Hand compartment syndrome secondary to contrast media extravasation: A case report.

INTRODUCTION: Contrast media extravasation injury is a recognized complication of contrast media use. Compartmental syndrome of the hand secondary to contrast extravasation is exceptional. We describe a case of compartment syndrome of the hand secondary to contrast media extravasation. CASE PRESENTATION: We present a 47-year-old woman with a history of pulmonary embolism who was diagnosed of compartment syndrome of the left hand after injection of contrast medium during a CT scan. Whose first diagnosis was mild contrast medium extravasation injury 24 h before the compartment syndrome. Standard radiography showed an accumulation of contrast medium in the left hand. The patient underwent a fasciotomy and secondary healing. Follow-up showed good radiographic, clinical, and hand function after 2 months. DISCUSSION: The occurrence of hand compartment syndrome secondary to contrast media extravasation is rare. Most of the time, they are initially diagnosed as medium extravasation before the worsening of symptoms. Because of its unknown incidence, treatment is not codified. The goal of treatment is to save the limb and restore function. This can be achieved rapidly with early surgery because of the unpredictable course. CONCLUSION: Contrast media injection is not a harmless gesture. Hand compartment syndrome after contrast extravasation is rare and is a severe injury, our experience with this case suggests that early surgery helps save the limb and restore function. Always fear a compartmental syndrome in case of extravasation of contrast medium.

Treatment of obstetrical brachial plexus palsy sequelae: Preliminary results about 18 cases.

Background: Severe obstetrical injuries of the brachial plexus lead to a complete or incomplete paralysis resulting in a significant functional handicap of the limb.This study aimed to assess the preliminary results of our management. Materials and methods: This prospective study involved 18 patients, with an average age of 7.7 years. The choice of the surgical technique depended on the type of palsy. We evaluated our patients using the Mallet, Gilbert-Raimondi, Brachial plexus World Group Heerlen, and Raimondi scores. Results: Patients in groups I and II of Narakas had an anterior shoulder release (n = 2) and transfer of the latissimus dorsi (n = 8). For those in group III, we performed 5 biceps rerouting and 2 radius derotation osteotomies, one of which was associated with a Zancolli I and an arthrodesis of the thumb MCP joint. In the wrist and hand, we performed two tendon transfers from the flexor carpi ulnaris to the extensor tendons of the fingers.After a mean follow-up of 30.52 months, in the first 9 patients, active external rotation of the shoulder increased from a mean value of -22.5°-38.8° and mean active abduction from 78.3° to 141.1°. In Group III, the mean spontaneous supination position of 75.5° was improved to 45° pronation. Regarding the two patients with tendon transfers, active wrist extension increased from 0° to 45° and from -60° to 0°, respectively. Conclusion: Palliative surgery in the treatment obstetrical brachial plexus palsy sequelae retains an important place in the restoration of upper limb function.

Spinal Cord Injury Due to Cervical Disc Herniation without Bony Involvement Caused by Wrestling - A Case Report.

INTRODUCTION: Many cases of cervical spinal disc herniation caused by sporting injury have been reported. Those cases generally accompanied high-energy trauma such as fractures and/or dislocations. The purpose is to present the case of spinal cord injury (SCI) due to cervical disc herniation without bony involvement caused by wrestling. CASE REPORT: We report a case of a 23-year-old man who sustained a cervical SCI during the wrestling competition. He was quadriplegic with no sensory or motor function preserved in sacral segments S4-S5. Conventional radiographs and computed tomography did not reveal bony abnormalities. Magnetic resonance imaging (MRI) showed a free herniated cervical disc severely compressing the spinal cord from central at C3/4 level. He underwent anterior cervical discectomy and interbody fusion using autologous iliac crest bone graft and fixation with the cervical plate. He made an eventful recovery, and 5 years later, he was playing at high competitive level. CONCLUSION: Competitive wrestling-related injuries are quite high. Fortunately, the incidence of SCI among wrestlers is extremely low. Although rare, SCI due to cervical disc herniation without bony involvement is a serious debilitating injury that exerts a devastating effect on a wrestler from a physical, psychological, and socioeconomic point of view, and places an immense burden on society from a public health perspective. The MRI is the golden examination in diagnosing such lesion. The management comprises surgical decompression of neural elements, stabilization, and fusion to provide a higher recovery rate from cord damage to return to play. Wrestler who is completely pain free with full range of motion and strength may be eligible for return to play.

