Absence Of Bony Injury Research Articles

Utilization and timing of surgical intervention for central cord syndrome in the United States.

Retrospective cohort analysis. CCS is the most common type of incomplete spinal cord injury and can occur without or with bony injury. Surgical intervention and its timing for patients diagnosed with CCS has been controversial. The current study assessed utilization of and factors associated with operative intervention and its timing in patients diagnosed with central cord syndrome (CCS) in the absence of bony injury. Adult patients diagnosed with CCS in the absence of vertebral fracture were queried from the national, multi-insurance, administrative 2015-2020 M151 PearlDiver database. The incidence, trends, and timing of operative intervention following CCS were assessed. Patient characteristics associated with surgical intervention and its timing were determined. From 2015 to 2020, 11,653 patients meeting inclusion criteria were identified, of which surgical intervention was identified for 2,003 (17.2%) and thus nonsurgical intervention for 9,650 (82.8%). The proportion of patients undergoing operative intervention evolved from 11.5% in 2015 to 19.7% in 2020 (p < 0.0001). Of those undergoing surgical intervention, the greatest increase was seen for those undergoing surgery within two days of diagnosis (5.5% in 2015 to 12.3% in 2020, p < 0.0001). On multivariable analysis, more recent year of service, region of service, younger age, and higher comorbidity burden were independent predictors of operative management (p < 0.05 for all). The majority of a large cohort of patients with first diagnosis CCS in the absence of bony injury were managed non-operatively. Operative management increased over the years of study, were performed earlier after diagnosis, and varied based on patient characteristic and geographic region.

A Prospective Study of Surgical Outcomes and Quality of Life in Severe Foot Trauma and Associated Compartment Syndrome After Fasciotomy

The purpose of the present prospective study was to analyze the predictors of outcome and review the quality of life of patients who underwent emergency fasciotomy for foot compartment syndrome after blunt trauma. A total of 14 patients were identified and followed for an average of 24 (range 14 to 33) months. The mean interval from initial presentation to decompressive fasciotomy was 5.8 (range 3 to 11) hours. The follow-up data from our patients revealed satisfactory functional and quality of life outcomes, with 11 of 14 (78.6%) able to return to work. Two (14.3%) patients developed claw-toe deformities and 3 (21.4%) patients had sensory deficits directly attributed to compartment syndrome. Finally, 4 (28.6%) patients required modified shoes or shoe inserts for comfortable ambulation. Our findings suggest that earlier fasciotomy results in better quality of life scores, American Orthopaedic Foot and Ankle Society scale scores, and visual analog scale pain scores and a greater likelihood of being able to wear all shoes comfortably, ambulate independently, and return to work. A shorter interval to fasciotomy, younger age, the absence of bony injury, the absence of other concomitant injuries, and a low velocity crush injury all tended to be predictors of good outcomes at the final review.

Traumatic Pediatric Pneumorachis

Case report. To report on a case of traumatic pneumorachis in a child and to review the existing literature. Pneumorachis, the presence of air in the spinal canal, is an extremely rare finding. It may be caused by diverse pathologies such as incidental durotomy, barotrauma, pneumothorax, and trauma. In the polytrauma patient, it may be an indication of an occult spinal fracture. The case of a 15-year old with complete paraplegia presenting with pneumorachis is presented. The initial computed tomography scan showed air in the spinal canal as well as surrounding subpleural and intramuscular spaces. However, there was near normal vertebral alignment with no fractures seen. Magnetic resonance imaging taken after the patient was stabilized showed a complete transaction of the spine at T3-T4 with ligamentous injury. A posterior instrumentation and fusion was performed. In the pediatric patient presenting with neurologic deficits and pneumorachis, ligamentous injury of the spine, even in the absence of bony injury, should be suspected.

