Unstable Trochanteric Fractures: The Role of Lateral Wall Reconstruction Using a Trochanteric Stabilization Plate with Cephalomedullary Nail

Introduction: Left ventricular non-compaction (LVNC) is characterized by extensively trabeculaed myocardium adjacent to normal compacted myocardium of the left ventricle (LV). Hypertrophic cardiomyopathy (HCM) typically appears as diffuse or segmental LV hypertrophy, with or without outflow tract obstruction. Cardiac sarcomere mutations are present in most HCM cases and have also been identified in LVNC. Whether or not there is clinically significant phenotypic overlap between the two diseases is less well understood. We present a case of known HCM that met criteria for both LVNC and HCM by cardiac MRI. Case: A 49-year old man with HCM due to a c.3742_3759dup variant in MYBPC3 presented to clinic after an episode of syncope and ICD firing. In clinic, the device was interrogated and he was found to have had ventricular flutter which was successfully treated with one shock and a new, high (>20%) burden of premature ventricular beats. An echocardiogram showed a stable ejection fraction at 42%, mild concentric LV hypertrophy without obstruction and a newly dilated LV with an end diastolic diameter of 7.1cm (previously 6.2cm). A cardiac MRI was performed ( Figure ) and showed LV noncompaction and diffuse transmural and mid myocardial hyperenhancement/fibrosis of the septum, basilar lateral wall, anterior wall, and distal right ventricle consistent with patient's long-standing history of hypertrophic cardiomyopathy. Discussion: This case highlights the phenotypic overlap between HCM and LVNC by cardiac MRI. Had this patient not already carried a genetic diagnosis of HCM, he would likely have been diagnosed with LVNC based on this cardiac MRI. The phenotypic overlap in these diseases raises questions about ICD guidelines, the role of anticoagulation and prognosis.

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Unstable Trochanteric Fractures in Elderly Osteoporotic Patients: Role of Primary Hemiarthroplasty

Orthopaedic Surgery ◽

10.1111/j.1757-7861.2012.00173.x ◽

2012 ◽

Vol 4 (2) ◽

pp. 89-93 ◽

Cited By ~ 8

Author(s):

Karuppaiah Karthik ◽

Mayilvahanan Natarajan

Keyword(s):

Trochanteric Fractures

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Medial migration in cephalomedullary nail fixation of pertrochanteric hip fractures

Bone and Joint Research ◽

10.1302/2046-3758.87.bjr-2018-0271.r1 ◽

2019 ◽

Vol 8 (7) ◽

pp. 313-322 ◽

Cited By ~ 3

Author(s):

G. W. Law ◽

Y. R. Wong ◽

A. K-S. Yew ◽

A. C. T. Choh ◽

J. S. B. Koh ◽

...

Keyword(s):

Cyclic Loading ◽

Hip Fractures ◽

Tensile Loading ◽

Biomechanical Analysis ◽

Cephalomedullary Nail ◽

Compression Loading ◽

Medial Migration ◽

Group 3 ◽

Group 2

Objectives The paradoxical migration of the femoral neck element (FNE) superomedially against gravity, with respect to the intramedullary component of the cephalomedullary device, is a poorly understood phenomenon increasingly seen in the management of pertrochanteric hip fractures with the intramedullary nail. The aim of this study was to investigate the role of bidirectional loading on the medial migration phenomenon, based on unique wear patterns seen on scanning electron microscopy of retrieved implants suggestive of FNE toggling. Methods A total of 18 synthetic femurs (Sawbones, Vashon Island, Washington) with comminuted pertrochanteric fractures were divided into three groups (n = 6 per group). Fracture fixation was performed using the Proximal Femoral Nail Antirotation (PFNA) implant (Synthes, Oberdorf, Switzerland; n = 6). Group 1 was subjected to unidirectional compression loading (600 N), with an elastomer (70A durometer) replacing loose fracture fragments to simulate surrounding soft-tissue tensioning. Group 2 was subjected to bidirectional loading (600 N compression loading, 120 N tensile loading), also with the elastomer replacing loose fracture fragments. Group 3 was subjected to bidirectional loading (600 N compression loading, 120 N tensile loading) without the elastomer. All constructs were tested at 2 Hz for 5000 cycles or until cut-out occurred. The medial migration distance (MMD) was recorded at the end of the testing cycles. Results The MMDs for Groups 1, 2, and 3 were 1.02 mm, 6.27 mm, and 5.44 mm respectively, with reliable reproduction of medial migration seen in all groups. Bidirectional loading groups showed significantly higher MMDs compared with the unidirectional loading group (p < 0.01). Conclusion Our results demonstrate significant contributions of bidirectional cyclic loading to the medial migration phenomenon in cephalomedullary nail fixation of pertrochanteric hip fractures. Cite this article: G. W. Law, Y. R. Wong, A. K-S. Yew, A. C. T. Choh, J. S. B. Koh, T. S. Howe. Medial migration in cephalomedullary nail fixation of pertrochanteric hip fractures: A biomechanical analysis using a novel bidirectional cyclic loading model. Bone Joint Res 2019;8:313–322. DOI: 10.1302/2046-3758.87.BJR-2018-0271.R1.

