1/73. 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 = 1keywords = fracture (Clic here for more details about this article) |
2/73. 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 = 1keywords = fracture (Clic here for more details about this article) |
3/73. 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 = 1keywords = fracture (Clic here for more details about this article) |
4/73. 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 = 8keywords = fracture (Clic here for more details about this article) |
5/73. 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 = 6keywords = fracture (Clic here for more details about this article) |
6/73. 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 = 2keywords = fracture (Clic here for more details about this article) |
7/73. Managing the pain of traumatic injury.Management of pain in the trauma patient is a complex issue requiring the ability to selectively match different injuries and patient situations with the most optimal pain management methods. Having an understanding of the various stages of trauma care helps clinicians to best support the goals of patient care while decreasing the detrimental effects of the stress response through good pain control interventions. When nurses have a good understanding of the various pain management interventions they are better able to assess the effectiveness, potential side effects, and goals of therapy. The following is a list of clinical pearls to help guide nurses to better manage the pain of traumatic injuries: Encourage your trauma team to standardize pain medications (particularly opioids). A protocol that uses a couple of opioids with varving routes of administration, onset, duration, mechanism of action, and side effects helps the team to become extremely familiar with them and better able to assess effectiveness and side effects. Frequent motor and sensory assessments are necessary in the injured-patient (especially with extremity and head injuries), and drug therapy choices must allow for a thorough baseline assessment and periodic checks to follow. patients with multiple rib fractures or flail segments (particularly elderly patients) and no contraindications deserve serious consideration for treatment with an epidural. When using various pain management techniques, the nurse needs to be prepared to treat complications if they should arise. Airway equipment, drugs (i.e., oxygen, opioid antagonists, pressors), and resuscitation means must be immediately available. nurses need to be extremely careful when receiving pain medication and other central nervous system depressant orders from various doctors involved in patients' care. If a pain management specialist is involved, all pain medication therapies should be supervised and ordered by that individual, particularly when spinal analgesia is employed. nurses must be knowledgeable regarding the effects of spinal medications (local anesthetics and opioids) at varying spinal levels so as to assess therapeutic as well as untoward effects. Institute a diligent bowel protocol when using opioids. Opioid administration combined with the immobility and altered nutrition often associated with trauma can easily result in constipation, abdominal distention, and bowel obstruction. It is not uncommon for epidural blocks to need supplementation with other drug therapy, and this should not be considered a failure of the epidural. Any addition needs to be ordered and closely supervised by one primary team of doctors. Use of nonopioid drugs, if not contraindicated should be considered in all trauma patients. This is especially true for patients sustaining trauma and being discharged to home within 24 hours. They need to be educated about the pain they can expect the next day and how to judge if it is normal and expected or possibly the sign of a missed injury or developing complication (i.e., compartment svndrome infection).- - - - - - - - - - ranking = 1keywords = fracture (Clic here for more details about this article) |
8/73. Traumatic lesions of the bilateral middle meningeal arteries--case report.A 44-year-old man presented with traumatic injuries of the bilateral middle meningeal arteries after a traffic accident. Neurological examination found left visual impairment due to left optic nerve injury. Computed tomography demonstrated a small amount of left epidural hemorrhage and bilateral skull fractures. Left external carotid angiography revealed a pseudoaneurysm of the left middle meningeal artery at the sphenoid ridge. Right external carotid angiography demonstrated a dural arteriovenous fistula fed by the right middle meningeal artery colocated with the right frontal convexity fracture. Transarterial embolization of the left middle meningeal artery pseudoaneurysm with four fibered platinum coils and transarterial embolization of the right dural arteriovenous fistula with poly(2-hydroxyethyl methacrylate-co-methyl methacrylate) were performed, resulting in complete obliteration of both lesions. Angiographic cure was obtained and the postoperative course was uneventful.- - - - - - - - - - ranking = 2keywords = fracture (Clic here for more details about this article) |
9/73. Emergency endovascular treatment of thoracic aortic rupture in three accident victims with multiple injuries.PURPOSE: To report an experience with emergency endovascular treatment of traumatic thoracic aortic ruptures in multi-injured patients. case reports: Three victims of motor vehicle accidents with multiple head, chest, and abdominal injuries in addition to fractures were treated urgently for thoracic aortic lacerations with transluminal placement of an endovascular graft during the initial emergent laparotomy. In all cases, ruptured visceral organs were treated first and the abdomen closed. femoral artery access was gained through a cutdown, and the endografts were delivered with no systemic heparinization. The endovascular component of the surgical session took approximately 50 minutes. All patients survived to discharge. Two patients are alive at 5 and 12 months with sustained endovascular exclusion of the pseudoaneurysm, but one patient with severe brain damage died 9 months after treatment from respiratory insufficiency. CONCLUSIONS: Acute endovascular treatment of thoracic aortic ruptures is feasible and has the advantage of avoiding thoracotomy in otherwise severely injured patients.- - - - - - - - - - ranking = 1keywords = fracture (Clic here for more details about this article) |
10/73. Driver and front seat passenger fatalities associated with air bag deployment. Part 1: A Canadian study.Real world motor vehicle collision research of injuries due to deployment of "first-generation" air bags has been conducted by Transport canada since 1993. Fifty-three fatal crashes (36 frontal impacts; 17 side collisions) involving 48 drivers and 10 right front passengers were reviewed. In the Canadian data, air bag deployment in five of nine low severity frontal crashes (delta-V (deltaV) < 25 km/h or 15 mph) was linked to five deaths, four of whom were autopsied (four adults with craniocervical (basal skull and C2 fracture with brainstem avulsion; "closed head injury"--no autopsy) or chest trauma (aortic or pulmonary artery tears); one child with atlanto-occipital dislocation). An occupant who is close ("out-of-position") to the air bag at the time of deployment is at risk for injury. In 27 high severity frontal impacts, unusual (e.g., pulmonary "blast" hemorrhage in one autopsied case) or isolated potentially survivable injuries (e.g., clinically documented ruptured right atrium; probable flail chest observed during the autopsy on a decomposed body) localized to the head, neck or chest in three possibly out-of-position drivers pointed to the deployed air bag as a source of injury. In one of 17 side collisions an out-of-position driver sustained a radiographically confirmed C1-C2 dislocation in a minimally intruded vehicle.- - - - - - - - - - ranking = 1keywords = fracture (Clic here for more details about this article) |
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