scholarly journals The management of intra-articular lateral femoral condyle (Hoffa) fracture of the knee using arthroscopy-assisted fixation: a case report

2018 ◽  
Vol 6 (11) ◽  
pp. 3759
Author(s):  
I. G. N. Wien Aryana ◽  
Trimanto Wibowo
Keyword(s):  
Internal Fixation ◽  
Femoral Fracture ◽  
Motor Vehicle ◽  
Lateral Condyle ◽  
X Rays ◽  
Distal Femoral Fracture ◽  
X Ray ◽  
Hoffa Fracture ◽  
Limited Range Of Motion ◽  
The Right

A Hoffa fracture is a type of supracondylar distal femoral fracture with fracture line located in the coronal plane. It is a rare injury consisting of tangential (coronal shear) fracture of distal femoral condyles. Unicondylar knee fractures are rare and present some diagnostic difficulties due to poor visibility on standard X-ray and are especially harder to identify in non-displaced fracture. A fifty-four-year-old male presented to our emergency room with a chief complaint of pain over his right knee that started 10 months prior. He previously was involved in a motor vehicle accident and underwent open reduction and internal fixation with plate and screws. Physical examination revealed swelling and tenderness over the right knee with limited range of motion. Plain X-ray showed union of tibia plateau fracture with plate and screws and no evidence of distal femoral fracture. A magnetic resonance imaging of the right knee was performed and revealed an intraarticular lateral condyle femur fracture with transverse configuration that was previously missed on plain X-ray. Arthroscopy-assisted reduction and internal fixation using antero-posterior and postero-anterior oriented screws were performed and good reduction was achieved. Diagnosis of this type of fracture is challenging and require some experience. Awareness of such entity and strong clinical suspicion are essential for diagnosis because most of the time the standard X-rays may appear normal. Arthroscopy-assisted fracture fixation using antero-posterior and postero-anterior oriented screws for Hoffa fracture offers many advantages and allows for early mobilization postoperatively without any loss of reduction.

scholarly journals Navigation-Assisted Posterior Open Reduction and Internal Fixation in a C-CLAMP Fashion for an Isolated C1 Fracture

2020 ◽  
Author(s):  
Daniele Starnoni ◽  
Timo Ecker ◽  
Juan Barges-Coll
Keyword(s):  
Neck Pain ◽  
Internal Fixation ◽  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
Lateral Displacement ◽  
Lateral Mass ◽  
Transverse Ligament ◽  
Alar Ligament ◽  
The Right

AbstractC1 fractures with an intact transverse ligament are usually treated conservatively. Patients who present with a progressive diastasis of bone fragments and a progressive articular subluxation mainly attributed to progressive lengthening of the transverse ligament (TAL) fibers can be treated with a C1 “C-clamp” fusion.A 75-year-old male who sustained a motor vehicle accident was neurologically intact. A computed tomography (CT) imaging demonstrated a Jefferson's type-C1 fracture with a slight lateral displacement of the C1 left lateral mass (LM) and a rotatory subluxation on the right. MRI showed an intact TAL and demonstrated an isolated rupture of the left alar ligament. Conservative treatment was chosen. Radiographic follow-up showed, at 3 months, progressive lateral mass displacement, most likely due to elongation of the TAL fibers; this was also associated with a persistent mechanical neck pain. For this reason, we performed a posterior reduction and internal fixation in a C-clamp fashion by placement of C1 lateral mass screws and posterior compression sparing the C1–2 joint. Using navigation, a 3.5-mm screw was inserted into the LM bilaterally. The screw heads were then connected with a rod and compression was applied before tightening. Postoperative CT scan demonstrated a satisfying reduction and further imaging will be made during the follow-up. The patient had a considerable relief of neck pain. Simple lateral mass fixation with C-clamp technique is a reasonable option in case of isolated C1 fractures in patients who have failed conservative management while preserving the range of motion (ROM) at the atlanto–axial joint.The link to the video can be found at: https://youtu.be/x8bsVwzCt_M.

