Jackson Wt

Percutaneous computed-tomography-stabilization of pelvic fractures: preliminary report.

The authors performed percutaneous computed-tomography (CT)-guided stabilization of reproduced pelvic fractures in eight cadaver studies and in three additional clinical cases. The details of the technique are illustrated in this article. The authors conclude that percutaneous CT-guided stabilization of pelvic fractures in selected cases can be performed safely, rapidly, and with less associated morbidity than conventional open methods presently used. Clinical studies are currently being expanded.

Internal fixation of the unstable cervical spine using posterior Roy-Camille plates : Preliminary report

We reviewed 13 cases of unstable cervical spine treated by stabilization with posterior Roy-Camille plates and fusion. The patients were treated between 1985-1988. Six patients had acute traumatic episodes, three patients had posttraumatic instabilities, one patient had laminectomy for cervical spondylotic myelopathy, and three patients had metastatic bone disease. All had successful fusion in approximately 3 months without complications. The indications and techniques of posterior Roy-Camille plating are outlined.

Low lumbar burst fractures : comparison between conservative and surgical treatments

Twenty-two low lumbar burst fractures (L3-L5) were treated, with an average follow up of 56.2 and 39.0 months in the conservative and surgically treated groups, respectively. Twenty patients were available for review; seven were treated conservatively and 13 were stabilized surgically. All patients were evaluated clinically for work status, activity level, residual pain, and subsequent development of neurologic symptoms. Roentgenograms were reviewed for severity of initial fracture, canal compromise, and maintenance of initial correction. In general, neurologically intact patients in both groups returned to similar postinjury employment levels. Persistent back pain was found to be more disabling in the surgically treated group, in which a fusion incorporating four or five lumbar segments was performed. There was no evidence of significant loss of initial reduction, and no patients experienced late neurological compromise in the surgical group. An average follow-up kyphosis of 9.2 degrees and 31% loss of vertebral height were observed in the conservative group, while a follow-up lordosis of 1 degree and 19% loss of vertebral height were observed in the surgical group. Conservative treatment of low lumbar burst fracture is a viable option in neurologically intact patients, but loss of lordosis and vertebral height may persist. Biomechanical and anatomic characteristics of the low lumbar spine differ from the thoracolumbar region and may account for the inherent stability of these injuries. If surgery is chosen, a long fusion with distraction instrumentation should be avoided in the low lumbar spine. A short rigid fixation with pedicular instrumentation may be of greater benefit.

Acute Anterior Compartment Syndrome in the Thigh: A Case Report and Review of the Literature

An unusual case of acute anterior thigh compartment syndrome promptly recognized and successfully treated in a young athletic patient is presented and the literature reviewed. With the increased interest in physical fitness in todays society, this condition may occur more frequently than it is recognized. Prompt diagnosis and treatment can reduce morbidity.

Heterotopic Ossification and Pseudoarthrosis in the Shoulder Following Encephalitis: A Case Report and Review of the Literature

Heterotopic bone formation, or myositis ossificans, is common, particularly following trauma, total hip arthroplasty, spinal cord injury, severe head injury, and long-term coma. Although the mechanism is unknown, the pathogenesis is assumed to depend on transformation of mesenchymal cells to bone forming cells in response to a variety of stimuli. The clinical findings, laboratory data, roentgeno-grams, and radionuclide studies are standard aids in the diagnosis of heterotopic ossification. The treatment usually consists of range-of-motion exercise, nonsteroidal antiinflammatory drugs, X-ray therapy, disodium etidronate (EHDP), and excisional surgery. Reported here is a rare case of peri-articular heterotopic ossification in the shoulder of a 38-year-old woman following head injury and 13 months in a coma. The unusual feature was the development of a pseudoarthrosis within the heterotopic bone. The patients shoulder became markedly stiff with the development of a heterotopic pseudoarthrosis. Excision of the heterotopic bone and pseudoarthrosis was performed to improve the range of motion. Clinical roentgenographic, radionuclide, and pathologic observations are presented on the formation of a synovial joint within the heterotopic bone.

Simultaneous Ipsilateral Intertrochanteric and Subcapital Fracture of the Hip: A Case Report

This article presents a previously unreported subcapital and intertrochanteric fracture which was sustained simultaneously, in a 94 year old man

Magnetic resonance imaging in the evaluation of a gunshot wound to the cervical spine.

A patient in the second trimester of pregnancy sustained a gunshot wound of the upper cervical spine with a partial Brown-Séquard syndrome. The patients condition was evaluated by conventional roentgenography, computed axial tomography (CT), and magnetic resonance imaging (MRI). The MRI alone clearly demonstrated the relationship of the bullet and the spinal cord, whereas the CT image was obliterated by metal artifacts. The bullet was removed from the spinal canal by a posterior approach with the patient in the sitting position and in skeletal cervical traction. The neurological status of the patient improved markedly after the surgery.

Anterior and posterior cervical spine fixation using titanium implants to facilitate magnetic resonance imaging evaluation

Summary Magnetic resonance (MR) imaging of the cervical spine is useful in the evaluation of both acute and chronic injuries to the spinal cord and meninges as well as in demonstration of mechanical impingement on the spinal canal and nerve roots. Anterior or posterior plate fixation of unstable cervical spine injuries has limited the postoperative use of MR imaging due to the extensive magnetic field distortion produced by the stainless steel implants commonly used in these procedures. We have compared titanium implants in a cadaver against stainless steel implants in two patients and show no significant MR artifacts produced in the spinal canal by titanium plates as opposed to extensive image distortion and obliteration by the steel plates. We recommend consideration of titanium (Ti6A14V) as a substitute for stainless steel in cervical spine fixation to preserve the option of subsequent examination by MR scanning.

Three-dimensional Computed Tomography in Evaluation of Occipital Condyle Fracture

Fracture of the occipital condyle is a rare sequela of craniocervical trauma. The diagnosis can be suspected in an injured patient with disproportionate torticollis, uncertain evidence of subluxation, and lower cranial nerve symptoms. Standard radiographic diagnosis of this fracture is difficult owing to its superimposition on other bony structures. Film tomography or computed tomography (CT) is usually required to identify the fracture. We report a case of occipital condyle fracture initially masked by atlantoaxial subluxation, but then best demonstrated by three-dimensional CT.

Open scapulothoracic dissociation with intact neurovascular status in a child

A case of open scapulothoracic dissociation with intact neurovascular status in an 8-year-old girl is reported. Scapulothoracic dissociation is a rare injury. Most cases present with significant soft tissue disruption in the shoulder region secondary to separation of the scapula from the thorax, and involve major vascular and brachial plexus injuries. This case report illustrates that an obvious roentgenographic scapulothoracic dissociation may be seen without any neurovascular deficit in a child. Successful treatment, with anatomical repair of the muscles and stabilization of the scapula, is described.