Missed diagnosis of femoral deep artery rupture after femoral shaft fracture: A case report.

BACKGROUND: Vascular injury is a rare complication of femoral shaft fractures, and rupture of the deep femoral artery is more difficult to diagnose because of its anatomical location and symptoms. Despite its low incidence, deep femoral artery rupture can lead to life-threatening outcomes, such as compartment syndrome, making early identification and diagnosis critical. CASE SUMMARY: A 45-year-old male patient was admitted to our hospital due to right lower limb trauma in a car accident, with complaints of severe pain and swelling on his right thigh. X-ray demonstrated a right femoral shaft fracture. During preparation for emergency surgery, his blood pressure and blood oxygen saturation dropped, and sensorimotor function was lost. Computed tomography angiography was performed immediately to confirm the diagnosis of rupture of the deep femoral artery and compartment syndrome, so fasciotomy and vacuum-assisted closure were performed. Rhabdomyolysis took place after the operation and the patient was treated with appropriate electrolyte correction and diuretic therapy. Twenty days after the fasciotomy, treatment with the Hoffman Type II External Fixation System was planned, but it was unable to be immobilized internally based on a new esophageal cancer diagnosis. We kept the external fixation for 1 year, and 3 years of follow-up showed improvement of the patient's overall conditions and muscle strength. CONCLUSION: For patients with thigh swelling, pain, anemia, and unstable vital signs, anterior femoral artery injury should be highly suspected. Once diagnosed, surgical treatment should be performed immediately and complications of artery rupture must be suspected and addressed in time.

Percutaneous kyphoplasty for the treatment of osteoporotic thoracolumbar fractures with neurological deficit: radicular pain can mimic disc herniation.

Osteoporotic vertebral fractures (OVFs) are the common disease found in elderly population. Neurological deficit in OVFs is rare despite the involved posterior cortex of the fractured vertebral body, severe kyphotic deformity, or the instability at the fracture site. OVF with resulting neurological deficit was considered as a contraindication for vertebral augmentation techniques. We reported a rare case of a 75-year-old woman with L1, L2 osteoporotic vertebral fractures and L5/S1 disc herniation who presented with back pain and radicular pain extending along the posterior aspect of the left leg. Physical examination showed slight weakness of her flexor hallucis longus and absence of ankle jerk on her left leg. The result of a straight leg-raising test was limited to an angle of 50 degrees. The radiographs showed that the nerve root was compressed by the retropulsed bone fragment of the L2 vertebral body and a herniated disc at the level of L5/S1 on the left side. After L1 and L2 kyphoplasty the radicular pain as well as the back pain was completely disappeared. At her two-year follow-up examination, the patient was completely symptom free and reported no radicular pain. This case suggested that minimally invasive techniques such as kyphoplasty or vertebroplasty are effective in certain OVF patients with neurological deficit. Radicular pain could be caused by osteoporotic fracture that involves the posterior cortex of the vertebral body. Understanding the anatomy of nerve roots and pathogenetic mechanism of radicular pain is particularly important for treatment option.

The application of a zero-profile implant in anterior cervical discectomy and fusion.

We analyzed the clinical efficacy of the Zero-P implant (Synthes GmbH Switzerland, Oberdorf, Switzerland) in the treatment of single level cervical spondylotic myelopathy. The clinical data of 47 patients with single level cervical spondylotic myelopathy were retrospectively analyzed. Twenty-two patients were treated with a Zero-P implant (Group A) and 25 with a titanium plate with cage (Group B) between January 2009 and September 2010. Operative time, intraoperative blood loss, preoperative and postoperative Japanese Orthopaedic Association (JOA) scores and JOA recovery rate, dysphagia incidence and adjacent segment degeneration rate were measured. The mean operative time in Group A and Group B was 98.18 minutes and 105.4 minutes, respectively. The average intraoperative blood loss in Group A and Group B was 87.95 ml and 92.4 ml, respectively. There were no statistical differences in operation time and intraoperative blood loss between the two groups (p>0.05). The JOA score was significantly improved in the two groups (p<0.001), and the recovery rate was similar (60.86% for Group A versus 62.95% for Group B, p>0.05). Dysphagia was experienced by one (4.5%) patient in Group A and eight (32%) patients in Group B, which was significantly different (p=0.044). There was no statistical significance found in the adjacent level degeneration rates between Group A and Group B (p=0.330). The Zero-P implant and traditional titanium plate with cage are effective treatments for single level cervical spondylotic myelopathy, but the Zero-P implant has a lower dysphagia incidence.