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Atypical Femoral Fractures due to long-term bisphosphonates therapy

Abstract

Introduction. Bisphosphonates (BPs) represent the main therapy in patients with osteoporosis, although a long-term treatment can lead to atypical fractures.

Material and methods. We conducted a retrospective study between 2008 and 2017 and included 23 female patients with atypical femoral fractures (AFFs). The mean period of BPs therapy administration was 5.2 years. We included 7 subtrochanteric fractures and 18 femoral shaft fractures. Two of the total patients presented bilateral femoral fractures. 18 patients presented prodromal symptoms from 2 to 18 months before the diagnosis of fractures, all of them following low energy trauma. All the patients included in our study underwent surgery with intramedullary nail or gamma nail. The postoperative mean follow-up was 2 years. Results. Of all 23 female patients with a total of 25 fractures – 10 underwent osteosynthesis with gamma nail and 15 underwent osteosynthesis with intramedullary nail. From the total number of patients: 13 patients achieved complete union, 6 presented delayed union and 3 non-union (2 intramedullary nail and one gamma nail), whereas in one patient treated previously with gamma nail we observed implant failure.

Conclusion. The treatment of AFFs after BPs therapy administration represents a challenge for orthopaedic surgeons regarding both surgical technique and postoperative follow-up.

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The epidemiology and influence of osteoarthritis on clinical, laboratory and ultrasound parameters of patients with early rheumatoid arthritis

Abstract

Background: Osteoarthritis (OA) and rheumatoid arthritis (RA) can overlap and the presence of OA can interfere with the evaluation of patients with RA.

Objectives: The aim of this study was to evaluate the possible impact of OA on the clinical, laboratory and ultrasound parameters currently evaluated in patients with early RA (ERA).

Methods: We have evaluated the data obtained from patients with ERA referred to our Early Arthritis Research Center (EARC). Only data from patients who fulfilled EULAR/ ACR 2010 criteria for RA and had symptom duration of less than 12 months were analyzed. All patients underwent clinical examination, laboratory tests and ultrasound (US) examination.

Results: There was a clear predominance of women (62.8%). The mean age was 55.47±13.71 years. At baseline, 21 patients (48.8%) were diagnosed with OA. Hand OA did not influence the values of any of the parameters assessed (p>0.05). For patients with knee OA, significantly higher values were observed only for DAS28 at baseline (p=0.018) as well as after 12 months of observation (p=0.031).

Conclusions: Significantly higher values of DAS28 were observed in patients with ERA who associated knee OA, while the values of SDAI were not influenced, suggesting that SDAI may be superior to DAS28 in evaluating patients with ERA and knee OA. The values of patient’s VAS were not influenced by the presence of hand or knee OA suggesting that these types of OA do not influence the patients’ perception of the disease activity. Moreover, the values of ultrasound scores were not influenced by the presence of OA.

Open access
GCT of knee treated with modular prosthesis-case presentation

Abstract

The GCT is an aggressive benign tumor with metastatic potential, most often within the lungs in 2-3% of the patients. It makes about 5% of total bone tumors and about 15% of total benign bone tumors.

The maximum incidence occurs between 30 and 40 years old, most frequently affecting the long bones epiphysis (distal femur, proximal tibia, and distal radius).

We report the case of a 50-year-old female, with no previous medical history, admitted in the emergency department (ED) for significant pain and functional impairment of the left knee. Clinical examination and imaging tests established the diagnosis of distal femoral tumor.

The patient underwent surgical segmental resection of the tumor within oncological limits and subsequent arthroplasty with cemented modular tumoral prosthesis was performed.

Even if the GCT is a benign tumor, it has an aggressive behavior and malignancy potential with an important impact on quality of life. Due to localization, this type of tumor can quickly manifest clinically, which allows an early diagnosis and a less invasive surgical technique.

Open access
In-hospital mortality rate after osteoporotic hip fracture in Bucharest

Abstract

Introduction: Hip fracture is the most severe consequence of osteoporosis and an important cause of excess mortality in the elderly.

Objective: We aimed to evaluate the in-hospital mortality rate after osteoporotic hip fracture in patients treated surgically or functionally in specialized centers in Bucharest.

Materials and methods: We calculated the in-hospital mortality rate in 745 patients (540 women [72.48%], with a mean age of 79.1 ± 11 years), surgically or functionally treated for fragility hip fracture over a 12 months period.

