1/29. Unilateral osseous bridging between the arches of atlas and axis after trauma.STUDY DESIGN: This is a case report. OBJECTIVE: To present a case of osseous bridging between C1 and C2 of posttraumatic origin and with an associated closed head injury and to discuss its pathogenesis and clinical outcome after surgical resection. SUMMARY OF BACKGROUND DATA: Heterotopic ossifications of posttraumatic origin in the spine are rare. To the authors' knowledge, no cases have been reported of spontaneous bony bridging between C1 and C2 with a posttraumatic origin. methods: Heterotopic ossifications were detected when pain and limited axial rotation (left/right 10 degrees/0 degree/20 degrees) were persistent, despite intensive physical therapy. Because heterotopic ossifications were ankylosing C1 and C2, the decision was to resect the osseous bridge in combination with a careful mobilization of the cervical spine. Functional computed tomography was performed for analysis of the postoperative results. RESULTS: Four months after surgery, clinical examination showed asymptomatic increased axial rotation. Functional computed tomography indicated that left C1-C2 axial rotation was reduced, possibly related to impingement caused by residual bony spurs. Pathologic changes in the surrounding soft tissue may be another important factor in the persistent limitation of rotation. CONCLUSIONS: Osseous bridging between C1 and C2 may be considered when persistent pain and limited axial rotation are observed after trauma. Operative resection, together with careful intraoperative and postoperative mobilization, may be the treatment of choice.- - - - - - - - - - ranking = 1keywords = soft (Clic here for more details about this article) |
2/29. decapitation as a result of suicidal hanging.A report is presented on a 47 year old man who committed suicide by hanging himself from a staircase bannister of an apartment house. The man, weighing 144 kg jumped with the noose of a 2 cm thick and 2 m long hemp rope around his neck and was completely decapitated. death from typical "normal" suicidal hanging is usually due to cerebral ischaemia caused by compression of the carotid (and vertebral) arteries. Except for bleeding at the clavicular insertions of the sternocleidomastoid muscles there are only occasional injuries to the cervical soft parts or hyoid bone and/or laryngeal cartilage. A fall with a noose around the neck, on the other hand, is associated with more frequent injuries to cervical structures through additional axial traction and radial shearing forces of the tightening noose. Complete decapitation can occur in rare cases under extreme conditions (heavy body weight, inelastic and/or thin rope material, fall from a great height).- - - - - - - - - - ranking = 1keywords = soft (Clic here for more details about this article) |
3/29. February 2002: 29-year-old woman with a skull mass for 2 months.A 29-year-old woman had a 2-month history of an enlarging lesion over her left frontal bone following minor trauma. CT scan showed an osteolytic lesion with an overlying soft tissue mass, thought to be an unhealed skull fracture with pseudomeningocele. Left frontal craniotomy revealed a soft tissue mass, which was resected. Histologic examination revealed multinucleated giant cells mixed with Langerhan's cells that showed the characteristic "coffee bean nuclei." eosinophils were scant. Immunostaining for CD1a and S100 revealed strong positive staining primarily in the Langerhans' cells while giant cells and inflammatory cells were negative. Immunostaining for CD68, in contrast, stained the osteoclast-like giant cells and macrophages. Electron microscopy confirmed the presence Birbeck granules. The final diagnosis was Langerhans' cell histiocytosis (histiocytosis X) of the skull.- - - - - - - - - - ranking = 2keywords = soft (Clic here for more details about this article) |
4/29. A mysterious temporal penetrating head wound without fracture.Unwitnessed head injuries are often diagnostic and management dilemmas. Low-velocity penetrating head wounds are rare. This paper describes a case of an accidental low-velocity penetrating head wound through the soft tissue of the temporal region. This lesion resulted in a deep intra-cerebral haemorrhage, after the initial assessment revealed no evidence of skull fracture, missile or missile track. The diagnostic evaluation and medical course of this case are presented. This is the first case in the medical literature of a brain injury by an object that penetrated the calvarium at low velocity but which did not produce a fracture of the skull. The evolving diagnostic dilemma is outlined to its conclusion, through 3 years of follow-up observation.- - - - - - - - - - ranking = 1keywords = soft (Clic here for more details about this article) |
5/29. Greater omentum in reconstruction of refractory wounds.OBJECTIVE: To evaluate the clinical efficacy of greater omentum in reconstruction of refractory wounds. methods: From August 1988 to May 2001, 20 patients with refractory wound underwent pedicle or microvascular free transfer of the greater omentum. Indications of surgery were electrical injury of the wrist and hand in 9 patients, electrical injury of the scalp and cranial bones in 3, avulsion injury of the scalp in 2, radiation-related ulcer of the chest wall in 2, ulcer and osteomyelitis following resection of the sternum sarcoma in 1, electrical injury of the abdomen in 1, bone and soft tissue defects following compound fracture of the leg in 1, and extensive scar and ulcer of the leg and footdrop following trauma in 1. Severe infection and extensive tissue necrosis were present prior to surgical operation in 12 patients. Eleven patients were treated with pedicled omental flaps, and 9 patients with free omental flaps. The size of the omental flaps ranged from 20 cm x 12 cm to 38 cm x 23 cm. RESULTS: All the omental flaps survived. Healing at the first intention of the wounds was achieved in 17 cases. The on-top skin grafts resulted in partial necrosis of lipid liquefaction developed in the omentum and healed with dressing change in 2 cases. A sinus tract of osteomyelitis occurred in one case and healed after delayed excision of the necrosed bone. Follow-up study of all cases from 3 to 24 months showed no recurrent wounds and post-operative abdominal complication. Recovery with acceptable appearance and restoration of function was satisfactory. CONCLUSIONS: Greater omentum provides a well-vascularized tissue with lymphatic ducts for wound coverage. It has strong resistance against infection. It is very malleable and can be molded easily. Therefore it is an ideal tissue in filling cavities and repairing defects, especially in covering large and irregular defects that can not be treated with skin or muscle flaps.- - - - - - - - - - ranking = 1keywords = soft (Clic here for more details about this article) |
