Iatrogenic Brachial Artery Injury During Long Proximal Humeral Interlocking System (PHILOS) Plating.

Iatrogenic vascular injuries are rare but potentially serious complications that can occur during orthopedic procedures involving the proximal humerus. We present a case report of a patient who sustained a brachial artery injury during a long Proximal Humeral Interlocking System (PHILOS) plating procedure for a proximal humeral fracture. A 62-year-old female patient with a left humerus proximal 1/3 shaft fracture underwent open reduction and internal fixation with a long PHILOS plate. During the procedure, difficulty was encountered in achieving adequate plate positioning due to osteoporotic bone and fracture comminution. Upon insertion of a distal second last screw, brisk brachial artery bleeding was encountered. Immediate hemostasis measures were taken, and a plastic surgeon was consulted. The brachial artery injury was identified and repaired with a cephalic vein graft harvested and flushed. Postoperatively, the patient developed median nerve neuropraxia. This case highlights the risk of iatrogenic brachial artery injury during left humerus proximal 1/3 shaft fracture fixation, especially in cases with technical challenges due to osteoporotic bone or comminution. Prompt recognition, involvement of vascular surgery, and appropriate management are crucial in mitigating potential devastating consequences. Associated neurological complications, such as nerve injuries, can also occur and should be monitored. Meticulous surgical technique, anatomical awareness, and vigilant monitoring are essential to minimize the risk of vascular and neurological complications during these procedures. Iatrogenic brachial artery injury is a rare but potentially serious complication of humerus proximal 1/3 shaft fracture. Early recognition, multidisciplinary involvement, and appropriate management strategies are crucial in optimizing patient outcomes and preventing long-term morbidity.

An Unusual Presentation of Intramuscular Cysticercosis in a Vegetarian Patient: A Case Report.

Cysticercosis is a parasitic infection. It can involve any tissue in the body, the brain being the most common site. Intramuscular cysticercosis is rare, and few cases have been reported. Here, we are reporting a case of incidental finding of intramuscular cysticercosis in a 22-year-old male having a purely vegetarian diet presented with pain, swelling, and tingling sensation in the forearm without any other systemic involvement after taking Albendazole for unrelated reasons. Diagnosis of intramuscular cysticercosis remains a challenge and should be considered in the differential diagnosis of intramuscular swelling, especially in endemic areas.

A Rare Case of Transepiphyseal Distal Femur Fracture Dislocation With Delayed Recovery of a Common Peroneal Nerve Injury.

The aim of this study is to bring attention to a unique case and our approach to treatment in this context. We describe a case of an 11-year-old male who presented to us with an injury to his left knee following trauma with pain, swelling, shortening and deformity for one day. An X-ray revealed a transepiphyseal fracture dislocation of the left distal femur (Salter-Harris type 1 injury) and neurovascular examination was conclusive of foot drop which pointed towards injury to common peroneal nerve (CPN). The patient was taken up for closed reduction with percutaneous pinning under mobile C-arm guidance. The fracture was reduced and fixed with two cross K-wires and immobilized with the above knee anterior-posterior slab for six weeks. The wires were removed after six weeks but there was no improvement in the dorsiflexion of the left ankle. An electromyography (EMG) and nerve conduction velocity (NCV) study test was performed after 12 weeks which showed decreased amplitude and prolonged latency in the left CPN with early denervation of the muscles supplied by the left CPN. Fifteen weeks of follow-up showed complete recovery in the dorsiflexion of the left ankle with a slight lag in the extension of the left great toe making this an unusually delayed recovery of CPN palsy following a distal femur transepiphyseal fracture.

Unusual Presentation of Cerebral Fat Embolism Syndrome Post-femur Fracture: A Case Study and Diagnostic Insights.

Cerebral fat embolism syndrome (CFES) is a rare but certainly devastating impediment following long bone fractures. The diagnosis of CFES primarily depends on identifying clinical manifestations like respiratory distress, petechial rash, and neurological symptoms. However, in rare instances, CFES can manifest with atypical or absent clinical features, posing diagnostic challenges. Here, we present a rare case report of a woman in her 20s who developed CFES after suffering a femur shaft fracture devoid of conventional clinical features. The diagnosis of CFES was built upon clinical suspicion and a typical MRI brain finding of a starfield pattern. Our case highlights the importance of including CFES in the differential diagnosis of neurological deterioration, especially after long bone fractures. We suggest early plate osteosynthesis to stop more emboli from forming in people with FES, as well as continuous neuromonitoring and a reminder that CFES can show up without any other signs or symptoms in the body.

A Neglected Fracture of Acetabulum Treated With Total Hip Replacement.

Total hip replacement (THR) for osteoarthritis or inflammatory arthritis yields better outcomes than THR for patients with neglected acetabular fractures. The inferior clinical results mostly arise from an unforeseen bone deficit, making the treatment more time-consuming and complex for instances requiring acetabular restoration and bone grafting. There is a lack of research on the clinical results of THR in cases where acetabular fractures have been overlooked. A 55-year-old male patient presented with a malunited anterior column of the acetabulum, non-union of the posterior column with protrusion, and a significant impaction fracture in the femoral head. He was then treated with open reduction and internal fixation (ORIF) of acetabular columns, along with the use of a reconstruction cage and bone grafting. At the five-year follow-up, the patient had a good outcome. The keys to success include meticulous preoperative planning using radiography and computed tomography (CT) scans, sufficient exposure to define the fracture pattern, and the availability of a full range of devices and backup implants. If there are any prior implants, they should only be removed if they are infected or in the way of cup implantation. However, if there is a significant amount of bone loss, complex fractures may require extensive repair using revision total hip arthroplasty (THA) implants.