This case report presents the failure of retrograde intramedullary (IM) nailing in a supracondylar distal femur fracture in a 72-year-old female after a fall from standing. Multiple medical comorbidities are a known risk factor for fracture nonunion. With the rising incidence of patients having osteoporosis and multiple medical comorbidities, orthopedic surgeons need to be prepared for the treatment of hardware complications.The patient is a 72-year-old severely obese female with multiple medical comorbidities including cardiac valvular disease, hypertension, type II diabetes mellitus, hypothyroidism, acute on chronic blood loss anemia, rheumatoid arthritis, and lupus arthritis. She presented after a fall from standing where she sustained a closed displaced left supracondylar distal femur fracture with intercondylar extension.Open reduction and internal fixation (ORIF) was performed on the left distal femur intercondylar split and retrograde intramedullary nailing for the left supracondylar distal femur fracture. Three-month follow-up Xrays revealed no osseous formation of the supracondylar distal femur fracture and catastrophic failure of the implants with two broken screws and a broken condylar bolt consistent with hardware failure.Treatment options included either non-weight-bearing for three months to evaluate for callus formation, which would require her to be in a wheelchair, or surgical referral for implant removal and distal femur replacement. The patient elected to undergo revision surgery consisting of distal femoral replacement. Following revision surgery, the patient was discharged with physical therapy referral. She disclosed a decrease in pain and increased range of motion (ROM) compared to the preoperative state. This case demonstrates an elderly, obese patient with multiple comorbidities including type II diabetes mellitus and autoimmune conditions that placed the patient at high risk for hardware failure following surgery. Due to pain and quality of life concerns, patients with such injuries may be forced into a situation with limited options. This case highlights the need for optimal surgeon-to-patient communication to ensure that patients and all members of their healthcare team are knowledgeable when certain clinical situations are considered high risk for failure. Moving forward, risk factor consideration and medication adjustments are preoperative topics of discussion that should be discussed at length with the patient in order to provide the best opportunity for a successful surgery.
We present the case of a collegiate football player with an extensive bilateral ligamentous knee injury history to elucidate the mechanisms and possible explanations behind why some athletes sustain recurrent injuries. We hope to initiate thought on altering rehabilitation schedules for athletes who are at an increased risk of re-injury. A 21-year-old collegiate American football player presented with a re-tear of his left anterior cruciate ligament (ACL) and medial meniscus following reconstructive surgery. The initial injury occurred to the patient when he was 15 and suffered a right ACL, lateral collateral ligament, and lateral meniscus tear in a non-contact injury. At the age of 19, he suffered his second injury, a contact-associated left ACL tear. Upon return to play six months following the left ACL tear, the patient sustained a non-contact bucket handle tear of the right medial meniscus. One year later, he presented with a re-tear of his left ACL. His initial left and right ACLs were repaired with hamstring autografts, and his current left ACL was repaired with a bone-patellar tendon-bone graft. This case illustrates an all too common situation plaguing the modern orthopedic sports medicine surgeon. At what point should a surgeon diverge from the standard rehabilitation schedule of ACL surgery due to a patient being at too high of a risk for a re-tear? We propose further investigations into risk factors as well as rehabilitation protocols to help surgeons identify and optimize treatment for these patients.
Se desarrolla una metodología de modelización de los procesos difusivos en condiciones de régimen estacionario, de contaminantes y nutrientes de origen superficial y puntual, aportados por los tributarios al Embalse Frontal de Termas de Río Hondo (Provincias de Tucumán y Santiago del Estero, República Argentina). El modelo analógico-digital, genera isolíneas de potencial V (curvas equipotenciales) o bien superficies reticuladas, que se corresponden con la dispersión espacial de contaminantes y nutrientes, en el medio líquido, cuando se emplea la Concentración C como parámetro distribuido. En los procesos de difusión y mezclado, en medio isótropo, con conductividad eléctrica O, independiente de la posición r, es posible emplear un sistema análogo de conducción eléctrica continua óhmica descrito por la ecuación de Laplace (V2 V (r) = O). El modelo, electro-analógico bidimensional, fue construido a escala con papel semiconductor, respetando la planimetría del Embalse Frontal de Termas de Río Hondo, cuando el espejo alcanza la cota máxima. Se obtuvieron valores de tensión o potencial eléctrico y de este modo, se generaron soluciones para la ecuación de Laplace V2 C (r) = O, que describe la distribución espacial de la concentración C de contaminantes y nutrientes, con coeficiente de difusión o mezclado D, independiente de la posición r . El dispositivo experimental empleado, incluye además del modelo electro-analógico, un pantógrafo; un voltímetro; un conversor analógico-digital y dos programas computacionales para controlar las tensiones aplicadas en los electrodos, en función de los caudales másicos aportados por los tributarios y gestionar la adquisición de datos, para generar archivos de ternas de puntos, pertenecientes a las soluciones del problema.Palabras clave: modelos analógico-digitales; difusión de Contaminantes y nutrientes; embalses; Ecuación de Laplace; régimen estacionario.
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