11/170. Isolated sternal fracture--a swing-related injury in two children.Isolated fracture of the sternum is an uncommon injury in a child. We report two cases of sternal fracture following falls from swings, which illustrate the mechanisms of injury in sternal fracture. One fracture resulted from a flexion compression injury of the thoracic spine, which has very rarely been reported in children. Sternal fracture should be considered in the differential diagnosis of acute chest pain in a child where there has been an activity involving hyperflexion force.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
12/170. Open scapulothoracic dissociation.Scapulothoracic dissociation refers to the traumatic separation of the shoulder from the chest wall. This most commonly occurs as a closed injury. We present a case of open scapulothoracic dissociation and emphasize clinical features unique to this injury. In both closed and open scapulothoracic dissociation, the force necessary to shear the scapula from its thoracic attachments results in vascular disruption and neurologic injury to the upper extremity. As a consequence, patients have a pulseless, flail upper extremity with a significant chest wall hematoma (closed) or active bleeding (open). The first priority is to resuscitate and address life-threatening injuries. If the patient has active bleeding, immediate vascular control to prevent exsanguination is essential. patients with ischemia and an incomplete injury or unreliable neurologic examination need revascularization. Outcome is based on the extent of brachial plexus or cervical nerve root avulsion. patients with loss of neurologic function ultimately benefit from amputation at the appropriate level.- - - - - - - - - - ranking = 4.9919570184803keywords = upper, chest (Clic here for more details about this article) |
13/170. The Upper Paleolithic triple burial of Dolni Vestonice: pathology and funerary behavior.This work focuses on paleopathological analysis of one of the skeletons from the Gravettian triple burial of Dolni Vestonice (Moravia) and addresses issues of Upper Paleolithic funerary behavior. The burial includes the well-preserved skeletons of three young individuals. The skeleton in the middle (DV 15) is pathological and very problematic to sex; the other two (DV 13 and DV 14) are males and lie in an unusual position. The young age, the possibility of a simultaneous interment, and the position of the three specimens have given rise to speculations about the symbolic significance of this spectacular and intriguing funerary pattern. The pathological condition of the skeleton in the middle further emphasizes its peculiarity. Main pathological changes of the DV 15 skeleton include: asymmetric shortening of the right femur and of left forearm bones, bowing of the right femur, right humerus, and left radius, elongation of fibulae, dysplasias of the vertebral column, and very marked enamel hypoplasias. Scrutiny of the medical literature suggests that the most likely etiology is chondrodysplasia calcificans punctata (CCP) complicated by trauma and early fractures of the upper limbs. CCP is a rare inherited disorder characterized by stippled ossification of the epiphyses. The cartilaginous stippling is a transient phenomenon that disappears during infancy, leaving permanent deformities on affected bones. Among the different forms of CCP, the X-linked dominant form is that resulting in asymmetric shortening and is lethal during early infancy in males. Thus, survival of DV 15 until young adult age would require the specimen to be a female. Clinical findings often associated with the disease (erythemas, ichthyosis, alopecia, cataracts, and joint contractures, among others) would emphasize the singular aspect of this individual, pointing to a condition that should be carefully taken into account when speculating on the significance of that peculiar burial.- - - - - - - - - - ranking = 1.4959785092402keywords = upper (Clic here for more details about this article) |
14/170. Unusual upper cervical fracture in a 1-year-old girl.Injuries to the child's cervical spine are rare and, unlike adults, most common from the occiput to C3. Most odontoid fractures in children occur through the basilar synchondrosis and only the dens is displaced anteriorly. The authors report the clinical and radiologic evaluation of a child who sustained an unusual cervical injury during a motor vehicle accident. The lesion consisted of an epiphyseal fracture-separation between the body and the neural arches of C2. There was also an associated spinal cord lesion.- - - - - - - - - - ranking = 5.9839140369606keywords = upper (Clic here for more details about this article) |
