1/5. Ipsilateral dislocation of knee, foot and ankle.We present a case of ipsilateral dislocation of the knee, ankle and midfoot. No previous report of this combination of injuries was found in a review of the literature. In spite of the type of injury, no neurovascular compromise or complications turned up. Closed reduction of the dislocations was possible and performed under general anaesthesia. At the last examination, 4 years after injury, the alignment of the joints was preserved, and the range of motion of the three joints resembled that of the opposite side. Without fractures, the closed reduction and temporary immobilisation of all the affected joints produced a remarkably good result.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/5. Traumatic anterior dislocation of the hip associated with ipsilateral femoral shaft fracture in a child: a case report.Traumatic anterior dislocation of the hip joint in children is rare, and only one case with ipsilateral femoral fracture has been reported in japan. We report a case of such dislocation and a review of the literature. The patient was a 31-month-old girl who was injured in a car accident while asleep on a tilted front passenger seat. Radiographic examination showed dislocation of the right obturator foramen and transverse fracture of the ipsilateral femoral shaft. The dislocation of the right hip was easily reduced without anaesthesia during radiography. We applied Bryant traction after reduction for 4 weeks, followed by cast application for 3 weeks. walking with support and full weightbearing were permitted 14 weeks and 16 weeks after the injury, respectively. radiography at 4.5 years after the injury showed a mildly enlarged right femoral head and femur overgrowth of approximately 8 mm. magnetic resonance imaging showed no evidence of suspected avascular necrosis of the femoral head. The patient has no subjective or objective symptoms, and is able to engage in all usual activities. The detailed mechanism of the injury is unknown. We assume that the lower leg was dislocated through abduction during flexion, or abducent, external flexion, considering that the child was sleeping at the time of the accident. Since she was hurled to the back seat, it was assumed that strong external force was vertically added to the femur, which caused the abducent force.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
3/5. Anaesthesia for major orthopaedic surgery in a child with an acute tracheobronchial injury.A 12-year-old boy presented after a motorbike accident with mediastinal and cervical emphysema but no pneumothorax, minor head injury and several fractures including a comminuted open leg fracture. The child had no signs of respiratory compromise and was stable. The presumed tracheobronchial injury was managed conservatively. To avoid general anaesthesia and the risks associated with intubation and ventilation, urgent surgery for correction of his orthopaedic injuries was successfully conducted under spinal, epidural and intravenous regional anaesthesia. The surgical and anaesthetic management of tracheobronchial injury is complex and controversial.- - - - - - - - - - ranking = 2keywords = anaesthesia (Clic here for more details about this article) |
4/5. hypotension due to unexpected cardiac tamponade.We report a case of profound hypotension, after induction of general anaesthesia, that resulted from unexpected cardiac tamponade. The differential diagnosis was complicated by the absence of any evidence to indicate that there was significant direct chest injury. Many of the recognised clinical signs of cardiac tamponade were absent, in particular, there was no compensatory tachycardia, and heart rate remained stable despite severe hypotension before surgical drainage of the pericardium. The possible aetiology and pathophysiology is discussed. It is suggested that after major trauma, cardiac tamponade should be considered as a possibility even in the absence of significantly abnormal cardiovascular signs, evidence of direct chest injury, or an abnormal chest X ray.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
5/5. Bilateral first rib fractures associated with driver's air bag inflation: case report and implications for surgery.A case of bilateral fractures of the first rib occurring in an otherwise fit road traffic accident victim is described. The only other injuries sustained were of the peripheral limbs. The driver's air bag was inflated during the crash, leading to speculation as to whether this may have contributed to the mechanism of injury. The patient was well oxygenated and cardiovascularly stable with no evidence of neurovascular damage to the thoracic aorta or its branches. Aortic arch aortography was not performed before internal fixation of the peripheral fractures was undertaken under general anaesthesia. A review of the indications for angiography in such patients follows. The policy that patients with fractures of the upper first ribs do not require angiography unless there is other evidence of neurovascular damage is supported.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |