scholarly journals Closed management of displaced Type II odontoid fractures: more frequent respiratory compromise with posteriorly displaced fractures

2000 ◽  
Vol 8 (6) ◽  
pp. 1-3 ◽  
Author(s):  
Gregory J. Przybylski ◽  
James S. Harrop ◽  
Alexander R. Vaccaro
Keyword(s):  
Respiratory Failure ◽  
Closed Reduction ◽  
Nasotracheal Intubation ◽  
Treatment Method ◽  
Consecutive Series ◽  
Type Ii ◽  
Respiratory Compromise ◽  
Odontoid Fractures ◽  
Posterior Displacement ◽  
Closed Treatment

Object Acute respiratory failure has been observed in patients after external immobilization for displaced odontoid fractures. The authors studied the frequency of respiratory deterioration in the acute management of displaced Type II odontoid fractures to identify patients at risk for respiratory failure. Methods The authors conducted a retrospective review of a consecutive series of 89 patients with odontoid fractures who were treated over a 5-year period to identify 53 patients with displaced Type II odontoid fractures. Patient demographics, degree of displacement, respiratory status, treatment method, and outcome were examined. Of the 32 patients with posteriorly displaced fractures, 13 experienced acute respiratory compromise, whereas only one of 21 patients with anteriorly displaced fractures had respiratory difficulties (p = 0.0032). The average posterior displacement was 6.9 mm. All 13 were initially managed using flexion traction for reduction of these fractures. Two of these patients died because of failure to emergently secure an airway during closed treatment of the fracture. Conclusions Frequent respiratory deterioration during acute closed reduction of posteriorly displaced Type II odontoid fractures was observed, whereas respiratory failure in patients with anteriorly displaced fractures was rare. The use of the flexed cervical position in the setting of retropharyngeal edema rather than the direction of the displacement may substantially increase the risk of respiratory failure. This may prompt early elective nasotracheal intubation during closed reduction of posteriorly displaced Type II odontoid fractures that require a flexed posture.

A COMPARATIVE STUDY ON OPEN AND CLOSED TREATMENT OF EDENTULOUS MANDIBULAR FRACTURES.

2021 ◽  
pp. 66-67
Author(s):  
Pravish. V ◽  
Syed Khaja Hussain. A ◽  
Soumitran. C S ◽  
Johnson. A G
Keyword(s):  
Closed Reduction ◽  
Geriatric Patients ◽  
Treatment Method ◽  
Treatment Modalities ◽  
Mandibular Fractures ◽  
Elderly Persons ◽  
Radiographic Assessment ◽  
Postoperative Assessment ◽  
Closed Treatment ◽  
Suitable Technique

Background And Objectives: The loss of bone mass and decreased vascularity decreases the strength of mandible and makes it vulnerable to fracture. Elderly persons with atrophic mandible have less osteogenic capability and reduced blood ow, and may have a complex medical history, so that management of a fracture of the mandible may require special considerations. An ideal treatment for these mostly geriatric patients is absolutely essential. In this context this particular study is being undertaken to compare with the two available treatment modalities open and closed reduction and to do an analysis to nd out which one will be a suitable technique for treatment. Method: This study involved 30 patients with edentulous mandibular fractures in which 15 patients for open reduction and 15 patients for closed reduction were selected. All the patients selected for the study were followed up postoperatively for a minimum period of 6 months. Postoperative assessment for pain, swelling, mobility of fracture segment, signs of Infections and radiographic assessment of fracture ends were done on the rst, third and sixth month respectively. Result: Postoperative assessment for pain, swelling, mobility of fracture segment, signs of Infections and radiographic assessment of fracture ends were done on the rst, third and sixth month showed no signicant differences. The results and observations from the study suggest us that there was no signicant difference between both methods on fracture healing.

scholarly journals REDUCTION AND INTERNAL FIXATION OF COMPLEX FRACTURES OF THE ODONTOID BY THE TRANSORAL APPROACH

2018 ◽  
Vol 17 (4) ◽  
pp. 330-332
Author(s):  
Geraldo de Sá Carneiro ◽  
Deoclides Lima Bezerra Júnior ◽  
Juliano Rodrigues Chaves ◽  
Saul Cavalcanti de Medeiros Quinino ◽  
Aline Figueiras da Trindade
Keyword(s):  
Cord Compression ◽  
Transoral Approach ◽  
Odontoid Fracture ◽  
Type Ii ◽  
Segmental Mobility ◽  
Level Of Evidence ◽  
Odontoid Fractures ◽  
Posterior Displacement ◽  
Therapeutic Study ◽  
Transoral Decompression

ABSTRACT Type II odontoid fractures with irreducible posterior displacement are uncommon, and can cause spinal cord compression, respiratory failure and even death. Treatment is usually surgical, with transoral decompression and posterior fusion or with reduction and fusion of C1-C2 by the transoral approach. We describe a case of type II odontoid fracture with irreducible posterior atlantoaxial dislocation that was treated exclusively by the transoral approach with osteosynthesis of the odontoid, thus preserving functional segmental mobility. Level of Evidence III; therapeutic study.