15/170. Sacral insufficiency fractures: a report of two cases and a review of the literature.Sacral insufficiency fractures (SIF) are a type of stress fracture that occur primarily in postmenopausal women. They were first described in 1982 by Lourie and have since been frequently overlooked as a cause of low back, buttock, or groin pain. We present two cases of SIF to demonstrate the clinical presentation, diagnosis, and treatment of patients with SIF. Both patients were elderly women with complaints of pelvic and low back pain in the absence of significant trauma. physical examination was significant for marked sacral tenderness. diagnostic imaging supported the diagnosis of SIF. Both patients underwent early rehabilitation, including early ambulation, and had good functional outcomes. These patients serve to illustrate how conservative treatment yields excellent clinical results in the majority of patients, with most reporting improvement within 1-2 weeks after fracture and complete resolution of symptoms after 6-12 months of treatment.- - - - - - - - - - ranking = 3.8016784069972keywords = back pain, back (Clic here for more details about this article) |
16/170. Acute aortic valve regurgitation secondary to blunt chest trauma.Blunt injury to the cardiac valves leads to progressive acute ventricular failure, which often requires urgent surgical management. In this case report, we describe an acute aortic valve rupture caused by air-bag inflation during an automobile accident. Laceration of an aortic valve cusp was treated successfully with urgent aortic valve replacement. A concomitant orthopedic injury was treated electively 15 days after cardiac surgery Acute aortic valve rupture is a very rare complication of blunt chest trauma. We discuss how to diagnose and manage this potentially catastrophic event.- - - - - - - - - - ranking = 5keywords = chest (Clic here for more details about this article) |
17/170. Traumatic 'mallet toe' of the hallux: a case report.We describe a case of a traumatic avulsion fracture of the distal phalanx of the hallux. In the upper limb this fracture leads to a "mallet" deformity. Such an injury in the great toe has not been reported previously in the English orthopaedic literature to our knowledge. The injury was treated in a dorsal extension splint for eight weeks. At six months follow-up, a satisfactory clinical outcome was achieved.- - - - - - - - - - ranking = 1.4959785092402keywords = upper (Clic here for more details about this article) |
18/170. spinal cord injury in children.The spinal injured child has speical needs owing to the processes of physical, mental and social growth. goals of physical treatment programs include prevention of: genitourinary complications; contractures; pressure sores; long bone fractures, hip subluxation and dislocation; spinal deformity. Nonoperative treatment of spinal deformity employing external support should be initiated when the potential for spinal deformity exists. External support delays the development of spinal deformity, improves sitting balance and allows free upper extremity use. The overall treatment programs must consider altered body proportions, immaturity of strength and coordination. Case examples of children with spinal injury are presented above to illustrate specific problems stemming from immaturity of physical, cognitive, and social development. Spinal surgery can be a conservative measure in the growing child when there is radiologic evidence of progressive spinal deformity. Posterior spinal fusion with Harrington instrumentation and external support permits immediate return to vertical activity.- - - - - - - - - - ranking = 1.4959785092402keywords = upper (Clic here for more details about this article) |
19/170. fibrin glue fixation of a digital osteochondral fracture: case report and review of the literature.Surgical treatment options for digital osteochondral fractures are limited by the small amount of bone available for fixation and the propensity for digital stiffness with the introduction of hardware. fibrin sealant is used in a variety of clinical settings as a biologic bonding agent and may circumvent the drawbacks of traditional fixation or simple excision for certain digital osteochondral injuries. Successful use of fibrin sealant fixation for a patient with an osteochondral fracture involving the proximal interphalangeal joint is documented, and the literature on fibrin sealant for osseous fixation is reviewed.- - - - - - - - - - ranking = 0.69586834805295keywords = back (Clic here for more details about this article) |
20/170. The treatment of double disruption of the superior shoulder suspensory complex.Between January 1997 and March 2000, we treated 13 patients with double disruption of the superior shoulder suspensory complex (SSSC). The mean age of the patients was 42 (20-63) years. All patients had associated chest injuries, but there were no injuries of the brachial plexus or the peripheral nerves. Three patients, whose general condition was poor, were treated conservatively. Five underwent internal fixation of both the clavicular and scapular fractures and five of the clavicle only. We evaluated the clinical results using the Rowe Score after a minimum follow-up of 1 year. All fractures united. The average time to union was 14 weeks for clavicular and 11 for scapular fractures. There was malunion in four of five scapular fractures treated conservatively. A functionally better result was obtained in the surgical group with a mean Rowe Score of 88, compared with the conservative group whose mean score was 77. Surgical treatment for double disruption of the SSSC is a good option, allowing early rehabilitation and giving good functional results.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
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