ABSTRACT
Guide wire plays an important role in the fixation of femoral neck fracture with dynamic hip screw (DHS). Breakage of a guide wire during operation is a very rare condition. We met such a dilemma in DHS fixation of a 54-year-old male patient who sustained Garden type IV fracture of the right femoral neck. The distal end of the guide wire broke and was entrapped in the fractured femoral neck. We tried to get the broken part out by a cannulated drill. Reaming was started with the cannulated drill slowly rotating around the guide K-wire until the reamer fully contained the target under fluoroscope. A bone curette was used to get the broken wire out but failed, so we had to use the cannuated drill to dredge this bone tunnel. Finally the broken wire end was taken out, mixed with blood and bone fragments. Through the existing drilling channel, DHS fixation was easily finished. The patient had an uneventful recovery without avascular necrosis of femoral head or non-union of the fracture at one year's follow-up. A few methods can be adopted to deal with the broken guide wire. The way used in our case is less invasive but technically challenging. When the guide wire is properly positioned, this method is very practical and useful.
Subject(s)
Humans , Male , Middle Aged , Bone Wires , Device Removal , Femoral Neck Fractures , Diagnostic Imaging , General Surgery , Fracture Fixation, Internal , Methods , RadiographyABSTRACT
<p><b>OBJECTIVE</b>To compare the effects of soy isoflavone with supplemental calcium to soy isoflavone or Ca alone on preservation of bone mineral density (BMD) and the expression of insulin-like growth factor (IGF)-I.</p><p><b>METHODS</b>Sprague-Dawley (SD) female Rats, 6 months old, were ovariectomized and randomized into five groups: sham-operated group (n = 10) or ovx (n = 40) group. Shams were fed a 3.272 g/kg Ca diet. Ovx rats were randomized to a 3.272 g/kg Ca diet alone (OVX) or with soy isoflavone (SI) extract (37.95 mg/kg.bw) or to a supplemental Ca diet (Ca, 4.676 g/kg) alone or a supplemental Ca diet with the isoflavone extract (SI + Ca) for 12 weeks. BMD of femur was measured by scanner of bone mineral density. The level of IGF-1 mRNA expression was measured by reverse transcriptase-polymerase chain reaction (RT-PCR), respectively.</p><p><b>RESULTS</b>There was no significant difference between group Sham (0.267 +/- 0.008) and group SI + Ca (0.263 +/- 0.007) g/cm(2) (P > 0.05) on femur BMD of distal end. Femur BMD of distal end in group Sham and group SI + Ca was greater (P < 0.05) as compared to group OVX (0.245 +/- 0.005) g/cm(2), SI (0.258 +/- 0.011) g/cm(2) or Ca (0.255 +/- 0.004) g/cm(2), P < 0.05. The liver tissue IGF-1 mRNA contents (IGF-1 cDNA/B-actin cDNA) were significantly decreased in group Sham (0.200 +/- 0.023) g/cm(2), SI (0.278 +/- 0.019) g/cm(2), Ca (0.302 +/- 0.026) g/cm(2) or SI + Ca (0.231 +/- 0.025) g/cm(2) as compared to group OVX (0.362 +/- 0.031) g/cm(2), P < 0.05; The liver tissue IGF-1 mRNA contents (IGF-1 cDNA/B-actin cDNA) were significantly decreased in group SI + Ca (0.231 +/- 0.025) g/cm(2) compared to group SI (0.278 +/- 0.019) g/cm(2) and Ca (0.302 +/- 0.026) g/cm(2), P < 0.05.</p><p><b>CONCLUSIONS</b>Soy isoflavones combined with supplemental Ca are more protective against the loss of femur BMD than soy isoflavones or supplemental Ca diet alone. The dose of SI (37.95 mg/kg.bw) might significantly restrain the rising of the liver tissue IGF-1 mRNA contents caused by ovariectomy.</p>