Management of six episodes of intraoperative cardiac arrests in an infant with traumatic bronchial rupture: A case report.

RATIONALE: Traumatic bronchial rupture in infants usually necessitates surgical intervention, with few reports documenting instances of multiple cardiac arrests occurring during surgery under conditions of severe hypoxemia. PATIENT CONCERNS: A 3-year-old boy after trauma presented with severe hypoxemia for 2 days and was urgently transferred to the operating room for surgery, 6 episodes of cardiac arrest happend during surgery. DIAGNOSES: The baby was diagnosed with bronchial rupture based on the history of trauma, clinica manifestations, and intraoperative findings. INTERVENTIONS: Intrathoracic cardiac compression and intravenous adrenaline were administrated. OUTCOMES: The normal sinus rhythm of the heart was successfully restored within 1 minute on each occasion, facilitating the smooth completion of the surgical procedure. By the end of surgery, SpO2 levels had rebounded to 95% and remained stable. LESSONS: Inadequate management of bronchial ruptures in infants frequently coincides with severe hypoxemia, necessitating immediate surgical intervention. Prompt identification and management of cardiac arrest by anesthetists during surgery is imperative to reduce mortality.

The anteromedial retinaculum in ACL-injured knees: An overlooked injury?

PURPOSE: The purpose of this study was to retrospectively analyse the pattern of injury to the medial knee structures in anterior cruciate ligament (ACL) injured patients. It was hypothesised that anteromedial injuries would be more common than posteromedial lesions. METHODS: One hundred and twenty subjects aged 18-25 years with a primary ACL injury were included. Patients were excluded if the time between injury and magnetic resonance imaging (MRI) was more than 28 days or if a knee dislocation or fracture was present. The MRIs were analysed with particular emphasis on injuries to the medial knee structures, menisci and bone bruise patterns. Injuries to the ligaments and anteromedial retinaculum (AMR) were graded according to severity, ranging from periligamentous oedema (grade I), partial fibre disruption of less or more than 50% (grade IIa or IIb) to complete tears (grade III). RESULTS: AMR injury was seen in 87 subjects (72.5%) on the coronal plane and in 88 (73.3%) on the axial plane, with grade III lesions observed in 27 (22.5%) and 29 knees (24.2%). Injuries to the superficial medial collateral ligament (sMCL), deep MCL (dMCL) and posterior oblique ligament (POL) were detected in 60 patients (50%), 93 patients (77.5%) and 38 patients (31.6%). However, grade III injuries to the POL were observed in only seven knees (5.8%). Medial meniscus injuries were associated with lesions of the sMCL and AMR (p < 0.05), while lateral meniscus injuries were significantly more common in patients with dMCL rupture (p < 0.05). CONCLUSION: Data from this study suggest that injuries to the AMR are much more common than posteromedial lesions in subjects with ACL injuries. LEVEL OF EVIDENCE: Level IV.

Spontaneous rupture of bladder diverticulum with pseudo renal failure:A case report and literature review.

BACKGROUND: Spontaneous or non-traumatic bladder rupture is rare but can be life-threatening. Bladder rupture caused by a diverticulum is extremely rare, with only a few case reports in medical literature. CASE PRESENTATION: We report the case of a 32-year-old woman admitted to hospital complaints of abdominal pain, oliguria and ascites with no history of trauma. Laboratory tests revealed an elevated serum urea nitrogen(UN) level of 33.5 mmol/l and an elevated creatinine levels of 528 umol/l. X-ray cystography confirmed the rupture of a bladder diverticulum. Subsequent transurethral catheterization led to a prompt increase in urinary output, and serum creatinine level returned to 40 umol/l within 48 h. The patient was successfully treated with laparoscopic diverticulectomy. CONCLUSION: Clinicians should maintain a high level of suspicion for urinary bladder rupture in cases presenting with acute lower abdominal pain, urinary difficulties, and oliguria. When acute renal failure, complicated ascites, and an elevated peritoneal fluid creatinine or potassium level exceeding serum levels are observed, intraperitoneal urine leakage should be suspected without delay. This case emphasizes the importance of early diagnosis and intervention in managing this rare but serious condition.

Clinical outcomes of traumatic globe rupture in corneal graft patients.

