1/19. Adjacent fracture-dislocations of the lumbosacral spine: case report.OBJECTIVE AND IMPORTANCE: Traumatic fracture-dislocations of the lumbosacral junction are rare, with all previously reported cases involving fracture-dislocations at a single level. No cases of multiple fracture-dislocations of contiguous spinal segments in the lumbosacral spine have been reported. A case of traumatic adjacent fracture-dislocations of the fifth lumbar segment is presented. CLINICAL PRESENTATION: An 18-year-old male patient sustained open lumbar spinal trauma after a motor vehicle accident. A neurological examination revealed an L4 level. Radiographic evaluation of the spine revealed a three-column injury at L5 with spondyloptosis of the L5 vertebral body. Aorto-ilio-femoral angiography revealed no evidence of vascular injury. INTERVENTION: The patient was treated with a combined anterior and posterior approach in a two-stage operation. Six months postoperatively, he was neurologically unchanged; however, he was able to walk with the aid of a cane. Plain films revealed normal alignment of the lumbosacral spine. CONCLUSION: The management of traumatic lumbosacral fracture-dislocations requires careful consideration of retroperitoneal structures and possible exploration of the iliac vessels in addition to spinal reconstruction.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/19. Anchor limited arthrodesis of the wrist.We present a case of lunate dislocation with total disruption of all ligaments and, consequently, nutrient vessels. The injury was handled by fusion of the lunate with the scaphoid, capitate and triquetrum. This 'anchor fusion' has led to a very good long-term result.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
3/19. Asymptomatic vertebral artery injury after acute cervical spine trauma.Two recent cases of vertebral artery injury from cervical fracture-dislocation prompted us to review the literature of these wrongly thought uncommon lesions. Extracranial vertebral artery injury during cervical trauma needs to be suspected not only in the case of vertebrobasilar ischemia, but also in asymptomatic patients presenting serious flexion-distraction deformities. Fracture of a transverse foramen or facet joint dislocation should alert the clinician. Magnetic resonance evaluates blood flow and vessel injury, usually unilateral, localized to the traumatized unstable vertebral segment. A four-stage classification is useful to understand and treat vertebral artery injury, also a standardized therapeutic protocol is not documented. Anterior cervical fusion seems indicated to decompress the injured vessel, and to avoid further damage to both vertebral arteries. Unstable spine conditions may also promote clot mobilization at the traumatized vessel leading to vertebrobasilar embolization. The benefit of antithrombotic therapy in reducing neurological morbidity and improving outcome is not yet established and needs long-term follow-up.- - - - - - - - - - ranking = 3keywords = vessel (Clic here for more details about this article) |
4/19. Posterior sternoclavicular joint dislocation in a wrestler.Injury to the sternoclavicular joint is uncommon but may be a life-threatening injury if the diagnosis is not made acutely. Posterior sternoclavicular joint dislocation is associated with a number of complications including tracheal tear or trauma to the great vessels. diagnosis by conventional radiography is difficult. Even experienced examiners may miss the diagnosis unless a high level of suspicion exists and the appropriate imaging studies are ordered. Computed tomography is the imaging modality of choice, and prompt diagnosis is essential for early, successful reduction of the joint.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
5/19. Complications of the minimally invasive repair of pectus excavatum.BACKGROUND: Minimally invasive repair of pectus excavatum (MIRPE) has become widely popular since its introduction in the late 1990s by Nuss. We describe 1 unusual complication after MIRPE and 1 life-threatening bleeding during removal of the pectus bar. methods: We report the cases of 2 patients in a single institution, more than 100 MIRPE procedures performed so far, and review of literature. CASES: A 14-year-old girl presented 6 months after MIRPE in another institution. During removal of the pectus bar, a massive hemorrhage from both chest wounds occurred, requiring emergency sternotomy. Arrosion of a pulmonary vessel close to the metal bar had led to the bleeding. The second case was a bilateral sternoclavicular dislocation after MIRPE, which has not caused symptoms so far, in a 13-year-old girl. CONCLUSIONS: Numerous operative and postoperative complications after MIRPE are feasible. This is the first report of a life-threatening bleeding during removal of the pectus bar. Minimally invasive repair of pectus excavatum procedure and removal of the pectus bar should only occur in specialized institutions with wide experience in thoracic surgery.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
6/19. Iatrogenic blunt arterial injury during a hip fracture surgery.Iatrogenic non-penetrating arterial injuries have been reported following primary and revision hip arthroplasties. We report a patient who developed acute limb ischaemia after dynamic hip screw fixation was performed for an unstable intertrochanteric fracture. We discuss a previously unreported mechanism of traction creating tension on the atherosclerosed vessels and medial retraction tenting and breaking the vessel wall lining. This case highlights a serious complication in one of the most commonly performed hip surgeries.- - - - - - - - - - ranking = 2keywords = vessel (Clic here for more details about this article) |
7/19. erysipelas of the left upper limb occurring after elbow dislocation.BACKGROUND: erysipelas is an acute infection occurring chiefly in the lower limbs, rarely in the upper limbs. observation: A 45-year-old patient suffering from charcot-marie-tooth disease with neuropathy of the limbs, presented with fever and a 24-hour history of a well-circumscribed inflammatory and infiltrated plaque of the left arm. erysipelas was diagnosed and intravenous penicillin was administered leading to regression of the inflammatory signs, however edema persisted in the inner part of the left elbow. An x-ray showed left elbow dislocation. The patient revealed trauma of the left upper limb 5 weeks before. DISCUSSION: The occurrence of erysipelas is usually associated with lymphatic edema or venous incontinence. Lymphatic lesions due to radiotherapy or surgery may afflict draining vessels leading to venous and lymphatic stasis and then infection occurs. We find no reported cases of erysipelas following elbow dislocation but we postulate its pathogenesis to be similar.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
8/19. Compartment syndrome as a complication of the Hauser procedure.A compartment syndrome developed in eleven patients who had undergone the Hauser procedure. The residual disabilities ranged from mild weakness and contracture of the muscles in the anterior compartment of the leg to complete muscle necrosis necessitating above-the knee amputation in two patients. Dissections of ten cadaver limbs demonstrated that the anterior tibial recurrent vessels have numberous leash-like branches that terminate along the lateral border of the tibial tubercle. When these vessels are sectioned they retract laterally and distally under the fascia and within the muscles of the anterior compartment. It is postulated that continued postoperative bleeding from these vessels after the Hauser procedure may lead to an ischemic compartment syndrome in the leg.- - - - - - - - - - ranking = 3keywords = vessel (Clic here for more details about this article) |
9/19. Computed tomography in the diagnosis of dislocations of the sternoclavicular joint.dislocations of the sternoclavicular joint can be easily characterized with computed tomography. Two typical cases, one demonstrating superior dislocation and the other showing posterior dislocation of the clavicle, illustrate the value of the method. Correlated anatomical observations demonstrate the proximity of the great vessels to the sternoclavicular joint.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
10/19. Traumatic disruption of the manubriosternal joint. A case report.A case of manubriosternal dislocation is presented. The possible mechanism of injury was hyperflexion of the spine which resulted in chin to chest contact, disrupting the manubriosternal joint. If the dislocation is Type I and the patient has compression symptoms on the trachea or major vessels, surgical treatment by wiring may be needed. In Type II dislocations, the best management is closed reduction and elastoplast strapping.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
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