1/22. Anterior process fracture or calcaneus secundarius: a case report.Avulsion of the anterior process of the calcaneus accounts for nearly 15% of calcaneal fractures according to some sources. Yet, this fracture rarely has been reported in the radiology literature. Lateral plain radiography of the foot may demonstrate an ossific structure, distinct from the distal end of the calcaneus, overlying the head of the talus. However, the fracture may be particularly subtle and go undetected on plain radiography. Furthermore, it may be mistaken for the calcaneus secundarius (CS), an accessory ossicle of the anterior facet of the calcaneus identified in up to 5% of the population during cadaveric studies. This article describes the physical and radiological findings in a patient with an anterior process fracture and how this fracture can be distinguished from the CS.- - - - - - - - - - ranking = 1keywords = process (Clic here for more details about this article) |
2/22. The posteromedial process fracture of the talus: a case report.Injuries to the ankle tend to be some of the most common injuries seen in practice. Of these ankle injuries, fractures of the posteromedial process of the talus are often misdiagnosed as ankle sprains because of poor visualization on routine ankle radiographs. The examining physician must have a heightened awareness of this injury to accurately diagnose and treat this fracture. Proper treatment could help to lessen the possibility of post-traumatic arthritis to the ankle and subtalar joints. The authors present a case of a fracture of the posteromedial process of the talus, after a medial subtalar dislocation, treated with open reduction and internal fixation with bioabsorbable pins.- - - - - - - - - - ranking = 1keywords = process (Clic here for more details about this article) |
3/22. Fractured lateral epicondyle with associated elbow dislocation.We describe a case series involving a very unusual injury in children, i.e. a Milch 1 fracture of the lateral condyle with an associated dislocation of the elbow. This fracture configuration is normally stable as the intact capitellotrochlear groove serves as a lateral buttress for the coronoid-olecranon ridge of the ulna. In this series, however, each patient had an associated dislocation. These injuries usually present as a clinical dislocation and if the elbow is manipulated before radiographic imaging, the fracture line can be difficult to see on the post-reduction films. We recommend that all patients with a dislocated elbow should have elbow stability assessed under general anaesthesia, because a missed lateral condylar injury can lead to abnormalities in carrying angle, epiphyseolysis or an unstable elbow.- - - - - - - - - - ranking = 1.0079235842865keywords = ridge (Clic here for more details about this article) |
4/22. Isolated avulsion fracture of the coronoid process requiring open reduction in a paediatric patient: a case report.Coronoid process fractures are reported to occur from avulsion by the brachialis muscle or to be associated with elbow dislocations. We report a rare case of coronoid process fracture due to avulsion by the anterior bundle of the medial collateral ligament rendering the elbow unstable. In children, small fracture fragments of the coronoid process (types 1 & 2) are in reality often much larger but the actual size is not appreciated radiographically, as the coronoid process contains considerable amounts of cartilage. If the fragment is seen to be significantly displaced it may have resulted from avulsion by important structures such as the medial collateral ligament and open reduction is required to stabilise the elbow.- - - - - - - - - - ranking = 1.3333333333333keywords = process (Clic here for more details about this article) |
5/22. Post-mortem diagnosis and age estimation of infants' fractures.Detection and dating of infants' fractures plays an important role in the diagnosis of the battered child syndrome. Under this aspect three cases of infants with multiple fractures of different ages due to child abuse were evaluated post-mortem. Radiological findings were compared with the autopsy results, followed by contact radiography and histopathological assessment. Out of a total of 44 osseous lesions, 27 fractures were diagnosed by post-mortem skeletal survey, additionally 5 recent rib fractures were suspected, 4 of which were confirmed histologically and all were located paravertebrally. The fractures not detected radiologically were mostly recent rib fractures diagnosed or suspected at autopsy or by contact radiography and confirmed histologically. The histological investigation allowed a more precise dating of the fractures, particularly with reference to the early stages of fracture healing. Microscopic signs of fracture healing processes, such as periosteal thickening, osteoid production and calcification of soft callus tissue, can be detected earlier and quantified more accurately. In advanced stages of healing the osseous apposition rate can be measured semiquantitatively up to a certain extent. A scheme involving a careful external investigation, skeletal survey, autopsy, contact radiography and histology has been proven useful for diagnosing and dating infants' fractures.- - - - - - - - - - ranking = 0.16666666666667keywords = process (Clic here for more details about this article) |
