scholarly journals A Suspicious Atypical Fracture of 5th Metatarsal Bone: A Case Report

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0033
Author(s):  
Byeong-Seop Park ◽  
Seungbum Koo ◽  
Won-keun Park ◽  
Ki-bum Kwon ◽  
Kyoung Min Lee
Keyword(s):  
Callus Formation ◽  
Weight Bearing ◽  
Femoral Fractures ◽  
Metatarsal Bone ◽  
Atypical Fracture ◽  
Atypical Fractures ◽  
Strenuous Activity ◽  
History Of ◽  
Surgical Fixation ◽  
The Right

Category: Trauma Introduction/Purpose: Long-term usage of bisphosphonate can severely suppress bone turnover and alter bone mechanical properties, thereby resulting in atypical fractures that mainly occur at the femur.We present a rare case of suspicious atypical fracture of the metatarsal bone. Methods: A 63-year-old woman presented to our clinic with a primary complain of a one-week history of pain in her right foot. The patient had no history of trauma to the right foot and denied any strenuous activity. She experienced lateral foot pain while walking within her home. She was on alendronate therapy for osteoporosis for a decade. X ray and CT examination revealed a fifth metatarsal fracture whose features were compatible with those of atypical femoral fractures (Figure 1). Results: The patient was advised to discontinue alendronate and underwent percutaneous surgical fixation of the fracture via a proximal approach using a 4.0-mm half-threaded cannulated screw. Postoperatively, a short leg cast was created and the patients performed non-weight bearing ambulation until the cast was removed at the sixth postoperative week. Radiography in the sixth postoperative week revealed callus formation. Conclusion: Our findings suggest that physicians must keep in mind that atypical fractures could possibly occur at bones other than the femur.

scholarly journals A Case of Teriparatide Use in Nonunion Atypical Ulnar Fracture

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A173-A173
Author(s):  
Yin Nwe Tun ◽  
Yan Russell ◽  
Helena Abby Guber
Keyword(s):  
Lower Extremity ◽  
Upper Limb ◽  
Callus Formation ◽  
Case Reports ◽  
Weight Bearing ◽  
Atypical Fracture ◽  
Limb Fracture ◽  
Ulnar Fracture ◽  
Upper Limb Fracture ◽  
The Right

Abstract Background: Atypical upper limb fracture is a rare complication of bisphosphonate use. The management of nonunion fractures is challenging, especially in patients who are not surgical candidates. Teriparatide, a novel anabolic drug for osteoporosis has been increasingly used off-label for treatment of nonunion fractures and bisphosphonate related atypical fractures of the lower extremity. The proposed mechanism of healing is by enhancement of callus formation and mechanical strength. Clinical Case: A 72 year-old woman with a history of bilateral lower extremity paralysis and bilateral upper extremity paresis, who mobilized short distances with Canadian crutches, had been treated for 15 years with alendronate, for osteopenia associated with multiple risk factors for osteoporosis. 11 months before referral, and a month after alendronate was discontinued, she sustained a muscle-spasm induced fracture of the mid-shaft of the right ulna. She was treated nonoperatively due to chronic osteomyelitis with recurrent bacteremia from a prior non-healing left ulnar fracture (with internal fixation). Bone density of the right forearm had been normal. Since the right ulna break was transverse with minimal comminution, located in the diaphysis, occurred after trivial force and exhibited delayed healing, it was thought to be an atypical fracture secondary to bisphosphonates. She was initiated on cyclical teriparatide injection 20 mcg subcutaneously daily, with 2 months on and 2 weeks off. In one year, patient responded with dramatic radiographic improvement by forming a large callus with almost complete healing of the fracture. Conclusion: Mid-forearm atypical fracture from long-term bisphosphonate use is rare and is at risk for nonunion. The management of atypical upper limb nonunion fracture in nonoperative patients is not well established. Case reports exist of patients with atypical upper limb fracture who are either treated conservatively, or surgically with fixation/bone grafting +/- teriparatide. Our case showed that teriparatide, when used cyclically, exerted positive osteogenic effect and improved healing of the nonunion of an atypical fracture of forearm in a patient who continued weight bearing activity on her only functional limb.

scholarly journals Violation of consolidation of the femur after untimely dynamization of the intramedullary blocking rod

2021 ◽  
pp. 69-72
Author(s):  
Diomyd Chabanenko ◽  
Oleksandr Polіvoda
Keyword(s):  
Femoral Fracture ◽  
Distal Part ◽  
Weight Bearing ◽  
Femoral Fractures ◽  
Femoral Shaft ◽  
Joint Control ◽  
Posterior View ◽  
Intramedullary Osteosynthesis ◽  
Fracture Consolidation ◽  
The Right

