Vitamin D Deficiency in Patients With Low-Energy Hip Fractures in Accordance With the Mediterranean Paradox.

Introduction Vitamin D deficiency (VDD) is considered one of the leading causes of poor bone quality. It may also be related to severe muscular weakness, especially in the elderly, which leads to frequent falls. Thus, VDD might be associated with fragility fractures of the hip, wrist, and spine in this age category. In this cross-sectional study, our goal was to present vitamin D levels in an elderly Mediterranean population with hip fractures and to assess whether its levels are related to the incidence or prevention of such injuries. Methods Between January and December 2021, 140 patients aged 65 years or older were hospitalized in our department with a fracture involving the hip joint. Serum calcium and vitamin D level control was performed upon admission, as well as recording whether anti-osteoporosis medication had been prescribed. Only patients with low-energy fractures were included, whereas oncologic patients and those with high-energy trauma were excluded. Results Thirty-eight men and 102 women, with a mean age of 83.12 and 84.88 years, respectively, participated in our study. Intertrochanteric fractures were the most common injuries (50.72%). Low vitamin D levels (<30 ng/mL) were observed in 132 patients (94.28%). A bone density scan during the last year had been conducted by only seven patients (5%), whereas in 136 patients (97.14%), no anti-osteoporotic medication was given. Conclusion There is an excessive percentage of aged patients with hip fractures in Greece, demonstrating a significant vitamin D insufficiency despite the high annual frequency of sunny days in this Mediterranean region. Presumably, most of these patients neither perform the routine bone density scan nor do they take any kind of preventive pharmaceutical treatment, which might reveal devaluation of osteoporosis from this age group due to contingent comorbidities.

Pure Posterior Native Hip Dislocation Following Low-Energy Injury - a Rare Case Report.

Hip dislocations are traumatic injuries that commonly derive from high energy trauma such as traffic accidents or falls from great heights. In addition, these injuries present an increased incidence after partial or total hip arthroplasty in elderly patients. Associate literature dictates that in case of a native hip dislocation, early reduction is crucial for avoidance of further complications such as avascular necrosis of the femoral head and post traumatic arthritis. In this article, we present a rare case of a native pure posterior hip dislocation after low-energy trauma. We also demonstrate the treatment and follow-up algorithm concerning this kind of injury.

Delayed Presentation of Acute Compartment Syndrome After Isolated Closed Fibular Shaft Fracture: A Case Report.

Post-traumatic compartment syndrome in the lower extremity has been commonly associated with fractures of the tibia. Only in rare cases, this critical condition might be related to isolated fibular fractures. We present a rare case of delayed onset of acute compartment syndrome after a solitary fracture of the fibula. A 40-year-old man with a history of coagulation disorders due to hepatic cirrhosis was admitted to a neighboring hospital after a car accident with left-sided fractures to ribs 9 and 10 and a transverse fracture in the mid-shaft of the left fibula. He was discharged from the hospital five days later with a posterior long leg splint and anticoagulant therapy. However, three days after discharge, he was seen in the emergency department of our hospital with severe pain and extensive swelling in the left leg. Weak posterior tibial and dorsalis pedis pulse in the right foot were detected. Moreover, sensory disturbances were found in the tibia and foot. Passive hallux dorsiflexion and plantar flexion were causing acute intense pain. A triplex ultrasound was negative for deep vein thrombosis. Apart from the clinical findings, the diagnosis of compartment syndrome was confirmed after evaluating intracompartment pressure measurements. The patient was taken emergently to the operating room for four-compartment fasciotomies. A large intramuscular hematoma was evacuated. Skin closure was accomplished in two stages within two weeks. Six weeks postoperatively, there was no sign of compartment syndrome sequelae and the patient was free of symptoms without any neurovascular deficiency in the operated limb and walked without crutches. Ten weeks later, he returned to his pre-injury daily activities. Although the majority of compartment syndrome cases are reported after high-energy trauma, patients with both coagulation disturbances and anticoagulation treatment are at higher risk of developing compartment syndrome secondary to simple fracture patterns.

