1/45. High-energy bilateral talar neck fractures secondary to motocross injury.The authors present a case of bilateral Hawkins type II talar neck fractures sustained during a motocross race in a 23 year old man. Due to the complexity of the injuries, open reduction with internal fixation and primary subtalar joint arthrodesis was performed bilaterally. This is one of the few cases of bilateral talar neck fractures reported in the literature in the past 15 years and one of the first utilizing open reduction and internal fixation with concomitant subtalar joint arthrodesis as a primary treatment.- - - - - - - - - - ranking = 1keywords = complex (Clic here for more details about this article) |
2/45. Traumatic fracture of the hyoid bone: three case presentations of cardiorespiratory compromise secondary to missed diagnosis.hyoid bone fractures secondary to blunt trauma other than strangulation are rare (ML Bagnoli et al., J Oral Maxillofac Surg 1988; 46: 326-8), accounting for only 0.002 per cent of all fractures. The world literature reports only 21 cases. Surgical intervention involves airway management, treatment of associated pharyngeal perforations, and management of painful symptomatology. The importance of hyoid fracture, however, rests not with the rarity of it, but with the lethal potential of missed diagnosis. We submit three cases with varying presentations and management strategies. All three of our cases incurred injury by blunt trauma to the anterior neck. Two patients required emergent surgical airway after unsuccessful attempts at endotracheal intubation. One patient presented without respiratory distress and was managed conservatively. After fracture, the occult compressive forces of hematoma formation and soft tissue swelling may compromise airway patency. It is our clinical observation that hypoxia develops rapidly and without warning, leading to cardiorespiratory collapse. With endotracheal intubation prohibited by obstruction, a surgical airway must be established and maintained. Recognition of subtle clinical and physical findings are critical to the diagnosis of laryngotracheal complex injuries and may be life-saving in many instances. To ensure a positive outcome, a strong degree of suspicion based on mechanism of injury is mandated.- - - - - - - - - - ranking = 1keywords = complex (Clic here for more details about this article) |
3/45. wrist arthroscopy and dislocation of the radiocarpal joint without fracture.The authors report a rare case of dorsal dislocation of the radiocarpal joint without any bony lesion associated. The traumatic cause was a high energy motorbike accident. Fractures of the other limbs were associated. The authors report the clinical, radiological, and arthroscopic features. wrist arthroscopy showed a complete tear of all the extrinsic ligaments, a radial avulsion of the triangular fibrocartilage complex, and the integrity of the intracarpal ligaments, which guided the treatment. The dislocation was treated by closed reduction and radiocarpal pinning. The authors propose wrist arthroscopy in radiocarpal dislocation for diagnosis of soft tissue and cartilaginous lesions to guide the treatment (close or open).- - - - - - - - - - ranking = 1keywords = complex (Clic here for more details about this article) |
4/45. Total dislocations of the navicular: are they ever isolated injuries?Isolated dislocations of the navicular are rare injuries; we present our experience of six cases in which the navicular was dislocated without fracture. All patients had complex injuries, with considerable disruption of the midfoot. Five patients had open reduction and stabilisation with Kirschner wires. One developed subluxation and deformity of the midfoot because of inadequate stabilisation of the lateral column, and there was one patient with ischaemic necrosis. We believe that the navicular cannot dislocate in isolation because of the rigid bony supports around it; there has to be significant disruption of both longitudinal columns of the foot. Most commonly, an abduction/pronation injury causes a midtarsal dislocation, and on spontaneous reduction the navicular may dislocate medially. This mechanism is similar to a perilunate dislocation. Stabilisation of both medial and lateral columns of the foot may sometimes be essential for isolated dislocations. In spite of our low incidence of ischaemic necrosis, there is always a likelihood of this complication.- - - - - - - - - - ranking = 1keywords = complex (Clic here for more details about this article) |
5/45. Termination of life support after major trauma.As the population continues to age, greater numbers and more severely injured elderly patients require care in ICUs. With the attendant increase in the medical complexity of such patients, investigators anticipate that trauma and critical care resources will become increasingly stretched. Because of economic and societal forces, it will become increasingly important for trauma surgeons to appropriately counsel patients and their families regarding the outcome from their injuries and to become comfortable approaching families about withdrawal of support when medical futility is recognized. The authors propose the following guidelines for discussing limitation or termination of life support with patients and their families. physicians should (1) discuss the patient's wishes regarding life support on admission or early in the hospital course; (2) at the initial discussion, establish who the decision maker will be if the patient is or becomes incapacitated; (3) maintain regular communication and continuity of care; and (4) inevitably, when conflict occurs, involve consultants and a hospital ethics committee for assistance in its resolution.- - - - - - - - - - ranking = 1keywords = complex (Clic here for more details about this article) |