Violation of femoral fracture consolidation after blocking intra­medullary osteosynthesis is a fairly common pathology, and requires the attention of physicians due to its prevalence. There are several reasons for this complication: it is the instabi­lity in the system «bone-implant», and the untimely dynamization of the locking nail. Methods. This article presents a case of fracture violated consolidation after blocking intramedullary osteosynthesis caused a nonunion due to nail failure. Results. Patient was injured on 29.12.2018, as a result of a traffic accident. 01.15.2019, the surgery was performed:  closed reduction, blocking intramedullary osteosynthesis of the fracture of the middle shaft of the right thigh, static fixation of the nail. Next visit to the clinic was on 02.01.2020, because of pain in the middle third of the thigh, problems with axial weight-bearing on the right leg, limitation of the flexion in the right knee joint. Control radiographs demonstrated no signs of consolidation of the femoral shaft fracture, and migration of the distal locking screw. 08.01.2020 revision surgical treatment was performed. Given the presence of 5 mutually perpendicular holes in the distal part of the nail, two of them were locked in the anterio-posterior view by the free hand method, the migrated screw in the distal part of the nail was replaced, and the nail was dynamized in the proximal part taking into account its design features. Conclusions. To normalize the consolidation processes in patients with nonunion femoral fractures, bone physiology and the positive effect of autocompression should be considered. The described case demonstrates the necessity for timely dynamization of the blocking nail, which confirms our own observations and literature data. Despite the fact that the dynamization of the nail was performed 1 year after blocking intramedullary osteosynthesis, fracture consolidation occurred 5 months after its implementation. Key words. Femoral fracture, blocked intramedullary osteosynthesis, disorders consolidation, dynamization of the construction.

scholarly journals A case of periosteal proliferative polyarthritis in a cat

2017 ◽  
Vol 55 (1) ◽  
pp. 46
Author(s):  
M. KARAYANNOPOULOU (Μ. ΚΑΡΑΓΙΑΝΝΟΠΟΥΛΟΥ) ◽  
Z. S. POLIZOPOULOU (Ζ.Σ. .ΠΟΛΥΖΟΠΟΥΛΟΥ) ◽  
A. F. KOUTINAS (Α. Φ. ΚΟΥΤΙΝΑΣ) ◽  
M. N. PATSIKAS (Μ.Ν. ΠΑΤΣΙΚΑΣ) ◽  
G. KAZAKOS (Γ. ΚΑΖΑΚΟΣ) ◽  
...  
Keyword(s):  
Elbow Joint ◽  
Complete Blood Count ◽  
Weight Bearing ◽  
Serum Biochemistry ◽  
Adverse Side Effect ◽  
Left Elbow ◽  
Normal Limits ◽  
Thoracic Limb ◽  
History Of ◽  
The Right

In this paper a case of periosteal proliferative polyarthritis in an 11-year old, female Siamese cat, that was admitted to the Surgery Clinic of the Veterinary School, A.U.Th., with a 6-month history of non-weight bearing lameness of the left thoracic limb, is described. At physical examination, restricted range of motion of the left elbow joint, local swelling and pain were detected. In the radiological examination of the affected joint the main finding was a periarticular extensive and irregular periosteal new bone formation. The results of the complete blood count and routine serum biochemistry were within normal limits and the cat was serologically negative for FeLV and FIV. Synovial fluid examination showed a lymphoplasmacytic pleocytosis, while the bacterial culture was negative. Prednisolone given at an anti-inflammatory dose for two consecutive weeks resulted in a marked improvement of the clinical sings. However, two months after the end of the treatment lameness reappeared, but this time in the contralateral thoracic limb, due to the involvement of the same joint. Radiology revealed the same type of lesions in the right elbow joint, whereas the left became ankylosed. Again, prednisolone, given at an immunosuppressive dose for two weeks, did not improve but fairly the clinical condition of the animal and the radiological changes as well. For this reason azathioprine at the dose of 1 mg/kg BW, every 48 hours, was added to therapy that lasted for 5 months. Transient mild leukopenia, that resolved after decreasing the dose of azathioprine by 25%, was the only adverse side effect noticed. At the end of the treatment, regression of the radiographical lesions in both elbows enabled the cat to walk with a stilted gait, despite the development of joint ankylosis bilaterally. The disease was kept in remission during the 12-month follow up period.

scholarly journals Atypical Insufficiency Fractures Associated with Long-Term Bisphosphonate Therapy: 3 Case Reports

