1/422. AAEM case report 33: costoclavicular mass syndrome. American association of Electrodiagnostic Medicine.A true costoclavicular mass syndrome associated with a brachial plexopathy is rare. We report the occurrence of a severe brachial plexopathy as a late complication of a displaced midclavicular fracture. An exuberant callus associated with the clavicular fracture acted as a mass lesion to compress the brachial plexus within the costoclavicular space (i.e., between the clavicle and the first rib). The clinical features and the electrodiagnostic findings in this patient were crucial in suggesting the diagnosis, which was subsequently confirmed by radiographic studies and surgical exploration. Surgical excision of the hyperabundant callus and freeing of the entrapped brachial plexus resulted in marked improvement of the patient's neurological symptoms. Recognition of this uncommon complication of a clavicular fracture is important for the timely diagnosis of this treatable problem.- - - - - - - - - - ranking = 1keywords = plexus (Clic here for more details about this article) |
2/422. Fracture-dislocations of the sacrum. Report of three cases.The pattern of fracture-dislocation of the upper part of the sacrum is demonstrated in three patients. The fracture line followed the segmental form of the sacrum and was usually caused by a posterior force against the pelvis which had been locked by hip flexion and knee extension. Fractures of the lumbar transverse processes also occurred, presumably from avulsion by the quadratus lumborum muscle. The damage to the sacral plexus found in all three cases recovered after several months. Radiographs of the injury are difficult to obtain in severely injured patients but oblique views of the sacrum help to determine the extent of the forward dislocation.- - - - - - - - - - ranking = 0.5keywords = plexus (Clic here for more details about this article) |
3/422. Radiologic case study. Fractures of the foot masquerading as ankle injuries.An ankle radiographic series frequently is obtained when a patient presents with an acute ankle and foot injury. Although many fractures are confined to the ankle and are readily apparent, fractures of the foot can mimic ankle injuries. It is important to differentiate these fractures of the foot from the more common ankle sprain. Most ankle sprains are treated with ice, compression, and elevation, followed by range-of-motion exercises and progressive weight bearing as tolerated. When foot fractures are not identified, however, lack of appropriate treatment can result in late complications. Concentration on key areas as described here will reduce the incidence of missed fractures of the foot in these patients.- - - - - - - - - - ranking = 0.011913129109596keywords = area (Clic here for more details about this article) |
4/422. osteotomy for malunion of a talar neck fracture: a case report.A malunion of the talar neck after a Hawkins type II fracture/dislocation of the talar neck occurred in a 34-year-old man after nonoperative treatment. Rigid varus deformity of the forefoot was a source of severe pain and disability in this patient. We describe our surgical technique for osteotomy of the talar neck with insertion of a tricortical iliac crest bone graft to correct the deformity. At follow-up (56 months), the patient had consistent relief of pain and was employed at his preinjury job doing heavy labor. The score on the American Orthopaedic foot and Ankle Society Ankle-Hindfoot Scale improved from 11 points, preoperatively, to 85 points, postoperatively. Radiographs showed maintenance in the position of the osteotomy and no evidence of avascular necrosis in the talar body. Evidence of arthrosis of the talonavicular joint was apparent radiographically, but the patient did not complain of symptoms referable to this area.- - - - - - - - - - ranking = 0.39259802708278keywords = pain, area (Clic here for more details about this article) |
5/422. Heterotopic bone formation in association with pelvic fracture and urethral disruption.PURPOSE: The initial and secondary management of pelvic fracture associated with disruption of the membranous urethra is the subject of a wide literature containing varied and controversial viewpoints. We have noted the presence of heterotopic bone formation surrounding the area of urethral injury in patients undergoing delayed repair. We investigated the etiology, incidence and risk factors associated with such an injury, as well as potential means of prophylaxis. MATERIALS AND methods: We reviewed the current literature on heterotopic bone formation with similar traumatic injury. While instances of severe urethral disruption of this type are fortunately rare in children we describe prepubertal boys with such an injury complicated by heterotopic ossification. RESULTS: The incidence of heterotopic ossification reported in children and adolescents is 3 to 15%, which is less than 15 to 80% reported in adults. risk factors associated with traumatic heterotopic ossification include prolonged operating time, hematoma formation, degree of bony debris, devitalized muscle and concomitant infection. Prophylaxis with single low dose radiation or nonsteroidal anti-inflammatory drugs has been shown to be effective in the prevention of heterotopic ossification and may be beneficial in this patient population. CONCLUSIONS: Heterotopic bone formation associated with severe traumatic injury in the presence of devitalized tissue resulting in the pathological formation of new bone is rare. This complication is only associated with the most severe pelvic fractures. Prophylaxis in these most severe cases with low dose radiation or nonsteroidal anti-inflammatory drugs can prevent the formation of heterotopic bone.- - - - - - - - - - ranking = 0.011913129109596keywords = area (Clic here for more details about this article) |
