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Echocardiography and femur fracture

Nima Rudd, Ivan Subiakto, Muhammad Asrar Ul Haq, Vivek Mutha, William J Van Gaal
BACKGROUND: The incidence of perioperative myocardial infarction (PMI) globally is known to be around 2 to 3% and can prolong hospitalization, increased morbidity and mortality. Little is known about the pathophysiology and risk factors for PMI. We investigate the presence of elevated novel cardiac markers and preoperative coronary artery plaque through contemporary laboratory techniques to determine the correlation with PMI, as well as studying ivabradine and atorvastatin as protective pharmacotherapies against PMI in the context of orthopedic surgery...
2014: Trials
S J Loxdale, J R Sneyd, A Donovan, G Werrett, D J Viira
The prevalence and severity of aortic stenosis in unselected patients admitted with a hip fracture is unknown. Derriford Hospital operates a routine weekday, pre-operative, targeted bedside echocardiography examination on all patients admitted with a hip fracture. We carried out a prospective service evaluation for 13 months from October 2007 on all 501 admissions, of which 374 (75%) underwent pre-operative echocardiography. Of those patients investigated, 8 (2%) had severe, 24 (6%) moderate and 113 (30%) had mild aortic stenosis or aortic sclerosis...
January 2012: Anaesthesia
Nicolas Portet, Béatrice Riu, Vincent Bounes, Vincent Minville, Olivier Fourcade
BACKGROUND: Intracardiac shunts are rare but very serious lesions after non-penetrating chest trauma. Their diagnosis is difficult. This pathology often goes unrecognized in the context of multiple trauma. CASE REPORT: We report the case of a 21-year-old man involved in a motor vehicle crash who presented with multiple injuries including myocardial contusion, severe brain injury, multiple pelvic fractures, closed femur fracture, bilateral lung contusion with a right pneumothorax, and intra-abdominal injuries...
December 2012: Journal of Emergency Medicine
Timothy S J Shine, Neil G Feinglass, Bruce J Leone, Peter M Murray
Fat embolus has been known to occur during major orthopedic surgery. In many cases, fat embolus syndrome is a postoperative complication of long bone orthopedic surgery, particularly femoral fractures occurring after trauma. Changes in intraoperative cardiopulmonary function have been reported in a subset of these patients, and they are associated with the degree of embolization occurring with manipulation or cementing of prostheses in the fractured femur. Intraoperative cardiovascular collapse has been reported, and this cardiac event is temporally associated with intramedullary manipulations such as reaming or cementing...
2010: Iowa Orthopaedic Journal
Krzysztof Laudanski, Samir P Patel, Yong G Peng
Pulmonary embolism (PE) by solid particles is an infrequent complication encountered during orthopedic procedures. A patent foramen ovale (PFO) allows embolic material into the left-sided circulation, potentially affecting several organs. A case of a 33-year-old woman undergoing total proximal femur resection with megaprosthesis reconstruction is presented. Towards the end of surgery, cement was injected to stabilize the prosthesis. Echodense particulate matter was first seen in the right atrium, subsequently in the right ventricle, and also in significant quantities in the left atrium and ventricle...
November 2009: Journal of Clinical Anesthesia
U Hamsen, C A Kühne, K Kröger, D Nast-Kolb, S Ruchholtz
This is a case report of a 31-year-old motorcyclist who was admitted to our emergency department with severe multiple injuries and an ISS score of 38 points.There were bone injuries on all 4 extremities, fractures of both proximal femurs, both radii, a great soft tissue injury of the lower limb, stable fractures of the spine and a blunt thoracic injury. A bone fragment compressed femoral vein and artery on the right side with consecutive thrombus in the inferior caval vein and thrombembolism of the central lung artery...
October 2009: Der Chirurg; Zeitschrift Für Alle Gebiete der Operativen Medizen
M Sandby-Thomas, G Sullivan, J E Hall
We conducted a national postal survey of trauma anaesthetists in the UK to ascertain current practice for the peri-operative anaesthetic management in patients with fractured necks of femur. We received 155 replies from 218 questionnaires sent (71.1% response rate). Regional anaesthesia was preferred by 75.8% of respondents, with 95.5% of these employing a spinal technique. This was generally performed bad side down (45.7%) using ketamine (37.3%) and/or midazolam (41.2%) to aid positioning. In all, 31.4% used fentanyl in the intrathecal injectate, whereas only 5...
