Cases reported "Multiple Trauma"

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11/235. Traumatic rupture of the tibialis posterior tendon after ankle fracture: a case report.

    Degenerative tears of the posterior tibial tendon associated with chronic disease are well documented in the literature. Traumatic ruptures of this tendon, however, are much less common and consequently have received little attention. An association has been shown between pronation-external rotation ankle fractures and tears of the tendons that cross the medial aspect of the ankle, most commonly the posterior tibial tendon. In the present case report, we share our unique experience of an open-ankle fracture associated with the traumatic rupture of the posterior tibial tendon. This injury illustrates that soft-tissue injury must always be suspected concomitantly in the treatment of certain fractures on the basis of both mechanism of injury and fracture pattern.
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ranking = 1
keywords = fracture
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12/235. Is there a place for external fixation in humeral shaft fractures?

    There is a good indication for unilateral axial dynamic external fixation in fractures of the humeral shaft when the fracture appears in the distal third or in cases of bilateral fractures. A non-union or a posttraumatic paralysis of the radial nerve may be indications for external fixation as well as fractures associated with multiple injuries. Further indications include osteitis, infected non-union and comminuted fracture. There is maximum protection of the soft tissue with this method of treatment. External fixation combines the advantages of conservative and operative treatment by influencing callus formation by dynamizing, distraction or compression. Minimizing soft tissue damage facilitates the decision for early exploration of the radial nerve in cases of palsy. A safer positioning technique of the distal screws of the fixator is described.
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ranking = 1.125
keywords = fracture
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13/235. Delayed presentation of traumatic left-sided diaphragmatic avulsion. A case report.

    We describe the case of a 35-year-old man who had suffered a severe multitrauma with blunt thoracic injury, left scapula and humerus fractures 5 years earlier. At the time of the trauma, a diaphragmatic lesion went unnoticed. Five years later, the patient had a 24-h history of increasingly severe abdominal pain with repeated vomiting. Helical CT showed a portion of the left hemidiaphragm avulsed from its insertions on the ribs with large-bowel loop obstruction herniated in the left hemithorax. The preoperative CT diagnosis was confirmed by surgery: reduction of the hernia and reinsertion of the hemidiaphragm to the lumbocostal arch were performed.
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ranking = 0.125
keywords = fracture
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14/235. Bilateral peroneal nerve injuries in a patient with bilateral femur fractures: a case report.

    The second reported case in the current literature of peroneal nerve palsy in bilateral femur fractures is described. This is the first case report of bilateral nerve palsies occurring in bilateral femoral fractures and the first report of bilateral peroneal nerve palsy associated with bilateral skeletal traction.
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ranking = 0.75
keywords = fracture
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15/235. Pelvic fractures in pregnant multiple trauma patients.

    OBJECTIVE: To study the outcome of pelvic fractures and fetuses in pregnant patients involved in blunt multiple trauma. DESIGN: Retrospective follow-up study. SETTING: Level I trauma center. patients: Pregnant multiple trauma patients with pelvic fractures between 1974 and 1998. INTERVENTIONS: Conservative and operative treatment of pelvic fractures adapted to the clinical status of the mother. MAIN OUTCOME MEASURES: Clinical, functional, and social outcomes were evaluated. RESULTS: Out of 4,196 patients with blunt multiple trauma treated between 1974 and June 1998, seven demonstrated the combination of blunt multiple trauma, pregnancy, and pelvic fractures. These patients had a mean injury severity score of 29.9 points. Five mothers and three fetuses survived their injuries. All dead fetuses died on the scene. One surviving fetus was found to have hydrocephalus unrelated to the injury; the remaining fetuses had an uneventful delivery and were healthy. In two of the three patients whose fetuses survived, the treatment of the pelvic fracture was modified for the sake of fetal well-being. In all of these patients, acceptable outcome was achieved. CONCLUSION: Modification of the treatment of the pelvic fracture in pregnant women with multiple trauma may be necessary to minimize the risk of fetal injury. In our experience with these rare cases, this modified treatment did not severely alter the clinical outcome of the mother's pelvic fracture.
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ranking = 1.375
keywords = fracture
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16/235. Traumatic cervical distraction complicated by delayed reduction due to traumatic vertebral artery pseudo-aneurysm.

