1/23. Acute compartment syndrome of the forearm in association with ulnar shortening osteotomy: a case report.A 41-year-old man experienced severe pain in the forearm after undergoing ulnar shortening osteotomy to treat positive ulnar variance, a complication of a fracture of the distal end of the radius. The patient had compartment syndrome with compartment pressure of 55 mm Hg. A decompressive fasciotomy of the volar compartment provided total relief of pain and, subsequently, full recovery of all functions. We report the case and discuss the serious nature of compartment syndrome, its associated complications, and methods of diagnosis and management.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/23. The interdisciplinary approach to oral, facial and head pain.BACKGROUND: Chronic oral, facial and head pain is a common clinical problem, and appropriate diagnosis and management are a challenge for health care professionals. patients often will first seek the care of dentists because of the pain's localization in the oral cavity and surrounding structures. This article emphasizes the importance of establishing accurate diagnoses and conducting appropriate triage of the patient with complex orofacial pain. CASE DESCRIPTIONS: The authors present two case reports illustrating the complex nature of oral, facial and head pain, and the potential and actual pitfalls in management of this condition. These representative cases demonstrate how orofacial pain--which appears to be localized in the peripheral dental and oral structures--can have extremely complex etiologies involving other anatomical structures, the central nervous system and psychological factors. The reports point to the need for the expertise of a number of specialists in such cases. CLINICAL IMPLICATIONS: If the symptoms and clinical findings do not appear to be consistent with typical oral disease, or if standard treatments do not alleviate the pain, the dental clinician must consider other, more complex orofacial pain diagnoses. The dental professional should not hesitate to make referrals to key specialists or to members of an interdisciplinary team at a pain treatment center who have the expertise to appropriately diagnose and manage chronic oral, facial and head pain.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
3/23. Episodic snapping of the medial head of the triceps due to weightlifting.We describe two patients who had episodic elbow snapping and ulnar nerve dysesthesias only after weightlifting. These symptoms would disappear soon afterward. The episodic nature of their complaints and findings led to misdiagnosis. We documented by repeated clinical examinations and magnetic resonance imaging that the presence of these symptoms correlated directly with the finding of intermittent, activity-related snapping of the medial triceps. In both patients, the symptoms disappeared when the medial portion of the triceps migrated medially but did not dislocate over the medial epicondyle with elbow flexion. Thus, a minor change in the configuration of the medial portion of the triceps (fluid accumulation) in the same individual at different times can cause intermittent dislocation of the medial triceps. Previous papers dealing with patients with snapping of the medial triceps describe symptoms exacerbated by athletic activities, but the constant finding of snapping on sequential examinations.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/23. Lateral cervical spine dislocation and vertebral artery injury.Although anterior and posterior traumatic displacement of cervical vertebrae are commonly noted, and the devastating neurological deficits associated with these injuries have been amply defined, lateral displacement with fractures has been rarely recognized, and the clinical significance of this injury has been overlooked. This report describes five cases of cervical spine fractures with lateral dislocation. All patients had lateral and anteroposterior cervical spine radiographs as well as cervical angiography or postmortem study demonstrating either complete occlusion or significant impairment of flow of the vertebral arteries. Two cases had traumatic vertebral artery occlusion with secondary medullary and cerebellar infarction resulting in the patient's death. vertebral artery injury apparently is not uncommon in this particular type of fracture. The diagnosis of these vascular injuries may require angiography or magnetic resonance angiography. A vertebral occlusion or dissection is a problem of considerable complexity, requiring individualized management depending on the patient's symptomatology, location and nature of the injury, and time lapsed since the injury.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