A new internal fixation concept for the distal femoral fracture after total knee arthroplasty

2003 ◽  
Vol 26 (6) ◽  
pp. 803-808
Author(s):  
Chuan‐Mu Chen ◽  
Chan‐Tsung Yang ◽  
Hung‐Wen Wei ◽  
Jiaun‐Jong Liau ◽  
Cheng‐Kung Cheng
Keyword(s):  
Total Knee Arthroplasty ◽  
Internal Fixation ◽  
Knee Arthroplasty ◽  
Femoral Fracture ◽  
Distal Femoral Fracture ◽  
Total Knee

scholarly journals Non -Union of Lateral Hoffa Fracture - A Case Report

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Amit Supe ◽  
Shubham Atal ◽  
Neetin P Mahajan ◽  
Prasanna Kumar. G S ◽  
Amey Sadar ◽  
...  
Keyword(s):  
Case Report ◽  
Internal Fixation ◽  
Open Reduction ◽  
Femoral Condyle ◽  
Left Knee ◽  
X Rays ◽  
Non Union ◽  
Hoffa Fracture ◽  
History Of ◽  
Missed Diagnosis

Introduction: Hoffa is a coronal fracture of the femoral condyle. It is an uncommon injury easily missed on X-rays, which later presents as a non-union. Computed tomography (CT) scan knee helps in diagnosing undisplaced fractures and planning the management. Case Report: A 24-year-old male patient presented to us with complaints of pain, decreased range of knee movements, difficulty in walking and clicking sound at the left knee for 9 years. The patient had a history of trauma 9 years back. X-ray of the left knee showed the non-union of left lateral Hoffa fracture, which was managed with open reduction and internal fixation with CC screws using the lateral para patellar approach. At present 1.5 years follow-up, the patient is comfortable with no pain and having a complete knee range of motion. Conclusion: Although Hoffa fracture is rare, clinical suspicion, along with radiological investigations, is essential to diagnose Hoffa fracture. A missed diagnosis can lead to malunion or non-union, which predisposes to knee arthritis. Timely and proper management of Hoffa non-union with open reduction, stable internal fixation and early knee mobilization help in getting a better outcome. Keywords: Lateral Hoffa fracture, non-union, internal fixation, functional outcome.

scholarly journals Abdominal pain and two x-rays: spot the difference

2012 ◽  
Vol 94 (2) ◽  
pp. e95-e95 ◽  
Author(s):  
Z Rajković ◽  
D Papeš ◽  
S Altarac ◽  
N Arslani
Keyword(s):  
Abdominal Pain ◽  
Portal Vein ◽  
Elective Surgery ◽  
Exploratory Laparotomy ◽  
X Rays ◽  
X Ray ◽  
Artery Embolism ◽  
The Difference ◽  
Bilioenteric Fistula ◽  
The Right

We present two patients with air found in the right upper quadrant on standard abdominal x-ray. One was diagnosed with pneumobilia and underwent elective surgery for a bilioenteric fistula. The other was diagnosed with portal vein gas and underwent an emergency exploratory laparotomy at which a superior mesenteric artery embolism was found. The differential diagnostic criteria for pneumobilia and portal vein gas are described. If portal venous gas is found on x-ray in patients with abdominal pain, it is recommended that management is aggressive, meaning an emergency exploratory laparotomy, because mortality in such cases is approximately 75%.

scholarly journals Oesophageal carcinoma with solitary patellar metastasis: a rare case report

2021 ◽  
Vol 49 (4) ◽  
pp. 030006052110098
Author(s):  
Yi Zhao ◽  
Qianqian Zhang ◽  
Helin Feng ◽  
Xiyan Zhu
Keyword(s):  
Bone Scintigraphy ◽  
Oesophageal Carcinoma ◽  
Limited Range ◽  
Additional Treatment ◽  
X Rays ◽  
Methylene Diphosphonate ◽  
Limited Range Of Motion ◽  
Rare Case Report ◽  
Paclitaxel Liposome ◽  
The Right

The incidence of tumours found in the patella, including primary and metastatic tumours, is low. Solitary metastasis of oesophageal carcinoma (OC) in the patella is even rarer. A 50-year-old man presented to our clinic because of pain and limited range of motion in the right knee for 4 hours and after a fall. On the basis of the patient’s medical history, he was diagnosed with OC 2 months previously and underwent two cycles of paclitaxel liposome combined with tiggio chemotherapy (oral tiggio, 40 mg, two times/day, with a treatment cycle of 3 weeks). A 99mTc-methylene diphosphonate bone scintigraphy scan showed increased radioactivity in the right patella. A right knee biopsy showed the presence of patellar metastasis from OC. Unfortunately, the patient denied additional treatment and was discharged for personal reasons. At the 1-month follow-up, which was conducted by a telephone survey, we learned that the patient had died of acute pulmonary embolism. X-rays and computed tomography are useful for diagnosing patellar metastases, but 99mTc-methylene diphosphonate bone scintigraphy can help physicians diagnose patellar metastasis of OC more rapidly. Biopsy with pathology is the gold standard for diagnosing patellar metastases. Additionally, timely surgical treatment prolongs the survival time of these patients.

