Surgical options for improving the ipsilateral femoral neck, shaft, and distal femoral fracture: A case report and literature review.

INTRODUCTION AND IMPORTANCE: Ipsilateral proximal, shaft, and distal femur fractures are extremely uncommon. It might be challenging and contentious to treat ipsilateral multi-level femur fractures. There are still unanswered questions regarding the order of fracture types that should be repaired first and the type of implant that should be used. CASE PRESENTATION: A twenty-nine-year-old male patient was assessed at the emergency department after a motorcycle accident. The patient had a clearly deformed left lower extremity and was complaining of pain in the left thigh. Preoperative radiographs revealed ipsilateral multi-level femur fracture on the left thigh involved basicervical fracture of femur (AO/OTA 31-B3) with transverse shaft fracture of femur (AO/OTA 32-A3) and extra articular supracondylar femur fracture (AO/OTA 33-A2). CLINICAL DISCUSSION: First, we performed proximal femur nail antirotation in order to stabilize the fracture of the femur neck and reduce the incidence of nonunion and avascular necrosis of the femoral head in young adults. The next step to fix the shaft and distal femur fracture was to perform the distal femur locking plate. The EQ5D and Harris Hip Score questionnaires showed improvement after implementing these procedures. CONCLUSION: Ipsilateral multi-level femur fractures have challenges and controversies in their management. In this situation, proximal femur nail antirotation and distal femur locking plates are viable options due to the condition of the injury and the higher risk of negative effects. After all fractures have been fixed, it is important to closely monitor the hip and knee joints to avoid stiffness or contracture.

Ligament reconstruction with modified suture anchor fixation technique for chronic distal radioulnar joint instability: A case report and literature review.

INTRODUCTION: The chronic instability of the DRUJ should be appropriately treated. Ligament reconstruction in the original technique needs an adequate length of the graft, which needs to be modified in such a case. CASE PRESENTATION: A 27-year-old male presented with right wrist pain accompanied by limited movement that has been felt for the last two months. There was an obvious deformity with tenderness. Palpation revealed a positive ballottement and piano-key sign test. An X-ray examination revealed a union fracture one-third distally on the right radius bone with dorsal dislocation of the right distal radioulnar joint. The result of an MRI confirmed a triangular fibrocartilage complex tear. The patient was diagnosed with chronic DRUJ instability. DISCUSSION: We performed a chronic DRUJ reconstruction using the harvesting palmaris longus tendon. However, the length of the graft is too short. Further, we performed a modified technique with suture anchor fixation for this patient. This technique could be a helpful alternative if the length of the graft is insufficient. As a result, there was an improvement in the DASH score and EQ5D questionnaires. CONCLUSION: Chronic DRUJ instability could be treated by ligament reconstruction with modified suture anchors fixation in the inadequate length of the graft situation.

Successful megaprosthesis in a nearly amputated lower extremity after crush injury: A case report and literature review.

Crush injury is one of the most challenging decisions for a surgeon to decide whether to proceed with an amputation or salvage a limb. We presented a 24-year-old man who complained of having suffered a crushed thigh 12 h before admission to the hospital. The patient was driving a truck and hit the iron bridge barrier, which penetrated his left thigh. The patient's left foot was cold, pallid, and pulseless, with a MESS score of 11. The femur x-ray showed a displaced fracture of the left femur associated with a 15 cm bone defect. The patient was diagnosed with a crush injury on the left femur with vascular compromise. We performed a proximal femoral megaprosthesis for a crush injury on the lower extremity, After the sixth year's follow-up, it shows a good outcome and increased quality of life for this patient. In addition, there was an improvement in the Harris Hip Score and EQ5D score. Megaprosthesis used to treat a crush injury revealed good functional outcomes despite the MESS score of 11. A multi-professional approach to the patient is essential for decision-making regarding limb salvage rather than the use of a score.

Successful lumbal sympathetic block as an alternative therapy for improving Buerger's disease: A rare case report and literature review.

