In upper lumbar burst fractures, complete lamina fracture is an indicator of injury severity. When detected preoperatively on CT or MRI scanning, it should be operated by open book laminectomy even if the patient is neurologically intact since it carries a high risk of neural entrapment, and its presence affects the intraoperative postural and instrumental trials for anterior vertebral height restoration.
Severity of the distal radius fractures is not associated with SLD. Intra-articular fractures were associated with significant increase in the prevalence of SLD. In some cases, SLD may appear after reduction in distal radius. Most cases with SLD are symptomatic, and this may be the reason of poor cases following distal radius fracture.
Primary cutaneous aspergillosis (PCA) can rarely affect immunocompetent people. There is limited knowledge about the prevalence, diagnosis and management of the disease because there are only case reports or small case series in the literature. For this reason, the diagnosis and treatment of three immunocompetent adult patients diagnosed with PCA were discussed by reviewing the literature. In the current report, in addition to treatment with voriconazole for 8-12 weeks we performed repeated surgical debridement for the treatment of these cases. After two negative tissue cultures, the wounds were either successfully closed primarily or reconstructed using a skin graft. Management of PCA cases will become easier as more reports and further studies of PCA contribute to our shared knowledge. Currently, the most appropriate management approach is to make individualized treatment decisions according to the patients' clinical features and treatment response which includes several surgical debridement as well as antifungal therapy.
Patients with cerebral palsy (CP) disorder often develop rotational hip deformity. Increasing deformities impair already diminished walking abilities; femoral osteotomies are often performed to maintain and improve walking abilities. Fixation of osteotomies with condylar plates has been used successfully, but does not often enable immediate postoperative full weight-bearing. To avoid considerable postoperative rehabilitation deficit and additional bone loss because of inactivity, a postoperative treatment with full weight-bearing, is therefore, desirable. Self-tapping Schanz screws with a unilateral external fixator crossing the knee joint providing stronger anchoring in osteopenic bone might fulfill these demands. A retrospective study was carried out on 27 ambulatory CP patients, mean age 17.5 years (range 9-22 years); 11 patients with bilateral severe intoeing deformities underwent a supracondylar femoral osteotomy between September 2008 and April 2012. All patients were allowed to bear their full weight postoperatively. The aim of this study was to describe the technique, the results of this technique, to evaluate the time required for bone healing, and the type of complications associated with a distal derotational femoral osteotomy fixed with a uniaxial external fixator crossing the knee joint. A total of 27 patients were studied [mean weight 48.8 kg (range 29.8-75 kg)]. The mean preoperative rotation included internal rotation of 69° and external rotation of 17°. All patients were evaluated clinically and radiographically for a minimum of 1 year after surgery. There was a significant decrease in the mean medial rotation from 69° to 32° (P=0.00034). The lateral rotation increased significantly from preoperative 17° to postoperative 45° (P=0.0011). The femoral anteversion decreased significantly from a mean of 55° preoperatively to a mean 17° postoperatively (P=0.030). All patients, except one, achieved solid fusion uneventfully. One patient was a 16-year-old female who had sustained a knee flexion contracture of 30° because of a delay in the physiotherapy program. One 13-year-old female patient with a bilateral osteotomy had a nondisplaced fracture in her right femur after a direct trauma 2 weeks after removal of an external fixator, and was treated by a cast. Another 17-year-old male patient developed a nonunion because of loosening of two pins and achieved solid union after revision by dynamic compression plate plating. Besides four cases with superficial pin-tract infection, no other complications were documented. Minimally invasive supracondylar femoral derotational osteotomy fixed with a unilateral external fixators crossing the knee joint is a reliable procedure in CP patients. Most patients can be treated with early postoperative full weight-bearing. However, removal of the knee joint crossing fixator should be performed as early as possible to achieve a full range of motion.
Ipsilateral proximal, diaphyseal and distal femur fractures are very rare. These fractures are seen especially in the adult population following motorcycle or in-vehicle traffic accidents. Treatment of ipsilateral multiple femur fractures are difficult and controversial. Variable types of fixation techniques and implants are proposed for these types of fractures, however, no evidence could be submitted for preference of any specific implant. The sequence of fracture type to be fixed first and type of implant to be used are questions yet to be answered.In this case report, we aim to draw attention to the diagnosis, treatment and follow up and also discuss complications which could be encountered during the treatment of these ipsilateral multiple femur fractures. (JAREM 2012; 2: 120-3) Key Words: Femur, multiple, fracture, fixation ÖZET Aynı taraf proksimal femur, femur cisim ve distal femur kırığı birlikteliği son derece nadir görülen bir durumdur. Bu güne kadar literatürde sadece 18 olgu bildirilmiştir. Bu tür yaralanmalar sıklıkla motorsiklet veya araç içi trafik kazaları gibi yüksek enerjili travmalar sonrasında özellikle genç toplumda meydana gelmektedir. Bu tip yaralanmaların tedavisi için birçok tespit yöntemi ve materyal önerilmiş fakat tercih nedeni olabilecek kanıtlar öne sürü-lememiştir. Bu tip kırıklarda tespitin sırası ve önemi ise günümüzde halen cevap bekleyen sorular arasındadır. Araç içi trafik kazası sonrası acil servise başvuran 28 yaşındaki erkek hastada aynı taraf proksimal femur, cisim ve distal femur kırığı saptandı. Hasta proksimal ve distal femur kırıklarının kanüle vidalarla, cisim kırığının da retrograd femur çivisi kullanılarak intramedüller tespiti ile tedavi edildi ve ameliyat sonrası 8. ayda değerlendirildi. Literatür ışığında ipsilateral proksimal femur, cisim ve distal femur çoklu yaralanmalarına yaklaşım, tedavi prensipleri ve karşılaşılabilecek muhtemel sorunlar bu yazıda değerlendirmiştir. (JAREM 2012; 2: 120-3)
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