Left Hip Research Articles

Unexpected Phosphaturic Mesenchymal Tumor of the Femoral Head.

Osteonecrosis of femoral head (ONFH) is clinically common and easily diagnosed via imaging examination, especially when there is a definite cause, such as a fracture, long-term hormonotherapy, etc. However, some rare neoplastic lesions of the femoral head can mimic its image performance in some situations, leading to misdiagnosis. We present the case of a 57-year-old male with bone pain in the left hip joint that persisted for 2 years. CT and MRI images were performed and both were suggestive of ONFH. Unexpectedly, the histopathologic results of left proximal femur resection revealed the diagnosis of phosphaturic mesenchymal tumor (PMT), a rare mesenchymal tumor. His hip pain was obviously relieved after surgery, and the course of 1-year follow-up was uneventful.

Effects of an exoskeleton-assisted walking program on bone strength in wheelchair individuals with spinal cord injury: A preliminary study using imaging and serum biomarkers

BACKGROUND: Lower extremity weight bearing is a key determinant in maintaining bone density and strength. Approximately 60% of individuals with chronic spinal cord injury use a wheelchair long-term as their primary mode of locomotion—leading to a substantial reduction in lower extremity weight bearing. Unfortunately, this contributes to the development of severe sub-lesional osteoporosis, particularly at the femur and tibia, with fragility fracture rates twice those reported among the general population. Overground exoskeleton-assisted walking programs provide a novel opportunity to increase lower extremity weight bearing and mobility which may strengthen bone and mitigate fracture risks and associated complications. OBJECTIVES: To measure the immediate effects of an exoskeleton assisted walking program on lower-extremity bone strength and serum bone biomarkers in individuals with a spinal cord injury who use a wheelchair as their primary mode of locomotion. METHODS: Ten participants completed a 16-week exoskeleton assisted walking program incorporating 34 individualized 1-hour sessions, progressing from 1 to 3 sessions per week. Outcomes were measured immediately before and after completion of the intervention (±7 days). Mechanical bone properties (density, mineral content, geometry and strength indexes) were assessed using dual-energy X-ray absorptiometry (left hip, left arm, left leg) and peripheral quantitative tomography (25% left femur, 66% left tibia). Bone turnover biomarkers (bone formation = osteocalcin, bone resorption = telopeptide-c collagen) and 25-hydroxyvitamine D were assessed using fasting blood samples. Wilcoxon signed-ranked tests were used to determine pre versus post differences ( p<0.05) in outcomes and standardized effect sizes (ES) were computed. RESULTS: At the femur, statistically significant increases in cortical bone mineral density (ES=0.652) and stress-strain index (ES=0.889), as well as decreases in cortical bone mineral content (ES=0.889), cortical cross-sectional area (ES=0.889) and cortical thickness (ES=0.849) were observed. At the tibia, a statistically significant increase in polar moment of inertia (ES=0.790) was observed. Levels of 25-hydroxyvitamine D increased significantly (ES=0.693). CONCLUSION: The completion of a 16-week exoskeleton-assisted walking program elicits promising bone responses. However, due in part to a lack of statistical power, the clinical significance of these findings as well as the ultimate effect on bone strength and fracture risk remains to be confirmed. Larger clinical trials are needed. Longer intervention durations, as well as multimodality interventions (e.g., functional electrical stimulation, pharmacotherapy, dietary) may ultimately prove to be the most effective. This work was supported by the Fonds de recherche du Québec - Santé (FRQS, grant #252532) and the John R. Evans Leaders Fund of the Canada Foundation for Innovation (grant #36243). This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Abstract #1408105: Treatment of Bisphosphonate Associated Atypical Femur Fracture with a Combination of Teriparatide and a Novel Surgical Technique

