Iliacus haematoma is a relatively rare condition, which may cause a local compressive neuropathy. It is usually diagnosed in adults with haemophilia or those on anticoagulation treatment and may occur after trauma. We present the case of a healthy 15-year-old boy with a femoral neuropathy due to an iliacus haematoma which resolved following conservative treatment.
The authors would like to present a retrospective study conducted on 178 patients having undergone a hip replacement. The aim of this study was to look at the immediate and short-term complications of hip replacement in relation to the body mass index (BMI). Patients ranging from age 49 to 90 were included in this study with an average age of 67.5. BMI ranged from 18 to 41. Length of stay ranged from 3 days to 76 days with an average of 11.5 days. Follow up of each patient included any wound complications, time to mobilisation and time to discharge. Operative blood loss and need to transfusion were also looked at. Blood loss was found to be from 150 mls to 2400 mls. A large number of orthopaedic surgeons use a BMI value of 35 as the upper cut off point to refuse elective surgery. Using the Null hypothesis the authors wanted to prove that a higher BMI resulted in higher complication rates. Statistical analysis of the data however did not show a significant relationship between BMI and early complications in hip replacement surgery. Parameters measured had a higher relationship to individual surgeons rather than the BMI. The authors would like to conclude that using the BMI as a predictor of a higher rate of short-term complications and refusing surgery to patients with a higher BMI is not justified.
We have prospectively compared the fixation of 100 intertrochanteric fractures of the proximal femur in elderly patients with random use of either a Dynamic Hip Screw (DHS) or a new intramedullary device, the Gamma nail. We found no difference in operating time, blood loss, wound complications, stay in hospital, place of eventual discharge, or the patients' mobility at final review. There was no difference in failure of proximal fixation: cut-out occurred in three cases with the DHS, and twice with the Gamma nail. However, in four cases fracture of the femur occurred close to the Gamma nail, requiring further major surgery. In the absence of these complications, union was seen by six months in both groups.
We report three patients in whom a fractured odontoid process was associated with a fracture of the superior articular process of the second cervical vertebra. Although there were no signs of neurological disorder, damage to the C1-C2 joint in all three patients made fusion necessary. Forced lateral flexion is suggested as the possible mechanism of injury.