Pain Control and Point-of-Care Ultrasound: An Approach to Rib Fractures for the Austere Provider.

Rib fractures are common injuries that cause significant discomfort and can lead to severe pulmonary complications. Rib injury most often results from high-velocity traumatic mechanisms, while rarely representing underlying metastatic disease or secondary injury due to pulmonary illness. Because most rib fractures are caused by obvious trauma, algorithms are focused on treatment rather than investigating the exact mechanism of rib fractures. Chest radiographs are often the initial imaging performed but have proven to be unreliable in identification of rib fracture. Computed tomography (CT) is a diagnostic option as it is more sensitive and specific than simple radiographs. However, both modalities are generally unavailable to Special Operations Forces (SOF) medical personnel working in austere locations. These medical providers could potentially diagnose and treat rib fractures in any environment using a standardized approach that includes clarity of mechanism, pain relief, and point-of-care ultrasound (POCUS). This case demonstrates an approach to the diagnosis and treatment of a rib fracture in a 47-year-old male who presented to a military treatment facility with unlocalized flank and back pain, but the methods employed have applicability to the austere provider working far from the resources of a medical center.

Possible bite-induced abscess and osteomyelitis in Lufengosaurus (Dinosauria: sauropodomorph) from the Lower Jurassic of the Yimen Basin, China.

We report an osseous abnormality on a specimen of the sauropod dinosaur Lufengosaurus huenei from the Fengjiahe Formation in Yuxi Basin, China. A gross pathological defect occurs on the right third rib, which was subjected to micro-computed tomographic imaging as an aid in diagnosis. The analysis of pathological characteristics and the shape of the abnormality is incompatible with impact or healed trauma, such as a common rib fracture, and instead suggests focal penetration of the rib, possibly due to a failed predator attack. The identification of characteristics based on gross morphology and internal micro-morphology presented by the specimen, suggests an abscess with osteomyelitis as the most parsimonious explanation. Osteomyelitis is a severe infection originating in the bone marrow, usually resulting from the introduction of pyogenic (pus-producing) bacteria into the bone. Micro-tomographic imaging of the lesion suggests a degree of healing and bone remodelling following post-traumatic wound infection with evidence of sclerotic bone formation at the site of pathological focus, indicating that L. huenei survived the initial trauma. However, as osteomyelitis can express through widespread systemic effects, including a lowering of immune response and overall condition, this disease may have been a contributing factor to the eventual death of the individual.

[Pseudoarthrosis of the first rib in a patient who practices yoga. A case report]. / Seudoartrosis de la primera costilla en una practicante de yoga. Presentación de un caso.

INTRODUCTION: Pseudoarthrosis of the first rib is a rare condition that may occur in athletes as a result of repetitive activities, mainly overhead. The usual clinical presentation is pain in the neck or the ipsilateral shoulder. CASE REPORT: This is the case of a 19-year-old female patient who had sudden pain of the base of the neck while doing yoga. Pseudoarthrosis of the first rib was diagnosed with X-rays and CAT scan. Treatment consisted of a rehabilitation and physical therapy program that was successful despite the persistence of the pseudoarthrosis. DISCUSSION: Cases of first rib fractures have been reported in athletes practicing multiple activities; however, pseudoarthrosis cases are rare since most of them progress to bone healing. This is the first reported case of a fracture or pseudoarthrosis in a patient practicing yoga. As in most reported cases, conservative treatment was successful. CONCLUSION: Fractures and pseudoarthrosis of the first rib are rare in athletes and should be included in the differential diagnosis of athletes presenting with shoulder and neck pain. Conservative treatment is successful in most cases.

[Arterial air embolism following multiple injuries after a fall from the tenth floor]. / Arterielle Luftembolie nach Polytraumatisierung bei Sturz aus dem 10. Stock.

We report about the case of a 20-year-old patient who fell from the tenth floor. The patient suffered multiple injuries and systemic gas embolism. He survived his injuries despite CPR, massive transfusion, development of ARDS and SIRS with minimal neurological deficit. The possible pathogenesis of the systemic gas embolism as well as the therapy are discussed. Besides stabilizing the circulation with i.v. fluids, blood transfusion and catecholamine therapy, the use of hyperbaric oxygenation was the decisive therapeutic measure.

First rib fracture of unknown etiology: a case report.

OBJECTIVE: The purpose of this study is to describe the case of a patient with a first rib fracture discovered with advanced imaging once the patient did not respond to an initial course of care. CLINICAL FEATURES: A 24-year-old otherwise healthy male electrician had medial scapular, upper thoracic, and sternal pain while using a power drill in the overhead position. INTERVENTION AND OUTCOME: An initial trial of treatments consisting of spinal manipulation and modalities failed to alleviate the patient's symptoms. Chiropractic treatment was discontinued and further diagnostic testing with advanced imaging was performed. Once the pathology was identified, the patient was placed on light duty at work with restrictions limiting overhead activities. No other treatment was rendered. The patient was symptom-free approximately 10 months after the onset of pain. CONCLUSIONS: Patients with complaints of spine and scapular pain may commonly present to a chiropractor for care. When these types of symptoms do not respond to conservative therapy, other causes should be investigated. In this case, the patient's symptoms resulted from a nontraumatic fracture of the first rib. First rib fractures should be considered in the differential diagnosis of patients with upper quadrant pain that is not responsive to conservative care.

Glomangiopericytoma causing oncogenic osteomalacia. A case report with immunohistochemical analysis.

A 47-year-old woman suffered from gait disturbance due to back pain and muscle weakness. Laboratory data showed serum hypophosphatemia, elevated alkaline phosphatase, and a normal level of ionized calcium. Radiological examinations revealed multiple pathologic fractures in the ribs and pubic rami. She had had no episode of familial or any other notable disorder, and so she was initially treated with medication for adult-onset osteomalacia. However, 19 years later (when she was 66 years old), she noticed a soft-tissue tumor in her buttock. The tumor was excised. The histological features were those of glomangiopericytoma characterized by both glomus tumor-like and hemangiopericytoma-like structures. After removal of the tumor, her symptoms disappeared immediately. Laboratory data normalized 8 months later. To our knowledge, this is the first report of oncogenic osteomalacia caused by glomangiopericytoma.

A 3-month-old baby with multiple fractures.

This case is presented to illustrate the radiographic and clinical findings of a condition of interest to orthopedic surgeons. The initial findings are noted on this page. The clinical and radiographic diagnoses are presented on the following pages.

Rib fracture due to bench pressing.

Rib fractures are commonly associated with blunt trauma, but there are instances where this is not the case. In this case a patient fractured the second rib during a "bench press" weight lifting maneuver. The possible etiology is proposed, and the incidence, causes, diagnosis, complications, and treatment of rib fractures are discussed.