Atypical femur fractures (AFF) caused by long term Bisphosphonate use are associated with high rates of delayed healing and non-union, posing a significant challenge in the management of these patients. We describe the case of a 64-year-old female with osteopenia on Bisphosphonate therapy for 15 years who sustained a displaced left AFF following a fall from standing height. She reported a 6-month history of antecedent left groin pain. Radiographs of the left femur showed an acute displaced transverse diaphyseal fracture with lateral cortical thickening and beaking. The right femur radiograph showed features of abnormal cortical remodeling with thickened, irregular cortices. DEXA showed T-scores of -2.1 at the left femoral neck, -1.4 at the left total hip, and -1.4 at the lumbar spine. She underwent an open reduction and internal fixation with insertion of a cephalomedullary nail placed in compression mode. A novel technique of intraoperative removal of the endosteal hypertrophied cortical bone at the fracture with a Midas rex cutting burr was used and there was excellent cortical contact after reduction. She had immediate relief of her pain and was permitted to fully weight-bear postoperatively. Her bisphosphonate was stopped immediately and Teriparatide was initiated at 7 weeks post-operatively. Radiographs 8 weeks after initiation of Teriparatide showed evidence of normal fracture union with mature callus formation. AFF caused by prolonged Bisphosphonate use have a high rate of delayed healing and non-union due to abnormal bone remodeling. Use of Teriparatide post-operatively has been shown to reduce healing time in recent small studies in surgically treated patients. Our case demonstrates expedited healing time when Teriparatide was combined with a novel surgical technique involving removal of a portion of the abnormal fracture end and placement of an intramedullary nail in compression mode. Furthermore, the patient had radiographic evidence of cortical thickening on her right femur, increasing her risk for contralateral AFF. Prophylactic surgical stabilization was recommended but the patient has deferred this. She remains fracture-free and pain-free on the right side, suggesting a possible benefit of Teriparatide use in patients at risk for impending AFF. Our case demonstrates an expedited healing time (3.5 months) relative to previously reported average healing times for AFF (10.7 months), supporting the use of the combination of Teriparatide and a novel surgical technique.

Abstract #1406603: An Atypical Clinical Presentation of a Parathyroid Adenoma

Parathyroid adenomas usually appear as well-defined, homogeneous, hypoechoic masses on ultrasound (US). However, atypical features on US including heterogeneity, cystic changes, and calcifications raise suspicion of malignancy. We present a patient with a suspicious atypical clinical presentation of a parathyroid adenoma. A 29-year-old female presented after a fall with a new right nondisplaced proximal tibial pathologic fracture through a large lytic bone lesion. Prior to bone biopsy and operative fixation of the fracture, lab work was significant for a calcium level of 14.8 mg/dL, albumin 4 g/dL, intact parathyroid hormone (PTH) 1,176 pg/mL, 25-hydroxy vitamin D 14 ng/mL, magnesium 1.6 mg/dL, alkaline phosphatase level 483 U/L and phosphorus 2.2 mg/dL. She denied any personal or family history of hypercalcemia, nephrolithiasis, osteoporosis, excessive calcium or vitamin D intake, malignancy or symptoms of abdominal pain, nausea, vomiting, constipation, or dysuria. Of note, the patient had a prior biopsy of the left lytic hip bone lesion eight months prior. Pathology initially revealed a benign process concerning for hemangioma of the bone or fibrous dysplasia; however, retrospective review was consistent with osteitis fibrosa cystica. A thyroid US revealed a heterogeneous 3.9 x 2.4 x 3.0 cm complex solid and cystic mass in the neck posterior to the thyroid between the trachea and carotid, concerning for a malignant neoplasm. Parathyroid scan revealed an intense nodular focus of radiotracer uptake at the inferior pole of the right thyroid lobe suspicious for parathyroid neoplasm. She required intravenous (IV) normal saline, calcitonin, and IV pamidronate due to persistent hypercalcemia. She underwent a right hemithyroidectomy and inferior parathyroidectomy with a closed treatment of her tibial fracture. A pre-excision intraoperative PTH level was 1,473 with a post-excision PTH level of 114. Pathology revealed a cystic parathyroid adenoma. Hungry bone syndrome was prevented postoperatively with calcium carbonate 1 g three times daily, calcitriol 0.5 mg twice daily, and vitamin D3 50,000 IU weekly. This atypical presentation of a parathyroid adenoma is significant because it highlights similarities it can share with parathyroid carcinomas. Initial imaging was highly suspicious for features of malignancy, but surgical pathology was consistent with a parathyroid adenoma. Furthermore, this case is unique because the pathologic finding of osteitis cystica is unusual in the early biochemical diagnosis of hyperparathyroidism. Therefore, clinicians should be aware of this form of disease and include it in their differential in a patient with multiple bone cysts.

