Multiple back fractures as a result of the first seizure.

Non-traumatic fractures due to seizures are an overlooked diagnostic group. It is well known that patients with generalized tonic-clonic seizures have an increased trauma risk. However, the cause of fracture is rarely due to the violent forces of muscle contractions. Usually, the primary patient examination focuses on the aetiology of the seizure, which sometimes delays the diagnosis of fractures. This is a case report of a 19-year-old woman who sustained three compression fractures of the thoracic spine due to a generalized tonic-clonic seizure, and a discussion of the diagnostic challenges in such a rare case.

[Surgical Stabilization of Traumatic Multiple Rib Fractures Using Absorbable Osteosynthesis Agent(u-HA/PLLA Composite Material)].

In case that met several indication criteria with 4 or more rib fractures, we performed surgical stabilization of multiple fractured ribs using a plate and screw system( Super FIXORB MX) that was made of uncalcined hydroxyapatite (u-HA)/poly-L-lactic acid (PLLA) composite material with excellent bioactivity and absorbability. We report our clinical experience of 7 cases in which this device was used. Although there is still room for further consideration of the technique and the strength of the device itself, computed tomography( CT) images taken 9 months after surgery showed that the fixative device was almost assimilated with the bone at the fracture repair site in cases where fixation was successful.

[The Surgical Indication of Multiple Rib Fractures of Patients by Traumas and Timing of the Surgical Stabilization of Rib Fractures].

It's reported that 10% of the inpatients by traumas have fractured ribs. It's easy to judge if it's the case of flail chest, or respiratory failure due to airway injury or pulmonary contusion. There is no guideline for treatments of a patient who has multiple ribs fractures without respiratory failure. We did the surgical stabilization of rib fractures for 10 cases from 2020 to October 2023. As a result, we find out useful surgical indication for treatment of rib fractures.

Treatment of Multiple Coronal Fractures in the Proximal Carpal Row with a Dorsal Distraction Bridge Plate: A Case Report.

Lunate coronal fracture is a rare injury, associated with impact along the capitate and lunate axis; neutralization of this axial force is important for satisfactory patient outcomes. This report presents a case of a 51-year-old man with a lunate coronal fracture associated with coronal fractures in the proximal carpal bones and volar and proximal dislocation of the distal carpal row. Open reduction and internal fixation with a dorsal distraction bridge plate were performed. Solid bony union was achieved at the fracture site and the patient resumed full activities without difficulty. Use of distraction bridge plate fixation can support treating this type of injury, in particular, in cases where the lunate fracture is difficult to treat with conventional osteosynthesis techniques; the presented approach provides good short-term results.

Wall Falls: Blunt Trauma Sustained from Border Wall Crossings.

ABSTRACT: The border wall between the United States and Mexico consists of stretches of metal fencing of varying heights alternating and overlapping with areas of electronic surveillance. Despite national conversations centered around the social, environmental, economic, and political implications of this wall, there is a paucity of studies on deaths occurring in this region. Herein are described 2 cases of fatal injuries sustained from scaling the fence and accidentally falling onto the United States' side in New Mexico. These injuries are compared with those typically incurred in falls from lower and higher heights, and implications of both lateral and vertical expansion of the wall are discussed.

Retrosternal hematoma in sternal fracture for prediction of concomitant injury on chest CT.

BACKGROUND: Isolated sternal fracture, a benign injury, has been increasing in the pan-scan era, although one-third of patients with sternal fracture still has trouble with concomitant injury. The differentiation of these two entities is important to optimize patient management. PURPOSE: To evaluate correlation between retrosternal hematoma and concomitant injury in patients with sternal fracture and to identify predicting factors for concomitant injury in sternal fracture. MATERIAL AND METHODS: A total of 139 patients (84 men; mean age = 54.9 ± 15.3 years) with traumatic sternal fracture were enrolled in this study. We reviewed medical charts and multiplanar computed tomography (CT) images to evaluate cause, location, and degree of sternal fracture, retrosternal hematoma, and concomitant injury. Univariate and multivariate analysis were used to identify variables that were associated with concomitant injury. RESULTS: Concomitant injury on chest CT was observed in 85 patients with sternal fracture. Of the patients, 98 (70.5%) were accompanied by retrosternal hematoma. Multivariate analysis revealed that retrosternal hematoma (odds ratio [OR] = 5.350; P < 0.001), manubrium fracture (OR = 6.848; P = 0.015), and motor vehicle accident (OR = 0.342; P = 0.015) were significantly associated with sternal fracture with concomitant injury. CONCLUSION: Manubrium fracture and retrosternal hematoma portend a high risk of concomitant injury and indicate the need for further clinical and radiologic work-up.