scholarly journals Comparison of standard radiography and magnetic resonance imaging in hand osteoarthritis

2021 ◽  
Vol 59 (4) ◽  
pp. 418-425
Author(s):  
D. M. Kudinskii ◽  
A. V. Smirnov ◽  
L. I. Alekseeva ◽  
E. A. Taskina ◽  
A. M. Lila ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Sensitivity And Specificity ◽  
Age Of Onset ◽  
Hand Osteoarthritis ◽  
X Rays ◽  
Resonance Imaging ◽  
X Ray ◽  
Right Hand ◽  
The Right

Standard radiography in direct projection is the “gold standard” in the diagnosis of hand osteoarthritis (HOA). However, the currently clinically most severe “erosive” or “inflammatory” phenotype of HOA is characterized by the presence of inflammatory symptoms such as bone marrow lession (BML), synovitis and tenosinovitis, which are not visible on the radiograph by the nature of the study due to the low optical density. In addition, X-ray examination is planar and has no possibility of multiplanar visualization. This dictated the need to search for a more informative visualization technique in HOA.Aim – to compare the sensitivity and specificity of standard radiography and magnetic resonance imaging (MRI) techniques in determining the symptoms of osteoarthritis (OA) of the distal interphalangeal (DIP), proximal interphalangeal (PIP) and metacarpophalangeal (MCP) joints of the right hand; to determine the indications for the appointment of MRI in patients with HOA.Materials and methods. The study included 64 women with clinically verified diagnosis of HOA according to ask criteria. For the first time, X-rays of the joints of the right hand in the anterior-posterior projection and MRI were performed for each of them. Each patient completed the AUSCAN questionnaire. X-rays were described according to the Kellgren and Lawrence systems, magnetic resonance imaging was analyzed according to the modified OHOA system. The sensitivity and specificity of the methods were compared based on the detection of 4 symptoms detected by radiography and MRI: joint space narrowing (JSN), osteophytes (OP), erosions and subluxations. The average age of the patients was 65.28±6.82 years, the age of onset was 48.81±7.73 years, the duration of the disease was 15.0 (10.0–19.5) years.Results. Both methods showed approximately equal identification JSN symptom in DIP and PIP, 95% definition JSN in MCP. OP were detected in 88% of patients in DIP according to radiography and in 95% – using MRI (p>0.05). In PIP OP were observed in 70% of patients on radiographs and in 86% on magnetic resonance imaging, in MCP – in 45% and 66% of cases, respectively. Erosion in DIP were found in 41% of patients according to MRI and 34% as a result of X-ray examination, in PIP – in 27% and 13% of cases, in MCP – in 60% and 8% of cases, respectively. Subluxations were determined in DIP 23% on radiographs in 31% of cases by MRI, in PIP – in 8% and 6% (p>0.05), in MCP subluxations almost never met – in 3% of cases by conventional radiography.Conclusions. MRI in HOA can be used in the detection of erosive process, differential diagnosis with other diseases of the joints, determination of inflammatory changes in the hands and assessment of their severity, but has no significant advantages over standard radiography in determining the symptoms of degenerative-dystrophic nature (JSN and OP). Subluxations of the MCP joints are not typical for the HOA.

scholarly journals Transfer Learning with Deep Convolutional Neural Network (CNN) for Pneumonia Detection Using Chest X-ray

2020 ◽  
Vol 10 (9) ◽  
pp. 3233 ◽  
Author(s):  
Tawsifur Rahman ◽  
Muhammad E. H. Chowdhury ◽  
Amith Khandakar ◽  
Khandaker R. Islam ◽  
Khandaker F. Islam ◽  
...  
Keyword(s):  
Neural Network ◽  
Convolutional Neural Network ◽  
Transfer Learning ◽  
Viral Pneumonia ◽  
Deep Convolutional Neural Network ◽  
X Rays ◽  
X Ray ◽  
Life Threatening ◽  
Chest X Ray ◽  
The Right