Abstract #1399358: Treatment of Familial Tumoral Calcinosis with Acetazolamide Plus a Phosphate Binder

Familial tumoral calcinosis is an autosomal recessive disease resulting from fibroblast growth factor 23 (FGF23) deficiency or resistance. Subsequent hyperphosphatemia can lead to painful ectopic calcifications, which are often unsuccessfully managed with surgical intervention. We present a case of a patient with intractable pain due to familial tumoral calcinosis who failed surgical management and was given a trial of acetazolamide in addition to calcium acetate. A 22-year-old female with a history of familial tumoral calcinosis presented for endocrine medical management. In her native country, she developed extensive, painful growths in her left shoulder and hip, for which she underwent surgical tumor debulking. She later developed additional growths in her left elbow and right wrist. Laboratory studies were remarkable for an elevated serum phosphorous level of 7.0 mg/dL (2.5-4.5 mg/dL), parathyroid hormone (PTH) level of 17 pg/mL (15-65 pg/mL), calcium level of 10.1 mg/dL (8.4-10.2 mg/dL) and albumin level of 4.5 g/dL (3.5-5.2 g/dL). FGF23 was found to be markedly elevated at 1,616 RU/mL (44-215 RU/mL). Radiographs of her bilateral shoulders and magnetic resonance imaging (MRI) of her right wrist were consistent with tumoral calcinosis. The patient was reluctant to undergo repeat surgical intervention due to the limited efficacy of her initial procedures. In addition to limiting dietary phosphorous intake, the patient was started on calcium acetate 667 mg three times daily before meals and acetazolamide 250 mg twice daily. Serum phosphorous level subsequently decreased to 6.4 mg/dL. Though she continues to report pain, she has not since developed any new growths. Familial tumoral calcinosis is a rare disease affecting phosphate metabolism. It is caused by inactivating mutations of the FGF23, klotho or GALNT3 genes, resulting in increased phosphate reabsorption in the kidneys. This excess circulating phosphorous binds to serum calcium, causing deposits to build up in soft tissues that can lead to significant discomfort. Given the high rate of recurrence after surgical intervention, medical management is the mainstay of treatment, focusing on limiting dietary phosphorous intake and absorption. Acetazolamide, a carbonic anhydrase inhibitor, has been proposed as an adjunctive treatment modality. By way of inducing a proximal renal tubular acidosis, acetazolamide can potentially augment the solubility of serum calcium-phosphate complexes, thus promoting renal phosphate clearance. This case serves to highlight both a rare diagnosis and it’s limited therapeutic options, as well as the potential efficacy of those therapeutic options in patient care.

HHV-7 Encephalitis: The Rare Infection and Its Outcome on a Child (P11-10.006)

<h3>Objective:</h3> The primary aims of this study were to relate HHV-7 infection with clinical manifestations of encephalitis, transient hip synovitis and hepatic changes in childhood and to evidence the effectiveness of early diagnosis and treatment in patients with encephalitis. <h3>Background:</h3> A 2-year-old male patient reported persistent high fever, coughing and rhinorrhea starting 1 week ago. They sought outpatient pediatric care and was prescribed ceftriaxone and prednisolone, with no satisfactory response. The symptoms evolved to vomiting and dehydration. During the physical exam, he showed irritation, with constant cervical stiffness and hyperextension, photophobia, and convergent strabismus. On arrival, he had been taking ceftriaxone, acyclovir and desloratadine. Laboratory tests were very altered in leukocytes, platelets, PCR, AST, ALT and GGT. During the ophthalmologic examination, a paresis of cranial nerve VI on the right was identified as secondary to a probable meningitis. After 21 days of treatment with acyclovir, the patient had a good prognosis, however, he had claudication upon movement of the left hip. <h3>Design/Methods:</h3> NA <h3>Results:</h3> The CSF results were colorless, cloudy, pH 8, Glucose 58, Leukocytes 40, Proteins 81. To confirm this observation, the molecular panel detected the presence of HHV-7. The imaging tests helped and added to the results of the blood count and CSF. Cranial MRI showed a hyperintensity in the FLAIR sequence of the perimesencephalic subarachnoid space and small accumulation of liquid. In addition, the abdomen CT found a bit of fluid in the hip region. <h3>Conclusions:</h3> Encephalitis is an inflammation of the brain parenchyma that leads to neurological dysfunction caused by infection or autoimmunity. In this occasion, the patient had a rare case of HHV-7 encephalitis. Basically, the treatment was carried out with acyclovir and ketoprofen, obtaining a progressive improvement of the clinical picture. Consequently, further research on the complications of HHV-7 is essential to develop a good characterization of this disease. <b>Disclosure:</b> Mr. Andrade has nothing to disclose. Miss MARQUES has nothing to disclose. Dr. Mota has nothing to disclose.

