361/2246. Avulsion fracture of the straight and reflected heads of rectus femoris. We present a rare case of avulsion fracture of the reflected head of rectus femoris. This occurred in a 13-year-old male footballer. diagnosis was made with pelvic radiology and treatment was bed rest and analgesia. ( info) |
362/2246. Gracilis muscle split into two free flaps. A case is presented in which the gracilis muscle was transversely split into two free flaps for coverage of two separate defects in a patient with a multi-segment fracture of the metatarsal bones and the ankle joint. ( info) |
363/2246. Cast adrift: Gortex cast liners allow greater patient activity. Extremity fractures are a common injury, with nearly 1.5 million cases reported in the united states in 1998. Treatment often involves lengthy periods of immobilization. This report outlines the use of a Gortex cast liner by a subject who was able to engage in swimming and scuba diving during the healing process. We report that a Gortex cast liner may be considered for an active patient who is keen to return to limited activities during fracture healing. Apparently because of a lack of knowledge of their existence, physicians currently are underutilizing this method of casting in active patients. The use of Gortex liners elsewhere has been reported to have higher patient and physician satisfaction in both use and performance, with no reported detrimental effects on outcome. ( info) |
364/2246. Computed tomography-guided screw fixation of a sacroiliac joint dislocation fracture: a case report. A 19-year-old woman sustained a vertical shear type pelvic fracture. Sacroiliac fixation using computed tomography (CT)-guided cannulated screws was performed for a left sacroiliac dislocation fracture, and a satisfactory result was obtained over time. patients who have posterior instability of the lateral compression or vertical shear type do not obtain adequate stability by fixation of the anterior part alone; and they often have persistent residual pain, necessitating internal fixation of the posterior part later. Advantages of CT-guided sacroiliac screw fixation include precise evaluation of the degree of reduction and absence of nerve and vascular damage during the time the screw is inserted into the sacral body. This procedure is a useful, safe method owing to its minimal invasiveness in patients with unstable pelvic fractures that are reducible by manual manipulation or traction. ( info) |
365/2246. The floating metatarsal: first metatarsophalangeal joint dislocation with associated Lisfranc dislocation. The authors report a case of an irreducible dorsal dislocation of the first metatarsophalangeal joint, with concomitant Lisfranc dislocation and fractures of the second, third, and fourth metatarsals. This combination has been reported only once in the literature. This extremely rare combined injury results in a floating metatarsal. Open reduction of the metatarsophalangeal joint dislocation and fixation of Lisfranc joint and metatarsal fractures with Kirschner wires was performed. One year after surgery, the patient is active and the first metatarsophalangeal joint is asymptomatic, but there is mild pain in the Lisfranc joint. ( info) |
366/2246. Traumatic diaphragmatic rupture in a pediatric patient: a case report. Diaphragmatic rupture following blunt abdominal trauma is an uncommon life-threatening injury in children. In addition to its high mortality rate, there is a significant amount of morbidity associated with this injury. emergency medicine physicians must maintain a high index of suspicion for diaphragmatic rupture and its associated complications when evaluating victims of blunt abdominal trauma. ( info) |
367/2246. Locked fracture dislocation of the calcaneus treated with minimal open reduction and percutaneous fixation: a report of two cases and review of the literature. Fractures of the calcaneus with associated locked dislocation of the posterior facet have been previously described. Two patients with a calcaneal fracture with a locked dislocation of a portion of the posterior facet were treated with minimally invasive open reduction and percutaneous screw fixation of the fragment with cannulated screws. Both patients had satisfactory reductions and healed the fractures without any soft-tissue complications. This technique can be a useful addition to the armamentarium of the surgeon treating these injuries, especially in the patient at high risk for wound complications. ( info) |
368/2246. Radiological vignette. Insufficiency fracture of the acetabulum. An insufficiency fracture (IF) involving the acetabulum is presented. This fracture occurred in a 67-year-old woman who had been hysterectomized and oophorectomized 27 years earlier for a carcinoma of the uterine cervix, and who had received external pelvic irradiation. This IF location has been rarely described earlier, and its awareness should preclude unnecessary aggressive diagnostic procedures especially in patients with osteoporosis and previous pelvic radiotherapy. ( info) |
369/2246. FDG-PET uptake in occult acute pelvic fracture. The role of FDG-PET in the diagnosis of bone metastases remains unsettled, although it is hoped that PET scans will add specificity to or replace bone scintigraphy. We report a case in which an acute traumatic fracture presented with a level of uptake generally considered indicative of neoplasm. It is important to recognize that increased FDG-PET activity in bone should not be accepted as definitive evidence of metastatic disease. ( info) |
| Arthroscopic reconstruction of the anterior cruciate ligament (ACL) using the middle third of the patellar tendon is an effective method for treating ACL insufficiency. Donor site morbidities are usually mild. This article presents a case of simultaneous patellar fracture and patellar tendon avulsion that occurred 8 weeks after this operation. Such a case has rarely been reported. Theoretically, an accelerated rehabilitation protocol after ACL reconstruction may increase patellar stress and the potential for patellar fracture. However, it is still very important because complications such as arthrofibrosis, muscle atrophy, and patellofemoral pain may outweigh the chance of patellar fracture if adequate rehabilitation is not performed. ( info) |