Fracture Of Left Femur Research Articles

ODP026 An Incidental Giant Normotensive Pheochromcytoma with Elevated Metanephrines demonstrated no evidence of hypertensive crisis during a major surgery

Abstract A 48-year-old Caucasian male with no known past medical history admitted to our hospital following MVA resulting in acute severely comminuted displaced fracture of the left femur and tibia. On admission, the patient was in severe pain. His vitals were significant for elevated blood pressure (BP) of 137/100 and pulse rate of 161 per minute, which resolved soon after pain medications and splint placement. On review of systems, he denied episodic spells of headaches, palpitations, pallor, tremors, anxiety, abdominal pain, or diaphoresis. He denied any family history of endocrine disorders. Physical exam was unremarkable, except for the left femur traction splint. He had multiple CT imaging performed for evaluation of his injuries. On CT scan of the abdomen, he was found to have a 7.2cm adrenal incidentaloma with imaging characteristics consistent with pheochromocytoma. He was admitted to the intensive care unit for one day for closer monitoring where he remained hemodynamically stable without any BP lowering medications. Laboratory work up for a pheochromocytoma was pending. However, due to concern of compartment syndrome of left lower extremity, patient underwent two emergent procedures of open reduction and internal fixation of left femur and tibial fracture repair. Robust monitoring of hemodynamics was performed during both surgeries but patient did not require any antihypertensive medications during the procedures. Eventually, serum total metanephrines drawn on admission day two, resulted as 7848 pg/ml (normal <205pg/ml), normetanephrines 3626 pg/ml (normal <148pg/ml), and metanephrines 4224 pg/ml (normal<57pg/ml). Serum cortisol, aldosterone, renin, dehydroepiandrosterone sulfate, and glucose were within normal limits. On day 3 of admission, repeated serum metanephrines were persistently elevated in 4000s. 24-hour (hr) urine studies showed total metanephrines 7353 mg/24hr (normal <832 mg/24hr), metanephrines 4934 mg/24hr (normal <315 mg/24hr), normetanephrines 2419 mg/24hr (normal <676 mg/24hr) and creatinine2.3g/24 hr (normal <2. 0g/24hr) . MRI abdomen confirmed pheochromocytoma abutting the pancreas and left upper pole of kidney. Interestingly, patient remained hemodynamically stable with highest BP measurement of 120/90 throughout the hospital course. He was eventually discharged on Prazosin 1 mg twice daily which was gradually increased to 5 mg daily in divided doses; increase fluid intake and high salt diet. Beta-blocker was not added due to borderline blood pressure. The patient underwent robotic left radical adrenalectomy without any intraoperative hemodynamic instability. Pathology was consistent with pheochromocytoma, confined to the adrenal gland without no capsular invasion. The patient refused genetic testing. Presentation: No date and time listed

A Case Report: Aneurysmal Bone Cyst Of Proximal Femur With Subtrochanteric Femur Fracture In A Child

Aneurysmal bone cysts are blood-filled lesions of the bone that are benign, expansile, aggressive, and locally damaging. They havean atypical presentation and an unknown etiology. We present the case of a 17-year-old male youngster who appeared with a historyof trauma that resulted in a pathological left femur fracture. A subtrochanteric fracture complicated a slowly forming aneurysmalbone cyst in the proximal femur. Excision of the tumor with curettage and open reduction with internal fixation with a titanium elasticnail were successful treatments, and the empty space was replaced with bone graft from the left iliac crest. The gold standard fordiagnosis is a biopsy. Bone grafting should be used in conjunction with fracture fixation to achieve bony union.

