Retroperitoneal hematoma due to spontaneous lumbar artery rupture during fondaparinux treatment. Case report and review of the literature.

We present the case of a 78 year-old man who developed a spontaneous rupture of the lumbar artery leading to a retroperitoneal hematoma while receiving fondaparinux therapy after a total hip replacement. A selective angiographic embolization stopped the bleeding. Fondaparinux was discontinuated and the patient presented a complete resolution of his medical status. Spontaneous hematomas has been well described during low molecular weight heparin (LMWH) treatment, expecially in elderly patients, but there are no previous reports of hematomas induced by fondaparinux. We reviewed the literature to identify the possible risk-factors of bleeding. Our review shows that even if many works suggest that fondaparinux is a safe and effective alternative to LMWH in the prevention of venous thromboembolism following major orthopaedic surgery, it should carefully be used in elderly people and patients with renal disfunction.

Three years of experience with the clos nail for tibial shaft fractures.

The Clos tibial nail is a new interlocking dynamic compression nail. From September 1998 to September 2001 fifty-six patients who had tibial shaft fractures were treated. Depending on positioning of the blocking screw, the system can be mounted in four different configurations: static configuration (19 cases), dynamic configuration (30 cases), static-compression configuration (1 case), and dynamic-compression configuration (6 cases). There were 40 male and 16 female (average age of 42 years); 36 simple fractures and 20 multifragmentary fractures. The fibula was safe in two cases, fractured at the same level of the tibial fracture in 34 cases and fractured at another level in 20 cases. The mean time to full weight bearing was 11 weeks (10-14). There were no cases of delayed union or dynamization or infections. All the fractures healed in a mean time of 16 weeks (10-20 weeks). There were 3 malunions, one in varus and two in valgus, and one patient healed with 3 cm of shortening. All patients returned to their previous activity levels.

The CLOS MB intramedullary nail for the treatment of pathological femoral shaft lesions.

Advances in systemic and radiation therapy have led to considerable improvement in the prognosis of patients with metastatic disease. As a result, orthopedic surgeons are being asked with increasing frequency to evaluate and treat the manifestations of skeletal metastases. Intramedullary nailing is a valuable technique for stabilizing (impending) pathological femoral fractures or osteolytic lesions. From January 1999 to January 2001 we treated 5 patients for skeletal metastases in the diaphyseal region of the femur. One month after surgical stabilization of the pathological lesion involving the femur, we observed significant improvement in quality of life, including pain relief and early ambulation.

Healing of fresh tibial fractures with OP-1. A preliminary report.

Osteogenic proteins (OP) are elements of a class of natural growth factors called Bone Morphogenetic Proteins (BMP). A specific member of this class is OP-1, a human recombinant protein that has osteogenic properties. The osteoinductive and osteoconductive properties of OP-1, with its specific collagen matrix, promote the generation of new functionally active, biologically and biomechanically mature bone. We carried out a clinical study to verify the potential of this protein in fresh tibial closed fractures, using OP-1 associated with osteosynthesis by means of a monolateral external fixator.