Successful salvage via re-osseointegration of a loosened implant in a patient with transtibial amputation

2020 ◽  
pp. 030936462095398
Author(s):  
Clemens Gstoettner ◽  
Stefan Salminger ◽  
Agnes Sturma ◽  
Veith Moser ◽  
Thomas Hausner ◽  
...  
Keyword(s):  
Case Report ◽  
Axial Rotation ◽  
Gait Pattern ◽  
X Rays ◽  
Transtibial Amputation ◽  
Shockwave Therapy ◽  
Prosthetic Limb ◽  
Novel Treatment ◽  
Implant Salvage

Case Description: Osseointegration is a relatively new technique for prosthetic limb attachment that offers various improvements for patients with amputation and facilitates joint preservation. We present a case of implant loosening during rehabilitation in a patient with transtibial amputation that was successfully managed through a combination of measures, aiming to promote re-osseointegration of the implant. Objectives: Not much is known about structured management of adverse events after osseointegration. Septic or aseptic loosening is currently regarded as implant failure, prompting removal and possible re-implantation at a later stage. The objective of this case report was to evaluate the feasibility of salvaging a loosened implant. Study Design: Case report. Treatment: A novel treatment approach was employed to enable renewed osseointegration of the implant. First, the bone-implant interface was disrupted and renewed through axial rotation and distal repositioning of the implant. Afterwards, extracorporal shockwave therapy and antibiotic treatment were administered. Prosthetic rehabilitation was then started anew. Regular follow-up x-rays and clinical evaluations were conducted, including standardized outcome tests. Outcomes: These combined measures led to a successful re-osseointegration of the implant. In a 21-month follow-up, the patient regained a stable and secure gait pattern, using his prosthesis every day for 15 hours and scoring above average on standardized outcome measures. Conclusion: This represents the first report of implant salvage after failed primary osseointegration. As the associated risks of this novel treatment are very low, investigations are warranted to evaluate this approach on a larger scale.

scholarly journals Neglected Trans-Scaphoid Volar Perilunate Dislocation with Post-Operative Complex Regional Pain Syndrome: A Case Report

2020 ◽  
pp. 9-11
Author(s):  
Apoorv Sehgal ◽  
Pratyush Shahi ◽  
Aarushi Sudan ◽  
Sushil Kamal ◽  
Umesh Meena ◽  
...  
Keyword(s):  
Case Report ◽  
Complex Regional Pain Syndrome ◽  
Scaphoid Fracture ◽  
Pain Syndrome ◽  
Late Presentation ◽  
X Rays ◽  
Perilunate Dislocation ◽  
Volar Approach ◽  
K Wires

We present the case report of a 30-year-old male who fell from a height of 15 feet on his palmar-flexed right wrist and came to us 1 month after the injury. He had a swollen, stiff wrist with painful movements and no neurovascular deficit. X-rays showed a trans-scaphoid volar perilunate dislocation. We used the volar approach for open reduction and internal fixation with a headless screw for scaphoid fracture and scapho- lunate and capito-lunate K-wires for intercarpal instability. The wrist was immobilised in a below-elbow POP slab for 6 weeks after which the K-wires were removed. The patient unfortunately developed complex regional pain syndrome (CRPS), which can be attributed to his late presentation after the injury. Active and passive range of motion exercises and contrast bath were initiated and he was kept on low dose amitriptyline. Gradually CRPS resolved and at 6-month follow-up, the patient had a wrist dorsiflexion of 30° and palmar-flexion of 45°.

scholarly journals Bifid Rib in a male cadaver : Serendipic or Syndromic

2018 ◽  
Vol 7 (02) ◽  
pp. 103-107
Author(s):  
Amit Purushottam Tirpude ◽  
Manisha R Gaikwad ◽  
Pradhnya Tirpude ◽  
Arpan Haldar ◽  
Mantu Jain
Keyword(s):  
Case Report ◽  
Transverse Colon ◽  
Anterior Part ◽  
Digital Camera ◽  
Intercostal Space ◽  
X Rays ◽  
Male Cadaver ◽  
Bifid Rib ◽  
Associated Abnormalities

