scholarly journals Internal Trauma, Humeral Fracture, and Radial Nerve Paralysis: How Could it Occur in the Sport Setting? A Case Report and Review of the Literature

2020 ◽  
Vol 8 (1) ◽  
pp. 1
Author(s):  
Elghoul Naoufal ◽  
Elantri Ismail ◽  
Bouya Ayoub ◽  
Bennis Azzelarab ◽  
Zaddoug Omar ◽  
...  
Keyword(s):  
Radial Nerve ◽  
Full Range ◽  
Humeral Fracture ◽  
Imaging Findings ◽  
Review Of The Literature ◽  
Significant Morbidity ◽  
Nerve Paralysis ◽  
Pathologic Fractures ◽  
Type Of Fracture

Thrower’s fractures are Spiral fractures of the humerus in the ball. They represent very uncommon clinical entities that can simulate pathologic fractures. Moreover, the concomitant neurologic deficient is rare. Herein we report a 27 years old muscular man presented a spiral fracture of the humerus following a forceful throw of the ball during an amateur throwing challenge. Clinical and imaging findings showed a displaced Thrower fracture with radial nerve neurapraxia (known as Holstein Lewis fracture) prompting the patient to undergo surgery. The intraoperative aspect found that the nerve was near to the beveled distal humeral fragment with no incarceration. We performed an internal fixation using the Leicester plate and the nerve was kept away from the plate by the interposition of a soft tissue sheet. At the last follow up, the fracture united and radial nerve neurapraxia resolved and the patient regained the full range of motion of his right upper limb with no pain. In conclusion, although this type of fracture is rare, given their significant morbidity, we emphasize that the reactional throwers should undergo appropriate preseason training before practicing a throwing challenge or generally a throwing sport.

scholarly journals Abdominal aortic aneurysms that have ruptured or are at imminent risk of rupture

2019 ◽  
Vol 52 (3) ◽  
pp. 182-186
Author(s):  
Ingrid Braga Corrêa ◽  
Bruna Leal Torres Alves ◽  
Tarcísio Angelo de Oliveira Sobrinho ◽  
Laura Filgueiras Mourão Ramos ◽  
Renata Lopes Furletti Caldeira Diniz ◽  
...  
Keyword(s):  
Abdominal Aortic Aneurysms ◽  
Aortic Aneurysms ◽  
Emergency Setting ◽  
Imaging Findings ◽  
Review Of The Literature ◽  
Abdominal Aortic ◽  
Risk Of Rupture ◽  
Pictorial Essay ◽  
Imminent Risk

Abstract The rupture of an abdominal aortic aneurysm (AAA) is considered a high-risk surgical emergency, given the catastrophic consequences and high mortality rate. The objective of this pictorial essay is to illustrate the radiological signs that indicate rupture or imminent rupture. To that end, we describe cases treated at our facility and present a brief review of the literature on the topic. The clinical diagnosis of imminent AAA rupture can be difficult, because patients are usually asymptomatic or have nonspecific pain complaints. In the subsequent follow-up, it is possible to identify radiological signs that indicate instability or rupture itself and thus change the prognosis. Computed tomography is the modality of choice for evaluating an AAA and abdominal pain in the emergency setting. It is therefore essential that the radiologist immediately identify the imaging findings that indicate AAA rupture or the imminent risk of such rupture.