6/45. Radiologic case study. rupture of the long head of the biceps tendon.rupture of the long head of the biceps tendon frequently is encountered in the setting of coexisting rotator cuff pathology and chronic impingement, but traumatic rupture is occasionally seen, as in this case. signs and symptoms are not always diagnostic, and MRI or MR arthrography can be a useful tool for evaluation of the tendon in difficult cases. Ideally, an empty bicipital groove is seen, indicating absence of the tendon and rupture. Scar tissue within the groove can be problematic, and correlation with oblique coronal and sagittal images is always recommended. The superior labrum at the attachment of the bicipital anchor should always be inspected carefully, as this is the most common site of rupture, and there may be an associated tear of the superior labrum. Magnetic resonance arthrography is not necessary for diagnosis in most cases, but will provide better visualization of the tendon and bicipital-labral complex.- - - - - - - - - - ranking = 1keywords = complex (Clic here for more details about this article) |
7/45. Use of an islanded fasciocutaneous flap in the lower limb following distraction callotasis.Severe limb injuries present a challenge to the attending surgeon and there has been an emergence of complex modes of treatment. The ilizarov technique for distraction osteogenesis is accepted as a worthwhile option in selected cases of massive segmental bone loss. The blood supply of the bone during this process has been studied experimentally but the response of the soft tissue envelope to the process of compression followed by slow and progressive elongation is not entirely understood. We present a case of lower limb trauma where a combined approach to reconstruction was required with acute shortening followed by distraction osteogenesis for a major segmental tibial defect. Late soft tissue reconstruction for persistent ulceration over the tibia was then undertaken using a distally based fasciocutaneous flap.- - - - - - - - - - ranking = 1keywords = complex (Clic here for more details about this article) |
8/45. Management of lawnmower injuries to the lower extremity in children and adolescents.Lawnmower-associated trauma remains a substantial source of extremity injury in the pediatric and adolescent patient populations, producing complex wounds that require a combined orthopedic and plastic surgical approach. The authors review their experience with 16 patients, 2 to 17 years of age (mean age, 6.2 years), who were admitted to Duke University Medical Center for lower extremity lawnmower trauma between January 1988 and December 1999. The average hospitalization time was 13.5 days, and an average of 2.9 surgical procedures per patient were performed. Early debridement and bony fixation were carried out in all patients; 8 patients sustained traumatic amputations. Fifteen of 20 nonamputation fractures involved the foot and were managed with either closed reduction or K-wire fixation. Three of five long-bone fractures underwent external fixation. Wound closure was achieved with direct closure or skin grafting in the majority of patients. However, five microsurgical free flap transfers were required for extensive defect reconstruction of the foot (N = 4) and knee (N = 1). Adequate immediate debridement, fracture reduction, and early primary or if necessary secondary wound coverage including microsurgical free tissue transfer to prevent further damage and long-term disability in these type of devastating injuries is recommended.- - - - - - - - - - ranking = 1keywords = complex (Clic here for more details about this article) |
9/45. Transepiphyseal fracture of the femoral neck with dislocation of the femoral head and fracture of the posterior column of the acetabulum in a child.We describe a 15-year-old boy with a posterior dislocation of the hip, fracture of the posterior column of the acetabulum and separation of the femoral capital epiphysis. To our knowledge no previous case in a child has been reported. Such high-energy injuries are extremely rare, and a poor outcome is expected. We advocate early referral to a specialised tertiary centre, and the use of a modification of Delbet's classification to reflect the complexity and displacement which may occur with this injury.- - - - - - - - - - ranking = 1keywords = complex (Clic here for more details about this article) |
10/45. The treatment of double disruption of the superior shoulder suspensory complex.Between January 1997 and March 2000, we treated 13 patients with double disruption of the superior shoulder suspensory complex (SSSC). The mean age of the patients was 42 (20-63) years. All patients had associated chest injuries, but there were no injuries of the brachial plexus or the peripheral nerves. Three patients, whose general condition was poor, were treated conservatively. Five underwent internal fixation of both the clavicular and scapular fractures and five of the clavicle only. We evaluated the clinical results using the Rowe Score after a minimum follow-up of 1 year. All fractures united. The average time to union was 14 weeks for clavicular and 11 for scapular fractures. There was malunion in four of five scapular fractures treated conservatively. A functionally better result was obtained in the surgical group with a mean Rowe Score of 88, compared with the conservative group whose mean score was 77. Surgical treatment for double disruption of the SSSC is a good option, allowing early rehabilitation and giving good functional results.- - - - - - - - - - ranking = 5keywords = complex (Clic here for more details about this article) |
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