Contextual anaesthesia for a rare case of pycnodysostosis with myriad presentation: a case report

BackgroundPycnodysostosis is a rare inherited syndrome characterized by classical craniofacial defects and diffuse osteosclerosis disorder of bones with tendency for fractures after minor trauma.We describe the anaesthetic management of a parturient with pycnodysostosis with dual concerns of precious pregnancy and a fractured femur.Case presentationA 33-year-old primigravida with 31 weeks of gestation presented with subtrochanteric fracture of left femur. Clinico-radiological features of diffuse osteosclerosis suggested a diagnosis of pycnodysostosis, which was confirmed by genetic testing. We encountered challenges for sequential surgeries of lower segment caesarean section, surgical fixation of the fractured femur and surgical wound debridement in this patient in view of a difficult airway, short stature, physiological changes of pregnancy, difficulties in positioning and possibility of increased blood loss. A combination of general anaesthesia with either neuraxial anaesthesia or regional block was performed, which helped in the safe management of this syndromic patient.ConclusionsMultidisciplinary team dynamics, communication and expertise played a crucial role in the successful care of the patient. Planning anaesthesia contextually for each surgical setting was vital. Anaesthetic gadgets like fibre-optic bronchoscope and ultrasound were a boon to anaesthesiologist at every surgical procedure to aid the anaesthetic plan.

Characteristics of femoral neck fractures in young and middle-aged adults based on fracture mapping technology

To analyze the characteristics of femoral neck fractures in young and middle-aged adults by means of medical image analysis and fracture mapping technology to provide reference for fracture treatment. A clinical data of 159 young and middle-aged patients with femoral neck fractures who were admitted between December 2018 and July 2019 was analyzed. Among them, 99 patients were male and 60 were female. The age ranged from 18 to 60 years, with an average age of 47.9 years. There were 77 cases of left femoral neck fractures and 82 cases of right sides. Based on preoperative X-ray film and CT, the fracture morphology was observed and classified according to the Garden classification standard and Pauwels' angle, respectively. Mimics19.0 software was used to reconstruct the three-dimensional models of femoral neck fracture, measure the angle between the fracture plane and the sagittal plane of the human body, and observe whether there was any defect at the fracture end and its position on the fracture surface. Through reconstruction, virtual reduction, and image overlay, the fracture map was established to observe the fracture line and distribution. According to Garden classification standard, there were 6 cases of type Ⅰ, 61 cases of type Ⅱ, 54 cases of type Ⅲ, and 38 cases of type Ⅳ. According to the Pauwels' angle, there were 12 cases of abduction type, 78 cases of intermediate type, and 69 cases of adduction type. The angle between fracture plane and sagittal plane of the human body ranged from -39° to +30°. Most of them were Garden type Ⅱ, Ⅳ and Pauwels intermediate type. The fracture blocks were mainly in the form of a triangle with a long base and mainly distributed below the femoral head and neck junction area. Twenty-six cases (16.35%) were complicated with bone defects, which were mostly found in Garden type Ⅲ, Ⅳ, and Pauwels intermediate type, located at the back of femoral neck and mostly involved 2-4 quadrants. The fracture map showed that the fracture line of the femoral neck was distributed annularly along the femoral head and neck junction. The fracture line was dense above the femoral neck and scattered below, involving the femoral calcar. The proportion of displaced fractures (Garden type Ⅲ, Ⅳ) and unstable fractures (Pauwels intermediate type, adduction type) is high in femoral neck fractures in young and middle-aged adults, and comminuted fractures and bone defects further increase the difficulty of treatment. In clinical practice, it is necessary to choose treatment plan according to fracture characteristics. Anatomic reduction and effective fixation are the primary principles for the treatment of femoral neck fracture in young and middle-aged adults.