Delayed Treatment of Persistent Radial Nerve Paralysis Associated with Fractures of the Middle Third of Humerus: Review and Evaluation of the Long-Term Results of 52 Cases

2007 ◽  
Vol 32 (5) ◽  
pp. 529-533 ◽  
Author(s):  
M. VERGA ◽  
A. PERI DI CAPRIO ◽  
M. A. BOCCHIOTTI ◽  
F. BATTISTELLA ◽  
S. BRUSCHI ◽  
...  
Keyword(s):  
Functional Recovery ◽  
Radial Nerve ◽  
Humeral Fracture ◽  
Long Term Results ◽  
Nerve Paralysis ◽  
Surgical Exploration ◽  
Delayed Treatment ◽  
Nerve Grafts ◽  
Nerve Surgery

This study was undertaken to determine the efficacy of delayed surgical treatment in cases of persistent radial nerve paralysis after fractures of the middle third of the humerus. We have limited this study to patients who had absolutely no functional recovery of the radial nerve 3 to 4 months after middle third humeral fractures. The fractures were treated by a variety of orthopaedic methods, conservative and surgical, in other departments and hospitals. Surgical exploration of the radial nerve was carried out 3 to 4 months after primary orthopaedic treatment. The outcome of this study concurs with data in the literature in showing that delayed nerve surgery (neurolysis or nerve grafts) in the absence of functional recovery of the radial nerve after humeral fracture can be useful in achieving good functional recovery and subjectively satisfying results.

scholarly journals Clinical treatment of humerus fracture using intramedullary humerus nailing system

2020 ◽  
Vol 6 (2) ◽  
pp. 266
Author(s):  
Pooja Rawat ◽  
Mohit Kumar ◽  
Gaurav Luthra
Keyword(s):  
Humeral Fracture ◽  
Clinical Results ◽  
Pain Scale ◽  
Humerus Fracture ◽  
Ao Classification ◽  
Reconstruction Nail ◽  
American Society ◽  
Fracture Compression ◽  
Type Of Fracture

<p class="abstract"><strong>Background:</strong> The clinical results of intramedullary humerus nailing system of humeral fracture is controversial variation in implants, and follow up factor and operative technical studies. Humerus fracture is the third long fracture after femoral and tibia bone fracture.</p><p class="abstract"><strong>Methods:</strong> In this prospective study, 45 patients (24 female and 21 male) between the age group of 18-75 years with humerus fracture were taken who did not get conservative management. Type of fracture was categorized according to AO classification. Intramedullary humeral nailing system (compression intramedullary humerus nail, reconstruction nail and reconstruction intramedullary humerus nail) manufactured at Auxein Medical Pvt. Ltd., was used to treatment of humerus fracture. Patient physical fitness was observed according to American Society of Anesthesiologist. Pain scale and outcomes was record from the patients using visual analog scale. Follow up of the patients were taken on 3-week, 8-week, 16-week, 1-year and 2-year.<strong></strong></p><p class="abstract"><strong>Results:</strong> At 2 years follow up, bone consolidation was present in 44 cases. Only one case has reported of mortality but that was not due to implant related. No clinical and biomechanical complications were reported.  Proper healing of implant was achieved.</p><p class="abstract"><strong>Conclusions:</strong> Intramedullary humeral nailing system is the best treatment option to treat the humerus fracture. Compression intramedullary humerus nail can minimize the gap and increase the biomechanical stiffness.</p>

scholarly journals Distal pronator teres motor branch transfer for wrist extension restoration in radial nerve paralysis

2020 ◽  
pp. 1-7
Author(s):  
Jayme Augusto Bertelli ◽  
Sushil Nehete ◽  
Elisa Cristiana Winkelmann Duarte ◽  
Neehar Patel ◽  
Marcos Flávio Ghizoni
Keyword(s):  
Median Nerve ◽  
Radial Nerve ◽  
Full Range ◽  
Medial Epicondyle ◽  
Wrist Extension ◽  
Motor Branch ◽  
Nerve Paralysis ◽  
Pronator Teres ◽  
Flexion Extension ◽  
Anterior Side

