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An impact of the endogenous intoxication on the treatment efficacy of the lower jaw fractures is not well-studied. Therefore, the aim of the present study was to examine the effect of endogenous intoxication on the dynamics of recovery from traumatic injuries of the lower jaw. Thirty-two patients with the open bilateral traumatic fracture of the lower jaw were enrolled in present study. All the patients were subjected for general blood analysis; the biochemical and hemostasis parameters and leukocyte intoxication index were also included. The patients were divided into the 3 experimental groups. Group 1 was composed of patients (26.3%) with low leukocyte intoxication index (< 1.0). The patients included into group 2 (47.4%) exhibited the index ranging from 1.0 to 1.4. For the patients included in group 3 (26.3%), this index exceeded 1.5. All the examinations were performed on day 1 after the injury and on day 5 after the reposition of fragments of the lower jaw. Thirteen patients were also examined for the macro- and microelement content and ratios in the oral fluid. We observed that due to the adverse effects of endogenous intoxication, the patient may develop the opposite reactions, including the restoration to normal values or development of sensitization of the body and tissue necrobiosis. We also found that significant changes in leukocyte intoxication index during the recovery period in all experimental groups. For example, in group 1, the leukocyte intoxication index decreased up to 0.88 ± 0.05 (p < 0.001), whereas in group 2, this index decreased up to 1.27 ± 0.04 (p < 0.001). Group 3 demonstrated a substantial decreased of this index, e.g., 2.0 ± 0.22 (p < 0.05). The precise molecular mechanisms of this phenomenon are unknown and remain to be further elucidated. We showed here for the first time that endogenous intoxication during the traumatic injuries of the lower jaw might trigger the development of sensitization or necrobiosis of the surrounding tissues, which has a significant impact on duration of the treatment and recovery period.

We report the case of a fracture healing after Ra in an 83-year-old wheelchair-bound man with prostate castration-resistant adenocarcinoma treated due to uncontrollable pain from widespread bone metastases. The patient fractured both right tibia and fibula 15 days prior to the first Ra cycle. After the first cycle, there was complete remission of his metastatic bone pain; after the second cycle, he began walking with support, which helped improve fracture healing; and after the third cycle, he presented complete mobility. Posttreatment images showed consolidated fractures. By improving metastatic bone pain with Ra, consolidation of the insufficiency fracture was possible.

We report a case of a temporal bone pneumatocele with full-thickness erosion of the cranium associated with aggressive nose blowing. This condition presented 9 years after traumatic fracture of the temporal bone. There are 17 reported cases of mastoid sinus hyperpneumatisation in the literature. Eleven of the 17 are associated with Valsalva manoeuvres or elevated middle ear pressure. However, no other cases of full-thickness erosion at the site of a former fracture have been reported. We propose that the fracture, in combination with elevated mastoid sinus pressure from aggressive nose blowing, led to escape and trapping of pressurised air in the epidural and subcutaneous spaces, which resulted in bone erosion.

Medial epicondyle entrapment after an acute fracture dislocation of the elbow is a common finding in the pediatric population, but a rare finding in adults. We present a case of an adult patient diagnosed with a traumatic fracture dislocation of the elbow joint with intra-articular entrapment of the medial epicondyle. After initial evaluation, closed reduction was done. Stability testing after reduction showed an unstable joint; thus, open reduction and internal fixation was decided.

Background Implant breakage after the fixation of traumatic fractures is rare; however, when it occurs, it is debilitating for the patients and a challenge for surgeons. The purpose of this study was to analyze and identify the independent risk factors for implant breakage of traumatic fractures treated with plate osteosynthesis. Methods We reviewed the medical records of patients with a fracture to any part of their four extremities, clavicle, hand or foot, who underwent surgical plate osteosynthesis from January 2005 to January 2015, and who sustained a subsequent implant breakage. Kaplan–Meier univariate and multivariate Cox regressions were performed to identify independent associations of potential risk factors for implant breakage in this cohort. Results We identified 168 patients who underwent plate osteosynthesis surgery and had subsequent internal fixator breakage. The mean patient age was 40.63 ± 16.71 years (range, 3 to 78 years), with 72.0% (121) males and 28.0% (47) females. The average time between surgery and implant breakage was 12.85 ± 12.42 months (range, 1 to 60 months). In the final regression model, we show that inserting screws close to the fracture line is an independent predictive risk factor for implant breakage (HR, 2.165, 95%CI, 1.227 to 3.822; P = 0.008). Conclusions We found that inserting screws close to the fracture line is related to an increased risk of internal fixator breakage in patients treated with plate osteosynthesis after fracture. Plates with additional holes likely lead to an increased risk of implant breakage, presumably because surgeons cannot resist inserting extra screws into the holes adjacent to the fracture line, which reduces the stiffness of the plate. We have addressed this problem by designing a plate without holes adjacent to the fracture line.