Early presentation of traumatic cervical disc herniation with neurologic deficit and without an adjacent bone lesion.

AIM OF THE STUDY: The purpose of this study was to explore clinical features and the operational opportunity of traumatic cervical disc herniation. METHOD: Patients with cervical spine injury (413) were retrospectively reviewed. Six patients with neurological deficits were identified to have disc herniation without adjacent bone lesion. The diagnosis was confirmed by MRI. The Japanese Orthopedic Association (JOA) score was used to assess the severity of clinical symptoms. Different grading systems have been used in analyzing various stages of herniated cervical discs. All patients underwent anterior cervical decompression, insertion of autologous iliac crest graft, and fixation with cervical plate. RESULTS: The causes of injury were road traffic accidents in four patients and sport and domestic accidents in one patient each. There were five patients with single intervertebral disc herniation and one patient with double. Pre-operative JOA score was 14 for three patients, the remaining three patients scored 10, 6, and 3 respectively. At final follow-up, the score was 17 for four patients and 14 for two patients. DISCUSSION: Traumatic cervical disc herniation with neurologic deficit and without adjacent bone lesion is a rare condition. MRI is the golden examination to confirm diagnosis. Early recognition is essential for appropriate therapy and to minimize the extent of neurological deficit. CONCLUSION: The MRI is mandatory in diagnosing different types of traumatic herniated cervical disc. Discectomy and anterior cervical interbody fusion using autologous iliac crest graft are the treatment options.

Treatment of pediatric multilevel cervical spine fractures in resource-limited settings: a case report.

AIM OF THE STUDY: The main purpose of this study was to highlight the therapeutic approach of pediatric multilevel noncontiguous cervical spine fractures in resource-limited settings. CASE PRESENTATION: We report the case of a 15-year-old teenager with C1, C2, C4, C6, and C7 fractures following fall from height treated with a modified external fixator. At final follow-up, he fully recovered neurologic functions with bone healing. CONCLUSION: The modified external fixator is a therapeutic modality for pediatric multilevel noncontiguous cervical spine fractures.

[Fracture-separation of the medial clavicular epiphysis: about 6 cases and review of the literature]. / Fracture-décollement de l'épiphyse médiale de la clavicule: à propos de 6 cas et revue de la littérature.

This study aims to describe the epidemiological characteristics and the different anatomo-clinical entities of the fracture-separation of the medial clavicular epiphysis but also to relate the morphological and functional results of bloody reduction followed by osteosuture using non absorbable thread. Five boys and one girl (mean age 14 years) showed a closed and isolated shoulder girdle trauma. Clinical examination and medical imaging, especially CT scan, allowed the diagnosis of epiphyseal separation and to classify the degree of medial clavicular epiphysiseal ossification indicating the direction of displacement as well as the nature of displacement according to the Salter-Harris classification. Bloody reduction followed by osteosuture using non absorbable thread (No. 1 decimal) was performed in 3 patients. One patient underwent cross-pinning the two younger patients were treated orthopedically. The displacement of the clavicle stump was anterior in 3 patients and retro-sternal in 3 patients. Posterior forms were complicated by odynophagia (n = 2) and asymptomatic compression of the subclavian vein (n = 1). One of the posterior forms was associated with an ipsilateral fracture of the medial one third of the clavicle. Consolidation was achieved in all patients with preservation of shoulder mobility. The fracture-separation of the medial end of the clavicle mimes clinically and radiologically the sternoclavicular dislocation. It can be serious because of the risk of visceral and vascular compression in its posterior form. Tomdensitometry is irreplaceable for an accurate diagnosis. Our preference is for bloody reduction followed by osteosuture using non metallic thread.