Dissociation of bipolar prostheses with hip subluxation: A case report and literature review

Bipolar hemiarthroplasty, a modular system, has been utilized for decades to treat intracapsular fractures of the femoral neck and avascular necrosis of the femoral head. Dislocation is one of the main complications of hip hemiarthroplasty performed for displaced femoral neck fractures. Classic dislocation of the hemiarthroplasty from the native acetabulum occurs in 2.6% of cases. Dissociation between the small head of the prosthesis and the polyethylene insert is an extremely rare complication of bipolar hemiarthroplasty and results in hip dislocation and severe disability. Surgeons must be cognizant of this rare complication and should proceed to open reduction to treat this problem

Disassembly and Dislocation of a Bipolar Hip Prosthesis

Dislocation of a hip prosthesis is a common complication. In usual cases of hip prosthesis dislocation, the prosthetic femoral head comes out from either the natural acetabular cavity in a bipolar hemiarthroplasty or the prosthetic acetabulum in a total hip arthroplasty. Only a few cases of bipolar hip prosthesis dislocation due to dissociation between the polyethylene and inner head of the prosthesis have been reported. We describe a rare case of disassembly of the inner head from the bipolar outer prosthesis in an osteoarthritic acetabulum. A 72-year-old woman had undergone bipolar hemiarthroplasty due to fracture of the left femoral neck about 10 years previously. Recently, she sustained an injury after falling from a chair, and examinations revealed an unusual disassembly−dislocation of the bipolar hip prosthesis. We classified this failure in our patient as a type II failure, representing extreme varus position of the outer head in the acetabulum, dislocation of the inner head from the outer head, and a detached locking ring around the stem neck. This mechanism of failure as shown in our patient rarely occurs in the bipolar prosthesis of the self-centering system. Osteoarthritic change of the acetabulum would place the outer head in the varus position, increasing wear on the beveled rim by impinging the femoral stem neck and causing dislodgment of the inner locking ring and consequent disassembly−dislocation of the inner head

Hip arthroscopic tenotomy for combined iliopsoas tendon impingement and snapping hip after total hip replacement

The combination of iliopsoas tendon impingement and snapping hip syndrome with persistent hip pain is rare in patients following total hip replacement (THR). Diagnosis should be made by clinical physical examination, with the exclusion of complications following THR by imaging or laboratory studies. Accurate diagnosis and adequate treatment can result in an excellent outcome and patient satisfaction. Hip arthroscopy can resolve both iliopsoas tendon impingement and snapping hip syndrome with minimally invasive surgery, immediate improvement, and rapid recovery

Acute arterial thoracic outlet syndrome after intramedullary fixation for nonunion of a midshaft clavicular fracture

In this case report, we describe a rare clinical situation of acute arterial thoracic outlet syndrome (TOS) after osteosynthesis, using an intramedullary Knowles pin, to treat nonunion of a midshaft clavicular fracture. Existing evidence was reviewed to appraise the relationship between TOS and nonunion of clavicular fractures, including the timing of the development of this complication, as well as to identify the relationship between surgical technique and choice of implant and the occurrence of TOS. Perioperative measures used to prevent TOS were identified

STRESS FRACTURE OF THE ULNA IN A BREAK-DANCER

Break dancing is a popular activity in teenagers and is associated with severe trauma to bones and tissues. We report the first known case of a break dancer with an ulnar stress fracture. Such injuries occur in a variety of sports due to substantial stress on the ulna and repetitive excessive rotation of the forearm. In this study we describe a patient who experienced an ulnar stress fracture during break dancing training. The diagnosis was established by history and physical examination. Initial radiographic findings were negative. However, radiographs taken 3 months after initial presented revealed callus formation over the ulnar shaft. This suggested that readjustment is required in break dancing training protocols. It is important to increase awareness of this injury among physicians to expedite the diagnosis and to prevent the possibility of conversion to an overt fracture in the futur

Spontaneous regression of osteochondroma of the distal femur: A Pediatric case report and literature review

Spontaneous regression of an osteochondroma of the distal femur is unusual. This report highlights the spontaneous regression of a sessile osteochondroma of the distal femur in a 9-year-old boy which resolved over a 4-year period. The mechanism underlying regression of the tumor is discussed with a review of previous reports. Since this type of osteochondroma can spontaneously resolve, conservative treatment is always the first choice to avoid unnecessary surgery

Long-term results of posterior cruciate ligament tear with or without reconstruction: A nationwide, population-based cohort study.

