A novel sliding double flexible intramedullary nail technique for the management of lower extremity long bone fractures and deformities in osteogenesis imperfecta.

This study aimed to investigate the effectiveness of the sliding double flexible intramedullary nail technique (SDFIN) in managing lower extremity long bone fractures and deformities in patients with osteogenesis imperfecta (OI) based on radiographic measurements. This study was conducted involving type III or IV Silence OI patients who underwent treatment with SDFIN for fractures, deformity correction, or previous device failure. The surgical technique involved the insertion of two straight flexible intramedullary nails in each bone segment, with one inserted from the caudal epiphysis and the other from the proximal region. Clinical and radiological outcomes were evaluated with a mean follow-up of 62.8 ±â€…20.3 months. Among the 33 lower extremity long bone segments treated with SDFIN, revision was required in 12 segments, resulting in an overall complication rate of 51.5%. Complications included nail migrations observed in 10 cases, decreased joint range of motion in seven, refractures and malrotations in five, nail fracture, and nail extrusion in one case were observed. The femur group had a complication rate of 50%, while the tibia group had a rate of 53.3%. The SDFIN technique demonstrated satisfactory outcomes in managing leg fractures and deformities in OI patients. The technique showed comparable results to newly designed Faisser-Duval rods at a lower cost. Further research and refinement of the technique are necessary to reduce complications and improve patient outcomes.

Atypical anterior wall fracture extending to anterior inferior iliac spine with preservation of pelvic brim: A case report and literature review.

Key Clinical Message: Anterior acetabular wall fractures that extend into the anterior inferior iliac spine are more likely to be unstable, and more likely to require surgical fixation. Abstract: Conventional acetabular anterior wall fractures originate below the anterior inferior iliac spine (AIIS) level and involve the pelvic brim. Since surgical treatment is preserved for instability and hip incongruency, atypical variation of this fracture usually jeopardizes hip stability. We report on a 33-year-old case of an acetabular anterior wall fracture extending to the anterior inferior iliac spine. He was prepared for the stress test and hip stability checked, that was unstable in extension and external rotation. The joint was exposed with the Smith-Peterson approach. Hip congruency was restored, and the AIIS fragment was stabilized by open reduction. Acetabular anterior wall fracture involving AIIS with preservation of pelvic brim is a rare equivalent of anterior wall fracture that jeopardizes hip stability and should be managed surgically. Anterior approaches are preferred in order to visualize the joint.

Two-step sequential management for hip arthroplasty after hip joint gunshot injury: A case report.

Combined fractures of the femoral head and acetabulum due to hip gunshot injuries (GSI) are rare, and there is no preferred treatment option. We present a 35-year-old male patient who sustained a right hip GSI. Delayed THA with a two-step sequential approach is a feasible management in this situation to manage soft tissue and decrease infection rate. At a 1-year follow-up visit, the pain was relieved, and the function improved significantly, and he had no complaints.

Spinopelvic imbalances are associated with worse postoperative functional outcomes in patients undergoing total hip arthroplasty.

PURPOSE: We aimed to investigate the relationship between spinopelvic imbalances and functional disabilities after total hip arthroplasty in an at least two years of follow-up. METHODS: Patients with normal sagittal alignment and normal motion (PI-LL < 10°, APP < 13°, ∆SS > 10°) were defined as control, and patients with any of sagittal alignment or motion abnormalities were defined as case groups. Visual Analog Scale, SF-36, Harris hip score, HOOS-JR, and complications were recorded. RESULTS: The differences of the means of Harris hip score, HOOS-JR, SF-36, and VAS score in the control and case groups were statistically significant. The mean of these parameters in patients with sagittal balanced (PI-LL < 10°) was much better than patients with sagittal unbalanced (PI-LL > 10°). Same results were noted in patients with decreased (∆SS < 10°) and normal spinopelvic motions (∆SS > 10°). CONCLUSION: Our observations indicate that spinopelvic imbalances are associated with worse postoperative functional outcomes in patients undergoing total hip arthroplasty.

Klebsiella pneumoniae and Enterobacter cloacae Induced Septic Arthritis in a Healthy Adolescent: A Rare Case Report.

Septic arthritis (SA) is a joint inflammation that develops secondary to infectious causes. SA in children is associated with a high rate of morbidity and mortality; therefore, it is regarded as an orthopedic emergency. Because SA of the hip joint usually mimics other musculoskeletal diseases, diagnosis remains challenging. Although this lesion usually shows a good outcome, treatment at an inappropriate time, neglect, or inadequate treatment could lead to poor outcomes. We report on the case of a healthy adolescent who complained of episodes of fever and chills, weight loss, pain in his left hip, and limping. After performing necessary workups, two differential diagnoses of tumor and SA were made. The results of Gram stain and culture of the synovial fluid after surgical excision showed Klebsiella pneumoniae and Enterobacter cloacae complex. To the best of our knowledge, this is the first report of SA due to co-infection with K. pneumoniae and E. cloacae in a healthy patient.