Notes

Temperature impacts the particular biotransformation and also deposition of a psychoactive pharmaceutical drug and its metabolite within water creatures.
A 14-year-old boy underwent open reduction and internal fixation (ORIF) of a tibial tubercle avulsion fracture. Seven weeks postoperatively, the patient slipped in the bathroom and was found to have a superior patellar pole periosteal sleeve avulsion injury.

We describe a rare case of periosteal sleeve avulsion fracture of the superior patella pole after tibial tubercle avulsion fracture ORIF in an adolescent male patient. The etiology of this injury pattern may be due to altered tensile forces transmitted through the extensor mechanism related to the previous surgery. Orthopaedic surgeons should be aware of this unusual sequela.
We describe a rare case of periosteal sleeve avulsion fracture of the superior patella pole after tibial tubercle avulsion fracture ORIF in an adolescent male patient. The etiology of this injury pattern may be due to altered tensile forces transmitted through the extensor mechanism related to the previous surgery. Orthopaedic surgeons should be aware of this unusual sequela.
A 69-year-old woman with a history of breast cancer, on long-term antiresorptive medications, was treated with carbon fiber cephalomedullary nails for bilateral atypical femur fractures. Her thigh pain was presumed to be from metastatic lesions and was treated with radiation without standard imaging. The index procedure was complicated by a left nail fracture. The patient underwent exchange cephalomedullary nail fixation with plate augmentation. At 1 year, the patient was asymptomatic with radiographs demonstrating healing.

This case highlights the importance of appropriate imaging in all patients with thigh pain on antiresorptive therapy and features an uncommon complication of carbon fiber cephalomedullary nail fixation.
This case highlights the importance of appropriate imaging in all patients with thigh pain on antiresorptive therapy and features an uncommon complication of carbon fiber cephalomedullary nail fixation.
A 64-year-old man suffered a pathologic left femoral neck fracture. Biopsy demonstrated metastatic urothelial cancer with a nonmuscle invasive bladder cancer primary confirmed by cystoscopy. The patient underwent hemiarthroplasty, chemotherapy, radiation, and eventually, a conversion to total hip arthroplasty. Today, over a decade from the initial surgery, the patient remains alive and highly functional. To our knowledge, this is the only report of bone metastatic bladder cancer with over 10-year survival.

Combined chemotherapy, radiation, and surgical resection of metastasis with reconstruction may confer a survival benefit in bony oligometastatic bladder cancer.
Combined chemotherapy, radiation, and surgical resection of metastasis with reconstruction may confer a survival benefit in bony oligometastatic bladder cancer.
A 75-year-old man, who was a carpenter, experienced neck pain and numbness in the upper and lower extremities while hammering a nail and later developed a gait disturbance. Initial magnetic resonance imaging (MRI) revealed a tumor-like mass at the C5 epidural space compressing the spinal cord. The first diagnosis was cervical epidural hematoma. The following day, the patient's symptom deteriorated. A second MRI revealed an increase in the size of the mass, and surgery was performed. Operative findings included a juxtafacet cyst.

Repeated job-related load on the facet joint in this patient caused rapid progression of facet cysts, causing myelopathy similar to an epidural hematoma.
Repeated job-related load on the facet joint in this patient caused rapid progression of facet cysts, causing myelopathy similar to an epidural hematoma.
A 76-year-old woman without a personal or family history of gout presented with complaints of left hip pain after a mechanical fall from her wheelchair. Advanced imaging revealed a nonspecific lesion and nondisplaced fracture of the femoral neck. Bcl-2 phosphorylation Intraoperative biopsy from the lesion/fracture demonstrated tophaceous gout.

Fractures resulting from osseous manifestations of the gout are rare with this report describing a hip fracture secondary to tophaceous gout. We emphasize the importance of including this potential etiology in the differential diagnosis of elderly patients presenting with hip pain, with or without a known history of gout.
Fractures resulting from osseous manifestations of the gout are rare with this report describing a hip fracture secondary to tophaceous gout. We emphasize the importance of including this potential etiology in the differential diagnosis of elderly patients presenting with hip pain, with or without a known history of gout.
The patient was a 60-year-old woman with a comminuted, open distal radius and distal ulna metadiaphyseal fracture. After fixation of the distal radius, the distal ulna was unstable and crepitant with rotation and anteroposterior translation. Because of limited bone stock and poor soft tissue, we spanned the distal ulna using a wrist spanning plate. This was removed at 6 weeks postoperatively. She healed and was satisfied with her outcomes.

This case describes the original use of a wrist spanning plate for a complex distal ulna fracture. Ulnocarpal-spanning plate fixation provides an alternative to traditional methods of fixation.
This case describes the original use of a wrist spanning plate for a complex distal ulna fracture. Ulnocarpal-spanning plate fixation provides an alternative to traditional methods of fixation.
A 78-year-old woman with rheumatoid arthritis and a massive rotator cuff tear of the right shoulder was treated with reverse shoulder arthroplasty, but a pseudoaneurysm in the posterior humeral circumflex artery suddenly ruptured 7 months after surgery. Embolization of the pseudoaneurysm and skin treatment successfully relieved her symptoms without implant removal.

Although a rare occurrence, vascular complication can occur after shoulder arthroplasty. The cause of the pseudoaneurysm was hypothesized to be repetitive contact between the humeral component and the artery and/or chronic traction of the blood vessel because of its chronic onset.
Although a rare occurrence, vascular complication can occur after shoulder arthroplasty. The cause of the pseudoaneurysm was hypothesized to be repetitive contact between the humeral component and the artery and/or chronic traction of the blood vessel because of its chronic onset.
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