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Combined Sciatic, femoral, and Obturator Nerve Blocks for Ankle Surgery in a Patient with Severe Pulmonary Hypertension—A Case Report

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Open Journal of Anesthesiology 2017年第8期7卷 203-209页

作者： Ju Hyun Lee Hyun Su Shin Ki Yoon Kim Ji Seon Jeong Justin Sangwook Ko Department of Anesthesiology and Pain Medicine Samsung Medical Center School of Medicine Sungkyunkwan University Seoul Korea

We report a patient with severe pulmonary arterial hypertension (PAH) undergoing tibio-talo-calcaneal fusion due to Charcot joint. Despite the advancement in the management of PAH, the risks of anesthesia, surgery, and postoperative morbidity and mortality still remain high. A 46-year-old female was presented with severe PAH and end stage renal disease requiring hemodialysis three times a week. Ultrasound-guided sciatic, femoral, and obturator nerve blocks were performed with 0.5% levobupivacaine 15 ml, 10 ml, and 5 ml, respectively. All the blocks were successful, and the patient underwent uneventful anesthesia and surgery. In addition, the postoperative pain control lasted for 15 h and the patient was discharged on POD 5 without any complications. Therefore, ultrasound-guided sciatic, femoral, and obturator nerve blocks are valuable alternative to the general or neuraxial anesthesia in patients with severe pulmonary hypertension.

关键词： femoral Nerve Block Obturator Nerve Block Sciatic Nerve Block Severe Pulmonary Hypertension Ultrasound-Guided

Current concepts in total femoral replacement

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World Journal of Orthopedics 2015年第11期6卷 919-926页

作者： Deepak Ramanathan Marcelo BP Siqueira Alison K Klika Carlos A Higuera Wael K Barsoum Michael J Joyce Department of Orthopaedic Surgery Cleveland Clinic Foundation

Total femoral replacement(TFR) is a salvage arthroplasty procedure used as an alternative to lower limb amputation. Since its initial description in the mid-20^(th) century, this procedure has been used in a variety of oncologic and non-oncologic indications. The most compelling advantage of TFR is the achievement of immediate fixation which permits early mobilization. It is anticipated that TFR will be increasingly performed as the rate of revision arthroplasty rises worldwide. The existing literature is mainly composed of a rather heterogeneous mix of retrospective case series and a wide assortment of case reports. Numerous TFR prostheses are currently available and the surgeon must understand the unique implications of each implant design. Long-term functional outcomes are dependent on adherence to proper technique and an appropriate physical therapy program for postoperative rehabilitation. Revision TFR is mainly performed for periprosthetic infection and the severe femoral bone loss associated with aseptic revisions. Depending on the likelihood of attaining infection clearance, it may sometimes be advisable to proceed directly to hip disarticulation without attempting salvage of the TFR. Other reported complications of TFR include hip joint instability, limb length discrepancy, device failure, component loosening, patellar maltracking and delayed wound healing. Further research is needed to better characterize the long-term functional outcomes and complications associated with this complex procedure.

关键词： Hip disarticulation Limb salvage Revision arthroplasty Total femur arthroplasty Total femoral arthroplasty Total femoral replacement Total femur replacement Salvage arthroplasty

Implantable Venous Access Ports for Chemotherapy in Lung Cancer Patients: Comparison of the femoral and Subclavian Vein Approaches without Guidance

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Open Journal of Radiology 2012年第2期2卷 39-45页

作者： Takeshi Fujita Masahiro Tanabe Masatoshi Kato Taiga Kobayashi Etsushi Iida Naofumi Matsunaga Department of Radiology Graduate School of Medicine Yamaguchi University Yamaguchi Japan

Background: The goal of this study was to retrospectively compare the initial success rate and rate of intraoperative and late complications between the femoral and subclavian vein approaches used to implant venous access ports without guidance in lung cancer patients. Methods: We conducted a retrospective review of total 163 lung cancer patients who underwent implantations of a central venous access port for chemotherapy. 95 patients received the ports by the femoral vein blind-puncture technique and 68patients had the port implanted via the subclavian vein blind-puncture technique. The initial success rate of port implantation and the frequency of occurrence of complications were calculated. Results: The primary success rate of venous port implantation was 93.7% for femoral approach and 88.2% for the subclavian approach respectively (p femoral approach group and in five patients (7.4%) in the subclavian approach group. Although a higher intraoperative complication ratio for the subclavian approach was encountered compared to that for the femoral vein approach, there was no statistically significant difference (p = 0.103). Nor was there any statistically significant difference in terms of the occurrence of late complications. Conclusions: Venous access port implantation via the femoral vein approach is safe, and its success rate is very high, with the equal complication rates comparable to the subclavian approach. This approach avoids many of the intraoperative complications. Thus, the femoral vein approach for implanting a venous access port in lung cancer patients should be considered a valid, and safe technique.

