Pseudoaneurysm of the Anterior Tibial Artery after Reduction with Pointed Bone Reduction Forceps on a Spiral Fracture of the Distal Tibia: A Case Report

This paper reports a pseudoaneurysm of the anterior tibial artery after reduction with pointed bone reduction forceps on a spiral fracture of the distal tibia. Most reported injuries occurred at the proximal part of anterior tibial artery during drilling of the proximal tibia. To the best of the authors' knowledge, injury of the distal part of anterior tibial artery has never been reported. This paper describes a 54-year-old woman with a pseudoaneurysm of the anterior tibial artery clinically detected 11 weeks after the index surgery. This report highlights the need for surgeons to be aware of and careful about this complication during and after surgical intervention.

Outcomes of Combined Neck and Trochanter Fractures of the Femur Treated with Cephallomedullary Nail in Elderly / 대한고관절학회지

PURPOSE: Proximal femur fractures are classified into intracapsular neck fractures and extracapsular trochanteric fractures, and several related treatment recommendations in elderly patients have already been introduced. Importantly, we have observed cases of combined intra and extracapsular fractures (i.e., ipsilateral neck and trochanter fractures). The purpose of this study is to report the outcomes of combined neck and trochanter fractures of the femur treated with cephalomedullary nail (CMN) in elderly patients. MATERIALS AND METHODS: From January 2010 to December 2014, 410 patients with proximal femoral fractures were fixed using CMN; among this group, 37 patients with combined neck and trochanter fractures were identified. Two of these patients died fewer than three months after injury and another two did not return for follow-up. Thirty-three patients were included and reviewed retrospectively in this study. RESULTS: All patients were injured by simple fall. Bone union was obtained in 28 of 33 patients. Of the five patients who failed treatment, three experienced implant penetration through head (cut-through and cut-out), one had breakage of CMN and the last one had a loosening of internal fixation device with persistent non-union at final follow-up. The former four patients underwent hip replacement surgery and the latter refused surgery because he had low demand in daily life and many medical problems. CONCLUSION: Eighty-five percent of elderly patients with combined neck and trochanter fractures of the femur treated with CMN achieved bone union; these complex fractures require more accurate reduction than usual extra-articular intertrochanteric fractures.

Lateral Femoral Bowing and the Location of Atypical Femoral Fractures / 대한고관절학회지

PURPOSE: Atypical femoral fractures (AFFs) occur in two distinct part, subtrochanter and diaphysis. The aim of this study was to investigate the relationship between the lateral femoral bowing angle and the location of AFF. MATERIALS AND METHODS: This study included a total of 56 cases in 45 patients who underwent surgical treatment between January 2010 and December 2015. For the diaphyseal and subtrochanteric AFFs, we evaluated the relationship between the anatomic location and lateral femoral bowing angle. Lateral femoral bowing angle was measured by two orthopaedic surgeons and average value of two calibrators was used in statistic analysis. Other variables like age, height, weight, body mass index and bone mineral density were also evaluated. We also calculated the cutoff value for the location of the fractures from the raw data. RESULTS: The average lateral femoral bowing angle was 10.10°±3.79° (3°-19°) in diaphyseal group and 3.33°±2.45° (1.5°-11°) in subtrochanter group. Lateral femoral bowing angle was statistically significant in logistic regression analysis. According to the receiver operating characteristic curve, cutoff value for the location of the fracture was 5.25°. In other words, the femoral diaphyseal fractures are more frequent if the lateral femoral bowing angle is greater than 5.25°. CONCLUSION: The lateral femoral bowing angle is associated with the location of the AFFs and the cutoff value of lateral femoral bowing angle was 5.25°.