scholarly journals Management and long-term outcome of type II acute odontoid fractures: a population-based consecutive series of 282 patients

2020 ◽  
Author(s):  
Syed Ali Mujtaba Rizvi ◽  
Eirik Helseth ◽  
Marianne Efskind Harr ◽  
Jalal Mirzamohammadi ◽  
Pål Rønning ◽  
...  
Keyword(s):  
Population Based ◽  
Consecutive Series ◽  
Type Ii ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Odontoid Fractures

Efficacy of anterior odontoid screw fixation in elderly patients with Type II odontoid fractures

2000 ◽  
Vol 8 (6) ◽  
pp. 1-4 ◽  
Author(s):  
James S. Harrop ◽  
Gregory J. Przybylski ◽  
Alexander R. Vaccaro ◽  
Kennedy Yalamanchili
Keyword(s):  
Elderly Patients ◽  
Screw Fixation ◽  
Demographic Data ◽  
Treatment Method ◽  
Outcome Data ◽  
High Risk Group ◽  
Type Ii ◽  
Halo Vest ◽  
Odontoid Fractures ◽  
Fusion Procedure

Object Type II odontoid fractures are the most common trauma-related dens fracture. Although Type III odontoid fractures have a high union rate when external immobilization is applied, Type II fractures are associated with high rates of nonunion, particularly in elderly patients and those with posteriorly displaced fractures or fractures displaced by more than 6 mm. Because elderly patients may not also tolerate external immobilization in a halo vest, alternative techniques should be explored to identify a method for managing these higher-risk patients. In this study the authors examine the efficacy of anterior odontoid screw fixation in a high-risk group of 10 elderly patients (> 65 years of age) treated for Type II odontoid fractures. Methods A retrospective review of all patients with Type II odontoid fractures treated at two institutions between September 1997 and March 2000 was performed. Demographic data, neurological examination, fracture type and degree of displacement, treatment method, and outcome data were examined at discharge. Ten patients older than 65 years who had sustained a trauma-related odontoid fracture and had undergone an anterior odontoid screw placement procedure were retrospectively reviewed. Fracture displacement (mean 6.6 mm) was observed in all but one patient, and in seven there were posteriorly displaced fractures. Seven were successfully treated with anterior screw fixation and external orthosis alone; in one patient in whom poor intraoperative screw purchase had been observed, the fracture healed after undergoing halo vest therapy. Only one patient was shown to develop a nonunion requiring a subsequent posterior fusion procedure. Conclusions Odontoid screw fixation can be safely performed in elderly patients, and frequent bone union is demonstrated. However, osteopenia may preclude adequate screw fixation in some patients.

scholarly journals Inferior Patella Dislocation due to Impaction in the Femoral Trochlea

2021 ◽  
pp. 89-92
Author(s):  
Ahmed Fadulelmola ◽  
Rob Gregory
Keyword(s):  
Closed Reduction ◽  
Early Mobilization ◽  
Patella Dislocation ◽  
Type Ii ◽  
Rare Presentation ◽  
Femoral Trochlea ◽  
Inferior Pole ◽  
Locked Knee ◽  
Inferior Dislocation ◽  
Superior Pole

Acute inferior dislocation of the patella is a rare presentation in trauma and orthopaedics. Type II is caused by direct upward force on the inferior pole of the patella when the knee is flexed impacting the superior pole osteophyte into the intercondylar notch. Impaction in the femoral trochlea is rarely reported. A 92-year-old lady presented with locked knee held in 85° of flexion with an abnormal knee contour. Radiographs demonstrated that the upper pole of the patella was impacted in the femoral trochlea with a fracture of a superior pole osteophyte. The extensor mechanism was intact. Closed reduction is achieved under strong opioid pain relief. The patient returned to her baseline knee function within 6 weeks. Closed reduction of an inferior patellar dislocation in elderly patients is aided by superior pole osteophyte fracture and facilitates early mobilization, and avoidance of general anaesthesia.

scholarly journals Respiratory Failure Due to Differentiation Arrest and Expansion of Alveolar Cells following Lung-Specific Loss of the Transcription Factor C/EBPα in Mice

2006 ◽  
Vol 26 (3) ◽  
pp. 1109-1123 ◽  
Author(s):  
Daniela S. Bassères ◽  
Elena Levantini ◽  
Hongbin Ji ◽  
Stefano Monti ◽  
Shannon Elf ◽  
...  
Keyword(s):  
Transcription Factor ◽  
Cell Differentiation ◽  
Respiratory Failure ◽  
Leucine Zipper ◽  
Type I ◽  
Type Ii ◽  
Alveolar Cells ◽  
Proliferating Cells ◽  
Therapeutic Benefits ◽  
Factor C