Conservative Treatment of Isolated Dorsal Dislocations of Fourth and Fifth Carpometacarpal Joints: A Report of a Rare Case.

Carpometacarpal (CMC) dislocations without associated fractures of the adjacent bones are extremely infrequent injuries. Dorsal or volar dislocations occur after high-energy injuries and may lead to early post-traumatic arthritis and carpal instability. The purpose of this study was to present a case of dorsal dislocation of both the fourth and fifth CMC joints that were treated with closed reduction and casting. A 31-year-old man developed severe acute pain, functional limitation, and deformity of the wrist after falling from a height. The clinical examination revealed intense localized tenderness, swelling, and palpable prominence over the fourth and fifth metacarpals. Standard anteroposterior and lateral views demonstrated dislocations of the examined CMC joints without any accompanied fracture. The injury was treated with anatomic closed reduction and cast immobilization for overall five weeks followed by early mobilization. Twelve weeks after injury, the patient had regained grip strength, and six months post-traumatically he satisfactorily returned to his previous hard labor-intensive activities without any functional deficits or chronic pain. Conclusively, CMC dislocations can be treated conservatively in case of early diagnosis and stable anatomic closed reduction.

Management of Heel Pad Degloving Injury After Severe Foot Crush Injury: A Case Report Study.

Crush injuries of the foot and ankle are uncommon and they have a poor prognosis leading to some form of disability. Degloving injuries of the heel and foot after crush injuries are rare and very challenging to manage due to the need for reconstruction of both osseous and soft tissue architecture. We present a salvage strategy for an open injury to the foot with extensive soft tissue detachment from the plantar and dorsal surface. A 30-year-old man was transferred to the Emergency Department from a neighboring hospital with a crush injury to the foot that had resulted in a degloving injury of the heel pad, after a motorcycle accident. The patient had a 20 cm circumferential wound that was extending from dorsal to the plantar surface along with rupture of the extensor digitorum longus (EDL) tendons and transection of the superficial peroneal nerve. There was an extensive detachment of soft tissues from the deep fascia and bones, whereas the posterior tibial artery was intact. In radiographic imaging, a small inferior avulsion fracture of the calcaneus along with fractures of the cuneiform bones was revealed. The initial management involved thorough surgical debridement, removal of necrotic tissues, repair of EDL tendons and fracture stabilization. Negative-pressure wound therapy was also applied for six weeks. Subsequently, a split-thickness skin graft was used to cover the skin defect. Six months after injury, the patient had a normal range of motion, intact sensation over the sole and could ambulate independently. Although the majority of heel pad degloving injuries have a poor prognosis, there are positive prognostic factors as presented in the current case for a satisfying functional final outcome, which include vascular intergrity, fracture stabilization, soft-tissue reconstruction with negative pressure wound therapy, and application of skin grafts.

Low-grade central osteosarcoma of distal femur, resembling fibrous dysplasia.

We report a case of a 32 year-old male, admitted for a lytic lesion of the distal femur. One month after the first X-ray, clinical and imaging deterioration was evident. Open biopsy revealed fibrous dysplasia. Three months later, the lytic lesion had spread to the whole distal third of the femur reaching the articular cartilage. The malignant clinical and imaging features necessitated excision of the lesion and reconstruction with a custom-made total knee arthroplasty. Intra-operatively, no obvious soft tissue infiltration was evident. Nevertheless, an excision of the distal 15.5 cm of the femur including 3.0 cm of the surrounding muscles was finally performed. The histological examination of the excised specimen revealed central low-grade osteosarcoma. Based on the morphological features of the excised tumor, allied to the clinical findings, the diagnosis of low-grade central osteosarcoma was finally made although characters of a fibrous dysplasia were apparent. Central low-grade osteosarcoma is a rare, well-differentiated sub-type of osteosarcoma, with clinical, imaging, and histological features similar to benign tumours. Thus, initial misdiagnosis is usual with the condition commonly mistaken for fibrous dysplasia. Central low-grade osteosarcoma is usually treated with surgery alone, with rare cases of distal metastases. However, regional recurrence is quite frequent after close margin excision.