21/860. Acute compartment syndrome complicating a distal tibial physeal fracture in a neonate. This case report of a neonate who developed an acute compartment syndrome secondary to a minimally displaced distal tibial physeal injury represents the youngest patient to be reported with such a condition. After undergoing emergency four-compartment decompression fasciotomies, the 4-week-old child had a return of normal neuromuscular function and anatomic remodeling of the fracture. It is difficult to diagnose compartment syndrome in a neonate. The patient can neither give a history, nor follow commands to cooperate with the exam. The physician must rely primarily on the physical examination; however, the quantitative measurement of intracompartmental pressure can corroborate the diagnosis of compartment syndrome. We have found using a monometer to measure intracompartmental pressure to be helpful in conjunction with a physical exam when evaluating a neonate suspected of having a compartment syndrome. ( info) |
22/860. Transcranial doppler detection of fat emboli. BACKGROUND AND PURPOSE: The fat embolism syndrome (FES) is characterized by the simultaneous occurrence of pulmonary and neurological symptoms as well as skin and mucosal petechiae in the setting of long-bone fractures or their surgical repair. Its pathophysiology is poorly understood, and effective treatments are lacking. We present 5 patients with long-bone fractures in whom in vivo microembolism was detected by transcranial Doppler. methods: Five patients with long-bone fractures were monitored with transcranial Doppler for microembolic signals (MESs) after trauma. Two patients also had intraoperative monitoring. A TC-2020 instrument equipped with MES detection software was used. Detected signals were saved for subsequent review. Selected signals satisfied criteria defined previously and were categorized as large or small. RESULTS: Cerebral microembolism was detected in all 5 patients and was transient, resolving within 4 days of injury. Intraoperative monitoring revealed an increase in MESs during intramedullary nail insertion. The characteristics of MESs after injury varied among patients, with large signals being more frequent in the only patient with a patent foramen ovale. CONCLUSIONS: Cerebral microembolism after long-bone fractures can be detected in vivo and monitored over time. These findings may have potential diagnostic and therapeutic implications. ( info) |
23/860. Prevention of skin and soft tissue entrapment in tibial segment transportation. We report of a ten year old patient with soft tissue damage and bone defect of the tibia as a sequel of osteomyelitis. After excision and stabilization with an Ilizarov fixateur segment transportation was started. In order to avoid skin and soft tissue entrapment in the docking region, we used a metal cage as a space provider, which was shortened as segment transportation progressed. To our knowledge this simple method has not been described so far. ( info) |
24/860. Combined talar body and tibial plafond fracture: a case report. We report a case of a crush fracture of the body of the talus associated with an anterior tibial plafond fracture. This injury is a rare variant of talar body fracture which merits special attention. The bony injury in this type of fracture is associated with multiple loose fragments involving both weightbearing surfaces of the ankle joint. After appropriate imaging to allow preoperative planning, we utilized a two-incision approach which was necessary to achieve adequate exposure and fixation. We used basic fracture management principles to deal with a previously undocumented fracture pattern. ( info) |
25/860. Split free flap and monofixator distraction osteogenesis for leg reconstruction. The use of a split muscle flap widens the indications of unilateral external fixation in the treatment of type IIIB open tibial fractures with large bone defects. The same frame can be used for early stabilization and for secondary distraction lengthening procedures. The use of a split flap allows an easy, safe, and painless pin migration. The combination of these techniques represents a very safe solution, especially for patients in poor general and vascular condition. ( info) |
26/860. Pulmonary nodules in early fat embolism syndrome: a case report. The radiologic abnormalities in a patient with mild clinical manifestations of fat embolism are reported. The findings consisted of small nodular opacities, which were shown on computed tomography (CT) scans to be located predominantly in the centrilobular and subpleural regions. The nodules presumably represented alveolar edema or hemorrhage secondary to the fat embolism syndrome. ( info) |
27/860. Use of a Dall-Miles plate and cables for the fixation of a periprosthetic tibial fracture. Although tibial periprosthetic fractures are uncommon, they are likely to be encountered more frequently with the increased use of total knee arthroplasty, and they present a challenging management problem. Here we present our solution to this problem, which provided a safe, effective means of fracture management, while maintaining the prosthesis. ( info) |
28/860. Developmental coxa vara associated with spondylometaphyseal dysplasia (DCV/SMD): "SMD-corner fracture type" (DCV/SMD-CF) demonstrated in most reported cases. BACKGROUND: This paper reports three children with short stature: developmental coxa vara unilateral in the first case and bilateral in the other two; somewhat squared and "ovoid" vertebral bodies in the first patient, and normal to slightly tall vertebral bodies in the third; metaphyseal changes in some long tubular bones including bone fragments similar to the corner fractures seen in child abuse in all three patients. MATERIALS AND methods: The first and second patients were sisters; their mother, also quite short, had surgical procedures in early life for bilateral "coxa vara"; their brother, also of short stature, had bilateral coxa valga with otherwise normal femoral heads and necks, and mild metaphyseal changes associated with two minute "corner fractures" in the proximal metaphysis of the left tibia. RESULTS: A review of reported cases of developmental coxa vara associated with spondylometaphyseal dysplasia revealed that simulated corner fractures were present in most instances. ( info) |
29/860. Insufficiency fractures of the distal tibiae. We describe two patients with uncommon types of insufficiency fractures that occurred at the distal tibiae. In case 1, a 71-year-old man with secondary osteoporosis due to hypogonadism fracture of his left distal tibia was overlooked because initial radiographs had seemed normal. However, bone scintigram obtained 2 months prior to the onset of fracture had already demonstrated abnormally high uptake at the site. In case 2, a 62-year-old woman with postmenopausal osteoporosis sustained an insufficiency fracture of the left distal tibia. Good clinical results were obtained with nonsurgical treatment. Based on the clinical course of case 1, we believe that bone scintigrams may be useful not only for the early diagnosis of insufficiency fracture but also for predicting such fractures. ( info) |
30/860. Osteoid osteoma after a stress fracture of the tibia: a case report. A 24-year-old man presented with a stress fracture over his left tibia following an infantry training 6 years ago. x-rays of his left tibia revealed a stress fracture and bone scan showed marked tracer uptake at the fracture. He was treated conservatively but his pain persisted since then. Five years later, x-rays and histological examination confirmed the diagnosis of osteoid osteoma. The stress fracture may act as a trigger for the formation of osteoid osteoma and caused a delay in diagnosis. ( info) |