PURPOSE: This study reports the mechanisms, complications and graft survival following sight-threatening traumatic globe rupture in patients having previously undergone corneal transplantation in the same eye. METHODS: A retrospective, observational, single-center consecutive cohort study at the Royal Victoria Infirmary, Newcastle upon Tyne, UK over a 20-year period. Medical records and Newcastle Corneal Transplantation Service electronic database (eNCTS) review was undertaken of all consecutive patients who underwent corneal transplantation with a history of traumatic globe rupture. Main outcome measures include mechanism of injury, final best-corrected distance visual acuity (BCDVA), graft survival and complications. RESULTS: A total of 921 keratoplasties were undertaken between 1997 and 2017 with 24 (3.0%) patients identified with a history of traumatic globe rupture. A bimodal relationship of age and mechanism of trauma was observed. The mean age (SD) of individuals reporting cause as a fall was 71.5 (14.8) years, and 45.3 (20.8) years (P < 0.05) amongst individuals reporting accidental trauma or assault. The pre- and post-trauma mean (SD) LogMAR BCDVA was 0.6 (0.9) and 1.7 (1.0), respectively (P = 0.001). The overall graft-failure rate was 60.9% (11 grafts) during a mean (SD) follow-up period of 3.5 (4.1) years. Globe rupture with lens damage was associated with poorer final BCDVA (P < 0.05). CONCLUSIONS: This study represents the first published series from England for this type of patient cohort. Overall visual outcomes were poor with a bimodal relationship of age and mechanism of trauma. Worse prognostic factors included lens and posterior segment complications. Re-grafting in these select group of patients may prove valuable.

An uncommon and easily overlooked case: Delayed intraperitoneal bladder rupture following blunt trauma: A case report and review of the literature.

INTRODUCTION: Delayed intraperitoneal bladder rupture is a rare clinical occurrence, frequently overlooked and misdiagnosed due to its nonspecific clinical manifestations. However, literature provides only a limited number of cases reporting delayed intraperitoneal bladder rupture resulting from blunt abdominal injury. PATIENT CONCERNS: A 72-year-old female pedestrian was struck by a vehicle and experienced sudden, severe abdominal pain on the 8th day following the injury. Abdominal B-ultrasound revealed a significant accumulation of peritoneal effusion. The abdominal puncture retrieved serosanguinous ascites. Then the patient was promptly transferred to our hospital. Upon transfer, the physical examination revealed the patient vital signs to be stable, accompanied by mild abdominal distension, slight tenderness, tension, and an absence of rebound tenderness. Urinalysis detected microscopic hematuria, while contrast-enhanced computed tomography (CT) revealed considerable fluid accumulation in the abdominal cavity, without evidence of solid organ damage, and the bladder was adequately filled. DIAGNOSIS: The diagnosis of delayed intraperitoneal bladder rupture primarily relied on intraoperative observations. INTERVENTIONS: An emergency exploratory laparotomy was performed, revealing a linear rupture at the dome of the bladder. Subsequently, the bladder rupture was repaired. OUTCOMES: Postoperative cystography demonstrated full recovery and the patient was discharged 28 days post-surgery. The postoperative recovery was uneventful without any complications. CONCLUSIONS: A well-distended bladder observed in CT does not definitively rule out the potential for bladder injury. False negatives may occur due to incomplete bladder filling during CT cystography. Retrograde cystography can identify cases missed by CT cystography. In cases of substantial intra-abdominal free fluid, surgical intervention should be actively considered for patients with blunt abdominal trauma without concurrent solid organ damage.

Late presentation of traumatic tricuspid valve chordal rupture and pericardial rupture with cardiac herniation: a case report.

BACKGROUND: Although chest trauma happens very often, accompanying tricuspid valve injuries occur rarely and may be manifested by scarce symptoms and signs. Pericardial rupture with cardiac herniation is even a bigger rarity. Transthoracic echocardiography plays a key role in the diagnosis of valve injuries but is of limited value in cardiac herniation. CASE PRESENTATION: We present the case of 58-year-old man who experienced severe chest trauma in a car accident. Symptoms of right heart failure occurred 10 years after the injury, due to the loss of tricuspid leaflet support caused by the rupture of tendinous chords with significant tricuspid regurgitation. Intraoperatively, old posttraumatic pericardial rupture into left pleura was also found, with partial cardiac herniation and pressure of the edge of pericardium on all left-sided coronary arteries simultaneously. The patient was successfully operated and is free of symptoms 4 years later. CONCLUSIONS: This case emphasizes the importance of timely diagnosis and underlines a mechanism that leads to delayed rupture of the tricuspid valve apparatus. Repeated echocardiography in all patients who experienced chest trauma could be of great importance. Also, given the limited value of echocardiography in posttraumatic pericardial rupture and cardiac herniation, cardiac computed tomography should be performed.

