Supracondylar Fractures of the femur are not as cammon as femoral neck or intertrochanteric fractures, but their treatment may be just as difficult. Few surgeons have had extensive experience with this complex fractures of uncommon frequency. Until a few years ago, conservative treatment was considered superior to internal fixation of supracondylar fractures of the femur in adults. However, the development of new fixation devices and techniques has, according to several investigations, improved the results of the treatment of these fractures. The following clinical results were shown by analysis of 27 cases of femoral supracondylar fractures experienced in the Department of Orthopedic Surgery, Capital Armed Forces General Hospital in the past 3 years from Jan. 1977 to Oec. 1979. 1. The most common cause of these fractures were traffic accidents. 2. Of 27 cases, 11 cases were treated by conservative method, 16 cases were treated by open reduction and internal fixation. 3. Anatomical reduction and rigid internal fixation led to 80% of good to excellent results whereas only 33.4% of good to excellent results were obtained in patients in whom the fixation was not absolutely rigid. 4. In the treatment of supracondylar fractures of the femur, anatomical reduction and rigid internal fixation (80% of good to excellent results) resulted in better functional recovery after union of fractures than conservative treatment (45.5%).
Accidents, Traffic ; Adult ; Arm ; Femur Neck ; Femur ; Hip Fractures ; Hospitals, General ; Humans ; Methods ; Orthopedics ; Surgeons

BACKGROUND: Multiple endocrine neoplasia type 1 (MEN1) is a rare inherited disorder characterized by the simultaneous occurrence of endocrine tumors in target tissues (mainly the pituitary, endocrine pancreas, and parathyroid glands). MEN1 is caused by mutations in the MEN1 gene, which functions as a tumor suppressor and consists of one untranslated exon and nine exons encoding the menin protein. This condition is usually suspected when we encounter patients diagnosed with tumors in multiple endocrine organs, as mentioned above. METHODS: A 65-year-old woman who underwent surgery for a pancreatic tumor (serous cystadenoma) 5 years previously was referred to our hospital due to neurologic symptoms of diplopia and left ptosis. Brain magnetic resonance imaging revealed a 3.4-cm lesion originating from the cavernous sinus wall and extending into the sellar region. It was thought to be a nonfunctioning tumor from the results of the combined pituitary function test. Incidentally, we found that she also had a pancreatic tumor, indicating the necessity of genetic analysis for MEN1. RESULTS: Genomic analysis using peripheral leukocytes revealed a heterozygous c.1621G>A mutation in the MEN1 gene that was previously reported to be either a pathogenic mutation or a simple polymorphism. We pursued a stereotactic approach to the pituitary lesion, and microscopic findings of the tumor revealed it to be an intrasellar cavernous hemangioma, a rare finding in the sellar region and even rarer in relation to oculomotor palsy. The patient recovered well from surgery, but refused further evaluation for the pancreatic lesion. CONCLUSION: There is great emphasis placed on genetic testing in the diagnosis of MEN1, but herein we report a case where it did not assist in diagnosis, hence, further discussion on the role of genetic testing in this disease is needed. Also, in cases of pituitary tumor with cranial nerve palsy, despite its low prevalence, intrasellar cavernous hemangioma could be suspected.
Aged ; Brain ; Cavernous Sinus ; Cranial Nerve Diseases ; Diagnosis ; Diagnostic Errors* ; Diplopia ; Exons ; Female ; Genetic Testing ; Hemangioma, Cavernous* ; Humans ; Islets of Langerhans ; Leukocytes ; Magnetic Resonance Imaging ; Multiple Endocrine Neoplasia Type 1* ; Neurologic Manifestations ; Paralysis ; Pituitary Function Tests ; Pituitary Neoplasms ; Prevalence