Profunda Femoris Pseudoaneurysm and Fatal Hemorrhage 2 Weeks After Modified Girdlestone Resection Arthroplasty: A Case Report.

CASE: A 62-year-old nonambulatory female patient presented with wound dehiscence and purulent bloody drainage 2 weeks after modified Girdlestone resection arthroplasty for subtrochanteric femur fracture. On developing an enlarging thigh hematoma and hemodynamic instability, the patient was taken to the vascular suite where a profunda femoris artery pseudoaneurysm was identified and ligated by the vascular surgery team. The proximal free edge of the resected femur was determined to be the likely cause of arterial injury. Two days later, the patient was taken by the orthopaedic surgery team for debridement and revision resection arthroplasty, but she ultimately decompensated and died. CONCLUSION: We believe this to be the first reported case of this serious complication of the Girdlestone procedure. We hope this case helps bring awareness to the complication and aids in early detection and prompt treatment of femoral artery complications.

Optimal Sequence of Corrective Surgeries for Concomitant Valgus Knee and Rigid Pes Planus Deformities: The Knee-First Approach.

In patients requiring surgical correction of ipsilateral valgus knee and rigid pes planovalgus deformities, the optimal operative sequence is controversial. Growing evidence suggests these 2 deformities are related in etiology and interrelated in disease course. We present the case of a 72-year-old female with concomitant valgus knee and rigid pes planovalgus deformities successfully treated with total knee arthroplasty followed by triple arthrodesis and Achilles lengthening. Surgical correction of these deformities must be carefully planned between the operating surgeons to avoid over- or under-correction of alignment that could further impact gait. In contrast with the limited available literature, the authors recommend correction at the knee first and the foot and ankle second. Further prospective studies are needed to elucidate the best operative sequence in these patients.

Contralateral Gluteal Compartment Syndrome After Prolonged Use of a Fracture Table in a Scissoring Position: A Case Report.

CASE: A 62-year-old Caucasian man presented with a comminuted subtrochanteric fracture after a low-energy fall. Physical examination postoperatively revealed a firm hard gluteal compartment in the contralateral buttocks. The patient underwent a fasciotomy, using the Kocher-Langenbeck approach, to release the gluteus maximus and lateral thigh fascia. At the most recent 6-month follow-up, gluteal function was intact with no long-term sequelae from compartment syndrome. CONCLUSION: Prolonged positioning on a fracture table can result in gluteal compartment syndrome of the contralateral extremity.

Intercalary Tricortical Iliac Crest Graft for Treatment of Midclavicle Nonunion With Bone Loss: Two Case Reports and Review of Literature.

Several articles support the use of cancellous iliac crest bone grafting in the treatment of clavicle nonunion; however, there is very little literature on the use of tricortical iliac crest grafts in the setting of clavicle nonunion with bone loss. When it has been studied, tricortical grafting has been shown to produce radiologically confirmed union in the clavicle, leaving patients satisfied with the ultimate outcome. We present two cases of clavicle fracture nonunion successfully treated with tricortical interposition bone grafting. In the first case, a 45-year-old female presented with an atrophic left midshaft clavicle fracture nonunion with failed hardware that had undergone two previous attempts at fixation without achieving union. She was treated with a structural interposition iliac crest bone graft with plate fixation and regained full painless function of the arm with radiographic fracture union. In the second case, a 50-year-old male presented after a left midshaft clavicle fracture that had undergone acute stabilization, followed by revision for nonunion that was unsuccessful, resulting in persistent nonunion with bone loss. He was treated with a tricortical iliac crest bone graft and plate fixation. Cultures from the time of surgery did grow Staphylococcus epidermidis and Propionibacterium acnes, and he was treated with intravenous vancomycin for six weeks. The patient's clavicle went on to union and he regained full, painless function by his six-month follow-up visit. These cases demonstrate the use of tricortical interposition bone grafting with compression plating as a viable option for rare instances in which previous surgical intervention has failed to progress a midshaft clavicle fracture to union.

Betwixt and Between: Intracranial Perspective on Zygomatic Arch Plasticity and Function in Mammals.

The zygomatic arch is morphologically complex, providing a key interface between the viscerocranium and neurocranium. It also serves as an attachment site for masticatory muscles, thereby linking it to the feeding apparatus. Though morphological variation related to differential loading is well known for many craniomandibular elements, the adaptive osteogenic response of the zygomatic arch remains to be investigated. Here, experimental data are presented that address the naturalistic influence of masticatory loading on the postweaning development of the zygoma and other cranial elements. Given the similarity of bone-strain levels among the zygoma and maxillomandibular elements, a rabbit and pig model were used to test the hypothesis that variation in cortical bone formation and biomineralization along the zygomatic arch and masticatory structures are linked to increased stresses. It was also hypothesized that neurocranial structures would be minimally affected by varying loads. Rabbits and pigs were raised for 48 weeks and 8 weeks, respectively. In both experimental models, CT analyses indicated that elevated masticatory loading did not induce differences in cortical bone thickness of the zygomatic arch, though biomineralization was positively affected. Hypotheses were supported regarding bone formation for maxillomandibular and neurocranial elements. Varying osteogenic responses in the arch suggests that skeletal adaptation, and corresponding variation in performance, may reside differentially at one level of bony architecture. Thus, it is possible that phenotypic diversity in the mammalian zygoma is due more singularly to natural selection (vs. plasticity). These findings underscore the complexity of the zygomatic arch and, more generally, determinants of skull form. Anat Rec, 299:1646-1660, 2016. © 2016 Wiley Periodicals, Inc.