1/56. Transoral missile removal from the anterior C1 region following transpharyngeal missile wound.We present a successful treatment result in a rare case of low velocity missile transpharyngeal wound to the upper cervical area in a 33-year-old man. There are very few reports concerning related cases, with some disagreement regarding their treatment. The retained missile was successfully removed from the anterior region of the C1 vertebra through a transoral-transpharyngeal approach using the explosive transpharyngeal wound sustained. Neurological status and spine stability were not affected due to the missile's low velocity. The early soft-tissue debridement, missile removal, pharyngeal closure without wound drainage and broad-spectrum antibiotic coverage resulted in an uneventful postoperative course and good long-term outcome. Early surgery is important to prevent complications in such cases. However, the prophylactic tracheostomy, wound drainage and applying of a nasogastric tube could be left to the surgeon's judgment based on the individual patient's respiratory status, intraoperative findings and wound contamination/colonization.- - - - - - - - - - ranking = 1keywords = soft (Clic here for more details about this article) |
2/56. Penetrating bladder injury caused by a medially placed acetabular screw.Cancellous bone screws are frequently used to improve the early stability of HA coated acetabular components during total hip arthroplasty. Avoidance of the anterosuperior and anteroinferior quadrants is recommended for transacetabular screw placement to minimize the risk of injury to intrapelvic structures. Revision arthroplasty in rheumatoid patients presents additional hazards in that the acetabular bone is often soft and deficient, and the protective depth of obturator internus and psoas is usually reduced. I report a case of delayed, but fatal, perforation of the bladder associated with a medially placed acetabular screw during revision arthroplasty in a rheumatoid patient. Unless directed safely into the superior pubic ramus, anterior quadrant screws should be avoided in these circumstances.- - - - - - - - - - ranking = 1keywords = soft (Clic here for more details about this article) |
3/56. Orbital foreign bodies after penetrating gunshot wounds: retrospective analysis of 22 cases and clinical review.We conducted a retrospective analysis of 22 patients having orbital penetrating gunshot wounds treated over a 4-years period. The neurological status and the site of injury for each patient are evaluated in this study. We propose a practical protocol in the management of these orbital foreign bodies. Surgical treatment was performed in 4 patients (had functional deficit) with medial orbitotomy in 2, lateral orbitotomy in 1, and superior orbitotomy in 1. 3 of them are improved, in one case the blindness has been continued. 18 patients were treated conservatively and all of them are improved. All patients were followed-up for 2 years with cranial x-rays and CT scans. Neurological sequelae were regressed which existed before the surgery. In conservatively treated cases, infection, migration and functional deficit were not seen. In conclusion, orbital penetrating gunshot wounds must be evaluated precisely by the surgeon and this evaluation sets the guidelines for management. The operation should be reserved for the patients in whom the necrotic soft tissues or orbital damages restrict ocular movements.- - - - - - - - - - ranking = 1keywords = soft (Clic here for more details about this article) |
4/56. Sea urchin puncture resulting in PIP joint synovial arthritis: case report and MRI study.Of the 600 species of sea urchins, approximately 80 may be venomous to humans. The long spined or black sea urchin, Diadema setosum may cause damage by the breaking off of its brittle spines after they penetrate the skin. synovitis followed by arthritis may be an unusual but apparently not a rare sequel to such injury, when implantation occurs near a joint. In this case report, osseous changes were not seen by plain x-rays. magnetic resonance imaging (MRI) was used to expose the more salient features of both soft tissue and bone changes of black sea urchin puncture injury 30 months after penetration. In all likelihood, this type of injury may be more common than the existing literature at present suggests. It is believed to be the first reported case in this part of the world as well as the first MRI study describing this type of joint pathology. Local and systemic reactions to puncture injuries from sea urchin spines have been described previously. These may range from mild, local irritation lasting a few days to granuloma formation, infection and on occasions systemic illness. The sea urchin spines are composed of calcium carbonate with proteinaceous covering. The covering tends to cause immune reactions of variable presentation. There are only a handful of reported cases with sea urchin stings on record, none of them from the Red Sea. However, this condition is probably more common than is thought and can present difficulty in diagnosis. In this case report, the inflammation responded well to heat treatment, mobilization and manipulation of the joint in its post acute and chronic stages. As some subtle changes in soft tissues and the changes in bone were not seen either on plain x-rays or ultrasound scan, gadolinium-enhanced MRI was used to unveil the marked changes in the joint.- - - - - - - - - - ranking = 2keywords = soft (Clic here for more details about this article) |