Pathological Fracture of Subtrochanteric Femur in Children with Simple Bone Cyst - Case Report

Introduction: Simple bone cyst (SBC) described as benign non-neoplastic serous-filled bone lesion which commonly affect children and has prevalence less than 1% in the general population. The diagnosis often in children with pathological fracture occurred. The management is determined based on the clinical conditions, and optimal strategy to minimalize the surgical complications. Case Presentations: We reported a case of 5-year-old female complained of pain in her left thigh after slipped. Physical and radiological examination revealed deformity with fracture of left subtrochanter femur. Curettage and biopsy were consequently done, followed with bone graft and fixation using plate and screw. Biopsy result confirmed our suspicion of SBC. Five months postoperatively, patient had been done activity without difficulties and walk normally with no leg length discrepancy. Discussion: By reason of this fracture scarcity, the management standard had not yet concluded. Surgical curettage and cyst excision along with bone grafting still become recommendation choice to manage SBC. Nevertheless, we treat the patient with locking plate and screw to ensure proper rotation and adequate curettage to avoid recurrency, besides of its cost-effectiveness. Conclusion: From this case the result was satisfactory with curettage, bone graft, and fixation with locking plate and screw for pathological subtrochanter femur fracture treatment in children with SBC. Clinical Importance: Vigilant diagnosis and preoperative planning are crucial in recognizing pathological fracture, especially in trivial, low-energy trauma to ensure the best outcome for the patient. Keywords: Simple bone cyst, pathological, fracture subtrochanteric, children.

Linezolid-Induced Pancytopenia and Hyponatremia

Linezolid (LnZ) is an antibiotic that is effective against Gram-positive bacteria and vancomycin-resistant enterococcus. LnZ is notorious to cause adverse hematological effects, primarily thrombocytopenia; however, pancytopenia is an infrequent complication. Euvolemic hyponatremia is a very rare adverse effect in patients receiving LnZ for more than 2 weeks. Early identification of pancytopenia and hyponatremia due to LnZ can result in avoidance of unnecessary investigations with improved patient outcome. An 80-year-old male with no previous comorbidities was admitted with a fracture neck of the left femur. He was empirically prescribed tablet LnZ 600 mg twice daily by the orthopedics team for soft-tissue infection over the sacral area. He underwent surgery for the left femur's fracture neck and was continued on LnZ in the postoperative period. Two weeks after the surgery, he was noticed to have pancytopenia and hyponatremia. After a thorough evaluation, LnZ was suspected to be the cause of pancytopenia and euvolemic hyponatremia. After 2 weeks of withholding LnZ, his pancytopenia and hyponatremia resolved. Physicians should be aware of the rare adverse effects of LnZ and should identify the patients at risk before administrating the drug. Regular monitoring of hematological and biochemical parameters is mandatory if intended to continue the drug for a more extended period.

A case presenting reduced safety and stability in movements in a crouching position following surgery for a left femoral trochanteric fracture

A case presenting reduced safety and stability in movements in a crouching position following surgery for a left femoral trochanteric fracture

Bilateral Floating Knee Injuries in an Infant: A Case Report and Literature Review

Background: Floating knee injury is defined as ipsilateral fractures of the femur and tibia. It was mostly seen among young men and is generally caused by high-velocity trauma such as motor vehicle accidents and falling from height. Although isolated fractures of the femur or tibia are relatively common in children, floating knee injuries are rare in adolescents and even less frequent in younger children.
 Case Report: In this study, we reported a case of bilateral floating knee injuries of a 10-month old girl infant. Radiographic examinations revealed diaphyseal fracture of the left femur and proximal metaphyseal fracture of tibia compatible with floating knee injury type B according to the classification proposed by Letts et al. To the best of our knowledge, there was not any previous report of bilateral infantile floating knee injury in the literature.
 Conclusion: Pediatric floating knee injuries are relatively uncommon and extremely rare among infants. The preferred method of treatment is a surgical fixation for all fractures of all ages.

