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Introduction: Neonatal compartment syndrome is a rare phenomenon with a limited number of cases reported in the literature with varying etiologies. Current literature categorizes etiologies as either intrinsic or extrinsic. To the best of our knowledge, difficult delivery and delivery through vacuum are the only two iatrogenic etiologies that have been reported in the literature. Thus, this may be the first reported case of neonatal compartment syndrome secondary to a failed peripherally inserted central catheter (PICC) insertion. Case Report: We present a case of a pre-mature neonate with diffuse discoloration, paralysis, and loss of palpable pulses of the right upper extremity after a failed PICC insertion. The clinical features led to a diagnosis of compartment syndrome. Interventions were not carried out due to the pre-maturity and instability of the patient. The patient passed away at 38 days of age due to refractory hypotension and patent ductus arteriosus. Conclusion: We present a case of neonatal compartment syndrome caused by a previously unreported etiology, highlighting the current dearth of knowledge. Clinicians should be aware of the unique clinical presentation of neonatal compartment syndrome and maintain high suspicion even without an obvious etiology.
RESUMO
Introduction: Non-ossifying fibroma (NOF) is a common benign fibrogenic bone lesion commonly found in the metaphysis of long bones. While small NOFs are typically asymptomatic and left untreated, large NOFs are often associated with pathologic fractures that can be treated conservatively or operatively. To our knowledge, the NOF presented in this case report is one of the largest reported in the literature. Case Report: We present a case of a 12-year-old Hispanic female who presented to our institution after falling off a horse and landing on her right leg and wrist. Radiographs revealed a right distal femur fracture through an unusually large lytic bone lesion. The patient was treated with curettage, grafting, open reduction, and internal fixation, given the unstable and pathological nature of the fracture. Conclusion: This case substantiates the literature that large fractures through a NOF can be appropriately managed operatively. However, orthopedic surgeons should be aware of the risks of surgery, including infection, when considering operative management of patients who present with large unstable pathologic fractures through a NOF.
RESUMO
With the incidence of primary total hip arthroplasty continuing to rise in the United States, the innovation behind improving current total hip arthroplasty systems inevitably grows with it-each new design potentially ushering in new flaws. We report a case of screw failure with the Arcos Modular Femoral Revision System-Trochanteric Bolt and Claw Technique in a 74-year-old male patient. The patient presented to the investigator's clinic for their 20-month follow-up evaluation of their complex right hip revision. Radiographs revealed failure of the screw attaching the claw plate to the stem resulting in dislodgement and relocation of the screw within the intra-articular cavity. The patient elected for nonsurgical management and will continue to be monitored. Consent by the patient involved in this case report was obtained.
Assuntos
Artroplastia de Quadril , Fêmur , Masculino , Humanos , Idoso , Fêmur/diagnóstico por imagem , Fêmur/cirurgia , Instituições de Assistência Ambulatorial , Placas Ósseas , Parafusos ÓsseosRESUMO
Introduction. The sensitivity and specificity for magnetic resonance imaging (MRI) diagnosis of osteomyelitis is 90% and 80%, respectively; findings include bone marrow edema, T2-weighted image hyperintensity (HI-T2WI), T1-weighted image confluent signal(CS-T1WI), and cortical erosion (CE). The goal is to determine which risk factors and MRI findings are most predictive of osteomyelitis. Materials and Methods. After institutional review board approval, records of patients who underwent bone biopsy of the foot/ankle between 2015 and 2017 were reviewed. Diagnosis was determined histologically. Blinded MRI review identified indicators of osteomyelitis: HI-T2WI, CS-T1WI, ulcer depth, and CE. Bivariate and multivariate regression determined an association between osteomyelitis and radiographic indicators. Results. Of 59 subjects, 41 (69.5%) and 18 (30.5%) had pathologic evidence of osteomyelitis or were indeterminate. The sensitivity and specificity by radiologist diagnosis was 51.4% and 91.7%, respectively. Diabetes (relative risk [RR]=2.9, 95% CI = 1.0.8-7.77, P = .034), CS-T1WI (RR = 1.6, 95% CI = 1.23-2.20, P < .001), and CE (RR = 1.8, 95% CI = 1.34-2.28, P < .001) were risk factors on bivariate analysis. Ulcer depth demonstrated a trend toward statistical significance. Diabetes (RR = 2.4, 95% CI = 1.00-5.69, P = .049) and CE (RR = 1.7, 95% CI = 1.27-2.37, P < .001) were independent risk factors on multivariate analysis. Discussion. Diabetes and CS-T1WI are independent risk factors for pedal osteomyelitis. Patients with diabetes, CS-T1WI, and CE should be evaluated for osteomyelitis with recommendation for bone biopsy in appropriate clinical settings.Levels of Evidence: Level III Retrospective Comparative Study.