6/29. Reconstruction of real world head injury accidents resulting from falls using multibody dynamics.OBJECTIVE: To reconstruct real life head injury accidents resulting from falls using multibody modelling software, with the aim of comparing simulation output to injuries sustained. BACKGROUND: Much previous research on head injury biomechanics has focussed on animals and cadavers. However, focus is increasingly turning towards the examination of real life head injury. Falls are a major cause of head injury and, in general, are simpler to model than other accident types. DESIGN AND methods: Five cases of simple falling accidents resulting in focal head injury were examined, and reconstructions were performed using a multibody model of the human body. Each case was reconstructed a number of times, varying the initial conditions and using two different sets of properties for head contact. RESULTS: Results obtained included velocities, accelerations and forces on the head during impact. This output appeared more sensitive to changes in head contact characteristics than to changes in initial conditions. Depending on the contact characteristics used, results were consistent with proposed tolerance limits from the literature for various lesion types. CONCLUSIONS: Provided it is used with caution, this method could prove a useful source of biomechanical data for the investigation of head injury biomechanics. RELEVANCE: Biomechanical investigation of real-life cases of head injury is very important, yet not as prevalent as work with animals and cadavers. Reconstruction of real life accidents is a good method of obtaining data that will aid in the investigation of mechanisms of head injury and human tolerance to head injury.- - - - - - - - - - ranking = 1keywords = soft (Clic here for more details about this article) |
7/29. Massive craniofacial injuries from recreational fireworks: a report of three cases.Recreational rocket injuries can result in massive destruction of facial soft tissues and bone and can produce long-term sequelae. This study reviews the cases of three patients who arrived at our medical center within a 3-week period in July 1990 who sustained severe craniofacial injuries from fireworks. A timely multidisciplinary approach is important in the care of these injuries, since there are usually associated serious ophthalmologic and cranial injuries that require immediate attention. We present the management dilemmas confronting the personnel who treat such injuries as well as tips on avoiding long-term complications.- - - - - - - - - - ranking = 1keywords = soft (Clic here for more details about this article) |
8/29. Virtopsy post-mortem multi-slice computed tomography (MSCT) and magnetic resonance imaging (MRI) demonstrating descending tonsillar herniation: comparison to clinical studies.Descending cerebellar tonsillar herniation is a serious and common complication of intracranial mass lesions. We documented three cases of fatal blunt head injury using post-mortem multi-slice computed tomography (MSCT) and magnetic resonance imaging (MRI). The results showed massive bone and soft-tissue injuries of the head and signs of high intracranial pressure with herniation of the cerebellar tonsils. The diagnosis of tonsillar herniation by post-mortem radiological examination was performed prior to autopsy. This paper describes the detailed retrospective evaluation of the position of the cerebellar tonsils in post-mortem imaging in comparison to clinical studies.- - - - - - - - - - ranking = 1keywords = soft (Clic here for more details about this article) |
9/29. The applicability of a computer model for predicting head injury incurred during actual motor vehicle collisions.BACKGROUND: head injury is a significant cause of both morbidity and mortality. Motor vehicle collisions (MVCs) are the most common source of head injury in the united states. No studies have conclusively determined the applicability of computer models for accurate prediction of head injuries sustained in actual MVCs. This study sought to determine the applicability of such models for predicting head injuries sustained by MVC occupants. methods: The Crash Injury research and engineering Network (CIREN) database was queried for restrained drivers who sustained a head injury. These collisions were modeled using occupant dynamic modeling (MADYMO) software, and head injury scores were generated. The computer-generated head injury scores then were evaluated with respect to the actual head injuries sustained by the occupants to determine the applicability of MADYMO computer modeling for predicting head injury. RESULTS: Five occupants meeting the selection criteria for the study were selected from the CIREN database. The head injury scores generated by MADYMO were lower than expected given the actual injuries sustained. In only one case did the computer analysis predict a head injury of a severity similar to that actually sustained by the occupant. CONCLUSION: Although computer modeling accurately simulates experimental crash tests, it may not be applicable for predicting head injury in actual MVCs. Many complicating factors surrounding actual MVCs make accurate computer modeling difficult. Future modeling efforts should consider variables such as age of the occupant and should account for a wider variety of crash scenarios.- - - - - - - - - - ranking = 1keywords = soft (Clic here for more details about this article) |
10/29. Surgical treatment of electrical burns by local flap plastic surgery.Electrical burns are a serious problem within burn medicine even though they are relatively uncommon. The size of the burn is small, but the wound is often deep, and frequently the patient has systemic complications as well. In the majority of patients with such injuries immediate surgical intervention is essential, consisting of escharotomy, fasciotomy, and debridement of the devitalized tissues, necrectomy of the burn area, and closure of the defect by a direct suture, a dermo-epidermal graft, or local flap. Our report consists of three case studies. The patients underwent local flap plastic surgery after a full thickness soft tissue loss. All three patients healed primarily and did not require further correction of flaps. Final functional and aesthetic results are very good if the local flap is used appropriately.- - - - - - - - - - ranking = 1keywords = soft (Clic here for more details about this article) |
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