Cases reported "Tibial Fractures"

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11/28. "Matching" ventilation/perfusion images in fat embolization.

    Forty-eight hours after fracture of the tibia and fibula, a 27-year-old man developed the triad of findings noted in the fat embolism syndrome (neurologic changes, respiratory distress, and petechiae). An initially normal chest-x-ray, which progressed to one of bilateral fluffy diffuse infiltrates, aided in making the diagnosis. ventilation/perfusion lung images were performed at the time of the radiographic changes and showed "matching" defects. Transcapillary passage of lipid breakdown products was considered to be the cause. While all parts of the lung showed reduced ventilation/perfusion, the upper half of the lung fields was affected more prominently, as opposed to emboli of venous origin, which most frequently involve the lung bases.
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keywords = x-ray
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12/28. Avulsion fracture of the tibial eminence associated with severe medial ligamentous injury in an adolescent. A case report and literature review.

    In the presence of open physes, tibial eminence fractures are usually isolated injuries. However, adults sustaining a fracture of the tibial eminence are more likely to have other associated injuries, most commonly a tear of the medial collateral ligament. A case of an adolescent with a tibial eminence fracture and a complete tear of the medial collateral ligament is reported. review of the literature revealed two similar cases in adolescents. If medial instability is demonstrated on valgus stress of the knee in an adolescent with tibial eminence fracture, we believe stress roentgenograms of the knee should be obtained to distinguish between physeal injury and collateral ligament tear.
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ranking = 34901.298425091
keywords = roentgen
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13/28. The guarded prognosis of physeal injury in paraplegic children.

    Unrecognized injury of the physis in neurologically impaired children, followed by repetitive trauma due to lack of sensation, results in a bizarre roentgenographic appearance which may resemble that of osteomyelitis or a malignant tumor (sarcoma or leukemia). The prolonged process of injury and repair in the injured physis and adjacent metaphysis is similar to that seen in Charcot neuroarthropathy. Lack of awareness of these roentgenographic features resulted in unnecessary diagnostic biopsy in two of the nine patients with such fractures reported in this study. Delayed healing is characteristic of this lesion and is a result of inadequate immobilization and failure to restrict weight-bearing. Premature closure of the physis occurred in five of nine patients. Early recognition and adequate immobilization allow more normal healing of this unusual injury.
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ranking = 69802.596850182
keywords = roentgen
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14/28. Roentgen stereophotogrammetric analysis of growth pattern after supination--eversion ankle injuries in children.

    In a prospective study of ankle fractures in children, the growth rate was registered with a roentgen stereophotogrammetric method. The injuries were classified traumatologically according to Gerner-Smidt and anatomically according to Salter and Harris. Twenty-six ankle fractures were classified as supination--eversion injuries. Of these, eight had intraarticular injuries, 16 had extraarticular injuries of the distal tibia, and two had a zigzag fracture through the growth plate of the distal fibula. Information about growth was obtained within 3 months after fracture, and the growth pattern was found stationary about 6 months after fracture. Five types of growth pattern were observed: Normal growth (1 case), initial growth stimulation of varying length (8), initial and temporary growth retardation (1), initial and permanent growth retardation (4), and initial and permanent growth arrest (7). The other 5 had very low growth rates bilaterally. Roentgen stereophotogrammetry was found useful in extraarticular supination--eversion injuries in girls up to 12 years of age and in boys up to 13 years of age. Intraarticular supination--eversion injuries always appear when there is low remaining growth; because of growth disturbance, no follow-up is indicated. The traumatological classification was found of value in recognizing the different fracture types. Combined with an anatomical classification, high precision in predicting growth disturbance was obtained. However, factors such as trauma, displacement, skeletal maturity, and treatment must be considered. The roentgen stereophotogrammetric method permits early determination of the growth pattern with high accuracy. The growth disturbance can be registered months before this is evident from conventional radiographic examinations.
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ranking = 69802.596850182
keywords = roentgen
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15/28. Early scintographic diagnosis of bone stress and fractures in athletic adolescents.

    A study of radionuclide bone scintigraphy in adolescents was conducted to evaluate the pattern of stress-related abnormalities and their correlation with both symptoms and roentgenography. In 26 episodes of stress-related abnormal scintigraphy, 12 (46%) had a multifocal pattern of abnormalities. Forty foci were identified by scintigraphy, with 11 (28%) exhibiting abnormal roentgenograms. These multiple abnormalities were frequently unsuspected clinically, and studies limited to symptomatic areas would have failed to detect them. It is recommended that patients with stress-related symptoms be screened utilizing radionuclide bone scintigraphy to facilitate the early detection of abnormalities in bone prior to the development of cortical disruption, thereby preventing increased morbidity and possible disabling sequelae.
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ranking = 69802.596850182
keywords = roentgen
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16/28. Roentgen stereophotogrammetric analysis of growth pattern after supination-adduction ankle injuries in children.

