Disappearing bone disease: a case report.
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Abstract:
Disappearing bone disease is a rare condition and usually affects young adults. Its aetiology is not known. A case of a 12-year-old female child, who had a fall and sustained a fracture mid shaft of femur and supracondylar region, is reported. On follow-up subsequent X-ray showed extensive osteolysis which was progressively affecting the other side of the pelvic girdle and femur. She was put on trial of calcitonin 50 IU by nasal spray for six months but there was no improvement. However, during the past three and half years the disease process had progressively extended to the other side of pelvic girdle and femur with fatal outcome. To the knowledge of the authors such progression in a short time has not been reported in any case so far.Keywords:
Pelvic girdle
Etiology
Osteolysis
Femur fracture
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Disappearing bone disease is a rare condition and usually affects young adults. Its aetiology is not known. A case of a 12-year-old female child, who had a fall and sustained a fracture mid shaft of femur and supracondylar region, is reported. On follow-up subsequent X-ray showed extensive osteolysis which was progressively affecting the other side of the pelvic girdle and femur. She was put on trial of calcitonin 50 IU by nasal spray for six months but there was no improvement. However, during the past three and half years the disease process had progressively extended to the other side of pelvic girdle and femur with fatal outcome. To the knowledge of the authors such progression in a short time has not been reported in any case so far.
Pelvic girdle
Etiology
Osteolysis
Femur fracture
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A prospective study of 120 Chinese patients with trochanteric fractures treated with the surgical method of Ender's Nailing was undertaken. The average age of the patients was 79 years (ranged from 57 to 105 years). The follow-up period ranged from 4 to 18 months, with an average of 8 1/2 months. The mortality rate was 6%. There was no incidence of non-union, delayed union or deep wound infection. Local complications included extrusion of the nails, perforation of the femoral head, supracondylar fracture of the femur, mild limb shortening and external rotational deformity. Hip and knee pain occurred in a small percentage of patients but these tended to improve with time. Weight bearing walking could be started in the first week after operation in most of the patients. The functional result at 6 months was good in 73% of the patients. This method had the advantage of a limited surgical approach, minimal blood loss and good functional result. Analysis of the causes of the local complications indicated that if operative precautions were taken, morbidity could be reduced.
Perforation
Delayed union
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We experienced 10 cases with hip disease for renal failure for 5 years. 10 patients with an average age of 54.3 years underwent operative treatment. They consisted of 3 hip fractures, 2 avascular necrosis of the femoral head, 2 coxarthrosis' and 3 ectopic calcification of the hip joint. The average hemodialysis period was 9.3 years, and the average follow-up period was 2.9 years.1 femoral neck fracture case showed nonunion after fixation with screws, for which we performed cemented bipolar hemiart-hroplasty. Revision was however required due to osteolysis around the prosthesis. Because the ratio of loosening due to hemodialys is still high, further tmprorement of the operation is neccessary.
Avascular Necrosis
Osteolysis
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Objective: We investigated causes and results of revision surgeries after artificial disc replacement of cervical spine (C-ADR).Methods: Twenty-one patients (mean age: 52.8) who underwent revision surgery after C-ADR and who had a minimum 2-year of follow-up were included into this study.The mean time between the primary and revision surgeries was 21 months.During their primary surgeries, 14 patients underwent single level C-ADR, 2 two-level C-ADR, and 5 two-level hybrid surgery for 16 radiculopathy, 3 myelopathy, and 2 adjacent segment diseases.Causes for revision surgeries were at least one of the followings: 17 poor patient selections, 7 insufficient decompressions, 7 malpositions, 6 subsidences, 3 osteolysis, and 1 postoperative infection.Results: Sixteen patients underwent anterior removal of C-ADR, one-level discectomy and fusion (N ¼ 11), two-level discectomy (N ¼ 3) or one-level corpectomy (N ¼ 2) and fusion.Three patients of keel type C-ADR with heterotopic ossification underwent posterior laminoforaminotomy and fusion.Two patients underwent combined procedures due to infection or severe subsidence and osteolysis.At the 2year follow-up, neck (7.3 vs 1.6) and arm (7.0 vs 1.3) visual analog scales and Neck Disability Index score (46.7 vs 16.32) were improved (all, p < 0.05).According to Odom's criteria, 86% of the patients were satisfied and 91% achieved solid fusion.No major complications developed except for transient dysphagia in 6 patients (29%).Conclusions: In this small case series, revision surgeries provided successful outcomes in failed C-ADR without major complications.Careful patient selection and meticulous surgical techniques are important to avoid disappointing clinical outcome or even failure of C-ADR.Level of evidence: Level IV, Therapeutic study.
