scholarly journals Near-miss Injury of Multiple Carpometacarpal Joint Dislocations: A Report of Two Cases

2021 ◽  
pp. 59
Author(s):  
Kow Ren Yi ◽  
Zaharul Azri Mustapha Zakaria ◽  
Ruben Jaya Kumar ◽  
Low Chooi Leng ◽  
Khairul Nizam Siron Baharom
Keyword(s):  
Near Miss ◽  
High Velocity Impact ◽  
Carpometacarpal Joint ◽  
Kirschner Wires ◽  
Partial Arthrodesis ◽  
Prompt Treatment ◽  
Joint Dislocations ◽  
Middle Ring ◽  
The Right ◽  
High Index Of Suspicion

Multiple carpometacarpal joint (CMCJ) dislocations are rare and are easily missed. The anatomical configuration renders stability to the joints. As a result, a high-velocity impact is required to dislocate the joint. We present two cases of multiple carpometacarpal joint dislocations with different mechanisms of injury and their subsequent management at our centre. In case 1, a 29-year-old gentleman presented with acute dislocations of the CMCJs involving the right middle, ring, and little fingers. An open reduction and fixation with Kirschner wires were done to stabilize the dislocated CMCJs and he subsequently recovered. In case 2, a 25-year-old gentleman had the CMCJ dislocations detected late due to other more profound injuries. Partial arthrodesis was performed to address the instability of the CMCJs of the right index, middle and ring fingers. He subsequently recovered and returned to work 6-months postoperatively. The diagnosis of carpometacarpal joint dislocation can be easily missed especially when there is a concurrent distracting injury. It is crucial to maintain a high index of suspicion as early diagnosis and prompt treatment is paramount to yield a better outcome.

scholarly journals Combined Dorsal and Ulnarward Carpometacarpal Dislocation Associated with Open Fracture of the Base of First Metacarpal and Severe Degloving Injury

2017 ◽  
Vol 2017 ◽  
pp. 1-4
Author(s):  
Ali J. Electricwala ◽  
Jaffer T. Electricwala
Keyword(s):  
Internal Fixation ◽  
Functional Outcome ◽  
Closed Reduction ◽  
Rare Case ◽  
Open Fracture ◽  
Kirschner Wires ◽  
Degloving Injury ◽  
The Right ◽  
High Index Of Suspicion

We report a rare case of dislocation of second to fourth carpometacarpal (CMC) joints of the right hand with combined dorsal and ulnarward displacement of the second to fourth digits and fracture of the shaft of the first metacarpal associated with degloving injury. These injuries were diagnosed early and treated successfully with closed reduction and internal fixation using Kirschner wires. The functional outcome was good at follow-up at 5 years. A high index of suspicion is required to successfully diagnose and treat this condition.

The value of real-time ultrasound-guidance for definite placement of a right supraclavicular subclavian central venous catheter

2021 ◽  
pp. 112972982199853
Author(s):  
Jens M Poth ◽  
Stefan F Ehrentraut ◽  
Se-Chan Kim
Keyword(s):  
Ultrasound Guidance ◽  
Venous Catheter ◽  
Needle Insertion ◽  
Major Surgery ◽  
Axillary Vein ◽  
Central Venous ◽  
Supraclavicular Fossa ◽  
The Right ◽  
High Index Of Suspicion ◽  
Insertion Process

Central venous catheters (CVC) are widely used in critically ill patients and in those undergoing major surgery. Significant adverse events, such as pneumothorax and hemothorax, can be caused by needle insertion during CVC insertion. CVC misplacement is less often described, yet equally important, as it can lead to deleterious complications. Here, we describe a case in which misplacement of a guidewire following infraclavicular puncture of the right axillary vein was detected by continuous ultrasound employing the right supraclavicular fossa view. Utilizing this ultrasound view, the insertion approach to the vessel was changed and correct CVC placement could be achieved. While ultrasound guidance is widely accepted for vessel puncture, this case demonstrates the value of continuous ultrasound guidance for the entire process of CVC insertion: vessel puncture, correct guidewire advancement, catheter placement, and exclusion of complications such as pneumothorax. It also shows that there should be a high index of suspicion for guidewire misplacement, even after successful venipuncture. In conclusion, ultrasound protocols covering the complete CVC insertion process should be implemented into current clinical practice.

scholarly journals A Case of Flexion Contracture of the Right Middle, Ring, and Little Fingers after Reduction of Both Bone Forearm Fractures

2004 ◽  
Vol 53 (4) ◽  
pp. 819-821
Author(s):  
Takayuki Iwanaga ◽  
Makoto Tamai ◽  
Hikaru Tashima ◽  
Futoshi Kuga ◽  
Kenichi Yawatari ◽  
...  
Keyword(s):  
Flexion Contracture ◽  
Forearm Fractures ◽  
Middle Ring ◽  
The Right