Male adolescent with cardiac rupture after blunt thoracic trauma.

Blunt cardiac injury, including a rupture of the atria or ventricle, is most commonly caused by motor vehicle collisions and falls from great heights. A rupture of a cardiac chamber is an extremely rare diagnosis with a high mortality rate. The best chance at survival can only be accomplished with timely intervention.To raise awareness of this potentially life-threatening injury, we describe the case of a male adolescent with cardiac rupture after blunt thoracic trauma. While the focused assessment with sonography in trauma (FAST) examination was negative, an additional CT showed pericardial effusion. During the operation a rupture of the right ventricle was observed.Even though the physical recovery of our patient is remarkable, the traumatic event still affects his mental well-being and activities in daily life. This case emphasises the need of a multidisciplinary approach to achieve the best possible physical and psychological recovery in multitrauma patients.

Rare case of haemoperitoneum secondary to a ruptured ovarian ectopic pregnancy superimposed by a bleeding corpus luteum cyst.

An adolescent female presented with an acute abdomen and elevated beta-human chorionic gonadotropin levels and underwent a laparoscopy for a suspected ruptured ectopic pregnancy. Intraoperatively, a ruptured haemorrhagic corpus luteal cyst and tissues suggestive of products of conception were noted in the same ovary. Histology confirmed an ovarian ectopic pregnancy. Haemorrhagic ovarian cysts, and ectopic pregnancies, can cause acute pelvic pain in women of childbearing age. Their similar clinical signs and symptoms pose a diagnostic dilemma for any gynaecologist. Ruptured corpus luteal cysts, as well as ruptured ovarian ectopic pregnancies, should be considered rare but differential diagnoses in women presenting with acute abdominal pain, an adnexal mass and ultrasound features of haemoperitoneum. The mainstay of treatment is a diagnostic laparoscopy, which is a safe and feasible management strategy without compromising patient safety or ovarian function in the long run.

Coronary microevaginations characterize culprit plaques and their inflammatory microenvironment in a subtype of acute coronary syndrome with intact fibrous cap: results from the prospective translational OPTICO-ACS study.

AIMS: Coronary microevaginations (CMEs) represent an outward bulge of coronary plaques and have been introduced as a sign of adverse vascular remodelling following coronary device implantation. However, their role in atherosclerosis and plaque destabilization in the absence of coronary intervention is unknown. This study aimed to investigate CME as a novel feature of plaque vulnerability and to characterize its associated inflammatory cell-vessel-wall interactions. METHODS AND RESULTS: A total of 557 patients from the translational OPTICO-ACS study programme underwent optical coherence tomography imaging of the culprit vessel and simultaneous immunophenotyping of the culprit lesion (CL). Two hundred and fifty-eight CLs had a ruptured fibrous cap (RFC) and one hundred had intact fibrous cap (IFC) acute coronary syndrome (ACS) as an underlying pathophysiology. CMEs were significantly more frequent in CL when compared with non-CL (25 vs. 4%, P < 0.001) and were more frequently observed in lesions with IFC-ACS when compared with RFC-ACS (55.0 vs. 12.7%, P < 0.001). CMEs were particularly prevalent in IFC-ACS-causing CLs independent of a coronary bifurcation (IFC-ICB) when compared with IFC-ACS with an association to a coronary bifurcation (IFC-ACB, 65.4 vs. 43.7%, P = 0.030). CME emerged as the strongest independent predictor of IFC-ICB (relative risk 3.36, 95% confidence interval 1.67-6.76, P = 0.001) by multivariable regression analysis. IFC-ICB demonstrated an enrichment of monocytes in both culprit blood analysis (culprit ratio: 1.1 ± 0.2 vs. 0.9 ± 0.2, P = 0.048) and aspirated culprit thrombi (326 ± 162 vs. 96 ± 87 cells/mm2, P = 0.017), while IFC-ACB confirmed the accumulation of CD4+ T cells, as recently described. CONCLUSION: This study provides novel evidence for a pathophysiological involvement of CME in the development of IFC-ACS and provides first evidence for a distinct pathophysiological pathway for IFC-ICB, driven by CME-derived flow disturbances and inflammatory activation involving the innate immune system. TRIAL REGISTRATION: Registration of the study at clinicalTrials.gov (NCT03129503).