Percutaneous bridge plating of extra-articular distal fibular fracture for the management of distal tibia type III open fracture.

PURPOSE: The aim of this study is to conduct clinical and radiographic evaluations of the use of percutaneous bridge plating for distal fibular fractures combined with distal tibia type III open fractures. METHODS: Thirty-four patients with acute distal third fibular shaft fractures (4F2A(c) and 4F2B(c) according to the AO/OTA classification) combined with distal tibia type III open fractures were enrolled. Concurrent fibular fractures were fixed with the percutaneous bridge plating simultaneously, while distal tibia open fractures were temporally stabilized with a spanning external fixator. Clinical and radiographic outcomes were evaluated using the Lower Extremity Functional Scale (LEFS), the proportional length difference of the fibula, the talocrural angle, the union rate of the fibula and tibia, the operation time, and complications at the final follow-up. RESULTS: All fibular fractures healed with an average bone healing time of 20.7 ± 6.3 weeks (range, 16-35). The mean proportional length difference was 0.492 ± 0.732% compared with that in the uninjured fibula. The functional assessment result according to the LEFS was 74.0 ± 3.70 points (range, 57-80). No cases of fibula fracture infection developed throughout the follow-up period in any of the patients. Iatrogenic postoperative superficial peroneal nerve injury was not found in any of the patients. CONCLUSION: With the perspective of minimizing soft tissue problems due to high-energy trauma, the application of percutaneous bridge plating for the treatment of distal fibular fractures can be an alternative to conventional treatment methods.

Multiple Fractures of Cervical Vertebrae Combined with Arcuate Foramen and Vertebral Artery Occlusion: A Case Report and Literature Review.

BACKGROUND: The arcuate foramen is a complete or partial bony bridge over the vertebral artery groove of atlas. The mechanism of the arcuate foramen is not clearly understood. Omission of the arcuate foramen sometimes causes lethal iatrogenic injury during spinal surgery. CASE PRESENTATION: We describe a patient who was diagnosed with multiple fractures of the cervical vertebrae, arcuate foramen, and right vertebral artery occlusion based on clinical and radiological exams. After conservative treatment, he resumed a normal and productive life. CONCLUSIONS: Arcuate foramen is a common variation that causes symptoms such as dizziness, headache, and migraine. If the patient does not develop severe symptoms, conservative treatment can achieve very good results without the necessity to remove the bone bridge. When serious symptoms occur, surgical treatment to resect the bony ridges can relieve the symptoms dramatically.

Safety and Efficacy of Multilevel Thoracolumbar Vertebroplasty in the Simultaneous Treatment of Six or More Pathologic Compression Fractures.

PURPOSE: To assess the safety and efficacy of multilevel thoracolumbar vertebroplasty in the simultaneous treatment of ≥ 6 painful pathologic compression fractures. MATERIALS AND METHODS: Retrospective review was conducted of 50 consecutive patients treated with vertebroplasty for ≥ 6 pathologic compression fractures in a single session for pain palliation at a tertiary single cancer center from 2015 to 2019. Outcomes measured included procedural safety according to Common Terminology Criteria for Adverse Events (CTCAE), change in 4-week postprocedure back pain by numeric rating scale (NRS), comparison of daily opioid medication consumption, and development of skeletal-related events. RESULTS: A total of 397 pathologic compression fractures were treated during 50 sessions (mean, 7.9 per patient ± 1.5). Mean procedure duration was 162 minutes ± 35, mean postoperative hospitalization duration was 1.6 days ± 0.9, and mean follow-up duration was 401 days ± 297. Seven complications were recorded, including 1 case of symptomatic polymethyl methacrylate pulmonary embolism. No major complications (CTCAE grade 4/5) were reported. NRS pain score was significantly decreased (5.0 ± 1.8 vs 1.7 ± 1.4; P < .0001), with a mean score decrease of 3.3 points (66%). Opioid agent use decreased significantly (76 mg/24 h ± 42 vs 45 mg/24 h ± 37; P = .0003), with a mean decrease of 30 mg/24 h (39%). Skeletal-related events occurred in 7 patients (14%). CONCLUSIONS: Multilevel vertebroplasty for ≥ 6 pathologic compression fractures is safe and provides significant palliative benefit when performed simultaneously.