Asymmetrical Bilateral Traumatic Hip Dislocation with Segmental Femur Fracture

Introduction: Hip dislocations are extremely rare, but they are orthopedic emergencies that need to be immediately intervened. Traumatic hip dislocations are usually unilateral and occur toward the posterior region. Bilateral traumatic hip dislocations, on the other hand, are rarer. Asymmetric occurrence of bilateral traumatic hip dislocations is even rarer. The possibility of spontaneous hip dislocation in a healthy person is very unlikely. This is because ligaments wrapping the hip joint make it quite stable. Thus, hip dislocation usually occurs due to a high-energy trauma. Case Report: In this paper we report a unique female patient with asymmetric bilateral traumatic hip dislocation accompanied by a segmental fracture of the femur due to a traffic accident. The patient’s right hip was reduced under sedoanalgesia at the emergency department and the left hip was reduced under anesthesia at operating room. Avascular necrosis did not develop at her 2-year follow-up; however, she has been re-operated after developing nonunion in the left femoral segmental fracture. Conclusion: In conclusion, hip dislocations should be treated in first six hours due to the risk of avascular necrosis. Uncomplicated hip dislocations without accompanied fractures can be treated with sedoanalgesia in emergency service settings. However hip dislocations which are complicated with accompanied fractures should be reduced in operation rooms without delay.

REMOVAL OF STUCK FEMUR INTERLOCKING NAIL BY LONGITUDINAL OSTEOTOMY OF FEMUR - A CASE REPORT

Introduction:Gerhard Kuntscher first introduced the technique of intramedullary nailing in 1940s . It is a clover leaf shaped hollow tubular nail for intramedullary fixation of long bones. This nailing system has been a technological breakthrough for femur fixation which can be both anterograde or retrograde. Case Report:A 34 year old Male patient resident of Shahapur brought by relatives to JJ hospital, with chief complaint of pain at left knee since 8 days. Patient had A/H/O RTA after fall from bike in 31/12/2012 with head injury with left shaft femur fracture. Patient was operated at JJH with left femur ILN. History of head injury operated in JJ hospital with no details known to patient. There was also history decreased vision in left eye since trauma. Discussion:Interlocking intramedullary nails are used as gold standard treatment in majority of tibial and femoral diaphyseal fractures. It can be removed in certain circumstances when it causes soft tissue irritation, prominent locking screws, implant failure, infection, nonunion, malunion etc. Conclusion:This study shows that in removal of stuck or bent femur interlocking nails in which all other closed techniques have failed, open longitudinal femoral osteotomy with retrograde hitting of the nail can effectively aid in successful removal of nail.

Legg-Calvé-Perthes disease following Ender nail fixation of a pediatric femoral fracture.

Introduction and importanceLegg–Calvé–Perthes disease (LCPD) sometimes occur in children, however it is difficult to diagnose it at the early stage especially in the cases there are no complaints of symptoms. Femoral shaft fractures in children cause various complications such as leg-length discrepancy, nonunion and malunion, refracture, and osteonecrosis of the femoral head. We presented a rare case in which a pediatric patient developed LCPD after femoral shaft fracture.Case presentationA healthy 8-year-old boy sustained a left femoral diaphyseal fracture following a pedestrian car accident. Fixation was achieved using retrograde Ender nails; bone union was confirmed at 3 months postoperatively, and the Ender nails were removed at 8 months postoperatively without any problems. Unfortunately, the morphological change of the ipsilateral femoral head and subtle symptoms were missed until the femoral head collapsed. LCPD was successfully treated with intertrochanteric varus osteotomy, which achieved a good clinical result.Clinical discussionAlthough the reason for the ipsilateral LCPD after the femoral shaft fracture is unclear, this case highlights the need for close postoperative follow-up of pediatric femoral fractures resulting from high-energy trauma to prevent the misdiagnosis of this coincidental complication.ConclusionThis case report describes a missed ipsilateral LCPD after a femoral diaphyseal fracture caused by high-energy trauma. Close postoperative follow-up with a detailed assessment and vigilant interpretation of postoperative radiography is imperative to avoid delayed/missed diagnosis of conditions for which early management may provide better outcomes.

