scholarly journals Isolated Scaphoid Dislocation: A Case Report and Review of the Literature

2020 ◽  
Vol 09 (05) ◽  
pp. 431-439
Author(s):  
Asgeir Amundsen ◽  
Sarah N. Bishop ◽  
Steven L. Moran
Keyword(s):  
Literature Review ◽  
Closed Reduction ◽  
English Language ◽  
Motor Vehicle ◽  
Rare Event ◽  
Common Mechanism ◽  
Type Ii ◽  
Vehicle Accidents ◽  
Wire Fixation ◽  
Ligamentous Reconstruction

Abstract Background Isolated scaphoid dislocation is an exceedingly rare event with only 55 cases described. Closed reduction followed by operative intervention with Kirschner's wires (K-wire) fixation and ligamentous reconstruction are the mainstays of treatment. Case Description We describe a patient with a solitary scaphoid dislocation treated with initial closed reduction and urgent open reduction with K-wire stabilization and ligamentous repair. The patient was immobilized for 6 weeks and on 24-month follow-up, the patient was doing well with no limitations in his daily living, no pain, and acceptable range of motion. Literature Review A literature review was performed on the 55 cases described in the English language. The majority of the patients were males, aged between 18 and 79 years, and presented with motor vehicle accidents as the most common mechanism. Historically, isolated scaphoid dislocations were treated with closed reduction. However, K-wire fixation and, now, K-wire fixation coupled with ligamentous injury repair remain the current treatments of choice. Avascular necrosis of the scaphoid remains a rare event with only one documented case. Overall, patients do well with only minor pain and limited wrist movements. Notably, only eight cases were associated with type-II lunates. Type-II lunates appear to be protective for carpal injury. Clinical Relevance Although isolated scaphoid dislocations remain a rare event, understanding the anatomy and the current ability to restore carpal anatomy is important. Type-II lunates appear to confer protection from carpal injuries.

Syncopal Episodes Associated with Cisapride and Concurrent Drugs

1998 ◽  
Vol 32 (6) ◽  
pp. 648-651 ◽  
Author(s):  
Vanessa Seals Gray
Keyword(s):  
English Language ◽  
Motor Vehicle ◽  
Concomitant Administration ◽  
Qt Prolongation ◽  
Azole Antifungals ◽  
Vehicle Accidents ◽  
Cardiac Dysrhythmias ◽  
Case Summary ◽  
First Case ◽  
Patients At Risk

OBJECTIVE: To report a case of QT prolongation and syncopal episodes resulting from concomitant use of cisapride and agents known to inhibit its metabolism. CASE SUMMARY: A 53-year-old white woman was involved in two motor vehicle accidents on the same day after experiencing syncopal episodes. Cardiac and neurologic evaluations were negative; the syncopal episodes were attributed to QT prolongation associated with the concomitant use of cisapride and agents known to inhibit its metabolism. DISCUSSION: This is the first case published in the English-language literature describing QT prolongation resulting from the concomitant use of cisapride and agents known to inhibit its metabolism. Clarithromycin inhibits CYP3A4, the isoenzyme responsible for the metabolism of cisapride. Concomitant administration of cisapride with agents known to inhibit CYP3A4 (i.e., azole antifungals, erythromycin, clarithromycin) may result in elevated cisapride concentrations. Elevated cisapride concentrations have been associated with QT prolongation, syncopal episodes, and cardiac dysrhythmias. CONCLUSIONS: Acquired QT prolongation is a well-recognized adverse effect of several drugs. Recognition of newer drugs and drug combinations that place patients at risk for this potentially fatal adverse event is imperative for appropriate monitoring and prevention.

