Cervical Fracture Dislocation

Cervical spine fractures resulting in a dislocation often occur with a high-energy trauma. Prompt and accurate diagnosis of a fracture can be obtained with a CT scan. Controversy exists as to whether closed reduction should be performed prior to obtaining an MRI due to concerns of traumatic disc herniation. Closed reduction of a fracture with a traumatic disc herniation can potentially worsen a neurologic deficit by creating more severe cord compression. Open or closed reduction of a cervical fracture should be followed by internal fixation. Anterior, posterior, or circumferential fixation should be instituted on a case-by-case basis. Postoperative care in an intensive care unit includes maintaining adequate mean arterial pressure for spinal cord perfusion, and monitoring for signs of neurogenic shock.

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Magnetic resonance imaging documentation of coexistent traumatic locked facets of the cervical spine and disc herniation

Journal of Neurosurgery ◽

10.3171/jns.1993.79.3.0341 ◽

1993 ◽

Vol 79 (3) ◽

pp. 341-345 ◽

Cited By ~ 94

Author(s):

Stephen E. Doran ◽

Stephen M. Papadopoulos ◽

Thomas B. Ducker ◽

Kevin O. Lillehei

Keyword(s):

Cervical Spine ◽

Magnetic Resonance ◽

Mr Imaging ◽

Disc Herniation ◽

Closed Reduction ◽

Clinical Status ◽

Cord Compression ◽

Herniated Disc ◽

Content Type ◽

Fine Print

✓ The coexistence of traumatic locked facets of the cervical spine and a herniated disc is not well described. The authors present a series of patients with traumatic locked facets who demonstrated a high incidence of associated disc herniation documented on magnetic resonance (MR) imaging. Thirteen patients with either unilateral (four cases) or bilateral (nine cases) locked facets of the cervical spine were analyzed retrospectively. Immediate closed reduction using traction and/or manipulation was attempted in the first nine cases treated and was successful in only three; however, the procedure was abandoned in three cases due to deterioration in the patient's clinical status. In the subsequent four patients, an MR image was obtained prior to attempts at closed reduction. All patients underwent MR imaging of the cervical spine. Of eight consecutive cases treated at the University of Michigan, frank disc herniation with fragmented disc in the canal was found in five while pathological disc bulging was found in the other three. All five cases contributed by other institutions had concurrent disc herniation. This series illustrates the importance of using MR imaging to document the presence of a herniated disc during the initial evaluation of a patient with traumatic locked facets of the cervical spine and prior to attempted reduction of the locked facets. Experience indicates that closed reduction of facet dislocation associated with disc rupture may result in increased spinal cord compression and neurological deficit. If a herniated disc is discovered. anterior discectomy and fusion would be favored as the initial therapy over attempts at closed reduction or operative posterior reduction.

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Case Study: Trans-styloid, Trans-scaphoid, Trans-triquetral, and Perilunate Dislocation

Journal of Orthopaedic Case Reports ◽

10.13107/jocr.2021.v11.i06.2260 ◽

2021 ◽

Vol 11 (6) ◽

Author(s):

Nicholas Frane ◽

Peter Regala ◽

Brandon Klein ◽

Joshua Mitgang ◽

Gus Katsigiorgis

Keyword(s):

