Fractura por estrés del cuello del fémur en una niña hiperactiva tratada con metilfenidato: Reporte de caso / Femoral neck stress fracture in a hyperactive child taking methylphenidate. Case report

Las fracturas por estrés afectan, con mayor frecuencia, a personas físicamente activas con hueso normal y son infrecuentes en los niños con placa de crecimiento abierta. Aun más infrecuentes son las fracturas por estrés del cuello femoral en la población pediátrica. Sin embargo, constituyen entidades muy importantes debido al riesgo de complicaciones graves, como la necrosis avascular. Se describe el caso de una niña de 7 años medicada con metilfenidato que sufrió una fractura por estrés del cuello del fémur atípica. La paciente consulta por dolor inguinal derecho sin limitaciones en las actividades cotidianas. La radiografía muestra una fractura por estrés del cuello del fémur, que se confirma con tomografía. Se instaura un tratamiento conservador, y la paciente está asintomática a las cuatro semanas. Este caso representa una alerta sobre esta infrecuente entidad en la que podrían presentarse errores diagnósticos. Investigaciones recientes también sugieren la posible participación de fármacos, como el metilfenidato, en la desmineralización ósea, que podría constituir un posible factor de riesgo de fractura. Nivel de Evidencia: IV

Stress fractures most commonly affect physically active individuals with normal bone, and they are rare in children with open growth plates. Even rarer are femoral neck stress fractures in pediatric age. Nevertheless, they constitute a very important entity due to the risk of severe complications, such as avascular necrosis. A seven-year-old girl, treated with methylphenidate, who suffered an atypical femoral neck stress fracture is presented. Patient complained of right inguinal pain without daily life activity limitations. The radiograph showed a stress femoral neck fracture, confirmed by CT imaging. Conservative treatment was instituted and the patient became asymptomatic after 4 weeks. This case report alerts the clinicians about this rare entity that might be misdiagnosed. Recent research also suggests a possible involvement of drugs, such as methylphenidate, in bone demineralization, which might constitute a possible risk factor for fractures. Level of Evidence: IV

Bone Mineral Density and Prevalence of Osteoporosis in Postmenopausal Korean Women with Low-Energy Distal Radius Fractures

The aim of this study was to evaluate the bone mineral density and the prevalence of osteoporosis in postmenopausal Korean women with low-energy distal radius fractures and compared with those of aged-matched normal Korean women. Two hundred and six patients with distal radius fractures between March 2006 and March 2010 were included in this study. Patients were divided into three groups by age; group 1 (50-59 years), group 2 (60-69 years), and group 3 (70-79 years). Controls were age-matched normal Korean women. The bone mineral density values at all measured sites, except for the spine, were significantly lower in group 1 than those of control. While the bone mineral density values in group 2 and 3 were lower than those of controls, these differences were not statistically significant. All groups had significantly higher prevalence of osteoporosis at the Ward's triangle; however, at the spine, femoral neck and trochanteric area it was not significantly different from those of age-matched controls. Although the prevalence of osteoporosis of the postmenopausal women with low-energy distal radius fractures may not be higher than that of the control, osteoporosis should be evaluated especially in younger postmenopausal patients to prevent other osteoporotic hip and/or spine fractures.

Femoral neck fracture; outcome of unipolar hemiarthoplasty in elderly patients

Objective of this study determines the outcome of unipolar hemiarthoplasty in elderly patients with femoral neck fracture at Liaquat University Hospital Hyderabad/ Jamshoro. Total 50 elderly patients were included in the study with femoral neck fracture and all the cases were selected from accident, emergency and OPD. All the patients with the history of pregnancy, those patients who were unfit for anesthesia, malignancy, neurological deficits of lower extremity, rheumatoid arthritis and Parkinson's disease regarding with systemically disease were excluded from the study. All the patients under went surgical hemiarthoplasty treatment with Austin moor-femoral head prosthesia. In the last all postoperative complications, functional outcome and mortality were noted on proforma. Total 50 patients were included in the study. Mean age of this study was mean +/- SD 64.98 +/- 4.13. Females were found in majority with male/ female ratio 1:1.27. Post operative pain was noted in the 50% of the cases and out of them severe pain was noted only in 4% of the cases. Superficial infection was seen in 4% of the cases and deep infection was not found in the cases and death was occurred in 10% of the patients. On the outcome, excellent results were found in the 44.44% of the study participants, good and fair results were seen in 26.66% and 20% respectively, while poor results were seen in 8.88% of the patients. It is concluded that unipolar hemiarthoplasty is of the reliable procedure by use of Austin-moor femoral head prosthesia for the treatment of femoral neck fracture in elderly

False Femoral Neck Fracture Detected during Shaft Nailing: A Mach Band Effect

Femoral neck fractures are associated with femoral shaft fractures in 1% to 9% of cases. Undisplaced neck fractures are susceptible to displacement during shaft nailing. We report the case of a 57-year-old male patient in whom we performed standard intramedullary nailing for a femoral shaft fracture. In doing so, we identified a vertical radiolucent line at the femoral neck, which was thought to be further displacement of a hidden silent fracture or an iatrogenic fracture that developed during nail insertion. Consequently, we decided to switch to reconstructive femoral nailing. Postoperative hip imaging failed to show the femoral neck fracture that we saw in the operating room. Here, we discuss the aforementioned case and review the literature concerning this artifact.

