Frequency of and risk factors for oxcarbazepine-induced severe and symptomatic hyponatremia.

Purpose: Hyponatremia is one of the most common adverse effects in patients treated with oxcarbazepine (OXC). Most patients with OXC-induced hyponatremia are asymptomatic, so the presence of severe or symptomatic hyponatremia, which requires electrolyte correction or discontinuation of OXC therapy, has more important clinically implications. However, data for OXC-induced severe and symptomatic hyponatremia are limited.

Comparison of internal bone transport and vascularized fibular grafting for femoral bone defects.

Objective: To compare results between vascularized fibular grafting and internal bone transport for large bone defects of the femur.

Design: Retrospective review of patients.

Setting: University teaching hospitals.

Increased perfusion of the femoral head in transient bone marrow edema syndrome.

The pathophysiology of transient bone marrow edema syndrome is not known. Ischemia has been suggested as the pathophysiologic factor, because the histologic findings are similar to those of early stage osteonecrosis. Angiographic studies of osteonecrotic femoral heads have shown arterial interruption and impaired perfusion.

Risk period for developing osteonecrosis of the femoral head in patients on steroid treatment.

Patients who require long-term steroid use are at risk for the development of osteonecrosis. However, the risk period for developing osteonecrosis of the femoral head has not yet been defined. The authors attempted to determine the onset of osteonecrosis of the femoral head following steroid treatment.

Mechanics of femoral head osteonecrosis using three-dimensional finite element method.

A three-dimensional finite element model of a femoral head was developed using a surface modeling technique. The distribution of the stress index S (S = effective stress / yield strength, sigma/sigmaY) in various sizes of segmental osteonecrosis was assessed. The stress index of the femoral head was within physiological limits when the necrotic angle was less than 110 degrees.

Impregnation of vancomycin, gentamicin, and cefotaxime in a cement spacer for two-stage cementless reconstruction in infected total hip arthroplasty.

Twenty-two patients with infected total hip arthroplasty were treated with 2-stage arthroplasty, using a cement spacer impregnated with a combination of 3 thermostable antibiotics (vancomycin, gentamicin, and cefotaxime). Initially, implants were removed, and a spacer was inserted. Six to 12 weeks later, the spacer was removed, and the patients underwent reconstruction using cementless components.

Concomitant fractures of the femoral head and neck without hip dislocation.

This case report describes two patients who sustained ipsilateral fractures of the femoral head and femoral neck without dislocation of the hip. The fractures in the two patients resulted from vehicle accidents. The femoral head was fractured in the sagittal plane, and the femoral neck was fractured at the subcapital portion.

Iliacus hematoma and femoral nerve palsy after revision hip arthroplasty: a case report.

Femoral nerve palsy occurred in a 65-year-old man after he had undergone a revision total hip arthroplasty using cementless components. The magnetic resonance imaging scan showed a mass in the iliacus muscle. The mass showed increased signal intensity on T1-weighted and T2-weighted spin-echo images and contained linear septa and a nodule.

Trochanteric rotational osteotomy for osteonecrosis of the femoral head.

The rate of success of transtrochanteric rotational osteotomy for osteonecrosis of the femoral head may be improved if patients are preselected using MRI. We have used three criteria for selection for osteotomy (i) minor collapse of the infarcted area, loss of congruity or the crescent sign, without narrowing of the joint space or acetabular involvement (ii) patients younger than 55 years and with a painful hip (iii) patients with an intact area constituting an arc of more than 120 degrees between the central vertical line of the femoral head and the posterior or anterior margin of the necrotic portion as seen on a midsagittal MRI. Seventeen patients were selected, with a follow-up of more than 42 months.

Bone marrow edema and associated pain in early stage osteonecrosis of the femoral head: prospective study with serial MR images.

Purpose: To determine whether the marrow edema around focal osteonecrosis on magnetic resonance (MR) images is associated with clinical symptoms.

Materials And Methods: Thirty-three patients with 37 hips showing early stage osteonecrosis of the femoral head were followed up at 3-month intervals with clinical evaluation, conventional radiography, and serial MR imaging.

Results: Seven (50%) of 14 symptomatic hips showed marrow edema around focal osteonecrosis on initial MR images, whereas only one (4%) of 23 asymptomatic hips showed edema (P < .

Fatty marrow conversion of the proximal femoral metaphysis in osteonecrotic hips.

To determine whether fatty marrow conversion of the proximal femoral metaphysis is related to osteonecrosis of the femoral head using a marrow conversion index ([signal intensity of the proximal femoral metaphysis/signal intensity of the greater trochanter] x 100 in T1 weighted magnetic resonance images), a case control study was conducted on 42 osteonecrotic hips in 28 patients. The 28 patients (42 osteonecrotic hips) were matched with 84 control patients (84 normal hips) for gender, age (5-year range), and time of presentation (1-year range). The marrow conversion index was measured in each hip studied.

Borderline necrosis of the femoral head.

To determine whether the histologic lesions classified by the system of Arlet et al as Type 2 (granular necrosis of fatty marrow) and Type 3 (complete medullary and trabecular necrosis) always progress to Type 4 (complete necrosis with marginal medullary fibrosis and appositional new bone formation), 10 femoral heads (nine patients) were monitored for 4 years using serial magnetic resonance images. These femoral heads had been diagnosed histologically as having either Type 2 (seven hips) or Type 3 (three hips) necrosis on initial core biopsies. On the initial magnetic resonance image, none of the femoral heads showed any focal lesions indicative of osteonecrosis.

Relationship between lateral subluxation and widening of medial joint space in Legg-Calvé-Perthes disease.

Fifty-five patients (61 affected hips and 49 unaffected hips) with Perthes disease were reviewed to evaluate the relationship between widening of medial joint space and lateral subluxation of the femoral head in radiographs. The components of the medial joint space were evaluated by using T1, T2, proton, and Gd-enhanced T1WI magnetic resonance images (MRI). The widened medial joint space in radiographs was filled with overgrown cartilage at the initial stage (27 hips) in MRI, with both overgrown cartilage and widened true medial joint space at the fragmentation stage (23 hips) and widened true medial joint space at the healing stage (11 hips).

Supracondylar osteotomy with Ilizarov fixation for elbow deformities in adults.

Stable fixation after a corrective supracondylar osteotomy in adults is difficult because of the irregularity of the area of bony contact, displacement of the fragments, the predominance of cortical bone, and the need for early mobilisation. We have used the Ilizarov apparatus for fixation in 15 patients who were treated by complex osteotomies with displacement of fragments for cubitus varus or valgus. Most patients with cubitus varus required medial displacement with rotation of the distal fragment.

Preventing collapse in early osteonecrosis of the femoral head. A randomised clinical trial of core decompression.

We performed a randomised trial on 37 hips (33 patients) with early-stage osteonecrosis (ON). After the initial clinical evaluation, including plain radiography and MRI, 18 hips were randomly assigned to a core-decompression group and 19 to a conservatively-treated group. All the patients were regularly followed up by clinical evaluation, plain radiography and MRI at intervals of three months.