Traumatic deformities affect the appearance and function of lower limbs. Different type, location, and severity correspond to different manifestations. Some patients suffer from delay in treatment or improper treatment at the first time. Traumatic and infection sequelae of lower extremity are divided into the following categories: 1. Malunion after traumatic fracture 2. Bone and joint deformity caused by scar contracture 3. Bone and joint deformity caused by ischemic muscle contracture after vascular injury 4. Bone and joint deformity caused by muscle imbalance as incomplete central or peripheral nerve damage 5. Joint deformity caused by early closure of the epiphysis resulting from trauma or infection 6. Joint deformity caused by septic arthritis 7. Complex lower limb deformities caused by severe complex injuries, and so on

This letter describes a hybrid plug/compartment (HyPC) kinetic model to fit dynamic indocyanine green fluorescence data acquired in a porcine model of long bone traumatic fracture. Parametric images of periosteal blood flow, endosteal blood flow, total bone blood flow and fraction of endosteal-to-periosteal flow were obtained by applying the HyPC model on a pixel-by-pixel basis. Intraoperative discrimination between healthy and damaged bone could facilitate debridement reducing post-operative complications from non-union and infection. The ability to quantify periosteal and endosteal blood flow could inform nail vs. plate-and-screw decisions to avoid further compromising cortical blood supply.

ObjectiveTo explore the risk factors of perioperative deep vein thrombosis (DVT) in patients with traumatic fracture after orthopaedic surgery and their potential diagnostic values in clinical.DesignRetrospective cohort study.SettingClinical Laboratory of Honghui Hospital, Xi’an JiaoTong University College of Medicine, Xi’an, Shaanxi, China.Materials and methodsA retrospective cohort study was conducted with surgically treated fracture patients in Honghui Hospital from 1 May 2016 to 31 February 2017.χ2test, independent sample t test and regression analysis were applied to examine the correlation between perioperative DVT and the factors of preoperative time, fracture sites, D-dimer value and chronic diseases (hypertension, diabetes and coronary disease).Results462 patients were enrolled for analysis. The preoperative time of patients with DVT was significantly longer than that of non-DVT patients (7.14±5.51 vs 5.45±3.75) (Pχ2test showed the significant differences in the rate of DVT among patients with different fracture sites (PConclusionsFracture site was correlated to the incidence of DVT; prolonged preoperative time and increased D-dimer value were independent risk factors for DVT in patients with lower extremity traumatic fractures.

Traumatic fracture of optic canal is a severe injury to the optic nerve and often causes permanent visual loss, and it is difficult to treat. This study is to evaluate the effectiveness of decompression of optic canal by nasal endoscope. Operation of optic canal decompression was performed on 210 cases (212 sides) with traumatic fracture of optic canal. Clinical effectiveness was assessed based on improvement of visual acuity. After following up for 6 months to 2 years, visual improvement with more than one visual acuity level was observed on 101 sides (47.6%). Among them, an excellent effect (increasing 2 levels of visual acuity) was achieved on 72 sides (34.0%). Among 133 sides performed within 5 days of injury, 61 sides (45.9%) showed excellent effect (improved 2 levels of visual acuity). In contrast, when operation was performed after 5 days of injury, only 11 out of 79 sides (13.9%) showed excellent effect with improvement of 2 levels of visual acuity. And the overall effectiveness between the operations were performed within and after 5 days of injury was different significantly (P < 0.05). Therefore, endonasal endoscopic optic decompression for traumatic optic neuropathy is an effective measure for patients with traumatic optical canal fracture. Operation within 5 days of injury significantly increases the success rate.

