Prior History Of Trauma Research Articles

Palisaded encapsulated neuroma clinically mimicking a mucocele: report of a case

ABSTRACT We report the case of a 21-year-old female patient with the chief complaint of a small tumor on the lower left lip. Intraoral examination revealed a two-month evolution nodular lesion on the left labial mucosa, of resilient consistency and asymptomatic. A history of prior trauma was reported by the patient. A provisional diagnosis of mucocele was established, and an excisional biopsy was performed. The diagnosis was palisaded encapsulated neuroma (PEN). As PEN is considered underdiagnosed by many authors, a discussion on the morphologic diagnostic criteria of this lesion will be provided.

Isolated abducens palsy of advanced age: a rare presentation of dural carotid cavernous fistula: a case report

Abducens palsy is the most common isolated cranial nerve palsy due to its long peripheral course. Multiple anatomical relationships, particularly within the cavernous sinus and orbita, make the nerve vulnerable. 67 year-old female patient was admitted with worsened headache and lateral gaze restriction of the left eye, which appeared recently. She had no prior history of trauma. Prominent appearance of the left cavernous sinus on cranial magnetic resonance imaging, raised the need of digital substraction angiography which revealed the presence of bilateral type D dural arteriovenous fistula of cavernous sinuses. Cavernous sinus pathologies, which are usually known to manifest with multiple ocular motor palsies because of the close relationship between 3rd, 4th and 6th nerves inside, might rarely present with isolated abducens palsy. The clinician should pay particular attention to headache in such kind of patients and dural carotid-cavernous fistula should be taken into account, even in the absence of previous trauma history.

Anteromedial temporal encephalocele: A rare cause for spontaneous cerebrospinal fluid rhinorrhoea

Spontaneous cerebrospinal fluid (CSF) rhinorrhea in an adult without prior history of head trauma is a rare occurrence. Neuroimaging is done to ascertain the site of bony defects in the cranium and breach in the continuity of dura to localize the site of CSF leakage. Encephaloceles into the sphenoid sinus occurring through congenital bony defects in the walls of the sinus are an extremely rare cause for CSF rhinorrhea. We present a case of spontaneous, nontraumatic CSF rhinorrhea due to an anteromedial encephalocele where the temporal lobe was seen herniating into the right sphenoid sinus through a congenital bony defect in the wall of the sinus. A review of the present literature is also presented.

Clinical profile of patients with ACL deficiency

Introduction: Anterior cruciate ligament is a very commonly involved ligament in contact sports injuries where pivoting of the knee involved and as modern sport is being more competitive, complex knee injury patterns are being recognized. With an incidence of 35 out of 100,000 and a two to three times higher risk of injury for females. Methodology: All 20 to 40 yr. Aged patients presented with unilateral knee pain, instability and prior history of trauma to the knee in the orthopedics out-patient department of super specialty hospital, were evaluated by a thorough general and local clinical examination of the knee. Results: The total of 19 cases (n=19) (63.3%) of the right knees were involved and 11 (n=11) (36.7%) of the left knee were involved in our study. Conclusion: The ratio of right knee to left knee involved in ACL injury was 1.72: 1. There were no bilateral cases in our study.

Congenital Peritoneal Band Causing Bowel Ischaemia Post Caesarean Section: A Rare Occurrence

Congenital peritoneal band is an extremely rare condition, but may induce small bowel obstruction (SBO) at any age, predominantly in childhood and rarely in adults. We report a case of extensive bowel ischaemia following caesarean section, due to trapping of an intestinal loop between a congenital peritoneal band and the mesentery. A 42-year-old, Gravida 2 Para 1, who has no history of prior abdominal surgery or trauma, presented in spontaneous labour and underwent an uncomplicated emergency lower segment caesarean section, for fetal distress. Postoperatively, she had worsening abdominal distension and pain, followed by vomiting. Computed Tomography Scan of the abdomen showed gross fluid retention with marked small bowel dilatation and fluid filled bowel loops. An emergency exploratory laparotomy was performed which revealed a congenital band, extending between the right fimbrial end and the small bowel mesentery, looping over the small bowel, causing extensive small bowel ischemia. Postoperative course was uneventful. In conclusion, congenital peritoneal band causing small bowel obstruction, although rare, should be considered in the differential, especially for patients with virgin abdomen.