    In a prospective study of supination-adduction (SA) ankle fractures in children, the post-traumatic growth pattern was registered with a roentgen stereophotogrammetric technique allowing exact determination of the growth rate within 3 months after fracture. It was possible to predict future growth pattern within 6 months. The SA injuries (10 cases) were divided into two stages according to Gerner-Smidt. One Stage I injury (physeal separation through the distal fibula) showed a growth stimulation. Nine Stage II injuries (including a fracture through the medial malleolus) showed four types of growth pattern besides symmetrical growth. The Salter-Harris classification alone showed no obvious correlation to the post-traumatic growth pattern, whereas factors such as age at injury, stage of injury, displacement, and treatment in combination with the Salter-Harris classification contributed to a better prediction of risk of deformity. It was found that displaced Stage II injuries in the younger child had the highest risk of developing a clinically significant varus deformity. Early determination of the post-traumatic growth pattern is of crucial importance in SA injuries with a high risk of growth deformities. Operative treatment in order to restore normal growth can be performed before a severe deformity has developed.
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ranking = 34901.298425091
keywords = roentgen
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17/28. Avulsion of lateral tibial condyle in skiing.

    The purpose of this article is to report four cases of avulsion of the lateral tibial condyle which occurred in one month of a skiing season at a large ski resort in west virginia. This includes three women and one man who all complained of knee pain following ski injury and showed avulsion or "chip" fracture of the lateral tibial condyle on roentgenographic examination. Two of the injuries were associated with nonrelease of ski bindings. In all four cases the diagnosis of anterolateral rotary instability was not appreciated by the initial examiner, however, and the knee was treated with a splint. Avulsion fracture of the middle third of the lateral tibial condyle, the so called "lateral capsular sign," represents a serious ligamentous injury which results in significant knee instability. Surgical repair of this type of injury is generally recommended.
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ranking = 34901.298425091
keywords = roentgen
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18/28. Growth disturbance after physial injury of distal femur and proximal tibia studied by roentgen stereophotogrammetry.

    Longitudinal growth determined by roentgen stereophotogrammetry was registered in three patients with physial injuries in distal femur and in two patients with physial injuries in proximal tibia during 18 months. The injuries in distal femur were classified as Type I, Type I kII and Type IV and in proximal tibia as Type I kII and Type IV in the different cases according to Salter and Harris. Markers of tantalum balls were implanted into the metaphysis and bony epiphysis of distal femur and proximal tibia permitting regular determination of longitudinal growth. Significant growth disturbances was registered in four patients. The Salter-Harris classification was difficult to use to predict growth disturbance after physial injuries around the knee. The roentgen stereophotogrammetric method was found useful to determine normal growth rate and after physial injuries to reveal growth disturbance leading to complete or partial growth arrest resulting in leg length discrepancy or angular deformity. This method facilitates preoperative planning if surgery is needed.
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ranking = 209407.79055055
keywords = roentgen
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19/28. Compression injury of the epiphyseal growth plate: fact or fiction?

    It has been hypothesized that a longitudinal compression force on a growing long bone may cause partial or complete closure of a physis by crushing the germinal cell layer. In the absence of a fracture of the physis, the roentgenograms at the time of injury would be normal. Thus, this diagnosis can be made only in retrospect. In order to prove such a hypothesis, the following criteria would have to be met: (a) normal findings on roentgenograms taken in at least two planes at the time of injury, (b) no treatment, and (c) subsequent positive roentgenographic findings showing partial or complete closure of the physis, compared with the contralateral side. We have been unable to find, either in our files or in the literature, any cases that meet these criteria. Many other causes of premature closure of physes have been well documented in the literature.
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ranking = 104703.89527527
keywords = roentgen
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20/28. On the nature of stress fractures.

    It is felt that stress fractures are caused by excessive, repetitive muscle forces acting across the affected bone. These fractures should be suspected in participants of athletic endeavors who present with a history of persistent, focal, activity-related pain regardless of their stage of physical conditioning. Associated physical findings are localized tenderness and swelling without evidence of a generalized systemic response. Bone scans and serial roentgenograms including specialized views may be required for documentation. Limitation of the athletic activity is the hallmark of the treatment program.
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ranking = 34901.298425091
keywords = roentgen
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