Coma from fat embolism syndrome after hemiarthroplasty of the hip for metastatic breast cancer to the proximal femur: a case report.

We present a case report of fat embolism syndrome (FES) that resulted in prolonged coma after cemented hemiarthroplasty in a patient with metastatic breast cancer. After the cemented hip prosthesis was placed, the patient developed decreased sensorium that progressed to coma in association with hypoxemia and tachypnea. Pulmonary compromise was mild, and the patient required only supplemental oxygen for support. The patient demonstrated no petechiae. Magnetic imaging results were consistent with FES. While the pulmonary symptoms resolved quickly, the patient remained unresponsive for 11 days without purposeful motor function. After waking she recovered rapidly, and at her 2-month follow-up appointment, demonstrated no adverse orthopedic, pulmonary, or neurologic sequelae.

Serious, often subtle, finger injuries: avoiding diagnosis and treatment pitfalls.

Three common finger injuries-proximal interphalangeal (PIP) injuries, mallet finger, and skier's thumb-present unique diagnostic and treatment challenges. Careful history-taking and physical examination are, of course, essential for diagnosing these injuries, but appropriate x-rays are often pivotal. For PIP joint dislocations and fracture-dislocations, extension block splinting is often appropriate, but surgery may be required for an unstable injury. Most mallet finger injuries can be treated with a Stack splint, but functional deformity may necessitate surgery. Skier's thumb can be a bony or ligamentous injury; to avoid fragment displacement, radiographs should be obtained before stressing the joint. Treatment includes a thumb spica cast for a nondisplaced fracture or stable joint, referral for a displaced fracture, and surgery for an unstable joint.

The long accessory flexor muscle: an anatomical study.

A total of 136 lower limbs from 68 human cadavers were dissected to determine the incidence of the long accessory flexor muscle and its origins and insertions. The muscle was present in 11 of 136 lower extremities (8%) and 9 of 68 cadavers (13%). Five long accessory flexor muscles originated from the tibia and fascia of the deep posterior compartment and six began on the fibula. All of the tendons were deep to the laciniate ligament and coursed within the tarsal tunnel. All five of the tendons originating from the tibia inserted on the quadratus plantae, with two of the tendons having an additional insertion on the flexor digitorum longus. Three of the tendons with fibular origin inserted on the quadratus plantae and three inserted on the flexor digitorum longus. The importance of the long accessory flexor muscle relates as a cause or association with tarsal tunnel.