1/60. death due to concussion and alcohol.We encountered 5 deaths following blunt trauma to the face and head in which the injuries were predominantly soft tissue in nature with absence of skull fractures, intracranial bleeding, or detectable injury to the brain. All individuals were intoxicated, with blood ethanol levels ranging from 0.22 to 0.33 g/dl. We feel that in these deaths, ethanol augmentation of the effects of concussive brain injury, with resultant posttraumatic apnea, was the mechanism of death.- - - - - - - - - - ranking = 1keywords = soft (Clic here for more details about this article) |
2/60. 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 = soft (Clic here for more details about this article) |
3/60. 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) |
4/60. Traumatic myositis ossificans of the superior belly of the omohyoid.The first case of traumatic myositis ossificans (TMO) involving a strap muscle of the neck is reported. TMO typically presents with an unresolved mass following trauma or surgery, requiring differentiation from other soft tissue and bone neoplasms. Opacification may be present on soft tissue x-rays. Computed tomography (CT) scan may demonstrate a characteristic zoning phenomenon to establish the diagnosis. The disorder is frequently self-limiting but surgery may be required for persistent symptoms.- - - - - - - - - - ranking = 2keywords = soft (Clic here for more details about this article) |
5/60. myositis ossificans traumatica in young children: report of three cases and review of the literature.myositis ossificans traumatica (MOT) is a rare musculoskeletal disorder in young children. Clinical and imaging presentation in the early stage of disease makes it difficult to differentiate between infection and musculoskeletal neoplasms, particularly in the absence of a history of trauma. Three cases of MOT in children under the age of 10 years, two with inferential trauma, are presented and the findings on different imaging modalities are discussed with reference to the existing literature. While findings based on a single imaging technique, including MRI, may be rather non-specific and even misleading, the combination of different modalities can assist in the consideration of MOT as a possible diagnosis. For example, the demonstration of soft-tissue haematoma on US would suggest the traumatic origin. A rational imaging approach is proposed.- - - - - - - - - - ranking = 1keywords = soft (Clic here for more details about this article) |
6/60. Traumatic scapulothoracic dissociation.Scapulothoracic dissociation is an infrequent injury with a potentially devastating outcome. The diagnosis is based on clinical and radiographic findings of forequarter disruption. These include massive soft tissue swelling of the shoulder, displacement of the scapula and neurovascular injuries (brachial plexus, subclavian artery and osseous-ligamentous injuries). The mechanism of injury appears to be the delivery of severe rotational force sheering the shoulder girdle from its chest wall attachments around the scapula, shoulder joint and at the clavicle. Early recognition of the entity and aggressive treatment are crucial. Outcome is not dependent on management of the arterial injury, but rather on the severity of the neurological deficit.- - - - - - - - - - ranking = 1keywords = soft (Clic here for more details about this article) |
7/60. Chronic exertional compartment syndrome after minor injury to the lower extremity.Since the 1950s, chronic exertional compartment syndrome of the lower leg has been thoroughly reported in the literature. The predisposing factors and pathophysiology of this condition, however, still are not fully understood. We present a case of a well-conditioned individual who developed a chronic exertional compartment syndrome of the left lower leg anterior compartment after a direct blow injury during a softball game. Trauma is not routinely implicated as a risk factor for chronic compartment syndrome, and the literature on this topic is scarce. We suggest that trauma, even low-velocity trauma, may precipitate a chronic exertional compartment syndrome. We review the literature regarding chronic exertional compartment syndromes preceded by trauma and offer explanations regarding the mechanisms by which a traumatic event may induce a chronic compartment syndrome.- - - - - - - - - - ranking = 1keywords = soft (Clic here for more details about this article) |
8/60. Posttraumatic benign pleomorphic adenoma of the lacrimal gland.A 55-year-old man presented with a painless and slowly developing mass in the right superior lateral eyelid region. He had sustained periorbital blunt injury about 4 years previously. The mass was observed several months later in the persisting traumatic tumefaction region. Computed tomography showed a cystic soft-tissue mass with central low density and peripheral enhancement over the upper anterior quadrant of the right orbit. Lateral orbitotomy was performed to remove the lesion. Histopathologic examination showed proliferation of epithelial and myoepithelial cells arranged in ductules and nests in the myxoid stroma. Benign pleomorphic adenoma of the lacrimal gland associated with traumatic tumefaction, as demonstrated in our patient, may be rare.- - - - - - - - - - ranking = 1keywords = soft (Clic here for more details about this article) |
9/60. Lenticular lesions: not always an epidural hematoma.Ewing's sarcoma is a tumor of the bone, which occurs most often in the diaphysis of long and flat bone. The most common sites of metastasis are the lungs and bones. Less frequently, the primary site is an intracranial or pelvic lesion (either as a soft tissue or a bone lesion). We report a case of a 16-year-old female with an extraosseous intracranial lesion, who presented with a history of minor trauma, unilateral facial swelling, and head pain. Though head computed tomography scan showed a lesion consistent with an epidural hematoma, further exploration revealed Ewing's sarcoma.- - - - - - - - - - ranking = 1keywords = soft (Clic here for more details about this article) |
10/60. Blunt innominate artery injury.Traumatic injury to the innominate artery is a rare occurrence. A literature review reveals that penetrating wounds account for the overwhelming majority of these injuries. Fewer than 90 cases of innominate artery injury caused by blunt trauma have been documented. Over the past 12 months the trauma service successfully treated two patients with blunt injury to the innominate artery. Both cases involved high-speed motor vehicle crashes with sudden deceleration. Both patients were wearing lap and shoulder restraints and had similar associated bruising following the line of the shoulder harness. The first patient presented with a wide mediastinum on chest X-ray. angiography revealed an innominate artery injury at the aortic arch. The second patient had a normal chest X-ray. Given the extent of soft tissue bruising from the shoulder harness he underwent a magnetic resonance angiography, which was suspicious for an innominate artery injury. Arch aortography confirmed a disruption of the innominate artery midway between its origin and its bifurcation. Both were repaired through a median sternotomy with cervical extension as necessary. Given the present technology of safety restraint devices this injury may occur with greater frequency. A "shoulder strap sign" should prompt a search for more extensive injuries.- - - - - - - - - - ranking = 1keywords = soft (Clic here for more details about this article) |
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