Ilkka Tulikoura

Bone stress injuries of the lower extremity: a review.

Bone stress injuries can cause long-lasting damage, especially in young athletes and military conscripts, if not diagnosed and treated properly. Diagnosis has been traditionally based on clinical, radiographic and scintigraphic examinations, but MRI has become increasingly important. High resolution MRI is particularly valuable for the grading of bone stress injuries. The clinician should be aware of the wide range of bone stress injuries and available diagnostic methods. Early diagnosis is the prerequisite for avoiding long-lasting complications. Most bone stress injuries heal with closed treatment, but surgery is necessary in some cases. They heal well if the diagnosis is not delayed and the treatment adequate.

Stress fracture of the navicular bone : nine cases in athletes

Nine cases of stress fractures of the tarsal navicular bone were treated in athletes. The diagnosis was made with radiographs and bone scan within 6 months. Only two patients were treated surgically. The only poor result was seen in a patient in whom the fracture was only explored.

Early intramedullary nailing of lower extremity fracture and respiratory function in polytraumatized patients with a chest injury: a retrospective study of 61 patients.

Background The optimal treatment of diaphyseal fractures of the lower extremities in patients who also have serious chest injuries is not known. Patients and methods We retrospectively evaluated the effect of an early intramedullary nailing (IMN) of femur or tibia fractures on respiratory function in 61 consecutive polytraumatized patients with unilateral or bilateral pulmonary contusion (thoracic AIS=3) admitted to our trauma intensive care unit between January 2000 and June 2001. 27 patients had a diaphyseal fracture of at least one long bone of the lower extremity, which was treated with IMN within 24 hours of admission. Results We found no difference between patients with or without a lower extremity fracture regarding the length of ventilator treatment, oxygenation ratio (PaO2/FiO2) or in the incidence of acute respiratory distress syndrome (ARDS), pneumonia, multi-organ failure or mortality. Interpretation In this retrospective study, IMN of a long bone fracture in a patient with multiple injuries and with a coexisting pulmonary contusion did not impair pulmonary function or outcome.

Injury to the deep femoral artery during proximal locking of a distal femoral nail--a report of 2 cases.

No Abstract available.

Surgical treatment of Rockwood grade-V acromioclavicular joint dislocations 50 patients followed for 15-22 years

Background and purpose Long-term outcome after surgery for grade-V acromioclavicular joint dislocation has not been reported. We performed a retrospective analysis of functional and radiographic outcome 15–22 years after surgery. Patients and methods We examined 50 patients who were treated at our hospital between April 1985 and December 1993. Various methods of stabilization were used: K-wires (n = 36), 4.5-mm screw (n = 12), or biodegradable screw (n = 2). Osteosynthesis material was removed after 6–8 weeks. Mean follow-up time was 18 (15–22) years. Outcomes were assessed with the Constant shoulder (CS) score, Disabilities of the Arm, Shoulder, and Hand (DASH) score, the simple shoulder test (SST), the Copeland shoulder impingement test, the cross-arm test, pain, stability of the AC joint, and complications. From radiographs, we evaluated AC and glenohumeral (GH) arthrosis, osteolysis of the lateral clavicle, and alignment of the clavicle with the acromion. Results Mean values were 90 (75–100) in CS score, 5.1 (0–41) in DASH score, and 11 (2–12) in SST. There was no statistically significant difference in CS score between the injured shoulder and the uninjured shoulder. The AC joint was clinically stable in 42 patients. In 38 patients, the clavicle alignment with the acromion was normal in radiographs. Lateral clavicle osteolysis (10 patients) appeared to be associated with permanent AC joint dislocation. Interpretation Surgery with a temporary fixation for acute grade-V AC joint dislocation leads to successful long-term functional results. Only minor disability occurred in some patients.

Myocardial contusion as a cause of delayed cardiac rupture. A case report

a Department of Orthopaedics and Traumatology, Helsinki Uni ersity Central Hospital, Topeliuksenkatu 5, FIN-00260 Helsinki, Finland b Department of Anatomy, Institute of Biomedicine, Uni ersity of Helsinki, Helsinki Finland c Department of Oral Medicine, Surgical Hospital, Helsinki Uni ersity Central Hospital, Helsinki, Finland d Department of Oral Medicine, Institute of Dentistry, Uni ersity of Helsinki, Helsinki, Finland

Traumatic deaths in the emergency room: A retrospective analysis of 115 consecutive cases

Objective:The aim of the present study was to characterise traumatic deaths occurring in the emergency room (ER) and to assess retrospectively the quality of given emergency care by evaluating whether any of the deaths could be identified as potentially preventable.Methods:All consecutive deaths of trauma patients between 1 January 1998 and 31 December 2006 in the ER of the Töölö Hospital Trauma Centre were retrospectively reviewed. The inclusion criterion was death of a trauma patient occurring in the ER. Both the pre- and inhospital medical charts and the autopsy reports of the patients were reviewed.Results:A total of 115 patients fulfilled the inclusion criteria, and the autopsy reports were obtained for all of these cases (100%). The patients were mainly males (n = 84; 73%), and the median age of the patients was 51 years (range 1–93 years). The average injury severity score (ISS) was 34.6. Blunt trauma was the most common type of injury in the study population. A total of 115 injuries in 50 patients were missed in both the clinical and radiological surveys in the ER, i.e., a missed injury was identified in 43% of the cases. Of these patients, 15.7% had a clinically significant missed injury (AIS ≥ 4). Based on our review of all available material, we consider that 11 deaths (9.6%) were potentially preventable.Conclusions:Missed injuries did not play a major role in the preventable deaths. Seven potentially preventable deaths were considered to be failures in the surgical decision-making process, resulting in futile non-operative treatment or a delay in surgical bleeding control.