Carpal Tunnel ◽

Closed Reduction ◽

Early Recognition ◽

Case Reports ◽

High Energy ◽

Fracture Dislocation ◽

Dominant Male ◽

Chronic Instability ◽

Perilunate Dislocation ◽

Ligamentous Repair

Introduction: Perilunate dislocations are rare high-energy injuries, and the diagnosis is not infrequently missed at initial presentation. The combination of fractures resulting in a trans-styloid, trans-scaphoid, and trans-triquetral perilunate fracture dislocation is extremely rare. Early recognition and diagnosis of these injuries is prudent to restore patient function and prevent morbidity. This injury pattern may progress through several distinct phases often involving the greater or lesser arc. The injury begins with traumatic disruption of the scapholunate joint, followed by an ordered progression of injury to the capitolunate, lunotriquetral, and radiolunate joints. When the radiolunate joint is disrupted, the lunate often dislocates volar transposing into the carpal tunnel, associated with median nerve compression. These injuries have the potential to cause lifelong disability of the wrist. Early treatment may prevent or lessen the chance of median neuropathy, post-traumatic wrist arthrosis, chronic instability, and fracture nonunion. Non-operative treatment is not indicated and is associated with poor functional outcomes and recurrent dislocation. Open reduction and internal fixation (ORIF) with ligamentous repair after emergent closed reduction and splinting is indicated for acute injuries (<8 weeks after injury). Case Report: We report a case of a 48-year-old right hand dominant male with a trans-styloid, trans-scaphoid, trans-triquetral, and perilunate dislocation after mechanical fall from height. He was evaluated in the ER and provisionally treated with closed reduction and splinting. ORIF of scaphoid, radial styloid, and triquetrum was performed, with ligamentous repair of the scapholunate joint and carpal tunnel decompression. Conclusion: The combination of fractures/injuries in this case has been very rarely been published in case reports to date. It is necessary to recognize these wrist injuries. Great detail should be given to physical and radiog

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Should Closed Reduction Be Attempted in The Emergency Department for An Acute Anterior Shoulder Fracture Dislocation?

JSES International ◽

10.1016/j.jseint.2020.09.014 ◽

2020 ◽

Author(s):

Wei Yuan ◽

Ivan Tjun Huat Chua

Keyword(s):

Emergency Department ◽

Closed Reduction ◽

Fracture Dislocation ◽

Shoulder Fracture

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Open anterolateral fracture dislocation of ankle joint: a rare case report

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20185347 ◽

2018 ◽

Vol 5 (1) ◽

pp. 192

Author(s):

Prasanna Anaberu ◽

R. Prathik ◽

R. Manish

Keyword(s):

Ankle Joint ◽

Fracture Fixation ◽

Road Traffic ◽

Emergency Operation ◽

High Energy ◽

Fracture Dislocation ◽

Anterior Dislocation ◽

Malleolar Fracture ◽

Rare Injury ◽

Wound Debridement

<p class="abstract">Anterior ankle dislocation with associated compound bi-malleolar fracture is a rare injury. Ankle fracture dislocations most frequently occurs in young males caused by high energy trauma. The direction of the joint dislocation is determined by the position of the foot and the direction of the force being applied. A middle aged male presented to us with history of road traffic accident and was diagnosed to have anterior dislocation of right ankle joint with compound bi-malleolar fracture. Patient was taken to emergency operation theatre for wound debridement and immediate ankle reduction done under sedation. Due to wound contamination fracture fixation was delayed, once the wound healed bi-malleolar fracture fixation was done.</p>

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Sleep Apnea and Unilateral Upper and Lower Extremity Allodynia as a Result of a Large Thoracic Disc Herniation: A Case Report

10.21203/rs.3.rs-233683/v1 ◽

2021 ◽

Author(s):

Tyler D. Alexander ◽

Anthony Stefanelli ◽

Sara Thalheimer ◽

Joshua E. Heller

Keyword(s):

Spinal Cord ◽

Sleep Apnea ◽

Sexual Dysfunction ◽

Lower Extremity ◽

Disc Herniation ◽

Cord Compression ◽

Thoracic Disc Herniation ◽

Lower Extremity Weakness ◽

Disc Herniations ◽

Thoracic Disc

Abstract BackgroundClinically significant disc herniations in the thoracic spine are rare accounting for approximately 1% of all disc herniations. In patients with significant spinal cord compression, presenting symptoms typically include ambulatory dysfunction, lower extremity weakness, lower extremity sensory changes, as well as bowl, bladder, or sexual dysfunction. Thoracic disc herniations can also present with thoracic radiculopathy including midback pain and radiating pain wrapping around the chest or abdomen. The association between thoracic disc herniation with cord compression and sleep apnea is not well described.Case PresentationThe following is a case of a young male patient with high grade spinal cord compression at T7-8, as a result of a large thoracic disc herniation. The patient presented with complaints of upper and lower extremity unilateral allodynia and sleep apnea. Diagnosis was only made once the patient manifested more common symptoms of thoracic stenosis including left lower extremity weakness and sexual dysfunction. Following decompression and fusion the patient’s allodynia and sleep apnea quickly resolved.ConclusionsThoracic disc herniations can present atypically with sleep apnea – a symptom which may resolve with surgical treatment.