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P273 The role of multimodality imaging in the evaluation of arteritis

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.130 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

T M Matajira Chia ◽

M Castineira Busto ◽

M Cespon Fernandez ◽

B Gimena Reyes ◽

F Calvo Iglesias ◽

...

Keyword(s):

Antinuclear Antibodies ◽

Aortic Wall ◽

Multimodality Imaging ◽

Lateral Wall ◽

Ascending Aorta ◽

Iliac Arteries ◽

Positron Emission ◽

Nuclear Antigens ◽

Pet Ct

Abstract A 61-year-old man was admitted to the hospital with an atypical pain lumbar with oligoanuria. Other comorbidities were: arterial hypertension, diabetes mellitus and smoking .On examination the patient was comfortable at rest, with a heart rate of 89 b.p.m. and a blood pressure of 147/2 mmHg. Normal S1 and S2 heart sounds were present. There were no signs of heart failure present. Patients complained of pain in hypogastrium on palpation. Creatinine 2.33 mg / dL. PCR 72. The immunological studies were normal (including IgG and IgA serological levels, antinuclear antibodies, extractable nuclear antigens, anti-neutrophil cytoplasmic antibodies. An Body CT was performed, it shows mass that includes the ureters as well as the iliac arteries and parietal thickening in aorta wall. The positron emission tomography–computed tomography (PET CT) scans was performed that evidences pathological hypermetabolism that surrounds both primitive iliac arteries with maximum SUV 12 g / ml. Pathological hypermetabolism in ascending aorta until reaching arch with maximum SUV of 9.1 mg / ml compatible with periaortitis in the ascending aorta. A study was completed with retroperitoneal mass biopsy that showed areas of retroperitoneal fibrosis with predominantly lymphoplasmacytic areas. IgG4 / IgG> 40% , Obliterative involvement of small venules suggestive of IgG4 disease. A transthoracic echocardiogram was performed which showed normal biventricular function, absence of significant valvular disease and thickening of the aortic wall compatible with periaortitis. The patient started glucocorticoid therapy with favorable response. A PET CT control was performed that showed disappearing retroperitoneal masses around iliac vessels and disappearance of activity in lateral wall of aorta and decrease activity about ascendent aorta. DIAGNOSIS : IgG4 -related aortitis Abstract P273 Figure.

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Morphology Specific Lateral Wall Reconstruction Techniques Using Cerclage Wires in Unstable Trochanteric Fractures

Indian Journal of Orthopaedics ◽

10.1007/s43465-020-00220-5 ◽

2020 ◽

Vol 54 (S2) ◽

pp. 328-335

Author(s):

Zackariya Mohamed Jafarullah ◽

Girinivasan Chellamuthu ◽

Durga Prasad Valleri ◽

Velmurugesan Purnaganapathy Sundaram ◽

Devendra Agraharam ◽

...

Keyword(s):

Lateral Wall ◽

Trochanteric Fractures

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Abstract 271: A Novel Functional Role for Plasma miR-30d in Dyssynchronous Heart Failure

Circulation Research ◽

10.1161/res.113.suppl_1.a271 ◽

2013 ◽

Vol 113 (suppl_1) ◽

Author(s):

Kirsty Danielson ◽

Yonathan Melman ◽

Bridget Simonson ◽

Andreas Barth ◽

Khalid Chakir ◽

...

Keyword(s):

