Acta Orthop Belg
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Cerebral embolism poses one of the most perplexing problems in cerebrovascular disease; fat emboli and marantic air emboli occur occasionally. However, the most common cause for a cerebral embolism is degenerative changes in the central arteries. ⋯ The patient awoke slowly, and when awake she showed a combination of contralateral hemiplegia, and right hemianesthesia with global aphasia; the CT scan showed an ischemic lesion in the territory of the middle cerebral artery; during the following two weeks the patient showed complete recovery from the clinical syndrome. This complication must be recognized by every orthopedic surgeon, and a high clinical index of suspicion remains essential to early diagnosis.
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A case of a bilateral posterior four-part fracture dislocation of the shoulder after a convulsive seizure was treated conservatively on one side, while the other shoulder was replaced by a hemiarthroplasty. A review of the literature and a treatment protocol for managing these injuries are presented. In four-part fracture-dislocations good results can be achieved with conservative treatment, but when avascular necrosis is likely to occur (delay in diagnosis or dubious relationship of the fragments after reduction) it is better to replace the humeral head.
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We retrospectively reviewed the radiographs of 255 patients with intertrochanteric fractures over a 2 year period. The incidence of osteoarthritis of the hip joint in these patients was 12.16%, which is less than that reported in the general population, and which confirms the protective effect of osteoarthritis against intertrochanteric fractures. Osteoarthritis was mild in 14, moderate in 19, and severe in 4 hips. ⋯ Three patients with severe osteoarthritis, who were waiting for a total hip replacement before the hip fracture occurred became asymptomatic. There was no significant clinical or radiographic progression of mild and moderate hip osteoarthritis in the remaining 13 patients (15 hips). Intertrochanteric fractures appear to have a beneficial "osteotomy-like" effect on hip osteoarthritis in symptomatic patients.
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Comparative Study
Paralysis of the peroneal nerve following hip fracture treatment.
A prospective study was performed over a period of 2 years to identify the cause of peroneal palsy following hip fracture treatment. Sixty-eight patients in Group I had their injured leg placed in traction in a splint with a metal frame. ⋯ The difference is significant. Direct pressure on the nerve in the area of the fibular head during the preoperative traction period seems to be the cause of this transient dysfunction.