INTRODUCTION AND IMPORTANCE: Buerger's disease is an inflammation of blood vessels that is strongly related to smoking habits. Lumbal sympathetic block is one kind of lumbal sympathectomy intervention that is used to manage chronic pain, including Buerger's disease. In this case report, we present the case of a Buerger's disease patient treated with a lumbal sympathetic block procedure. CASE PRESENTATION: A 63-year-old male was referred to our emergency room with chronic pain and ulcers on his left foot. He had already undergone two debridement procedures at his previous hospital without any improvement. After a comprehensive assessment, our cardio-thoracic specialist chose to refer the patient to undergo the lumbal sympathetic block with the orthopaedic specialist. After two procedures, we found a reduction in pain (VAS 6-7 to 2-3), the skin looked more colored, and the patient's walking distance improved from 10 to 100 m without any complaints. We also found good wound healing of the ulcers in his left foot; they became smaller and dryer. CLINICAL DISCUSSION: Lumbal sympathetic block is thought to be able to reduce peripheral retention that causes the opening of an arteriovenous anastomose, thus increasing blood flow to skin tissue and leading to vasodilatation. It showed its capability to prevent Buerger's disease progression, reduce patient complaints, and heal the wound. CONCLUSION: Lumbal sympathetic block should be considered as an alternative therapy for Buerger's disease.

Good outcome after an 8-year radial head resection on a Monteggia fracture in a young patient: A case report and literature review.

INTRODUCTION AND IMPORTANCE: Monteggia fractures are proximal ulna fractures that involve radial caput displacement. Radial caput excision or resection is only suggested in situations of Monteggia lesions with radial caput fractures. Radial head resection should be avoided because the radial head is the principal stabilizer of the elbow and forearm. In this case report, we present a case of radial head resection at a young age after Monteggia reconstruction. CASE PRESENTATION: A 26-year-old female came to the orthopaedic clinic for removal implant control after eight years postoperatively, patient had motorcycle accident at 2015 and performed ORIF Monteggia fracture with radial head resection. The patient also showed good alignment of the antebrachi, and there were no limitations in performing supination, pronation, and flexion of elbow and wrist movements. There were also no complications related to the radial head resection from the x-ray examination. CLINICAL DISCUSSION: After eight years postoperatively of ORIF Monteggia reconstruction with radial head resection showed a good outcome and improved quality of life for this patient. There was improvement in DASH and MEPS scores. CONCLUSION: Patients with radial head resection at a young age after Monteggia reconstruction had good results and should be considered.

One-year follow-up after partial sacrectomy without stabilization in sacral chordoma: A case report and literature review.

INTRODUCTION AND IMPORTANCE: Chordoma is a rare sarcoma of the bone with a slow-growing nature but an aggressive nature locally. The subtle onset and minor symptoms cause a delayed diagnosis. Unfortunately, Chordoma is discovered when the prognosis is poor, which make the management procedure more difficult. CASE PRESENTATION: A 56 years old woman presented with back pain, bowel and bladder dysfunction, and numbness around the anus for the last six months. Sensory examination revealed hypoesthesia on the S2-S4 dermatomes and the rectal toucher revealed a mass. Pelvic x-ray revealed an osteolytic lesion on the sacrum and a MRI revealed a sacrum mass on S2. Confirmed by a CT Scan lumbosacral contrast that revealed a solid mass with osteolytic and osteosclerotic changes on the sacrum bone from S2 to the coccyx. We performed a partial en bloc sacrectomy by posterior approach with an inverted goblet incision without lumbopelvic stabilization. CLINICAL DISCUSSION: A few months after surgery, the patient still had some similar complaints and went to physiotherapy and radiotherapy on a regular basis. 1 year follow-up, there was no recurrence process proven by adjunct examination and the improvement was demonstrated by the relief of back pain, and ability to do daily activities. CONCLUSION: Chordoma can be improved by partial sacrectomy without lumbopelvic stabilization that revealed good results from function and complication. A multi-professional approach to the patient is essential.