Pancytopenia in a Patient With Severe Hypothyroidism: A Case Report

Abstract Introduction: Hypothyroidism usually affects red blood cell line most commonly seen as normochromic normocytic anemia. We present a unique case of a patient with pancytopenia in the setting of severe hypothyroidism, which improved following IV thyroid hormone replacement. Case: An 85-year-old female with history of type II diabetes mellitus and hypothyroidism who was admitted for open reduction and internal fixation (ORIF) of a displaced left femur fracture following a mechanical fall. Patient has a long-standing history of hypothyroidism on replacement with levothyroxine 75 mcg, which was inadvertently discontinued at the nursing home 2 weeks prior to presentation. CBC on admission was notable for pancytopenia with macrocytic anemia with hemoglobin of 6.2 g/dl (baseline of 11), leukopenia with WBC of 4.2 x103/ul and thrombocytopenia with platelet of 77 X 103 /ul. TSH was 83 uIU/mL (reference range: 0.34 - 5.6) and Free T4 was < 0.11 ng/dl (reference range: 0.93 - 1.7). Patient was on the verge of developing myxedema coma as she presented with hypotension with blood pressure of 103/55 mmHg, hyponatremia 133 mmol/L and mild change in mental status. There was no evidence for hypothermia or bradycardia. Presence of a small thigh hematoma on examination partially explained the acute drop in hemoglobin. Iron panel, folic acid and vitamin B12 levels were found to be within normal range. Patient had no active of infection to suggest sepsis and she did not receive any myelosuppressive medication. Rapid replacement with IV levothyroxine was started before proceeding with surgery to prevent development of myxedema coma. Free T4 normalized at 1.05 ng/dl after receiving a total of 700 mcg of IV levothyroxine on day 5 of hospitalization. ORIF was done with no complications. Pancytopenia resolved upon thyroid replacement therapy and she was discharged on her regular dose of levothyroxine 75 mcg daily. Discussion: Most common hematologic abnormality associated with hypothyroidism is normochromic normocytic anemia. Currently, there are less than 10 reported cases of pancytopenia associated with hypothyroidism. The exact mechanism is unclear but proposed hypothesis is transient bone marrow hypoplasia. The most common clinical presentation, as seen in our patient, is profound hypothyroidism with ultimate outcome of myxedema coma. Most of these patients had resolution of pancytopenia following adequate thyroid hormone replacement. Interestingly, all cases have been reported in female patient population. Further research is needed to understand pathophysiology, risk factors, prognosis and the risk of pancytopenia recurrence in patients with severe hypothyroidism. More importantly, hypothyroidism must certainly be entertained as a differential diagnosis of pancytopenia.

Effect of vitamin K1 on the healing process of osteoporotic fracture in aged rats and its mechanism

Objective To investigate the effect of vitamin K1 on the healing process of osteoporotic fracture and its mechanism by measuring interleukin- 6(IL-6), bone gla protein (BGP) and alkaline phosphatase (ALP) in animal serum. Methods 64 Sprague-Dawley male aged osteoporosis rats (body weight 560±20g, age 20 months) were enrolled. The left femoral fracture model was made in rats and intramedullary fixation was performed with a 1.5mm diameter Kirschner wire. They were randomly divided into two groups: vitamin K1 injection group (32 rats) and control group (32 rats). The vitamin K1 group was intraperitoneally injected with vitamin K115mg/kg/3d after surgery, and the control group was intraperitoneally injected with 0.9% sodium chloride injection of the same volume for 8w. At 2w, 4w, 8w and 12w after fracture, 8 rats in the vitamin K1 injection group and 8 rats in the control group were randomly selected, and venous blood was collected. The levels of IL-6 and BGP in serum were detected by radioimmunology. The contents of calcium, phosphorus and ALP in serum were determined by spectrophotometry. Bone callus was taken for hematoxylin-eosin (HE) staining. Bone mineral density (BMD) of bone callus and right femur were measured at 2w, 4w, 8w and 12w. Radiological observation (X-ray) was performed at 12W. Results The serum IL-6 of vitamin K1 injection group was lower than that of control group at each time point, but the serum BGP, ALP, calcium and phosphorus product and BMD were higher than that of control group (P<0.05). The results of HE staining showed that chondrogenesis and endochondral osteogenesis were earlier in the vitamin K1 group than in the control group. X-ray films showed that the fracture line of vitamin K1 group was blurred 12 days after surgery, the bone callus connected the broken end, and the medullary cavity was recanalized. In the control group, the fracture line was still relatively clear 12 weeks after operation, and the callus connection at the broken end was not close. Conclusion Vitamin K1 can reduce the serum IL-6 content, increase the BGP, ALP content and the product of calcium and phosphorus, and then promote the healing of osteoporotic fracture in aged rats. Vitamin K1 can promote fracture healing, accelerated cartilage osteogenesis, accelerated mineralization, bone callus and whole body bone density increase.

