Iatrogenic Lumbar Vertebral Fracture during Osteosynthesis for a Trochanteric Fracture of the Femur in Diffuse Idiopathic Skeletal Hyperostosis.

Vertebral fractures occur with only slight trauma in patients with diffuse idiopathic skeletal hyperostosis (DISH). However, a lumbar vertebra fracture, due to an intraoperative body position has not been previously reported. An 87-year-old woman with kyphosis sustained a left trochanteric fracture of her femur. The patient was placed in a supine position during the operation. Postoperatively, the patient experienced severe right thigh pain. Magnetic resonance imaging revealed an L4 vertebral fracture. Computed tomography revealed ankylosis from the upper thoracic spine to the sacrum. While in a supine position under general anesthesia, the contact of the patient's lower back with operating table likely created a fulcrum at her lumbosacral spine acting as a long lever arm, bearing the mass of her upper body. We performed L1-S2 posterior stabilization. DISH patients with kyphosis placed in a supine position have an increased risk for lumbar vertebral fracture.

A pediatric case of single-level idiopathic cervical intervertebral disk calcification with symptom relapse 1 year after initial onset.

BACKGROUND: To date there has been only 1 reported case of the symptom relapse of pediatric idiopathic intervertebral disk calcification (PIIDC), as described by Yoon and colleagues in 1987, who reported symptom relapse in a patient with multilevel PIIDC. Thus, symptom relapse in patients with single-level PIIDC have not been reported. METHODS: We report here a case of single-level PIIDC with symptom relapse 1 year after the initial onset. RESULTS: The patient was a 7-year-old girl who developed cervical pain and fever up to 38°C without an obvious cause. Computed tomography (CT) revealed calcification in the C4/5 intervertebral disk space and in the epidural space at the C3-5 vertebral levels. The patient was diagnosed with PIIDC and treatment with oral nonsteroidal anti-inflammatory drugs was begun. Both cervical pain and fever gradually improved and resolved in approximately 1 week. CT obtained 6 months after the initial onset showed calcifications localized in the posterior area of the C4/5 intervertebral disk space and reduced epidural calcifications, which had nearly resolved. One year after the initial onset, the patient developed similar symptoms. CT revealed an enlarged calcified lesion in the epidural space. Thus, the patient was diagnosed with symptom relapse of PIIDC. Although there was enlargement of calcifications in the epidural space, there were no calcifications involving the intervertebral disk at the time of relapse. The patient was treated conservatively. Follow-up CT revealed that the lesion resolved with time. CONCLUSIONS: This report described a patient with single-level PIIDC and symptom relapse 1 year after the initial onset. In the case presented herein, calcifications of the intervertebral space had extruded into the epidural space, thus causing a symptom relapse. The patient was treated conservatively at the initial onset and at the time of relapse. The symptoms improved both times. Although patients with single-level PIIDC usually have an uneventful clinical course, it is necessary to be mindful of potential symptom relapse.

Keloid formation after trigger finger release: a case report.

We report a case of keloid formation on the palm of the hand after trigger finger release. A 58-year-old male with trigger finger of the right index, middle and ring fingers was treated with open release at a nearby hospital. Three months after this operation, a progressively enlarging skin lesion formed at the surgical site. A diagnosis was made of keloid formation after trigger finger release, and keloid excision with full thickness skin graft and postoperative radiation therapy was done. One year postoperatively, the patient was asymptomatic and had not experienced a recurrence. This is a first report about keloid formation on the palm after trigger finger release. Our patient had a good outcome with keloid excision, full thickness skin graft and postoperative radiation therapy.

Ulnar nerve palsy associated with closed midshaft forearm fractures.

Ulnar nerve palsy is a rare complication of closed midshaft forearm fractures; only 8 cases have been reported. This article describes a case of ulnar nerve palsy associated with a midshaft forearm fracture. A 12-year-old girl sustained a right midshaft forearm fracture. Whether she had a peripheral nerve injury was unknown due to strong pain. She underwent emergency manual reduction and intramedullary pinning. However, ulnar nerve palsy was remarkable postoperatively and gradually worsened. Therefore, neurolysis was performed 9 weeks later. The nerve had adhered to surrounding scar tissue. Six months after a second surgery, she had no motor dysfunction. The pathogenesis of ulnar nerve palsy complicated with midshaft forearm fractures varies and may be the result of direct contusion, direct damage by a bony spike, bony entrapment after closed reduction, and entrapment by a scar. In the current case, the patient was uncooperative at initial examination. Therefore, it is unknown whether she presented with immediate ulnar nerve palsy after the fracture. However, the ulnar nerve was not entrapped at the fracture site, and the surrounding muscle was intact but adhered to the surrounding scar tissue. The etiology of this case was considered to be entrapment by scar formation. According to a literature search, the authors recommend exploring the nerve approximately 8 to 10 weeks after primary surgery, after which neurological symptoms do not tend to improve.