The Treatment of Mason Type II Radial Head Fractures using Closed Reduction and K-wire Fixation

2004 ◽  
Vol 17 (3) ◽  
pp. 277
Author(s):  
Byung Ki Kwon ◽  
Song Lee ◽  
Dong Ki Ahn ◽  
Joon Seong Park ◽  
Sang Kyu Cha
Keyword(s):  
Radial Head ◽  
Closed Reduction ◽  
Type Ii ◽  
Radial Head Fractures ◽  
Wire Fixation

scholarly journals Renal trauma: the current best practice

2018 ◽  
Vol 10 (10) ◽  
pp. 295-303 ◽  
Author(s):  
Tomer Erlich ◽  
Noam D. Kitrey
Keyword(s):  
Renal Injury ◽  
Best Practice ◽  
Motor Vehicle ◽  
Penetrating Trauma ◽  
High Energy ◽  
Renal Trauma ◽  
Common Mechanism ◽  
Trauma Patients ◽  
Vehicle Accidents ◽  
Enhanced Computed Tomography

The kidneys are the most vulnerable genitourinary organ in trauma, as they are involved in up to 3.25% of trauma patients. The most common mechanism for renal injury is blunt trauma (predominantly by motor vehicle accidents and falls), while penetrating trauma (mainly caused by firearms and stab wound) comprise the rest. High-velocity weapons impose specifically problematic damage because of the high energy and collateral effect. The mainstay of renal trauma diagnosis is based on contrast-enhanced computed tomography (CT), which is indicated in all stable patients with gross hematuria and in patients presenting with microscopic hematuria and hypotension. Additionally, CT should be performed when the mechanism of injury or physical examination findings are suggestive of renal injury (e.g. rapid deceleration, rib fractures, flank ecchymosis, and every penetrating injury of the abdomen, flank or lower chest). Renal trauma management has evolved during the last decades, with a distinct evolution toward a nonoperative approach. The lion’s share of renal trauma patients are managed nonoperatively with careful monitoring, reimaging when there is any deterioration, and the use of minimally invasive procedures. These procedures include angioembolization in cases of active bleeding and endourological stenting in cases of urine extravasation.

Child Debriefing: A Review of the Evidence Base

2015 ◽  
Vol 30 (3) ◽  
pp. 306-315 ◽  
Author(s):  
Betty Pfefferbaum ◽  
Anne K. Jacobs ◽  
Pascal Nitiéma ◽  
George S. Everly
Keyword(s):  
Children And Adolescents ◽  
English Language ◽  
Motor Vehicle ◽  
Empirical Studies ◽  
Evidence Base ◽  
Bibliographic Databases ◽  
Publication Type ◽  
Vehicle Accidents ◽  
Lack Of Information ◽  
Randomized Design

AbstractIntroductionDebriefing, a controversial crisis intervention delivered in the early aftermath of a disaster, has not been well evaluated for use with children and adolescents. This report constitutes a review of the child debriefing evidence base.MethodsA systematic search of selected bibliographic databases (EBM Reviews, EMBASE, ERIC, Medline, Ovid, PILOTS, PubMed, and PsycINFO) was conducted in the spring of 2014 using search terms related to psychological debriefing. The search was limited to English language sources and studies of youth, aged 0 to 18 years. No time limit was placed on date of publication. The search yielded 713 references. Titles and abstracts were reviewed to select publications describing scientific studies and clinical reports. Reference sections of these publications, and of other literature known to the authors that was not generated by the search, were used to locate additional materials. Review of these materials generated 187 publications for more thorough examination; this assessment yielded a total of 91 references on debriefing in children and adolescents. Only 15 publications on debriefing in children and adolescents described empirical studies. Due to a lack of statistical analysis of effectiveness data with youth, and some articles describing the same study, only seven empirical studies described in nine papers were identified for analysis for this review. These studies were evaluated using criteria for assessment of methodological rigor in debriefing studies.ResultsChildren and adolescents included in the seven empirical debriefing studies were survivors of motor-vehicle accidents, a maritime disaster, hostage taking, war, or peer suicides. The nine papers describing the seven studies were characterized by inconsistency in describing the interventions and populations and by a lack of information on intervention fidelity. Few of the studies used randomized design or blinded assessment. The results described in the reviewed studies were mixed in regard to debriefing’s effect on posttraumatic stress, depression, anxiety, and other outcomes. Even in studies in which debriefing appeared promising, the research was compromised by potentially confounding interventions.ConclusionThe results highlight the small empirical evidence base for drawing conclusions about the use of debriefing with children and adolescents, and they call for further dialogue regarding challenges in evaluating debriefing and other crisis interventions in children.PfefferbaumB, JacobsAK, NitiémaP, EverlyGSJr.Child debriefing: a review of the evidence base. Prehosp Disaster Med. 2015;30(3):110.

