Clinical and Radiological Outcomes of Halo Vest Application for Type II and III Odontoid Fractures.

Objective: To assess halo vest applications for type II and III odontoid fractures and to ascertain the radiological and clinical outcomes of this approach. Methods: A cross-sectional retrospective study was conducted by reviewing the medical charts of selected patients having type II and III odontoid fractures who underwent halo vest treatment at the King Saud Medical City Orthopaedic Department. Radiographic evaluations for the cervical spine (anterior-posterior, lateral, and open-mouth views) were used. Computed tomography scans were used to delineate the extent of the fracture and to measure the magnitude of displacement, the degree of the angulation, the vertebrae involved, and the fracture type. Results: A total of 45 patients with odontoid fractures (55.6% of the patients with type II odontoid fractures and 44.4% of patients with type III) received halo vest treatment. In the present study, in type II odontoid fractures, union was achieved in 15.6% of patients, 28.9% of patients had malunion and 11.1% had nonunion. In type III odontoid fractures, union cases comprised 15.6% of patients, while malunion cases accounted for 28.9% of patients and nonunion cases were found in 4.4% of the patients. Conclusion: The halo vest management for type II and III odontoid fracture requires a prolonged course of cervical immobilisation. Multiple factors contribute to the alteration of the management protocol, patient adherence, and difficulties related to HV, and a significant rate of reduction loss ultimately results in malunion or nonunion.

Air-gun pellet at C1: a case report and literature review.

Background: Air-gun pellet injuries commonly occur in children between the age of 1-18 years old. These injuries could be fetal because it linked to injury to vital organs such as brain, heart, and eyes. In the literature, there are few studies that reported spine injury by air-gun pellet. Our case is a C1 foreign body in a pediatric patient without any neurological deficits after an air-gun injury. Case Description: A 6-year-old boy, known case of Hirschsprung disease presented to the emergency department after an air-gun injury in June 2021. On examination, the patient was hemodynamically stable, and asymptomatic. Neurological exam was intact with power 5/5 in C5-S1 and sensation 2/2 in C5-S1. Computed tomography (CT) of the cervical spine showed a foreign body at C1. After discussing the treatment options with his parents, we treat the patient conservatively by close follow-up and analgesia only. After 1 week, the patient presented to the clinic and the patient was still asymptomatic. A cervical X-ray at that time done and showed no changes in the position from the initial CT. Weekly follow-up was difficult for the family to adhere to due to their socioeconomic status. Therefore, the patient was followed up over the phone call through telemedicine at 6 months and 1 year after the injury. Conclusions: The treatment of these types on injuries is highly controversial. The treatment options could be surgical or non-surgical (conservative) such as antibiotic use. Also, there is always a debate about the choice of the treatment options.

Surgical Treatment of Irreducible AcuteTraumatic Atlantoaxial Rotatory Subluxation in an Adult.

Traumatic atlantoaxial rotatory subluxation (AARS) is a condition that is extremely rare in adults when compared to the pediatric population. The most common symptoms of this condition are torticollis and post-traumatic neck pain. Our patient is a 41-year-old male who presented to the emergency room within hours of the injury. He came by himself with his relative as a case of road traffic accident. He was the first passenger and had been restrained during the car accident, with no ejection or rollover. He presented with stiffness/pain and reduced range of motion in the neck. Computed tomography (CT) of the cervical spine showed rotatory subluxation of C1 over the C2 with a locked facet. Within 24 hours of the RTA and patient admission, we attempted cervical traction. The reduction was not successful. So, we decided to reduce AARS through a surgical approach. The patient was taken to the operating room for open reduction and fixation using the Harms technique for C1-C2 fusion. The patient recovered from the surgery uneventfully, without any complications, recovered cervical mobility, and improved torticollis. Surgical management through open reduction and internal fixation is recommended for AARD cases in which close reduction fails due to a locked facet.

Surgical Management of Traumatic Cervicothoracic Junction Spondyloptosis Without Neurological Injury: A Case Report and Review of the Literature.