March 2008: Anaesthesia
Yasufumi Asai, Yoshihiko Kurimoto
Most left ventricular true aneurysms that occur secondary to blunt trauma gradually become symptomatic as they enlarge, which validates conservative management as a reasonable initial course of action. We report a case of impending rupture of a left ventricular true aneurysm that showed rapid expansion within a few weeks. A 17-year-old youth was involved in a head-on collision into a car while riding a motorcycle. He underwent repair of a ruptured jejunum and internal fixation of a fractured femur; 28 days after the accident, he was transferred to another hospital for rehabilitation...
2007: Surgery Today
Eve Vaidla, Inga Talvik, Andres Kulla, Hiljar Sibul, Katre Maasalu, Tuuli Metsvaht, Andres Piirsoo, Tiina Talvik
The authors present the case of an infant girl with severe generalized weakness, multiple bone fractures, and heart defect. She needed mechanical ventilation from birth. Radiographs showed mid-diaphyseal fractures of both humeri and of the right femur as well as generalized osteopenia. Electroneuromyography showed spontaneous fibrillations at rest with no active movements. Motor response to a stimulus could not be registered. A systolic heart murmur was detected, and echocardiography showed a large atrial septal defect and an additional membrane in the left atrium...
January 2007: Journal of Child Neurology
Abdulaziz Alghamdi, James Tam
A 59-year-old man developed an episode of syncope while he was driving. This resulted in a motor vehicle accident, and the patient sustained an open fracture of the left femur. Biopsy of the left femur fracture showed a metastastic renal cell carcinoma, and echocardiography revealed a right ventricular mass without contiguous vena caval or right atrial involvement. This is one of the few reported cases of renal cell carcinoma associated with syncope as an initial symptom.
December 2006: Canadian Journal of Cardiology
H Sekiya, K Noguchi, Y Ohashi, Y Kariya, Y Hoshino, H Konishi
We present a case of recurrent saddle embolism 6 days and 9 days following corrective osteotomy of the left femur in a 64-year-old man with a history of atrial fibrillation. Although saddle embolism is a relatively rare event, orthopaedic surgeons should be aware of this condition.
August 2006: Journal of Orthopaedic Surgery
Alexander Joist, Marc Schult, Christian Ortmann, Uwe Frerichmann, Thomas Frebel, Hans-Ullrich Spiegel, Albert Kröpfl, Heinz Redl
BACKGROUND: Reamed intramedullary nailing causes an increase of intramedullary pressure. A new rinsing-suction reamer (RSR) can reduce this problem, and it was evaluated in animal experiments in comparison with the AO reamer (AOR) to see its effects on intramedullary pressure and fat intravasation. METHODS: Reamed intramedullary nailing was performed in 14 sheep using the RSR or AOR. The following parameters were evaluated: intramedullary pressure, hemodynamics, blood tests, lung histology, and radiographs of the femur that was operated on...
July 2004: Journal of Trauma
E Guryel, D J Redfern, D M Ricketts
BACKGROUND: About 60,000 patients are treated for hip fractures each year in the UK and the incidence is increasing. The majority of these patients are elderly and sick, and delay to operation may be fatal. The National Confidential Enquiry into Peri-Operative Deaths (NCEPOD) guidelines aim to improve quality of care for such patients. However, we present an audit highlighting the importance of balancing the implementation of such guidelines with available local resources to ensure that established priorities in the care of these patients remain paramount...
May 2004: Annals of the Royal College of Surgeons of England
James G Ravenel, Laura E Heyneman, H Page McAdams
Pulmonary fat embolism probably occurs commonly after major orthopedic injuries and after orthopedic surgery. Furthermore, tiny fat emboli can often be shown by transesophageal echocardiography during orthopedic surgery. However, large macroscopic are rarely identified radiologically. Macroscopic fat emboli have been previously described in the common femoral vein and inferior vena cava on abdominal imaging. To the authors' knowledge, a macroscopic fat embolus in the pulmonary arteries has not been previously described...
