Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association
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Case Reports
Computed tomography-guided screw fixation of a sacroiliac joint dislocation fracture: a case report.
A 19-year-old woman sustained a vertical shear type pelvic fracture. Sacroiliac fixation using computed tomography (CT)-guided cannulated screws was performed for a left sacroiliac dislocation fracture, and a satisfactory result was obtained over time. ⋯ Advantages of CT-guided sacroiliac screw fixation include precise evaluation of the degree of reduction and absence of nerve and vascular damage during the time the screw is inserted into the sacral body. This procedure is a useful, safe method owing to its minimal invasiveness in patients with unstable pelvic fractures that are reducible by manual manipulation or traction.
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This case report describes a lumbar epidural abscess that caused septic shock. A 48-year-old woman who developed a high temperature was diagnosed as having a respiratory tract infection. She became unconscious the next day and was transferred to the intensive care unit for monitoring and treatment. ⋯ Surgical drainage of the epidural abscess was performed as an emergency procedure, and the patient recovered immediately. The primary source of the epidural abscess was probably the respiratory tract infection, which spread to the epidural space through hematogenous dissemination. The initial treatment of the epidural abscess was rest and antibiotics, but surgical treatment was needed to save the patient because of septic shock.
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Randomized Controlled Trial Comparative Study Clinical Trial
Effects of cyclical etidronate with alfacalcidol on lumbar bone mineral density, bone resorption, and back pain in postmenopausal women with osteoporosis.
The purpose of the present open-labeled, randomized, prospective study was to compare the effects of cyclical etidronate combined with alfacalcidol with those of cyclical etidronate alone on lumbar bone mineral density (BMD), bone resorption, and back pain in postmenopausal women with osteoporosis. Forty postmenopausal women with osteoporosis, 60-86 years of age, without any vertebral fractures in the lumbar spine, were randomly divided into two groups with 20 patients in each group. One group was treated with cyclical etidronate (oral etidronate 200 mg daily for 2 weeks every 3 months) and the other was given cyclical etidronate combined with alfacalcidol (cyclical etidronate plus alfacalcidol 1 Ig daily continuously). ⋯ Cyclical etidronate combined with alfacalcidol significantly increased the lumbar BMD with a more significant reduction in the urinary NTX level than cyclical etidronate alone, but cyclical etidronate alone did not significantly increase the lumbar BMD. Alleviation of back pain was similar in the two groups. These results suggest that cyclical etidronate combined with alfacalcidol appears to be more useful than cyclical etidronate alone for increasing the lumbar BMD by more markedly suppressing bone resorption in postmenopausal women with osteoporosis.
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We treated 16 patients with equinus contracture using the Ilizarov method without open soft tissue release. No hinge was used in seven patients; instead, their ankle joint was used as the hinge (natural hinge; unconstrained construct). In the remaining nine patients, medial and lateral hinges connecting the tibial and foot rings were placed at the center of the talar dome (rotating hinge; constrained construction). ⋯ The natural hinge system is therefore the method of choice for treating equinus contracture because it is less invasive and simpler. However, particular care is needed during correction to avoid complications such as anterior subluxation of the talus and joint space narrowing. When complications do occur, intervention should be immediate.
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We describe two cases of combined fractures of the odontoid process and upper thoracic spine that have not been previously reported. The first patient, a 21-year-old man, sustained an odontoid process fracture with posterior displacement and a fracture-dislocation injury at T4/5 in a motorcycle accident. The second patient, a 66-year-old woman, fell from a cliff and sustained an odontoid process fracture with posterior displacement and a bursting fracture at T3 and T4 with rotation. ⋯ The second patient escaped neurological deficit. Both underwent anterior screw fixation of the odontoid process and posterior fusion of the upper thoracic spine. In both cases the cervical spine seemed to be in hyperextension, and the upper thoracic spine experienced sudden flexion and rotation forces.