1/95. Traumatic hemipelvectomy before body image has developed.Traumatic hemipelvectomy is rarely observed because very few patients have survived from the initial trauma. We describe one male child who survived from this massive trauma with a good functional outcome. The boy was 28 months old when he was accidentally struck by a truck. He had severe open trauma of the pelvis and hemorrhage of the left lower limb. amputation of the left hemipelvis, colostomy, cystostomy and removal of the left avulsed testicle were performed. Once healing had been achieved, he was transferred to our Department of Physical medicine and rehabilitation and rehabilitative management was begun, including prosthetic measurement and psychologic intervention for the patient and his parents. For 13 years of long-term follow-up, his prosthesis was readjusted annually. Now he is a 16-year-old middle school student. He is functioning remarkably well with a prosthesis. The psychologic report shows that he is emotionally stable and has good scholastic performance. Although hemipelvectomy appears to be a radical procedure in children, the potential for rehabilitation in a group of children before body image has developed appears to be unexpectedly good.- - - - - - - - - - ranking = 1keywords = open (Clic here for more details about this article) |
2/95. Transcatheter gelfoam embolization of posttraumatic bleeding pseudoaneurysms.Diagnostic angiography combined with transcatheter therapeutic embolization is a simple and effective means of treating complex clinical situations associated with posttraumatic hemorrhage. Bleeding pseudoaneurysms, even when large, can be readily managed by this combined modality with resultant decrease in morbidity and hospital stay. Five patients with posttraumatic pseudoaneurysms are presented. All five were treated by transcatheter therapeutic embolization with Gelfoam. Of these five cases, three involved extremities, one involved the retroperitoneal space, and the last was of renal origin. Two of the five cases still required surgical intervention after initial successful therapeutic embolization, one for recurrent bleeding from collaterals and the other for evacuation of a massive pseudoaneurysm which was causing distraction of fracture fragments. The early use of angiography in suspected cases of posttraumatic hemorrhage, together with careful evaluation of potential collateral supply, is stressed. The use of transcatheter therapeutic embolization in the extremities as presented here is yet another example of the ever-broadening applicability of this technique.- - - - - - - - - - ranking = 219.7484189764keywords = fracture (Clic here for more details about this article) |
3/95. GVHD after transfusion of stored RBC concentrates in a solution of mannitol, adenine, phosphate, citrate, glucose, and NaCl following trauma.BACKGROUND: It has not previously been reported that WBC-reduced RBC preparations can cause transfusion-associated GVHD, even in an immunocompetent individual. CASE REPORT: A 74-year-old man suffered a hemorrhage from the mesentery of the transverse colon after a traffic accident. During surgery, he received 10 units of RBCs from 10 donors in a solution containing mannitol, adenine, phosphate, citrate, glucose and NaCl (MAP). MAP RBCs had been stored for 7 to 8 days before use. On the 27th day after surgery, an erythematous, pruritic rash appeared over the face, neck, and trunk, which was associated with low-grade fever and pancytopenia. Transfusion-associated GVHD was strongly suspected and was confirmed by skin biopsy. To determine the origin of lymphocytes causing GVHD, several microsatellite loci were amplified from dna of the patient's nails and blood and from blood samples of all 10 RBC donors by using PCR. Amplified alleles derived from the patient's blood were identical to those from one of the 10 samples. CONCLUSION: These findings indicate that transfusions of MAP-RBCs can cause transfusion-associated GVHD in an elderly but immunocompetent host.- - - - - - - - - - ranking = 1keywords = open (Clic here for more details about this article) |
4/95. Lumbosacral nerve root avulsion: report of a case and review of the literature.The 14th myelographically demonstrated case of lumbosacral nerve root avulsion is presented with a summary of the previously reported cases. In most cases lumbosacral nerve root avulsion is associated with pelvic fractures and sacroiliac dislocation, which cause a stretching force to be applied to the nerves of the lumbar and sacral plexuses, and in turn to the nerve roots intradurally. This force causes nerve root avulsion in the intradural course of the nerve root. The myelographic defect is a pseudomeningocele or diverticulum-like outpouching created by the tearing of the arachnoid covering of the nerve roots. myelography clearly indicates nerve root avulsion and surgical exploration is not indicated.- - - - - - - - - - ranking = 219.7484189764keywords = fracture (Clic here for more details about this article) |
5/95. Congenital insensitivity to pain with anhidrosis. Report of a case and review of the literature.In a previous paper published in this journal, we reported two cases of "Congenital Sensory Neuropathy with Anhidrosis" with reference to the orthopedic complications (Theodorou et al., 1985). We now present a new typical case, under the currently used term: "Congenital Insensitivity to pain with Anhidrosis" (CIPA) and a brief review of the literature on the incidence, etiology and problems arising in various systems. CIPA is an autosomal recessive form of sensory neuropathy manifesting with typical clinical features. Universal insensitivity to pain, anhidrosis or hypohidrosis, bouts of hyperpyrexia from very young age, self inflicted injuries, defective or absent lacrimation and mental retardation are specific diagnostic findings. Orthopedic, maxillofacial, dermatological and ophthalmologic complications are common. counseling of the family and school personnel for the prevention of injuries is necessary. early diagnosis is very important for the prevention and treatment of various complications. The etiology and pathogenesis of the condition is still unclear. The recent detection of a new gene, which encodes a receptor tyrosine kinase for nerve growth factor and lately of a specific point mutation associated with the gene inactivation11, may open new ways for the study and management of this disabling condition.- - - - - - - - - - ranking = 1keywords = open (Clic here for more details about this article) |
