RESUMO
PURPOSE: Cephalomedullary nails are used widely today for pertrochanteric fractures, and intraoperative lateral wall fractures can cause adverse effects. Recently, a high incidence of coronal fragments in pertrochanteric fractures was reported when analyzed with 3D CT reconstructions. In this study, we analyzed the association between the type of coronal fragments and perioperative lateral wall fractures. METHODS: Patients diagnosed with pertrochanteric fractures and treated by cephalomedullary nails at three university hospitals from September 2016 to December 2020 were examined. A total of 463 patients were included. We examined the coronal fragments and divided the patients into two groups according to the involvement of the posteromedial cortex. Postoperative X-rays were scanned for fracture lines at the blade entry site. RESULTS: Twenty-two patients among 463 patients had perioperative lateral wall fractures. The AO type A2 fractures, use of provisional pins, existence of coronal fragments, involvement of the posteromedial cortex, and the existence of anterior big neck fragments were significantly relevant to perioperative lateral wall fractures. 11 of 22 lateral wall fracture patients were delayed fracture patients, identified 4 weeks after surgery. A coronal fragment combined by anterior big neck fragments had a 9.24 times higher risk of lateral wall fractures compared to fractures with only coronal fragments. CONCLUSION: Pertrochanteric fractures with large coronal fragments and anterior big neck fragments have a high risk of perioperative lateral wall fractures when treated by cephalomedullary nails. Surgeons should examine the width of the intact lateral wall, and take caution to preserve its integrity.
Assuntos
Fraturas do Fêmur , Fixação Intramedular de Fraturas , Fraturas do Quadril , Pinos Ortopédicos , Fraturas do Fêmur/cirurgia , Fraturas do Quadril/diagnóstico por imagem , Fraturas do Quadril/cirurgia , Humanos , Complicações Intraoperatórias , Estudos Retrospectivos , Resultado do TratamentoRESUMO
RATIONALE: The incidence of venous thromboembolism (VTE) after knee arthroscopy is remarkably lower than that of arthroplasty. We describe a patient with symptomatic bilateral massive pulmonary thromboembolism (PTE) and deep vein thrombosis (DVT) in the femoral and popliteal veins after arthroscopic meniscus repair surgery. PATIENT CONCERNS: The patient underwent arthroscopic meniscus repair with no intraoperative complication. There were no underlying diseases such as hypertension or diabetes. On day 5 postoperative, the patient complained of dyspnea, chest discomfort, and nausea after standing. DIAGNOSIS: On DVT and PTE computed tomography, there were multifocal PTEs in the distal portion of the main and segmental branches of both pulmonary arteries. There was a focal thrombosis in the left deep femoral vein, as well as small DVTs in the left popliteal and calf veins. INTERVENTIONS: After 3âdays of low-molecular-weight heparin 1âmg/kg every 12âhours, treatment was changed to an oral drug, dabigatran, for 6âmonths. OUTCOMES: There were no PTE or DVT findings on computed tomography at 6âmonths postoperative. The patient did not complain of symptoms related to PTE or DVT at 6âmonths after the operation, has returned to work, and is living without discomfort. LESSIONS: The frequency of VTE is very low after arthroscopic meniscus surgery, but it represents a life-threatening event. Our patient had risk factors for VTE including obesity, surgery time of â¼60 minutes, and immobilization. Although arthroscopic meniscus surgery is relatively safe, evaluation of risk factors for VTE should be performed before and after surgery, and appropriate thromboprophylaxis should be provided when necessary.
Assuntos
Artroscopia/efeitos adversos , Menisco/lesões , Complicações Pós-Operatórias/etiologia , Embolia Pulmonar/etiologia , Trombose Venosa/etiologia , Adulto , Anticoagulantes/administração & dosagem , Dabigatrana/administração & dosagem , Eletrocardiografia , Veia Femoral/diagnóstico por imagem , Heparina de Baixo Peso Molecular/administração & dosagem , Humanos , Masculino , Menisco/cirurgia , Veia Poplítea/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/tratamento farmacológico , Artéria Pulmonar/diagnóstico por imagem , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/tratamento farmacológico , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Trombose Venosa/diagnóstico , Trombose Venosa/tratamento farmacológicoRESUMO
RATIONALE: Herpes zoster frequently causes dermatomal vesicular rash accompanied by severe neuralgia, and reaching a differential diagnosis may be challenging before the appearance of the vesicular rash. PATIENT CONCERNS: A 40-year-old male patient visited the emergency department with a complaint of sudden onset motor weakness and ipsilateral radiating neuralgia to the Lt. thigh. He had suffered from chickenpox during childhood. DIAGNOSES: No skin lesion was present at the initial visit. The reverse Straight Leg Raise test was negative. Magnetic resonance imaging showed asymmetrically swollen dorsal root ganglion with Gadolinium enhancement. The vesicular rash that appeared on the sixth day after the symptom onset led to the diagnosis of herpes zoster. INTERVENTIONS: Antiviral agent of valacyclovir (1000âmg t.i.d.) was administered for 7 days. OUTCOMES: The patient recovered from motor weaknesses by 2 weeks from the onset of the symptom. Mild degree post-herpetic neuralgia recovered by 2 months. LESSONS: A high index of suspicion is necessary to differentiate early herpes zoster radiculitis before the appearance of vesicular rash from compressive radiculopathy. In L2-3 ipsilateral radiating pain along the dermatome or myotome, the absence of reverse Straight Leg Raise sign may be a possible factor in differentiating herpes zoster radiculitis from compressive radiculopathy.