Traumatic Anterior Cruciate Ligament (ACL) Rupture from Muaythai Kickboxing: A Case Report

A 30-year-old female Muaythai boxer presented with a 48 hour history of instability and acute pain in her right knee after hearing a �pop�. There was no prior history of trauma. On the previous day, she had been training in Muaythai, specifically, clinching and knee-sparring, a common activity as part of fighter training. X-ray showed no acute fracture and only small suprapatellar joint effusion. Initial clinical examination was performed by a licensed physical therapist/certified athletic trainer with board specialties in orthopedics and sports.

Traumatic Anterior Cruciate Ligament (ACL) Rupture from Muaythai Kickboxing: A Case Report

A 30-year-old female Muaythai boxer presented with a 48 hour history of instability and acute pain in her right knee after hearing a pop. There was no prior history of trauma. On the previous day, she had been training in Muaythai, specifically, clinching and knee-sparring, a common activity as part of fighter training. X-ray showed no acute fracture and only small suprapatellar joint effusion. Initial clinical examination was performed by a licensed physical therapist/certified athletic trainer with board specialties in orthopedics and sports.

Trauma and PTSD in the WHO World Mental Health Surveys

ABSTRACTBackground: Although post-traumatic stress disorder (PTSD) onset-persistence is thought to vary significantly by trauma type, most epidemiological surveys are incapable of assessing this because they evaluate lifetime PTSD only for traumas nominated by respondents as their ‘worst.’Objective: To review research on associations of trauma type with PTSD in the WHO World Mental Health (WMH) surveys, a series of epidemiological surveys that obtained representative data on trauma-specific PTSD.Method: WMH Surveys in 24 countries (n = 68,894) assessed 29 lifetime traumas and evaluated PTSD twice for each respondent: once for the ‘worst’ lifetime trauma and separately for a randomly-selected trauma with weighting to adjust for individual differences in trauma exposures. PTSD onset-persistence was evaluated with the WHO Composite International Diagnostic Interview.Results: In total, 70.4% of respondents experienced lifetime traumas, with exposure averaging 3.2 traumas per capita. Substantial between-trauma differences were found in PTSD onset but less in persistence. Traumas involving interpersonal violence had highest risk. Burden of PTSD, determined by multiplying trauma prevalence by trauma-specific PTSD risk and persistence, was 77.7 person-years/100 respondents. The trauma types with highest proportions of this burden were rape (13.1%), other sexual assault (15.1%), being stalked (9.8%), and unexpected death of a loved one (11.6%). The first three of these four represent relatively uncommon traumas with high PTSD risk and the last a very common trauma with low PTSD risk. The broad category of intimate partner sexual violence accounted for nearly 42.7% of all person-years with PTSD. Prior trauma history predicted both future trauma exposure and future PTSD risk.Conclusions: Trauma exposure is common throughout the world, unequally distributed, and differential across trauma types with respect to PTSD risk. Although a substantial minority of PTSD cases remits within months after onset, mean symptom duration is considerably longer than previously recognized.

Incidentally Detected Renal Arteriovenous Malformation: A Case Report and Review of the Literature

Renal arteriovenous malformations and fistula are an uncommon, underdiagnosed condition that can be asymptomatic. However, there is a real risk of rupture and severe bleeding. Imaging techniques have a critical role in planning the treatment. Arteriography is the gold standard but is invasive. Diagnostic selective arteriography can be followed by embolisation of the lesion during the same procedure. Although invasive, because of the potential risk for rupture, arteriography is the elective technique when intervention is planned. We report a rare case of an adult male patient incidentally diagnosed with arteriovenous malformation. Since he had no prior history of renal intervention or trauma, a diagnosis of idiopathic renal arteriovenous malformation was made. We describe the computed tomography findings and management outcome. This asymptomatic, though potentially lethal, condition can be treated with minimally invasive methods.

Benign or Malignant: A Case Report of Multifocal Epithelioid Hemangioma of Fibula