    A 23-year-old male involved in a high-speed collision acquired, among other injuries, a wide fracture distraction at C2/C3. Reduction was delayed by an enlarging vertebral artery pseudo-aneurysm at the site of injury which was successfully treated by proximal endovascular occlusion with a detachable polymer-filled balloon. A traumatic arachnoid cyst or pseudomeningocele was also demonstrated at the injury site but intervention was not required. The treatment and outcome of these three uncommon injuries in the literature is reviewed and discussed. Given the severity of the injury, the absence of severe long-term neurological disability is notable.
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ranking = 0.125
keywords = fracture
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17/235. Reconstruction of a tibial defect with microvascular transfer of a previously fractured fibula.

    A 43-year-old man sustained severe injuries to his lower limbs with extensive soft-tissue damage and bilateral tibial-fibular fractures. Acutely, the patient underwent external fixation and a free latissimus dorsi flap for soft-tissue coverage of the left leg. However, the tibia had a nonviable butterfly fragment that left a 7-cm defect after debridement. Subsequently, the contralateral fractured fibula was used as a bridging vascularized graft for this tibial defect. The transfer of a fibula containing the zone of injury from a previous high-energy fracture has not been reported. This case demonstrates the successful microvascular transfer of a previously fractured fibula for the repair of a contralateral tibial bony defect.
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ranking = 1
keywords = fracture
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18/235. Current management of pelvic fractures.

    Blunt pelvic injuries are becoming more common in this era of high-speed, high-energy collisions. At least 5% of blunt injuries result in pelvic fracture. With mortality rates approaching 55% for severe crush injuries of the pelvis, early stabilization and control of bleeding, as well as assessment for other injuries, requires a focused, multidisciplinary approach. We discuss early management and stabilization of severe pelvic fractures.
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ranking = 0.75
keywords = fracture
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19/235. Combined carotid artery injury and laryngeal fracture secondary to dog bite: case report.

    Approximately 914 new dog bite injuries requiring emergency department visits occur daily in the united states. Attacks by dogs with training and strength to attack should be triaged cautiously because of the possibility of serious internal injury. A high index of suspicion is needed when treating patients with neck injuries secondary to dog bites. We report a case of successfully treated combined carotid artery and laryngeal injury produced by a dog bite.
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ranking = 0.5
keywords = fracture
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20/235. Management of lawnmower injuries to the lower extremity in children and adolescents.

    Lawnmower-associated trauma remains a substantial source of extremity injury in the pediatric and adolescent patient populations, producing complex wounds that require a combined orthopedic and plastic surgical approach. The authors review their experience with 16 patients, 2 to 17 years of age (mean age, 6.2 years), who were admitted to Duke University Medical Center for lower extremity lawnmower trauma between January 1988 and December 1999. The average hospitalization time was 13.5 days, and an average of 2.9 surgical procedures per patient were performed. Early debridement and bony fixation were carried out in all patients; 8 patients sustained traumatic amputations. Fifteen of 20 nonamputation fractures involved the foot and were managed with either closed reduction or K-wire fixation. Three of five long-bone fractures underwent external fixation. Wound closure was achieved with direct closure or skin grafting in the majority of patients. However, five microsurgical free flap transfers were required for extensive defect reconstruction of the foot (N = 4) and knee (N = 1). Adequate immediate debridement, fracture reduction, and early primary or if necessary secondary wound coverage including microsurgical free tissue transfer to prevent further damage and long-term disability in these type of devastating injuries is recommended.
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ranking = 0.375
keywords = fracture
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