We here with present a case of post - traumatic fracture non - union of proximal humerus with compromised rotator cuff in a 50 yrs old retired BSF jawan, who presented to our OPD with a chief complaint of pain, decreased ROM of rt.shoulder. He had an h/o previous injury following RTA on 16/2/2012 & was treated with ORIF on 25/2/2012. X - ray sh ows fracture non - union of proximal humerus with migration of humeral head relative to glenoid in superior direction, also there is acetabularisation of acromion & femoralisation of proximal humerus. MRI shows compromised rotator cuff. Both x - ray & MRI are suggestive of rotator cuff arthropathy. After, thorough investigations &rulling out any other associated co - morbidities, pre - operative planning was done to maintain gothic arch, modularity (for reestablishing normal gleno - humeral anatomic relationship), In ferior tilting of glenoid component by 15. Implant was removed & reverse shoulder arthroplasty was done. Per - operative & post - operative periods were uneventful. Patient was relieved of the symptoms and is now under follow - up.

Background Poor clinical outcomes and adverse events following orthopaedic trauma are common, which may lead to litigation. To our knowledge, factors associated with litigation following fracture care have not previously been evaluated. Methods A retrospective review of fracture-related malpractice lawsuits from 1988 to 2015 was completed utilizing VerdictSearch (ALM Media Properties), a medicolegal database. Defendant and plaintiff characteristics along with fracture type, allegations, litigation outcomes, and the association of case characteristics with outcomes were analyzed. Results A total of 561 cases were evaluated; 360 cases were excluded, resulting in a total of 201 cases that were analyzed in detail. The mean age of the plaintiff was 43.1 years (standard deviation [SD],19.4 years). Twenty-four fracture types were represented among the analyzed cases. The most common fractures were of the radius (44), the femur (32), the tibia (30), the ulna (29), the humerus (26), the spine (24), the hip (17), and the fibula (15). Overall, 129 (64.2%) cases resulted in a defense verdict, 41 (20.4%) cases resulted in a plaintiff verdict, and 31 (15.4%) cases resulted in a settlement. For plaintiff verdicts, the mean indemnity payment was $3,778,657 (median, $753,057; range, $89,943 to $27,926,311). For settlements, the mean indemnity payment was $1,097,439 (median, $547,935; range, $103,541 to $9,445,113). The mean indemnity for plaintiff verdicts was significantly greater than the mean indemnity for settlements (p = 0.03). The presence of a neurological deficit was associated with a significantly greater likelihood of a favorable outcome for the plaintiff (52.8% for plaintiffs with neurological deficit versus 32.1% for plaintiffs without neurological deficit; p = 0.019). Conclusions This study examined malpractice litigation following traumatic orthopaedic injuries. In cases with decisions for the plaintiff, indemnity payments were on average more than $2.5 million larger than payments for settlements. In fracture cases with neurological deficit, malpractice cases were more likely to result in a favorable outcome for the plaintiff.

Fat embolism syndrome is a serious consequence of fat emboli producing a distinct pattern of clinical symptoms and signs. It is most commonly associated with fractures of long bones and the pelvis. Patients usually present with signs and symptoms of multiorgan dysfunction, particularly involving the triad of lungs, brain, and skin. A combination of clinical criteria and MRI brain will enable early and accurate diagnosis of FES. Prevention, early diagnosis, and adequate symptomatic treatment are the mainstay of management. We present a case who became drowsy, after a few hours of a traumatic fracture and developed pulmonary insufficiency, cutaneous petechiae. MRI findings were consistent with cerebral fat embolism. Treatment included intensive care, artificial respiration, and symptomatic therapy. The patient had recovered completely. DOI: http://dx.doi.org/10.3329/bccj.v1i1.14370 Bangladesh Crit Care J March 2013; 1: 49-52

Traumatic fracture of the premaxilla is a rare event, and there is minimal data regarding the presentation, management, and outcome of these patients. This article reports 2 patients with bilateral cleft lip and palate who each presented with traumatic fracture and displacement of the premaxilla. To authors' knowledge, the occurrence and management of a traumatic fracture and displacement of the premaxilla in a patient with cleft lip and palate has not been reported.

Symptomatic pneumocephalus is frequently seen after traumatic fracture of the skull base bone. However, it has rarely been reported after spinal surgery and its mechanism has not been fully explained. In this paper, we present a 30 year old male patient who had lumbar discectomy due to a symptomatic midline lumbar disc herniation. He had developed symptomatic pneumocephalus after the lumbar disc surgery associated with application of a vacuum suction device. We present and discuss our patient in the light of the literatures.

