No abstract

Insufficiency fractures are often overlooked, particularly when associated with greater trochanteric avulsion fractures. Here, we report magnetic resonance imaging (MRI) findings of insufficiency femoral intertrochanteric fractures associated with greater trochanteric avulsion fractures treated by internal fixation. We identified 8 patients (3 men and 5 women; age range, 58-92 years old). All cases used internal fixation devices. Operations were performed within 30 min with a total recorded blood loss within 50 ml. We studied MRI findings, hospital stay (number of days), the ambulatory status at hospital discharge, and complications. We were able to identify intertrochanteric fractures using MRI which we could not identify with radiographs. The average hospital stay was 28 days. Seven patients could walk with support and one patient could walk without support. There were no complications regarding the operation itself. Insufficiency femoral intertrochanteric fractures associated with greater trochanteric avulsion fractures were often overlooked. We successfully treated these fractures by internal fixation.

Objective: We investigated whether elderly patients treated for a proximal femoral fracture would be able to return home. Patients and Methods: The subjects of this study were 834 patients. We defined the acute care hospital group as patients who returned home from the acute care hospital and the kaihukuki group as patients who were transferred from an acute care hospital to a rehabilitation hospital. We recorded the proportion of patients who returned home. We also analyzed walking ability and the Barthel index (BI) of patients. Results: After 2013, the proportion of patients who returned home from the acute care hospital fell below 20%. The proportion of patients who returned home from the kaihukuki hospital stayed within the 75–85% range. The BI before injury and at discharge was 86 and 76 points, respectively, in the acute care hospital group. The acute care hospital group included patients who walked without an aid before the injury or when leaving the hospital. In the kaihukuki group, the BI before an injury, at admission, and at discharge from the rehabilitation hospital was 85, 56, and 74 points, respectively. In the kaihukuki group, the ability of patients to walk recovered more slowly than that of patients in the acute care hospital group. Conclusion: Walking ability and BI are important factors for determining whether patients with a proximal femoral fracture are able to return home.

We report a case of idiopathic thrombocytopenic purpura (ITP) accompanied by steroid-induced avascular necrosis of the femoral head in a 68-year-old woman. Extremely low platelet counts of ITP patients prohibit any surgical interventions. Her platelet count was 25,000/μL. We performed a total hip arthroplasty with high-dose immunoglobulin therapy and transfusion of platelet concentrates. Her platelet count increased to 94,000/μL just before the operation. No hemostatic complications were encountered perioperatively, and the postoperative course was uneventful. She left the hospital 20 days after the operation with a T-cane. Her platelet count decreased to 34,000/μL on the day she left the hospital. Three years after the operation, she had no groin pain and could walk without ambulatory assistive devices. We did not observe implant loosening.

This is to report a case of femoral fracture caused by removal of a femoral intramedullary nail. The patient was a 28-year-old male. We performed intramedullary nailing for his femoral shaft fracture with an interlocking femoral nail made of stainless steel with fluted structure and roughened surface. The nail was removed 2 years and 5 months later, and fresh fracture lines were found in the postremoval radiograph. We suspected there existed problems with the structure of the intramedullary nail as well as late removal of the nail.