Case Presentations: A 63-year-old female with no significant prior trauma and relevant past medical history presented with a 2-month history of severe, persistent, gradually worsening, sharp and non-radiating pain over her left distal fibula. Physical examination revealed extreme tenderness to palpation over the lateral distal fibula. There was soft tissue prominence over the mid to lower third of the fibula. Results: Left lower leg radiographs depicted two ill-defined osteolytic destructive lesions measuring 29 and 37 mm in length in the fibular diaphysis. A pathologic fracture was present through the distal lesion. A laboratory test, including serum protein electrophoresis, alkaline phosphatase and basic metabolic profile, was ordered to evaluate for multiple myeloma. CT scans of the chest and abdomen were obtained to evaluate for primary malignancy or any evidence of metastatic disease. The results of these tests were unremarkable. Image-guided biopsy of the lesions was performed and revealed epithelioid hemangioma (EH). The patient was initially managed with a walker boot. At the 2-month follow-up, an additional third smaller lesion was detected along with an interval increase in size of the two previously seen lesions. The patient proceed with preoperative embolization followed by surgical curettage and open reduction and internal fixation. Angiogram was done and tumor feeding artery was identified but tumor embolization was unsuccessful. The patient underwent fibular bone lesion curettage, PRO-DENSE bone grafting and open reduction and internal fixation with the left fibular diaphyseal plate. Radiographs revealed continued healing with bone graft incorporation at 1.5-, 3- and 7-month follow-ups. The patient was permitted to return to all activities without restriction 1.5 months after the surgery. Conclusions: EH is an uncommon, slow-growing vascular tumor that generally presents on the skin and the subcutaneous soft tissues of the head, with osseous EHs being rare. Although osseous EHs can present as multifocal lesions, the majority of bony EHs are solitary and arise in the diaphysis or metaphysis of long tubular bones, with a predilection for the lower extremity. Radiographically, EH may present as well-defined lytic lesions with sclerotic margins or mixed lytic and sclerotic lesions. These lesions are often located eccentrically and may demonstrate a disrupted or intact cortex.

Evisceration and ocular tumors: What are the consequences?

Evisceration can be performed for blind, painful eyes. This surgery can promote the dissemination of tumor cells within the orbit if an ocular tumor has been missed preoperatively. We reviewed the medical records of patients who were eviscerated for blind, painful eyes between 2009 and 2014 and who were referred after the surgery to the Institut Curie or the Rothschild Foundation in Paris. We included the patients with a histological diagnosis of ocular tumor or orbital recurrence. Cytogenetic analysis was performed whenever possible. Four patients turned out to have an ocular tumor after evisceration (two choroidal melanomas, a rhabdoid tumor and an adenocarcinoma of the retinal pigment epithelium); two had a history of prior ocular trauma. The tumors were diagnosed either on histological analysis of the intraocular contents (2patients) or biopsy of orbital recurrence (2patients). Prior to evisceration, fundus examination was not performed in 3patients. One had preoperative imaging but no intraocular tumor was suspected. At the time of this study, 3patients had had an orbital recurrence and died. We also found 2patients who had an evisceration despite a past history of choroidal melanoma treated with proton beam therapy. We showed that evisceration of eyes with unsuspected ocular malignancies was associated with a poor prognosis due to orbital recurrence and metastasis. The evisceration specimen should therefore always be sent for histological analysis in order to perform prompt adjuvant orbital radiotherapy if an ocular tumor is found.

An unusual presentation of ventral post-traumatic pseudolipomas in a surfer: a case report

Background: Pseudolipomas are normal adipose tissues that accumulate in abnormal locations and postulate an association with trauma. Post-traumatic pseudolipomas (PTLs) are benign, soft tissue tumors that develop in various anatomic sites following acute, chronic or repetitive trauma. PTLs remain a poorly recognized and investigated clinical entity. They follow a benign course and early recognition of this clinical entity may allay anxiety in patients who suspect a more serious underlying condition or malignancy. Case presentation: We present an unusual case of a 31 year old male with a history of repetitive surfboard trauma in the past presenting with symmetric, painless soft tissue swelling of upper abdomen. Magnetic resonance imaging was consistent with Ventral PTLs. Conclusion: PTLs are a distinct clinicopathological entity but, owing to unpredictable presentations, are poorly recognized by physicians and surgeons alike. Inclusion of PTL in the differential of a lipomatous lesion can be achieved by eliciting a prior history of trauma. PTLs have not been documented to undergo malignant transformation and patient anxiety may be allayed with the diagnosis. Liposuction or surgical excision may be offered for cosmetic reasons or if symptoms arise.

Periprosthetic Occult Fractures of the Acetabulum Occur Frequently During Primary THA.