SummaryTraumatic patellar fracture in cats mainly occurred in male neutered cats with an average age of four years, six months and a mean weight of 4.8 kg. Patellar fractures were concurrent with long bone fractures and cruciate ligament rupture or occurred after gunshot. The patella luxated medially or laterally in four cats. Fracture fragments were usually small, either from the proximal pole (base) or distal pole (apex) or longitudinal fragments. Treatment was by fragment excision when the fragment was small or by reconstruction with pins and wires when fractures were comminuted. The outcome in six cats was reported as ′good′ to ′normal′ and three cats were ′improving′ or had ′mild′ intermittent lameness at the last follow up.

The differential diagnosis of a fractured clavicle includes acute traumatic fracture, stress fracture, pathologic fracture secondary to radiation exposure, neoplasm, infection, or metabolic bone disease, and fracture-like conditions such as infection and bony dysplasias. An appropriate workup should identify most of these underlying conditions. We report a case of concurrent bilateral nontraumatic fractures of the clavicle occurring in a healthy young man in the absence of repetitive trauma. Workup revealed no underlying explanation for the fractures. To our knowledge, this has not been reported. Our case suggests the differential diagnosis of a fractured clavicle should be expanded to include idiopathic nontraumatic fractures.

SummaryThis case report describes a traumatic fracture of the lesser tuberosity of the humerus in a one-year-old dog. Conservative management failed to allow healing, and pronounced medial instability of the shoulder and partial rupture of the biceps brachii tendon developed. Tenodesis of the biceps brachii tendon and repair of the fractured lesser tuberosity by lag screw fixation resulted in a complete recovery of limb function.

Neurocentral synchondroses (NCS) are growth plates that contribute to the transverse growth of the vertebra. Fractures through these NCS are very rare and none have been reported in the lumbar spine. We present a rare case of a traumatic fracture through the neurocentral synchondroses of L3 vertebra in a 5-year-old child.

Key Clinical Message Traumatic fracture of the malleus handle without tympanic membrane perforation is a rare incidence. Diagnosis of conductive hearing loss can only be confirmed with manipulation of the ossicles under sedation as computerized tomography is not informative. We present a 39-year-old lady with Q-tip injury when she get sudden phone call.

Background and objectives: Celiac disease is a disease affecting the digestive system whereby the patient is unable to tolerate gluten-containing food. The aims of this study were to study the prevalence of dental defects and oral hygiene status of a group of celiac disease patients in Benghazi. Materials and methods: A group of celiac disease patients (n = 40 & Male: Female ratio is 1: 2.4 & age range 3-19 years, mean 10 years, SD ± 4.8) were recruited from Benghazi Pediatric Hospital where they had already been diagnosed in gastroenterology units at private clinics. The patient’s dental status was assessed through measuring their Decayed, Missing and Filled Teeth index (DMFT), oral hygiene index (OHI) and CPITN using disposable mouth mirrors, explorers and periodontal probes. Descriptive statistics was applied to give a picture about the oral hard and soft tissue prevalence this group of patients. Results: Descriptive statistics of the celiac sample showed that 29 (72.5%) had enamel hypoplastic defects. The mean and SD values for DMFT, CPITN and OHI were measured (DMFT: 4.5 SD ± 4.7 & CPITN: 0.8 SD ± 0.5; and OHI: 1.1 SD ± 0.7). Besides, only two patients (6.4%) reported a history of oral ulceration during the course of their therapy. Healthy controls showed comparative values, being less in only OHI, while they were slightly more in DMFT and CPITN. Conclusion: This is a cross-sectional clinical survey showing that patients with celiac disorder should be expected to have higher prevalence of defective incisor teeth, which makes their front teeth liable to traumatic fracture. The presence of frequent soft tissue ulcers in their mouths might indicate a warning sign of the possibility to develop the disease and thus urge the child’s parents or guardians to consult a physician to confirm or negate the suspicion.

We describe two cases of avascular necrosis after traumatic fracture of the femoral neck. The size and signal intensity of the necrotic areas changed on follow-up magnetic resonance images. Magnetic resonance imaging is suitable for showing resolvable changes that radiographic study cannot demonstrate during the clinical course.

Stress fractures occur due to repetitive forces on the bones and develop over time. The etiology differs from a traumatic fracture and therefore stress fractures are more an overload injury. Stress fractures of the foot and ankle are frequently seen in athletes and can be a potentially career ending injury for these high demanding sportsmen. Some locations are considered as high-risk stress fractures due to slow healing and high rates of non-unions. This article discusses the most common sites for stress fractures of the foot and ankle, the risks and evidence on best treatment options.

