ABSTRACT
Introduction: The purpose of this study was to determine if augmentation of the helical blade with polymethylmethacrylate bone cement decreases the rates of varus cut-out and medial perforation in geriatric intertrochanteric hip fracture fixation. Methods: This was a retrospective comparative cohort study at two urban Level I trauma centers. Patients with an intertrochanteric hip fracture (classified as AO 31A1-3) who were treated with the TFN-Advanced Proximal Femoral Nailing System (TFNA) from 2018 to 2021 were eligible for the study. Medical records and post-operative radiographs were reviewed to determine procedure complications and reoperations. Results: Of the 179 patients studied, cement augmentation (CA) was used in 93 patients (52%) and no cement augmentation (NCA) was used in 86 (48%). There were no significant differences between group demographics and fracture reduction grades. Varus cut-out occurred three times in the CA group and five times in the NCA group (p = 0.48). Medial perforation occurred three times, all in the NCA group (p = 0.11). The most frequent complication was symptomatic blade lateralization from fracture collapse, with eight occurrences in the CA group compared with two in the NCA group (p = 0.10). There were 10 reoperations in the CA group and 9 in the NCA group (p = 0.99). The most common reason for reoperation was varus cut-out and the most common revision procedure was hip arthroplasty. Conclusions: Intertrochanteric hip fractures treated with the TFNA fixation system with and without cement augmentation have similar complication profiles and reoperation rates.
ABSTRACT
Neurologic deficit after lumbar spine surgery is a rare and serious complication that must be promptly diagnosed and treated to avoid long-term neurologic disability. Anterior lumbar interbody fusion (ALIF) is an effective technique for the treatment of recurrent disc herniation and lumbar disc degeneration. This case report describes a 20-year-old female with L5-S1 recurrent disc herniation and lumbar degeneration. She underwent an L5-S1 ALIF complicated by post-operative lower left extremity paralysis. Revision surgery with downsizing of the ALIF cage was performed with normal neuromonitoring throughout the procedure. The patient displayed persistent post-operative neurologic deficits despite no evidence of central or foraminal compression. Patient was later diagnosed with conversion disorder by neurology during her hospitalization. This case report presents the initial diagnosis of conversion disorder after a routine ALIF procedure, which led to surgical re-exploration and prolonged inpatient hospital stay. Psychiatric diagnoses must be considered when neurologic deficits are present with no apparent organic cause.
ABSTRACT
CASE: An 18-year-old male polytrauma patient sustained a high-energy posterior fracture dislocation of his left elbow associated with a comminuted and irreparable O'Driscoll type 2 subtype 3 anteromedial facet coronoid fracture. He underwent early coronoid reconstruction using ipsilateral olecranon osteoarticular autograft with incorporation of the sublime tubercle attachment of the medial collateral ligament and repair of the lateral ulnar collateral ligament. A 3-year follow-up revealed a functional, painless, congruent, and stable elbow. CONCLUSION: Early reconstruction of a highly comminuted coronoid fracture may be a useful salvage option for the polytrauma patient, thereby avoiding complications associated with late reconstruction of posttraumatic elbow instability.
