Cases reported "Shoulder Fractures"

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1/141. brachial plexus lesions complicating anterior fracture-dislocation of the shoulder joint.

    Four cases of brachial plexus lesions caused by anterior fracture-dislocation of the shoulder are reported. The incidence, mechanism of injury and prognosis are reviewed. ( info)

2/141. Arthroscopic-assisted reduction and percutaneous external fixation of a displaced intra-articular glenoid fracture.

    Arthroscopic reduction and percutaneous external fixation is a well-known technique for treating selected fractures. This is the first report of a method of treating intra-articular glenoid rim fracture using shoulder arthroscopy and percutaneous external fixation. The surgical trauma associated with open operative treatment of these fractures can be minimized using minimally invasive techniques under arthroscopic control. This technique not only allows for anatomic reduction with minimal surgical trauma but provides a valid diagnostic and treatment alternative for associated injuries. Arthroscopic reduction and percutaneous external fixation yielded excellent results with no complications. The authors describe the principles of the procedure and discuss its advantages compared with traditional surgery. ( info)

3/141. Bilateral anterior shoulder fracture-dislocation. A case report and a review of the literature.

    We report an unusual case of bilateral anterior shoulder dislocation following trauma. Previously reported cases were either of bilateral dislocations or bilateral fracture dislocations. In our case the patient suffered bilateral anterior dislocation with a three part fracture dislocation on the right. A review of the literature is presented. ( info)

4/141. homicide or accident off the coast of florida: trauma analysis of mutilated human remains.

    In the many years Dr. William R. Maples served as a forensic anthropologist, he saw diverse sources of trauma presented in the victims of violent crime, accident and suicide in the state of florida. In 1996 the District 18 Medical Examiner's Office of florida requested the assistance of Dr. Maples in the analysis of human remains recovered by the U.S. Coast Guard. The deceased was in an advanced state of decomposition characterized by skin slippage and discoloration. The torso bore multiple lacerations, including nearly parallel lacerations in the skin of the back. Specimens were carefully macerated and the fractures reconstructed. The skeletal trauma was caused by a device capable of delivering robust cuts and blunt trauma in linear paths, as is consistent with propeller trauma. Unusual in this case were blows to the ventral and dorsal surfaces of the body. Based on the anthropological analysis and interviews with the family of the deceased, the F.B.I. proceeded with the case as a homicide investigation. ( info)

5/141. CT imaging and three-dimensional reconstructions of shoulders with anterior glenohumeral instability.

    Glenohumeral instability is a common occurrence following anterior dislocation of the shoulder joint, particularly in young men. The bony abnormalities encountered in patients with glenohumeral instability can be difficult to detect with conventional radiography, even with special views. The aim of our study was to evaluate the bony abnormalities associated with glenohumeral instability using CT imaging with 3-D reconstruction images. We scanned 11 patients with glenohumeral instability, one with bilateral symptoms; 10 were male, one female, and their ages ranged from 18-66 years. Contiguous 3 mm axial slices of the glenohumeral joint were taken at 2 mm intervals using a Siemens Somatom CT scanner. In the 12 shoulders imaged, we identified four main abnormalities. A humeral-head defect or Hill-Sachs deformity was seen in 83% cases, fractures of the anterior glenoid rim in 50%, periosteal new bone formation secondary to capsular stripping in 42%, and loose bone fragments in 25%. Manipulation of the 3-D images enabled the abnormalities to be well seen in all cases, giving a graphic visualization of the joint, and only two 3-D images were needed to demonstrate all the necessary information. We feel that CT is the imaging modality most likely to show all the bone abnormalities associated with glenohumeral instability. These bony changes may lead to the correct inference of soft tissue abnormalities making more invasive examinations such as arthrography unnecessary. ( info)

6/141. Arthroscopic treatment of acute traumatic anterior glenohumeral dislocation and greater tuberosity fracture.

    We present a case and a description of treatment of an anterior dislocation of the shoulder with a greater tuberosity fracture. Both the Bankart lesion and the tuberosity fracture were repaired using arthroscopic techniques. ( info)

7/141. Pathologic fracture of the humerus due to metastatic cholangiocarcinoma.

    cholangiocarcinoma is a rare tumor of the bile duct system known to frequently metastasize to the axial skeleton, lungs, adrenal glands, brain, and lymphatic system. Spread to the long bones has not previously been reported in the literature partly because of the short life expectancies of patients with this disease. We discuss a case of a pathologic humerus fracture due to metastatic cholangiocarcinoma. ( info)

8/141. 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. ( info)

9/141. Axillary nerve injuries in children.

    Isolated axillary nerve injury is uncommon, particularly in children. The motor deficit of shoulder abduction may not recover spontaneously and can be a substantial handicap. Detection may be difficult initially, as the injury is masked by trauma such as head injury, and concomitant shoulder injury requiring immobilization. After mobilization, patients learn to partially compensate by using alternate muscles. There are few reports of surgical management of this nerve injury. Most concern predominantly adults, and the results are mixed with on average slightly greater than half having a good recovery (defined as grade 4-5 Medical research Council muscle power). We present our experience with 4 pediatric patients who had axillary nerve injury. Three patients had an interposition nerve graft, and 1 patient underwent neurolysis. All patients recovered to grade 4-5 deltoid muscle power. Children with an axillary nerve injury which fails to recover spontaneously by 4-6 months should strongly be considered for surgical exploration. ( info)

10/141. Irreducible acute anterior dislocation of the shoulder caused by interposed fragment of the anterior glenoid rim.

    Failure of manipulative reduction of acute anterior dislocation of the shoulder is extremely rare. A 55-year-old man dislocated his right shoulder when he fell heavily. Initial radiographs and computed tomographs demonstrated an anterior dislocation with fracture of the glenoid rim. Several attempts at closed reduction were unsuccessful. At the time of open reduction, the cause of failure was found to be interposition of a fragment of the anterior inferior glenoid rim in the joint. To prevent redislocation, the fragment was held in place by two Herbert mini bone screws after anatomic reduction, and the ruptured subscapularis was reattached to the lesser tuberosity. Two and a half months after surgery, the shoulder was stable with full range of motion. To the best of our knowledge, this is the first reported case of interposition of a fracture-fragment of the anterior inferior glenoid rim causing failure of reduction. ( info)
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