331/2246. wrist fracture in a patient undergoing electroconvulsive treatment monitored using the "cuff" method. We report on a case of a 64-year-old female patient who received electroconvulsive treatment for major depression. The patient sustained a fracture to the distal radius of the arm blocked by the "cuff" method (Smith fracture). Subsequent investigations revealed that she was suffering from osteoporosis. This case report underlines the importance of special treatment procedures for osteoporotic patients and other patient groups at risk for fractures. We recommend screening for osteoporosis in routine pre-ECT evaluation, even in younger patients, and propose not attaching the cuff to the arm in those at risk for fractures. In our patient, electroconvulsive therapy was safely continued using higher doses of succinylcholine and without the cuff method. ( info) |
332/2246. Lateral fracture dislocation of the second and third carpometacarpal joints. We report a case of a rare injury, lateral fracture dislocation of the second and third carpometacarpal joints, which presented late and was managed by fusion of the involved joints. ( info) |
333/2246. Genetic and epigenetic alterations in tumor progression in a dedifferentiated chondrosarcoma. In this case of a dedifferentiated chondrosarcoma, we searched for genetic or epigenetic alterations in both components of the tumor, the low grade chondroblastic component, and the high grade osteosacomatouscomponent. To date, only little is known about aberrant patterns of dna methylation in chondrosarcomas. microdissection was used as a valuable method for clearly separating the tissues. We examined CpG island methylation of 8 tumor suppressor genes and candidate tumor suppressor genes, which are involved in different pathways: cell cycle (p21WAF1, p16INK4, p14ARF), apoptosis (DAPK, FHIT), dna repair (hMLH1), and cell adherence (E-Cadherin). We found p16INK4 and E-cadherin promotor methylation in the low grade chondroid compartment of the dedifferentiated chondrosarcoma. P16INK4, FHIT, and E-cadherin were methylated in the highly malignant osteosarcomatous compartment of the tumor. Earlier investigations of this chondrosarcoma showed p53 mutation and p53-LOH in the anaplastic component. As shown in this case, it was accompanied by Rb-LOH. Early methylation of p16IK4 and E-cadherin in the chondroid compartment could point to the monoclonal origin of demonstrated dedifferentiated chondrosarcoma. Further alterations, as shown in p53, Rb and FHIT, are responsible for the "switch" to a high grade anaplastic sarcoma. ( info) |
334/2246. hemorrhage secondary to pelvic fracture: coil embolization of an aberrant obturator artery. PURPOSE: To describe the anatomical variations of the corona mortis, a vascular anomaly that may lead to dangerous hemorrhage and possible death. CASE REPORT: A 46-year-old male cyclist was involved in a collision with a car, during which he sustained fractures to the left ribs and pelvic ring. Abdominal ultrasound imaging demonstrated a large (12x6x7 cm) nonhomogeneous mass ventral to the bladder, suggestive of a hematoma, which was confirmed on computed tomography. During angiography, 2 branches of the internal iliac artery were identified as sources of the bleeding; these were successfully embolized with microcoils, but the bleeding continued. Examination of the external iliac system found a lacerated aberrant obturator artery arising from the inferior epigastric branch of the external iliac artery, a condition known as the corona mortis. Additional embolization quelled the hemorrhage. CONCLUSIONS: Coil embolization of the internal iliac artery branches is very effective in managing hemorrhage due to pelvic fractures, but variations in the origin of the obturator artery from the internal or external iliac artery may be additional sources of bleeding. ( info) |
335/2246. A pitfall in triple contrast CT of penetrating trauma of the flank. This brief report describes the case of a 20-year-old man who was stabbed in the left flank. He underwent triple contrast helical CT of the abdomen and pelvis that showed a hyperdense focus in the area of the stab wound. This structure was a chip fracture of pelvis, but was misinterpreted as contrast extravasation, and the patient underwent negative exploratory laparotomy. ( info) |
336/2246. Oblique shear fractures of the lunate. Traumatic fractures of the lunate are rare. This article presents two patients who had displaced oblique lunate fractures and distal radius fractures. Both fractures achieved union; however, transient avascular necrosis occurred in the proximal healing of one patient. ( info) |
337/2246. Intramedullary transmetatarsal Kirschner wire fixation of Lisfranc fracture-dislocations. Lisfranc joint injuries are frequently the result of high-energy accidents. The usual method of treatment is open reduction and internal fixation or closed reduction with percutaneous pinning. In cases in which soft tissue injury may compromise open reduction and internal fixation or traditional pinning techniques, transmetatarsal Kirschner wire fixation may be performed, allowing the placement of temporary hardware away from the site of soft tissue injury. The following report details this technique as it has been used in 3 patients. ( info) |
338/2246. Coronal fractures of the proximal scaphoid: the proximal ring sign. We present two coronal fractures of the proximal scaphoid which were both missed in the acute stage as interpretation of initial radiographs was difficult. In both cases, recognition of the so-called "Proximal Ring Sign" on the PA ulnar deviation radiographs may have helped diagnosis. CT scans were necessary to fully demonstrate the fractures. Open reduction and internal fixation, performed 2 and 4 months after the injury, resulted in union in both cases. ( info) |
339/2246. Hip arthroscopy for osteochondral loose body removal after a posterior hip dislocation. We report on the application of hip arthroscopy to remove an osteochondral fragment created by a posterior hip dislocation. Preoperative and postoperative radiographs and computed tomography scans correlate with intraoperative arthroscopic photographs and are presented with this report. arthroscopy allowed excellent visualization of the joint and facilitated straightforward removal of the fragment. We were able to avoid the larger incision required by an arthrotomy and decreased the patient's overall morbidity from this condition. ( info) |
340/2246. First and second metatarsophalangeal joint dislocation. A case report. A case of dislocated first and second metatarsophalangeal joints was reported along with the mechanics and mechanism of injury. The practitioner must be familiar with the mechanism of injury and radiographic classification to determine the proper indications for closed versus open reduction. The authors' review of the literature did not reveal a similar case involving a dislocation of the first and second metatarsophalangeal joints. ( info) |