Corpectomy
Osteolysis
Neck pain
Discectomy
Diskectomy
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The goal of the current study was to analyze patients treated with the Gamma nail, and to describe techniques that prevent commonly reported complications. One hundred patients with closed peritrochanteric femur fractures were treated by one surgeon using the Gamma nail. Ninety patients met the minimum 6 month followup requirement. Eighty-eight of the 90 fractures (98%) healed after the index procedure. There were nine (10%) complications (nine patients) with four patients (4%) requiring surgical intervention. One patient required total hip arthroplasty because of nonunion, and one patient required cerclage wiring of a postoperative femoral fracture. The third patient had an infection develop which resolved after debridement and a course of antibiotics. The fourth patient complained of thigh pain, which resulted in hardware removal. In the five remaining patients with complications, one patient had multi-infarct dementia and the family refused additional treatment, two patients with intraoperative femur fractures did not require treatment and two patients with thigh pain did not require additional treatment. Surgical time averaged 53 minutes and blood loss averaged 104 cc. Percutaneous fixation using the Gamma nail is effective in treating patients with peritrochanteric fractures. Surgical time and blood loss were minimized, early weightbearing was initiated, and previously reported complications were decreased.
Femoral fracture
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Twenty-seven femoral shaft fractures in 23 patients with acute spinal cord injuries were reviewed for evaluation of the outcome of operative versus nonoperative treatment. Three groups were identified: 11 nonoperative, eight early operative, and eight delayed operative. Patients treated initially by nonoperative methods developed five impending nonunions (31%), which subsequently were treated by open reduction and internal fixation. One femur in each of the operative groups developed a re-fracture after early removal of metal fixation devices. In the delayed operative group, four patients (50%) required manipulation under general anesthesia for treatment of poor knee motion. Patients with complete neurologic lesions whose femurs were treated nonoperatively incurred more complications, i.e., decubitus ulcers, than those treated operatively. Operative stabilization of the femur within six weeks of injury rendered the most favorable outcome with the least number of orthopedic or medical complications in patients with both complete and incomplete cord lesions. All of the eight fractures united.
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Purpose: The purpose of this study was to evaluate the short term follow-up results of minimally invasive (MI) two-incision total hip arthroplasty (THA) for treating acute displaced femoral neck fractures in active elderly patients. Materials and Methods: We performed a retrospective review of 39 cases (average age: 72 years old, range: 60 years and above) of elderly patients who underwent MI two-incision THA within 30 days of their injury for treating displaced acute femoral neck fracture s. They were followed up for a minimum of 12 months. Clinical evaluation was done by comparing the pre-injury and postoperative daily activities, the Harris Hip score (HSS) and the Western Ontario and McMaster University (WOMAC) score. The radiographs were checked to evaluate for implant alignment and periprosthetic abnormalities. The postoperative complications were analyzed. Results: The average postoperative HSS was 88.3 and the average WOMAC s core was 28.8. All the patients were able to walk without any assistive device. One patient had a HHS of less than 70. There were 2 dislocations but there was no recurrence. Radiographically, there was no case with a limb length discrepancy of more than 5mm. The femoral stems did not reveal any subsidence of more than 5mm. Other complications such as osteolysis, infection, neurologic injury and intraoperative periprosthetic fracture were not noted. Especially, no patient complained of any groin pain, which often occurs after bipolar hemiarthroplasty. Conclusion: The short term follow-up results were good for MI two-incision THA to treat acute displaced femoral neck fractures in active elderly patients, and these procedures were done by an experienced hip surgeon.
WOMAC
Groin
Harris Hip Score
Osteolysis
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Five hundred eight consecutive cases (481 patients) treated with the extensively porous coated Anatomic Medullary Locking prosthesis were followed for an average of 9 years (range, 5-14 years). Thirty-one (6%) hips were lost to followup and 33 (7%) hips had complications that required revision surgery. The indications for revision were symptomatic stem loosening (six cases), symptomatic cup loosening (five cases), asymptomatic periarticular osteolysis (seven cases); trochanteric fracture through an osteolytic cyst (four cases), polyethylene fracture (five cases), sepsis (one case), and heterotopic ossification (one case). The surgical treatment of these complications is described. After these revisions, 11 (33%) cases had additional complications, most commonly a dislocation. Four required a second revision. Questionnaires and physical examinations were used to compare the outcome of the cases requiring revision with the outcome of those that did not. There were no differences in patient satisfaction between cases requiring revision surgery and those that did not (97% and 95% patient satisfaction, respectively). Function was also similar between the two groups, with 93% reporting increased function in each group.
Sports medicine
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Femur fracture
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The goal of the current study was to analyze patients treated with the Gamma nail, and to describe techniques that prevent commonly reported complications. One hundred patients with closed peritrochanteric femur fractures were treated by one surgeon using the Gamma nail. Ninety patients met the minimum 6 month followup requirement. Eighty-eight of the 90 fractures (98%) healed after the index procedure. There were nine (10%) complications (nine patients) with four patients (4%) requiring surgical intervention. One patient required total hip arthroplasty because of nonunion, and one patient required cerclage wiring of a postoperative femoral fracture. The third patient had an infection develop which resolved after debridement and a course of antibiotics. The fourth patient complained of thigh pain, which resulted in hardware removal. In the five remaining patients with complications, one patient had multi-infarct dementia and the family refused additional treatment, two patients with intraoperative femur fractures did not require treatment and two patients with thigh pain did not require additional treatment. Surgical time averaged 53 minutes and blood loss averaged 104 cc. Percutaneous fixation using the Gamma nail is effective in treating patients with peritrochanteric fractures. Surgical time and blood loss were minimized, early weightbearing was initiated, and previously reported complications were decreased.
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