Conservative treatment for patients with high-risk massive pulmonary embolism

Abstract Rationale: Acute pulmonary embolism (PE) is the most serious complication of venous thromboembolism. A high-risk PE is associated with high mortality as it may manifest as shock. Although there is a guideline, sometimes it cannot be implemented optimally. Therefore, conservative treatment is given. In this article, we report 2 cases of high-risk PE treated conservatively with anticoagulants. Patient concerns: In the first case, a 54-year-old woman presented with a chief complaint of sudden dyspnea. She had a history of open left supracondylus femur fracture. In the second case, a 53-year-old woman presented with chief complaints of sudden dyspnea and atypical right sided chest pain. She had a history of neglected right collum femur fracture. Diagnoses: Diagnosis of PE was made in both cases based on the results from electrocardiogram, chest X-ray, and echocardiography evaluation. In addition, computed tomography pulmonary angiography was also performed in the first case. Interventions: Conservative treatment with anticoagulant was chosen because of limited resources for surgery or intervention since both patients refused thrombolytic therapy and refused to be referred. Outcomes: The symptoms of both patients were resolved, and the clinical condition was improved. Imaging evaluation with TEE and duplex ultrasound 1 week later showed good results. Follow-up 3 months afterwards showed that both patients were alive and well without any complaints. Lessons: Acute PE with high-risk condition is life-threatening, that is sometimes difficult to diagnose as it varies in clinical symptoms. Sudden onset dyspnea with signs of shock indicates higher mortality. Echocardiography and computed tomography pulmonary angigraphy evaluation are reliable tools for diagnosis. With Conservative treatment using anticoagulant and routine follow up, patients with acute PE can be managed well.

Protective Effect of Crocin on Liver Function and Survival in Rats With Traumatic Hemorrhagic Shock

BackgroundThis study investigated the underlying mechanism of crocin in protecting rats with traumatic hemorrhagic shock (THS) from liver injury. Materials and MethodsEighty Sprague Dawley rats were randomly divided into four groups (n = 20), namely, Sham group, THS group, crocin group, and Sodium Acetate Ringer group. A rat model of THS was induced by hemorrhage from the left femur fracture. The effects of crocin on hemodynamics, cardiac output, blood gas, animal survival rate, and liver function in the rats with THS were determined, and its relationship with oxidative stress was also explored. ResultsCrocin significantly improved the survival rate, hemodynamic parameters, increased tissue blood flow, and promoted the liver function of the THS rats. Further results indicated that crocin significantly inhibited oxidative stress in serum and liver tissue of THS rats, with increased levels of superoxide dismutase, catalase, and glutathione, and also reduced levels of malondialdehyde and myeloperoxidase levels. In addition, crocin greatly increased nuclear factor erythroid 2-related factor 2/heme oxygenase-1 level in liver tissues of THS rats. ConclusionsThe protective mechanism of crocin on the liver of THS rats may be attributed to its abilities to stabilize hemodynamics, improve cardiac output and blood gas, increase antioxidant enzyme activity, reduce serum liver enzyme levels, and promote nuclear factor erythroid 2-related factor 2/heme oxygenase-1 pathway, thereby reducing oxidative stress.