2015 ◽  
Vol 1 (1) ◽  
Author(s):  
Sandrine Malochet Guinamand
Keyword(s):  
Case Reports ◽  
Femoral Fractures ◽  
Bisphosphonate Therapy ◽  
Fracture Site ◽  
Atypical Fracture ◽  
Mineral Research ◽  
The Third ◽  
First Case ◽  
The Right

Atypical femoral fractures as defined by the American Society for Bone and Mineral Research (ASBMR) are linked with long-term bisphosphonate therapy. We report the cases of 3 patients treated with bisphosphonates, and presenting non femoral atypical fracture. Our first patient presented with a series of fractures after being treated with risedronate: the left tibia, bilateral tibial plateau successively, the left femoral and tibial metaphysis, the right tibia and calcaneus, the left talus, and the left talar dome. The second patient had been taking alendronate and presented with a spontaneous fracture of the spine of the left scapula. The third patient had been treated with alendronate and presented with a fracture of the upper right tibial diaphysis with an unusual oblique orientation. These fractures could be suggestive of bisphosphonate therapy failure or stress fractures. However, the number of fractures in our first case, the fracture site in the second and the fracture line orientation in the third brings to mind the hypothesis of atypical non femoral fractures associated with bisphosphonate therapy. We therefore suggest the possibility of a new type of atypical fracture in patients treated with bisphosphonates, and whose causal relationship with bisphosphonates is even more difficult to demonstrate.

scholarly journals SAT-381 Adjunct Benefit of Aquatic Therapy in Juvenile Hypophosphatasia Initiated in an Adult

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Abdul Mannan Khan ◽  
James Lightell ◽  
Corey Majors
Keyword(s):  
Alkaline Phosphatase ◽  
Lumbar Spine ◽  
Physical Therapy ◽  
Range Of Motion ◽  
Weight Bearing ◽  
Standing Balance ◽  
Home Exercise ◽  
Aquatic Therapy ◽  
History Of ◽  
The Right

Abstract Background: This is a case of improvement in visual analog scale pain rating and objective functional capacity in juvenile hypophosphatasia (HPP) following treatment with asfotase alfa and adjunct physical therapy (PT) performed in an aquatic environment. Clinical Case: A 45-year-old female with a history of psoriatic arthritis and osteoarthritis was referred for low serum alkaline phosphatase (ALKP) (<10 U/L). Her history of eight fractures over the preceding 25 years including bilateral femur nonunion repaired with rods eight years prior to presentation led to a diagnosis of juvenile HPP, and asfostase alfa was ordered. She is ambulatory only with a rolling walker from a deficit in dynamic standing balance and chronic pain. Referrals were made for both PT and pain management for these symptoms. The initial PT evaluation established reasonable goals to include the performance of in-home exercise, increase strength and range of motion, decrease pain, improve standing balance, and progress from walker to cane. Aquatic therapy was chosen in order to reduce patient’s effective weight. The right hip complex, lumbar spine, and left leg were chosen as areas of focus based on pain reports. A four-week follow-up evaluation by the therapist reported patient had been performing at home exercises. Pain scale reports of the lumbar spine, right hip, and left leg were within the moderate range and near or meeting the patient’s self-reported least pain experienced. Goniometric measurements of the right hip showed range of motion improvements averaging 9%. The lumbar spine’s range of motion increased an average of 18%. Discussion: HPP is capable of creating severe disability, and its rarity has led to a dearth of investigation into appropriate treatment. Recommendations have been made previously for PT in children and infants presenting with juvenile or infantile HPP; this case suggests these recommendations are applicable to adults as well. The mechanisms of these improvements remain unclear; however, evidence exists that weight-bearing exercise may result in increased levels of bone-specific isoforms of ALKP. This endogenous path to increased serum ALKP may play a role in potentiating the effects of asfostase alfa. 1. Shapiro JR, Lewiecki EM. Hypophosphatasia in Adults: Clinical Assessment and Treatment Considerations. Journal of Bone and Mineral Research 2017;32(10):1977–1980. 2. Phillips D, Case LE, Griffin D, Hamilton K, Lara SL, Leiro B, Monfreda J, Westlake E, Kishnani PS. Physical therapy management of infants and children with hypophosphatasia. Molecular Genetics and Metabolism 2016;119(1–2):14–19. 3. Rudberg A, Magnusson P, Larsson L, Joborn H. Serum Isoforms of Bone Alkaline Phosphatase Increase During Physical Exercise in Women. Calcified Tissue International 2000;66(5):342–347.

scholarly journals Multiple myeloma associated with IgA lambda gammopathy and multiple myeloma oncogene 1 in a Yorkshire terrier