Acute patellar dislocation: how skeletal maturity affects patterns of injury.

OBJECTIVE: The main objective of this study was to understand the role of skeletal maturity in the different patterns of osteochondral and ligamentous injuries after an acute lateral patellar dislocation. MATERIALS AND METHODS: Two radiologists independently reviewed MRIs of 212 knees performed after an acute lateral patellar dislocation to evaluate the presence of high-grade patellar osteochondral injury, femoral osteochondral injury, and medial patellofemoral ligament injury. The association of skeletal maturity (indicated by a closed distal femoral physis), age, sex, and first-time versus recurrent dislocation with each of these various lesions was analyzed using Chi-square or T test, and multivariable logistic regression with estimation of odds ratios (OR). RESULTS: Skeletal maturity was significantly associated with high-grade patellar osteochondral injury [OR=2.72 (95% CI 1.00, 7.36); p=0.049] and femoral-side MPFL tear [OR=2.34 (95% CI 1.05, 5.25); p=0.039]. Skeletal immaturity was significantly associated with patellar-side MPFL tear [OR=0.35 (95% CI 0.14, 0.90); p=0.029]. CONCLUSION: Patterns of injury to the patella and medial patellofemoral ligament vary notably between the skeletally immature and mature, and these variations may be explained by the inherent weakness of the patellar secondary physis.

Fall-related ocular trauma in patients over 90 years in tertiary ophthalmic center in Germany: 90-TOSG Report 1.

PURPOSE: To investigate the clinical characteristics of fall-related ocular trauma in patients over 90 years of age. METHODS: Retrospective, medical record reviews. Patients over the age of 90 years treated in a tertiary center with fall-related ocular trauma were included in the study. RESULTS: Fifty consecutive patients (fifty eyes) were analyzed. The mean age was 93.6 ± 1.8 years and 41 patients (82%) were female. The most common site of the injuries was orbital fracture (18 patients, 36%), accompanied with open globe rupture (OGR) in three patients, and globe contusion in two patients. Seventeen patients (34%) presented with OGR. Ocular trauma score in those patients was category 1 in 10 patients (58.8%) and category 2 in the others. Conjunctival hemorrhage and/or periocular contusion was seen in 14 patients (28%) and globe contusion in six patients (12%). At the presentation, the mean best corrected visual acuity (BCVA) was 2.82 ± 0.24 logMAR in patients with OGR and 1.98 ± 0.81 logMAR in six patients with globe contusion. Three of the patients with OGR had a final vision of 20/200 or better whereas the remaining patients had hand movements or less. The most common risk factors were female gender (82%) and use of antihypertensive drugs (46%). CONCLUSION: Patients with OGR had a poor visual outcome despite the early treatment. It is important to raise public awareness about of the poor prognosis of ocular injuries due to falls in the elderly population in order to establish preventive measures.

[Treatment of acute injury of the anterior cruciate ligament : Always only reconstruction?] / Behandlung der akuten Verletzung des vorderen Kreuzbands : Immer nur Rekonstruktion?

The aim of treatment of a ruptured anterior cruciate ligament (ACL) is the return of the patient to an acceptable level of activity without giving way phenomena as well as adequate treatment of prognostically relevant concomitant lesions. The treatment of acute ACL ruptures can be either early reconstruction or a primary physiotherapy with optional later reconstruction. Which path is taken depends on possible concomitant injuries that require early surgical intervention (e.g., repairable meniscal injury or distal rupture of the medial collateral ligament) and on patient-specific factors (age, level of activity). Isolated ruptures of the ACL can also be primarily treated without surgery. Then the injured knee joint should first be so far conditioned by rehabilitative measures that pain, swelling and posttraumatic restriction of movement are improved and neuromuscular training can be started. A screening test consisting of jumping tests, patient-reported outcome measures and the testing for giving way phenomena can be suitable to differentiate compensators (copers) from noncompensators (non-copers). Surgical reconstruction of the ACL should be recommended to non-compensators in the sense of participatory decision-making. Activity modification (adapter) can also be considered as a treatment strategy. If instability events (giving way) or secondary meniscal lesions occur during nonsurgical therapy, cruciate ligament reconstruction should be considered.