April 2002: Journal of Thoracic Imaging
Mehdi Mousavi, Roland David, Ilse Schwendenwein, Eva Schaden, Stefan Marlovits, Alexander Kolonja, Erhard Schwanzer, Thomas Heinz, Vilmos Vécsei
This study assessed the influence of driving speed and revolution rate per minute of two reamers on femoral intramedullary pressure increases and fat intravasation. The AO and Howmedica reamers were tested in four groups with different combinations of driving speed and revolution rate per minute in both femurs in a sheep model. The 24 animals were exposed to hemorrhagic shock after midshaft osteotomy and were resuscitated before reaming of both femoral shafts. Controlled reaming was performed at 15 and 50 mm/second driving speed with 150 and 450 revolutions per minute...
January 2002: Clinical Orthopaedics and related Research
C M Robinson, C A Ludlam, D C Ray, D G Swann, J Christie
We measured the changes during operation in seven markers of coagulation in a prospective series of 84 patients with fractures of the tibia or femur who were undergoing reamed intramedullary nailing. All patients were also continually monitored using transoesophageal echocardiography to assess marrow embolism. In a subset of 40 patients, intraoperative cardiopulmonary function was monitored, using pulmonary and systemic arterial catheterisation. The procedure produced a significant increase in prothrombin time, activated partial thromboplastin time, the level of prothrombin fragments F1+2 and D-dimers, and a decrease in the fibrinogen level, suggesting activation of both the coagulation and fibrinolytic pathways...
September 2001: Journal of Bone and Joint Surgery. British Volume
R E Coles, F M Clements, J W Lardenoye, G V Wermeskerken, L A Hey, J A Nunley, L S Levin, A W Pearsall
We quantified the embolic load to the lungs created with two different techniques of femoral nailing. Eleven patients with 12 traumatic femur fractures were randomized to reamed (7 fractures) and unreamed (5 fractures) groups. Intramedullary nailing was with the AO/ASIF* universal reamed or unreamed nail. Transesophageal echocardiography (TEE) was used to evaluate the quantity and quality of emboli generated by nailing. Data were analyzed using software that digitized the TEE images and quantified the area of embolic particles in each frame...
2000: Journal of the Southern Orthopaedic Association
S Matsuda, T Hatta, S Kurisu, H Ohyabu, T Koyama, Y Kita
A 62-year-old man who had suffered fractures of the left chest wall and hemothorax 1 year earlier was admitted to our hospital with multiple injuries as a result of a traffic accident. Chest drainage was immediately performed under the diagnosis of left hemothorax followed by immobilization of fractures of the femur and radius. On the second day after admission, he suddenly developed severe chest pain and dyspnea after sitting up in bed. Echocardiography and chest computed tomography (CT) showed herniation of the left ventricle into the left thoracic cavity, whereby a diagnosis of cardiac herniation due to rupture of the pericardium was made and an emergency surgical repair was successfully performed...
1999: Surgery Today
M Genoni, R Jenni, M Turina
A 26 year old man was admitted to hospital following a traffic accident. He had been sitting in the back of a car without wearing a seat belt. He suffered crush injuries on the anterior chest wall, trunk, and legs. On admission he was awake and cooperative, but restless, and obviously in severe pain. Radiography of the skull, facial bones, chest, spine, pelvis, and legs revealed a shaft fracture of the left femur and tibia and fracture of the 7th and 8th right ribs. The patient was transferred to the University Hospital of Zurich for further assessment and surgical repair of the lower limb fractures three days later...
September 1997: Heart: Official Journal of the British Cardiac Society
H Sato, M Takahashi
An 84-year-old man with non-Hodgkin's malignant lymphoma presented with a pathological fracture of the femur and also an intra-atrial mass on echocardiography. The patient was given palliative low-dose chemotherapy, but died of tumor dissemination, hypercalcemia, and dehydration. Autopsy revealed diffuse large B-cell lymphoma involving multiple bones and lymph nodes (the latter were not detected during staging), and a solitary mass on the posterior wall of the right atrium. This rare lesion appeared to be due to hematogenous spread, since the myocardium and pericardium were free of tumor infiltration...
June 1993: Internal Medicine
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