Trivial Injury Research Articles

Unstable pelvic insufficiency fracture of the pelvis in rheumatoid arthritis patient: evaluation and treatment

Pelvic insufficiency fracture (PIF) occurs when the quality of the bone is compromised due to various reasons. A trivial injury can lead to a pathological fracture. These fractures are usually stable and are managed by conservative means. If the fracture pattern is unstable, it mandates some form of surgical fixation. An appropriate method of fixation in rheumatoid patient’s is not well emphasised in the literature. We report a case of a rheumatoid patient who presented to our hospital with an unstable ‘PIF’. The fracture was managed as an emergency and had in situ ilio-sacral screw/s screw fixation. The patient remained free of presenting symptoms after 3, 6 and 12 months during follow up. Early surgical treatment in such cases may alleviate symptoms and avoid long-term morbidity.

Traumatic clival subdural hematoma in an adult

Retroclival hematomas are a rare entity. They are usually associated with significant trauma, and patients frequently have focal neurological deficits, especially cranial nerve palsies. Previous case reports of epidural clival hematomas have been described almost exclusively in the pediatric population. The authors report a unique case of traumatic clival subdural hematoma, which has never been described in an adult except in the context of hemophilia. An 18-year-old man presented with continuing nausea and headaches following a seemingly trivial head injury. He was found to have a posterior fossa retroclival hematoma extending into the spinal subdural space but without any neurological deficits. He was treated conservatively, with a good outcome. The authors discuss the possible mechanisms of injury, management, and complications related to this rare condition, and they review the pertinent literature.

Spinal Cord Stimulation: “Neural Switch” in Complex Regional Pain Syndrome Type I

Complex regional pain syndrome type I (CRPS I) is a neuropathic pain disorder of unclear etiology. It commonly follows a trivial injury and is characterized by spontaneous pain manifesting regionally that is disproportionate to the inciting event. Associated signs and symptoms include allodynia, hyperalgesia, edema, sudomotor, vasomotor abnormalities, and trophic changes. Although multiple modalities exist to treat CRPS I, significant disability, diminution in quality of life, and reduction in overall health often accompany the syndrome. A case of a 57-year-old man with CRPS I who was treated with spinal cord stimulation (SCS) after failing conservative therapy is presented. One month following treatment, he experienced complete symptom resolution such that stimulation was subsequently discontinued without recurrence over the 1-year follow-up period. To date there is currently no reliably validated "cure" for CRPS. There has only been one recent report where SCS resulted in the complete eradication of the signs and symptoms associated with CRPS. This series involved adolescent girls aged 11-14 years of age, who tend to have a more benign and self-limited treatment course than that seen in adults. This raises the question as to whether a "neural switch" exists, and if so, where it is located. We postulate that the inter-neuronal connections between the central and peripheral nervous systems implicated by the current pathophysiological model is the most plausible site of this "neural switch," and that reorganization of this interface can account for the ability of SCS to effect a complete "cure" in CRPS.

Geriatric Literature Review: Revisited

Geriatric Literature Review: Revisited

Treatment of femoral neck fractures in pediatric patients.

Objective To investigate the therapeutic results of femoral neck fractures in pediatric patients in our center and review the literature. Methods Authors conducted a computerized search of med-ical records to identify all children with femoral neck fractures treated at our institution from January 1986 to December 2007. Records were reviewed to determine injury mechanism, fracture type (Delbet's classification: type Ⅰ to Ⅳ), displacement, age, treatment and complication. Twenty-three patients with a mean age of 12.8 years (range, 3-16 years) with femoral neck fractures were identified and 3 cases with cerebral palsy were excluded. There were 13 male patients and 10 female patients. Nineteen cases underwent operation, includ-ing closed reduction for 15 cases, and open reduction for other 4 cases. Four cases were treated conservation. The mean follow-up was 4 years (range, 1.1-11 years). We studied timing of surgery, type of fixation, and quality of reduction with respect to the primary outcome measure-radiographic evidence of union and avascu-lar necrosis. The BMI and BMD data of latest 3 patients were obtained due to specially trivial injury mecha-nism. Results Eighteen of 19 operated cases have satisfied healing of fracture in good to excellent posi-tions. One patient had Haidukewych classification of fair reduction with delayed union and required hip screw revision and bone grafting. One had coxa varus, one had coxa valgus. Four patients were treated more than 24 hours after injury, including the patient who had delayed union. The mean time to fixation for the remaining patients was 11.2 hours after injury. The BMI and BMD data of 3 patients were abnormal when compared with children of the same age group. Conclusion The study shows that closed or open reduction, decompression and cannulated screw stable internal fixation for femoral neck fractures in children should be a standard treatment which leads to satisfactory results without occurrence of avascular necrosis. Key words: Child; Femoral neck fractures; Femur head necrosis