ABSTRACT The leucine zipper family transcription factor CCAAT enhancer binding protein alpha (C/EBPα) inhibits proliferation and promotes differentiation in various cell types. In this study, we show, using a lung-specific conditional mouse model of C/EBPα deletion, that loss of C/EBPα in the respiratory epithelium leads to respiratory failure at birth due to an arrest in the type II alveolar cell differentiation program. This differentiation arrest results in the lack of type I alveolar cells and differentiated surfactant-secreting type II alveolar cells. In addition to showing a block in type II cell differentiation, the neonatal lungs display increased numbers of proliferating cells and decreased numbers of apoptotic cells, leading to epithelial expansion and loss of airspace. Consistent with the phenotype observed, genes associated with alveolar maturation, survival, and proliferation were differentially expressed. Taken together, these results identify C/EBPα as a master regulator of airway epithelial maturation and suggest that the loss of C/EBPα could also be an important event in the multistep process of lung tumorigenesis. Furthermore, this study indicates that exploring the C/EBPα pathway might have therapeutic benefits for patients with respiratory distress syndromes.

Surgical Treatment of Unstable Type II Odontoid Fractures in Skeletally Mature Individuals

Spine ◽  
2010 ◽  
Vol 35 (Supplement) ◽  
pp. S209-S218 ◽  
Author(s):  
Alpesh A. Patel ◽  
Ron Lindsey ◽  
Jason T. Bessey ◽  
Jens Chapman ◽  
Raja Rampersaud
Keyword(s):  
Surgical Treatment ◽  
Type Ii ◽  
Odontoid Fractures ◽  
Unstable Type

scholarly journals Crotoxin-Induced Mice Lung Impairment: Role of Nicotinic Acetylcholine Receptors and COX-Derived Prostanoids

Biomolecules ◽  
2020 ◽  
Vol 10 (5) ◽  
pp. 794
Author(s):  
Marco Aurelio Sartim ◽  
Camila O. S. Souza ◽  
Cassiano Ricardo A. F. Diniz ◽  
Vanessa M. B. da Fonseca ◽  
Lucas O. Sousa ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Early Phase ◽  
Late Phase ◽  
Lung Mechanics ◽  
Respiratory Compromise ◽  
Nicotinic Acetylcholine ◽  
Crotalus Durissus Terrificus ◽  
Crotalus Durissus ◽  
The Impact ◽  
Lung Impairment

Respiratory compromise in Crotalus durissus terrificus (C.d.t.) snakebite is an important pathological condition. Considering that crotoxin (CTX), a phospholipase A2 from C.d.t. venom, is the main component of the venom, the present work investigated the toxin effects on respiratory failure. Lung mechanics, morphology and soluble markers were evaluated from Swiss male mice, and mechanism determined using drugs/inhibitors of eicosanoids biosynthesis pathway and autonomic nervous system. Acute respiratory failure was observed, with an early phase (within 2 h) characterized by enhanced presence of eicosanoids, including prostaglandin E2, that accounted for the increased vascular permeability in the lung. The alterations of early phase were inhibited by indomethacin. The late phase (peaked 12 h) was marked by neutrophil infiltration, presence of pro-inflammatory cytokines/chemokines, and morphological alterations characterized by alveolar septal thickening and bronchoconstriction. In addition, lung mechanical function was impaired, with decreased lung compliance and inspiratory capacity. Hexamethonium, a nicotinic acetylcholine receptor antagonist, hampered late phase damages indicating that CTX-induced lung impairment could be associated with cholinergic transmission. The findings reported herein highlight the impact of CTX on respiratory compromise, and introduce the use of nicotinic blockers and prostanoids biosynthesis inhibitors as possible symptomatic therapy to Crotalus durissus terrificus snakebite.

scholarly journals Passage of an Anterior Odontoid Screw through Gastrointestinal Tract

2017 ◽  
Vol 2017 ◽  
pp. 1-4 ◽  
Author(s):  
L. Leitner ◽  
C. I. Brückmann ◽  
M. M. Gilg ◽  
G. Bratschitsch ◽  
P. Sadoghi ◽  
...  
Keyword(s):  
Screw Fixation ◽  
Treatment Method ◽  
Preoperative Imaging ◽  
Screw Loosening ◽  
Gi Tract ◽  
Revision Operation ◽  
Odontoid Fractures ◽  
Esophagus Perforation ◽  
And Migration

Purpose. Anterior screw fixation has become a popular surgical treatment method for instable odontoid fractures. Screw loosening and migration are a rare, severe complication following anterior odontoid fixation, which can lead to esophagus perforation and requires revision operation. Methods. We report a case of screw loosening and migration after anterior odontoid fixation, which perforated the esophagus and was excreted without complications in a 78-year-old male patient. Results. A ventral dislocated anterior screw perforated through the esophagus after eight years after implantation and was excreted through the gastrointestinal (GI) tract. At a 6-month follow-up after the event the patient was asymptomatic. Conclusion. Extrusion via the GI tract is not safe enough to be considered as a treatment option for loosened screws. Some improvements could be implemented to prevent such an incident. Furthermore, this case is a fine example that recent preoperative imaging is mandatory before revision surgery for screw loosening.

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