scholarly journals Displaced supracondylar humeral fractures in children: Comparison of three treatment approaches

2016 ◽  
Vol 144 (1-2) ◽  
pp. 46-51 ◽  
Author(s):  
Sinisa Ducic ◽  
Marko Bumbasirevic ◽  
Vladimir Radlovic ◽  
Petar Nikic ◽  
Zoran Bukumiric ◽  
...  
Keyword(s):  
Closed Reduction ◽  
Open Reduction ◽  
Type Ii ◽  
Percutaneous Pinning ◽  
Cast Immobilisation ◽  
Fractures In Children ◽  
Supracondylar Humerus Fractures ◽  
Wire Fixation ◽  
Supracondylar Humeral Fractures ◽  
Humerus Fractures

Introduction. Closed reduction and percutaneous pinning are the most widely used treatment options for displaced supracondylar humerus fractures in children, but there is still no consensus concerning the most preferred technique in injuries of the extension type. Objective. The aim of this study was to compare three common orthopaedic procedures in the treatment of displaced extension type supracondylar humerus fractures in children. Methods. Total of 93 consecutive patients (66 boys and 27 girls) referred to our hospital with Gartland type II or III extension supracondylar humeral fractures were prospectively included in the study over a six-year period. At initial presentation 48 patients were classified as Gartland type II and 45 as Gartland type III fractures. The patients were subdivided into three groups based on the following treatment modality: closed reduction with percutaneous pinning, open reduction with Kirschner wires (K-wires) fixation, and closed reduction with cast immobilisation. The treatment outcome and clinical characteristics were compared among groups, as well as evaluated using Flynn?s criteria. Results. Excellent clinical outcome was reported in 70.3% of patients treated with closed reduction with percutaneous pinning and in 64.7% of patients treated with open reduction with K-wire fixation. The outcome was significantly worse in children treated with closed reduction and cast immobilisation alone, as excellent outcome is achieved in just 36.4% of cases (p=0.011). Conclusion. Closed reduction with percutaneous pinning is the method of choice in the treatment of displaced pediatric supracondylar humeral fracture, while open reduction with K-wire fixation is as a good alternative in cases with clear indications.

Diffuse Axonal Injury

Neurotrauma ◽  
2019 ◽  
pp. 63-72
Author(s):  
Hussein A. Zeineddine ◽  
Cole T. Lewis ◽  
Ryan S. Kitagawa
Keyword(s):  
Cerebral Perfusion ◽  
High Speed ◽  
Motor Vehicle ◽  
Axonal Injury ◽  
Diffuse Axonal Injury ◽  
Common Mechanism ◽  
White Matter Tract ◽  
Vehicle Accidents ◽  
Wide Range ◽  
Tract Damage

Diffuse axonal injury (DAI) is a type of traumatic brain injury (TBI) that results from a blunt head injury. In this particular subtype, accelerating-decelerating motions cause white matter tract damage and preferentially impact regions including the corpus callosum and brainstem. The neurological compromise therefore relates to the severity of the axonal insult. The most common mechanism for DAI is high-speed motor vehicle accidents, and the clinical presentation is typically out of proportion to the CT findings. As a result, MRI is the modality of choice. Currently, there are limited therapeutic options, and management is identical to other forms of TBI including intracranial pressure and cerebral perfusion pressure management. As this disease is heterogeneous, survivors have a wide range of functional outcomes.

scholarly journals Type II D Phalangeal Neck Fractures in Children: A Series of 20 Cases Treated According to a Preset Stepwise Algorithm

