Cases reported "Fractures, Bone"

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1/115. Eighteen fractures in a man with profound mental retardation.

    A 39-year-old man with generalized tonic clonic epilepsy and profound mental retardation sustained 18 fractures (15 in appendicular and 3 in axial bones) during 19 years. Both femoral necks were fractured, requiring surgical repair. Although he had been on antiepileptic drugs for 35 years, he had no radiographic or biochemical sign of osteomalacia. He had a very low bone mineral density, suggesting osteoporosis. This case illustrates an important medical problem affecting people with developmental disability and a management challenge for their caretakers.
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2/115. osteotomy for malunion of a talar neck fracture: a case report.

    A malunion of the talar neck after a Hawkins type II fracture/dislocation of the talar neck occurred in a 34-year-old man after nonoperative treatment. Rigid varus deformity of the forefoot was a source of severe pain and disability in this patient. We describe our surgical technique for osteotomy of the talar neck with insertion of a tricortical iliac crest bone graft to correct the deformity. At follow-up (56 months), the patient had consistent relief of pain and was employed at his preinjury job doing heavy labor. The score on the American Orthopaedic foot and Ankle Society Ankle-Hindfoot Scale improved from 11 points, preoperatively, to 85 points, postoperatively. Radiographs showed maintenance in the position of the osteotomy and no evidence of avascular necrosis in the talar body. Evidence of arthrosis of the talonavicular joint was apparent radiographically, but the patient did not complain of symptoms referable to this area.
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3/115. Complete disruption of the female urethra.

    PURPOSE: We report a rare condition of complete rupture of the bladder neck with an anterior vaginal laceration secondary to blunt pelvic trauma in a 19-year-old woman. methods: Management consisted of a suprapubic cystostomy, followed by end-to-end anastomosis 3 days later. RESULTS/CONCLUSIONS: After 6 months, the patient is continent without any urinary disturbances.
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4/115. 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.
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5/115. 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.
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6/115. Fractures due to hypocalcemic convulsion.

    We report on two cases of patients in whom hypocalcemic seizures during hemodialysis led to right scapular body fracture in one and bilateral femoral neck fractures in the other.
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7/115. Pediatric atlas fracture: a case of fracture through a synchondrosis and review of the literature.

    OBJECTIVE AND IMPORTANCE: Although uncommon, atlas fractures occur in the pediatric population. We present an illustrative case of a patient with a fracture through a synchondrosis of the atlas, and we review previous reports of pediatric first cervical vertebral fractures. The clinical and radiographic findings are described. In addition, we describe the use of magnetic resonance imaging in characterizing a pediatric atlas fracture. CLINICAL PRESENTATION: A 6-year-old boy who fell from a tree onto his vertex presented with neck pain, cervical muscle spasm, and head tilt. Computed tomographic and magnetic resonance imaging studies demonstrated a fracture through a left anterior synchondrosis with surrounding edema. In the literature, 10 cases of pediatric atlas fracture have been reported. INTERVENTION: Treatment of pediatric atlas fractures consists of rigid bracing such as a Minerva jacket. All of the cases of isolated C1 fracture in children, except the patient originally described by Sir Geoffrey Jefferson, survived and recovered with full function. Surgery is rarely indicated for isolated atlas fractures. CONCLUSION: The classic clinical presentation, combined with an appropriate injury scenario, should alert the clinician to the possibility of a pediatric atlas fracture and should prompt rapid evaluation with imaging studies to establish a diagnosis. When the injury is appropriately diagnosed and treated, an excellent outcome can be expected.
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8/115. Avascular necrosis after minimally displaced talus fracture in a child.

    This is a case report of a delayed diagnosis in a 5 year old child who sustained a minimally displaced fracture of the proximal or posterior aspect of the talar neck of the left foot with no subluxation at the subtalar or ankle joint of his left talus. Avascular necrosis (AVN) appeared 6 months after the injury. The further course was protracted with another 12 months of non-weight bearing. The case was followed until 36 months after the injury with nearly full functional recovery. An extensive literature review revealed a calculated incidence of AVN after reportedly non-displaced talus fractures in children of 16 per cent which is considerably more than is reported in adults. Nearly half of all reported cases occurred after the fracture had been missed initially. 8 of 11 cases with reported age occurred between 1 and 5 years. No child was older than 9 years, which indicates that the immature talus may be more prone to AVN. Some possible causes for the higher incidence of AVN in children with non-displaced talus fractures are discussed. Prolonged non weight-bearing cannot be recommended, since it reportedly does not alter the course of the disease.
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9/115. Fractures of the lateral process of the talus in children.

    Fractures of the lateral process of the talus are an uncommon injury, which are often misdiagnosed as severe ankle sprain. This error may result in inappropriate treatment of an intraarticular fracture, with subsequent posttraumatic arthrosis. To date, only one fracture of a lateral talar process has been reported in a child, in whom delayed diagnosis and initial mismanagement led to a suboptimal result. The sport of 'snowboarding', which is gaining in popularity, has been significantly associated with fractures of the lateral talar process, leading some authors to dub this fracture 'Snowboarder's Fracture'. This and the ever-increasing incidence of major trauma lead us to believe that this fracture will be encountered more frequently, even in the pediatric population, as the two factors mentioned do not pass over this group. We report lateral talar process fractures in two children: one in a 9-year-old girl and one in an 11-year-old boy, the latter associated with talar neck and body fractures. Timely diagnosis enabled prompt open reduction and internal fixation, preventing subtalar arthrosis. We discuss the pertinent anatomy and mechanism, and present the clinical picture, imaging studies and treatment. Two important points are exemplified by these cases. First, this fracture, although rare, does occur in children, and should be sought in appropriate settings. Second, despite the severe talar injury in the 11 year old, early diagnosis and intervention conserved foot function.
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10/115. A missed Jefferson fracture in chiropractic practice.

    OBJECTIVE: To review the case of a missed cervical spine fracture in a patient with neck pain. CLINICAL FEATURES: A 21-year-old thatcher with neck pain presented to a chiropractic clinic after a fall from a roof 4 m high. The hospital radiographs were read as normal. The chiropractor suspected a Jefferson fracture of the atlas after evaluation of the same radiographs. INTERVENTION AND OUTCOME: The chiropractor retook the anteroposterior open-mouth radiograph to confirm the suspected fracture. The patient was referred for further imaging and underwent neurosurgical treatment, after which he recovered well. CONCLUSION: Normal radiologic reports from a hospital cannot be relied on for contraindications to manipulative treatment in all instances, as shown in this case of a missed fracture. Chiropractors should therefore always evaluate radiographs that are brought to them.
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