Posterior shoulder dislocation associated with acromion fracture

We report a case involving a combination of posterior glenohumeral dislocation and acromion fracture in which the initial treating physician missed the shoulder dislocation. There are only two documented cases with a similar combination of injuries. A correct diagnosis of posterior dislocation is usually delayed due to subtle physical and radiological signs. Associated trivial injuries like acromion fracture may mask more significant injuries, which, if left untreated, may result in significant functional disability. The mechanism of injury, management and outcome in the present case is presented. The utility of CT scan in definitive diagnosis of posterior shoulder dislocation and identification of associated injuries is emphasized.

Reversible parkinsonism due to chronic bilateral subdural hematomas

Subdural hematoma is a rare cause of secondary parkinsonism. We report a 65-year-old woman with reversible parkinsonism due to bilateral chronic subdural hematomas. Symmetrical parkinsonism evolved acutely 45 days after a trivial head injury. Mild pyramidal signs were also present on her left side. MRI revealed bilateral chronic subdural hematomas. The patient’s parkinsonism was completely abolished one month after successful neurosurgical evacuation of the hematomas.

Necrotizing Fasciitis of the lower extremity: a case report and current concept of diagnosis and management

Necrotizing fasciitis is a severe soft tissue infection characterized by rapidly progressing necrosis, involving subcutaneous tissues. This rare condition carries high mortality rate and require prompt diagnosis and urgent treatment with radical debridement and antibiotics.We describe a case of 21-year old man who presented with the history of trivial injury to the knee. Initially he was admitted and treated for septic arthritis but later was diagnosed as necrotizing fasciitis which was successfully treated with no ill effects what so ever from this devastating condition.This rare condition has been reported in literature but still early diagnosis, which is a key for successful treatment, remains a challenge.

Leptomeningeal cyst: a complication of trivial head injury

Acute skull fracture can be complicated by a dural tear. This results in an expanding cystic mass with the dura and CSF resulting in the fracture diastasis. The position of the cystic swelling prevents the osteoblast from migrating and this prevents fracture healing. The continuous pulsatile CSF pressure causes resorption of adjacent bone. Trivial trauma in the history is often missed. CLINICAL PRESENTATION A 3 year old presented with a palpable, firm, cystic, pulsatile and non-tender 2X2 cms mass of the left forehead (figure 1) with no signs of inflammation.

Syndrome de Collet-Sicard après dissection carotidienne

Collet-Sicard syndrome is a rare condition, defined as unilateral palsy of the last four cranial nerves. It differs from Villaret syndrome because of absence of sympathetic involvement. Collet-Sicard syndrome is most often caused by skull tumors, carotid artery dissections or head and neck trauma. We report the case of a 57-year-old man who presented palsy of the left lower cranial nerves IX-XII linked to carotid artery dissection after trivial neck injury.

Diffuse Skull Base/Cervical Fusion Syndromes in Two Siblings With Spondylocostal Dysostosis Syndrome

A study on a pair of male sibs to reach for the etiological understanding of unusual skull base/spine maldevelopment. Previously, radiographs alone were used to formulate this diagnosis. Here, three-dimensional computed tomography (3D CT) studies further clarified the typical diagnostic findings associated with spondylocostal dysostosis (SCD). Interestingly, patients with SCD are at increased risk for diffuse skull base/cervical fusion syndromes and can result in severe neurologic deficits associated with any degree of trauma. Classically SCD is defined as a skeletal dysplasia with clinical and radiologic manifestations, consisting of short neck and trunk, nonprogressive scoliosis and abnormalities of vertebral segmentation and of the ribs. Radiograms have been adopted as the only modality for the classification and prognostication of patients with SCD. Detailed clinical and radiographic examinations were undertaken with emphasis on the significance of the 3D CT scanning. We observed extensive fusion of the clivus with the cervical/entire spine, resulting in a remarkable solid, immobile, and fixed bony ankylosis of extremely serious outcome. Patients with spondylcostal dysostosis are predisposed to develop extensive skull-base-cervical spine fusion. The latter might lead to the development of a solid, immobile, and fixed bony ankylosis. In children/adults trivial injuries and/or high-energy trauma can lead to serious intracranial and spinal cord injury. Comprehensive orthopedic and neurosurgeons management must follow the recognition of these anomalies. To the best of our knowledge, no previous CT studies of the spine have been published in patients with SCD.