BACKGROUND:There is increasing interest in the long-term outcomes of patients with posterior cruciate ligament (PCL) tears following conservative treatment or reconstruction. However, limited information is available regarding these results because of the relative rarity of cases and lack of long-term follow-up. PURPOSE:The goals of this study are to (1) compare the occurrence of secondary meniscal tears, osteoarthritis (OA) or subsequent total knee replacement (TKR) in patients with or without PCL injury, and (2) evaluate the potential protective effect of PCL reconstruction against long-term sequela in patients with PCL deficiency. STUDY DESIGN:Cohort study; Level of evidence, 3. METHODS:This retrospective cohort study evaluated the long-term results of PCL deficiency with or without reconstruction in Taiwan based on data from the National Health Insurance Research Database (NHIRD) from 2000 to 2015. The cumulative incidence rates of meniscus tear, OA and TKR were analyzed using the Kaplan-Meier estimator. Cox proportional hazards models were applied to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS:A total of 4,169 patients diagnosed with PCL tear from 2000 to 2015 in Taiwan were included in the study. There was a higher cumulative incidence of meniscus tear (1.13%), OA (2.71%) and subsequent TKR (0.91%) among patients with a PCL tear than among patients without one (0.22%, 1.90%, 0.62%; all p < 0.05). PCL reconstruction patients had a decreased cumulative incidence of meniscus tear (0.41%), OA (2.30%) and subsequent TKR (0.48%) compared with non-reconstructed patients (2.44%, 3.46%, 1.69%; all p < 0.05). After adjusting for covariates, PCL-injured patients who underwent reconstruction within one year after PCL injury showed a significantly lower risk of subsequent sequelae than those who never underwent reconstruction (within 1 month: adjusted HR = 0.390, 95% CI = 0.284-0.535; 1 month to 1 year: adjusted HR = 0.546, 95% CI = 0.398-0.748). CONCLUSIONS:Patients with PCL tears have a significantly higher risk of meniscus tear, OA and subsequent TKR than patients without PCL tears. PCL reconstruction could decrease the cumulative incidence of these outcomes. The results suggest that PCL-injured patients should undergo reconstruction as early as possible (within one year) to reduce the risk of further degeneration

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

Ginkgo biloba extract individually inhibits JNK activation and induces c-Jun degradation in human chondrocytes: potential therapeutics for osteoarthritis.

Osteoarthritis (OA) is a common joint disorder with varying degrees of inflammation. The ideal anti-OA drug should have immunomodulatory effects while at the same time having limited or no toxicity. We examined the anti-inflammatory effects of Ginkgo biloba extract (EGb) in interleukin-1 (IL-1)-stimulated human chondrocytes. Chondrocytes were prepared from cartilage specimens taken from patients with osteoarthritis who had received total hip or total knee replacement. The concentrations of chemokines and the degree of cell migration were determined by ELISA and chemotaxis assays, respectively. The activation of inducible nitric oxide synthase (iNOS), mitogen-activated protein kinases (MAPKs), activator protein-1 (AP-1), and nuclear factor-kappaB (NF-κB) was determined by immunoblotting, immunohistochemistry, and electrophoretic mobility shift assay. We found that EGb inhibited IL-1-induced production of chemokines, which in turn resulted in attenuation of THP-1 cell migration toward EGb-treated cell culture medium. EGb also suppressed IL-1-stimulated iNOS expression and release of nitric oxide (NO). The EGb-mediated suppression of the iNOS-NO pathway correlated with the attenuation of activator protein-1 (AP-1) but not nuclear factor-kappaB (NF-κB) DNA-binding activity. Of the mitogen-activated protein kinases (MAPKs), EGb inhibited only c-Jun N-terminal kinase (JNK). Unexpectedly, EGb selectively caused degradation of c-Jun protein. Further investigation revealed that EGb-mediated c-Jun degradation was preceded by ubiquitination of c-Jun and could be prevented by the proteosome inhibitor MG-132. The results imply that EGb protects against chondrocyte degeneration by inhibiting JNK activation and inducing ubiquitination-dependent c-Jun degradation. Although additional research is needed, our results suggest that EGb is a potential therapeutic agent for the treatment of OA