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Myofacial Release for the Management of Cervical Compressive Myelopathy – Case Study

10.47363/jjcmr/2021(1)105 ◽

2021 ◽

Vol 1 (2) ◽

pp. 1-5

Author(s):

Patitapaban Mohanty ◽

Keyword(s):

Soft Tissue ◽

Disc Herniation ◽

Cord Compression ◽

Surgical Decompression ◽

Cervical Cord ◽

Myofascial Release ◽

Cervical Compressive Myelopathy ◽

Compressive Myelopathy

Cervical compressive myelopathy commonly occurs due to degeneration or disc herniation. The persons with cervical meylopathy are usually advised for surgical decompression. Person with signs of cervical cord compression was treated with myofacial release and found to be improved in signs as well as the symptoms. Total 34 numbers of similar cases (31 males and 3 females) age ranging from 25 to 61 years were treated by myofascial release of periscapular soft tissue structures over last 2 & ½ years (2017 to 2020) and found to return back to their activities after 6 months of follow up.

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Delayed Peroneal Neuropathy After Bosworth Fracture Dislocation of the Ankle

Journal of the American Podiatric Medical Association ◽

10.7547/20-013 ◽

2021 ◽

Vol 111 (4) ◽

Author(s):

Sung Hoon Choi ◽

Jeong Min Hur ◽

Kyu-Tae Hwang

Keyword(s):

Soft Tissue ◽

Internal Fixation ◽

Closed Reduction ◽

Open Reduction ◽

Fracture Dislocation ◽

Tibial Tubercle ◽

Proximal Fragment ◽

Rare Injury ◽

Soft Tissue Swelling ◽

Severe Soft Tissue

The Bosworth ankle fracture-dislocation is a rare injury and is often irreducible because of an entrapped proximal fragment of the fibula behind the posterior tibial tubercle. Repeated closed reduction or delayed open reduction may result in several complications. Thus, early open reduction and internal fixation enable a better outcome by minimizing soft-tissue damage. We report on a 27-year-old man who underwent open reduction and internal fixation after multiple attempts at failed closed reduction, complicated by severe soft-tissue swelling, rhabdomyolysis, and delayed peroneal nerve palsy around the ankle.

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Evaluation of results of three and four-part fracture dislocations of proximal humerus in young adults using philos (proximal humerus internal locking system)

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20180303 ◽

2018 ◽

Vol 6 (2) ◽

pp. 585

Author(s):

Amit Thakur ◽

Khalid Muzzafar ◽

Sumeet Singh Charak ◽

Bias Dev ◽

Abdul Ghani

Keyword(s):

Proximal Humerus ◽

Young Patients ◽

Soft Tissue Injuries ◽

Functional Results ◽

High Energy ◽

High Rate ◽

Fracture Dislocation ◽

Rotator Cuff Insufficiency ◽

Fracture Dislocations ◽

Adequate Management

Background: The fractures of proximal humerus constitute about 5% of fractures in adults third in number to fracture colles and hip usually in elderly patients due to a low energy trauma. In young patients the fractures are mostly due to high energy trauma and as such are associate with other soft tissue injuries. A sub group of young patients have a three or four fracture dislocation of shoulder joint. The aim of this study was to find the results of fixation by PHILOS in these young patients.Methods: This study was done in a teritiary referral centre over a period of about 1 year. All patients were operated within three weeks. Open fractures, patients with age more than 50 years were excluded from the study. All patients underwent open reduction and fixation using commercially available PHILOS. A minimum of 6 months follows up was essential for inclusion into the study. Final functional results were evaluated by Constant Murley scoring.Results: 14 patients were included in the study. The average age of patients was 38.42years. All fractures united. We had 71.4% excellent or good results. The complications noted were shoulder stiffness in 3, inadequate post op reduction, rotator cuff insufficiency, head necrosis, secondary osteo arthritis 1 each.Conclusions: Despite the relatively high rate of complications encountered in the management of these complicated high-energy fractures, the PHILOS plating system could be considered an adequate management of these patients.

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