MRI of patellar stabilizers: Anatomic visibility, inter-reader reliability, and intra-reader reproducibility of primary and secondary ligament anatomy.

OBJECTIVE: To compare MRI features of medial and lateral patellar stabilizers in patients with and without patellar instability. METHODS: Retrospective study of 196 patients (mean age, 33.1 ± 18.5 years; 119 women) after diagnosis of patellar instability (cohort-1, acute patellar dislocation; cohort-2, chronic patellar maltracking) or no patellar instability (cohort-3, acute ACL rupture; cohort-4, chronic medial meniscus tear). On MRI, four medial and four lateral stabilizers were evaluated for visibility and injury by three readers independently. Inter- and intra-reader agreement was determined. RESULTS: Medial and lateral patellofemoral ligaments (MPFL and LPFL) were mostly or fully visualized in all cases (100%). Of the secondary patellar stabilizers, the medial patellotibial ligament was mostly or fully visualized in 166 cases (84.7%). Other secondary stabilizers were mostly or fully visualized in only a minority of cases (range, 0.5-32.1%). Injury scores for all four medial stabilizers were higher in patients with acute patellar dislocation than the other 3 cohorts (p < .05). Visibility inter- and intra-reader agreement was good for medial stabilizers (κ 0.61-0.78) and moderate-to-good for lateral stabilizers (κ 0.40-0.72). Injury inter- and intra-reader agreement was moderate-to-excellent for medial stabilizers (κ 0.43-0.90) and poor-to-moderate for lateral stabilizers (κ 0-0.50). CONCLUSION: The MPFL and LPFL were well visualized on MRI while the secondary stabilizers were less frequently visualized. The secondary stabilizers were more frequently visualized medially than laterally, and patellotibial ligaments were more frequently visualized compared to the other secondary stabilizers. Injury to the medial stabilizers was more common with acute patellar dislocation than with chronic patellar maltracking or other knee injuries.

Pseudoparesis and pseudoparalysis in the setting of massive irreparable rotator cuff tear: demographic, anatomic, and radiographic risk factors.

BACKGROUND: The primary purpose of this study was to identify demographic, anatomic, and radiographic risk factors for active forward elevation (AFE) <90° in the setting of massive, irreparable rotator cuff tear (miRCT). The secondary purpose was to identify characteristics differentiating between patients with pseudoparalysis (AFE <45°) and pseudoparesis (AFE >45° but <90°). METHODS: This was a retrospective case-control study reviewing patients with miRCTs at a single institution between January 12, 2016 and November 26, 2020. Patients were separated into 2 cohorts based on presence or absence of preoperative AFE <90° with maintained passive range of motion. Demographics, RCT pattern, and radiographic parameters were assessed as risk factors for AFE <90°. A secondary analysis was conducted to compare patients with pseudoparalysis and pseudoparesis. RESULTS: There were 79 patients in the AFE <90° cohort and 50 patients in the control cohort. Univariate analysis confirmed significant differences between the AFE <90° and control cohort in age (71.9 ± 11.0 vs. 65.9 ± 9.1 years), arthritis severity (34.2% vs. 16.0% grade 3 Samilson-Prieto), acromiohumeral distance (AHD; 4.8 ± 2.7 vs. 7.6 ± 2.6 mm), fatty infiltration of the supraspinatus (3.3 ± 0.9 vs. 2.8 ± 0.8) and subscapularis (2.0 ± 1.2 vs. 1.5 ± 1.0), and proportion of subscapularis tears (55.7% vs. 34.0%). On multivariate analysis, age (odds ratio [OR] 1.08, P = .014), decreased AHD (OR 0.67, P < .001), severe arthritis (OR 2.84, P = .041), and subscapularis tear (OR 6.29, P = .015) were independent factors predictive of AFE <90°. Secondary analysis revealed tobacco use (OR 3.54, P = .026) and grade 4 fatty infiltration of the supraspinatus (OR 2.22, P = .015) and subscapularis (OR 3.12, P = .042) as significant predictors for pseudoparalysis compared to pseudoparesis. CONCLUSIONS: In patients with miRCT, increased age, decreased AHD, severe arthritis, and subscapularis tear are associated with AFE <90°. Furthermore, patients with AFE <90° tend to have greater supraspinatus and subscapularis fatty infiltration. Lastly, among patients with AFE <90°, tobacco use and grade 4 fatty infiltration of the supraspinatus and subscapularis are associated with pseudoparalysis compared with pseudoparesis.

