1/18. Occult craniocerebral injuries from dog bites in young children.Although dog bite injuries to the head and scalp of children occur frequently, penetrating dog bite wounds to the cranial vault occur only occasionally and may go unnoticed on initial examination. Substantial morbidity and mortality can ensue if these penetrating injuries are not detected and treated. The authors detail the evaluation of dog bites of the scalp in young children. They highlight the ease with which puncture wounds of the calvarium may be missed during physical examination as a result of scalp displacement at the time of puncture. The cranial puncture may not be large and may later be covered by scalp that returns to its native position. Well-scrutinized skull films and a careful, methodical physical examination are advocated. Recognized craniocerebral injuries should be explored. Depressed cranial fractures should be irrigated, debrided, and elevated. Dural tears should be repaired. Expedient management is necessary to prevent meningitis and its associated sequelae.- - - - - - - - - - ranking = 1keywords = fracture (Clic here for more details about this article) |
2/18. Bronchial repair with pulmonary preservation for severe blunt trauma.After a motorcycle accident, a 22-year-old male was diagnosed with multiple rib fractures, left-sided tension pneumothorax, hemothorax and left upper lobe bronchus rupture at its origin. An emergency left thoracotomy revealed an almost complete avulsion of the upper lobe bronchus from the main stem bronchus, a severely damaged pulmonary artery, and a concurrent deep intraparenchymal lower lobe laceration. Since the patient was hemodynamically stable, a decision was made to preserve as much lung as possible. In the event of complex pulmonary trauma, pulmonary preservation is desirable since emergency pneumonectomy is usually associated with high mortality. Early bronchoscopic assessment, careful anesthetic management, and meticulous surgical technique with liberal use of fibrin glue were crucial to successful outcome.- - - - - - - - - - ranking = 1keywords = fracture (Clic here for more details about this article) |
3/18. Nasoethmoid orbital fractures: diagnosis and management.BACKGROUND AND OBJECTIVES: Trauma to the central midface may result in complex nasoethmoid orbital fractures. Due to the intricate anatomy of the region, these challenging fractures may often be misdiagnosed or inadequately treated. The purpose of this article is to aid in determining the appropriate exposure and method of fixation. methods AND MATERIALS: This article presents an organized approach to the management of nasoethmoid orbital fractures that emphasizes early diagnosis and identifies the extent and type of fracture pattern. It reviews the anatomy and diagnostic procedures and presents a classification system. The diagnosis of a nasoethmoid orbital fracture is confirmed by physical examination and CT scans. Fractures without any movement on examination or displacement of the NOE complex on the CT scan do not require surgical repair. Four clinical cases serve to illustrate the surgical management of nasoethmoid fractures. RESULTS AND/OR CONCLUSIONS: Early treatment using aggressive techniques of craniofacial surgery, including reduction of the soft tissue in the medial canthal area and restoration of normal nasal contour, will optimize results and minimize the late post-traumatic deformity. A high index of suspicion in all patients with midfacial trauma avoids delays in diagnosis.- - - - - - - - - - ranking = 10keywords = fracture (Clic here for more details about this article) |
4/18. Posttraumatic anosmia in craniofacial trauma.Although the clinical implications of anosmia can be significant, posttraumatic anosmia is generally given relatively little attention in the clinical setting. patients who sustain craniofacial trauma are most at risk. The incidence of posttraumatic anosmia varies according to the severity of injury and has an overall estimated incidence of 7%. Factors that increase the risk of developing anosmia include anterior skull base fractures, bilateral subfrontal lobe injury, dural lacerations, and cerebrospinal fluid leakage. recovery of function has been estimated to be approximately 10%. time of recovery, if it occurs, varies between 8 weeks and 2 years. Presented herein are the clinical, radiographic, pathophysiologic, and anatomic substrata of posttraumatic anosmia.- - - - - - - - - - ranking = 1keywords = fracture (Clic here for more details about this article) |
5/18. A minimally invasive approach to bile duct injury after blunt liver trauma in pediatric patients.A 12-year-old boy presented with a large liver laceration after blunt abdominal trauma. He was treated nonoperatively and subsequently had bile peritonitis from a bile leak. Endoscopic retrograde cholangiopancreatography (ERCP) visualized the bile duct injury and allowed decompression of the biliary tree with an endoscopically placed biliary stent. A drain also was placed over the laceration through a small subcostal incision. The patient recovered rapidly after this minimally invasive procedure and went home 9 days later.- - - - - - - - - - ranking = 0.013872940009738keywords = compression (Clic here for more details about this article) |
6/18. exsanguination due to right ventricular rupture during closed-chest cardiopulmonary resuscitation.We report on a 61-year-old woman in whom cardiopulmonary resuscitation (CPR) was unsuccessful. While the patient was initially resuscitated from the primary cardiac arrest, with evidence of neurologic recovery, she ultimately succumbed to injuries resulting directly from closed-chest CPR. autopsy revealed multiple rib fractures, a sternal fracture, pulmonary laceration, and cardiac rupture. In a patient with deteriorating vital signs following successful closed-chest CPR, such injuries should be considered.- - - - - - - - - - ranking = 2keywords = fracture (Clic here for more details about this article) |