Heart Failure ◽

Functional Role ◽

Lateral Wall ◽

Canine Model ◽

Cardiac Resynchronization ◽

Tissue Samples ◽

Diagnostic Strategies ◽

Qrt Pcr ◽

Dyssynchronous Heart Failure

Introduction: We have previously shown that plasma miR-30d level is an independent predictor of echocardiographic response to cardiac resynchronization therapy (CRT) in patients with dyssynchronous heart failure (DHF). We now test the hypothesis that miR-30d is dynamically regulated in cardiomyocytes (CMs) and plays a functional role in DHF. Methods: miR-30d levels were assessed in a canine model of DHF and CRT using qRT-PCR, and potential miR-30d targets were identified using a bioinformatics approach. miR-30d targets were validated in the canine model and in CMs in culture. The regulation and functional role of miR-30d was investigated in CMs in culture using microscopy, western blotting and qRT-pCR. Results: miR-30d is enriched in the coronary sinus compared to peripheral blood in human patients, suggesting a cardiac origin (n=7, p<0.05). In tissue samples from the canine model of DHF, miR-30d levels are highest in the lateral wall, in concert with the greatest wall stress, and decreases with CRT (n=5, p<0.05). Bioinformatics analysis using differential gene expression data and in silico miR target prediction algorithms identified integrin and PI3/Akt signaling pathways as targets of miR-30d. Several targets including MAP4K4 and lims1 were further validated in tissue as well as in cultured CMs (n=4, p<0.05). miR-30d appears to be expressed in CMs, packaged into exosomes and micovesicles, and released in response to pathological rotational stress (n=2). Over-expression of miR-30d in CMs induces cellular hypertrophy with a unique expression signature of cardiac hypertrophy markers most consistent with physiological hypertrophy (n=3, p<0.05). Overexpression of miR-30d appears to be cardioprotective by abrogating TNF-induced increase in MAP4K4 expression (n=4, p<0.05). Conclusions: miR-30d is dynamically regulated in DHF and appears to play an important role in CM biology. Further insight into the role of ‘stretch’-regulated microRNAs such as miR-30d may pave the way for novel therapeutic and diagnostic strategies.

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SHORT VS LONG PROXIMAL FEMORAL NAIL IN UNSTABLE INTERTROCHANTERIC FRACTURES OF FEMUR

10.36106/ijar/4802716 ◽

2021 ◽

pp. 74-77

Author(s):

Chandra Sekhar.S ◽

Manikumar. C.J ◽

Pardhasaradhi. B

Keyword(s):

Lateral Wall ◽

Medullary Canal ◽

Proximal Femoral Nail ◽

Trochanteric Fractures ◽

Female Ratio ◽

Medical College ◽

Operative Duration ◽

Distal Locking ◽

Femoral Nail ◽

Minimum Age

BACKGROUND; The current methods of treatment of Inter Trochanteric fractures of femur are either DHS plating for a stable Intertrochanteric fracture or a Proximal Femoral Nail for an unstable IT fracture. There are increased surgical demands and complications associated with Unstable IT fractures. Fracture patterns like –Posteromedial large separate fragment, Basi cervical pattern, Reverse obliquity pattern, Displaced and/or avulsed greater trochanter, Lateral wall fractures pose challenges before operating surgeon. Failure to reduce the fracture before internal xation and failure to hold the reduction till denitive xation are the most frequent causes of poor results irrespective of the implant used for xation. . Present surgeon's usual preference is towards long PFN. There is an added advantage of increased stability due to splinting of the whole length of femur with the use of long PFN. However there are times where short PFN is preferred over long one when there is a mismatch of curvature between the nail and the femur. However, there is no pre-established treatment choice protocol in choosing long nail or short nail for trochanteric fractures, but many surgeons are reluctant to use short proximal femoral nails biased by literature showing more fracture rates with short PFN usage and with a belief that long nails can avoid stress risers in the diaphysis and make peri- prosthetic fracture rates acceptable. Some of the drawbacks of long PFN include increased operative duration, reaming of the medullary canal distally, unavailability of distal locking jig, leading to prolongation of distal locking time and exposing the surgical team to more radiation. Stacking the above facts the study tried to verify these in the practical scenario. The study was conducted at the department of orthopaedics Andhra Medical College Visakhapatnam Andhra Pradesh. Salvage procedures like Dimon osteotomy and Sarmiento osteotomy were not entertained in the present study.This effectively limits the study to cephalomedullary xation of un stable per trochanteric fractures with short and long Proximal Femoral Nail. METHODS: Study design: Hospital Based Comparative study. Study period: October 2017 to September 2019. Sample size: 30 (N=30, Short PFN-15, Long PFN-15) The study population was randomly divided into 2 groups with 15 patients in each group. Group S (odd): The patients who were operated with Short Proximal Femoral Nail. Group L (even): The patients who were operated with Long Proximal Femoral Nail. RESULTS Thirty cases of unstable inter-trochanteric fractures treated with reduction and internal xation with long or short proximal femoral nail were studied. In the present study minimum age was 29 years and maximum age was 75 years. Majority of the patients were between 51 to 70 years of age. Mean age for long PFN was 52.83 +/- 10.33 SD years, (Range 29-70). Mean age for short PFN was 58.16 +/- 13.94 SD years, (Range 35-75). In the present study males predominate females with a male to female ratio of 3:2. CONCLUSION We conclude that both short and long nails appear acceptable for use in unstable inter-trochanteric fractures. A reduction in operative duration and reduction in blood loss, which translates into a reduced blood transfusion requirement more importantly signicant reduction in image intensier exposures seen with short PFN makes it a surgeon friendly implant. We prefer long PFN for xation of unstable trochanteric fractures with osteoporosis so as to splint the whole femur.

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