2018 ◽  
Vol 63 (No. 4) ◽  
pp. 187-192
Author(s):  
S. Kim ◽  
E. Son ◽  
S. Lee ◽  
S. Lee ◽  
H. Kim ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Bone Marrow ◽  
Plasma Cells ◽  
Weight Bearing ◽  
Serum Biochemistry ◽  
First Case ◽  
History Of ◽  
Immunofixation Electrophoresis ◽  
The Right ◽  
Yorkshire Terrier

An eight-year-old spayed female Yorkshire terrier was presented with a one-month history of conspicuous weight-bearing lameness in the right hindlimb, mild anorexia, intermittent vomiting and marked polydipsia and polyuria. Radiographs revealed circular radiolucent foci of variable size in the skeleton. Haematological and serum biochemistry examination revealed mild leucopoenia with severe neutropaenia, mild non-regenerative anaemia, moderate thrombocytopoenia, moderate hyperglobulinaemia, mild hypoalbuminaemia, mild azotaemia and moderate hypercalcaemia. Quantification of serum immunoglobulins revealed elevated IgA and IgG. Serum protein electrophoresis showed a broad appearance with a β-region spike. Plasma cells accounted for 7.6% of the cells in the bone marrow. Serum immunofixation electrophoresis (IFE) revealed IgA lambda gammopathy. Immunohistochemistry in the bone marrow was diffusely positive for multiple myeloma oncogene 1 (MUM-1) and CD20. To our knowledge, this is first case report of multiple myeloma associated with IgA lambda gammopathy confirmed via IFE and immunohistochemical expression of MUM-1 in a dog.

Traumatic craniolateral shoulder luxation and fracture of the lesser tubercle of the humerus in a dog

2011 ◽  
Vol 24 (06) ◽  
pp. 474-477 ◽  
Author(s):  
M. S. Bergh ◽  
J. L. Huck
Keyword(s):  
Surgical Repair ◽  
Articular Surface ◽  
Weight Bearing ◽  
Complete Healing ◽  
Joint Function ◽  
Thoracic Limb ◽  
Anatomic Reduction ◽  
History Of ◽  
The Right ◽  
Displaced Fracture

SummaryA five-year old, spayed female, Bearded Collie was presented with a 24-hour history of non-weight-bearing lameness of the right thoracic limb after sustaining vehicular trauma. Radio-graphs revealed a craniolateral scapulohumeral luxation and a distally and medially displaced fracture of the lesser tubercle of the humerus. Open reduction and internal fixation of the fracture was achieved with lag screw fixation and an anti-rotational Kirsch-ner wire. Surgical repair resulted in compression across the fracture line, anatomic reduction of the articular surface, and a stable scapulohumeral joint following reduction of the humeral head in the glenoid. Six weeks postoperatively, the patient exhibited no evidence of pain or lameness on the right thoracic limb and radiographs revealed complete healing of the fracture and normal articulation of the scapulohumeral joint. This is the first report of a lesser tubercle fracture associated with a craniolateral shoulder luxation. Surgical intervention resulted in the return of full shoulder joint function in this dog.

scholarly journals DIAPHYSEAL FEMORAL FRACTURES

2015 ◽  
Vol 22 (04) ◽  
pp. 476-482
Author(s):  
Muhammad Azeem Akhund ◽  
Karam Ali Shah ◽  
Allah Nawaz Abbasi ◽  
Zulfiqar Ali Mastoi
Keyword(s):  
Road Traffic ◽  
Callus Formation ◽  
Weight Bearing ◽  
Femoral Fractures ◽  
P Value ◽  
Female Ratio ◽  
Femur Fractures ◽  
Group A ◽  
The Mean ◽  
Group B