Pneumonia is a life-threatening disease, which occurs in the lungs caused by either bacterial or viral infection. It can be life-endangering if not acted upon at the right time and thus the early diagnosis of pneumonia is vital. The paper aims to automatically detect bacterial and viral pneumonia using digital x-ray images. It provides a detailed report on advances in accurate detection of pneumonia and then presents the methodology adopted by the authors. Four different pre-trained deep Convolutional Neural Network (CNN): AlexNet, ResNet18, DenseNet201, and SqueezeNet were used for transfer learning. A total of 5247 chest X-ray images consisting of bacterial, viral, and normal chest x-rays images were preprocessed and trained for the transfer learning-based classification task. In this study, the authors have reported three schemes of classifications: normal vs. pneumonia, bacterial vs. viral pneumonia, and normal, bacterial, and viral pneumonia. The classification accuracy of normal and pneumonia images, bacterial and viral pneumonia images, and normal, bacterial, and viral pneumonia were 98%, 95%, and 93.3%, respectively. This is the highest accuracy, in any scheme, of the accuracies reported in the literature. Therefore, the proposed study can be useful in more quickly diagnosing pneumonia by the radiologist and can help in the fast airport screening of pneumonia patients.

scholarly journals A novel mutation in TNFRSF11A gene causes pediatric osteopetrosis: case report

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
You Xu ◽  
Xiaoyan Yu ◽  
Mengjie Huang
Keyword(s):  
Bone Density ◽  
Histological Examination ◽  
Novel Mutation ◽  
Osteoclast Formation ◽  
Hematopoietic Progenitor Cell ◽  
X Rays ◽  
Laboratory Findings ◽  
Hematopoietic Stem ◽  
X Ray ◽  
The Right

Abstract Background Osteopetrosis is a rare inherited bone disorder affected individual by osteoclast disfunction and increasing bone density. Surgery was taken for histological examination of the specimen and evidence of malignancy was not found. Finally, X-ray and gene detection lead to the diagnosis. Case presentation We report a 10-year-old girl with two years history of pus rhinorrhea, nasal obstruction and smelly nose. She was diagnosed and treated as sinusitis. But the symptoms were recurrent. Ten months ago, she was afflicted with persistent swelling and broken skin on the right cheek. All the laboratory findings showed normal. During surgery, we resected the right gingiva, the right nasal mucosa and the right facial tissue for biopsies. Histological examination showed proliferation of granulation tissue in chronic inflammatory mucosa. X-rays showed generalized sclerosis. Genetic analysis strongly supported a novel mutation of TNFRSF11A gene which caused osteoporosis. We found a novel mutation of the c.1196C > G (p.S399X) in exon 9 of TNFRSF11A. The TNFRSF11A gene encodes RANK, which is fundamental for osteoclast formation. Conclusion Osteopetrosis is a rare genetic bone disease characterized by increased bone density because of bone resorption failure. Diagnosis is based on X-ray and gene analyze. Osteoclasts are bone-related cells derived from hematopoietic cell lines. Since osteoclasts arise from a hematopoietic progenitor cell of the monocytic lineage, the defect can be corrected by hematopoietic stem cell transplantation (HSCT). Better understanding of this pathological situation and pathogenesis is so important to plan appropriate immunotherapy to benefit.

scholarly journals Spontaneous fetal femoral fracture: a case report and literature review

2018 ◽  
Vol 46 (3) ◽  
pp. 1282-1287 ◽  
Author(s):  
Mingming Yu ◽  
Dapeng Xu ◽  
Aiguo Zhang ◽  
Jun Shen
Keyword(s):  
Case Report ◽  
Caesarean Section ◽  
Femoral Fracture ◽  
Femoral Fractures ◽  
Timely Manner ◽  
Left Femur ◽  
X Ray ◽  
Clinical Presentations ◽  
The Right

Spontaneous fetal femoral fractures are uncommon in the paediatric setting. The major clinical presentations of a spontaneous fetal femoral fracture are femoral angulation, shortness of the femur and even a marked fracture line. This case report describes a spontaneous fetal femoral fracture of the right femur, which was detected by routine ultrasonography during the 19th week of gestation in a 24-year-old woman. On routine follow-up visits, the angulation of the right femur in the fetus gradually improved. A caesarean section was undertaken at 39 weeks +5 days of gestation and an X-ray was taken on the second day after birth, which showed that the fracture had healed and the callus had been absorbed. The lengths of the two femurs of the baby were not equal; the right femur was 84 mm, which was 11 mm shorter than the left femur. In cases like this, postnatal follow-up is essential so that an operation can be carried out in a timely manner when the deformity is apparent.

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