Proximal femur fractures in patients taking anticoagulants.

Thirty per cent of patients presenting with proximal femoral fractures are receiving anticoagulant treatment for various other medical reasons. This pharmacological effect may necessitate reversal prior to surgical intervention to avoid interference with anaesthesia or excessive peri/post-operative bleeding. Consequently, delay to surgery usually occurs.

Flexor Hallucis Longus Tendon Single-Incision Transfer Stabilized With Autologous Bone Fixation.

Flexor hallucis longus transfer is routinely used as a technique to salvage a chronic or neglected Achilles tendon rupture. The single-incision (or short harvest) technique provides adequate graft suitable for fixation with interference screws. We have used a bore corer instead of a drill to establish the tendon tunnel and at the same time use the harvested autograft for interference fit and avoid the use of screws, providing what we consider to be a more biologic form of fixation.

Physical Health and Psychological Outcomes in Adult Patients with Long-bone Fracture Non-unions: Evidence Today.

Background: Research has suggested that bone fractures can hinder the health status of patients' life. However, limited research has examined the impact that the healing process of a fracture has on the physical health and psychological state of individuals, particularly in considering the short- and long-term impact of having a fracture that fails to heal and drops into a non-union. The aim of this systematic review is to better understand the impact of fracture non-union to physical health and to respective psychological outcomes.

Hip arthrodiastasis combined with core decompression and diamond concept for postcollapse femoral head avascular necrosis.

In postcollapse hip avascular necrosis (AVN), the femoral head cannot be salvaged, necessitating total hip replacement. We report a case of a 39-year-old woman who developed idiopathic femoral head AVN with marked symptoms and radiological evidence of articular surface collapse. We treated her with core decompression combined with the 'diamond concept' (implantation of bone marrow concentrate, a growth factor and bone graft substitute) and distracted the hip joint with external fixator.

Arthroscopically-assisted removal of distal centraliser of an MS-30 femoral stem using a cannulated reamer in revision hip arthroplasty.

Background: Revision hip arthroplasty can be challenging especially when difficulties to remove distal centralisers arise.

Case: We report a case where we removed a well-fixed 1st-generation solid MS-30 distal centraliser combining standard cannulated trauma reamers and arthroscopical guidance. Such case has not been reported in the past and this technical tip can be useful in revision procedures of the specific implant.

Treatment of Incarcerated Impaction of Acetabular Fractures With Concomitant Osteochondral Femoral Head Fractures by the Use of a Posterior Wall Osteotomy and Surgical Hip Dislocation: A Novel Technique.

Acetabular articular impaction may well accompany acetabular fractures. Anatomic restoration of acetabular congruence is imperative to achieve longevity of the hip joint. Combination of incarcerated acetabular impaction with osteochondral femoral fracture is a true challenge for the pelvic surgeon to address.

A novel technique to remove a broken tibiotalocalcaneal intramedullary nail using Moreland hip revision instrumentation.

Hindfoot intramedullary devices are increasingly used in tibiotalocalcaneal arthrodesis after failed total ankle arthroplasty or as a salvage procedure after complex trauma. Nail breakage is a well-described complication and numerous techniques for removal of broken parts can be found in the literature, especially for femoral and tibial nails. There is a relative paucity regarding techniques solving the challenge of removing a broken hindfoot intramedullary nail.

Clinical Outcome After Anterior Lumbar Interbody Fusion With a New Osteoinductive Bone Substitute Material: A Randomized Clinical Pilot Study.

Study Design: Pilot, single-center, single-blinded, parallel-group, randomized clinical study.

Objective: The aim of this study was to pilot a randomized clinical study to evaluate whether instrumented anterior lumbar interbody fusion (ALIF) with a new nanocrystalline hydroxyapatite embedded in a silica gel matrix (NH-SiO2) leads to superior radiologic and clinical outcomes at 12-month follow-up compared with instrumented ALIF with homologous bone.

Summary Of Background Data: ALIF completed with interbody cages is an established technique for performing arthrodesis of the lumbar spine.

Tibialis anterior tendon traumatic rupture secondary to a closed talar neck fracture: A case report.

A case of a 22 year-old woman who sustained a closed Hawkins type II talar neck fracture after her left foot was caught in a rope while rock climbing outdoors is described. She presented to emergency department with a swollen and neurovascularly intact foot and a displaced talar neck fracture was identified. Intraoperatively a traumatic rupture of tibialis anterior tendon was found and was primarily repaired after the talar fixation.