Primary leiomyosarcoma of bones – a rare entity in two different presentations

Introduction. Leiomyosarcomas (LMS) originate from smooth muscle cells. They are very rare malignant neoplasms. Bony Leiomyosarcoma is a variant of spindle cell sarcoma, primarily affecting long bones, predominantly the distal femur and the proximal tibia followed by craniofacial skeleton. Aim. To describe clinical presentation and diagnostic approach of primary leiomyosarcoma of bones in two different patients. Description of the cases. Case 1. A 64-year-old male with a fracture of left distal femur after a fall was investigated and found to have a pathological fracture. An open biopsy of the fracture site confirms leiomyosarcoma. Case 2. A 58-year-old previously healthy female presented with a swelling on right side mandibular region. Orthopantomogram radiograph (OPG) of mandible and Cone beam CT (CBCT) mandible was taken initially and revealed a large area of bone destruction of the right side of the mandible associated with a soft tissue mass. Initial incisional biopsy made the diagnosis of spindle cell sarcoma followed by excisional biopsy, which confirms the diagnosis of moderately differentiated leiomyosarcoma. Conclusion. Primary leiomyosarcoma of bones is very rare. Imaging features are helpful in the evaluation of such conditions, but final diagnosis should be based on histopathologic and immunohistochemical features.

Anesthesia for Osteosynthesis of Femur in a Cane Toad (Rhinella marina)

Background: The taxonomic order Anura is composed of frogs and toads, with approximately 6000 species worldwide, of which 900 species are found in Brazil. Rhinella marina, popularly known as “sapo-cururu,” is the most commonly found frog in Brazil. Although most of these animals are found in research laboratories and zoos, they are increasingly being reared as pets. Therefore, sedation or anesthesia is often necessary for these animals to facilitate medical care, complementary examinations, or surgical procedures. However, there are only a few reports of anesthesia in frogs. Therefore, the present report aimed to describe the anesthetic protocol for femoral osteosynthetic surgery in an adult cane toad.Case: An adult cane toad presented with a history of difficulty in moving the left hindlimb and loss of limb movements. Radiography showed a simple, complete, transverse, and closed average shaft of the left femur and bone shaft fracture deviation. The animal was referred for an osteosynthetic surgery to stabilize the fracture. Animal restraint was performed using humidified gloves on the operating table. As premedication, ketamine, meloxicam, and morphine were administered, and general anesthesia was induced with isoflurane through a face mask. The anesthesia was maintained with isoflurane through a drip on the animal's back for cutaneous absorption. Lidocaine (2%) anesthetic gel was applied on the incision line to complement the somatic analgesia. The fracture was fixed using an intramedullary Kirschner pin. The heart rate was measured based on the beep of the arterial pulse using a Doppler ultrasonic device, respiratory rate was recorded by visual observation of the animal’s respiratory motion, and body temperature was assessed using an esophageal digital thermometer—all of these remained stable during the procedure. Morphine, enrofloxacin, and meloxicam were administered postoperatively. The animal was discharged from the hospital seven days after the surgery, and 14 days later, the animal was deemed clinically stable with favorable wound healing.Discussion: Toads use their skin to breathe and maintain osmotic balance. Therefore, their skin is extremely sensitive to dehydration, requiring constant wetting. General anesthesia in amphibians is recommended for prolonged and painful procedures, as in the present case. Different anesthetics, analgesics, and associated drugs may be used. Ketamine is often used for chemical restraint in amphibians, and the induction and recovery times may vary due to sensitivity and drug resistance. Inhalational anesthesia with isoflurane may also be effective; in the present case, the anesthetic was administered using a mask placed on the frog’s skin, without any irritation. Analgesia is essential for any animal, and amphibians have opioid receptors that may be used as targets of non-steroidal anti-inflammatory agents. As indicated for all species, the animal was monitored throughout the procedure. Assessment of heartbeat is the simplest way to monitor anesthesia using Doppler (on the heart or throat); in the present case, was placed on the axillary artery for clear auscultation. In addition, other parameters, such as temperature and primary respiratory movements, were monitored. Anesthetic recovery can take hours or even days, whereas excretion depends on the metabolic rate of each animal. In the present case, recovery was observed 4 h after completion of the procedure, using fresh water on the animal’s body to accelerate recovery, as indicated in the literature. This case demonstrated that anesthesia and medications used for anesthesia induction, maintenance, and recovery are safe in toads. For cane toads, during femoral osteosynthesis, this anesthetic procedure has never been described previously in the literature. Finally, such information can aid veterinarians in performing safe and adequate analgesic and anesthetic procedures for the wellbeing of animals.Keywords: amphibians, analgesia, surgery, skin absorption.