2020 ◽  
Author(s):  
Mohammad M. Al-Qattan ◽  
Saad A. Almohrij ◽  
Batool Alaskar ◽  
Turki S. Alhassan
Keyword(s):  
Closed Reduction ◽  
Demographic Data ◽  
P Value ◽  
Type Ii ◽  
Fracture Fragment ◽  
Fractures In Children ◽  
Wire Fixation ◽  
The Mean ◽  
Distal Fracture

Abstract Introduction Type II phalangeal neck fractures are defined as displaced fractures with bone-to-bone contact at the fracture site. In the type II D subtype, the distal fracture fragment is thin. A review of the literature did not reveal any study investigating the outcome of management of these fractures. Patients and Methods This is a retrospective study of 20 consecutive children with type II D phalangeal neck fractures treated over the past 4 years. Demographic data were reviewed. All cases were managed according to the preset stepwise algorithm. The outcome of management at final follow-up was documented using Al-Qattan’s grading system. Results The mean age was 30 months (range 12–80 months). There were 12 males and 8 females. The mean follow-up was 2 years (range 7 months to 3 years). The largest two categories within the management algorithm were patients with minimally displaced fractures treated conservatively (n = 8) and those with displaced fractures treated with closed reduction and percutaneous K-wire fixation (n = 9). Fischer exact test was used to compare the outcome in these two groups and the p value was significant (p = 0.015), indicating a significantly better outcome in the former group. Conclusion Several conclusions were made from the study. Type II D of phalangeal neck fractures tend to occur in young children and the majority involve the middle phalanx. The thinness of the distal fracture fragment makes standard techniques of closed reduction more difficult. However, flexion of the proximal and distal joints appears to be effective in reducing dorsally displaced type II D fractures by closed means. Finally, a more conservative approach to minimally displaced type II D fractures results in a better outcome compared with closed reduction and percutaneous K-wire fixation.

scholarly journals Bi-columnar fixation of displaced distal humeral metaphyseal fractures in children: functional outcome assessment of 100 fractures

2019 ◽  
Vol 5 (6) ◽  
pp. 1202
Author(s):  
Mohamad Gouse ◽  
Manoharan Muthulingam ◽  
Nandakumar Rangarajan
Keyword(s):  
Functional Outcome ◽  
Closed Reduction ◽  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
Early Mobilization ◽  
Functional Results ◽  
Type Ii ◽  
Supracondylar Fractures ◽  
Fractures In Children ◽  
Supracondylar Humerus Fractures

<p class="abstract"><strong>Background:</strong> Supracondylar fractures of the humerus are one of the commonest fractures encountered around the elbow in children. The treatment of these fractures continues to pose challenges even in this age of advancing orthopedics. These fractures have the propensity to go for malunion with cosmetic deformity. This study was done to evaluate the functional results of surgical management of supracondylar fractures of the humerus in children using closed reduction and percutaneous bi-columnar pinning technique.</p><p class="abstract"><strong>Methods:</strong> 100 patients with Gartlands type II, III and IV supracondylar humerus fractures were operated with closed reduction and pinning using K-wires. Patients were followed up at six weeks, twelve weeks and six months and final evaluation were done using the Mayo elbow performance score (MEPS).<strong></strong></p><p class="abstract"><strong>Results:</strong> In our study, there were 70 males and 30 female patients with mean age of 6.5 years. 85 cases were had fall on outstretched hand as mode of injury and rest following motor vehicle accident. Gartland type II fractures accounted for 10 cases; type III fractures accounts 88 cases and type IV was only 2 cases. Excellent to good results were seen in 80 cases as per the MEPS at 6 months follow-up.</p><p><strong>Conclusions:</strong> From our study, we could conclude that closed reduction and bi- column percutaneous pinning offers a reliable fixation which permits early mobilization and good functional outcome in displaced fractures. Increasing the number of wire will allow early mobilization and prevent stiffness. </p>

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