Our investigation sought to describe a patient who exhibited refractory prosthetic joint infection (PJI) coupled with debilitating peripheral arterial disease, necessitating the extreme measure of hip disarticulation (HD). Despite prior instances of HD for PJI, this case stands out for its combination of an exceptionally high infection load and advanced vascular disease, which defied all prior treatment approaches.
We document a rare case of an elderly patient who, having previously undergone a left total hip arthroplasty, developed PJI and severe peripheral arterial disease, and subsequently underwent a hemiarthroplasty procedure, leaving the hospital with only minimal complications. Before this major surgical undertaking, numerous attempts at surgical revisions and antibiotic schedules were made. The peripheral arterial disease occlusion led to a failed revascularization procedure for the patient, and as a consequence, a necrotic wound arose at the surgical site. Irrigation and debridement of associated necrotic tissue failing to yield positive results, along with concerns about cellulitis, prompted the patient-approved hyperbaric oxygen therapy (HD) procedure.
Hemipelvectomy (HD), a procedure reserved for the most severe lower limb conditions, represents a minuscule portion (1-3%) of all lower limb amputations, and is used only when faced with extremely detrimental conditions such as infection, ischemia, or trauma. Reported figures for complication rates and five-year mortality rates have been as extreme as 60% and 55%, respectively. Despite the observed rates, this patient's case demonstrates a situation in which early identification of HD indicators stopped any further negative developments. This case illustrates that high-dose therapy is a plausible treatment option for patients with severe peripheral arterial disease who, despite revascularization attempts and prior moderate treatment, remain resistant to treatment. However, the scarce availability of data on high-definition imaging, along with a spectrum of comorbid conditions, compels further analysis of the resultant outcomes.
In the realm of lower limb amputations, the highly specialized HD procedure is exceptionally uncommon, comprising only 1-3% of the total. It is employed only for the most severe indications, including infection, ischemia, and trauma. The figures for five-year mortality rates and complication rates are both reported to be as high as 55% and 60%, respectively. Although these rates existed, the patient's case exemplifies a scenario where early detection of HD indicators averted subsequent detrimental consequences. Considering the circumstances of this case, we posit that high-dose therapy is a rational treatment option for individuals with severe peripheral arterial disease who have been unresponsive to revascularization and prior moderate treatment strategies. Yet, the restricted availability of data involving high-definition modalities and assorted comorbid conditions warrants more in-depth analysis concerning consequences.
Long bone deformities, a consequence of X-linked hypophosphatemic rachitis (XLHR), the most prevalent hereditary form of rickets, often demand multiple surgical correction procedures. read more Adult XLHR patients demonstrate a reported high prevalence of fractures. This study details a case of femoral neck stress fracture in an XLHR patient, treated by correcting the mechanical axis. The literature search did not locate any previous studies that examined the combination of valgus correction and cephalomedullary nail fixation.
At the outpatient clinic, a 47-year-old male patient with a diagnosis of XLHR presented with the chief complaint of severe pain in his left hip. Radiographic imaging, in the form of X-rays, exposed a left proximal femoral varus deformity and a concurrent femoral neck stress fracture. Despite a lack of pain improvement and radiographic evidence of healing after a month, a cephalomedullary nail was utilized to address the proximal femoral varus deformity and the cervical neck fracture. read more By the eighth month of follow-up, radiographic images demonstrated healing of the femoral neck stress fracture and the proximal femoral osteotomy, resulting in relief from hip pain.
The literature was scrutinized for any case reports pertaining to the fixation of femoral neck fractures in adult patients secondary to coxa vara. The conditions coxa vara and XLHR are associated with the risk of femoral neck stress fractures. A surgical procedure for a unique femoral neck stress fracture in a XLHR patient with coxa vara was outlined in this study. Pain relief and bone healing were obtained through the method of combined deformity correction and fracture fixation with a femoral cephalomedullary nail implant. A patient with coxa vara undergoing cephalomedullary nail insertion, along with the technique for deformity correction, is shown.
