1/2495. Assessment, documentation, and treatment of a developing facial asymmetry following early childhood injury. Prepubertal trauma is often implicated as the cause of asymmetric growth of the mandible. A series of photographs taken before and after early childhood injury to the orofacial complex illustrates the development of a three-dimensional dentofacial deformity in a patient. The diagnosis and combined surgical orthodontic treatment plan to correct the facial asymmetry and malocclusion are discussed. ( info) |
2/2495. Reversed dynamic slings. A new concept in the treatment of post-traumatic elbow flexion contractures. Following the successful treatment of knee-flexion contractures in haemophiliacs using an external corrective system with reversed dynamic slings, these have been adapted to treat post-traumatic elbow contractures. A case is described in which 90 degrees of fixed flexion was corrected in 1 week without discomfort. Clearly there is no need to resort to an internally applied hinge-distractor apparatus or capsulectomy if a simple external sling system is successful without complications. ( info) |
3/2495. An unusual ulnar nerve injury associated with dislocation of the elbow. A case of anterior traumatic transportation of the ulnar nerve presenting as a nerve palsy after dislocation of the elbow is described. ( info) |
4/2495. Acute traumatic proximal tibiofibular joint dislocation confirmed by computed tomography. High-quality AP and lateral radiographs of both knees are essential to confirm the diagnosis. Computed tomography may help resolve diagnostic uncertainty and enable earlier closed reduction to be performed. Moreover, CT scans may be more consistently reproducible than the varied quality of emergency radiographs. In this case, the relative severity of the patient's pain and suggestive radiographs led us to obtain CT scans, which confirmed the diagnosis and enabled early successful closed reduction. ( info) |
5/2495. Posterior sternoclavicular inveterate dislocation. The authors report a case of posterior inveterate sternoclavicular dislocation, which came to their observation after tangential resection of the clavicle. They discuss the surgical technique of reduction and stabilization and clinical results. CT scan was the method most-suited to evaluate dislocation of the clavicle. ( info) |
6/2495. Palmar (displaced) fracture of the proximal index metacarpal. A patient sustained a fracture of the ulnar side of the proximal end of the second metacarpal. The fragment was completely displaced into the palmar soft tissues. Open reduction was necessary. ( info) |
7/2495. Atlantoaxial rotary subluxation in children. Traumatic torticollis is an uncommon complaint in the emergency department (ED). One important cause in children is atlantoaxial rotary subluxation. Most children present with pain, torticollis ("cock-robin" position), and diminished range of motion. The onset is spontaneous and usually occurs following minor trauma. A thorough history and physical examination will eliminate the various causes of torticollis. Radiographic evaluation will demonstrate persistent asymmetry of the odontoid in its relationship to the atlas. Computed tomography, especially a dynamic study, may be needed to verify the subluxation. Treatment varies with severity and duration of the abnormality. For minor and acute cases, a soft cervical collar, rest, and analgesics may be sufficient. For more severe cases, the child may be placed on head halter traction, and for long-standing cases, halo traction or even surgical interventions may be indicated. We describe two patients with atlantoaxial rotary subluxation, who presented with torticollis, to illustrate recognition and management in the ED. ( info) |
8/2495. Dislocation of the first metatarsophalangeal joint with fracture of fibular sesamoid. A case report. Dorsal dislocations of the first metatarsophalangeal joint are classified by Jahss into two types. In Type 1, the hallux with the intact intersesamoid ligament dislocates dorsally over the metatarsal head. Such cases in the literature have been irreducible by closed manipulation. In Type 2 the hallux is dislocated dorsally with rupture of the intersesamoid ligament, resulting in wide separation of the sesamoids (Type 2A) or a transverse fracture of one or both sesamoids (Type 2B). The importance in classifying these injuries allows one to predict whether closed reduction will be successful as in Type 2. The patient reported had a fracture of the fibular sesamoid in addition to dislocation of the hallux. The clinical findings were consistent with Type 1 injury, including an intact intersesamoid ligament, but the radiographs showed, in addition to the dislocation, that there was a fracture of the fibular sesamoid. Reduction was achieved surgically through a dorsal approach. Although such injuries have been unreported previously, Type 1 injuries may be associated with a fracture of the fibular sesamoid but without rupture of intersesamoid ligament, so the injury reported is classified as Type 1A. ( info) |
9/2495. Delayed dislocation of radial head following upper radial epiphysial injury. Injury to the upper radial epiphysis is mainly a radiological diagnosis. Delayed dislocation of the radial head following such injuries, where there is no evidence of primary subluxation or dislocation, has not been recorded in the literature. We have identified three such cases that needed open reduction. As long term results of delayed treatment of dislocation of any joint is not good, we advocate the awareness of this complication and also a longer period of routine follow-up (up to a year) of all upper radial epiphysial injuries, to avoid a catastrophe in an entirely preventable situation. ( info) |
10/2495. AAEM case report 33: costoclavicular mass syndrome. American association of Electrodiagnostic medicine. A true costoclavicular mass syndrome associated with a brachial plexopathy is rare. We report the occurrence of a severe brachial plexopathy as a late complication of a displaced midclavicular fracture. An exuberant callus associated with the clavicular fracture acted as a mass lesion to compress the brachial plexus within the costoclavicular space (i.e., between the clavicle and the first rib). The clinical features and the electrodiagnostic findings in this patient were crucial in suggesting the diagnosis, which was subsequently confirmed by radiographic studies and surgical exploration. Surgical excision of the hyperabundant callus and freeing of the entrapped brachial plexus resulted in marked improvement of the patient's neurological symptoms. Recognition of this uncommon complication of a clavicular fracture is important for the timely diagnosis of this treatable problem. ( info) |