Type III Kounis Syndrome Caused by Iodine Contrast Media After Improvement of Allergic Symptoms.

Kounis syndrome is an acute coronary syndrome (ACS) caused by an allergic reaction that almost always occurs immediately and simultaneously with allergic symptoms. We present a case of Kounis syndrome type III that developed after complete resolution of contrast-induced anaphylaxis in a 60-year-old man with a coronary stent placed in the proximal left anterior descending (LAD) artery branch for ischemic heart disease. Contrast-enhanced computed tomography revealed anaphylactic shock. Symptoms quickly improved with intramuscular adrenaline injection; however, chest pain appeared after approximately 30 min. ECG revealed ST-wave elevation in the precordial leads. Coronary angiography revealed acute stent thrombosis with total occlusion of the proximal LAD, and percutaneous coronary angioplasty was performed. We diagnosed Kounis syndrome based on the allergic symptoms and ACS. Because some cases of Kounis syndrome develop after anaphylactic symptoms have resolved, it is advisable to follow-up patients with allergic symptoms and pay attention to chest symptoms and ECG changes, especially when they have a history of noted or treated coronary artery disease.

Accuracy of percutaneous pedicle screw placement with 3-dimensional fluoroscopy-based navigation: Lateral decubitus position versus prone position.

The accuracy of percutaneous pedicle screw (PSS) placement in the lateral decubitus position has seldom been reported. This study aimed to retrospectively compare the accuracy of PPS placement with 3-dimensional (3D) fluoroscopy-based navigation in 2 cohorts of patients who underwent surgery in the lateral decubitus or prone positions at our single institute. A total of 265 consecutive patients underwent spinal surgery with PPS from T1 (thoracic 1) to S (sacrum) under the 3D fluoroscopy-based navigation system at our institute. Patients were divided into 2 groups based on their intraoperative patient positioning: lateral decubitus (Group L) or prone (Group P). A total of 1816 PPSs were placed from T1 to S, and 76 (4.18%) PPSs were assessed as deviated PPS. Twenty-one of 453 (4.64%) PPSs in Group L deviation and 55 of 1363 (4.04%) PPSs in Group P had deviated PPS, but with not significant difference (P = .580). In Group L, although the PPS deviation rate was not significantly different between the upside and downside PPS, the downside PPS significantly deviated toward the lateral side compared with the upside PPS. The safety and efficacy of PPS insertion in the lateral decubitus position were similar to those in the conventional prone position.

Double plating via anterolateral and posterolateral approach for distal femoral fracture.

Although there are some reports highlighting the applicability of double plates in distal femoral fractures, there is no standard approach or fixation method for supracondylar fractures combined with posterior coronal shear fractures. We report a case of distal femoral fracture treated with a lateral locking plate and posterior buttress plate using anterolateral and posterolateral approaches from one incision. A 70-year-old man was hit by a motorcycle and had an intra-articular distal femoral fracture involving a long medial proximal spike and a single lateral condyle fragment, with the lateral condyle fragment posteriorly displaced. A 12-cm lateral skin incision was made, and the joint was developed using a para-patellar approach from the anterior to iliotibial band. Posterior buttress plate fixation was successfully performed from behind the iliotibial band using a posterolateral approach, followed by cannulated cancellous screw and lateral locking plate fixation from the anterolateral window. Combined anterolateral and posterolateral approaches from one incision enable intra-articular exposure and fixation based on fixation principles for lateral condyle fragments combined with supracondylar fracture.

Reliability of the Garden Alignment Index and Valgus Tilt Measurement for Nondisplaced Femoral Neck Fractures.

Anteroposterior (AP) alignment assessment for nondisplaced femoral neck fractures is important for determining the treatment strategy and predicting postoperative outcomes. AP alignment is generally measured using the Garden alignment index (GAI). However, its reliability remains unknown. We compared the reliability of GAI and a new AP alignment measurement (valgus tilt measurement [VTM]) using preoperative AP radiographs of nondisplaced femoral neck fractures. The study was designed as an intra- and inter-rater reliability analysis. The raters were four trauma surgeons who assessed 50 images twice. The main outcome was the intraclass correlation coefficient (ICC). To calculate intra- and inter-rater reliability, we used a mixed-effects model considering rater, patient, and time. The overall ICC (95% CI) of GAI and VTM for intra-rater reliability was 0.92 (0.89−0.94) and 0.86 (0.82−0.89), respectively. The overall ICC of GAI and VTM for inter-rater reliability was 0.92 (0.89−0.95), and 0.85 (0.81−0.88), respectively. The intra- and inter-rater reliability of GAI was higher in patients aged <80 years than in patients aged ≥80 years. Our results showed that GAI is a more reliable measurement method than VTM, although both are reliable. Variations in patient age should be considered in GAI measurements.