1/12. Traumatic pseudoaneurysm of the brachial artery.Detection and treatment of vascular injuries in extremity and pelvic trauma can be challenging. angiography, while no longer routinely used in asymptomatic patients, is still a primary means of diagnosis. Appropriate patient selection based on physical examination, along with other less invasive imaging modalities, can decrease the need for angiography while still detecting the vast majority of clinically significant injuries. angiography also plays a definitive therapeutic role in most cases of significant hemorrhage in the pelvis through precise identification and selective embolization of bleeding vessels.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/12. myositis ossificans after a supracondylar fracture of the humerus in a child.myositis ossificans After a Supracondylar Fracture of the humerus in a child. In addition to the better known complications of supracondylar humerus fractures, myositis ossificans is often listed as a less common complication. This complication is extremely rare in children and historically has been attributed to high-energy trauma, manipulation, surgical intervention, aggressive passive range-of-motion exercises, or associated head injury. We present a case report of a 3-year-old girl who developed myositis ossificans after a low-energy supracondylar fracture of the humerus despite having been treated without manipulation, surgery, or physical therapy. This report illustrates that supracondylar humerus fractures can be complicated by myositis ossificans despite the best attempts at prevention.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/12. cementoplasty and the oncologic population.The first and only description of percutaneous cementoplasty, to date, has been described in the French medical literature in 1994. In this series of 12 cases, radiologists successfully instilled a cement derivative into the acetabulum under fluoroscopic control. As in these cases, the major indication for cementoplasty is to provide pain control and stabilization of an osteolytic lesion. Potential complications include physical or thermal damage to the adjacent neurovascular structures, either during needle positioning or from cement leakage, respectively. Although no absolute contraindications exist, one should proceed cautiously in patients with coagulopathies. Results may be suboptimal as well in patients with pathologic fractures.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/12. False aneurysm of the brachial artery complicating closed fracture of the humerus. A case report.A 66-year-old, obese, mentally retarded man sustained a closed spiral fracture of the humerus accompanied by development of a large false aneurysm arising from a small rent in the distal third of the brachial artery. Because of the patient's body habitus, mental deficiency, and paucity of objective physical findings, the arterial injury was not suspected until expensive pressure necrosis necessitated shoulder disarticulation as a lifesaving measure. Although false aneurysms are known to complicate penetrating trauma and various surgical procedures using metallic implants, the lesion has not been previously reported with closed long bone fractures. The authors wish to alert others to occurrence of the occult arterial injury in association with a relatively common extremity fracture. The need to exercise special awareness and suspicion of subtle injuries in patients whose age, mental status, or associated trauma render communication of symptoms impossible, cannot be overemphasized.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/12. Four-year review of burns as an etiologic factor in the development of long bone fractures in pediatric patients.Reduced bone density has been documented in children after burns. This loss of bone may place children at heightened risk for fractures. The medical records of all acutely injured patients with burns in excess of 40% TBSA burn admitted to our institution between January 1, 1997, through December 31, 2000, were reviewed for fracture incidence. patients with fractures sustained during the course of initial trauma were not included in the review. One hundred four records were reviewed. These patients had a mean age of 6.7 /- 0.51 years, (range, 0.2 to 18.0) and a mean %TBSA burn of 59.9 /- 1.60 (range, 40 to 98) with a mean full-thickness %burn of 51.7 /- 2.16 (range, 0 to 95). Fifteen long bone fractures were documented in six patients during the review time frame. All fractures were initially suspected by physical therapy personnel upon regularly scheduled therapy sessions and subsequently verified by x-ray. All fractures identified by this review occurred in children less than 3 years of age. Most fractures were noted during the rehabilitation phase of injury (range, 73 to 283 days after burn) once wounds were more than 95% healed, except for one child, who sustained multiple fractures during the acute recovery phase at a referring hospital. A 5.8% incidence of fractures was noted in patients with burns in excess of 40% (6 of 104 admissions). The etiology of the fractures is unknown, although the hormonal milieu postburn, depressed vitamin d status, inadequate protein intake, and decreased weight-bearing activity are potential contributory factors. In addition, infants and toddlers tend to provide more resistance to therapy because of an inherent lack of cognition. This may account for the increased breaks in this population.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