Cardiac Arrhythmia Caused by a Kirschner Wire inside the Heart

1997 ◽  
Vol 22 (3) ◽  
pp. 402-404 ◽  
Author(s):  
T. A. T. HAAPANIEMI ◽  
U. S. HERMANSSON
Keyword(s):  
Atrial Fibrillation ◽  
Thoracic Surgery ◽  
Cardiac Disease ◽  
Kirschner Wire ◽  
Previous History ◽  
Kirschner Wires ◽  
Left Hand ◽  
Plain Chest ◽  
History Of ◽  
The Right

A 45-year-old woman with no previous history of cardiac disease woke up one morning with an irregular heartbeat and fatigue. An electrocardiogram showed atrial fibrillation and plain chest radiographs revealed the presence of a metallic pin at the position of the heart. A 24 mm-long metallic pin was removed by open thoracic surgery from within the right ventricle of the heart. Postoperative examination of the pin showed it to be one of the 0.8 mm Kirschner wires that had been used for finger osteosynthesis in her left hand 31 months previously.

scholarly journals Obstructed right Duari hernia

2021 ◽  
Vol 55 (3) ◽  
pp. 229-231
Author(s):  
Ugochukwu U Nnadozie, ◽  
Otuu Onyeyirichi ◽  
Charles C Maduba ◽  
Andrew C Ekwesianya
Keyword(s):  
Femoral Hernia ◽  
Uneventful Recovery ◽  
Transverse Incision ◽  
Midline Laparotomy ◽  
Accident And Emergency ◽  
Accident And Emergency Department ◽  
The Right ◽  
High Index Of Suspicion ◽  
Groin Swelling ◽  
Laparotomy Incision

The caecum and appendix are uncommon contents of femoral hernia (Duari hernia). Diagnosis is usually intraoperative. We report a rare case of obstructed right femoral hernia in a 65-year-old woman. She was admitted into the accident and emergency department because of sudden irreducibility of a previously reducible right groin swelling of 5 years duration. She had obstructive symptoms with an irreducible right groin mass clinically diagnosed as obstructed right femoral hernia. A combination of infra-inguinal transverse incision and a lower midline laparotomy incision was used. The intraoperative findings included the herniation of the caecum and appendix into the right femoral canal. Patient had an uneventful recovery. Duari hernia is uncommon. A high index of suspicion and an experiencedsurgeon, who can handle uncommon findings should be involved in the management of obstructed femoral hernias.

scholarly journals Pulmonary Tuberculosis mimicking a right Eventration on Radiography: The falsity of single view radiograph in the diagnosis of a precursor of pulmonary disease: A Case Report

2021 ◽  
Vol 4 (1) ◽  
pp. 33-37
Author(s):  
John Ogunkoya ◽  
Oluwatosin Yetunde Adesuyi
Keyword(s):  
Pulmonary Tuberculosis ◽  
Lower Lobe ◽  
Middle Lobe ◽  
The Body ◽  
Single View ◽  
Lymph Node Enlargement ◽  
History Of ◽  
Chest X Ray ◽  
The Right ◽  
High Index Of Suspicion

Background: The diaphragm is one of the most important muscles of respiration in the body separating the abdomen from the thorax. Abnormalities of the diaphragm could be congenital or acquired, morphological or functional while pulmonary infection e.g. pulmonary tuberculosis, is implicated in its etiology. Case presentation: A 63-year- old man with six weeks history of cough productive of yellowish sputum. Chest X-ray showed a uniform well-circumscribed opacity in the right lower lobe abutting on or in continuum with the right diaphragm consistent with a diaphragmatic hump. Sputum Gene Xpert was positive for Mycobacterium tuberculosis. Chest CT scan revealed bilateral lymph node enlargement with hyperdense lesions in the anterior basal segment of the right lower lobe and medial bronchopulmonary segments of the right middle lobe. He was treated for 6 months with first-line anti-tuberculosis drugs. Discussion: The incidence of the diaphragmatic hump on chest radiograph worldwide and among Nigerians is unknown. The association of diaphragmatic hump with chest infection has been well document. The association of diaphragmatic hump with pulmonary tuberculosis is uncommon. Conclusion: A high index of suspicion is needed to diagnose pulmonary tuberculosis with atypical clinical and radiological presentations. Such prompt diagnosis will aid the treatment of the disease.

