Optimizing Fixation and Biologic Augmentation in Aseptic Femoral Nonunion Management: A Retrospective Case Series.

Nonunion poses significant difficulties for both patients and orthopedic surgeons, often requiring intricate reconstructive surgeries to achieve bone healing and eliminate infections. Surgeons must navigate numerous contributing factors to nonunion, and they also face challenging hardware issues during revision procedures. These issues can include infections, loose or failing hardware, misaligned components, or inappropriate hardware configurations. This case series includes five cases of nonunion femur fractures and the goal is to carefully analyze the best treatment option for treating nonunion. All the cases underwent the removal of whole or part of the hardware followed by bone grafting and attainment of the stable construct with load-sharing devices and augmentation with neutralizing plates. All the cases had a radiological bone union at an average of four to seven months with improvement of Harris Hip Score.

Unusual Presentation of Cerebral Fat Embolism Syndrome Post-femur Fracture: A Case Study and Diagnostic Insights.

Cerebral fat embolism syndrome (CFES) is a rare but certainly devastating impediment following long bone fractures. The diagnosis of CFES primarily depends on identifying clinical manifestations like respiratory distress, petechial rash, and neurological symptoms. However, in rare instances, CFES can manifest with atypical or absent clinical features, posing diagnostic challenges. Here, we present a rare case report of a woman in her 20s who developed CFES after suffering a femur shaft fracture devoid of conventional clinical features. The diagnosis of CFES was built upon clinical suspicion and a typical MRI brain finding of a starfield pattern. Our case highlights the importance of including CFES in the differential diagnosis of neurological deterioration, especially after long bone fractures. We suggest early plate osteosynthesis to stop more emboli from forming in people with FES, as well as continuous neuromonitoring and a reminder that CFES can show up without any other signs or symptoms in the body.

Minimally Invasive Surgery to Remove a Broken and Retained Epidural Catheter Fragment.

Epidural anaesthesia (EA) has consistently been used for treatments affecting the pelvis, lower limbs, lower abdomen, and perineum; however, it is progressively employed as a single anaesthetic or supplement to general and spinal anaesthesia for a broader range of procedures. The retention of a broken epidural catheter piece is an uncommon but well-known complication. In this report, we present a 30-year-old male with avascular necrosis (AVN) of the hip who was referred for total hip replacement (THR). An epidural catheter had been placed at the presumed L2-3 interspace to administer EA. The catheter had been set too deep and it broke on extraction with the Tuohy needle, leaving a fragment inside. The patient was then given general anaesthesia and the planned procedure of THR was done in the lateral position. The patient was then shifted to the prone position to remove the retained fragment of the epidural catheter by a minimally invasive spinal surgery (MISS). Right-sided L2 laminotomy was done, as the epidural catheter was inserted from the right side, to retrieve the broken fragment without any added postoperative neurological complications. MISS may be attempted by experienced surgeons for the removal of a retained fragment of the epidural catheter from the spinal canal before adhesion as a safe option.