7/18. Flap tear of rectus muscles: an underlying cause of strabismus after orbital trauma.PURPOSE: To present an avulsion injury of the rectus muscle after orbital trauma, usually the inferior rectus, and detail its diagnosis and operative repair. methods: Forty-three patients underwent repair of flap tears of 62 rectus muscles. During surgery, we found the muscle abnormality was often subtle, with narrowing or thinning of the remaining attached global layer of muscle. The detached flap of external (orbital) muscle was found embedded in surrounding orbital fat and connective tissue. Retrieval and repair were performed in each case. RESULTS: The causes of orbital trauma were as follows: orbital fractures (15 patients), blunt trauma with no fracture (11 patients), suspected trauma but did not undergo computerized tomographic scan (12 patients), and status after retinal detachment repair (5 patients). Of note, 15 of the 43 patients (35%) underwent repair of the flap tear alone, without any additional orbital or strabismus surgery. Diagnostically, the predominant motility defect in 45 muscles was limitation toward the field of action of the muscle, presumably as a result of a tether created by the torn flap; these tethers simulated muscle palsy. Seventeen muscles were restricted away from their field of action, simulating entrapment. The direction taken by the flap during healing determined the resultant strabismus pattern. All patients with gaze limitation toward an orbital fracture had flap tears. The worst results after flap tear repair were seen in patients (1) who had undergone orbital fracture repair before presentation, (2) who had undergone previous attempts at strabismus repair, and (3) who had the longest intervals between the precipitating event and the repair. The best results were obtained in patients who underwent simultaneous fracture and strabismus repair or early strabismus repair alone. CONCLUSIONS: Avulsion-type flap tears of the extraocular muscles are a common cause of posttraumatic strabismus. Early repair produces the best results, but improvement is possible despite long delay.- - - - - - - - - - ranking = 5keywords = fracture (Clic here for more details about this article) |
8/18. Multiple heart and pericardial lacerations due to blunt trauma from assault.A case of 80-year-old woman who died of hemorrhagic shock as a consequence of multiple heart and pericardial lacerations as well as myocardial contusion due to blunt trauma from assault is reported. At postmortem examination, fractures of the body of the sternum and bilateral ribs were detected. A laceration of the anterior left-sided pericardium, a 2.8-cm linear tear in the right venous sinus from the origin of the inferior to the origin of the superior vena cava, a 3-cm laceration between the venous sinus and the right auricle, and a 2-cm tear in the anterior wall of the left atrium, behind the aortic trunk, were visible. Multiple heart and pericardial lacerations were thought to be caused by compression of the heart between sternum and vertebrae, together with multiple rib fractures and extensive movements of the sternum toward the spine as a result of kicking.- - - - - - - - - - ranking = 2.0138729400097keywords = fracture, compression (Clic here for more details about this article) |
9/18. Isolated supraorbital rim fracture displaced out of scalp: a case report.Isolated fractures of the supraorbital rim are rarely seen. In this report, an isolated supraorbital rim fracture is presented in which the segment of the rim was completely removed from its location onto the frontal bone in a traffic accident. It was thought to be a foreign body and was delivered outside the scalp in the emergency service. It was replaced 24 hours after the trauma, and the patient healed without any problem.- - - - - - - - - - ranking = 6keywords = fracture (Clic here for more details about this article) |
10/18. Successful limb reperfusion using prolonged intravascular shunting in a case of an unstable trauma patient--a case report.When peripheral vascular injuries present in conjunction with life threatening emergencies, controlling hemorrhage from a peripheral blood vessel may take initial priority, however, sacrificing a limb to preserve life is a well-established dictum. The use of intravascular shunts has allowed arterial and venous injuries to be controlled and temporized while treating other injuries. Typically, intravascular shunts are used for short time periods while orthopedic injuries are repaired or other life threatening injuries are managed. The following case demonstrates the long-term use of an intravascular arterial shunt to treat a traumatic transection of the common femoral artery and vein in a patient with an open pelvic fracture from blunt trauma. A 20-year-old woman fell between a subway platform and an oncoming train. She sustained a crush injury to her lower extremity and pelvis as she was pinned between the train and platform. The patient presented with active hemorrhage from a groin laceration, quickly became hemodynamically unstable, and was brought to the operating room. In addition to a pelvic fracture with massive pelvic hematoma she sustained a complete transection of the bifurcation of the common femoral artery (CFA), the common femoral vein (CFV), and associated orthopedic injuries. Vascular shunts were placed in the common femoral artery and vein. The patient became hypotensive from an expanding retroperitoneal hematoma. Pelvic bleeding was controlled with angioembolization and the venous injury was repaired. At this time the patient became cold, acidotic, and coagulopathic. It was thought unsafe to proceed with the arterial repair and it was elected to keep her arterial shunts in place and perform a planned reexploration in 24 hours after correcting her physiologic status. The patient returned to the operating room for an elective repair of her CFA the following day. Her shunt had remained patent throughout this time. She underwent a reverse saphenous vein graft from her CFA to her SFA. After a prolonged hospital course she was ultimately transferred to a rehabilitation center with intact pulses in both lower extremities. This case demonstrates the effectiveness of prolonged (>6 hours) use of an intravascular shunt as part of damage control surgery for peripheral arterial and venous injuries. In a patient who would otherwise undergo an amputation for their injury, the risk of shunt thrombosis, or infection, during damage control resuscitation may not be a contraindication for placement.- - - - - - - - - - ranking = 2keywords = fracture (Clic here for more details about this article) |
| | Next -> |