Complete traumatic fracture-dislocation of the lumbar spine is a rare spinal injury often leading to death. Surgical intervention is an effective treatment modality to decrease mortality. Our patient was a 16 year old boy who had a collision caused by fall from a construction material lifter. He was referred to our hospital with waist trauma. Later, the patient underwent posterior surgical decompression during which vertebral column restoration by long segment fixation was performed. After surgery there were no significant changes in the patient condition.

The implantation of massive allografts is a reconstruction alternative after limb salvage for aggressive bone tumours. It is hoped that durable long-term results can be obtained with these biological reconstructions. Revitalization of the allografts is one of the most important factors with regard to durability. One massive proximal femoral osteoarticular allograft is described that was followed up for 22 years. Twenty-one years after the implantation, a traumatic fracture in the middle of the allograft occurred, and formation of massive callus showed that revitalization even in the central parts of massive allografts is sufficient for fracture healing. This is why it may be justified to expect long-lasting results.

Background Acrobatic Gymnastics is a competitive discipline where gymnasts work together, perform acrobatic moves, dance and tumbling. Objective Investigate the prevalence of musculoskeletal (MS) disorders in former gymnasts. Design Survey of MS disorders (past and present), sent to former gymnasts. Setting This study included former gymnasts. Participants Retired gymnasts of national teams (n=200) and clubs (n=390) from all over the world (16 countries, 4 continents); 612 responders, 590 included according to the inclusion criteria. Interventions The survey included questions on country, gender, position, years of practice, hours of training/week and competition level, as well as medical information: reason for stopping practice (medical/nonmedical, specify the problem), injuries during practice years, present impact in daily life. Main Outcome Measurements Proportion (%) who stopped practicing as a consequence of a serious MS injury. Proportion (%) having any current MS disorder. Pre-specified analysis of relationship between training hours/week, competition level, position and % with current MS disorders in the present. Results Of 590 gymnasts, 294 (50%) reported having suffered a training injury, while 166 (28%) reported still having current medical problems as result of these. A total of 131 gymnasts (22%) reported having stopped practicing because of a medical problem and 121 (21%) reported having a current MS disorder. The most common injury was a traumatic fracture (n=125), most commonly affecting the knee (n=74) and ankle/foot (n=73). As a consequence of the training period, the most common current problems were spine pathology (n=43) and tendinopathies(n=38). Concerning actual symptoms, 402 (68%) reported low back pain, 320 (54%) knee and 219 (37%) shoulder disorders. Conclusions This is the first study of former gymnasts, allowing us to evaluate the impact of training on the future life quality of the athletes, to identify the most frequent injuries, as well as those with the greatest impact. This may lead to improvements in the treatment of acute injuries, as well as to monitor the level and quality of training, to prevent and also to rehabilitate injuries.

Intra-articular injections of the elbow can be performed in the treatment of a variety of pathological conditions.

SummaryAcute traumatic fracture of the me-dial coronoid process occurred in two adult dogs. The fracture was the sole injury in one dog, but was associated with further elbow trauma in the other. Surgical removal of the fractured portion of medial coronoid process resulted in a rapid return to normal elbow function which was sustained on long-term follow-up. Radiographs showed some osteophyte formation within the elbow joints at one year postoperatively. Two years later, repeat radiography of the elbow of one of the dogs did not show any further osteophyte production. In contrast, the surgical removal of fragmented coronoid processes frequently results in continuing lameness, reduced range of elbow movement and progressive osteoarthritis.Removal of a traumatically fractured portion of the medial coronoid process in two adult dogs resulted in a rapid return to soundness. Elbow function in both dogs remained normal on long-term follow-up.

This article describes an osteolytic odontogenetic lesion found on the mandible of a Neanderthal from the Middle Paleolithic site of Riparo Mezzena near the city of Verona (Italy). A pathology was revealed through X-ray and computerized-tomodensitometric examinations. This lesion was compared to present and sub-contemporary populations and indicates that it may have been of infectious origin, resulting from a bacterial invasion of the root canal of a coronal pulp exposure. The bacterial contamination may have resulted either from a traumatic fracture, a cavity, or extensive wear on the tooth.; Cet article présente une lésion ostéolitique odontogène observée sur la mandibule d'un fossile Néandertalien provenant du site Paléolithique moyen de Riparo Mezzena, près de la ville de Vérone en Italie. Cette pathologie a été mise en évidence par des examens radiologiques et tomodensitométriques. Par comparaison avec une lésion d'aspect similaire chez un patient actuel, l'étiologie de cette pathologie semble être d'ordre infectieux. Elle serait, sans doute, due à une invasion bactérienne de la cavité pulpaire à partir de la surface occlusale, par suite de la cassure accidentelle de la dent, ou d'une carie, ou encore d'une très forte abrasion.