Riddles in the diagnosis and treatment of osteoid osteoma in child foot: A concisive study.

Background: Osteoid osteoma in child foot is very unusual. We investigate its polymorphism and difficulties in approach.

Methods: We retrospectively studied 12 children (7 girls, 5 boys) treated in our department from February 1995 until February 2010.

Osteoid osteoma of the pisiform. Can it exist in a child?

Carpal osteoid osteomas are extremely rare, and only six cases in the pisiform have ever been described, but all concerned exclusively adults. We have treated a unique case of osteoid osteoma in the pisiform of a 13-year-old girl. We excised en bloc the nidus, which resulted in total excision of the pisiform.

Septic shock with tension fecothorax as a delayed presentation of a gunshot diaphragmatic rupture.

Diaphragmatic rupture (DR) after thoracoabdominal trauma has a reported rate of 0.8% to 5% and up to 30% of diaphragmatic hernias are accompanied with delayed diagnosis. The DR occurs after high-energy blunt or penetrating (stab or gunshot wounds) trauma.

Treatment of humeral shaft fractures with antegrade intramedullary locking nail.

Antegrade interlocked humeral nailing for stabilization of humeral fractures was introduced many years ago, and studies on this method in the orthopedic literature have shown mixed results. The purpose of this investigation was to document the clinical outcome and complications associated with the use of an antegrade intramedullary nail (T2, Stryker) for the humeral fractures. Between 2005 and 2008, 52 fractures of the humeral shaft were treated operatively with this intramedullary nail in our department.

Human pulmonary Dirofilariasis: one more case in Greece suggests that Dirofilaria is a rather common cause of coin lesions in the lungs in endemic areas of Europe.

Herein we describe a case of a 52 year-old male from Greece who presented with a coin lesion in the right lung, which proved to be an infection from Dirofilaria immitis. A careful review of the literature shows that, contrary to the common perception, humans may be frequently infected by Dirofilaria species. For this reason the authors suggest that in every case which presents with a coin lesion in the lung in endemic areas, dirofilariasis should always be considered, and excluded before any other intervention is decided.

Etilefrine use in the management of post-operative chyle leaks in thoracic surgery.

Etilefrine, a sympathomimetic drug, was used 11 times in 10 patients with thoracic (n=8) or abdominal (n=2) chyle leak occurring after thoracic surgical procedures. It was given as a 4.2-5 mg/h intravenous infusion.

Sputum retention after lung operation: prospective, randomized trial shows superiority of prophylactic minitracheostomy in high-risk patients.

Background: Sputum retention after lung operation is a potentially life-threatening condition. The minitracheostomy (Minitrach II, SIMS Portex, Hythe, Kent, UK) is a 4-mm percutaneous cricothyroidotomy device, which allows immediate and repeated aspiration of the tracheobronchial tree by minimally trained staff, and can effectively treat sputum retention. This trial was designed to test the hypothesis that prophylactic minitracheostomy could prevent sputum retention in a high-risk group.

Tumors of the ribs: experience with 47 cases.

Objectives: To emphasise the existing difficulties in differentiating benign from malignant rib tumours, and especially the problems that a clinical doctor encounters when dealing with a hyperplastic rib.

Methods: Forty-seven patients with rib tumour underwent surgery in a period of 12 years (1984-1996). In 40 cases (85%), the lesion was benign and in seven (15%) was malignant.

Salmonella osteomyelitis of the rib.

Salmonella rib osteomyelitis is extremely rare; we found only one previously reported case. A 33-year-old man presenting with a discharging sternal sinus was diagnosed by means of computed tomography and bone isotope scans and confirmed by excision of the affected portion of the rib. The operation was curative.

Gigantic primary lipoma of the diaphragm presenting with respiratory failure.

Primary diaphragmatic lipomas are rare. A 66-year-old female case is reported, with the unusual presentation of progressive dyspnoea leading to respiratory failure, mainly because of a large fatty mass occupying the base of the left hemithorax. The completely resected mass (16 x 14.

Magnetic resonance imaging of blunt traumatic rupture of the right hemidiaphragm.

A patient suffering from blunt traumatic rupture of the right hemidiaphragm is presented. Chest radiography and computed tomography (CT) suggested the type of injury, but magnetic resonance imaging (MRI) established unequivocally the correct preoperative diagnosis.