La Chirurgia degli organi di movimento
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Case Reports
Spontaneous bilateral patellar tendon rupture: a case report and review of the literature.
Bilateral rupture of the patellar tendon is a very rare injury. It occurs in association with chronic systemic diseases or corticosteroid medications. We report a case of a 13-year-old child with Ehlers-Danlos syndrome presenting a bilateral patellar tendon disruption of proximal insertion that occurred with a trivial trauma. Surgical management consisting in tendon repair with a suture anchor technique protected temporarily with a cerclage wiring gives a good outcome.
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Analysis of 80 bilateral hip replacement surgeries performed in a single session. Feasibility study.
Patients affected with bilateral coxarthrosis often present with clinical and radiographic findings that are similar on both sides. The experience with 80 patients submitted to bilateral hip replacement in a single session demonstrated the usefulness and the reduction in costs in relation to hospitalization and rehabilitation. Indications and contraindications must be taken seriously.
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It is the purpose of this paper to present the case of a patient who came to our observation because of the occurrence of non-elastic hardening of the skin (stone hard skin) and of the subcutaneous tissue that began during early childhood. The parents reported having observed the gradual functional limitation of numerous joints with asymmetrical distribution, more evident in the elbow and the right scapulohumeral joint. There were no signs of involvement of the internal organs; hematologic testing was normal. ⋯ Modifications are manifested during early childhood causing gradual functional limitation of the hips and knees, with consequent difficulty related to posture and walking. Deficit in the upper limbs is less important. The literature describes about 25 cases with little incidence of familiarity; etiopathogenesis is unknown.
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Isolated fracture or detachment of the lesser trochanter is an infrequent occurrence. In most cases the event is part of a complex of fractures involving the femoral neck and the greater trochanter. Isolated fracture caused by direct trauma is rare because of the anatomical location of the lesser trochanter which is protected anteriorly and posteriorly by large muscular masses, superiorly by the head and the neck of the femur, laterally by the femur itself, and medially by the ilio- and ischio-public branches of the pelvis. ⋯ Diagnosis is based on radiographic ascertainment, obtained with the thigh in extra-rotation, supported by rather typical clinical findings such as acute pain in the inguinal region and in Scarpa's triangle, limping, passive movement of the hip in all directions with pain in maximum extension and relief when seated. Nonsurgical treatment with the limb resting in flexion, further confirmed by the case presented in this study, still remains the treatment of choice in most cases, obtaining excellent functional results. The authors believe that it was of interest to report this clinical case because of the rareness of the pathology observed and because of the specific features of its etiology.