5/23. Management of an unusual extreme extension contracture of the wrist: role of a custom-designed exercise program in achieving a good range of movement and prevention of recontraction.An extreme extension contracture of wrist with dorsal contracture of fingers 15 years after burn injury is described. Shortening of extensor tendons, secondary lengthening of flexor tendons, contracted wrist joint capsule, unusual dislocation of carpals, dorsal dislocation of metacarpophalangeal joints of fingers, and provision of sufficient amount of good-quality skin were some of the issues that had to be addressed in treatment. The contracture was released, the carpals and metacarpophalangeal joint dislocations were corrected and fixed with K wires, and the resulting defect was covered with a sheet split-thickness skin graft. An exercise program was designed that consisted of isotonic, isokinetic, and isometric resistance exercises and passive, active, and active-assistive range of motion exercises. These exercises were pursued with the intention of increasing dynamic strength, endurance, and overall functional recovery of the flexor muscles by exploiting the immature nature of early scar tissue. The resultant enhanced flexor muscle power from exercises along with the dynamic splint helped in lengthening of extensor tendons, wrist joint capsule, and split-thickness skin graft. It also helped in resisting the recontracting tendency, with further recovery of good range of wrist and fingers movements, obviating the need of tendon-lengthening surgery and flap coverage. One and half years of follow up didn't show any sign of recontracture, and the patient was able to perform his routine activities. Postburn wrist contractures of such magnitude have been seldom described. Emphasis is put on simple contracture release and a postoperative exercise program.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
6/23. Isolated anterolateral proximal fibular head dislocation.A 28-year-old woman fell and sustained an isolated anterolateral dislocation of the proximal fibula. This injury generally presents with a characteristic history and associated physical examination and radiographic findings, but the subtle nature of the salient findings contributes to a high degree of misdiagnosis. Emergency physicians should be familiar with this injury because early reduction reduces long-term morbidity.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
7/23. Cervical spine fracture-dislocation birth injury: prevention, recognition, and implications for the orthopaedic surgeon.spinal cord birth injury is rare, and orthopaedic surgeons infrequently encounter it. The injury is associated with hyperextension of the fetal head in utero and during delivery and with forceps-assisted breech vaginal deliveries. These cervical spinal cord injures may be complete or partial. They most commonly occur in the absence of bony injury, which can lead to diagnostic difficulties. Ultrasound and MRI studies are valuable diagnostic tools for identifying spinal cord injury in cases of hypotonic newborns with difficult deliveries. The authors report an unusual case of spinal cord birth injury with frank cervical fracture-dislocation following a difficult footling breech vaginal delivery. Early recognition of hyperextension of the fetal head in utero and planned cesarean section are important prevention methods. While this type of injury is rare, the pediatric orthopedic surgeon must understand its nature and severity to facilitate timely treatment.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
8/23. Complete L1-L2 lateral dislocation without fracture and neurologic deficit in a child.spinal injuries in the infantile age group are relatively rare, mainly due to anatomical and biomechanical features of the pediatric spine. With its hypermobile character, pediatric spine can withstand trauma without fracture, and the elastic nature of the young spine allows easy slippage between segments, especially under the age of 8. Clinically, a few of the cases present with subluxation only, which seldom involve the lumbar level. We report an extremely rare case of traumatic complete upper lumbar lateral lystesis in a 3-year-old boy. The patient was treated conservatively and followed up for 2 years with some degree of correction.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
9/23. Open subtalar dislocation.Open subtalar dislocation is a rare injury, accounting for about 0.1% of all dislocations and, consequently, the natural history and outcome of this injury and their relevance to treatment are not well documented. A retrospective study at Westmead Hospital revealed 10 patients who presented with this injury between 1978 and 1988. We had the opportunity to review all of these patients in 1987 and again in 1989. We found a high incidence (60%) of poor results, and that the only factor that influenced the outcome was infection. It is concluded that the poor prognosis is due to the nature of the injury itself, rather than any particular factors in the subsequent management. Specifically, there was no relation to the direction of the dislocation, the presence of fractures in the foot, the time elapsed before reduction, or the period of immobilization.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
10/23. Idiopathic blepharospasm-oromandibular dystonia syndrome (Meige's syndrome) presenting as chronic temporomandibular joint dislocation.A case of idiopathic blepharospasm-oromandibular dystonia (Meige's syndrome) is reported, presenting as chronic bilateral dislocation of the temporomandibular joints. The nature of the syndrome is discussed, together with the difficulties in diagnosis and management.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
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