Osteonecrosis of the femoral head following an electrical injury to the leg

Electrocuted Hip: Late Consequences of Electrical Shock Injuries of Orthopaedic Relevance: A Case Report and Review of Literature

CASE

A 43-year-old man suffered household electric shock from 220 V alternating current when he accidently touched a live wire with his left hand. Subsequently, he was diagnosed to have osteonecrosis of the left femoral head and underwent total hip arthroplasty.

CONCLUSION

We suggest that the electric current could have thrombosed the terminal subsynovial vessels of the femoral head, leading to osteonecrosis. To the best of authors' knowledge, only 2 cases of osteonecrosis of the hip after electric shock have been reported in the literature. A literature review of the delayed consequences of electric shock injuries pertaining to orthopaedics is also presented.

Electric Shock-Induced Vertebral Fracture: A Case Report and Literature Review with Special Emphasis on Fracture Morphology

CASE

A 35-year-old man suffered electric injury with 220 V alternating current when he was connecting electric wires at approximately 5 feet height and accidentally touched a live wire. He was diagnosed to have fracture involving superior and inferior endplates of L2 vertebral body without involvement of posterior elements. He, subsequently, underwent spinal stabilization with percutaneous pedicle screws fixation.

CONCLUSION

Electric shock can cause vertebral fractures even at a low voltage. These fractures tend to have coronal plane involvement and involve both superior and inferior end plates.

Osteonecrosis

Younger patients are affected more often by osteonecrosis than by osteoarthritis, and osteonecrosis has significantly greater long-term morbidity.

Corticosteroids are the most common cause of nontraumatic osteonecrosis.

The femoral head is the most common site of osteonecrosis.

In rare instances, osteonecrosis of the jaw has been associated with bisphosphonate exposure. This phenomenon is more common with repeated intravenous infusions of bisphosphonates.

Case reports of osteonecrosis of the jaw in association with other medications, such as denosumab, have been reported.

The final common pathway in the pathogenesis of osteonecrosis is disruption of blood supply to a segment of bone.

Abnormalities in lipid metabolism, bone homeostasis, regulation of apoptosis, coagulopathies, innate immunity, and oxidative stress may play a role in the pathogenesis of osteonecrosis.

Epigenetics may alter the predisposition to develop osteonecrosis.

MRI is currently the optimal test for early diagnosis and identification of the extent of osteonecrosis.

Nonsurgical treatment of osteonecrosis does not change the natural history of the disease.

Although surgical treatment of femoral head osteonecrosis has many variations, most symptomatic patients eventually require total hip arthroplasty.

Knowledge of risk factors and early detection are crucial to the successful management of osteonecrosis.

Because of the lack of successful treatment options, new modes of management focus on the prevention of osteonecrosis.

Spontaneous Fracture of the Humerus 18 Months after a High Voltage Electrical Injury: A Case Report

Electrical burn occurs when a current passes through the body, interfering with the function of internal organs or sometimes burning tissue. Four major mechanisms of electricity-induced injuries are presently known. In this case report, a 29-year-old farmer sustained electrical trauma to extremities from a high voltage transformer, followed by a major, deep burn wound on upper lateral aspect of his left arm, and a deep burn wound over the left medial ankle. After a few months, the patient developed left arm fracture with complete separation of two segments, and plantar wound with purulent discharge accompanied by complete destruction of the head of 4th metatarsal bone which was in favor of chronic osteomyelitis. In this case, passage of the high voltage current and direct trauma could destroy metaphyseal, medullary and periosteal blood supply. Patients with high voltage electrical-induced bone injuries who underwent reconstructive surgery seem to be susceptible to osteonecrosis and pathologic fractures; therefor, these patients should be under close follow-up and periodic radiologic evaluations may be recommended.

Osteonecrosis

Osteonecrosis affects younger patients more often than osteoarthritis and has significantly greater long-term morbidity.

Corticosteroids constitute the most common cause of nontraumatic osteonecrosis.

The femoral head is the most common site of osteonecrosis.

Bisphosphonate use is associated with osteonecrosis of the jaw.

The final common pathway in the pathogenesis of osteonecrosis is disruption of blood supply to a segment of bone.

Abnormalities in lipid metabolism, bone homeostasis, regulation of apoptosis, coagulopathies, and oxidative stress may play a role in the pathogenesis of osteonecrosis.

Magnetic resonance imaging is currently the optimal test for early diagnosis and identification of the extent of osteonecrosis.

Nonsurgical treatment of osteonecrosis does not change the natural history of the disease.

Although there are many variations on surgical treatment of femoral head osteonecrosis, most patients eventually require total hip arthroplasty.

Knowledge of risk factors and early detection are crucial to the successful management of osteonecrosis.

Due to the lack of successful treatment options, new modes focus on prevention of osteonecrosis.

Ischemic stroke after low-voltage electric injury in a diabetic and coagulopathic woman

Electric injury is a common physical injury in daily life. Because of the low resistance of vascular tissue, vascular injury and thrombosis are frequently found in cases of high-voltage electric injury but are rarely reported in low-voltage conditions. We present the case of a diabetic woman who suffered symptomatic brainstem stroke after a short duration of 60 Hz/110 V alternate current electric contact with a home washer socket. A stroke risk factor survey did not reveal remarkable cardiac or vascular abnormality, except increased glycohemoglobin levels and decreased protein C activity. In contrast to a direct and adequate energy transfer in high-voltage electric injury, a pre-existing vasculohemostatic deficit, such as coagulopathy, has been proposed to provide a predisposition to thrombosis in low-voltage electric injury. Nevertheless, the findings in this patient remind the possibility of physical triggering factor for stroke occurrence in our environment as new technology and product generates rapidly enough for understanding their safety and biologic effect.