OBJECTIVEThe authors describe the anatomy of the motor branches of the pronator teres (PT) as it relates to transferring the nerve of the extensor carpi radialis brevis (ECRB) to restore wrist extension in patients with radial nerve paralysis. They describe their anatomical cadaveric findings and report the results of their nerve transfer technique in several patients followed for at least 24 months postoperatively.METHODSThe authors dissected both upper limbs of 16 fresh cadavers. In 6 patients undergoing nerve surgery on the elbow, they dissected the branches of the median nerve and confirmed their identity by electrical stimulation. Of these 6 patients, 5 had had a radial nerve injury lasting 7–12 months, underwent transfer of the distal PT motor branch to the ECRB, and were followed for at least 24 months.RESULTSThe PT was innervated by two branches: a proximal branch, arising at a distance between 0 and 40 mm distal to the medial epicondyle, responsible for PT superficial head innervation, and a distal motor branch, emerging from the anterior side of the median nerve at a distance between 25 and 60 mm distal to the medial epicondyle. The distal motor branch of the PT traveled approximately 30 mm along the anterior side of the median nerve; just before the median nerve passed between the PT heads, it bifurcated to innervate the deep head and distal part of the superficial head of the PT. In 30% of the cadaver limbs, the proximal and distal PT branches converged into a single trunk distal to the medial epicondyle, while they converged into a single branch proximal to it in 70% of the limbs. The proximal and distal motor branches of the PT and the nerve to the ECRB had an average of 646, 599, and 457 myelinated fibers, respectively.All patients recovered full range of wrist flexion-extension, grade M4 strength on the British Medical Research Council scale. Grasp strength recovery achieved almost 50% of the strength of the contralateral side. All patients could maintain their wrist in extension while performing grasp measurements.CONCLUSIONSThe distal PT motor branch is suitable for reinnervation of the ECRB in radial nerve paralysis, for as long as 7–12 months postinjury.

scholarly journals Sinonasal Phosphaturic Mesenchymal Tumor: Case Report and Systematic Review

2014 ◽  
Vol 5 (3) ◽  
pp. ar.2014.5.0100 ◽  
Author(s):  
Nicholas L. Deep ◽  
Rachel B. Cain ◽  
Ann E. McCullough ◽  
Joseph M. Hoxworth ◽  
Devyani Lal
Keyword(s):  
Systematic Review ◽  
Head And Neck ◽  
Paraneoplastic Syndrome ◽  
English Language ◽  
Mesenchymal Tumor ◽  
Phosphaturic Mesenchymal Tumor ◽  
Review Of The Literature ◽  
Pathologic Fractures ◽  
Aggressive Tumor

We report a case of sinonasal phosphaturic mesenchymal tumor (PMT) and conduct a systematic review of the literature to highlight a unique paraneoplastic syndrome associated with PMT. We used English language publications from Medline and Cochrane databases (1970–2013) as data sources. A systematic review of the literature was conducted. All reported cases of head and neck PMTs were included. The presence or absence of the associated paraneoplastic syndrome was noted. We found 33 cases of PMT in the head and neck reported in the literature, 17 of which occurred in the sinonasal area. Approximately 5% of all PMTs are located in the head and neck. Just greater than half are concentrated in the sinonasal area, and the remaining involve various bony and soft tissue structures of the head and neck. PMT is sometimes associated with a paraneoplastic syndrome of tumor-induced (oncogenic) osteomalacia (TIO) causing bone pain, muscle weakness, and pathologic fractures. We present the 18th reported case of sinonasal PMT. A smooth mucosa-covered midline intraseptal mass filling the posterior nasal cavity with destruction and erosion of the skull base was found in an adult male. The patient underwent successful endoscopic resection with wide negative margins and is without recurrence at 24-month follow-up. PMT is a benign, locally aggressive tumor with rare malignant transformation. Knowledge of the bony invasion and destruction caused by this tumor is essential in planning surgical resection with wide negative margins. Familiarity with the associated TIO is essential to investigate for and manage any associated bony morbidity.

scholarly journals Traumatic Avulsion Fracture of the Origin of the Brachioradialis Muscle: A Case Report and Review of the Literature