6/422. Staged operative treatment in a septic patient with an infected, unstable pelvis, and a missed bladder rupture.This case demonstrates once again the potential and serious complications of pelvic fractures, especially when associated urogenital injuries are missed. Missing the bladder rupture proved almost fatal to our patient. Second, it was confirmed that in very unstable pelvic fractures, external fixation alone does not provide enough stability. Local stability is the cornerstone in the treatment of (bone) infection, and in these cases, maximal stability is only obtainable with internal fixation. The advantages of metal implants in infected areas outweigh the disadvantages by far. For the bladder-rupture, we chose a two-stage approach. First, we performed a urinary diversion, to avoid surgical closure of the infiltrated bladder wall. All cavities, including the open bladder, were packed with omentum to fill the dead space with highly vital tissue to offer stout resistance to infection. Two years later, with the patient in excellent physical condition, urinary undiversion was carried out. Ultimately physical and social recovery was complete.- - - - - - - - - - ranking = 0.011913129109596keywords = area (Clic here for more details about this article) |
7/422. What if your patient prefers an alternative pain control method? Self-hypnosis in the control of pain.Despite the availability of specialized treatments for chronic pain, including biofeedback training, relaxation training, and hypnotic treatment, most physicians rely on the traditional approaches of surgery or pharmacotherapy. The patient in this case study had severe and chronic pain but found little relief from pain medications that also caused side effects. She then took the initiative to learn and practice self-hypnosis with good results. Her physician in the resident's internal medicine clinic supported her endeavor and encouraged her to continue self-hypnosis. This patient's success shows that self-hypnosis can be a safe and beneficial approach to control or diminish the pain from chronic pain syndrome and can become a useful part of a physician's therapeutic armamentarium.- - - - - - - - - - ranking = 2.4744518368257keywords = pain (Clic here for more details about this article) |
8/422. Avulsion fracture of the great toe: a case report.A case involving an isolated bony avulsion fracture of the extensor insertion on the distal phalanx of the great toe is described. The fracture was displaced 2 mm with 30 degrees dorsal angulation; the joint was congruent and not subluxed. The patient was treated nonsurgically with a rigid-soled sandal. Bony healing at the fracture site was clearly evident at 16 weeks postinjury. The patient began using a normal shoe at 10 weeks and resumed his running activities without pain at 16 weeks. The nonsurgical treatment of this injury, similar to that of a mallet finger, was successful.- - - - - - - - - - ranking = 0.19034244898659keywords = pain (Clic here for more details about this article) |
9/422. Fracture of the lateral process of the talus: appearance at MR imaging and clinical significance.The case of a 59-year-old man with chronic lateral ankle pain following an inversion injury is presented. MR imaging performed to evaluate for soft tissue injury revealed an unsuspected fracture of the lateral process of the talus. The patient underwent surgical exploration of the fracture with debridement of adjacent loose bodies and is currently undergoing aggressive physical rehabilitation.- - - - - - - - - - ranking = 0.19034244898659keywords = pain (Clic here for more details about this article) |
10/422. Desmoid fibromatosis of the shoulder and of the upper chest wall following a clavicular fracture.A desmoid tumor of the shoulder girdle infiltrating the upper chest wall and weighing 1500 g was almost completely removed in an 18-year-old man, 27 months after a bifocal fracture of the clavicule. Thirteen years later, the patient was free of recurrence. The interval time between trauma and diagnosis, as the particular characteristics of aggressive fibromatosis, strongly support a major causal role of the clavicular fracture in the occurrence of this tumor.- - - - - - - - - - ranking = 0.15288094781476keywords = chest (Clic here for more details about this article) |
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