Pelvis Insufficiency Fracture after Total Knee Arthroplasty / 대한정형외과학회잡지

Pelvic insufficiency fracture is a very rare complication after total knee arthroplasty (TKA). This fracture occurs in elderly osteoporotic patients, spontaneously or after minor trauma, and its diagnosis can be difficult unless there is a high degree of clinical suspicion. The consequence of missed pelvic insufficiency fracture can be profound: this fracture may progress into an unstable fracture that leads to significant disability. Bone scans assist in the early diagnosis of this fracture. We present a case of osteoporotic pelvic insufficiency fracture after bilateral TKA. A 76 year-old female underwent bilateral TKA for advanced osteoarthritis in her both knees. She also had osteoporosis, and thus we filled an oral bisphosphonate (weekly Risedronate) prescription. Nine months after TKAs, she presented with significant pain around the left buttock and inguinal area without specific trauma. With the use of plain radiographs and a bone scan, a pelvic insufficiency fracture was detected. We successfully treated the patient with conservative management including rest with a pelvic strap, and continued medication for osteoporosis.

Osteochondroma of the 5th and 6th Cervical Vertebral Body: One Case Report / 대한척추외과학회지

Here, the case of an osteochondroma, which developed on the cervical spine of an 18-year old boy, is presented. Generally, an osteochondroma is very difficult to diagnose, due to their rarity and non-specific or lack of symptoms, and because they show radiolucency on plain X-ray. Due to the neurological symptoms of this patient, including radiating pain and a palpable protruding hard mass, the CT and MRI images were checked for a more accurate radiological evaluation. These images showed evidence of spinal cord compression or obliteration of the neural foramen. An en bloc excisional biopsy of the bony mass and cartilage cap, and a decompressive laminectomy were performed.

Insufficiency Fractures of the Femoral Shaft Associated with Osteoporosis

PURPOSE: To present a clinical experience of the insufficiency fractures of the femoral shaft associated with osteoporosis MATERIALS AND METHODS: From January 1995 to December 2002, four patients (8 cases, four females) more than 1-year follow up were reviewed retrospectively. The mean age was 61 years (range, 55 to 73). Medical records and roentgenograms were reviewed. RESULTS: The fractures were bilateral. Plain film revealed fracture line in six among seven cases excluding 1 displaced fracture at initial presentation. All cases presented osteoporosis, anterolateral bowing of the femur, and hot spot in bone scan. Five cases (four displaced, one impending displaced fracture) underwent interlocking intramedullary nailing and all five of them manifested no evidence of delayed union. The preoperative thigh and knee joint pain improved postoperatively. CONCLUSION: Femoral shaft insufficiency fracture could occur rarely in patients with anterolateral bowing of the femur and postmenopausal osteoporosis. Careful history taking, radiography and bone scan are necessary, and bone scan is helpful for early diagnosis. Once diagnosed as the insufficiency fracture with fracture-related symptoms, prophylactic nailing may be necessary lest complete displaced fracture should occur.