Cases reported "Fractures, Bone"

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1/138. Insufficiency fractures, an often unrecognized diagnosis.

    diagnosis of sacral insufficiency fractures is difficult since the onset is mild, and usually discomfort is attributed to degeneration of the lumbar spine. Computed tomography and radionuclide bone scans are helpful in making the diagnosis, as regular X-ray and magnetic resonance imaging usually fail to demonstrate the fracture.
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keywords = ray
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2/138. External rotation-lateral view of the ankle in the assessment of the posterior malleolus.

    Demonstration of a posterior malleolar fragment on a radiograph of an ankle fracture is important in the diagnosis and evaluation of posterior malleolus fractures. The size and extent of displacement of a posterior malleolar fragment can be evaluated. The diagnosis of non-union of the posterior malleolus is also important because it can lead to failure of reduction of ankle fractures. The authors present a case in which nonunion of the posterior malleolus was diagnosed by an external-rotation lateral view of the ankle. This could not be demonstrated on the AP or the lateral views. Thirteen cadaver feet were then used to study the external-rotation lateral view. A posterior malleolar fracture was created, and the borders of the fracture line were marked with solder wire. The average external rotation angle required to best demonstrate the posterior malleolar fracture was 50 degrees (range, 43 degrees -55 degrees). The actual size of the posterior malleolus fragment was measured and compared to the x-ray measurement. There was a 0.10 correction for the determination of the actual size of the fragment. The unmarked fragment could not be demonstrated on AP and lateral views.
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keywords = ray, x-ray
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3/138. cardiac tamponade due to post-cardiac injury syndrome in a patient with severe haemophilia A and hiv-1 infection.

    An 18-year-old man with severe haemophilia A (FVIII:C < 1%) and human immunodeficiency virus 1 (hiv-1) infection was admitted to the hospital with fever and chest pain for 7 days. Eight weeks prior to his admission he had an accident for which he underwent, at another hospital, clinical and laboratory examination that revealed bone fractures of the nose cavity, and he was given factor viii concentrates for seven days due to nasal bleeding. On admission, chest roentgenogram showed a large cardiac silhouette and echocardiography confirmed the presence of a large quantity of pericardial fluid. A presumptive diagnosis of the post-cardiac injury syndrome was made and he was given anti-inflammatory drugs plus infusion of recombinant factor viii concentrate (35 units kg-1 b.i.d.). On the seventh day he exhibited cardiac tamponade for which he underwent subxiphoid pericardiotomy with drainage of approximately 1500 mL of bloody exudate. He had an uncomplicated recovery and 10 days later he left hospital. He was given a continuous prophylactic treatment of 15 units kg-1 of recombinant FVIII every 2 days for 6 months, and 30 months after this episode the patient is free of any symptom.
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keywords = roentgen
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4/138. Acetabular fracture.

    A twenty-eight-year-old female bicyclist was struck by a car. Associated injuries after trauma work-up included a splenic laceration that is to be treated with observation and a history of loss of consciousness with a negative head CT. x-rays and representative CT scan cuts are enclosed.
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keywords = ray
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5/138. Fracture of the hook of the hamate, often misdiagnosed as "wrist sprain".

    A patient with fracture of the hook of the hamate is described, in whom the diagnosis was delayed for 1 year after the initial trauma. This delay in correct diagnosis is often seen, as routine anteroposterior and lateral roentgenograms of the wrist are unlikely to show the fracture. The trauma is often misinterpreted as a "wrist sprain." Nevertheless, with a careful trauma history and a detailed clinical examination and with minimal additional roentgenographic views, it should be possible to correctly diagnose the fracture. Relief of the disabling pain can then be offered by removal of the un-united fracture fragment.
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ranking = 919.92328714043
keywords = roentgen
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6/138. calcitonin and spinal fusion.

