Venous thromboembolism during hip plaster cast immobilisation: review of the literature.

INTRODUCTION: There is a paucity of data regarding the risk of deep vein thrombosis during hip plaster cast immobilisation. The purpose of this article was to review the available evidence regarding the incidence of symptomatic venous thromboembolism (VTE) during hip plaster cast immobilisation. METHODS AND MATERIALS: All papers describing hip plaster cast immobilisation published in the English literature retrieved from PubMed, EMBASE and the Cochrane database were reviewed. Articles regarding children, hip dysplasia, congenital hip dislocation and Legg-Calvé-Perthes were excluded. A total of three papers were available for analysis. We also describe a case of pulmonary embolism during hip cast immobilisation. RESULTS: The overall incidence of symptomatic VTE during hip plaster cast immobilisation was 0% in 343 patients. The incidence of symptomatic VTE in hip cast brace was 2.3% (range 0-3%). DISCUSSION: Our systematic review of the literature showed a paucity of data regarding the incidence of VTE during hip plaster cast immobilisation. We describe the first case of pulmonary embolism during hip plaster cast immobilisation. We recommend that patients who are fitted with a hip plaster cast should be routinely screened for additional risk factors. When risk factors are present, patients should be considered for pharmacological thromboprophylaxis.

Posterior dislocation fractures of the shoulder in seizure disorders--two case reports and a review of literature.

We present two patients with complaints of shoulder pain after an epileptic seizure. Both patients had a posterior dislocation fracture of the shoulder. After reviewing the literature the following conclusions can be drawn: (1) A posterior shoulder dislocation fracture is rare. (2) One should not underestimate the muscular forces in seizure disorders and be alert for dislocation fractures of the shoulder and/or other joints. (3) The diagnosis is frequently missed, but an axillary radiograph or a CT scan always reveals the fracture.

[An innocent bone cyst in the proximal humerus]. / Een onschuldige botcyste in de proximale humerus.

We discuss four cases of bone cyst in the proximal humerus, in two boys aged 8 and 9, and two girls aged 2 and 5. Differentiation between a solitary and an aneurysmatic bone cyst can be difficult. The bone cyst in the proximal humerus is mostly benign. In one case (the 2-year-old girl) a malignancy, a telangiectatic osteosarcoma, was observed after 2-5 years follow-up. Humerus resection was performed.

Treatment of congenital elevation of the scapula. 10 (2-18) year follow-up of 37 cases of Sprengel's deformity.

We studied retrospectively and partially prospectively all 37 cases of Sprengel's disease who were treated between 1970 and 1990, 23 of whom were operated on. Many of the patients were severely handicapped by abnormal shoulder abduction and elevation. Neurological deficits were not found. 34 of our cases had other congenital malformations. Several operative techniques were used. In cases with only cosmetic problems we now prefer resection of part of the superior angle. In cases with impaired function we prefer the Woodward-procedure.

The first branch of the lateral plantar nerve and heel pain.

The course and ramification pattern of the lateral plantar nerve was studied in serial sections from 4 fetal feet and in dissections from 34 adult feet with special reference to the so called first branch. This branch was found in all of the observed fetal and adult specimen. From its originating point the nerve runs immediately distally to the medial process of the calcaneal tuberosity in a lateral direction to the proximal part of the abductor digiti minimi muscle. During its course the FB gives two branches. One of them penetrates sometimes the insertion of the quadratus plantae muscle, whereas in adult feet it always sends fibres to the periosteum around the medial process of the calcaneal tuberosity and the long plantar ligament. The other innervates the flexor digitorum brevis muscle. The site of a possible entrapment is located between the abductor hallucis muscle and the medial head of the quadratus plantae muscle. There is strong indirect evidence that the nerve is of a mixed type consisting of sensory fibres for the calcaneal periosteum and the medial head of the quadratus plantae muscle. There is strong indirect evidence that the nerve is of a mixed type consisting of sensory fibres for the calcaneal periosteum and the long plantar ligament as well as motor fibres for the quadratus plantae, flexor digitorum brevis and abductor digiti minimi muscles, which may explain the characteristic pain complaints of the heel pain syndrome. The occurrence of a stiff fascia perforated by the nerve branch or a bursa around the insertion of the plantar aponeurosis as has been described by several authors and which was put forward as a possible aetiological factor could not be confirmed in our material.

The use of autologous graft and human umbilical vein graft in femorocrural bypasses--a preliminary report.

In this article the results are presented with autologous saphenous and human umbilical vein grafts in the femorocrural crossing. Autologous saphenous vein grafts were employed in 22 limbs and the human umbilical vein grafts in 25 limbs. The results were retrospectively analysed by the Life-Table method. Follow-up was between six months and 21/2 years. The patency rates of the autologous saphenous vein graft was significantly better than that of human umbilical vein grafts.