Bilateral femoral neck stress fractures in military recruits with unilateral hip pain.

Femoral neck stress fractures are rare and can be easily missed and failure to diagnose these injuries early can lead to avascular necrosis, malunion and osteoarthritis. It is important to have a high index of suspicion for femoral neck stress fractures in military recruits. We present three cases of bilateral femoral neck fractures in military recruits, all presenting with unilateral hip symptoms and signs. All the asymptomatic contralateral hips had femoral neck stress fractures diagnosed by screening MRI. Tension type and displaced femoral neck fractures were treated surgically. All the fractures managed healing without complications. Military recruits with unilateral groin pain should have an early referral for MRI hip to rule out femoral neck stress fractures and those military personnel with ipsilateral femoral neck fracture should have MRI of the contralateral hip. Two of the patients had vitamin D deficiency, of which one had elevated parathyroid hormones and low bone mineral density. Our case series highlights the significance of vitamin D deficiency among military recruits.

Wrist gouty arthritis presenting as scaphoid erosions with scapholunate ligament disruption.

We report a 43-year-old man who presented with features of acute wrist inflammation with scapholunate dissociation. Radiologically, erosions were noted in the proximal pole of the scaphoid. The patient underwent wrist arthrotomy, exploration and washout with intraoperative bacterial cultures and histology specimens were obtained. Histological analysis revealed the diagnosis of gout. We discuss the clinical presentation and literature review of this topic. This case illustrates that gout may mimic infection.

Inadequate dietary calcium intake in elderly patients with hip fractures.

INTRODUCTION: Calcium supplementation and pharmacotherapy are recommended in the preventive management of osteoporosis. Many previous studies report of underdiagnosis and undertreatment of osteoporosis among elderly patients with hip fractures. We undertook this study to determine the dietary calcium levels in our local elderly population who were admitted with hip fractures. METHODS: 77 patients, between the ages of 60 and 98 years of age, and admitted to our department between January 2001 and September 2001 for hip fractures, were studied. The dietary calcium intakes of these patients were determined by a food frequency questionnaire and a detailed diet history. Bone mineral density (BMD) studies were performed on 55 of these patients to confirm the diagnosis of osteoporosis. RESULTS: The mean daily calcium intake was found to be 650 mg. Only six of our hip fracture patients (7.8 percent) had a daily calcium intake above the recommended levels of 1,000 mg per day. For the 55 patients who had BMD performed, only one patient had a BMD within the normal range. 34 patients (64.2 percent) had hip T-scores in the osteoporotic range and 18 patients (33.9 percent) had hip T-scores in the osteopenic range. We found that the patients with BMD in the osteoporotic and osteopenic ranges had no significant difference in the dietary calcium intake. CONCLUSION: The dietary calcium intake of our elderly patients with hip fractures is insufficient. They would benefit from dietary education and calcium supplements to prevent deterioration in bone density and subsequent osteoporotic fractures.

Traction and spica casting for closed femoral shaft fractures in children.

PURPOSE: To evaluate the treatment outcome of skin traction followed by spica casting for closed femoral shaft fractures in children. METHODS: Between September 1997 and December 2001 inclusive, outcomes of 63 children aged one month to 15 (mean, 5.3) years with closed femoral shaft fractures managed with skin traction and spica casting were reviewed. Depending on age, patients were kept in traction from 2 to 15 (median, 9) days, then in spica casts for 2 to 8 (median, 5) weeks. RESULTS: Bony union took 3 to 12 (median, 6) weeks. There were no malunion, nonunion, or rotational deformities. Nor were there any significant limb length discrepancies, pressure sores, or nerve palsies. On no occasion was a spica cast removed and reapplied for loss of fracture reduction. At final follow-up, limb length discrepancy was noted in 14 (22%) of the patients, but none had a discrepancy of greater than 1.5 cm or a short-legged gait. CONCLUSION: Skin traction followed by spica casting for closed femoral shaft fractures in children is safe, cost-effective and associated with a low complication rate. It is effective in children below 5 years of age and no less effective in older children, except in instances of open fracture, multiple fractures, or older children with large statures, which conditions render them intolerant to spica casts.

True digital artery aneurysm of the ring finger: a case report.

True aneurysms of the digital artery are very rare. Only 13 cases, caused by chronic trauma from occupational or sports-related overuse, have been reported. We present the first case of a true aneurysm of the digital artery of the left ring finger caused by chronic repetitive trauma from a wedding ring. The patient was a 44-year-old teacher who presented with a 1.5-cm subcutaneous mass on the radial aspect of the proximal phalanx of the finger, just proximal to the proximal interphalangeal joint. Exploration of the mass revealed a 1-cm aneurysm continuous with the radial digital artery. The aneurysm was excised and the proximal and distal ends of the radial digital artery ligated. Microscopic examination of the excised specimen confirmed the diagnosis of a true aneurysm with the lumen filled with an organising thrombus. The patient had an uneventful recovery with good wound healing, intact sensation, and normal capillary return.