关键词： Central Venous Access Implantable Port femoral Vein Subclavian Vein Lung Cancer Patients

The recover from the excision in head and neck of femoral after therapy with low level laser

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Journal of Biomedical Science and Engineering 2012年第2期5卷 58-62页

作者： Cristina Pacheco-Soares Carmen de Lurdes Moreira Gusmao Patricia D. M. Ferreira Miguel A. C. Salgado Dynamics of Cellular Compartments Laboratory Research and Development Institute Universidade do Vale do Paraíba Sao Paulo Brazil Histology Laboratory Faculty of Odontology Universidade Estadual de Sao Paulo Sao Paulo Brazil

Degenerative articulate diseases, resulting from dysplasia and aseptic necrosis of the femoral head and neck, chronic dislocation of the femur and osteoarthrosis, are often treated surgically by an excision in the femoral head and neck. This procedure entails the formation of a false fibrous articulation, providing pain relief. The action of low level laser therapy (LLLT) has been described in orthopedic applications, to repair both bone and articular tissue. LLLT has demonstrated favorable results in vitro and in vivo in stimulating bone repair. A diode laser, 650 nm, with a potency of 30 mW, was used trans-surgically to irradiate. A diode laser (780 nm and the potency of 40 mW) was used on the skin for post-surgery applications. For the experiment, 10 clinically normal New Zealander rabbits underwent surgery and were then divided into two groups, one submitted to irradiation and the other kept for sham. Fifteen days after the surgery, samples of the newly formed tissue were collected from both groups, for macroscopic evaluation of the fibrous pseudo-articulation forming process on the irradiated and sham groups. The macroscopic and microscopic appearance of the samples, suggest that the utilization of the LLLT in the formation of fibrous pseudo-articulation was effective in accelerating the cicatrization process and in improving the quality of the formed tissue.

关键词： Diode Laser femoral Leson Excision

Large parathyroid adenoma presenting as a femoral fracture in a young male

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Case Reports in Clinical Medicine 2013年第8期2卷 457-459页

作者： Duncan Light Chakri Munipalle Vijay Kurup General Surgery North Tees and Hartlepool NHS Foundation Trust Stockton on Tees UK

Parathyroid adenoma classically presents symptoms of hypercalcaemia. Here, we present a case of a rare presentation of a parathyroid adenoma in a young male patient with a pathological fracture.

关键词： Parathyroid Adenoma Hypercalcaemia femoral Fracture

Etiology of the bifid (double) femoral head, with prior history of developmental dysplasia of the hip

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Case Reports in Clinical Medicine 2013年第5期2卷 318-321页

作者： Leonard P. Seimon Christine Kohler-Ekstrand Howard D. Dorfman Montefiore Medical Center Albert Einstein College of Medicine Bronx USA

Our patient presented with a double femoral head, that is, two separate heads with individual epiphyses, but a single contiguous metaphysis. Two similar cases had been described in the literature. The only common feature in these three cases is that they had open reduction for Developmental Dysplasia of the Hip (DDH) through an anterior approach. No other pathology was detected in these patients. A rabbit model was created in which the cartilaginous anlage of the rabbit femoral head was surgically split. After 2-4 weeks a bifid femoral head developed, mimicking that described in the literature. We suggest that inadvertent damage to the femoral head during surgery for DDH may in fact lead to the development of a bifid femoral head. Prior history of DDH should be considered when the isolated bifid femoral head is identified.

关键词： Bifid femoral Head Etiology Rabbit Study

Distal locking in femoral intramedullary nailing system: Is one cross screw sufficient?

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Journal of Biomedical Science and Engineering 2012年第10期5卷 593-596页

作者： S. V. Karuppiah A. J. Johnstone Orthopaedic Unit Woodend Hospital Aberdeen UK

