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Risk factors for extensor pollicis longus tendon rupture following non-displaced distal radius fractures
No full textIntroduction: Distal radius fractures (DRFs) are common, with an increasing incidence, particularly among the elderly. Rupture of the extensor pollicis longus (EPL) tendon, essential for thumb extension, is a notable complication, especially in non-displaced DRFs. Several mechanisms, such as local adhesion, ischemic atrophy, and tendon laceration, are associated with EPL tendon rupture. This multicenter retrospective study aims to identify risk factors for EPL tendon rupture in non-displaced DRFs.
Materials and methods: The study reviewed 20 cases of EPL tendon rupture and 52 control cases from 2005 to 2022, excluding those who underwent surgery or had incomplete computed tomography (CT) data. We investigated age, sex, location of fracture line, and the morphology of Lister’s tubercle as variables. Logistic regression and decision tree analyses were employed to determine the risk factors for EPL tendon rupture based on these variables.
Results: Fracture lines distal to Lister’s tubercle and specific shapes of Lister’s tubercle, characterized by shallow peak height and a higher radial peak than the ulnar peak, increased the risk of EPL tendon rupture. Decision tree analysis confirmed them as major risk factors. There was a significant difference in the predicted probability rate of tendon rupture between the case with these factors and those without them (P
Conclusion: The location of fracture line and the shape of Lister’s tubercle are key factors influencing EPL tendon rupture in non-displaced DRFs. Understanding these factors can help orthopedic surgeons predict and prevent EPL tendon ruptures, improving patient outcomes following these fractures
A Case of Charcot Spine Arthropathy at the Lumbosacral Level in a Patient With Ankylosis of the Spine
No full textCharcot spinal arthropathy, a rare refractory progressive disease, is characterized by symptoms such as pain, deformity, and neurological impairment, which can significantly reduce functional ability, quality of life, and life expectancy. We report a case of Charcot spine at the L5/S1 level with long segment ankylosis to the L5 vertebra. We first performed thorough debridement via a posterior approach. We used antibiotic-containing cement as a spacer to fill the dead space, facilitating the second surgery approach. In the second surgery, transdiscal screws, which have a low profile and strong force, were used as anchors, and bulk bone harvested from both iliac bones was grafted to the intervertebral space. The lumbosacral alignment was kyphotic, and the patient could sit and move independently. Disimpaction was impossible, and a stoma had to be created
Conversion to Hip Arthroplasty After Internal Fixation Failure in an Intertrochanteric Femoral Fracture: A Case Report
No full textIntertrochanteric femoral fractures are mainly managed by internal fixation. However, failures such as over-telescoping, cut-out, nonunion, or implant failure can occur, especially in osteoporotic elderly patients. We report the case of a patient in whom we performed artificial hip replacement surgery after fixation failure following internal fixation of an intertrochanteric femoral fracture. We report the case of an 85-year-old woman who sustained a left intertrochanteric femoral fracture treated with a dynamic hip screw (DHS). One week postoperatively, radiographs revealed over-telescoping of the lag screw. The patient did not complain of pain, but she underwent conversion to cemented bipolar hemiarthroplasty under general anesthesia. One possible cause of over-telescoping of the lag screw after surgery was that the longitudinal fracture line in the calcar of the proximal bone fragment, as seen in the initial CT image, may have extended horizontally at the neck level. During surgery, a fracture at the same site caused the anterior medial fragment to fail, resulting in a coronal shear fracture and fixation failure. When a longitudinal fracture line is observed in the calcar of the proximal fragment, it is necessary to keep in mind that it may extend horizontally at the neck level
Avoiding splenectomy in splenic sclerosing angiomatoid nodular transformation through endoscopic ultrasound-guided tissue acquisition: a 36-month follow-up case report
No full textA 48-mm splenic mass was incidentally discovered in a 78-year-old man upon computed tomography. Follow-up imaging at 12 months revealed enlargement to 60 mm, prompting endoscopic ultrasound-guided tissue acquisition with a 22-gauge needle. Histopathological analysis confirmed that it was a sclerosing angiomatoid nodular transformation. The patient was asymptomatic and had no hematologic abnormalities; therefore, splenectomy was not performed. After biopsy, the lesion regressed from 60 mm to 46 mm, possibly owing to hematoma formation or vascular disruption, and remained stable during 36 months of follow-up. Although splenectomy has been performed in most reported cases of sclerosing angiomatoid nodular transformation because of diagnostic uncertainty, a few recent reports have demonstrated that sclerosing angiomatoid nodular transformation can be diagnosed by endoscopic ultrasound-guided tissue acquisition, thereby avoiding splenectomy. This case highlights the diagnostic utility of endoscopic ultrasound-guided tissue acquisition and supports spleen-preserving management for biopsy-proven sclerosing angiomatoid nodular transformation
Metamorphic pressure-temperature conditions of garnet granulite from the Eastern Iratsu body in the Sambagawa belt, SW Japan
Full text linkSeveral coarse-grained mafic bodies with evidence for eclogite-facies metamorphism are present in the Besshi area of the Sambagawa subduction-type metamorphic belt, SW Japan. Among them the granulite-bearing Eastern Iratsu metagabbro body involves an unresolved problem of whether it originated in the hanging-wall or footwall side of the subduction zone. The key to settle this problem is its relationship with the adjacent Western Iratsu metabasaltic body, which includes thick marble layer and certainly has the footwall ocean-floor origin. Several previous studies consider that the Western and Eastern Iratsu bodies were originally coherent in the footwall side and formed the shallower and deeper parts of a thick oceanic crust, respectively. The validity of this hypothesis may be assessed by deriving pressure-temperature history of the Eastern Iratsu body, or especially the pressure (depth) condition of the granulite-facies metamorphism before the eclogite-facies overprinting because, if the pressure was relatively high, the oceanic crust assumed in the above hypothesis might be too thick to tectonically achieve the present-day adjacence of the two bodies on the geological map. This study petrologically analyzes a garnet-bearing granulite from the Eastern Iratsu body and newly reports stable coexistence of garnet and orthopyroxene in the sample. By utilizing a garnet-orthopyroxene geothermobarometer, the minimum P-T conditions of the granulite-facies stage was estimated to be 0.8 GPa (∼ 27 km in depth) and 780 °C. If the Western and Eastern Iratsu bodies were assumed to have formed a coherent oceanic crust before their subduction, the original thickness of it was >27 km and this demands unusually strong ductile shortening (<1/9) or unrealistically large vertical displacement on intraplate faulting, suggesting invalidity of the assumption. The Western and Eastern Iratsu bodies, therefore, are originally bounded by subduction-boundary fault and the obtained pressure of 0.8 GPa can be interpreted to represent that of the hanging-wall lower continental crust in the subduction zone, where the Eastern Iratsu body originated. After the granulite-facies metamorphism, the Western Iratsu body, which was located near the footwall surface, initiated subduction and was subsequently juxtaposed with the above-located Eastern Iratsu body at the corresponding depth (∼ 27 km or greater) along the subduction boundary