Tibial plateau fracture: mathematical model to correlate agent force trauma The upper tibial extremity is in the midlle of inferior limb and coresponds aproximately to the upper quarter of the shank. Diafizo metafizar quarter segment of the upper tibia assure the conection between massive epifizar in four angles and triangular diaphysis section. In all cases, will be trying to mention trauma mechanism to allow such research orientation and direction demands resulting from this fracture topographies, where the chorus flows associated ligament injuries. Research ligament injuries should be charged with two kinds of etiologies: ligament injuries induced fractures or ligament injuries induced mechanism. As a general rule, ligament injuries induced fracture alters a lesser extent than the prognosis of ligament injuries induced even by mechanism This paper proposes an power matching agent against the traumatic fracture type and it produces cross ligaments through creation of a mathematical model to answer two of the above questions:-Ligament injuries are caused by fractures or does this happen? -Ligament injury may be stage-based mechanism?

Fractures of pelvic ring are the result of high-energy trauma and they can be treated surgically with external or internal fixation. Traumatic fracture dislocation of S1 vertebra can be stabilised effectively with spinal instrumentation. Combined pelvic ring disruption with fracture-olisthesis of S1 is reported to be very uncommon and challenging to treat. We present a patient with such an unstable injury pattern and the surgical treatment in one stage procedure he underwent.

OBJETIVO: Avaliar o resultado da reconstrução do ligamento cruzado anterior (LCA) com o autoenxerto dos tendões flexores da coxa. Serão analisados os dados com relação ao sexo, ao índice de massa corporal (IMC) e a associação com fratura no membro inferior (MI). MÉTODOS: Foi analisado um grupo de 265 pacientes submetidos à artroscopia do joelho para fins de reconstrução do LCA com enxerto ipsilateral dos tendões flexores da coxa no período de 6 de julho de 2000 a 19 de novembro de 2007. RESULTADOS: 176 pacientes foram avaliados com média de 34,95 ± 18,8 meses (mediana 31 meses) (IIQ: 20-48 meses). A avaliação mínima foi aos 12 meses e a máxima aos 87 meses. Obtivemos 138 (78,4%) pacientes com resultado excelente, 22 (12,5%) com resultado bom, oito (4,5%) com resultado regular e oito (4,5%) pacientes apresentaram resultado ruim. Não foi considerada significativa a maior incidência de bons e excelentes resultados para o sexo masculino (p = 0,128), para os pacientes com IMC < 25 (p = 0,848) e para os pacientes sem a lesão do LCA relacionada a episódio inicial traumático com fratura no MI (p = 0,656). CONCLUSÕES: A técnica de reconstrução do LCA com o autoenxerto dos tendões flexores da coxa demonstrou bons e excelentes resultados em 91,4% da amostra. O sexo masculino parece apresentar tendência maior a bons e excelentes resultados. Não observou-se diferença estatisticamente significativa quando foram analisados os resultados com relação ao IMC e a associação com episódio inicial traumático de fratura no MI. OBJETIVE: To evaluate the results of single band arthroscopic anterior cruciate ligament (ACL) reconstruction with flexor tendon autografts. We analyzed data about sex, body mass index (BMI) and lower limb fracture associated with the initial trauma. METHODS: Two hundred and sixty-five patients who underwent arthroscopic anterior cruciate ligament (ACL) reconstruction with ipsilateral thigh flexor tendon autografts from July 6, 2000, to November 19, 2007, were evaluated. RESULTS: One hundred and seventy-six patients were evaluated at an average follow up time of 34.95 ± 18.8 months (Median 31 months) (IIQ: 20 - 48 months). The minimum evaluation time was 12 months and the maximum 87 months. One hundred and thirty-eight (78.4%) patients had excellent results, 22 (12.5%) patients good, 8 (4.5%) patients fair, and 8 (4.5%) poor results. No statistical significance was found for the better results for males (p = 0.128), for patients with a BMI < 25 (p = 0.848), or for patients with ACL trauma unrelated to a fracture of the lower limb (p = 0.656). CONCLUSION: ACL reconstruction with ipsilateral thigh flexor tendon autografts showed good and excellent results in 91.4% of the patients. Male patients appear to obtain better results. No statistical difference was found when the results were analyzed in relation to BMI or association with an initial traumatic fracture that tore the ACL.

SummaryIn the dog, the pelvis is frequently injured following motor vehicle accidents (1). Injuries to the lower urinary and intestinal tracts may accompany pelvic fractures in man (2, 3, 4, 5) and the dog (1, 6, 7). This paper describes an unsual case of bladder retroflexion and herniation through a tear, into the rectum of a dog, following traumatic fracture of the pelvis. The successful management and repair is outlined and a biomechanical sequence leading to the abnormal bladder position is proposed.An unusual case of bladder retroflexion and herniation through a tear, into the rectum of a dog, following traumatic fracture of the pelvis is described. Repair was accomplished by manipulation of the bladder into its normal position through a coeliotomy incision and suturing of the rectal tear after prolapsing the rectum through the anus. The proposed biomechanical sequence leading to this injury is tearing by the inwardly rotated, fractured left hemipelvis as well as or alternatively, shearing forces along lines of excessive tension.

Entre un tercio y la mitad de los riñones en herradura son asintomáticos y se diagnostican incidentalmente. Esta anomalía congénita de fusión se ha mostrado como condición predisponente a la lesión renal ante un traumatismo abdominal, aunque con frecuencia el grado de afectación renal no precise cirugía. Más excepcional es el hallazgo de fractura de riñón en herradura, requiriéndose un estudio diagnóstico completo para un manejo adecuado a sus características cuando la cirugía está indicada. Se aporta el caso de un varón de 15 años con riñón en herradura no previamente conocido, que presentó una fractura de localización atípica polar superior y mesorrenal derecha, tras un traumatismo abdominal de baja intensidad. El correcto diagnóstico prequirúrgico permitió una cirugía diferida con preservación del polo renal inferior derecho y del istmo del riñón en herradura. Las características del trauma, la desproporción de la repercusión clínica y la búsqueda de posibles anomalías congénitas asociadas y de signos radiológicos compatibles, pueden orientar esta rara posibilidad diagnóstica, confirmándose el TAC con contraste como la mejor prueba de imagen.

The case of a fracture of the clivus in a 10-year-old boy following a road traffic accident is reported. He also suffered a contusion of the cerebellar vermis and the management dilemma in this case is highlighted. Fracture of the clivus in a child is extremely rare; this is the second reported case and the first reported with survival.

Two patients had fracture of a flexible, open-loop, anterior chamber intraocular lens (IOL) caused by ocular trauma. Case 1 was a 78-year-old woman with a three-point-fixation IOL. The two portions of the fractured lens were removed from the anterior chamber. Visual acuity at 10 months postoperatively was hand motion as a result of corneal decompensation. Case 2 was a 36-year-old man with a four-point-fixation IOL that broke and dislocated into the vitreous. A pars plana vitrectomy was performed; the two lens portions were removed and exchanged with a sutured posterior chamber lens. Best corrected visual acuity 4 months postoperatively was 20/20. In both cases, the lens fracture took place at the loop-optic junction and with minimal visible damage to the eye structures.

A case is reported of traumatic fracture and non-union in a patient with isolated distal symphalangism of unusual distribution.

Activated recombinant coagulation factor VII (rFVIIa) effectively prevents and controls bleeding in patients with coagulopathy. Data show that rFVIIa may reduce blood loss and eliminate the need for transfusion in patients with normal haemostasis undergoing major surgery. We assessed the efficacy of rFVIIa in patients with normal haemostasis undergoing repair surgery of major traumatic fracture of the pelvis or the pelvis and acetabulum, who were expected to have a large volume of blood loss.

Fracture of the pancreas is a rare injury caused by blunt abdominal trauma. Abdominal CT is probably the best modality for the detection of this uncommon injury. Ultrasonography is excellent for demonstrating an accompanying pseudocyst, but it is otherwise considered less effective than CT in the evaluation of pancreatic trauma. We report a case where we were able to demonstrate a fracture through the body of the pancreas along with disruption of the pancreatic duct, using a conventional ultrasound scanner.

Although many renal transplant recipients are protective of their grafts and often express concern about the possibility of traumatic injury, such injury has been reported only rarely. We describe a case report of a boy who sustained an injury to his renal allograft after a bicycle accident. Despite a dramatic anatomic abnormality seen on magnetic resonance imaging, he suffered only minor and self-limited symptomatic and clinical consequences. We reviewed the literature addressing traumatic injuries affecting renal allografts. The long-term consequences of such injuries on allograft function and survival are unknown.