Propedêutica radiológica do impacto femoroacetabular em tempos de tomografia computadorizada e ressonância magnética: o que o radiologista precisa saber / Radiological propedeutics of femoroacetabular impingement in times of computed tomography and magnetic resonance imaging: what a radiologist needs to know

Após breve descrição dos tipos de impacto femoroacetabular, este trabalho demonstra o protocolo de radiologia convencional, tomografia computadorizada e ressonância magnética para os casos de impacto, desenvolvido nos últimos oito anos em parceria com serviços de referência em ortopedia. Demonstra-se a propedêutica radiológica básica de cada método, revisando os aspectos mais relevantes na avaliação do quadril.

Following a brief description of the types of femoroacetabular impingement, the present article describes the protocol of conventional radiology, computed tomography e magnetic resonance imaging for cases of impingement, developed over the last eight years in a partnership with reference orthopedic institutions. Basic radiological propedeutics is described for each of the methods, reviewing the most relevant findings in the assessment of the hip.

[Stress fracture of femoral neck [Report of 3 observations]]

Authors bring back 5 cases of fractures of stress of the femoral collar respectively at 3 patient aged of 26, 36 and 47 years with bilateral reach in 2 cases. The diagnosis of stress fracture has kept before a bundle of arguments to know: the traumatic absence and the existence of an obvious intense physical activity in case, the pathological antecedent absence, the normality of the biologic balance well as the reminiscent radiological aspect. The treatment consisted in a vissage in 4 cases total arthroplastie of the hip in a case. To the light of these 3 observations and a magazie of the literature, authors analyze epidemiologic, etiopathogenic and physiopathologic aspects aspects as well as the therapeutic possibilities of the fractures of stress of the femoral collar. They also underline especially the gravity of this pathology and the interest of data of the imagery to the precocious stadiums of the illness the scintigraphie and the IRM, the key of the treatment being the precocious

Evolución de una fractura de cadera en pacientes mayores de 90 años: estudio observacional / Evolution of a hip fracture in patient bigger than 90 years: I study observational

Del período 1992-97 se revisaron 25 fracturas del fémur proximal en mayores de 90 años. La relación Femenino/Masculino fue de 3.1/1 (19/6) ninguno procedía de una institución de salud o de cuidados de enfermería. El 72 por ciento cumplía con labores domésticas y eran independientes en su domicilio y en la comunidad. El 32 por ciento no tenía ningún tipo de enfermedad el 72 por ciento no consumía medicamento. El 20 por ciento fumaba o masticaba chimo. El 64 por ciento con fractura en el área del trocánter. Permanecieron hospitalizados entre 0-15 días el 72 por ciento y el 95 por ciento se intervino en este mismo lapso. Los implantes más utilizados para resolver este tipo de lesión eran: para las fracturas del trocánter mayor la placa angulada de 95 grados en el 62 por ciento (8/13) y para las del cuello femoral la prótesis de Thompson en el 67 por ciento de las lesiones (4/6), es de hacer notar que 6 pacientes con fracturas del cuello femoral no se intervinieron. El en 47 por ciento de los casos la cirugía duro 91 y 120 minutos, al 79 por ciento se le suministró anestesia general. En los primeros 6 meses no se murió ningún paciente, en los siguientes 180 días falleció el 100 por ciento de los no operados el 26 por ciento (5/19) de los intervenidos. Entre 1 y 3 años mortalidad ascendió al 47 por ciento (9/19), el 26 por ciento sobrevivió más de 3 años. Luego de la cirugía el 64 por ciento no camino el 70 por ciento quedó con acortamiento, el 75 por ciento con dolor y el 50 por ciento con algún tipo de incapacidad. El 67 por ciento de estas complicaciones están relacionadas con la placa angulada de 95 grados.

Transient osteoporosis with bilateral fracture of the neck of the femur during pregnancy: a case report.

A case of bilateral non-nion of femoral neck fracture during the last trimester of pregnancy was reported. Bilateral hemiarthroplasty with bipolar prosthesis was performed in May, 2000. The result after one year follow-up was excellent.