Second to Fourth Digit Ratio and Exercise Performance in Untrained Adult Males

This study was based on a random sample from a Prospective Cohort study including one hundred healthy young untrained male volunteers, with mean age ± standard deviation (SD) of 22.820 ± 2.271 years. The aim of this study was to evaluate the role of the digit ratio as an indicator for the performance of untrained adult males in endurance sports. The parameters that have been measured were: Index and ring fingers length of both right and left hand, body weight, height, waist and hip circumferences, body composition (including: fat, muscle and water percents) and exercise performance (including: distance and time). The descriptive analyses of this study showed that normative values of male 2D:4D ratio vary between 0.912-1.036. and it also revealed that there is a strong inverse relation-ship between digit ratio of the subjects and exercise performance according to the distance and time; as the subject briskly walked on the treadmill at fasting state

Second to Fourth Digit Ratio and Exercise Performance in Untrained Adult Males

This study was based on a random sample from a Prospective Cohort study including one hundred healthy young untrained male volunteers, with mean age ± standard deviation (SD) of 22.820 ± 2.271 years. The aim of this study was to evaluate the role of the digit ratio as an indicator for the performance of untrained adult males in endurance sports. The parameters that have been measured were: Index and ring fingers length of both right and left hand, body weight, height, waist and hip circumferences, body composition (including: fat, muscle and water percents) and exercise performance (including: distance and time). The descriptive analyses of this study showed that normative values of male 2D:4D ratio vary between 0.912-1.036. and it also revealed that there is a strong inverse relation-ship between digit ratio of the subjects and exercise performance according to the distance and time; as the subject briskly walked on the treadmill at fasting state

DENSIDAD MINERAL ÓSEA BAJA EN VARONES JÓVENES CON INFECCIÓN ASINTOMÁTICA POR EL VIRUS DE LA INMUNODEFICIENCIA HUMANA EN TRATAMIENTO ANTIRRETROVIRAL

The aim of this study was determine the frequency of low bone mineral density (BMD) in young men with asymptomatic Human Immunodeficiency Virus (HIV) infection on antiretroviral therapy for less than 2 years, as well as to compare the frequency of low and normal BMD according to antiretroviral treatment (ART) scheme and level of physical activity. 39 young men with asymptomatic HIV infection and ART less than 2 years were included. A bone densitometry was performed, and the following areas were evaluated: lumbar spine, left femoral neck and total left hip. 12 patients (31%) with low BMD and 27 patients (69%) with normal BMD were found. No differences were found between patients with normal and low BMD according to type of ART and level of physical activity. The frequency of low BMD is high in young men with asymptomatic HIV infection under antiretroviral treatment for less than 2 years.

Hip Pain after Distal Femoral Derotational Osteotomy for a Patient with Patellar Instability: A Case Report

Increased torsional deformity of femur is one of the most important factors in recurrent patellofemoral instability. And distal femoral derotational osteotomy is an effective treatment option in patients with increased femoral torsional deformity. However, groin pain is a rare complication after femoral derotational osteotomy. The patient was a 23-year-old female suffering from anterior knee pain and patellar instability in her left leg. Continuous CT scans of the hip, knee, and ankle were performed and the femoral anteversion was 44.99°. Considering the significant enlargement of the femoral internal torsion which may contribute most for dislocation of patella, we did a derotational osteotomy of distal femur. The anterior knee pain and patellar instability were resolved after surgery. The femoral internal torsion angle was corrected to 21.47°. But she developed left hip pain in the groin area which she had never encountered before 1 year after the surgery. We believed that the hip pain was closely related to the surgery. And the imaging and follow-up partly confirmed this. The situation of the hip joint should be carefully evaluated before doing derotational osteotomy in recurrent patellofemoral instability and patient should be informed that derotational osteotomy may cause hip pain. Clinical studies are needed to further clarify the impact of derotational osteotomy on the hip.

