1/9. rib fractures in infants: red alert! The clinical features, investigations and child protection outcomes.OBJECTIVE: To examine clinical features, investigation methods and outcomes of infants with rib fractures. METHODOLOGY: All infants aged 2 years or younger who presented over a 5-year period with documented rib fractures were identified from the medical records database of a tertiary referral paediatric hospital and data collected by retrospective chart review. Additional data regarding notifications and placements were obtained from the Department of Families Youth and Community Care, queensland. RESULTS: rib fractures were attributed to child abuse in 15 of 18 infants identified. The initial presentation in the abused infants was most often as a result of intracranial pathology and limb fractures. In four cases the rib fractures were incidental findings when abuse had not been suspected. Bone scintigraphy revealed eight previously undetected rib injuries in four cases. In three cases of abuse, the rib fractures were an isolated finding. Three of the infants with inflicted rib injuries were discharged home. In one such infant a significant re-injury occurred. Three returned home with implicated adults no longer in residence, and nine spent a mean period of 12 months in foster care. CONCLUSIONS: rib fractures in infancy are usually caused by severe physical abuse. Accidental rib fractures are rare in infants and result from massive trauma. rib fractures, multiple or single, may occur in isolation in abused infants. The implications of such injuries must be recognized to ensure appropriate, safe and consistent child protection outcomes. Bone scintigraphy is more sensitive than radiographs in the detection of acute rib fractures and should be performed in all cases of suspected infant abuse.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/9. mitral valve plasty for mitral regurgitation after blunt chest trauma.A 21 year-old woman was admitted to our hospital because of chest and back pain after blunt chest trauma. On admission, consciousness was clear and a physical examination showed labored breathing. Her vital signs were stable, but her breathing gradually worsened, and artificial respiration was started. The chest roentgenogram and a subsequent chest computed tomographic scans revealed contusions, hemothorax of the left lung and multiple rib fractures. A transthoracic echocardiography (TTE) revealed normal left ventricular wall motion and mild mitral regurgitation (MR). TTE was carried out repeatedly, and revealed gradually progressive MR and prolapse of the posterior medial leaflet, although there was no congestive heart failure. After her general condition had recovered, surgery was performed. Intraoperative transesophageal echocardiography (TEE) revealed torn chordae at the posterior medial leaflet. The leaflet where the chorda was torn was cut and plicated, and posterior mitral annuloplasty was performed using a prosthetic ring. One month later following discharge, the MR had disappeared on TTE.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/9. Musculoskeletal causes of chest pain.BACKGROUND: chest pain is a common presenting problem to general practitioners and accident and emergency departments. Such a symptom generates anxiety in both patients and their medical attendants, for fear that this symptom represents a life threatening event. Numerous investigations often ensue, adding to the physical and financial burden on an already stressed health system. Musculoskeletal causes of chest pain are common but frequently overlooked. OBJECTIVE: This article aims to outline some of the more common musculoskeletal problems which may present as chest pain, and to present a practical approach to their diagnosis and management. DISCUSSION: It is estimated that somewhere in the vicinity of 20-25% of noncardiac chest pain has a musculoskeletal basis. Careful history taking to identify red flag conditions differentiates those who require further investigation. Historical features suggesting a musculoskeletal cause include pain on specific postures or physical activities. A musculoskeletal diagnosis can usually be confirmed by clinical examination alone, the key to which is reproducing the patient's pain by either a movement or more specifically palpation over the structure that is the source of the pain. Confirming the diagnosis, explanation and reassurance allay anxiety. Management strategies include manual therapy, the provision of analgesia and anti-inflammatory agents, either topically, orally or by injection. Focal injection of local anaesthetic alone may also be a useful diagnostic and therapeutic tool.- - - - - - - - - - ranking = 2keywords = physical (Clic here for more details about this article) |
4/9. ectopia lentis secondary to physical abuse in a traumatized, elderly individual.The proper diagnosis of ocular emergencies is usually straightforward since the patient generally can communicate the nature and circumstances of the injury. However, the mental status of the patient occasionally may seriously complicate obtaining an accurate history of the trauma. This may be particularly important when the patient has been physically abused by a relative. ectopia lentis is a possible consequence of trauma. The elderly patient herein presented suffered ectopia lentis and had evidence of other systemic trauma. The proper management of a patient of this type will be discussed.- - - - - - - - - - ranking = 5keywords = physical (Clic here for more details about this article) |
5/9. Delayed life-threatening hemothorax associated with rib fractures.We present two cases of delayed, massive, life-threatening hemothorax due to intercostal hemorrhage in association with fractured ribs and severe blunt chest trauma (SBCT), a combination we have not seen described in the literature. Blunt chest trauma is not benign. Significant intrathoracic injuries are frequent although usually not life threatening. However, associated extrathoracic injuries are also common and much more lethal. Most cases of hemo- and pneumothorax associated with SBCT can be treated without thoracotomy. However, rapid blood loss requires immediate open thoracotomy and surgical attention. Several days of observation in hospital may be required for patients with SBCT and fractured ribs even without any other obvious intra- or extra-thoracic injuries. Vigorous activity or chest physical therapy may be dangerous during the first several days after the injury.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
6/9. Surfer's rib: isolated first rib fracture secondary to indirect trauma.A case of anterolateral first rib fracture produced by indirect trauma in a surfer is presented. A 17-year-old man was seen in the emergency department with the complaint of left shoulder pain that developed while he performed a so-called lay back maneuver on a surfboard. No history of direct trauma was elicited. After physical examination revealed point tenderness high in the left axilla, radiographic evaluation of the chest showed an isolated fracture of the anterolateral aspect of the left first rib. No morbidity was associated with this fracture which, when produced by other forces, can have serious sequelae.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
7/9. hemothorax in a child. An unusual cause of chest pain.The pediatrician should search carefully in a child with chest pain for evidence in the history or physical examination of an organic cause. hemothorax is one of the pathologic processes that can present with this symptom. The differential diagnosis of hemothorax in children is reviewed.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
8/9. rupture of the cervical esophagus from blunt trauma.A patient had a left anterolateral linear tear of the lower cervical esophagus with concomitant second rib fracture after a steering wheel injury. diagnosis of the lesion was delayed because of initial absence of physical signs. Subsequent operative drainage and repair were unsuccessful.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
9/9. Laceration of the liver with delayed massive intra-abdominal hemorrhage: a case report of child abuse.A 3-year-old girl was found unresponsive in the bedroom and expired at a hospital. autopsy revealed massive intra-abdominal bleeding due to laceration of the liver and mesenterium with multiple rib fractures and multiple fresh and old bruises. The time of the assault causing the liver trauma was questioned because the perpetrator, her mother's boyfriend, denied any outrages on that particular day although he confessed that he had physically abused her for several months. Microscopically, numerous polymorph leucocytes infiltrated exclusively surrounding the lacerated area of the liver. Many hepatocytes were necrotic and cord arrangement of the parenchymal cells was destroyed. There should be a certain time lag between the major assault and massive intra-abdominal hemorrhage, which was not inconsistent with the statement of the perpetrator.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |