John A. Gehweiler

Traumatic Anterior Atlanto-occipital Dislocation

The five cases of atlanto-occipital dislocation reported in the world literature are reviewed, and four additional cases are presented, including two survivors. The pathological anatomy of this potentially catastrophic injury and its management are briefly discussed. Because immediate recognition of the atlanto-occipital dislocation is critical to proper treatment and because the neurological findings are extremely varied, a new radiographic criterion for its identification has been developed.

Fractures of the atlas vertebra

In a series of 400 patients with fractures and dislocations of the cervical spine, 5% involved the atlas. There are nearly equal numbers of fractures of the posterior arch, bursting fractures of Jefferson, and horizontal fractures of the anterior arch. Atlas fractures are rarely associated with neurologic deficit, but they may be the cause of severe pain. Hypotheses concerning the mechanism of injury in each type of fracture are discussed. The characteristic roentgenographic findings and the differential diagnoses are reviewed.

Cervical spine trauma: the common combined conditions.

The two most common groups of combined traumatic conditions of the cervical spine are hyperextension and hyperflexion fracture-dislocations. In a series of 400 patients with fractures and/or dislocations of the cervical spine, 25% had hyperextension and 19% hyperflexion fracture-dislocations. A computer analysis of the cases revealed that there are five distinct types of hyperextension and four types of hyperflexion fracture-dislocations. Each of the types is considered as to incidence, causes, mechanism of injury, and roentgen and differential diagnosis.

Diffuse Biarticular Pigmented Villonodular Synovitis

Diffuse biarticular pigmented villonodular synovitis is rare. In this paper, we will describe two histologically proved cases seen at the Duke University Medical Center and review the clinical, pathologic, and radiologic features of this lesion. In 1941, Jaffe, Lichtenstein, and Sutro (10) described the pathological evolution and natural history of a process involving the synovial lining of joints which had been known by various names, depending upon the major histologic manifestations. These lesions were termed in the literature chronic hemorrhagic villous synovitis, giant-cell fibro-hemangioma, fibro-hemosideric sarcoma, sarcoma fusigigantiocellulare, and benign polymorphocellular tumor of the synovial membrane. Since the lesion basically combined pigmentation and villous and nodular proliferation of the synovium, and seemed to be an inflammatory process rather than a true neoplasm, it was named pigmented villonodular synovitis by Jaffe and his associates. They also described similar lesions of the burs...

Horizontal fracture of the anterior arch of the atlas.

Horizontal fracture of the anterior arch of the atlas can be easily overlooked on lateral radiographs. The fracture is not associated with neurological deficit but may be the cause of severe pain. A review of the literature reveals only 3 previously reported cases. Seven new cases, including 2 without other cervical spine fractures, indicate a much higher incidence than was previously thought. Hypotheses about the mechanism of injury are discussed.

Teratoma of the face associated with a patent canal extending into the cranial cavity (Rathke's pouch) in a three-week-old child.

Abstract A midline facial teratoid mass associated with a patent Rathkes Pouch has not been, reported previously. Such a case was encountered in a three-week-old white female who subsequently underwent surgery for repair of the facial defect. At the time of excision, the teratoma was found to connect with a passage which emitted spinal fluid. The mass had previously been shown to have its own EEG pattern, but at autopsy it had no direct neuronal connection with the brain of the infant. However, the canal opening into the anterior portion of the sphenoid bone contained extensions of the meninges and remnants of pituitary tissue.

Computed tomography in the evaluation of severe facial trauma

Computed tomography (CT) is a simple, rapid, and safe method of evaluating patients with severe facial trauma. It has its greatest value in defining the extent of soft tissue damage as well as in assessing the skeletal disruption. In a group of 32 patients with severe facial trauma, CT outlined the degree of soft tissue and skeletal fracture. In 13 of these patients who also underwent conventional pleuri-directional tomography CT was determined to be just as effective in identifying all fractures. CT was also shown to be useful for follow up evaluation of patients with previous severe facial trauma.

Complication of Unrecognized Dislocation of Charnley-Müller Hip Prosthesis: Importance of Early Roentgen Diagnosis

Subtle dislocations of Charnley-Muller total hip prosthesis may be diagnosed by noting the geometric relationship of the wire ring in the acetabular cup, which should be equidistant from the margin of the prosthetic femoral head on each side. Dislocation causes asymmetry in this relationship. A case is presented in which failure to recognize subtle early dislocation led to gross dislocation with formation of a false acetabulum.