2021 ◽  
pp. 250-254
Author(s):  
Dany k. Aouad ◽  
Nabil Dib ◽  
Chady Kharrat ◽  
George El Rassi
Keyword(s):  
Avulsion Fracture ◽  
Full Range ◽  
Structure And Function ◽  
Neutral Position ◽  
Review Of The Literature ◽  
Closed Fracture ◽  
And Function ◽  
Flexion Strength ◽  
Unique Mechanism

Avulsion fracture of the brachioradialis muscle origin at the proximal two-thirds of the lateral supraepicondylar ridge of the humerus is an extremely rare fracture with only 4 reported cases in the literature so far. In this article, we describe the case of a 50-year-old male patient who had sustained a closed fracture of the latter after falling from a height of 1.5 m on a flexed elbow and pronated hand. The patient was managed with immobilization of the elbow and wrist with a posterior splint in neutral position for 3 weeks, followed by wrist and elbow therapeutic mobilization sessions for 3 months. At the final follow-up, the patient had painless active and passive full range of motion of the elbow along with good flexion strength. The unique mechanism by which this avulsion fracture occurred is explained on the basis of the mode of injury, position of the limb, and structure and function of the brachioradialis muscle.

Analysis of Tsuge's Procedure for the Treatment of Radial Nerve Paralysis

Hand Surgery ◽  
2003 ◽  
Vol 08 (01) ◽  
pp. 17-20 ◽  
Author(s):  
O. Ishida ◽  
Y. Ikuta
Keyword(s):  
Radial Nerve ◽  
Wrist Joint ◽  
Middle Finger ◽  
Metacarpophalangeal Joint ◽  
Extensor Pollicis Longus ◽  
Nerve Paralysis ◽  
Radial Deviation ◽  
Pronator Teres ◽  
Extensor Carpi Radialis

Radial deviation and limited flexion of the wrist joint and a lack of abduction of the thumb have been noticed after the Riordan's procedure. Therefore, Tsuge et al. modified the Riordan's procedure, and their procedure includes transfer of the pronator teres to the extensor carpi radialis brevis, the flexor carpi radialis (FCR) to the extensor digitorum communis (EDC), and the palmaris longus to the extensor pollicis longus, along with tenodesis of the abductor pollicis longus. We reviewed the charts of 21 patients with isolated radial nerve paralysis who were treated with the Tsuge's procedure. Mean follow-up period was 11.3 years. Postoperatively, patients showed good extension of the metacarpophalangeal joint measured at the middle finger, useful flexion of the wrist joint, and decreased radial deviation of the wrist. The FCR transfer to the EDC is an excellent procedure for extension of the fingers. However, reconstruction of active abduction of the thumb remains controversial.

Pneumomediastinum: A Rare Presentation of Inflicted Injuries in Infants

2020 ◽  
Author(s):  
Adam Lee ◽  
Adam Bajinting ◽  
Abby Lunneen ◽  
Colleen M. Fitzpatrick ◽  
Gustavo A. Villalona
Keyword(s):  
Literature Review ◽  
Retrospective Review ◽  
Review Of The Literature ◽  
Rare Presentation ◽  
Spontaneous Pneumomediastinum ◽  
Nonaccidental Trauma ◽  
Comprehensive Literature Review ◽  
Healthy Infants ◽  
History Of

AbstractReports of incidental pneumomediastinum in infants secondary to inflicted trauma are limited. A retrospective review of infants with pneumomediastinum and history of inflicted trauma was performed. A comprehensive literature review was performed. Three infants presented with pneumomediastinum associated with inflicted trauma. Mean age was 4.6 weeks. All patients underwent diagnostic studies, as well as a standardized evaluation for nonaccidental trauma. All patients with pneumomediastinum were resolved at follow-up. Review of the literature identified other cases with similar presentations with related oropharyngeal injuries. Spontaneous pneumomediastinum in previously healthy infants may be associated with inflicted injuries. Clinicians should be aware of the possibility of an oropharyngeal perforation related to this presentation.

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