A patient with severe polytrauma with massive pulmonary contusion and hemorrhage successfully treated with multiple treatment modalities: a case report.

BACKGROUND: The mortality rate is very high for patients with severe multiple trauma with massive pulmonary contusion containing intrapulmonary hemorrhage. Multiple treatment modalities are needed not only for a prevention of cardiac arrest and quick hemostasis against multiple injuries, but also for recovery of oxygenation to save the patient's life. CASE PRESENTATION: A 48-year-old Japanese woman fell down stairs that had a height of approximately 4 m. An X-ray showed pneumothorax, pulmonary contusion in her right lung, and an unstable pelvic fracture. A chest drain was inserted and preperitoneal pelvic packing was performed to control bleeding, performing resuscitative endovascular balloon occlusion of the aorta. A computed tomography scan revealed massive lung contusion in the lower lobe of her right lung, pelvic fractures, and multiple fractures and hematoma in other areas. An emergency thoracotomy was performed, and then we performed wide wedge resection of the injured lung, clamping proximal to suture lines with two Satinsky blood vessel clamps. The vessel clamps were left in the right thoracic cavity. The other hemorrhagic areas were embolized by transcatheter arterial embolization. However, since her respiratory functions deteriorated in the intensive care unit, veno-venous extracorporeal membrane oxygenation was used for lung assist. Planned reoperation under veno-venous extracorporeal membrane oxygenation was performed on day 2. Since her respiratory condition improved gradually, the veno-venous extracorporeal membrane oxygenation circuit was withdrawn on day 7. She was transferred to the psychiatric ward of our hospital on day 75. CONCLUSION: Utilizing multiple treatment modalities such as resuscitative endovascular balloon occlusion of the aorta, damage control surgery, transcatheter arterial embolization, and veno-venous extracorporeal membrane oxygenation with appropriate timing saves a patient with severe polytrauma with massive pulmonary contusion including intrapulmonary hemorrhage.

Pain Management for Traumatic Rib Fractures with ESP Block in ICU.

Rib fractures are common injuries in blunt chest trauma, that cause severe thoracic pain, which limits patients' ability to cough and breathe deeply, which can lead to atelectasis and pneumonia. Various treatments for pain management of rib fractures have been described such as analgesics and regional anaesthesia. The ultrasound-guided erector spinae plane block (ESP) is a novel myofascial plane block for thoracic analgesia after thoracic or abdomen surgery. It is simple to perform the block because the key landmarks of tip of transverse processes and erector spinae muscle are easily visualised on ultrasound. This also allows to treat patients more easily in intensive care unit (ICU). We present a case that used ESP for pain management related to traumatic multiple rib fractures and prevented pulmonary complications with ESP block in ICU.

Malposición del tubo endotraqueal en paciente con traumatismo facial / Malposition of the endotracheal tube in patient with facial trauma

No disponible

Improving the Diagnosis of Ipsilateral Femoral Neck and Shaft Fractures: A New Imaging Protocol.

BACKGROUND: Despite increased awareness of ipsilateral femoral neck fractures in patients with high-energy femoral shaft fractures and advanced imaging with thin-cut high-resolution computed tomography (CT), failure of diagnosis remains problematic. The purpose of the present study was to determine if the preoperative diagnosis of ipsilateral femoral neck fractures in patients with high-energy femoral shaft fractures can be improved with magnetic resonance imaging (MRI) compared with radiographic and CT imaging. METHODS: In response to delayed diagnoses of femoral neck fractures despite thin-cut high-resolution CT, our institutional imaging protocol for acute, high-energy femoral shaft fractures was altered to include rapid limited-sequence MRI to evaluate for occult femoral neck fractures. All patients received standard radiographic imaging as well as thin-cut high-resolution pelvic CT imaging upon presentation. Rapid limited-sequence MRI of the pelvis was obtained to evaluate for an occult femoral neck fracture. RESULTS: Thirty-seven consecutive patients with 39 acute, high-energy femoral shaft fractures resulting from blunt trauma were included. The average age of the patients was 29.1 years (range, 14 to 82 years). Ten (25.6%) of the 39 femoral shaft fractures were open. Two femoral shaft fractures (5.1%) were associated with ipsilateral femoral neck fractures that were detected on radiographs, and no MRI was performed. None of the remaining 37 femoral shaft fractures were associated with a femoral neck fracture that was identified on CT imaging. Thirty-three (89.2%) of 37 patients underwent pelvic MRI to evaluate the ipsilateral femoral neck. Four (12.1%) of those 33 patients were diagnosed with a femoral neck fracture (2 complete, 2 incomplete) that was not identified on thin-cut high-resolution CT or radiographic imaging. CONCLUSIONS: Rapid limited-sequence MRI of the pelvis for patients with femoral shaft fractures identified femoral neck fractures that were not diagnosed on thin-cut high-resolution CT in 12% of our patients. Our results suggest that the frequency of femoral neck fractures may be underrepresented on CT imaging; rapid limited-sequence MRI was feasible without delaying definitive treatment even in polytraumatized patients. LEVEL OF EVIDENCE: Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Concurrent Ipsilateral Tibial Shaft and Distal Tibial Fractures in Pediatric Patients: Risk Factors, Frequency, and Risk of Missed Diagnosis.