[Extensor pollicis longus rupture in a pediatric patient: case report and a literature review]. / Rotura del extensor pollicis longus en paciente pediátrico: reporte de caso y revisión de la literatura.

INTRODUCTION: the rupture of the extensor pollicis longus (EPL) tendon is a rare pathology and usually occurs in adult women in relation to distal radius fractures. MATERIAL AND METHODS: we present the case of an adolescent female patient who, after conservative treatment with splinting of a Peterson type I physeal fracture of the radius, suffered an acute extension deficit of the thumb at six weeks, diagnosed with clinical radiological examination as spontaneous rupture of the extensor pollicis longus (EPL). She was treated with extensor pollicis indicis propius (EIP) transfer with satisfactory results and recovering her usual activity one month after surgery. CONCLUSION: this kind of injuries are infrequent in pediatric ages and rarely described in a pediatric patient with immature skeleton, what makes this case something exceptional. It is necessary considering these complications in patients of low ages even with no other risk factors. The most frequent treatment applied in adults as in children is the EIP transference with good results in the long term.

INTRODUCCIÓN: la rotura del tendón extensor pollicis longus (EPL) constituye una patología infrecuente y se presenta normalmente en mujeres adultas en relación con fracturas de radio distal. MATERIAL Y MÉTODOS: se presenta el caso de una paciente adolescente femenino que, tras tratamiento conservador con férula de una fractura fisaria Peterson tipo I en radio, sufre a las seis semanas déficit agudo de extensión del pulgar, diagnosticada mediante examen clínico radiológico de rotura espontánea del extensor pollicis longus. Es tratada por medio de transferencia del extensor propio del índice (EPI) con resultados satisfactorios y recuperación de su actividad habitual al mes postoperatorio. CONCLUSIÓN: este tipo de lesiones son poco frecuentes en edad pediátrica y casi nunca descritas en un paciente pediátrico con inmadurez esquelética, lo cual hace de este caso algo excepcional. Es necesario tener en cuenta este tipo de complicaciones en pacientes de baja edad aún sin otros factores de riesgo asociados. El tratamiento aplicado más frecuentemente, tanto en adultos como en niños, es la transferencia del extensor propio del índice con buenos resultados a largo plazo.

Simultaneous Bilateral Quadriceps Tendon Rupture Secondary to Parathyroid Carcinoma: A Case Report.

Simultaneous bilateral quadriceps tendon ruptures are a rare occurrence commonly associated with a traumatic event or systemic disease. A 31-year-old man presented with simultaneous bilateral quadriceps tendon ruptures with associated hyperparathyroidism secondary to parathyroid carcinoma. The injury occurred after the patient attempted to lift a small wooden log from the ground. We discussed the multidisciplinary management of this patient resulting in bilateral quadriceps tendon repairs, tumor resection, and oncological and endocrinological restoration. Clinical follow-up is reported at 15 years after surgery. Parathyroid carcinoma is an extremely rare cancer and rarely the cause of hyperparathyroidism. The systemic effects of the tumor eventually lead to the rupturing of both quadriceps tendons. Orthopaedic physicians must remain vigilant in identifying the root cause of injuries that are atypical in nature.

Spontaneous rupture of the extensor pollicis longus tendon after conservative treatment of a non-displaced distal radius fracture in an adolescent.

A spontaneous rupture of the extensor pollicis longus (EPL) tendon after a fracture of the distal radius is a known complication in adults. In contrast, there are a paucity of reports concerning EPL tendon ruptures in children and adolescents. The authors present a case of a spontaneous rupture of the EPL tendon in a 15-year-old girl after a non-displaced distal radius fracture. The patient had no predisposing factors including rheumatoid arthritis or steroid injection. During surgery, the EPL tendon was found to be ruptured at the extensor retinaculum (third compartment). Extensor indicis proprius (EIP) to EPL transfer was performed. At the 18-month follow-up, the patient was asymptomatic and showed satisfactory thumb function, with normal active extension.

