Tsu-Te Yeh

Risk factors for nonunion in patients with intracapsular femoral neck fractures treated with three cannulated screws placed in either a triangle or an inverted triangle configuration.

BACKGROUND Intracapsular femoral neck fractures are associated with high rates of nonunion. We aimed to identify risk factors for nonunion in patients with both displaced and nondisplaced intracapsular femoral neck fractures treated with three 7-mm parallel cannulated screws, placed in either a triangle or an inverted triangle configuration, using failure of fixation as the primary outcome. METHODS Clinical and radiographic data for patients with intracapsular femoral neck fractures treated with either triangle fixation (one proximal screw and two distal screws) or inverted triangle fixation (two proximal screws and one distal screw), between January 1, 2000, and July 30, 2009, were analyzed. RESULTS A total of 202 patients, seventy-six men and 126 women with an average age (and standard deviation) of 64.53 ± 15.81 years (range, nineteen to ninety-three years), were included in the analysis. Union occurred in 158 patients, and nonunion occurred in forty-four. There were no differences between the union and nonunion groups with respect to age, sex, fracture side, fracture angle, fracture level, or estimated bone density. There were significant differences in fracture type, fixation configuration, reduction quality, and screw-tip subchondral purchase between patients with and without union. The estimated odds ratio for fracture nonunion was 2.93 (95% confidence interval [CI], 1.08, 7.96) in subjects with displaced fractures compared with those without displaced fractures (p = 0.035), 18.92 (95% CI, 1.91, 187.09) in subjects with borderline and unacceptable reduction compared with those with anatomic reduction (p = 0.012), and 2.92 (95% CI, 1.27, 6.69) for internal fixation with a triangle configuration compared with fixation with an inverted triangle configuration (p = 0.010). CONCLUSIONS Screw fixation with a triangle configuration, a displaced fracture, and poor reduction are risk factors for nonunion in intracapsular femoral neck fractures treated with fixation with multiple screws.

Pelvic Primary Pyomyositis Complicated by Septic Pulmonary Embolism and Shock in a Young Adult

Pyomyositis is an acute infection of skeletal muscles. It can be life-threatening if diagnosis and treatment are delayed. We present a case of a 23-year-old male delayed diagnosis of pyomyositis of the iliacus muscle and gluteal minimus muscle complicated with pulmonary septic embolism and septic shock who was treated with early goal directed cardiovascular resuscitation and surgical exploration combined with parenteral antibiotics. Computed tomography is useful in making the diagnosis. Early diagnosis and treatment may avoid surgery and reduce mortality.

Surgical Treatment of Iatrogenic Femoral Neck Fracture during Closed Reduction for Posterior Fracture Dislocation of the Hip: A Technical Note

Fracture-dislocation of the hip is a rare event that usually results from high-energy injury. These patients require a systemic trauma survey to uncover concomitant injuries. Early closed reduction within 6 h is recommended to decrease the incidence of avascular necrosis of the femoral head. Iatrogenic complete femoral neck fracture during closed reduction for posterior dislocation of the femoral head is a rare complication. A modified technique, the Kocher-Langenbeck approach, for open reduction of the femoral neck fracture using antegrade guide pins and retrograde cannulated screws fixation can resolute this situation in one stage. This method provides an anatomic reduction and stable fixation for this kind of injury.

Ante-grade intramedullary nailing for the treatment of humeral shaft metastatic bone tumor

Background: The surgical treatment of humeral fractures is controversial, and conservative therapy of pathologic fractures is not recommended. Materials and Methods: We performed a retrospective study of eight patients who had pathological humeral shaft fractures. All fractures were stabilized with ante-grade intramedullary nailing and wide resection of the tumor. Bone defects were filled with polymethylmethacrylate cement augmentation. Results: The mean operative time for the procedure was 160 min (range, 120-190 min), and the mean duration of hospitalization was 10.5 days (range, 5-15 days). Relief of pain was rated as good to excellent. There were no wound problems, deep infections, nerve palsies, or implant failures observed. X-ray studies demonstrated the improved stability of the humerus. Conclusion: Interlocking intramedullary nailing for pathological humeral shaft fractures provides immediate stability and can be accomplished with wide resection of tumor and bone defect augmentation with cement. Early return of functional status and pain relief greatly improved the patients quality of life.

Arthroscopic Treatment for Intra-articular Lipoma Arborescens of the Knee Joint

Lipoma arborescens is a rare intra-articular lesion of unknown etiology. We present a 70-year-old woman with a 10-year history of recurrent swelling and effusion in the right knee. Histological examination after surgical synovectomy confirmed the diagnosis of lipoma arborescens. The fatty nature and frond-like appearance of the tumor was demonstrated on magnetic resonance imaging (MRI). Open synovectomy is the curative treatment. Although this syndrome is rare, it is important to recognize it and make differential diagnosis from other synovial lesions using MRI.

Possible Mechanism for Pathogenesis of Aneurysmal Bone Cyst Degenerated from Intraosseous Lipoma: Case Report and Literature Review

Intraosseous lipomas are rare bone tumors, the pathogenesis of which remains controversial. In the involution of lipomas, many conditions were reported, such as fat necrosis, cystic formation, and dystrophic calcifi cation. Moreover, degeneration of an intraosseous lipoma into an aneurysmal bone cyst (ABC) is extremely rare. We report a patient who had coexisting features of an intraosseous lipoma and ABC diagnosed by a radiologist, pathologist, and orthopedic surgeon. No such case has been published, and we propose a possible mechanism according to the most tenable hypothesis. The patient was successfully treated with intralesional curettage and implantation of polymethylmethacrylate. There are a number of hypotheses regarding the etiologic factors for intraosseous lipomas and ABCs. The rare case reported herein may provide some clues about the pathogenesis of these two diseases.