6/22. Fracture of the lateral process of the talus associated with snowboarding.Snowboarding is one of the fastest-growing winter sports and is associated with a relatively high rate of ankle injuries. Presented is a patient who, after falling while snowboarding, complained of lateral ankle pain and was misdiagnosed with an ankle sprain. Further workup revealed a lateral process of the talus fracture, an injury that is rare outside of snowboarding. A lateral process of the talus fracture should be suspected when there is a history of inversion with dorsiflexion and there is tenderness over the lateral process of the talus. Results of plain films are negative up to 40% of the time, and therefore a computed tomographic scan is the imaging modality of choice. Treatment includes immobilization and not bearing weight for 4 to 6 weeks for nondisplaced fractures or open reduction and fixation for displaced fractures. Up to two thirds of patients with lateral process of the talus fractures report chronic pain. Early recognition may decrease this relatively high rate of morbidity.- - - - - - - - - - ranking = 1.3333333333333keywords = process (Clic here for more details about this article) |
7/22. Autologous stem cells (adipose) and fibrin glue used to treat widespread traumatic calvarial defects: case report.This is a report of a 7-year-old girl suffering from widespread calvarial defects after severe head injury with multifragment calvarial fractures, decompressive craniectomy for refractory intracranial hypertension and replantation of cryopreserved skull fragments. Chronic infection resulted in an unstable skull with marked bony defects. Two years after the initial injury the calvarial defects were repaired. Due to the limited amount of autologous cancellous bone available from the iliac crest, autologous adipose derived stem cells were processed simultaneously and applied to the calvarial defects in a single operative procedure. The stem cells were kept in place using autologous fibrin glue. Mechanical fixation was achieved by two large, resorbable macroporous sheets acting as a soft tissue barrier at the same time. The postoperative course was uneventful and CT-scans showed new bone formation and near complete calvarial continuity three months after the reconstruction.- - - - - - - - - - ranking = 0.16666666666667keywords = process (Clic here for more details about this article) |
8/22. Unsuspected damage to lumbar zygapophyseal (facet) joints after motor-vehicle accidents.Three zygapophyseal joints from each of 31 lumbar spines of subjects who died of injuries (mostly as a result of motor-vehicle accidents) were sectioned for low-power histological study. Bony injuries, in the form of fractures of the superior articular process or infractions of the subchondral bone plate, were found in 11 of the 31 subjects and soft-tissue injuries to the capsule or articular cartilage were found in one-or-more joints in 24 of the 31 subjects, with capsular and articular-cartilage damage in 77% of cases. Healed injuries of a similar type, which were unrelated to the cause of death, were found in other lumbar spines. None of these lesions was diagnosed by standard radiological examination of the spine post mortem. It is suggested that, in survivors, bony and soft-tissue injuries to zygapophyseal joints may result in considerable pain and dysfunction and may predispose to early arthritis.- - - - - - - - - - ranking = 0.16666666666667keywords = process (Clic here for more details about this article) |
9/22. Cervical spine fracture following a motor vehicle accident.We present the case of a 50-year-old man who visited our emergency department 12 h after an alcohol-related motor vehicle accident complaining of shoulder pain and neck stiffness. Cervical spine radiographs were obtained and interpreted as normal, and the patient was discharged. Subsequent review by a radiologist raised the question of a second cervical vertebra (C-2) abnormality, and the patient was recalled. Cervical computed tomography (CT) scan revealed an unstable oblique fracture of C-2 and a congenital nonfusion of the arch of C-1. The patient was placed in halo traction, and subsequent radiographs revealed a fracture of the transverse process of C-7. The patient made an uneventful recovery. The limitations of routine cervical radiographs are well-documented, but no feasible alternative exists as a screening procedure. Thus, a certain level of uncertainty must be accepted. Both physician and patient must recognize the limitations inherent in all medical practice and that follow-up examination and treatment are essential.- - - - - - - - - - ranking = 0.16666666666667keywords = process (Clic here for more details about this article) |
10/22. Irreducible fracture of the calcaneus in a child.Displaced fractures of the calcaneus are rare in children, and most do not require open reduction as a treatment modality. The case of a 4-year 8-month-old boy who sustained a fracture of the anterior process of the calcaneus requiring open reduction is presented; no similar fracture in childhood has been previously reported. Treatment guidelines for calcaneal fractures in children are reviewed.- - - - - - - - - - ranking = 0.16666666666667keywords = process (Clic here for more details about this article) |
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