The literature was examined for any case reports describing the fixation of femoral neck fractures in adults who had coxa vara. Coxa vara and XLHR are both implicated in the development of femoral neck stress fractures. A surgical technique for addressing a rare femoral neck stress fracture in a patient affected by both XLHR and coxa vara was detailed in this study. The combination of deformity correction and fracture fixation, specifically with a femoral cephalomedullary nail, yielded positive results in pain relief and bone healing. The steps of correcting deformities and placing cephalomedullary nails in coxa vara patients are detailed and shown.
Benign, expansile, and locally aggressive, aneurysmal bone cysts (ABCs) are a group of lesions, usually presenting as fluid-filled cysts, primarily in the metaphyseal areas of long bones. Atypical etiologies and uncommon presentations are often observed in children and young adults who are commonly affected by these conditions. Treatment modalities for this condition encompass en bloc resection, curettage with or without bone grafting or substitution, instrumentation, sclerosing agents, arterial embolization, and adjuvant radiotherapy.
A 13-year-old male presented to the emergency room with a severe right hip pain and inability to ambulate after a trivial fall while playing, exhibiting a rare case of ABC and a proximal femoral pathological fracture. Open biopsy curettage was performed, subsequent to which modified hydroxyapatite granules were implanted, along with internal fixation using a pediatric dynamic hip screw and a four-hole plate for the subtrochanteric fracture, resulting in a favorable outcome.
For these distinctive cases, there is a lack of a standardized management principle; curettage, combined with bone grafts or substitutes and coexistent internal fixation of any related pathological fractures, continually achieves bony union with appropriate clinical success.
These cases' unique presentations prevent the establishment of a uniform management guideline; the combination of curettage with bone graft or substitute materials, coupled with internal fracture fixation, consistently leads to successful bony union and satisfactory clinical outcomes.
Total hip replacement surgery can unfortunately be followed by periprosthetic osteolysis (PPO), a severe complication. Immediate measures are critical to preventing its spread to nearby tissues and potentially restoring proper hip function. A patient with PPOL underwent a particularly intricate and challenging course of treatment, which we now present.
A 75-year-old patient with PPOL, whose disease subsequently encompassed the pelvic and soft tissues, is detailed 14 years following their primary total hip replacement procedure. Throughout the course of treatment, the synovial fluid aspirate from the left hip joint displayed a consistently elevated neutrophil-dominant cell count, while microbiological cultures proved negative. Significant bone loss, coupled with the patient's general state of health, made further surgical treatment inappropriate, and the strategy for future actions is undecided.
Overcoming severe PPOL presents a formidable challenge, given the scarcity of surgical interventions promising sustained positive long-term outcomes. To avert the more severe progression of complications, prompt treatment is required if an osteolytic process is suspected.
Surgical strategies for severe PPOL are often hindered by a scarcity of procedures that yield enduring positive long-term effects. Treatment of a suspected osteolytic process is urgently needed to prevent the escalation of any complications arising from it.
Ventricular arrhythmias, encompassing premature ventricular contractions, non-sustained ventricular tachycardia, and life-threatening sustained varieties, can occur in patients experiencing mitral valve prolapse (MVP). Among young adults who experienced sudden death, the presence of MVP, as ascertained from autopsy series, has been estimated at a rate between 4% and 7%. Subsequently, arrhythmic mitral valve prolapse has emerged as an underappreciated factor in sudden cardiac deaths, consequently leading to heightened interest in the study of this correlation. A small population of patients with arrhythmic MVP experience frequent or complex ventricular arrhythmias, unassociated with other arrhythmic mechanisms. MVP, with or without mitral annular disjunction, may be a factor in this particular group. We are still in the process of developing a comprehensive understanding of their coexistence, especially in terms of modern management and prognosis. Although recent consensus documents offer direction, the diverse literature surrounding arrhythmic mitral valve prolapse (MVP) necessitates a summary of the supporting evidence for diagnostic methods, prognostic insights, and focused therapies for MVP-related ventricular arrhythmias. read more We also encapsulate recent findings about left ventricular remodeling, which increases the difficulty of mitral valve prolapse coexisting with ventricular arrhythmias. Predicting the risk of sudden cardiac death linked to MVP-associated ventricular arrhythmias is difficult, as available evidence is limited and primarily derived from retrospective studies with insufficient data. Consequently, we sought to compile potential risk factors from existing key reports, with the goal of incorporating them into a more trustworthy predictive model, which will necessitate further prospective data collection.