Kompartment-Syndrom nach Stoßstangen-Anpralltrauma

A 67-year-old woman, having been hit in the lower leg by a car bumper in a road accident, developed a compartment syndrome in the lower leg without any bone injury. In the following weeks typical contractures of the affected muscles occurred with talipes equinus and clawfoot deformities. In addition there developed insertion tendinitis of the affected muscle groups of the anterior tibia. A year later magnetic resonance imaging (with normal radiological findings) revealed fatty degeneration and muscle fibrosis. The patient complained of pain at rest and on movement in the proximal tibia, and there was definite pain on pressure over the proximal end of the tibia. Conservative treatment having failed, the Achilles tendon and the long flexor muscle of the toes were lengthened by operation. Both signs and symptoms then improved. A compartment syndrome may develop after blunt trauma even in the absence of bony injury. If there are the appropriate clinical signs, intracompartmental pressure measurement is the procedure of choice to confirm the diagnosis quickly and thus avoid sequelae.

Cervical Spine Fracture-Dislocation Birth Injury

Spinal cord birth injury is rare, and orthopaedic surgeons infrequently encounter it. The injury is associated with hyperextension of the fetal head in utero and during delivery and with forceps-assisted breech vaginal deliveries. These cervical spinal cord injures may be complete or partial. They most commonly occur in the absence of bony injury, which can lead to diagnostic difficulties. Ultrasound and MRI studies are valuable diagnostic tools for identifying spinal cord injury in cases of hypotonic newborns with difficult deliveries. The authors report an unusual case of spinal cord birth injury with frank cervical fracture-dislocation following a difficult footling breech vaginal delivery. Early recognition of hyperextension of the fetal head in utero and planned cesarean section are important prevention methods. While this type of injury is rare, the pediatric orthopedic surgeon must understand its nature and severity to facilitate timely treatment.

Pediatric cervical spine injuries: Defining the disease

Background/Purpose: Pediatric cervical spine injuries are uncommon. Most previous studies have been hampered by the small number of patients available for evaluation. The purpose of this study is to determine the incidence and characteristics of pediatric cervical spine injury utilizing a multiinstitutional pediatric trauma database, and to assess the impact of age and level of spine injury on mortality rate. Methods: All children with cervical spine injury entered into the National Pediatric Trauma Registry over a consecutive 10-year period were identified. Patients were stratified by age, mortality, presence or absence of bony injury, level of cervical spine injury, and presence of neurologic deficit. Data were analyzed utilizing Student's t test for continuous variables and χ2 analysis for categorical variables. Statistical significance was accepted at the P less than.05 level. Results: From a database of 75,172 injured children, 1,098 were identified with cervical spine injury, overall incidence 1.5%. The mean age of the study group was 11 ± 5 years, and 61% were boys. Nine hundred eight children (83%) had bony spine injury. Distribution of bony injury among upper cervical spine, lower cervical spine, or both was 52%, 28%, and 7%, respectively. The remaining 13% comprised unspecified levels of injury. Upper cervical spine injuries were prevalent among all age groups (42%, age ≤ 8; 58%, age > 8), whereas lower spine injuries predominated in older children (85%, age > 8). One third of children in the study group had neurologic injury, and half of these had no radiographic evidence of bony injury. Ninety-four children (24%) had a complete cord injury, and the remaining 76% had an incomplete spinal cord injury. One hundred eleven children (23%) with upper spine injury died compared with 11 children (4%) with lower spine injury. Mortality rate was highest (48%) in those with atlanto-occipital dislocation. Conclusions: From this, the largest experience with pediatric cervical spine injury, several conclusions can be drawn. (1) Cervical spine injury occurs in 1.5% of injured children. (2) Upper cervical spine injuries are not limited to younger children but are equally prevalent in both age groups. (3) Associated mortality rate is nearly 6-fold higher in patients with upper cervical injury. (4) Seventeen percent of children with cervical spine trauma show no radiologic anomaly, yet 50% of children with cervical spinal cord injury have no initial radiologic abnormalities. (5) Of those in whom cervical spine injury is associated with a neurologic deficit, the deficit is complete in 24% of children. J Pediatr Surg 36:373-376. Copyright © 2001 by W.B. Saunders Company.

Subclavian artery rupture (An unusual seat-belt injury)

A case of blunt injury to the subclavian artery in the absence of bony injury or dislocation sustained while wearing a seat belt is described. Its rarity and diagnostic pitfalls are discussed. The mechanism of the injury is analysed. The value of angiography is emphasized. It is suggested that, even in the presence of collateral circulation, exploration and repair should be undertaken.