Diaphragmatic flutter

2018 ◽  
Vol 18 (3) ◽  
pp. 224-226 ◽  
Author(s):  
Dean Walton ◽  
Michael Bonello ◽  
Malcolm Steiger
Keyword(s):  
Respiratory Distress ◽  
Medical Treatment ◽  
Abdominal Wall ◽  
Phrenic Nerve ◽  
High Frequency ◽  
Rare Disorder ◽  
Nerve Crush ◽  
Irregular Variable ◽  
The Right ◽  
High Index Of Suspicion

A 78-year-old woman presented with involuntary movements of her abdomen, which started after a right hemispheric stroke. She had irregular, variable, hyperkinetic predominantly right-sided abdominal wall movements. MR scan of brain confirmed a recent infarct in the right occipitotemporal lobe and the right cerebellum. Diaphragmatic fluoroscopy confirmed high-frequency flutter as the cause of her abdominal movements and confirmed the diagnosis of van Leeuwenhoek’s disease. Anthonie van Leeuwenhoek first described this condition in 1723 and had the condition himself. He was a Dutch businessman who is often acknowledged as the first microscopist and microbiologist. He disagreed with his physician who attributed his ailment as being of cardiac origin. Diaphragmatic flutter is a rare disorder that requires a high index of suspicion with symptoms including abnormal abdominal wall movements, dyspnoea and respiratory distress. Despite medical treatment, the patient was still highly symptomatic, so she is currently being considered for a phrenic nerve crush.

scholarly journals Rare Case of Servelle Martorelle Syndrome

2014 ◽  
Vol 10 (4) ◽  
pp. 91-94
Author(s):  
A Bhatnagar ◽  
M Deshpande
Keyword(s):  
Soft Tissue ◽  
Upper Limb ◽  
Rare Case ◽  
Prompt Treatment ◽  
Congenital Vascular Malformation ◽  
History Of ◽  
The Right ◽  
Scapular Region

Servelle Martorelle Syndrome is a congenital vascular malformation associated with soft tissue hypertrophy and bony hypoplasia. This rarely involves whole of an extremity, with involvement of part of limbs reported in literature. We present a case of a twelve year boy who presented to the Department of Plastic Surgery SGPGIMS in April 2011 ,with history of circumferential soft tissue hypertrophy involving whole of left upper limb, scapular region and axilla since birth. The entire left upper limb length was lesser than the right upper limb. Hence this is a very rare case of Servelle Martorelle Syndrome having extensive limb involvement at a very young age. Highlighted is the role of conservative treatment and close follow-up to understand the natural history of the diseases, with prompt treatment of complications. DOI: http://dx.doi.org/10.3126/kumj.v10i4.11011 Kathmandu Univ Med J 2012;10(4):91-94

scholarly journals Intramuscular Hemangioma of the Forearm with Flexion Contracture

2019 ◽  
Vol 2019 ◽  
pp. 1-5
Author(s):  
Sunyarn Niempoog ◽  
Waroot Pholsawatchai
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Surgical Excision ◽  
Conventional Radiography ◽  
Flexion Contracture ◽  
Resonance Imaging ◽  
Anterior Compartment ◽  
Intramuscular Hemangioma ◽  
Middle Ring ◽  
The Right

Intramuscular hemangiomas can be an infrequent but important cause of musculoskeletal pain. This report describes a 25-year-old male who presented with pain in the right forearm and contracture of the right hand for 4 years. Physical examination revealed severe tenderness of the midforearm with contracture of the flexor tendons in the index, middle, ring, and little fingers. Conventional radiography of the forearm revealed a soft tissue phlebolith. Magnetic resonance imaging showed a well-defined lobulated mass partially involving the FDP tendon. An intramuscular hemangioma within the deep anterior compartment of the forearm was suspected. Following surgical excision of the hemangioma, the patient’s symptoms resolved completely. In conclusion, intramuscular hemangioma can be a rare cause of flexion contracture of the hands and should be considered as a cause of a flexion contracture that fails to respond to conservative treatment.

scholarly journals Forearm Compartment Syndrome following Thrombolytic Therapy for Massive Pulmonary Embolism: A Case Report and Review of Literature

2011 ◽  
Vol 2011 ◽  
pp. 1-4 ◽  
Author(s):  
Ravi Badge ◽  
Mukesh Hemmady
Keyword(s):  
Pulmonary Embolism ◽  
Thrombolytic Therapy ◽  
Compartment Syndrome ◽  
Signs And Symptoms ◽  
Massive Pulmonary Embolism ◽  
Heparin Therapy ◽  
Arterial Line ◽  
The Right ◽  
High Index Of Suspicion ◽  
Passive Stretch

Use of thrombolytic therapy in pulmonary embolism is restricted in cases of massive embolism. It achieves faster lysis of the thrombus than the conventional heparin therapy thus reducing the morbidity and mortality associated with PE. The compartment syndrome is a well-documented, potentially lethal complication of thrombolytic therapy and known to occur in the limbs involved for vascular lines or venepunctures. The compartment syndrome in a conscious and well-oriented patient is mainly diagnosed on clinical ground with its classical signs and symptoms like disproportionate pain, tense swollen limb and pain on passive stretch. However these findings may not be appropriately assessed in an unconscious patient and therefore the clinicians should have high index of suspicion in a patient with an acutely swollen tense limb. In such scenarios a prompt orthopaedic opinion should be considered. In this report, we present a case of acute compartment syndrome of the right forearm in a 78 years old male patient following repeated attempts to secure an arterial line for initiating the thrombolytic therapy for the management of massive pulmonary embolism. The patient underwent urgent surgical decompression of the forearm compartments and thus managed to save his limb.

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