Missed lateral end clavicle fracture in adolescent patients: The value of undertaking additional clavicle radiographic views.

Clavicle fractures are extremely common, accounting for 5%-10% of all pediatric fractures. Due to the increased radiation dose, additional radiographic views are less frequently performed, particularly in skeletally immature patients. In Trauma and Orthopedic practice, it is well known that 2 radiographic views are essential for any fracture assessment, with additional views such as oblique views for selected cases. Oblique views are recommended, especially for extremity trauma as this has shown to reduce the incidence of missed diagnoses. Although 2 views of the clavicle, A-P and 45° cephalic tilt are recommended, it is the usual practice in most radiology departments to undertake A-P view of clavicle only. We report a case of a lateral end displaced clavicle fracture in a 16-year-old sustained following football injury. This was completely missed at the initial encounter and the patient later presented with pain and difficulty to move his right shoulder. We believe if this patient had a 45° cephalic tilt view at the time of presentation, the fracture would have been identified and appropriate treatment would have been instituted. Awareness of obtaining a minimum of 2 radiographic views for lateral clavicle fractures will reduce the incidence of missed clavicle fractures.

Distribution patterns of zoochlorellae and zooxanthellae hosted by two Pacific Northeast anemones, Anthopleura elegantissima and A. xanthogrammica.

This study investigated patterns in the relative abundance of two photosynthetic algal symbionts, zoochlorellae (ZC) and zooxanthellae (ZX), hosted by two temperate anemones, Anthopleura elegantissima and A. xanthogrammica. Previous studies have documented varying proportions of each symbiont along environmental gradients, presumably determined by their respective physiological capabilities. To test for differences in the algal type between the two host species, we sampled anemone tissues (tentacle or tentacle and body column) of similarly sized polyps that were located close together in multiple habitats: tidepools, crevices, underneath rock ledges, and along natural light gradients in caves. The ZC-A. elegantissima symbiosis was rare on the west coast of Vancouver Island, British Columbia, Canada. Even in low-irradiance habitats, ZC were the dominant algae hosted by A. xanthogrammica, while nearby A. elegantissima hosted ZX or was algae-free. As a first step in determining whether symbiont growth rates differed between the two host species, we quantified mitotic index (MI), the percentage of cells with division furrows, under artificial light and in the field by simultaneously sampling tentacles from both species. MI was more stable in A. elegantissima: the MI of ZX isolated from the tentacles of A. xanthogrammica was slightly higher at a light level of 80 micromol quanta m(-2) s(-1) than it was for ZX from A. elegantissima (respectively, 7.3 vs. 6.2) and relatively lower at 40 micromol quanta m(-2) s(-1) (3.9 vs. 5.6). Our data indicate host-specific differences in symbiont distributions and MI when extrinsic physical parameters were similar.