Total hip arthroplasty for Crowe type IV developmental dysplasia of the hip combined with intertrochanteric fracture: a case report and literature review

BackgroundTotal hip arthroplasty for Crowe type IV developmental dysplasia of the hip (DDH) is a complex procedure. Crowe type IV DDH combined with intertrochanteric frature is very rare.Case presentationA 75-year-old patient suffering from left hip pain after a fall was sent to our hospital. Plain radiographs and computed tomography scans were used to diagnose this patient with DDH combined with an intertrochanteric fracture. We conducted a total hip arthroplasty using an S-rom prosthesis following subtrochanteric shortening osteotomy in this patient, after which steel wires were used to fix the intertrochanteric fracture. The patient did not suffer any significant intraoperative or postoperative complications, and treatment was sufficient to overcome lower leg abnormalities. The patient was encouraged to resume walking with support at 3 days post-surgery, and at 6-month postoperatively he had regained the majority of his original range of motion. At 10-month postoperatively, the intertrochanteric fracture and subtrochanteric osteotomy of left femur had healed effectively,and the patient’s VAS and mHSS scores had improved significantly.ConclusionsTotal hip arthroplasty is an effective approach to treat patients suffering from Crowe type IV DDH combined with an intertrochanteric fracture, and can achieve satisfactory clinical outcomes.

Une coagulopathie intravasculaire disséminée liée à une malformation veineuse

IntroductionCoagulopathy related to venous malformations can be life threatening. This complication is little known and underestimated. Case reportWe report the case of a 52-year-old female patient who presented with a left femoral fracture. She had a pre-existing muscular infiltrating venous malformation of the left hip. During surgery, she developed acute disseminated intravascular coagulation. The latter was probably a consequence of both surgery and localized intravascular coagulation that was unknown before the trauma. ConclusionIt is important to diagnose localized intravascular coagulation in venous malformations, since the risk of disseminated intravascular coagulation can be prevented by anticoagulant therapy.

Open complex distal femur intraarticular fracture with Hoffa extension, extensor mechanism tear and post-recovery secondary traumatic peri implant fracture: report on an uncommon chronology

&lt;p class="abstract"&gt;Complex distal femur fractures with Hoffa’s extension are uncommon. An associated open fracture with extensor mechanism disruption are rarely reported. A secondary post-traumatic post-recovery peri-implant fracture is a rare presentation. 28-year-old pilon rider male sustained open complex fracture of left metaphyseal distal femur with Hoffa extension and tear in extensor mechanism. He was treated within a golden hour period of wound management. Primary stabilization by distal femoral locking plate and cannulated cancellous screw was done along with primary bone grafting and repair of extensor mechanism. At sixteen weeks, clinic-radiological progression allowed him his pre-injury activities. At seven months, a second trauma resulted in a non-prosthetic peri-implant femoral fracture, another unusual occurrence. Re-osteosynthesis with grafting was done. At twenty months of the primary injury, there was good functional outcome with a painless range of knee flexion to 130° without any extensor lag. Open complex distal femur injury with an associated secondary hit peri-implant fracture presented with significant challenges in management of soft-tissue and reconstruction of bony defect. The early presentation within a golden hour period allowed an early injury assessment to implement primary biological fixation as a treatment modification. Aim was to achieve favorable functional outcome which allowed early return to pre-injury status.&lt;/p&gt;