La rotura espontánea del tendón del extensor largo del pulgar (EPL) tras una fractura distal del radio es una complicación conocida en adultos. En cambio, son escasos los informes sobre roturas del tendón del EPL en niños y adolescentes. Los autores presentan un caso de rotura espontánea del tendón del EPL en una niña de 15 años tras una fractura distal del radio no desplazada. La paciente no presentaba factores predisponentes como artritis reumatoide o inyección de esteroides. Durante la intervención quirúrgica, se descubrió que el tendón del EPL estaba roto a la altura del retináculo extensor (tercer compartimento). Se realizó una transferencia del extensor indicis proprius (EIP) al EPL. A los 18 meses de seguimiento, el paciente estaba asintomático y mostraba una función satisfactoria del pulgar, con una extensión activa normal.

Does glenoid bone loss accompany posterior shoulder instability with only labral tear? A magnetic resonance imaging-based study.

BACKGROUND: The primary aim of this study was to investigate bone loss in the glenoid with magnetic resonance imaging in posterior shoulder instability with only a labral tear. METHODS: A total of 76 patients operated on because of posterior and anteroposterior shoulder instability only with a labral tear between 2006 and 2019 (n = 40 and n = 36, respectively) were included in this study. The instability type, a presence of an additional superior labrum anteroposterior (SLAP) lesion, the number of dislocations, and the magnetic resonance imaging-based measurements (the glenoid diameter and the bone defect size in the glenoid, the Hill-Sachs lesion [HSL] and the reverse HSL [rHSL] length, the angle and the arc length of HSL and rHSL, and the humerus head diameter and its area) were analyzed. RESULTS: The size of the anterior glenoid defect, the rHSL measurements (length, angle, and arc length), and the ratio of the anterior glenoid defect size to the glenoid diameter were significantly higher for anteroposterior instability (P < .01) cases. There was no significant difference (P = .49, .64, and .82, respectively) for the presence of an additional SLAP pathology, the glenoid diameter, the posterior glenoid defect, and the ratio of the posterior glenoid defect size to the glenoid diameter in posterior and anteroposterior instability groups. The increased number of dislocations was associated with increased rHSL length and total arc length (P = .04 and .03, respectively). An additional SLAP lesion in posterior shoulder instabilities was not associated with the bone defect size (P = .29). CONCLUSION: Although the posterior shoulder instability with only a labral tear is likely to cause a bone defect, we have shown that the instability is not expected to be caused by the bone defect. Therefore, this study points out that only soft tissue repair without considering the bone defect could be promising in this patient group.

Delayed rupture of traumatic anterior cerebral artery A4 segment aneurysm: A case report.

RATIONALE: Delayed rupture of traumatic intracranial aneurysms is relatively rare, and traumatic anterior A4 segment aneurysms may be associated with trauma to the cerebral falx. The mortality rate in patients with delayed traumatic rupture of intracranial aneurysms is>50%. Therefore, early diagnosis and treatment are critical. Herein, we present a case of a patient who did not have an intracranial aneurysm on computed tomographic angiography (CTA) after admission. Subsequently, the patient consciousness deteriorated, and CTA revealed aneurysm and bleeding. PATIENT CONCERNS: A 55-year-old man fell from a 3-meter-high truck and was unconscious. During the following few hours, the gradually regained consciousness. No intracranial aneurysms were found on CTA of the patient head immediately after admission. DIAGNOSES: The final diagnosis was delayed rupture of traumatic intracranial aneurysms. INTERVENTIONS: The patient underwent endovascular and symptomatic treatments. OUTCOMES: The patient gradually recovered and was referred to the rehabilitation department for further treatment. LESSONS: Considering the catastrophic consequences of the disease, we should review CTA or digital subtraction angiography many times after admission, and take appropriate surgical procedures in time.

Right-sided luxation of the heart caused by blunt traumatic pericardial rupture.

Cardiac luxation is a rare condition in cases of blunt thoracic trauma, yet it is quite fatal. We present a case of a 28-year-old man, admitted to the emergency room after a motorcycle accident in a hemodynamically unstable condition and radiographic presentation of multiple rib fractures, bilateral pneumothorax, pneumomediastinum, and significant dislocation of the heart to the right. After performing emergency bilateral tube thoracostomy and achieving hemodynamic stability, a CT scan was performed and the patient was diagnosed with pericardial rupture with right-sided luxation of the heart. An emergency sternotomy was performed with repositioning of the heart and pericardial reconstruction. In the postoperative period, suspicion of myocardial infarction was ruled out and the patient was discharged with persistent traumatic monoplegia of the left upper limb and Claude Bernard-Horner syndrome. An analysis of this very rare type of chest trauma has been made and the probable mechanism for its occurrence has been discussed.