BACKGROUND: The purpose of this study was to determine the frequency of concurrent ipsilateral distal tibial fractures with tibial shaft fractures in the pediatric population; to identify patient and fracture characteristics that increase the likelihood of a concurrent fracture; and determine if any of these concurrent distal tibial fractures were missed on initial radiographic examination. METHODS: Retrospective chart review was done to identify patients 5 to 17 years old who were treated for a tibial shaft fracture at a large, Level 1 free-standing children's hospital and an outpatient orthopaedic practice between 2008 and 2016. Patient and fracture characteristics were recorded. RESULTS: Of 517 fractures (515 patients), 22 (4.3%) had concurrent ipsilateral distal tibial fractures: 11 triplane, 5 medial malleolar, 3 bimalleolar, and 2 Tillaux (Salter-Harris III) ankle fractures, and 1 Salter-Harris II distal tibial fracture. Age was the only patient characteristic significantly associated with a second, more distal fracture: patients with both fractures were older (12.7 y) than those with an isolated tibial shaft fracture (11 y). There was no difference in the rate of distal tibial fractures between high-energy and low-energy mechanisms of injury and no differences in the rate of open injuries or the presence of a fibular fracture. Patients with a tibial shaft fracture at the junction of the middle and distal thirds were significantly more likely to have a concurrent distal tibial fracture; oblique and spiral fracture patterns were more frequent in the group with concurrent distal tibial fractures than in the isolated tibial shaft fracture group. CONCLUSIONS: In our series, 36% of the concurrent distal tibial fractures were not diagnosed until chart review for this study, which suggests the need for ankle-specific imaging in certain patients. We recommend ankle-specific imaging when an oblique or spiral tibial shaft fracture is located at the junction of the middle and distal thirds of the tibia or in patients in whom a distal tibial fracture is suspected because of pain, swelling, or bruising. LEVEL OF EVIDENCE: Level III-retrospective comparative study.

Management of ocular dystopia and lacrimal pathway obstruction in old multiple midfacial fractures: Case report.

Midfacial fracture is discontinuity of the bone affect maxilla, palate, zygomatico-maxillary complex, nasal bones, orbits, nasal-orbital-ethmoid complex, and frontal sinus. Delayed treatment can lead to malunion or nonunion bone. A 28 years old man presented with epiphora of the left eye and upgaze diplopia. There were enophthalmos, hypoglobus of the left eye, flat nasal bridge, and depressed left malar eminence. CT scan examination revealed multiple fractures of left nasal bone, left and right anterolateral wall of maxillary sinuses, left medial orbital wall and orbital floor, and left zygomatic bone. Lacrimal irrigation test showed obstruction of left nasolacrimal duct. He underwent osteotomy and fixation with plate and screw, orbital floor reconstruction with silicone block implant, external dacryocystorhinostomy with silicone tube insertion procedure. In delayed treated malunion of midfacial fracture, fixation with plate and screw after refracture using an osteotome and orbital floor reconstruction with silicone block can be a good option for restoring normal anatomy. External dacryocystorhinostomy with silicone tube insertion is an effective treatment for post traumatic nasolacrimal duct obstruction.

Analysis of the advantages of 3D printing in the surgical treatment of multiple rib fractures: 5 cases report.