Results: Average length of hospitalization was 18.12 days. In hospital mortality rate was 5.36% (n=40, women 60%). An important risk factor associated with mortality was age, p=0.001. The male sex was also a risk factor with a mortality rate of 7,8% (n=16), compared to 4.44% in women, p<0.005, with OR of 1.57. Out of the 40 patients, 57.5% had a femoral neck fracture, 35% intertrochanteric, and 5.5% atypical fracture in absence of bisphosphonates. 7.5% had previous fragility fractures. 85% of the patients had a history of one or more cardiac pathologies (34.28% with atrial fibrillation), 57.5% underwent surgical intervention (n=23) with an average day of intervention of 8.82 after admission. None of the patients had an osteoporosis treatment before the event and on average 3.73 medications with an increased risk of falling and fracture.

Conclusion: In-hospital mortality rate after hip fracture remains high; probably this being related to the high comorbidity associated with male sex and increased age as risk factors.

Open access
Incidence and location of bone metastases in breast cancer

Abstract

This report represents an analysis of 19 confirmed cases of breast cancer throughout a period of 14 months (January 2018 - February 2019), in which we assessed the incidence and sites of osseous metastases, in correlation with their histopathologic classification. This retrospective analysis is based on medical imaging techniques (X-ray radiography and nuclear medicine functional imaging).

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Is intraabdominal pressure a predictive factor for mortality and morbidity in abdominal trauma?

Abstract

The clinical signs and symptoms of an acute in increase intraabdominal pressure (IAP) are subtle, especially in the conditions of the polytraumatized patient. Thus, abdominal compartment syndrome (ACS) can brutally occur and can have a major impact on the body’s main organs and systems. The purpose of our research was to identify the influence of intraabdominal pressure, intra-abdominal hypertension, and abdominal compartment syndrome, in the evolution of polytraumatized patients. Our study analyzed the patients admitted in the IIIrd Department of General Surgery of University Emergency Hospital in Bucharest between 1st of January 2010 and 31st of December 2018. The value of intraabdominal pressure, on admission, correlated with the risk of IAH/ ACS in patients with abdominal trauma - being major causes of morbidity and mortality. IAP monitoring should become a mandatory part of the management plan for patients with abdominal trauma.

Open access
Knee arthrodesis as a salvage method for septic TKA failure

Abstract

Periprosthetic joint infection is the most common reason for a failed TKA, with a septic TKA reported rate of 1 to 4% of primary TKA patients. Septic TKA has a various number of treatment options which include chronic-suppressive antibiotics, irrigation and debridement, single or staged revision arthroplasty. The goal is to eradicate the periprosthetic joint infection and reimplant a sterile and fully functional total knee prosthesis. In case the infection becomes uncontrollable, there is only one option to eradicate the infection: knee arthrodesis or above-knee amputation.

We report the case of a 63-year-old patient who in 2009 underwent TKA, the 1 year follow-up showed periprosthetic infection. At first stage, the prosthetic implants were removed and a solid cement spacer was shaped to occupy the remaining space. In 2011, after achieving complete clinical and biological remission of the infection, the cement spacer was removed and LCCK revision prosthesis was inserted.

In 2013 reinfection occurred leading to removal of the prosthetic implants and reinsertion of an antibiotic impregnated cement spacer.

Since the patient suffered significant bone loss and the local conditions were unfavorable, being prone to infection, there were 2 options to evaluate: knee arthrodesis or above knee amputation. We chose knee arthrodesis using Ilizarov external fixation technique.

Many surgical techniques are available to achieve knee arthrodesis: internal fixation with plates or intramedullary nails and external fixation. The Ilizarov method is a very effective technique that could be taken into consideration when knee arthrodesis is required.

Open access
Osseous metastases and ovarian cancer

Abstract

This article analyses a series of 22 confirmed cases of ovarian cancer throughout a period of 14 months (January 2018 - February 2019), in which we assessed the incidence of osseous metastases, in correlation with their histological features. This retrospective study, based on medical imaging techniques, demonstrates that bone metastases are not uncommon in ovarian cancer.

Open access
Simultaneous quadriceps and contralateral patellar tendon ruptures in a patient with chronic renal failure following electric shock; a case report and review of the literature

Abstract

Bilateral extensor tendon ruptures of the knee are not uncommon. However, simultaneous ruptures of the patellar tendon (PT) and contralateral quadriceps tendon (QT) are relatively rare injuries. These ruptures are frequently associated with chronic renal failure and minor trauma. However, they can occur spontaneously in healthy individuals. In this case report, a 43-year-old male with chronic renal failure who sustained bilateral extensor tendon ruptures (right knee: QT rupture, left knee: PT rupture) following an alternating current electrical shock was reported. To our knowledge, simultaneous quadriceps and contralateral patellar tendon rupture following an electric shock have not been reported yet. Etiology, mechanism of injury and treatment options of this rare injury are discussed together with a thorough literature review.

Open access