Introduction: The indications for intramedullary nail fixation of fractures of the femoral shaft have been greatly expanded by techniques of interlocking nailing. However, distal locking screw fixation remains the most technically demanding and problematic portion of the procedure and maybe responsible for as much as one-half of the exposure of the surgeon’s hands to radiation during the procedure. Objective: This biomechanical study was undertaken to compare the stability of using one distal locking cross screw versus two cross screws in femoral fractures fixed with intramedullary nailing (IMN) system. Materials: A composite model made from a stainless steel IMN (12 mm × 1 mm) was connected to a load cell (Instron machine). Axial forces upto 2 kN (3 times body weight) was applied or until a maximum displacement of 1 mm was reached. The distal locking end of the intramedullary nail was secured with stainless steel cylinders of different dimensions 50 mm × 5 mm, 75 mm × 5 mm and 100 mm × 3 mm to represent the proximal femoral diaphysis, diaphyseo-metaphyseal junction and distal femoral metaphyseal respectively. The distal locking end of the intramedullary nail was attached to the cylinder with a dedicated single or two rods (5 mm diameter), made from stainless steel, to represent the distal locking cross screw. Results: In the 50 mm cylinder, the mean stiffness (±standard deviation) of the system using either single or two screws were similar i.e. 3298 ± 144 N/mm. But in the 75 mm and 100 mm cylinders, the mean stiffness of the fracture model with two distal locking cross screws fixation was 2.059 ± 96 N/mm and 0.816 ± 122 N/mm and with single distal locking cross screw fixation were 0.643 ± 142 N/mm and 0.289 ± 88 N/mm respectively. Conclusion: Single distal locking cross screw fixation provide poorer fracture stability compared to two distal locking cross screws when used to fix distal femoral metaphyseal fractures.

关键词： femoral Nail Two Cross Screws Biomechanics Study Stability of Fracture

Comparitive Study between Proximal femoral Nailing and Dynamic Hip Screw in Intertrochanteric Fracture of Femur

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Open Journal of Orthopedics 2013年第7期3卷 291-295页

作者： Ujjal Bhakat Ranadeb Bandyopadhayay Bankura Sammilani Medical College Bankura India Bankura Sammilani Medical College Bankura India.

Background: Internal fixation is appropriate for most intertrochanteric fractures. Optimal fixation is based on the stability of fracture. The mainstay of treatment of intertrochanteric fracture is fixation with a screw slide plate device or intramedullary device. So it is a matter of debate that which one is the best treatment, dynamic hip screw or proximal femoral nailing. Method: A prospective randomized and comparative study of 2 years duration was conducted on 60 patients admitted in the Department of Orthopedics in our hospital with intertrochanteric femur fracture. They were treated by a dynamic hip screw and proximal femoral nail. Patients were operated under image intensifier control. The parameters studied were functional outcome of Harris hip score, total duration of operation, rate of union, amount of collapse. These values were statistically evaluated and two tailed p-values were calculated and both groups were statistically compared. Result: The average age of our patient is 67.8 years. Among the fracture, 31% were stable, 58% were unstable, 11% were reverse oblique fracture. The average blood loss was 100 and 250 ml in PFN and DHS group, respectively. In PFN there was more no. of radiation exposure intraoperatively. The average operating time for the patients treated with PFN was 45 min as compared to 70 min in patients treated with DHS. The patients treated with PFN started early ambulation as they had better Harris Hip Score in the early period (at 1 and 3 months). In the long term both the implants had almost similar functional outcomes. Conclusion: In our study we have found that the unstable pattern was more common in old aged patients with higher grade of osteoporosis and PFN group has a better outcome in this unstable and osteoporotic fracture. PFN group has less blood loss and less operating time compared to DHS group. In PFN group patients have started early ambulation compared to DHS group.

关键词： Intertrochanteric Fracture Dynamic Hip Screw (DHS) Proximal femoral Nail (PFN) P Value

The Correlation between femoral Anteversion and femoral Condyle Rotation in Patients with Osteoarthritis of the Hip Joint: Investigation about the Asian Female Patients

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Open Journal of Orthopedics 2017年第11期7卷 369-374页

作者： Hiroshi Yonezu Hiroshi Mikami Koichi Oba Katsutoshi Miyatake Michihiro Takai Akihiro Nitta Department of Orthopedics Yoshinogawa Medical Center Tokushima Japan

An abnormality of femoral anteversion (FA) is often recognized in patients with osteoarthritis of the hip joint (hip OA). And it is considered that rotation abnormality in the knee and the lower leg occurs as compensation, in cases of FA abnormality. The purpose of this study was to assess the magnitude and variability of FA and femoral condyle rotation (FCR) in order to identify the association between FA and FCR in female patients with hip OA who require total hip arthroplasty. A total of 174 hips from 174 hip OA patients undergoing THA were included in this study. All patients were Asian women (average age: 71.1 years). An equilateral correlation was accepted in FA and FCR. It was thought that FA abnormality might be accompanied by morphological rotation abnormalities of the knee joint. Caution is needed in considering femoral anteversion using the posterior condylar line. We must consider FA in patients undergoing THA after having considered the whole leg rotation.

关键词： femoral Anteversion femoral Condyle Rotation Osteoarthritis of the Hip Posterior Condylar Line Epicondylar Line Total Hip Arthroplasty (THA)