BACKGROUND: Rib fractures account for a fairly high proportion of chest injuries, ranging from 55 to 80%. The most common mechanisms of injury include: traffic accident, extrusion and falls from significant heights. Besides, the surgical treatment of multiple rib fractures has been accepted by more and more medical professionals. We reported 5 clinical cases of patients with multiple rib fractures undergoing open reduction and internal fixation using 3D printing technology. CASE PRESENTATION: Retrospective analysis of 5 clinical cases of multiple rib fractures from January 2017 to August 2018 in our hospital. A preoperative CT thin slice scan was used to reconstruct the 3D model according to the scanning results, and 3D printing technology was adopted to prepare the rib model. Preoperative reconstruction of the rib's normal shape and lock plate for the shaped ribs was created according to reconstructed model. For multiple fractures especially patients with severely deformed rib shape, it is suggested to intraoperative shape directly to the metal bone plate fixed on the ribs on both ends of the fracture line, in order to establish a basic support frame. The other various fracture section can be fixed on the lock plate respectively. Postoperative chest radiographs of the 5 patients showed that the internal fixations were in good and natural shape. The thoracic contour was well formed and symmetrically with the contralateral side. CONCLUSION: Making the rib model and the pre-shaped titanium alloy rib locking plate using 3D printing technology, provided a more minimally invasive and precisely individualized treatment for some rib fracture operations.

The Reamer-Irrigator-Aspirator in Nonunion Surgery.

The reamer-irrigator-aspirator (RIA) autograft provides large volumes of autogenous graft that exhibit excellent osteogenic, osteoinductive, and osteoconductive properties. These features, combined with the relative ease of graft harvest and low donor site morbidity when compared with the gold standard iliac crest bone graft (ICBG), have made RIA autograft a viable alternative to ICBG. Some suggest RIA autograft is superior to ICBG, particularly in the setting of large segmental bone defects managed with the induced membrane technique. Although significant complications such as fracture and cortical perforation have been reported, they are preventable if proper surgical strategy and tactics are used.

Comparison of the Effectiveness of Surgical Versus Nonsurgical Treatment for Multiple Rib Fractures Accompanied with Pulmonary Contusion.

OBJECTIVE: To compare the effectiveness of surgical versus nonsurgical treatment for multiple rib fractures accompanied with pulmonary contusion. METHODS: The clinical records of consecutive 167 patients with multiple rib fractures accompanied with pulmonary contusion, who were treated from June 2014 to June 2017, were retrospectively analyzed. Of them, 75 and 92 underwent surgery (surgery group) and non-surgical treatment (non-surgery group), respectively. Patient pain score, complications, length of hospital stay, cost of hospitalization, and post-treatment 3-month follow-up results were compared. RESULTS: The mean number of days and moderate pain in the surgery group was significantly lower than that of the non-surgery group (p <0.01). The incidence of post-treatment complications was significantly lower in the surgery group than in the non-surgery group. The length of hospital stay of the surgery group was also significantly shorter than that of the non-surgery group (p <0.01). The cost of hospitalization was significantly higher in the surgery group than in the non-surgery group (p <0.01). The chest computed tomography (CT) scan which was performed 3 months after the treatment revealed that the surgery group had a better recovery than the non-surgery group. Physical recovery of the surgery group was also significantly better than that of the non-surgery group. CONCLUSION: Surgery to treat multiple rib fractures (≥ 4 fractures) accompanied with pulmonary contusion is safe and effective.

Establishment of Classification of Tibial Plateau Fracture Associated with Proximal Fibular Fracture.

OBJECTIVE: The purpose of this retrospective study was to determine the incidence of fibular fractures as an associated injury in tibial plateau fractures according to CT scan. We also attempt to introduce a new morphological sub-classification on this associated injury and to analyze the correlation between this classification and tibial plateau fractures. METHODS: We selected cases with fibular fractures from all the tibial plateau fracture patients. The cases were further divided into 2 groups: unicondylar group and bicondylar group. On the basis of our new classification system of fibular fracture, all the included cases were divided into 5 subgroups. RESULTS: Finally, a total of 150 cases associated with fibular fractures in 502 tibial plateau fracture cases were identified from our institution database. The incidence of fibular head fracture in tibial plateau fractures was 29.88% (150/502). Seventy-one cases (47.3%) were involved one condyle, and 79 cases (52.7%) involved both. It shows significant difference in the subgroup of avulsion fracture with horizontal fracture line (Type A) which is ratio of 16.9% in unicondylar group and 1.27% in bicondylar group. CONCLUSION: A new classification of this associated injury describing the morphology of the fracture fragments may improve operative planning.