351/2246. Open reduction and internal fixation of an acetabular fracture during pregnancy. Fractures of the pelvis and acetabulum are common injuries in a mechanized society and frequently occur in the younger age groups. Commonly associated injuries such as hemorrhage, urethral tears, gastrointestinal injuries, and major vessel damage are well reported and well known to orthopaedic surgeons. Another less frequently reported complication of pelvic fractures is the potential association with pregnancy and subsequent childbirth. This problem was first described by Malgaigne in 1857 in his classic article on double vertical fractures of the pelvis, in which he described a 34-year-old woman with a pelvic fracture who subsequently died during childbirth. A review of the literature reveals numerous articles addressing potential problems with parturition subsequent to a pelvic fracture and several articles dealing with pelvic fractures occurring during pregnancy. The current literature on pelvic fractures during pregnancy, however, recommends only nonoperative treatment and, to our knowledge, there have been no reports of operative fixation during pregnancy. The purpose of this article is to report a case of an acetabular fracture in a pregnant woman treated with open reduction and internal fixation, who went on to carry a full-term baby and have a normal delivery. ( info) |
352/2246. Fracture of the laryngeal cartilage. An incidental finding on bone scintigraphy. A patient complaining of headaches and bone pain at multiple sites had Tc-99m MDP scintigraphy performed for possible bone trauma after a motor vehicle accident. Bone imaging revealed a small focal increase in tracer uptake in the area of the laryngeal cartilage. There was some reluctance to place a label on this abnormality because the findings were so unusual. The initial diagnosis was a probable fracture of the laryngeal cartilage. Computed tomography of the neck also demonstrated a fracture but correctly localized it to the thyroid cartilage. ( info) |
353/2246. Epiphyseal plate fracture-separation of the olecranon: description of one case. A rare case of traumatic olecranal epiphyseal plate fracture-separation in a patient aged 14 years is described. Non-surgical treatment was not capable of guaranteeing fracture reduction. Thus, internal fixation with tension band wire method, like in fracture of the same type in the adult, was used. ( info) |
354/2246. Simultaneous flexion of the thumb and index finger after a fracture of the first metacarpal bone. A case report. We report a case in which simultaneous flexion of the thumb and index finger occurred after a fracture of the 1st metacarpal bone. This was demonstrated to be due to a fibrous adhesion around an anomalous slip between the tendons of flexor pollicis longus and flexor digitorum profundus indicis. ( info) |
355/2246. Avascular necrosis of the hamate: a case report with reference to the hamate blood supply. Avascular necrosis of the hamate bone has not previously been reported. In this case the proximal fragment of the fractured hamate underwent avascular necrosis and prolonged healing. In an attempt to explain this sequela, angiography of the cadaver carpus followed by dissection of intact wrists and a study of enzyme-cleaned hamates showed that their wedge-shaped proximal segments were mostly enveloped by a distal extension of the midcarpal joint cavity and thus totally dependent on intraosseous nutrition. Consequently, the segment is at risk when a fracture line transects the body proximal to the base of the wedge. Clinically, this condition resulted in persistent discomfort and limitations of motion. A postinjury bone scan of the wrist indicated avascular changes in the proximal third of the hamate, and a delayed union was followed by later revascularization and a more normal scan image. ( info) |
356/2246. Pelvic injuries in child abuse. Three cases of child abuse are described in which pelvic injuries were prominent findings on radiologic examination: Two patients had pelvic fractures, and one was found to have heterotopic ossification of the soft tissues of the pelvis and thighs corresponding to extensive bruising in the pubic, genital, buttock, and thigh areas, resulting from physical and sexual abuse. These represent uncommon radiographic findings. Skeletal survey in cases of suspected child abuse should include the entire pelvis, and special attention should be paid to the ischiopubic rami the most common site of these rare pelvic injuries. ( info) |
357/2246. Massive skeletal trauma in renal transplant patients. A review of 251 renal transplants done at the Vanderbilt University Medical Center since October 1962 revealed three patients who had suffered subsequent skeletal injuries sufficient to cause hospitalization. In a 37-year-old woman, a closed fracture of the pelvis healed satisfactorily in the usual period of time. In a 30-year-old man, closed fractures healed well, but there was prolonged delay in the healing of massive open wounds resulting from crushing injuries of the lower extremities. He required prolonged hospitalization, but satisfactory result was achieved after early amputation and close cooperation between orthopedic and renal teams. No significant alterations in the function of either patient's transplanted kidney occurred. It is postulated that severe trauma in transplantation patients may become more common in the future, and certain guidelines for its management are set forth. With close cooperation between the orthopedic surgical and medical renal teams, a successful outcome can be expected. ( info) |
358/2246. Intrapelvic intrusion of the lumbosacral spine. A 34-year-old female fell 7 meters onto her lower back and side, and sustained a nondislocated fracture of the 7th thoracic vertebra, a complex pelvic fracture with symphysiolysis and a left acetabular fracture in combination with a bilateral comminuted sacral fracture and downward intrusion of the lumbosacral spine. There was also a cauda equina-syndrome. laparotomy with exploration of the lumbosacral area was terminated early because of hemorrhage. Later internal fixation of the fractures was performed by an anterior approach with complete reduction of the bilateral sacral fracture and the lumbosacral spine intrusion. We conclude that an anterior approach to this area gives good visualization, but is hazardous owing to the close proximity of the fractures to the central vessels and retroperitoneal muscles. A posterior approach gives less good visualization but may cause less hemorrhage. ( info) |
359/2246. Bipedicled fasciocutaneous flaps in the lower extremity. It is well known that a bipedicled skin flap permits survival of longer flaps due to the secondary recruitment of vascularity. Inclusion of the deep fascia with such a flap, obeying the principles of the single-pedicled fasciocutaneous flap, provides even greater security for the immediate transposition of yet larger or riskier flaps without the need for delay maneuvers. This variation is especially valuable for the management of difficult wounds encountered in the lower extremity when no other local options may be available. Thirteen local bipedicled fasciocutaneous flaps including both vertical and horizontal orientations, without isolation of any discrete fascial perforators, have been successfully used for soft tissue coverage in the distal leg and ankle with only three (23%) minor complications as untoward sequelae. Another major advantage of this bipedicled version of the fasciocutaneous flap was that the inclusion of a distal pedicle simultaneously may be designed to prevent bone or tendon exposure at the donor site that otherwise frequently is a concern with a unipedicled flap. ( info) |
360/2246. The 'stove-in shoulder': results of treatment by early mobilization. The 'stove-in shoulder' is an injury in which the scapula is fractured and the lateral fragments are displaced medially. Out of 10 patients, eight treated by early mobilization regained full shoulder function within 1 year. ( info) |