RESUMEN
Case: We present a case report on the management and outcome of a periprosthetic tibial shaft fracture treated with intramedullary nailing. The patient, a 78-year-old female, presented with a history of having undergone total knee arthroplasty ten years ago due to osteoarthritis. She sustained a periprosthetic fracture of the tibial shaft with compromised soft tissues surrounding the fracture site following a motor vehicle accident. Plain radiographs revealed a displaced tibial shaft fracture with a flipped large spiral wedge fragment located distal to the total knee prosthesis. Due to the poor soft tissue condition and the risk of complications in wound healing, as well as the desire to avoid prolonged bed rest and immobilization, intramedullary nailing was chosen as the primary treatment modality. Despite the challenging circumstances, the patient achieved satisfactory healing and recovered her pre-injury ambulation status with no significant complications at the six-month follow-up. Conclusion: Managing periprosthetic tibial shaft fractures in the presence of compromised soft tissues presents significant challenges for orthopedic surgeons. In this case, intramedullary nailing proved to be a suitable treatment option, minimizing soft tissue trauma and providing stable fixation to facilitate early mobilization and weight bearing.
RESUMEN
Case: We present a case of a 28-year-old beginner golfer who sustained multiple episodes of isolated spinous process fractures of the lower cervical and upper thoracic vertebrae (clay-shoveler's fracture) and its ten-year follow-up. The patient is complaining of intermittent mild dull pain and discomfort in the posterior aspect of the cervicothoracic junction even after 10 years from initial injury. Radiologic evaluation revealed non-union of avulsed fragments and the patient's symptoms are possibly associated with non-union. Nevertheless, he recovered to full activity with no limitations in activities of daily living. Conclusion: In case of non-union of previous fractures, it seems to affect biomechanical stability of surrounding muscles and ligaments of the spinous processes and increase stress in motion on spinous processes of adjacent vertebrae during vigorous activity. It is associated with additional fractures of adjacent vertebrae.