1/48. scalp laceration: an obvious 'occult' cause of shock.scalp lacerations are often present in patients requiring emergency care for blunt trauma. These injuries are most commonly seen in unrestrained drivers or occupants involved in motor vehicle crashes in which the victim is partially or totally ejected. patients with scalp lacerations often have associated injuries that redirect the clinician's attention to other injury sites. Some scalp lacerations are severe enough to cause hypovolemic shock and acute anemia. If the patient arrives in shock, the perfusion pressure may be low, and there may be minimal active scalp bleeding. Under such circumstances, the scalp wound may be initially dismissed as trivial and attention appropriately turned to assuring an adequate airway, establishing intravenous lines, initiating volume resuscitation, and searching for more "occult" sources of blood loss. However, as the blood pressure returns toward normal, bleeding from the scalp wound becomes more profuse and presents a hemostatic challenge to the clinician. A case presentation illustrates some of these issues and confirms the effectiveness of an often overlooked but simple technique to control scalp hemorrhage--Raney clip application.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/48. Acute traumatic compartment syndrome of the foot in children.Acute traumatic compartment syndrome of the foot is a sequelae of serious injury to the foot, which, if unrecognized, may result in significant motor and sensory deficits, pain, stiffness, and deformity. It is nearly always associated with fractures, dislocations, and crush injuries to the foot. Vascular injuries and coagulopathic states are also risk factors for the development of an acute foot compartment syndrome. In children, the presentation of an acute foot compartment syndrome may be masked by the pain and edema caused by associated fractures and dislocations. A high index of suspicion is warranted in children presenting with foot injuries that are associated with foot compartment syndrome. Recognition of the signs and symptoms of compartment syndrome in the emergency room are paramount; the diagnosis is best confirmed by multiple compartment pressure readings. The urgency of diagnosis of a compartment syndrome must be underscored, as the complications of a missed foot compartment syndrome includes contractures, claw toe deformity, sensory loss, stiffness, and chronic pain. Prompt orthopaedic consultation is mandatory; urgent compartment fasciotomies are associated with a good clinical outcome.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
3/48. Compartment syndrome following isolated ankle fracture.We report two cases of compartment syndrome following isolated ankle fractures. Both required decompression of all the compartments following early clinical diagnosis and measurements of the intra-compartmental pressures.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
4/48. A case of peroneal neuropathy-induced footdrop. Correlated and compensatory lower-extremity function.This article reports on the case of a man with peroneal neuropathy-induced footdrop who was seen at the authors' institution 3 years after open reduction and internal fixation of a proximal fibular fracture and a distal, spiral, oblique tibial fracture of the right leg. A comprehensive gait analysis was conducted. A significant footdrop in gait resulted in a "reverse check mark" center-of-pressure pattern, an increased transverse-plane rotation of the foot, and excessive knee and hip flexion in the sagittal plane. These objective findings documented significant dysfunction within the involved lower extremity; in addition, aberrant biomechanics were observed in structures other than the site of initial injury within both limbs.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
5/48. Operative treatment of a transverse fracture-dislocation at the S1-S2 level.SUMMARY: The authors recently treated a multiply injured patient who sustained a rare fracture-dislocation at the S1-S2 level. The S1 vertebra was displaced forward into the pelvic cavity and was located just in front of the S2 vertebra. Because the patient also had extensive neurologic injury to the lumbar plexus and instability of the pelvic ring, operative treatment was deemed necessary. Surgery to stabilize the pelvis and decompress the lumbar plexus proved successful, and the patient experienced marked improvement in her postoperative neurologic function. Nonoperative treatment has traditionally been recommended for this injury, but advances in spinal surgery have made transverse sacral fractures more amenable to open reduction and fixation. Potential benefits of this operative treatment include relief of pressure from the lumbar plexus, a stable pelvis and facilitation of return of neurologic function.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
6/48. 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 = 0.5keywords = pressure (Clic here for more details about this article) |
7/48. False aneurysm of the brachial artery complicating closed fracture of the humerus. A case report.A 66-year-old, obese, mentally retarded man sustained a closed spiral fracture of the humerus accompanied by development of a large false aneurysm arising from a small rent in the distal third of the brachial artery. Because of the patient's body habitus, mental deficiency, and paucity of objective physical findings, the arterial injury was not suspected until expensive pressure necrosis necessitated shoulder disarticulation as a lifesaving measure. Although false aneurysms are known to complicate penetrating trauma and various surgical procedures using metallic implants, the lesion has not been previously reported with closed long bone fractures. The authors wish to alert others to occurrence of the occult arterial injury in association with a relatively common extremity fracture. The need to exercise special awareness and suspicion of subtle injuries in patients whose age, mental status, or associated trauma render communication of symptoms impossible, cannot be overemphasized.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
8/48. Traumatic cardiac injury following sternal fracture: a case report and literature review.Myocardial injury used to be thought as one of the major complications associated with sternal fracture even though recent studies on injuries associated with fracture of sternum are contrary to this belief. Many authors now believe the presence of sternal fracture is no longer indicative of occult injuries to the underlying structure such as the heart. However, clinicians should still maintain a high index of suspicion for the presence cardiac tamponade in cases presented as blunt chest trauma as early diagnosis and surgical intervention is vital to the patient's survival. Presented is a case of a 38-year-old female patient transferred to our hospital after being injured in a motor vehicle accident. On arrival her blood pressure (BP) was 90/50 mmHg but it then dropped to 60/30 mmHg two hours later. Although her chest roentgenography and electrocardiography (ECG) did not reveal any significant findings, the two-dimensional echocardiography was performed and revealed a moderate amount of pericardial effusion. The chest computerized tomography (CT) scan later revealed sternal fracture and cardiac tamponade. A diagnosis of cardiac rupture resulting from sternal fracture following blunt chest trauma was made. Under midline sternotomy, her right atrial rupture was repaired. The patient was reported to be doing well during a three months, post-operative follow-up.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
9/48. Compartment syndrome of the scapula. Definition on clinical, neurophysiological and magnetic resonance data.compartment syndromes of the scapula and pelvic girdle have received scant attention in the literature. In 1938, Comolli first described a clinical sign which he considered specific to fracture of the scapula. We report data on two patients, one presenting with prolonged pressure on the posterior surface of the scapula and the other with symptoms associated with scapular fracture. In one of these patients we were able to measure pressures around the scapula, perform neurophysiological assessment of nerve function and produce magnetic resonance images of the area. In the other case, surgical exploration revealed an established ischaemic contracture of the infraspinatus muscle within its compartment. These findings suggest that the muscles around the scapula are vulnerable to the development of compartment syndrome.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
10/48. brain death due to abdominal compartment syndrome caused by massive venous bleeding in a patient with a stable pelvic fracture: report of a case.We report a rare case in which abdominal compartment syndrome resulting from venous hemorrhaging developed in a patient with stable pelvic fractures, resulting in a fatal outcome. An 84-year-old man with mild pelvic fractures developed hypovolemic shock and underwent transcatheter arterial embolization. He became hemodynamically stable after the procedure, but became hypotensive for the second time 11 h after admission. urinary bladder pressure rose to 32 mmHg from 4-7 mmHg. Rebleeding from the pelvis with the development of abdominal compartment syndrome was suspected. Repeated transcatheter arterial embolization and laparotomy were performed; however, 1 min into the procedure, both pupils symmetrically dilated and the light reflex disappeared. This case suggests that brain death can sometimes occur due to abdominal compartment syndrome.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
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