5/56. Ultrasound-guided Kopans' needle location and removal of a retained foreign body.Penetrating injury with retained foreign body is a common problem. Location of the foreign body and surgical excision may be difficult. Ultrasound can be a sensitive and cost-effective tool in both the detection and surgical removal of retained foreign bodies in soft tissue. We report a case in which ultrasound-guided needle localization was used for removal of a wooden foreign body- - - - - - - - - - ranking = 1keywords = soft (Clic here for more details about this article) |
6/56. Hyperbaric oxygen therapy in the treatment of soft tissue necrosis resulting from a stingray puncture.Necrotizing soft tissue processes of the foot secondary to an acute stingray envenomation can be a challenge to manage. Very little is reported in the orthopaedic literature to aid the practicing surgeon faced with this problem. In this case report, we describe the wound management and team approach employed in this patient's care, including the indications for hyperbaric oxygen therapy, which, in this case, was ultimately successful.- - - - - - - - - - ranking = 5keywords = soft (Clic here for more details about this article) |
7/56. aneurysm of the internal carotid artery following soft tissue penetration injury.Aneurysms of the extracranial arteries are in most cases secondary to atherosclerosis but may also be due to degeneration, congenital abnormalities, trauma or unclear etiology. They present either with bulging in the lateral pharyngeal wall or the neck. Therefore, otolaryngologists are often among the first physicians to see the patient. In this report, we present a case of spontaneous oral bleeding that was caused by a pseudoaneurysm following 2 weeks after a soft tissue penetration injury in a child. The facial swelling of the child was initially diagnosed to be mumps by its pediatrician and the fever treated with aspirin. A pseudonaneurysm of the internal carotid artery was identified by arteriography as the source of the abrupt oral bleeding and required immediate surgical treatment including radiological means. Our report should illustrate the importance of careful preoperative evaluation as well as a high index of suspicion especially in children, where evaluation of history is difficult.- - - - - - - - - - ranking = 5keywords = soft (Clic here for more details about this article) |
8/56. Migrating foreign body in the tracheobronchial tree: an unusual case of firework penetrating neck injury.Firework injuries can manifest themselves in many different ways; usually as an explosive or burn injury. This case describes an unusual presentation of a firework penetrating injury resulting in a sharp coiled metal foreign body travelling through a small entry wound in the neck and subsequently lodging itself in the tracheobronchial tree. A foreign body such as this can potentially travel a considerable distance through the soft tissues and end up in an unsuspecting distant site. There must, therefore, be a high index of suspicion with the appropriate radiological investigations for appropriate management of such cases.- - - - - - - - - - ranking = 1keywords = soft (Clic here for more details about this article) |
9/56. herpes simplex reactivation following laser in situ keratomileusis and subsequent corneal perforation.PURPOSE: To present a case of corneal perforation secondary to herpes simplex reactivation after laser in situ keratomileusis (LASIK) and its subsequent management. METHODSL A case report of a 69-year-old man who underwent LASIK after penetrating keratoplasty for herpes simplex keratitis (HSK) is presented. RESULTS: The patient is a 69-year-old man who had a penetrating keratoplasty of the right eye 6 years prior for corneal scarring secondary to HSK. A spectacle refraction of -13.25 6.00 x 45 yielded 20/60 visual acuity in his grafted eye. LASIK was performed, and the patient's visual acuity without correction on postoperative day 1 was 20/60. Ten days after LASIK, the patient developed thinning of the cornea at the temporal edge of the flap, which perforated the following day. The perforation site was glued with cyanoacrylate adhesive and covered with a soft contact lens. After 7 months, a 4-mm lamellar keratoplasty and conjunctivoplasty was performed. Nine months after surgery, the patient's visual acuity without correction is 20/50 and the graft remains intact. CONCLUSION: herpes simplex keratitis may be a contraindication for LASIK in postkeratoplasty patients. Bandage contact lenses and cyanoacrylate adhesive can be used successfully to manage the rare complication of corneal perforation after LASIK.- - - - - - - - - - ranking = 1keywords = soft (Clic here for more details about this article) |
10/56. Healon5 tamponade of corneal perforation during transplantation surgery.In "a chaud" keratoplasty in cases of corneal perforation, the main difficulty is the trephination of the recipient cornea in a soft eye. A temporary tamponade of the perforation can be provided by filling the anterior chamber with sodium hyaluronate 2.3% (Healon5). The cornea can then be grasped with vacuum and trephinated.- - - - - - - - - - ranking = 1keywords = soft (Clic here for more details about this article) |
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