Acute traumatic cervical spondyloptosis in neurologically intact patients is uncommon and involvement of the cervicothoracic junction is rare. Herein, we report a case of traumatic C7-T1 spondyloptosis in a 56-year-old neurologically intact male patient, with radiographic findings of C7-T1 grade V traumatic listhesis associated with C7 floating segment, cord compression with myelomalacia, extensive ligamentum injury, and intervertebral disc traumatic change and protrusion. He underwent global spine fixation starting with a posterior approach. Follow-up at six months showed good outcomes. The patient was neurologically intact and pain-free; radiographs showed well-maintained fusion and alignment. Controversy surrounds the management of cervical fracture dislocation from all aspects, from "when" to "what." This is the first case reporting a 540° posterior-anterior-posterior approach with successful outcomes. The rarity of cervical spondyloptosis without neurologic injury complicates the management approaches. As few cases are reported in cervicothoracic spondyloptosis literature, it is important to report the present case.

Is It Compartment Syndrome? Two Case Reports and Literature Review.

Recently, a unique entity of acute compartment syndrome (ACS) has been termed "silent" compartment syndrome. These patients develop ACS in the absence of classic pain and physical findings. We report two cases of posttraumatic silent ACS in two healthy competent adult patients presenting mainly with swollen tense compartments. In the first case, ACS was suspected in a 37-year-old male with left tibia and fibula shaft fractures after reassessment of the patient's post-backslap application, which revealed painless swollen and tense compartments. In the second case, ACS suspicion was raised in a 27-year-old male with right comminuted tibial plateau fracture and a swollen but soft compartment that became tense over time. In both cases, intraoperative intracompartmental pressure testing during external fixator application confirmed the diagnosis, and both underwent emergent fasciotomy with good postoperative outcomes. The absence of pain does not exclude the diagnosis of ACS. Physicians must have a high index of suspicion when risk factors are present for ACS, and the diagnosis can be confirmed with intracompartmental pressure measurement. These case reports and literature review aim to enlighten the physicians about silent compartment syndrome.

Traumatic spinal injuries in Saudi Arabia: a retrospective single-centre medical record review.

OBJECTIVES: To describe the patterns and outcomes of traumatic spinal injuries (TSIs) in a tertiary care trauma centre in Riyadh, Saudi Arabia. DESIGN: Retrospective medical record review. SETTING: Level 1 trauma centre for all patients presented from 1 February 2016 to 31 December 2018. PARTICIPANTS AND DATA: Records of patients presenting with any spinal trauma were reviewed, and the data obtained included age, gender, nationality (as Saudi and non-Saudi), date of presentation, site of fracture/injury, associated injuries, mechanism of injury, presence of neurological involvement and hospital mortality. MAIN OUTCOMES: Frequencies of different types of TSI across various subgroups. RESULTS: We identified 692 patients who presented with TSI throughout the study period. The mean age was 36.9 years. Males represented 83.2% (n=576) of the sample size, and the most common mechanism of injury was motor vehicle collision (MVC), accounting for 66.8% of cases (n=462), while fall-related injuries were seen in 31.6% of cases (n=219). A total of 454 (65.6%) of all patients were Saudi, and 332 (73.1%) of the TSIs in Saudis were due to MVC. Non-Saudi cases accounted for 238 (34.4%) of all patients, and 89 (37.4%) of the non-Saudi injuries were due to falls from height, and this association was statistically significant (p<0.001). CONCLUSION: TSI was not thoroughly examined in Saudi Arabia; therefore, this study is considered the first to be done in the Kingdom using a representative sample. The fact that non-Saudi patients had a higher proportion of falls as a mechanism of injury should be taken into consideration in terms of raising awareness and taking more safety precautions, as most construction workers tend to be expatriates.

Open Fracture of the Acromion: An Isolated Injury with Oblique-Type Fracture.

Open acromial fractures are a rare set of fractures. We report a case of Gustilo IIIA open acromial fracture (14A2 as per OTA scapular fracture classification) that was isolated from any other injury. Our patient had a good recovery and showed excellent clinical outcome after irrigation and screw fixation of the acromial fracture. We also reviewed the literature for other cases of open acromial fracture.