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Malpresentation And Malposition
Published in Vincenzo Berghella, Obstetric Evidence Based Guidelines, 2022
Alexis C. Gimovsky, Andrea Dall’Asta, Giovanni Morganelli, Tullio Ghi
While the rate of short-term fetal bradycardia can be as high as 20%, the rate of the need for urgent CD for nonreassuring fetal heart rate tracing (NRFHT) after an external cephalic version (ECV) is about 1/600 [25]. Placental abruption (<1%) and onset of labor are uncommon complications. Rare fetal deaths following attempts at version have not been determined to be a result of the procedure [1]. Femur fracture has been reported. In a meta-analysis, there was a 4.7% risk of transient abnormal cardiotocography, 0.21% risk of abnormal cardiotocography leading to emergency CD (with good neonatal outcomes), and 0.35% risk of emergency CD. Other risks included 0.24% risk of stillbirth, 0.18% risk of placental abruption, 0.18% risk of cord prolapse, and 0.19% risk of fetal death. These complications were not found to be directly related to the ECV procedure. Vaginal bleeding related to ECV occurred in 0.34% of patients, and rupture of membranes related to ECV occurred in 0.22% of patients [26]. An additional retrospective review showed a 3.32% risk of spontaneous reversion to breech [27].
Knee Pain
Published in Benjamin Apichai, Chinese Medicine for Lower Body Pain, 2021
The posterior cruciate ligament is one of the two cruciate ligaments of the knee, and it is one of four stabilizers of the knee joint. Its functions are to prevent the femur from continuing to move anteriorly on the tibia and prevent the tibia from moving posteriorly on the femur. It also prevents hyper-extension and limits internal rotation, adduction, and abduction at the knee joint.9
Healing Trauma
Published in R. Annie Gough, Injury Illustrated, 2020
Once at the hospital, Javier underwent extensive radiology studies. These CTs, MRIs, and x-rays ended up in a huge pile of CDs on my desk. He suffered multiple fractures of his face, including his mandible and a line of destruction passing through both maxillary sinuses via his nose. His spine suffered an L1 burst fracture, remarkably not paralyzing his legs. Pelvic fractures on the right were balanced by a massive femur fracture on the left. The skin on his hands and knees was scraped away, stinging and bleeding. Illustrations summarized his medical chronology, beginning with Javier as normal and unhurt in his wheelchair. This image is contrasted by his summary of injuries, with his overturned wheelchair in the background. The femur repair was illustrated with surgical incision and hip fixation hardware. A page illustrated his spinal surgery and lumbar spine rods and screws. I allowed several pages to detail Javier's facial repair surgery including the exposure of his jaw fracture and placements of various plates and screws in his skull.
Modeling attachment and compressive loading of locking and non-locking plate fixation: a finite element investigation of a supracondylar femur fracture model
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2022
Amir Samiezadeh, Stewart McLachlin, Matthew Ng, Saeid Samiezadeh, Jeremie Larouche, Cari Whyne
Treatment of distal femur fractures remains a challenge with respect to optimizing the mechanical environment for healing and minimizing risk of implant fatigue failure (Henderson et al. 2011a, 2011b; McLachlin et al. 2017). Understanding how screw type and attachment affects strains in lateral plating is important to characterize risk of implant fatigue failure. This FE study showed the importance of using bolt pretension as a way to represent plate strains induced via non-locking screw attachment. While the plate strains values in the current study were compared to experimental data obtained with synthetic bone models, the modeling approach demonstrated in the current study is clinically relevant towards optimization of lateral plating techniques by capturing the changes in the baseline plate strains that occur with plate attachment using non-locking screws. Non-locking screws induce these large plate strains by pulling or conforming the plate to the bone surface. This elevated baseline level of mean plate stress directly contributes to a higher risk of fatigue failure under alternating cyclic loading experienced during daily activities such as walking.
Same-side insufficiency fractures of the tibia and femur after denosumab discontinuation: a case report
Published in Modern Rheumatology Case Reports, 2021
Hidefumi Koiwai, Mikio Kamimura, Yukio Nakamura, Jun Takahashi, Akira Taguchi
Severe left knee joint pain appeared without trauma at 18 months after DMAB cessation. Pain and tenderness were observed in the proximal part of the left tibia, with no apparent lesions in radiographs of the distal part of the tibia (Figure 1(a)). Soon after, she was hospitalised for 2 weeks due to heart failure, during which time her knee pain disappeared spontaneously. Two weeks after discharge, she complained of severe left knee joint pain again. Pain and tenderness were noted in the distal part of the medial femoral condyle. Radiographs showed osteosclerotic change in the proximal part of the tibia in the absence of lesions in the distal part of the femur (Figure 1(b)). Magnetic resonance imaging (MRI) revealed the presence of a subchondral, well-defined, striped pattern area of decreased signal intensity on T1-weighted images and decreased signal intensity on T2-star weighted images on both sides of the distal femur and the proximal tibia (Figure 1(c)). Three weeks after the onset of the second bout of knee joint pain, radiographs disclosed osteosclerotic change in the distal part of the femur (Figure 1(d)). Bone insufficiency fractures of the tibia and femur were diagnosed from these plain radiographic findings and MRI results.
Image-based finite-element modeling of the human femur
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2020
Cristina Falcinelli, Cari Whyne
Numerical predictions of bone strength through image-based finite element (FE) modeling techniques have been widely studied and developed for over 20 years. The ultimate aim of this work is the translation of such techniques from bench to bedside to develop mechanics-based indices for accurate identification of clinical cases at high risk of bone fracture. Exploring femoral structural weaknesses arising from pathological conditions such as osteoporosis and metastasis that render the femur more prone to fracture, represents one of the most investigated areas in the field of biomechanics (Orwoll et al. 2009; Keyak et al. 2011; Falcinelli et al. 2014, 2019; Kopperdahl et al. 2014; Qasim et al. 2016; Sternheim et al. 2018). Femur fractures have serious clinical implications leading to reduced mobility and quality of life and an increased risk of mortality (Thorne et al. 2016; Nguyen 2018).