Exceptional survival of an airplane stowaway, treated successfully with hyperbaric oxygen.

Survival of airplane stowaways is rare. Here we report an exceptional case of successful treatment and full recovery. After a transcontinental flight an unconscious stowaway was discovered in a wheel well of a Boeing 747-400F. Airport paramedics confirmed regular respiration and achieved 100% oxygen saturation (pulse oximetry) by high-flow oxygen. Rectal body temperature was 35.5 °C. On arrival at the emergency department, the patient's vital signs were stable. He did not respond to verbal stimuli. He localized to painful stimuli with both arms, however, there was no reaction to stimuli to both legs. We suspected his neurological deficits were caused by posthypoxic encephalopathy or altitude decompression sickness (DCS), the latter amenable to hyperbaric oxygen therapy (HBOT). HBOT was performed for 5 h (US Navy Treatment Table 6) and afterwards, full neurological recovery was documented. About 24 h after admission a new proximal paresis of the left leg was noted. Assuming recurrence of DCS, daily HBOT was scheduled for three days, after which motor function had again returned to normal. Stowaways travelling in airplane wheel wells experience extreme environmental circumstances. The presented patient survived an eight-hour exposure to calculated barometric pressures as low as 190 mmHg and ambient PO2 of 40 mmHg. Apart from creating awareness of this rare patient category, we want to stress the risk of altitude DCS in unpressurized flights. When DCS is suspected, immediate high-flow oxygen therapy should be initiated, followed by HBOT at the earliest opportunity.

Quantitative measurements of the coronoid in healthy adult patients.

PURPOSE: We investigated the hypothesis that a quantitative 3-dimensional computed tomography (CT) modeling technique that can measure size, shape, and proximal articular surface area can be used to develop formulas that could predict the volume and proximal surface area of the intact coronoid based on anatomical and demographic data available in patients with fracture of the coronoid process. METHODS: We used a consecutive series of 50 CT scans with a slice thickness of 1.25 mm or less obtained in patients with fracture of the distal humerus, but no injury to the coronoid, to create 3-dimensional models. The volume and articular surface area of the coronoid were measured, and predictive formulas were based on anatomical measurements. We calculated gender using multiple linear regression. RESULTS: There were significant correlations between total coronoid volume and coronoid articular surface area for coronoid width, radial neck diameter, radial head diameter, height, weight, and gender. Multiple linear regression modeling with the factors radial head diameter, radial neck diameter, coronoid width, height, weight, and gender resulted in formulas that could account for 71.8% of the variation in coronoid volume and 66.2% of the variation in coronoid articular surface area. The average relative percent difference was 1.32% for the coronoid volume and 0.68% for the coronoid articular surface area. CONCLUSIONS: The volume and articular surface area of the coronoid can be estimated based on anatomical measurements and gender. This may lead to better estimates of lost fragments when modeling the fractured coronoid and CT scan of the opposite limb is not available.

Quantitative measurements of the volume and surface area of the radial head.

PURPOSE: We investigated the hypothesis that a quantitative 3-dimensional computed tomography (Q3DCT) modeling technique based on anatomical and demographic data that can measure size, shape, and proximal articular surface area can be used to develop formulas that could predict the volume and proximal surface area of the intact radial head in patients with fractures of the radial head. METHODS: We used a consecutive series of 50 computed tomography scans with a slice thickness of 1.25 mm or less obtained in patients with fracture of the distal humerus, but no injury to the radial head, to create 3-dimensional models. The volume and proximal articular surface area of the radial head were measured, and predictive formulas based on anatomical measurements and gender were calculated using multiple linear regression. RESULTS: There were significant correlations between total radial head volume and proximal radial head articular surface area for height, weight, radial head diameter, radial neck diameter, coronoid diameter, and gender. Multiple linear regression modeling resulted in formulas that could account for 89% of the variation in radial head volume and 75% of the variation in proximal articular surface area. CONCLUSIONS: The volume and proximal articular surface area of the radial head can be estimated based on anatomical measurements and gender. This may lead to better estimates of lost fragments when it is not possible to directly model the fractured radial head and computed tomography scan of the opposite limb is not available.

Quantitative three-dimensional computed tomography measurement of radial head fractures.

BACKGROUND: We developed a method to quantitatively analyze fracture fragment morphology on quantitative 3-dimensional computed tomography (3DCT) images in terms of size, shape, and articular surface area. MATERIALS AND METHODS: We analyzed 46 adult patients with a computed tomography scan of a fractured radial head with quantitative 3DCT. We defined an unstable fracture as complete loss of cortical contact of at least 1 fragment. Of the patients, 3 had a Mason type 1 fracture (all stable), 26 had a type 2 fractures (7 stable [27%] and 19 unstable [73%]), and 17 had a type 3 fracture (all unstable). The volume and articular surface area of each articular fracture fragment were measured. A small fragment was defined as having a volume of less than 100 mm(3) or an articular surface of less than 100 mm(2). RESULTS: Partial head fractures (Mason type 2) (26 fractures) are usually multi-fragmented (19 of 26 [73%]) and often have small fragments by volume (32 fragments) and surface area (46 fragments) criteria, particularly when the fracture is displaced and unstable. Only 4 of the 17 patients (25%) with whole-head fractures (Mason type 3) had greater than 3 fragments, but 9 of 17 fractures (69%) with 3 or fewer fragments had small fragments. CONCLUSIONS: According to this initial application of quantitative 3DCT analysis, partial-head fractures are often complex and difficult to repair (small fragments), and most whole-head fractures have 3 or fewer fragments, but many of those fragments are small and may be difficult to repair.