Periprosthetic fractures of the acetabulum occurring during primary THA are rare. Periprosthetic occult fractures are defined as those not identified by the surgeon during the procedure which might be missed on a routine postoperative radiograph. However, it is unclear how frequently these fractures occur and whether their presence affects functional recovery. In this study, using routine CT scans that were obtained as part of another primary hip arthroplasty study protocol, we retrospectively assessed (1) the prevalence of occult fractures of the acetabulum occurring during primary THA, (2) the location of occult fractures of the acetabulum during THA, and (3) risk factors contributing to such occult fractures. Between 2004 and 2013, our institute performed 585 primary THAs (cementless or hybrid) in 494 patients with DICOM pre- and postoperative CT; during the period in question, all patients undergoing THA underwent CT before and after surgery. Preoperative CT images were taken as part of a CT-based three-dimensional templating software and navigation system. Postoperative CT images were taken an average of 1 week after surgery as part of a different protocol to evaluate cup position, restoration of leg length and offset, volume of postoperative hematoma to assess anticoagulation effects after THA, and fractures that were not found on routine postoperative radiographs (which we defined as occult fractures). Patients with a history of prior pelvic osteotomy, trauma, and infection were excluded (88 patients/99 hips); 406 patients (102 males and 304 females; 486 hips) form the basis of this report. The mean age of the patients was 60 ± 11 years, with a mean BMI of 23 ± 4 kg/m2. The mean followup of the patients with periprosthetic fracture of the acetabulum was 58 ± 28 months (range, 12-131 months). Potential risk factors for occult acetabular fracture including age, sex, BMI, preoperative diagnosis, additional dome screw fixation, composition and size of each cup, and acetabular design were examined in multivariate analysis. Acetabular component designs were categorized as true hemispheric, peripheral self-locking, and elliptical; during the period in question the indications for each cup design were based on the brand of stem used. Comparison between preoperative and postoperative CT images was done to detect the fractures. Patients with fractures identified during surgery were treated with additional dome screw fixation and a 3-week period of nonweightbearing. Patients with occult fractures in this series did not receive additional treatment as we had confirmed secure fixation of the cup during surgery. Occult fractures occurred in 41 hips (8.4%); periprosthetic fractures of the acetabulum were seen during surgery in an additional two hips (0.4%). The superolateral wall was the most frequent location for occult fractures of the acetabulum. After controlling for relevant confounding variables, only the use of peripheral self-locking cups was associated with an increased risk of occult fracture (odds ratio [OR], 2.6 compared with hemispheric cups; 95% CI, 1.2-5.6; p < 0.05). All patients with occult fractures showed bone ingrowth fixation at the final followup, without any additional surgical intervention. Periprosthetic occult fractures of the acetabulum may occur relatively frequently during press-fit impaction. We observed a higher rate of fractures associated with the use of peripheral self-locking components. Occult acetabular fractures not detected on routine postoperative plain films may be ignored if secure fixation of the cup has been confirmed during the operation. Level III, therapeutic study.

Evaluating Outcomes After Midfoot Bone Block Arthrodesis

Category: Midfoot/Forefoot Introduction/Purpose: Midfoot arthrodesis requires a structural graft where bone loss from AVN, osteomyelitis and erosive arthritis is present in the navicular, cuneiform or 1st metatarsal. The goal of this study was to evaluate radiographic outcomes of midfoot bone block arthrodesis. Methods: A retrospective, IRB approved study was completed evaluating midfoot arthrodesis between 2002 and 2014. where structural bone graft was used as part of an arthrodesis of the tarsometatarsal (TMT) joints or the naviculocuneiform (NC) joints or both. Demographic characteristics were obtained including age, body mass index (BMI), diagnosis, diabetes or tobacco use, indication for use of bone block, location of the bone block, and type of graft used. Radiographic data collected included time to union, the number of patients in which union was obtained, and graft length Results: Over a 12-year period, there were a total of 33 with an average age of 57.9 years, and included 20 females and 13 males with an average BMI of 29. The average length of follow up was 24 months. The most common diagnoses was erosive midfoot arthritis (11) and prior navicular fracture associated with AVN (9). Structural allograft was used in all patients. (first TMT (10), talocuneiform (9), other combinations (14)). Various types of biologic agents were used in 20 of 33 arthrodeses. Radiographic evidence of union was found in 21/33 patients (63.6%) at an average of 4.7 months after surgery. Twelve patients developed a nonunion. The risk factors for nonunion include age &gt; 50, the presence of erosive osteoarthritis, AVN of the navicular and lack of use of biologic stimulation. There was no correlation between the presence of diabetes, a prior history of infection or prior history of trauma and development of nonunion. Conclusion: The radiographic fusion rate of patients undergoing large structural midfoot bone graft arthrodesis was 63.6% with radiographic evidence of healing present in this group at 4.77 months after surgery. This is the first known study reporting on radiographic outcomes of structural bone graft arthrodesis of the midfoot. The rate of fusion seen here is slightly better compared with recent studies evaluating healing of large defects using femoral head structural allografts. Nonetheless, the risk of non-union remains far greater than when an in situ arthrodesis of these same joints are performed.