AbstractBifid rib presents usually as an isolated and asymptomatic finding on x-rays and cadaveric dissections. This may be due to atypical process of segmentation of developing somites. Sometimes it may occur with other malformations. Aim of the case report presented here was to give a description of the characteristics ofbifidrib and to look for any associated abnormalities. During routine dissection, bifid rib was found in thoraco-abdominal region of a male cadaver. The dimensions of the bifid rib were measured with digital vernier calliper of resolution 0.01mm and photographed using a digital camera. Survey of other regions of the cadaver was done by dissection. Bifurcation of anterior part of right third rib enclosing an additional intercostal space was found. Follow-up dissection in other regions of the cadaver revealed characteristics of Crohn's disease of jejunum, ileum, and transverse colon and signs of dysmorphism of both the kidneys. The knowledge of such variations will be of use to the clinicians, radiologist and anatomist to investigate any incidental bifid rib finding.

scholarly journals Single-Stage Bilateral Stemless Shoulder Hemiarthroplasty using a Subscapularis-Sparing Approach for Bilateral Dysbaric Osteonecrosis of the Humeral Head in a Diver: A Case Report

2021 ◽  
Vol 11 (6) ◽  
Author(s):  
Gabriel Cárdenas ◽  
Gregory Gasbarro ◽  
Gianella Aceituno
Keyword(s):  
Case Report ◽  
Rotator Cuff ◽  
Humeral Head ◽  
Decompression Sickness ◽  
Vascular Occlusion ◽  
Single Stage ◽  
X Rays ◽  
Shoulder Hemiarthroplasty ◽  
Total Recovery

Introduction: Dysbaric osteonecrosis (DON) is a specific type of atraumatic osteonecrosis that has been shown to occur mainly in deep-sea divers and workers exposed to increased air pressure environments. The pathophysiology is not entirely understood but is thought to be due to subclinical decompression sickness resulting in arterial gas emboli. This leads to vascular occlusion and subsequent bone death. Case Report: An active 56-year-old male diver presented with progressive bilateral shoulder pain and dysfunction due to bilateral DON of the humeral head and associated posterosuperior rotator cuff tearing. The diagnosis was confirmed by physical examination, X-rays, and magnetic resonance imaging. Due to failure of conservative treatment, a single-stage bilateral, subscapularis-sparing, stemless shoulder hemiarthroplasty with concomitant rotator cuff repair was performed. At 24-month follow-up, the patient showed satisfactory functional outcomes in both shoulders without complication. Conclusion: This single-stage surgical treatment is an exceptional indication for a bilateral dysbaric humeral head osteonecrosis that can be considered in selected cases because may reduce the total recovery time and can be safe and effective at 24 months postoperatively. Keywords: Dysbaric osteonecrosis, humeral head, rotator cuff.

scholarly journals Arthroscopic treatment of an unusual distal clavicle ostheochondroma causing rotator cuff impingement: case report and literature review

2020 ◽  
Author(s):  
Piermarco Messinese ◽  
Valeria Vismara ◽  
Giuseppe Sircana ◽  
Vincenzo Campana ◽  
Fabrizio Mocini ◽  
...  
Keyword(s):  
Case Report ◽  
Rotator Cuff ◽  
Conservative Treatment ◽  
Shoulder Pain ◽  
X Rays ◽  
Distal Clavicle ◽  
Shoulder Impingement ◽  
First Case ◽  
Common Causes

Chronic shoulder impingement is one of the most common causes of shoulder pain. Intrinsic, extrinsic and secondary factors play a role in this syndrome; however the etiology of the pathology is still under debate. In rare cases, it can be caused by tumors, such as an osteochondroma. In the present study, a 49-year-old patient presented with shoulder pain for 6 months. Initially he underwent conservative treatment, without relief of symptoms. X-rays and MRI were then performed and showed the presence of an exostotic formation on the undersurface of the lateral third of the clavicle. The formation was arthroscopically removed. Histologic examination confirmed the diagnosis of osteochondroma. After surgery, the patient resumed fully activities with no symptoms within 3 months. At 1 year follow up, there are still no clinical or radiological signs of recurrence. This is, to our knowledge, the first case where an arthroscopic approach was used to remove an ostochondroma of the distal third of the clavicle.

Intensive Stuttering Therapy With Telepractice Follow-up: A Case Study

2011 ◽  
Vol 21 (1) ◽  
pp. 11-21 ◽  
Author(s):  
Farzan Irani ◽  
Rodney Gabel
Keyword(s):  
Case Report ◽  
Therapeutic Intervention ◽  
Intensive Therapy ◽  
Positive Outcome ◽  
Eclectic Approach

This case report describes the positive outcome of a therapeutic intervention that integrated an intensive, residential component with follow-up telepractice for a 21 year old male who stutters. This therapy utilized an eclectic approach to intensive therapy in conjunction with a 12-month follow-up via video telepractice. The results indicated that the client benefited from the program as demonstrated by a reduction in percent stuttered syllables, a reduction in stuttering severity, and a change in attitudes and feelings related to stuttering and speaking.