The femur fractures usually happen with oomph forces like motor vehicleaccidents. Objectives: To assess the mode of injury and complications of the management, indiaphyseal femoral fractures, in comparison of close versus open intramedullary interlockingnail (IMN). Study Design: Experimental and comparative study. Period: April 2013 to March2014. Setting: Department of Orthopaedic Surgery, Peoples University of Medical & Healthsciences, Nawabshah. Methods: The cases were divided into two groups A and B. Group Awas treated by open nailing (n = 20) and group B by close nailing (n = 20), all the cases wereoperated within 48 hours of admission. All the data were recorded on well structured proforma.Serial radiographies were performed at 3, 6, 12 weeks, and 6 months; additional radiographieswere performed as needed postoperatively. Knee, ankle, and hip motions were begun andprotected weight bearing was started on the second day postoperatively and increasedgradually to full WB depending on x-ray findings of callus formation. The patients were followedfor two years. Results of open and closed I.M.N were assessed and the complications if anywere observed over a mean follow-up period of two years. Results: The mean age in groupA was 29.40 years and the mean age in group B was 30.45 years. Out of 40 cases, 32(80.0%)were males with male to female ratio 1:4. Mean ± SD hospital stay was 19.80 ± 14.60 days ingroup A, and 17.90 ± 5.95 days in group B (p value 0.55). Average time between injury andadmission was 1.53 days (n = 40), in the group A it was 1.05 days, and in the group B it was2.0 days (p value 0.03). The average of time between injury and operation in the group A was8.75 days, and in the group B, it was 8.20 days, (p value 0.71). The average of time betweenadmission and discharge in the group A was 11.0 days, and in the group B was 9.15 days,(p value 0.55). Mean ± SD union time was 11.70 ± 6.45 weeks, in group A and 11.90 ± 5.77weeks, in group B. (p value 0.91). All the patients had full ranged of hip motion and 2 (10.0%)patients of group A had mild limitation of knee motion with a flexion ranges between 80 and110 degrees. Final functional results based on Thoresen BO criteria16. Excellent results wereobserved in 19 (47.5%) cases, out of them 5(25.0%) were in group A and 14(70.0%) were ingroup B. Good results were found in 13(32.5%) patients, out of these 7(35.0%) were in group Aand 6(30.0%) were in group. Fair and poor results were detected in 4(10.0%) cases of group A.Conclusions: Road traffic accidents by motorcycle was found the commonest (47.5%) causeof femur fracture, a few complications were observed in open interlocking nailing as comparedto closed interlocking nails.

Avulsion fragmentation of the tibial tuberosity apophysis and associated patellar tendon enthesopathy in a skeletally immature dog

2013 ◽  
Vol 26 (03) ◽  
pp. 242-247 ◽  
Author(s):  
S. Kalff ◽  
A. Parry ◽  
M. Whitehead ◽  
W. M. McKee ◽  
G. W. Brown
Keyword(s):  
Patellar Tendon ◽  
Tibial Plateau ◽  
Weight Bearing ◽  
Slope Angle ◽  
Varus Deformity ◽  
Tibial Tuberosity ◽  
Computed Tomographic ◽  
History Of ◽  
Pelvic Limb ◽  
The Right

SummaryA 9.5-month-old, female entire, 31.3 kg crossbred dog was presented with a 12 week history of moderate weight-bearing right pelvic limb lameness. Radiographic, computed tomographic, and ultrasonographic imaging revealed progressive avulsion fragmentation of the right tibial tuberosity apophysis and a patellar tendon insertional enthesopathy without physeal involvement. Conservative management was successful in achieving a good clinical outcome. A progressive avulsion of the contralateral proximal tibial physes that occurred concurrently resulted in development of an excessive tibial plateau slope angle. The additional development of a moderate left distal femoral varus deformity was surgically corrected. This is the first report of a progressive, traction injury to the tibial tuberosity apophysis in a dog that appears clinically and radiographically very similar to Osgood-Schlatter disease in humans.

scholarly journals Repair of supracondylar femur fracture in a Lhasa Apso dog by cross pinning technique: A case report

2020 ◽  
Vol 1 (2) ◽  
pp. 140-143
Author(s):  
M. Raghunath ◽  
P. Vidya Sagar ◽  
P. Ravi Kumar ◽  
B. Sailaja ◽  
V. S. C. Bose
Keyword(s):  
Case Report ◽  
Hind Limb ◽  
Femur Fracture ◽  
Weight Bearing ◽  
Supracondylar Fracture ◽  
Implant Failure ◽  
History Of ◽  
K Wires ◽  
The Right ◽  
Radiographic Union

Abstract: A three-year-old Lhasa apso was presented with a history of fall from a height resulting in limping of the right hind limb. It was radiographically diagnosed as a complete, transverse, displaced supracondylar fracture of the femur. The fractured fragments were reduced and stabilized by cross pinning technique using k-wires, and the weight-bearing was seen from 3rd post-operative day. On the seventh post-operative day, the same animal was presented with limping on the same limb due to sudden fall from a height again. Radiographically it was confirmed as catastrophic implant failure with collapsed fragments. In surgery, the migrated pins were removed and the fragments were restabilized by cross pinning using k-wires. Post-operative application of robertjones bandage and regular physiotherapy was provided. The animal showed complete weight-bearing from 10th post-operative day, and the full radiographic union was observed on 35th post-operative day. Keywords: supracondylar fracture, k-wires, robertjones bandage, cross pinning technique

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