What is the role of preoperative imaging for cochlear implants in adults with postlingual deafness?

What is the role of preoperative imaging for cochlear implants in adults with postlingual deafness?

The regenerating naevus

The re-emergence of a melanocytic proliferation at the site of a previously excised pigmented lesion may not only cause great concern clinically but may also be amongst the most difficult of all melanocytic lesions for pathologists to assess. These lesions can adopt an appearance which may be impossible to confidently distinguish from a regressing or traumatised melanoma on histological grounds alone. For this reason, careful attention must be paid to the clinical context which has given rise to the lesion or a misdiagnosis may occur. In the absence of a corroborating history of prior surgery or trauma to the site, a diagnosis of a regenerating naevus may only be provisional. When considering a diagnosis of regenerating naevus, whenever possible, it is important to review and confirm the benign nature of the precursor lesion. Nevertheless, 50 years of research into this phenomenon has identified certain characteristic clinical features and histological patterns which provide clues both to clinicians and pathologists that will assist them to make the correct diagnosis and avoid over diagnosing as melanoma what is ultimately a benign process.

Osteomyelitis Caused by &lt;i&gt;Mycobacterium fortuitum&lt;/i&gt;-a Case Report

Non-tuberculous rapidly growing mycobacteria have been known to cause a variety of skin and soft tissue infection. The diagnosis of NTM in bone and joint infections is easily missed because of non-specific signs and symptoms. We report a case of a 65 year old male with osteomyelitis of the right knee of 4 years duration. The patient had no prior history of trauma or injury and finally presented with discharging sinus and edema of the right knee. The discharge persisted in spite of empiric therapy with anti-tubercular therapy. Rapidly growing Mycobacteria was isolated from the exudate which was identified as Mycobacterium fortuitum based on biochemical analysis. The isolate was found to be susceptible to Clarithromycin, Clindamycin, Gentamicin, Amikacin, Tetracycline, Co-trimoxazole and Imipenem The patient responded to medical therapy by oral Clarithromycin. An accurate diagnosis and effective treatment of an atypical mycobacteria infection of the musculoskeletal system is therefore mandatory to prevent severe bone and joint destruction. With non-specificity of imaging findings and clinical symptoms and signs, culture of mycobacteria becomes crucial in establishing the diagnosis.

Gardner-Diamond syndrome

Gardner-Diamond syndrome, which also is knownas autoerythrocyte sensitization disorder, is a raresyndrome of inflammatory, edematous papulesthat evolve into painful ecchymoses on the trunkand lower legs after a period of stress with no priorhistory of trauma. This syndrome usually occurs inwomen with a history of psychiatric disorders, themost common one being depression. Although theexact mechanism of injury is not well understood,it is hypothesized that these patients haveautoantibodies to phosphatidylserine, which is aphospholipid membrane component in erythrocytes.Treatment for this disorder includes symptomatictherapies and psychotropic medications to treat theunderlying psychiatric disorder.

Orbital apocrine hidrocystoma with immunohistochemical confirmation

The authors report the first case in Brazilian literature of orbital apocrine hidrocystoma with immunohistochemistry confirmation. The tumor had been growing slowly and progressively, there was no history of impaired vision, diplopia, watering, discharge, or prior trauma. There was no proptosis and extraocular mobility was normal. The radiologic study by orbital computerized tomography revealed an extraconal nodule, with partially defined limits, with cystic and solid areas in the superomedial right orbit. An anterior orbitotomy, with full excision of the tumor was performed. A histopathology examination revealed apocrine hidrocystoma and immunohistochemistry confirmed the diagnosis. After surgery, the patient had total remission of symptoms.

Frontal mucocele in the developing sinus

Abstract We report the first paediatric case of mucocele formation in a developing frontal sinus with no known associated lesions. A 10-year-old girl presented with a 12-month history of left frontal pain with no response to nasal steroid and antibiotics. CT-imaging revealed a left frontal mucocele enclosed by bone covering the sinus ostium, despite no prior history of trauma or surgery. The patient underwent image guided endoscopic sinus surgery with successful relief of symptoms. The rarity and non-specific symptoms of frontal mucoceles may result in misdiagnosis and delayed treatment, why this pathology should be considered in children with persistent frontal pain.