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INTRODUCTION: Symptomatic calcification of ligamentum flavum (CLF) is a rare condition of the cervical spine compared to other degenerative diseases. CLF manifests as myelopathic symptoms due to the compression of the spinal cord. Calcium pyrophosphate dihydrate (CPPD) deposition disease is the most prevalent cause of CLF. This is the first reported case of CLF caused by CPPD in the Middle East. PRESENTATION OF CASE: A 75-year-old female patient presented with gait disturbance for two years. The imaging studies demonstrated two symmetric bulging masses with a density similar to bone between the inferior border of the C5 laminae and the superior border of the C6 laminae. Histologic evaluation of the resected tissue confirmed the CLF and CPPD disease pathology. The patient underwent a C5-C6 laminectomy. The symptoms resolved, and in a six-month follow-up period, the walking improved. DISCUSSION: The diagnosis of CLF due to CPPD is based on the interpretation of the symptoms concurrent with MRI, CT scan, and histopathological examination. Due to the high reoccurrence rates of the condition following the pharmacological treatment and sub-optimal response in those with negative inflammatory markers, open decompression with either cervical laminectomy or laminoplasty is considered the gold-standard therapeutic option in CFL due to CPPD deposition disease. CONCLUSION: CLF is a rare cervical spine disorder that compresses the spinal cord and manifests as myelopathic symptoms. Early surgical intervention, preferably in the first five months of the disease initiation, is associated with favorable outcomes.
RESUMO
INTRODUCTION AND IMPORTANCE: Femoral neck fractures account for roughly half of the two million hip fractures that occur each year worldwide. There is a high rate of neglected cases and potential complications such as nonunion or avascular necrosis (AVN) in developing countries. More than 30 % of patients may experience non-union following a femoral fracture. There is no consensus on the best neglected femoral neck fracture treatment. CASE PRESENTATION: A 30-year-old female known case of rheumatoid arthritis came with a neglected femoral neck fracture to our center. We salvaged the viable hip by subtrochanteric valgus osteotomy and fixation by angled blade plate (ABP). After eight months, she returned with left hip pain and nonunion of the fracture and osteotomy sites. We refixed the fracture with a longer ABP together with autografting of both sites. After two years, she had complete union, full hip range of motion, and painless ambulation. CLINICAL DISCUSSION: Subtrochanteric valgus osteotomy is susceptible to nonunion especially in patients with medical comorbidities. CONCLUSION: Careful selection of osteotomy site and appropriate fixation device might prevent of non-union.
RESUMO
Complex pelvic ring injuries in childhood can be difficult to treat, and literature mentions several techniques for fixing SIJ fracture-dislocations. In accordance with the CAse REport (CARE) guidelines, this study describes a five-year-old boy with a complex pelvic ring fracture caused by a car accident: vertically unstable pelvic fracture consists of bilateral superior rami fractures and type I of Denis sacral fracture. Fixation was achieved by inserting a 6.5 mm major diameter cannulated screw with a 60 mm length and 16 thread into the SIJ at the level of S1. The pelvic inlet view corrected the anterior-posterior position, and the pelvic outlet view adjusted the superior-inferior position to determine a suitable sacral level. After three months, the SI joint has shown an anatomically fracture consolidation, and he could ambulate with full weight-bearing and full ROM with no pain. A 3-year follow-up showed promising results in radiological and functional terms. We conclude that percutaneous SI screw fixation using a cannulated screw is a suitable technique for pediatrics because it provides anatomic reductions and is minimally invasive. Children as young as five can be treated safely with SI screws for sacral fractures and SIJ injuries.