A case of a 27 year old man who developed anemia after fracture of the sella turcica is reported. The diagnosis of anterior pituitary insufficiency was made by a combined provocative test with TRH, LHRH, and insulin. The anemia was characterized by a hypocellular bone marrow which appeared to be functioning only in the thoracic-lumbar vertebrae, an absence of measurable erythropoietic activity, and by the return to normal of the hematological findings after hormonal replacement therapy. This patient had the highly unusual combination of proven panhypopituitarism and significant anemia resulting from a distinct fracture of the sella turcica.

An economically and structurally conservative restoration procedure that also provides optimal esthetic quality is discussed.

Accidental blunt trauma to a pseudophakic eye fractured the Choyce-style lens which had been implanted 11 months previously. This lens was removed, and its fracture was examined microscopically and duplicated experimentally using a torque-loading force and a shock-loading force. The nature and occurrence of lens fracture in situ depends on the direction of trauma.

Seven cases of traumatic fracture dislocation of the hip treated by open reduction were reported.The most frequent complications were avascular necrosis and osteoarthritis.The treatment should be indicated to avoid these complications, for this reason weight-bearing should be avoided for 3 or 4 months after the operation.

The substances most commonly used in the repair of defects of the skull are autogenous bone, sheet tantalum, and plastics of various kinds. All have certain disadvantages. Bone, whether from rib or iliac crest, is difficult to shape into the proper contours; moreover, even autogenous bone grafts sometimes fail to unite, and may then be absorbed. Tantalum, in many ways a satisfactory alloplastic material, is impervious to diagnostic roentgen rays and this can be inconvenient when neuroradiological investigation is needed later. Zirconium, which was recommended for cranioplasty and other purposes by Bates et al., 1 apparently has the same disadvantage, although it is considerably lighter than tantalum. The plastics now in use in this country are chiefly of the acrylic group, and with careful technique these substances give good cosmetic results. However, there has been at least one report of traumatic fracture of a plastic insert, 4 and experiment has shown that an acrylic plate must be at least as thick as the skull if it is to give comparable protection; when the skull is thin, it is indeed quite difficult to mould a plate that will be strong enough, yet not palpable subcutaneously. Titanium, a light (atomic No. ~) metal, is frequently used for implants in orthopaedic surgery. As a material for cranioplasty, it has certain advantages which have appeared to justify its use, though it is by no means an ideal substance. It is well tolerated by the tissues; 3 recent spectrographic studies 2 show that, like vitaltium, a titanium implant undergoes very slight electro

There was a partial thickness laceration of the right cornea at the junction of the middle and lower thirds extending in an irregular horizontal line from side to side. From the depth of this laceration the cornea was split to the lower limbus and in the lamellar pocket so formed were embedded multiple fragments of a shattered corneal contact lens. At no point did this lamellar laceration penetrate the full thickness of the cornea. Above this wound and towards the nasal side of the cornea was a smaller, partial thickness laceration of the cornea, also containing fragments of contact lens and again not penetrating the full thickness of the cornea. There was also an irregular conjunctival laceration temporal to the limbus and a small hyphaema. There were also multiple lacerations of the eyelids and face most of which contained fragments of shattered windscreen. The left eye was uninjured.

Spondylolysis is a defect in the bony portion of the posterior neural arch of a vertebra [1]. It occurs in the pars intenarticulanis between the superior and inferior articulan facets and, if bilateral, separates the vertebral body from its posterior fixation. Such breaks may cause a spondyioiisthesis, a forward slipping of the affected vertebral body oven the one below. Some investigators believe that spondylolysis is a congenital defect, citing a higher incidence in Eskimos [2] and other ethnic groups. However, most now believe the defect to be a traumatic fracture [3]. The occurrence of spondylolysis with acute and other types of trauma [4], and as a result of a stress fracture [5] advancing to complete fracture, has been documented in numerous articles [3]. It has been theorized that a genetic predisposition to fracture exists in some persons [6]. Although healing of the pans intenarticulanis defect (fracture spondyiolysis) has occasionally been reported [7, 8], it appears to be quite uncommon, perhaps because immobilization of the spine and/on surgical fixation is difficult and, in most cases, not warranted. Despite the plethora of reports on spondyiolysis, few details of the soft tissues surrounding the bony defects are known. In our patient a capsule continuous with that of the apophyseal joint may be present.