Monostotic Fibrous Dysplasia of the Hip Treated with Autologus Non-Vascularized Fibular GraftMonostotic Fibrous Dysplasia of the Hip Treated with Autologus Non-Vascularized Fibular Graft

Fibrous dysplasia represents a dysplastic disorder of bone characterized by solitary or multifocal polyostotic intramedullary lesions composed of proliferations of fibroblast-like spindle cells with a characteristic whorled pattern in which trabeculae of immature woven bone. A 20 years old female with pain and limping on his left hip has been suffered for about 1 month. The pain was localized on the left hip with dull characteristics, and worsen when she moves and walks. The pain intensity also decreased with rest. Then she came to hospital and performed X-ray with shepherd crook deformity on her left hip and performed ipsilateral non-vascularized fibular strut graft on her left hip. Right after post-operative wound has been healed the chief complain was marked decrease. For about 2 years after the surgery follow up by X-ray and also MRI examination with contrast the condition of the fibular strut graft was viable, the complaint was gone and the progression of the disease has been stopped.

Reversibility in male idiopathic osteoporosis possible.

A 44-year-old athletic man presented in 2009 with severe low back pain. Dual-energy x-ray absorptiometry revealed severe osteoporosis; serum testosterone was 189 ng/dL while serum estradiol (E2) measured by liquid chromatography/mass spectrometry was 8 pg/mL. DNA was extracted and sequenced from a blood sample from the patient since his maternal first cousin also had low bone mass and both patients were screened for aromatase dysfunction by PCR analysis for the CYP19A1 gene, which encodes aromatase. No known pathologic mutations were observed in the coding exons, but novel single nucleotide polymorphisms were detected both in the proband and in his cousin. Treatment with topical testosterone started in August 2010. Over the next 8 years, testosterone dosage was varied and switched from topical gel to injections and maintained on depo-injections of testosterone at about 60 mg once per week. Re-examination in March 2012 included a brain MRI to exclude pituitary lesions; hyperparathyroidism was ruled out (normal serum parathyroid hormone, calcium, and calcium to phosphorous ratio) and celiac disease was excluded (negative transglutaminase antibodies). Follow-up in October 2018 showed improved bone mineral density of the lumbar spine by 29% and of the left femoral hip by 15% compared to baseline measurements. This reveals the importance of measuring serum E2 for making the correct diagnosis, as well as for monitoring a therapeutic effect. Herein, we propose treatment of male osteoporosis where serum E2 levels are below about 20 pg/mL with testosterone to reverse osteoporosis. Estrogen deficiency in the diagnosis of male idiopathic osteoporosis. Importance of serum estradiol in male osteoporosis. Role of polymorphisms in aromatase gene on bone health. Reversal of osteoporosis. Tailored testosterone treatment for bone health.

Infección osteoarticular multifocal en un recién nacido

Both osteomyelitis and septic osteoarthritis in the neonatal period are infrequent pathologies. Bone involvement of the cervical spine is even rarer, being exceptional in neonates. These are serious pathologies, with high morbimortality, where early diagnosis and aggressive treatment are of utmost importance for the vital and functional prognosis.We present the case of a neonate who presented with sepsis due to multidrug-resistant S. Aureus, associated with osteomyelitis of the first cervical vertebra and septic osteoarthritis of the left hip. He was treated early surgically and with antibiotic therapy, presenting a good evolution.Key words: neonate, sepsis, osteomyelitis, septic osteoarthritis, spine Translated with www.DeepL.com/Translator (free version)

All that illuminates on radionuclide imaging is not a metastatic lesion: Role of complementary imaging

Radionuclide imaging is a non-invasive modality based on tracer physiology widely utilized in the diagnosis, staging, therapeutic evaluation, and monitoring of metastatic disease in a spectrum of malignancies. Calcific tendinopathy is a well-recognized disorder related to the deposition of calcium hydroxyapatite crystals within tendons. We describe a patient with urothelial carcinoma of the bladder revealing increased uptake at the left hip on 99mTc labeled methylene diphosphonate scintigraphy suggesting a metastatic lesion. Cross-sectional imaging with magnetic resonance imaging confirmed the accurate diagnosis of calcific tendinopathy of gluteus maximus insertion. This case report highlights the importance of a thorough clinical evaluation and complementary imaging in assessing benign pathologies which may mimic metastatic bone lesions.