6/95. Seat belt aorta: endovascular management with a stent-graft.PURPOSE: To report the endovascular treatment of a relatively uncommon type of deceleration injury to the abdominal aorta. CASE REPORT: A 21-year-old backseat passenger was wearing a single lap belt without shoulder harness when the car was involved in a collision. He sustained a transverse (Chance) fracture of the third lumbar vertebra and a circumferential dissection of the infrarenal abdominal aorta with pseudoaneurysm. As an interim measure while a stent-graft was obtained, a Wallstent was deployed to tack down the dissection and prevent distal embolization. Thirty-six hours later, an AneuRx endograft was successfully implanted inside the Wallstent to seal the pseudoaneurysm. The patient's recovery was uneventful, and the endograft remains secure and the pseudoaneurysm excluded at 10 months after the accident. CONCLUSIONS: Endovascular repair of "seat belt aorta" is a minimally invasive, straightforward method of management for this type of aortic injury. The potential for infection in a contaminated peritoneal cavity and the long-term outcome of this treatment have not been determined.- - - - - - - - - - ranking = 219.7484189764keywords = fracture (Clic here for more details about this article) |
7/95. Traumatic T9 burst fracture in an 8-month-old infant: incomplete neurologic deficit and its recovery.STUDY DESIGN: Case report of a rare burst fracture of the ninth thoracic vertebra in an 8-month-old male infant. OBJECTIVES: To describe a rare traumatic lesion in an infant. SUMMARY OF BACKGROUND DATA: There are two reported cases of fracture-dislocation in an infant in the literature, both of which were managed surgically. However, this is the first reported clinical case of burst fracture in an infant. methods: The patient was treated conservatively and observed for 40 months. His spine was examined by using roentgenography and magnetic resonance imaging. His neurologic condition was evaluated by clinical examination and somatosensory-evoked potential (SEP). RESULTS: The infant became ambulant with no need for support 2 years after injury. At that time, the burst vertebra was remodeling gradually and showed no spinal deformity. CONCLUSION: Fracture-dislocation of the spine with neurologic deficit requires surgical management. However, burst fracture can be managed conservatively, provided the neurologic condition improves.- - - - - - - - - - ranking = 1757.9873518112keywords = fracture (Clic here for more details about this article) |
8/95. Triple "E" syndrome: bilateral locked posterior fracture dislocation of the shoulders.Bilateral locked posterior fracture dislocation of the shoulders is one of the least common injuries of the shoulder, and this injury has been suggested to be pathognomonic of seizures when diagnosed in the absence of trauma. The authors present a case of idiopathic bilateral locked posterior fracture dislocations of the shoulder, along with a review of the medical literature. The authors also present the "triple E syndrome," describing the possible etiologies of this injury: epilepsy (or any convulsive seizure), electrocution, or extreme trauma.- - - - - - - - - - ranking = 1318.4905138584keywords = fracture (Clic here for more details about this article) |
9/95. Traumatic lumbosacral dislocation: case report.STUDY DESIGN: A case report of a bilateral lumbosacral dislocation without a fracture is presented. OBJECTIVE: To report the diagnosis and treatment of a traumatic lumbosacral dislocation. SUMMARY OF BACKGROUND DATA: Lumbosacral dislocations without fractures are rare injuries, with only four cases reported in literature. The recommended treatment consists of an anterior lumbar interbody fusion after posterior reduction with pedicle screw instrumentation. methods: The 1-year follow-up evaluation of a 17-year-old male with a traumatic lumbosacral dislocation, diagnosed with computed tomography and magnetic resonance imaging, and treated with a posterior lumbar interbody fusion procedure combined with a posterolateral fusion is reported. RESULTS: At 1 year after surgery the patient is asymptomatic and has resumed his heavy manual work. Radiologic evidence of interbody fusion is present. CONCLUSIONS: Lumbosacral dislocations are rare injuries. The authors demonstrate the feasibility of a posterior lumbar interbody fusion procedure in combination with posterolateral instrumentation and fusion.- - - - - - - - - - ranking = 439.49683795281keywords = fracture (Clic here for more details about this article) |
10/95. Avance: silver hydropolymer dressing for critically colonized wounds.Avance is a hydropolymer dressing that has a silver compound bonded into it. The silver acts as a bacterial shield to prevent bacterial invasion, and as a bacterial barrier to impede cross-infection. This article aims to give an overview of the use of silver in eradicating surface bacteria, and provides case study evidence of the use of Avance on the leg ulcers of two patients. Both patients had complex medical histories and underlying aetiologies that delayed the wound-healing process.- - - - - - - - - - ranking = 0.36015682857579keywords = compound (Clic here for more details about this article) |
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