Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Feb 2002
Case ReportsSacral insufficiency fracture, an unsuspected cause of low-back pain in elderly women.
Sacral insufficiency fractures (SIF) usually occur in elderly women and are secondary to various conditions, mainly postmenopausal or steroid-induced osteoporosis and radiation therapy. They are often overlooked or confused clinically and radiographically with metastatic disease. We report a case of a 72-year-old woman who presented to our department with severe low-back pain. ⋯ Computed tomography (CT) confirmed sclerotic changes interpreted as insufficiency fractures through both sacral alae. Increased awareness of these fractures may help to avoid unnecessary investigations and treatment. Bed rest and analgesia followed by rehabilitation provide good relief of symptoms.
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Malignant lymphoma of bone is rare. In many cases, its diagnosis is delayed because of unspecific clinical signs and equivocal radiographs. Therapy in general is multimodal, including surgery and radio- and chemotherapy. ⋯ Treatment generally is conservative, based on the stage of the disease. Local radiation with or without systemic chemotherapy should be used. The long-term survival is favorable, but dependent on the stage of the disease and the amount of bone involvement.
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Arch Orthop Trauma Surg · Feb 2002
Case ReportsFatal retroperitoneal hemorrhage caused by perforation of a guidewire pin for proximal femur fixation.
A 77-year-old woman with a slightly displaced intertrochanteric two-fragment fracture of the left hip was treated by internal fixation using a screw-nail device (gamma nail). After the operation she became hemodynamically unstable, and ultrasound revealed a large retroperitoneal fluid accumulation in the left lower abdomen. ⋯ However, despite the successful treatment of the retroperitoneal hemorrhage, the patient developed an oligosymptomatic myocardial infarction associated with clinical evidence of a cerebrovascular insult and pulmonary decompensation and died 2 weeks after her accident. The hemorrhage in this patient was most likely caused by surgical damage to the obturator artery during placement of the guidewire pin (with threaded tip) to position the screw of the implant.
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Arch Orthop Trauma Surg · Feb 2002
Case ReportsMelorheostosis with occlusion of dorsalis pedis artery.
Melorheostosis is an unusual sclerotic dysplasia of bone. The case of a 51-year-old female patient with melorheostosis and occlusion of the dorsalis pedis artery is described. Although numerous vascular anomalies have been noted in patients with melorheostosis, occlusion of the dorsalis pedis artery has not been reported previously.
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Arch Orthop Trauma Surg · Feb 2002
Case ReportsOsteolytic lesion in the greater trochanter mimicking tumor.
Two patients with an osteolytic lesion of the greater trochanter suggesting a malignant bone tumor are presented. Biopsy, microbiological and histological examination suggested a diagnosis of trochanteric tuberculosis. Treatment consisted of multiple surgical debridements and antituberculous chemotherapy. The incidence of similar cases is expected to increase with the rising incidence of tuberculosis.