Standardized Tendon Fenestration with Injection of Autologous Blood for Treatment of Lateral Epicondylitis

2020 ◽  
Author(s):  
Chul Ki Goorens ◽  
Pascal Wernaers ◽  
Joost Dewaele
Keyword(s):  
Tennis Elbow ◽  
Autologous Blood ◽  
Lateral Epicondylitis ◽  
Pain Scale ◽  
Short Term ◽  
Shockwave Therapy ◽  
Other Substances ◽  
Injured Tendon ◽  
Satisfaction Rates

AbstractLateral epicondylitis (LE) of the elbow is often treated with conservative methods. Several techniques including injections with different substances are widely performed. No standardization exists. This prospective study describes the results of the short-term follow-up of 56 patients with mean age 48 years (range: 30–68 years) treated with the Instant Tennis Elbow Cure Medical device, which fenestrates the injured tendon in a standardized way through a holder of 12 small needles. Depth and position of the needles are determined beforehand by ultrasonography. Unprepared autologous blood was injected through the holder in the tendon. Visual analog pain scale (VAS) decreased significantly in rest by 61% and during activity by 47% after 6 weeks. VAS decreased significantly in rest by 79% and during activity by 66% after 3 months. VAS did not remain significantly different after 6 months. Satisfaction rates were 71% after 6 weeks and 82% after 6 months. This suggests that the therapeutical effect sustains and in some cases increases over time. Patient Related Tennis Elbow Evaluation score ameliorated after 3 months by 71%. Comparative studies are needed to confirm this effect versus other techniques as physiotherapy, shockwave therapy, and injections with other substances.

Congenital Syphilis Simulating Bone Neoplasm in 2-Month Old Infant – Case Report

2017 ◽  
Vol 2 (1) ◽  
Keyword(s):  
Case Report ◽  
Congenital Syphilis ◽  
Eosinophilic Granuloma ◽  
Osteolytic Lesion ◽  
Lower Limbs ◽  
Upper Body ◽  
Elective Cesarean Section ◽  
Distal Fibula ◽  
X Ray

Introduction: Congenital Syphilis (CS) occurs through the transplacental transmission of Treponema pallidum in inadequately treated or non-treated pregnant women, and is capable of severe consequences such as miscarriage, preterm birth, congenital disease and/or neonatal death. CS has been showing an increasing incidence worldwide, with an increase of 208% from 2009 to 2015 in Brazil. Case report: 2-month old infant receives care in emergency service due to edema of right lower limb with pain in mobilization. X-ray with osteolytic lesion in distal fibula. Infant was sent to the Pediatrics Oncology clinic. Perinatal data: 7 prenatal appointments, negative serology at 10 and 30 weeks of gestation. End of pregnancy tests were not examined and tests for mother’s hospital admission were not requested. Mother undergone elective cesarean section at 38 weeks without complications. During the pediatric oncologist appointment, patient showed erythematous-squamous lesions in neck and other scar-like lesions in upper body. A new X-ray of lower limbs showed lesions in right fibula with periosteal reaction associated with aggressive osteolytic lesion compromising distal diaphysis, with cortical bone rupture and signs of pathological fracture, suggestive of eosinophilic granuloma. She was hospitalized for a lesion biopsy. Laboratory tests: hematocrit: 23.1 / hemoglobin 7.7 / leukocytes 10,130 (without left deviation) / platelets 638,000 / Negative Cytomegalovirus IgG and IgM and Toxoplasmosis IgG and IgM / VDRL 1:128. Congenital syphilis diagnosis with skin lesions, bone alterations and anemia. Lumbar puncture: glucose 55 / total proteins 26 / VDRL non reagent / 13 leukocytes (8% neutrophils; 84% monomorphonuclear; 8% macrophages) and 160 erythrocytes / negative VDRL and culture. X-ray of other long bones, ophthalmological evaluation and abdominal ultrasound without alterations. Patient was hospitalized for 14 days for treatment with Ceftriaxone 100mg/kg/day, due to the lack of Crystalline Penicillin in the hospital. She is now under outpatient follow-up. Discussion: CS is responsible for high rates of morbidity and mortality. The ongoing increase of cases of this pathology reflects a severe health issue and indicates failures in policies for the prevention of sexually transmitted diseases, with inadequate follow-up of prenatal and maternity protocols.

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