Rehab Centers: Outcomes of Osteoporotic Trochanteric Fractures Treated With Cement-Augmented Dynamic Hip Screw.

Outcomes of osteoporotic trochanteric fractures treated with cement-augmented dynamic hip screw.

Filed under: Rehab Centers

Indian J Orthop. 2012 Nov; 46(6): 640-5
Gupta RK, Gupta V, Gupta N

Dynamic hip screw (DHS) has been the standard treatment for stable trochanteric fracture patterns, but complications of lag screw cut out from a superior aspect, due to inadequate bone anchorage, occur frequently in elderly osteoporotic patients. Polymethylmethacrylate (PMMA) has been used as an augmentation tool to facilitate fixation stability in cadaveric femora for biomechanical studies and in pathological fractures. However, there are very few reports on the utilization of PMMA cement to prevent these complications in fresh intertrochanteric fractures. A prospective study was conducted to evaluate the outcome and efficacy of PMMA augmented DHS in elderly osteoporotic patients with intertrochanteric fractures.The study included 64 patients (AO type31-A2.1 in eight, A2.2 in 29, A2.3 in 17 patients, and 31-A3.1 in five, A3.2 in three, and A3.3 in two patients) with an average age of 72 years (60 – 94 years) of which 60 were available for final followup. PMMA augmentation of DHS was performed in all cases by injecting PMMA cement into the femoral head with a custommade gun designed by the authors. The clinical outcome was rated as per the Salvati and Wilson scoring system at the time of final followup of one year. Results were graded as excellent (score > 31), good (score 24 – 31), fair (score 16 – 23), and poor (score < 16).Fracture united in all patients and the average time to union was 13.8 weeks (range 12 - 16 weeks). At an average followup of 18 months (range 12 - 24 months), no incidence of varus collapse or superior screw cut out was observed in any of the patients in spite of weightbearing ambulation from the early postoperative period. There was no incidence of avascular necrosis (AVN) or cement penetration into the joint in our series. Most of the patients were able to regain their prefracture mobility status with a mean hip pain score of 8.6.Cement augmentation of DHS appears to be an effective method of preventing osteoporosis related complications of fracture fixation in the trochanteric fractures. The technique used for cement augmentation in the present study is less likely to cause possible complications of cement augmentation like thermal necrosis, cement penetration into the joint, and AVN hip. HubMed – rehab


Impulse control disorders in Parkinson disease: Is cognitive-behavioral therapy worth a wager?

Filed under: Rehab Centers

Neurology. 2013 Jan 16;
Macphee GJ, Carson A

Parkinson disease (PD) is now conceptualized as a neuropsychiatric disorder with characteristic motor features.(1) It is increasingly recognized that standard dopaminergic treatments, particularly dopamine agonist drugs, can trigger devastating impulse control behaviors (ICB) in patients with PD.(1-3) ICB encompass impulse control disorders (ICD) and related disorders such as dopamine dysregulation syndrome (DDS), punding (stereotyped behaviors), and hobbyism. These disorders are linked by being reward- or incentive-based, and involve repetitive and compulsive acts despite potential long-term harmful consequences.(4).
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Prolonged Survival in an Aged Labrador Retriever with a Metastatic Insulinoma.

Filed under: Rehab Centers

J Am Anim Hosp Assoc. 2013 Jan 17;
Rychel J, Worley DR, Hardy CS, Webb BT

This case report highlights an unusually prolonged, asymptomatic, disease-free interval in an aged male Labrador retriever that underwent partial pancreatectomy for a functionally active pancreatic insulinoma with histologically confirmed hepatic metastasis. The patient developed pancreatitis and nonseptic suppurative peritonitis 24 hr after surgical resection of the insulinoma and was managed medically until discharge. Three mo after surgery, the dog was diagnosed with exocrine pancreatic insufficiency (EPI) that was effectively managed with parenteral pancreatic enzymes. Due to normal glucose levels 3 mo postsurgically, liver samples from the initial surgery were resubmitted for immunohistochemistry. Results confirmed insulinoma metastasis with insulin expression. Ten mo postsurgically, the blood glucose was normal and serum insulin levels were slightly above the upper reference limit. The first hypoglycemic episode was documented 23 mo postoperatively, which was effectively managed with prednisone. The cause for the prolonged disease remission and survival was unknown, but was possibly a result of pancreatitis and peritonitis, partial spontaneous regression of metastatic lesions, or idiopathic. Despite life-threatening postoperative complications, this patient enjoyed a profoundly longer than expected survival. This case highlights the importance of removing the primary tumor (insulinoma) despite the presence of metastatic disease.
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The approach of ameloblastoma of the mandible: a case treated by hyperbaric oxygen therapy and bone graft reconstruction.

Filed under: Rehab Centers

Oral Maxillofac Surg. 2013 Jan 17;
Oliveira MT, Rocha FS, de Paulo LF, Rodrigues AR, Zanetta-Barbosa D

BACKGROUND: Reconstruction of mandibular defects after tumor resection is a challenge to the head and neck surgeon because of associated functional and esthetic problems. The intention of mandibular reconstructive surgery is to achieve maximum possible functionality, which means the restoration of masticatory function and speech with a good esthetic result. Hyperbaric oxygen therapy (HBO) is already a well-accepted adjunct in the treatment of extensive bone defects. It has been shown to enhance osteogenesis and improve soft tissue wound healing in a variety of circumstances. CASE REPORT: The following case report describes a 29-year-old woman who was diagnosed with mandibular ameloblastoma. The treatment of choice is resection with mandibular base maintenance. The patient underwent 10 sessions of hyperbaric oxygen therapy and subsequent nonvascularized iliac crest graft. Six months after, mandibular reconstruction is possible to observe the preservation of mandibular contouring and facial esthetics. A panoramic radiograph revealed good positioning of the bone graft and volume maintenance. DISCUSSION: The mandibular reconstruction is extremely important for the rehabilitation of the patient who underwent bone resection. The restoration of mandibular function and facial esthetics is essential to maintain the quality of life. The use of HBO in mandibular reconstruction is an important adjunct to successful treatment, however, more studies are needed to establish the best modalities of rehabilitation.
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