Bucket handle injury of small bowel: a case report

Hollow viscus or mesenteric injuries account for 1-6% of injuries in a patient with blunt abdominal trauma. A 63-year-old male, presented with a history of tree fall while he was on a two-wheeler. With a history of left hip pain and abdominal pain, examination revealed he was tachycardic, normotensive with abrasions and dislocation of left hip joint. Abdomen examination revealed diffuse tenderness with sluggish bowel sounds with blood at the meatus. FAST was positive. CECT showed mesenteric hematoma, intra-peritoneal rupture of bladder and multiple pelvic fractures. Laparotomy revealed a rent in the anterior wall and neck of urinary bladder, which was repaired along with a bucket handle tear of mesentery, 40 cm from ICJ, with gangrene of ileum which required resection anastomosis. Post-operative period was uneventful. Rapid deceleration in a road traffic accident causes shearing forces between segments of bowel fixed in the retroperitoneum and the more mobile peritoneal segments, which leads to avulsion of mesentery from the bowel known as bucket handle injury. These are traumatic ischemic injury, which require urgent surgical intervention. Due to the varying CT findings, a pre-operative diagnosis is very challenging and required high index of suspicion. Prompt diagnosis and surgical management is required to prevent delayed complications in bucket handle injuries of bowel.

Primary hyperparathyroidism in an adolescent presenting with genu valgus progressing to extensive bone disease; a case report

BackgroundPrimary hyperparathyroidism which is rare in adolescents presents commonly with non-specific symptoms and systemic complaints. Though there are few reported cases of genu valgus, genu valgus progressing to extensive bone disease despite mildly elevated calcium had not been reported before.Case presentationA 12-year-old male had been evaluated for bilateral (left > right) genu valgus and short stature. Serum calcium and phosphate levels had been normal. X-ray of the femora and pelvic bones had not shown additional abnormalities. Valgus deformity progressed despite left femoral plating, and a left distal femoral medial closed wedge osteotomy had been performed at 15 years. Plain imaging at that time had shown localised osteopaenia. At the age of 17 years, he developed multiple fragility fractures of his left hip rendering him wheelchair-bound. Further evaluation revealed a serum PTH level of 2571 (10–65) pg/mL with calcium of 2.82 (2.2–2.6) mmol/L and inorganic phosphate of 1.7 (2.2–4.7) mg/dL. The lumbar spine DXA scan showed a Z-score of -5.8. A left parathyroid adenoma was localised and there was evidence of hyperparathyroid bone disease including brown tumours. He underwent left parathyroidectomy and left thyroid lobectomy after which his PTH level dropped to 4.03 pg/mL. He developed hypocalcaemia which was managed successfully with calcium and alfacalcidol replacement.ConclusionsPrimary hyperparathyroidism can present with genu valgus in adolescents. Initial normocalcaemia which could be due to concomitant vitamin D deficiency could mask this leading to delayed diagnosis until severe irreversible bone disease ensues.

A Case Report on Integrated Management of Hematological Abnormalities like Thrombocytosis and Leukocytosis in Sickle Cell Crisis Patient

Abstract: An Indian tribal population amongst dense forest area mainly suffers from sickle cell anaemia for a long. Considering the pathogenesis and geographical limitations only symptomatic management is available as there is no cure. Diagnosis of vaso-occlusive crisis or existing complication is a critical factor in sickle cell anaemia. Increased platelets, white blood cells, and clinical manifestations demand more attention in sickle cell patients. In the current case study, a patient was presented to the site for daycare management in minimal consciousness condition with SpO2 96% complains of left hip pain and unable to walk, joint pain, pallor, backache, and general weakness. The clinical evaluation thrombocytosis, leukocytosis, and x-ray suggested developed avascular necrosis of the hip. Considering his condition patient was started on an integrated treatment approach with T-AYU-HM Premium 300mg tablet. Regular monitoring of condition and strict adherence to treatment has lessened the financial and logistical burden of prolonged hospital stays, blood transfusion needs, and vaso-occlusive crisis sequelae. A key observation in this case study is a remarkable improvement in thrombocytosis, leukocytosis, and walking impairment in patient due to avascular necrosis. Looking at the improvement in the clinical conditions to proceed with utilising the information for better healthcare, a patient had consented for the same. The prognostic significance of platelet and white blood cells is suggestive of disease severity and progression in sickle cell anaemia patients. During the treatment, no untoward effect was reported or observed. This integrated treatment approach might become helpful in managing such kind of clinical complications in sickle cell anaemia. Keywords: Thrombocytosis, Leukocytosis, Vaso-occlusive crisis, Avascular necrosis, Sickle cell disease.