6/12. axillary artery injury from humeral neck fracture: a rare but disabling traumatic event.axillary artery injury from blunt trauma to the shoulder is uncommon. Fracture of the neck of the humerus is a rare cause of injury to the axillary artery. Four cases of axillary artery thrombosis from humeral neck fracture are reported. Each of the first 2 patients presented with a pulseless and acutely ischemic limb after a trivial fall. A repair of the axillary artery with saphenous vein interposition graft was performed in the first patient. The extremity was salvaged, but a residual radial and ulnar neurologic deficit persisted. The second patient presented with a pulseless insensate upper extremity accompanied by motor loss. He underwent primary axillary artery repair. Still early in his postoperative course, he has had global brachial plexopathy and is undergoing intensive physical therapy. The third patient had a delayed presentation of brachial plexopathy and sympathetic reflex dystrophy. Arterial reconstruction was not required owing to excellent collateralization. The fourth patient presented with a cool pulseless extremity. His recovery is nearly complete after bypass of the axillary artery with a reversed saphenous vein graft. In addition, a review of the literature revealed 24 cases of axillary artery injury associated with humeral neck fracture. The mean age was 66.6 years. The most common mechanism of injury was a fall (79%). Thirteen patients (46%) presented with a neurologic deficit. Acute ischemia was present in 68%. physical examination predicted the arterial injury in all but 1 patient. The injured axillary artery was repaired in 26 cases. Revascularization by an interposition graft was the most common procedure. All grafts and reanastomoses were patent and led to limb salvage. Of 9 primary repairs, 3 amputations were performed. Although limb salvage rate was 89%, a good functional outcome was obtained in only half of the patients. A high index of suspicion is required for early diagnosis of axillary artery injury. Despite excellent results of vascular reconstruction, the outcome remains determined by the excessive neurologic morbidity. Recognition of the associated brachial plexus injury is essential to improve the functional outcome of this unusual arterial injury.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
7/12. Skeletal injuries associated with sexual abuse.BACKGROUND: Sexual abuse is often associated with physical abuse, the most common injuries being bruising and other soft-tissue injuries, but fractures occur in 5% of sexually abused children. The fractures described to date have formed part of the spectrum of injuries in these children and have not been specifically related to the abusive act. OBJECTIVE: To describe concurrent sexual abuse and fractures. MATERIALS AND methods: Three children with pelvic or femoral shaft injuries in association with sexual abuse. RESULTS: A 3-year-old girl with extensive soft-tissue injuries to the arms, legs and perineum also sustained fractures of both pubic rami and the sacral side of the right sacro-iliac joint. A 5-month-old girl with an introital tear was shown to have an undisplaced left femoral shaft fracture. A 5-year-old girl presented with an acute abdomen and pneumoperitoneum due to a ruptured rectum following sexual abuse. She had old healed fractures of both pubic rami with disruption of the symphysis pubis. CONCLUSIONS: Although the finding of a perineal injury in a young child may be significant enough for the diagnosis of abuse, additional skeletal injuries revealed by radiography will assist in confirmation of that diagnosis and may be more common than hitherto suspected.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
8/12. Avulsion fractures of the lesser tuberosity of the humerus in adolescents: review of the literature and case report.Isolated fracture of the lesser tuberosity is an unusual phenomenon in children and adolescents. These injuries are difficult to diagnose acutely and often present as chronic shoulder pain. In this study, we report on 1 case of a displaced lesser tuberosity apophysis avulsion fracture in an adolescent treated with open reduction and internal fixation, as well as a review of the literature. A 14-year-old adolescent male presented to the senior surgeon complaining of left shoulder pain and weakness 10 days after a wrestling injury. He was diagnosed with a displaced, isolated fracture of the lesser tuberosity apophysis for which he underwent open reduction and internal fixation. A combination of sutures passed through drill holes in the proximal humerus and bioabsorbable suture tacks were used to anatomically fix the lesser tuberosity fragment and subscapularis tendon. Postoperatively, he underwent a progressive physical therapy regimen. At 4 months follow-up, he had full range of motion, complete return of strength, and returned to competitive athletics. We report here on the successful surgical treatment of a fracture of the lesser tuberosity apophysis in an adolescent.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
9/12. Fracture of bone with an aneurysmal bone cyst during lactation.A case is presented of a 28-year-old lactating Nigerian mother who developed a pathological fracture of the left humerus following inapparent physical stress. There was radiographical and histological evidence of aneurysmal bone cyst disease involving both humerus. A possible pathogenetic role of bone-calcium dyshomeostasis during pregnancy and, indeed, lactation is entertained. A strong case is made for calcium supplementation in the pregnant and/or lactating mother, especially in the developing countries with an increased probability of marginal nutrition status.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
10/12. Articular cartilage sleeve fracture of the lateral humeral condyle capitellum: a previously undescribed entity.Salter-Harris type IV fractures of the lateral humeral condyle are well-recognized injuries that have been previously described and classified. The case of an 11-year-old boy who sustained an unusual fracture of the distal humerus with the free fragment composed of 75% of the articular cartilage of the capitellum is presented. The cartilage was attached to only a thin shell of subchondral capitellar bone in continuity with the lateral aspect of the distal humeral physis and metaphysis. Radiographs did not show the magnitude of the articular cartilage component of the fracture, although physical examination was significant for elbow crepitus through a limited range of motion. Open reduction and internal fixation were necessary to achieve a congruous joint and restore anatomic alignment.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
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