    The authors report on the efficacy of nonsurgical treatment of an older patient with a fractured odontoid process. The patient, an 85-year-old woman, had multiple medical problems that put her at an increased surgery-related risk. Therefore, an alternative approach was elected, including immobilization with a philadelphia collar and the provision of calcitonin nasal spray. Bone union and clinical recovery were achieved within 8 weeks of initiating the nasal calcitonin therapy (12 weeks postinjury). Considering the patient's age, comorbidities, and the severity of the fracture, the recovery period was unusually short. The authors believe that calcitonin played a pivotal role in the healing process of the fractured odontoid bone. There is no question that the fusion in this patient could be unrelated to the medical therapy. This description of one patient, as well as the lack of a large randomized study, precludes any scientific conclusions. Nevertheless, the authors believe that the development of a successful fusion in this high-risk patient should be reported as an observation that merits confirmation and study. The authors also discuss the physiological effects of calcitonin and the research and clinical experience with this hormone in different conditions affecting bone.
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7/138. Three-dimensional CT modeling versus traditional radiology techniques in treatment of acetabular fractures.

    Recently, the authors have used the computer-generated three-dimensional (3-D) CT moving images for preoperative planning and screw/pin insertion in more than 28 cases involving plate and screw fixation of complex acetabular fractures. The authors also used stereolithography (wax or plastic 3-D model of bony anatomy) to develop a computer-generated "clip on" interpositioning template for accurate placement of plate and screws. Application of these new technologies gives the surgeon precise information about the fracture patterns and provides an effective means for preoperative planning and accurate fixation of acetabular fractures. The accuracy of the 3-D virtual presentation of the anatomy is impressive and was substantiated by phantom studies. Postoperation CT revealed no case of screw penetration in the joint. Among other benefits over conventional surgical technique, the computer-assisted surgery provided decreased operative time and morbidity, decreased radiation exposure, and obviated the need for oblique, inlet and outlet roentgen views of the pelvis for preoperative planning. A case report specifically demonstrates preoperative planning for reconstruction of acetabular fracture.
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ranking = 459.96164357022
keywords = roentgen
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8/138. Intraspinal migration of a Kirschner wire 3 months after clavicular fracture fixation.

    The authors describe a patient who had Kirschner (K-) wire osteosynthesis of a right lateral clavicular fracture and developed a tetraparesis after 3 months. Plain X-ray and CT scan showed an intraspinal migration of one K-wire through the intervertebral foramen of C5/6. The K-wire was pulled out through an opening of the wound over the right clavicle. No CSF fistula was seen. The patient recovered without any postoperative neurological deficit. patients with K-wire osteosynthesis should be informed about the risk of dislocation and wandering and should regularly be seen in the outpatient clinic. Regular x-rays should be performed. The K-wires must be sufficiently bent at the distal end to prevent wandering into the proximal direction. The K-wires should be removed soon after 6 weeks and, in cases of dislocation and migration, as early as possible.
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9/138. Lesions of the trochlea tali. Osteochondral fractures and osteochondritis dissecans of the trochlea tali.

    Osteochondral fracture of the trochlea tali, which can result in osteochondritis dissecans of this trochlea, is often not recognized as such and therefore not adequately treated. The nonrecognition is mainly due to the fact that the fracture can either remain asymptomatic or produce symptoms of inversion-distortion; to a lesser degree it is also due to the fact that the lesion is not identified in the radiograph. In view of these facts it would seem necessary in all cases of distorsion to make an X-ray examination of the ankle, ascertaining that the trochlea tali is adequately visualized. Unless the symptoms abate within a week, radiological examination should be repeated. The same applies to patients whose initial recovery is followed by a relapse of symptoms. Surgical treatment of choice for osteochondral fractures. The symptomatology and therapeutic results in 46 osteochondral fractures studied were in agreement with data from the literature. Therapeutic results can be improved by earlier diagnosis and more adequate treatment of the condition.
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10/138. Isolated supra-acetabular insufficiency fracture: a case report.

    In the absence of trauma, fracture of the acetabulum is a rare injury, and an isolated insufficiency fracture in the supra-acetabular region is extremely rare. We describe a 59-year-old postmenopausal woman with systemic lupus erythematosus (SLE) who developed a fracture in the roof of the acetabulum with underlying corticosteroid-induced bony insufficiency. Faint medullary sclerosis over the roof of the acetabulum was observed on plain roentgenograms. diagnosis was made using magnetic resonance imaging. Irregular linear low signal intensity lines were observed on T1-weighted, T2-weighted, proton density, and contrast enhanced images, and these represented the fracture. The fracture healed with conservative management. Insufficiency fracture in this location should be suspected in an osteopenic woman with spontaneous hip pain.
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ranking = 459.96164357022
keywords = roentgen
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