr
REPOSITORIES: biostudies-other
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Project description:IntroductionAnterior cruciate ligament (ACL) avulsion fracture after unicompartmental knee arthroplasty (UKA) has not been reported until recently. We describe a case of ACL avulsion fracture that developed after medial UKA.Case presentationA 57-year-old woman underwent UKA for right medial compartment osteoarthritis. She developed knee pain and swelling at 2 weeks after UKA, and radiographs showed an ACL avulsion fracture at 3 weeks after UKA. After conservative treatment failed, the fracture was fixed using screws. After 5 months from internal fixation, bone union was confirmed, and the screws were removed. At 16 months after removing screws, there was no further complication.DiscussionThe patient did not exhibit a fracture on the radiograph taken immediately after UKA. We carefully re-examined the radiographs and observed a 5-mm horizontal cement shadow on the lateral side of the tibial component. It is thought that excessive lateral resection of the proximal tibia during UKA may have resulted in a micro fracture and this outcome. In the present case, the posterior slope angle of the tibial component measured postoperatively was 11.5 degrees. The angle of more than 7 degrees along with excessive horizontal resection of the proximal tibia probably increased load on the ACL.ConclusionIf patients exhibit a horizontal cement shadow near the tibial component and a higher posterior slope angle of the tibial component on the radiograph after UKA, surgeons should be aware of possible ACL avulsion fracture and perform additional radiological examinations in patients with continuous knee pain and swelling.
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Project description:BackgroundNerve injury during acetabular and pelvic fracture fixation can have devastating consequences for trauma patients already in a compromised situation.Questions/purposesThis study aims to evaluate the efficacy of multimodality intraoperative neurophysiologic monitoring during acetabular and pelvic fracture fixation in identifying emerging iatrogenic nerve injury.MethodsSixty patients were retrospectively identified after surgical fixation following acetabular or pelvic fracture. Neuromonitoring during surgery was performed using three different modalities, transcranial electric motor evoked potential (tceMEP), somatosensory evoked potential (SSEP), and electromyographic (EMG) monitoring. Each modality was evaluated for sensitivity and specificity of detecting an intraoperative nerve injury.ResultstceMEP monitoring was found to be 100% sensitive and 86% specific at detecting an impending nerve injury. The sensitivity and specificity of SSEP were 75% and 94%, while EMG sensitivity was unacceptably low at 20% although specificity was 93%.ConclusionsMultimodality neuromonitoring of transcranial electric motor and peroneal nerve somatosensory evoked potentials with or without spontaneous EMG monitoring is a safe and effective method for detecting impending nerve injury during acetabular and pelvic surgery.
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Project description:BackgroundPopliteal artery pseudoaneurysm is a state of vascular wall rupture in the popliteal artery. It is generally a rare situation and the most common etiologic factor is iatrogenic causes.Case presentationThis case report presents a successful diagnosis and management of a 31-year-old patient who was presented with a mass behind the knee, three months after femoropopliteal bypass for the treatment of a gunshot to the knee. An endovascular approach using coils was utilized for the patient, which led to complete remission for the patient.DiscussionThe current patient had two primary therapeutic challenges: bleeding and hematoma growth, clot development causing blood flow restriction, and limb ischemia. Pseudoaneurysm also caused internal inflammation, which increased the risk of thrombosis and bypass graft damage during open surgery. Due to the risk of recurrence and graft damage, ultrasound-guided compression was not possible. Thus, endovascular therapy was preferred.ConclusionThe endovascular approach using coils is an option for the management of PAP. However, the endovascular approach should be considered carefully according to the patient's status.
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Project description:BackgroundPeripheral neuropathy after surgical treatment is an under recognized potential untoward event. Pelvic surgery may be associated with nerve lesions by essentially three main mechanisms: transection, entrapment and pressure-stretching; the latter is the modality most frequently linked to patient's positioning on the operating room table.Presentation of the caseA 25 years old woman, after undergoing a laparoscopic gynaecologic procedure lasted >3 hours, on postoperative day one presented with numbness over her lateral right leg and dorsum of the foot, right foot drop and gait instability due to compression-stretching of the right superficial peroneal nerve.DiscussionPatient's diagnostic work up, treatment and outcome are reported and measures on how to prevent the occurrence of such type of lesion are outlined together with the importance of an early postoperative diagnosis in order to avoid permanent nerve damage.ConclusionSuch lesions are sometimes so unexpected that delayed diagnosis leads to damages which are difficult or impossible to repair. Primary prevention plays a key role and it is realized by adhering to specific protocols. In the occurrence of the lesion a prompt diagnosis is highly recommendable and a comprehensive therapeutic plan is necessary to correctly address the specific pathology.
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Project description:BackgroundThe optimal method for the determination of ankle stability remains controversial in rotational ankle fractures without medial bony injury.Questions/purposesThe purposes of this study were to (1) evaluate whether posterior malleolar (PM) fracture displacement is associated with deltoid ligament injury in supination-external rotation (SER) ankle fractures and (2) compare the diagnostic accuracy of PM displacement and magnetic resonance imaging (MRI) evaluation of the deep deltoid ligament in identifying fractures with deltoid ligament incompetence.MethodsPatients with rotational bimalleolar injuries containing lateral malleolar and PM fractures without bony medial injury were included. After operative lateral and PM fixation, an external rotation stress test was performed to evaluate deltoid ligament stability. Operative dictations were reviewed to confirm injury pattern, stability on stress test, and visual inspection of the deltoid ligament. Maximum PM displacement was assessed on lateral X-ray. Pre-operative MRI of the ankle was performed following closed reduction and splinting.ResultsThe final cohort consisted of 13 trimalleolar equivalent fractures (torn deltoid ligament) and 20 bimalleolar fractures (medial malleolus and deltoid ligament intact). Average PM displacement was significantly higher for SER trimalleolar equivalent patterns when measured on lateral X-ray. The sensitivity of detecting trimalleolar equivalent fracture was higher on all reported X-ray findings than the sensitivity obtained by the reported MRI findings of deltoid ligament injury.ConclusionPM displacement on X-ray is a useful adjuvant along with external rotation stress radiography and MRI evaluation of deep deltoid integrity to distinguish between stable and unstable fracture patterns and thus helps facilitate treatment decisions.
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