Biomechanical evaluation of a healed acetabulum with internal fixators: finite element analysis

BackgroundTreatment of complicated acetabular fracture with internal fixation usually has high risk of failure because of unbefitting fixation. However, evaluation of the biomechanical effect of internal fixation under physiological loading for fracture healing is still generally rarely performed. The purpose of this study is to analyze the biomechanical characteristics of a healed acetabulum with designed internal fixators under gait and to explore the biomechanical relationship between the healed bone and the internal fixator.MethodsA patient-specific finite element model of whole pelvis with designed internal fixators was constructed based on the tomographic digital images, in which the spring element was used to simulate the main ligaments of the pelvis. And the finite element analysis under both the combination loading of different phases and the individual loading of each phase during the gait cycle was carried out. The displacement, von Mises stress, and strain energy of both the healed bone and the fixation were calculated to evaluate the biomechanical characteristics of the healed pelvis.ResultsUnder the combination loading of gait, the maximum difference of displacement between the left hip bone with serious injury and the right hip bone with minor injury is 0.122 mm, and the maximum stress of the left and right hemi-pelvis is 115.5 MPa and 124.28 MPa, respectively. Moreover, the differences of average stress between the bone and internal fixators are in the range of 2.3–13.7 MPa. During the eight phases of gait, the stress distribution of the left and right hip bone is similar. Meanwhile, based on the acetabular three-column theory, the strain energy ratio of the central column is relatively large in stance phases, while the anterior column and posterior column of the acetabular three-column increase in swing phases.ConclusionsThe acetabular internal fixators designed by according to the anatomical feature of the acetabulum are integrated into the normal physiological stress conduction of the pelvis. The design and placement of the acetabular internal fixation conforming to the biomechanical characteristics of the bone is beneficial to the anatomical reduction and effective fixation of the fracture, especially for complex acetabular fracture.

The effect of a gait and balance training program on an unstable mudflats surface in older adults: A randomized controlled pilot study.

Balance training on an unstable support surface has been known to improve postural control. The aim of this study was to investigate the effect of a gait and balance training program on an unstable mudflats surface in older adults. A total of 28 older people were assigned to participate in a gait and balance training program on an unstable mudflats surface (experimental group) or on firm ground (control group). All participants received the training program for 55 minutes per session, 2 sessions per day for 5 days. The primary outcomes were the Berg Balance Scale (BBS) and single-leg stance (SLS) test. Secondary outcomes were Timed Up and Go (TUG), 10-meter walk test (10MWT), Modified Falls Efficacy Scale (MFES), Motricity Index (MI) of the lower extremities, and medical research council (MRC) scale of lower extremities. SLS with eyes open and the MRC of the left and right ankles showed a large effect size whereas the MI of the left and right lower extremities and MRC of the left and right knees showed a medium effect size in the experimental group. Intergroup differences in changes from baseline to after the exercise program included a large effect size of the SLS with eye open and MI of the right lower extremity and a medium effect size of the MI of the left lower extremity and MRC of the right ankle and left hip. Muscle strength and balance of older people could be improved with gait and balance training on an unstable mudflat surface.

Pyogenic sacroiliitis caused by Salmonella schwarzengrund in a young healthy woman: a case report and literature review

BackgroundSalmonella species are a leading cause of diarrheal diseases worldwide. Recent epidemiological studies have shown that Salmonella schwarzengrund (S. schwarzengrund) is highly prevalent in various regions. Herein, we report that S. schwarzengrund caused sacroiliac joint (SIJ) infection with septic shock in a young woman, although she was immunocompetent.Case presentationA 20-year-old woman presented with left hip pain, accompanied by vasopressor-requiring hypotension. Her imaging examinations showed fluid collection in her SIJ and a small abscess in the left iliac muscle. Later, the blood and aspiration fluid culture and genetic analysis revealed the presence of S. schwarzengrund. We diagnosed sacroiliac joint (SIJ) infection with septic shock caused by S. schwarzengrund. Her condition improved after performing several interventional radiology (IVR) procedures for SIJ abscesses and providing appropriate antibiotic treatment. Finally, she was discharged without any sequelae. Screening tests and genetic analysis about her immunodeficiency did not indicate a congenital disorder.ConclusionThese clinical courses indicate that S. schwarzengrund could cause the fatal SIJ infection irrespective of the host immunocompetence. Considering the recent increase in the diagnostic rate of S. schwarzengrund, this case emphasized the need to be more cautious about Salmonella species infection.