Infekte der Hand

Delayed or insufficient surgical intervention of hand infections can lead to long periods of being unfit for work as well as severe functional disabilities of the hand. The reasons that surgery is delayed for too long can be due to trivialization of injuries or incorrect primary treatment. In order to avoid such severe complications following hand injuries the same diagnostic procedure must be implemented including examination of the case history must be carried out with patients who present with so-called trivial hand injuries as with patients with severe injuries. The operative planning and techniques are carried out much further than the edges of the assumed infection limits far into the healthy tissue without consideration of possible functional loss or residual defects. Plastic surgery and other reconstructive surgical measures are often subsequently necessary to correct defects. Antibiotic treatment is only implemented after adequate débridement and according to an antibiogram. In addition to sufficient immobilization and strict bed rest, early exercise, physiotherapeutic and ergotherapeutic mobilization are absolutely necessary.

Studies need to make explicit the theoretical and case definitions of injury

Pick up almost any issue of Injury Prevention and you will find statements such as the following: > “Results of this study are subject to limitations. NEISS-AIP only includes injuries...

Carotid Trauma: Bluntly

Injuries to the extracranial carotid arteries resulting in dissection are serious and potentially fatal events. Dissections are now believed to be responsible for most ischemic strokes in patients younger than 45 years of age [Beletsky, V., Nadareishvili, Z., Lynch, J., Shuaib, A., Woolfenden, A., & Norris, J. (2003). Cervical arterial dissection: time for a therapeutic trial? Stroke, 34, 2856–2860]. Many patients have a history of notable blunt trauma, but dissections can also be precipitated by trivial injuries, or may even occur spontaneously [Lyrer, P., & Engelter, S. (2003). Antithrombotic drugs for carotid artery dissection [Review]. The Cochrane Database of Systematic Reviews, 3, 1–25]. More aggressive screening protocols to detect these injuries, largely used in trauma centers across the nation, have contributed to an increase in early detection and early treatment, thereby preventing their associated disabling or fatal sequelae [Biffl, W. L., Moore, E. E., Offner, P., Brega, K., Francoise, R., & Burch J. (1999). Blunt carotid injuries: implications of a new grading scale. Journal of Trauma, 47(5), 845–853]. We present a review of traumatic dissection pathology, common clinical presentations, and a case report to highlight the diagnosis and management of these injuries.

Lesión órbito-craneal penetrante tras traumatismo palpebral mínimo: a propósito de un caso

We report a patient who, while in a drunken state, sustained a cerebral hemorrhage associated with an apparently trivial eyelid injury after an aggressive attack with a metallic object. Any apparently trivial eyelid injury may be associated with serious cerebral lesions. Making a correct diagnosis that distinguishes between that of drunkenness and an organic injury is essential, because failure to do so may result in both clinical and legal repercussions.

Hereditary Neuropathy with Liability to Pressure Palsies: A Report of Two Cases

Hereditary neuropathy with liability to pressure palsies (HNPP) is an autosomal-dominant disorder characterized by self-limited, recurrent compressive mononeuropathies at common entrapment sites precipitated by trivial injuries. This disorder typically develops in early adulthood. Electrodiagnostic studies revealed diffuse mild demyelinating neuropathies with entrapment over common entrapment sites. Nerve biopsies frequently show segmental demyelination and thickening of the myelin sheath which is mostly caused by 1.5 Mb deletion of the 17p 11.2 site containing the peripheral myelin protein 22 (PMP22) gene on the 17(superscript th) chromosome. This report describes the clinical features, electrodiagnostic studies, and genetic studies of a Taiwanese family. Among the 5 members evaluated, 1 latent and 2 symptomatic cases had generally decreased nerve conduction velocities with further focally decreased conduction velocities or conduction blocks at common entrapment sites. Genetic studies demonstrated deletion of the Charcot-Marie-Tooth type IA sequences in 17p 11.2 in all 3 patients. Our case studies suggested that diagnosis of HNPP can be based on clinical suspicion, positive family history, and electrodiagnostic tests; however final confirmation should be based on genetic study.

Ischiopubic and odontoid synchondrosis in a boy with progressive pseudorheumatoid chondrodysplasia

PurposeTo present the case of a 14-year-old boy with clinical and radiographic features of pseudorheumatoid chondrodyspalsia with additional, potentially serious, cervical malformations.MethodsDetailed clinical and radiological examinations were undertaken with emphasis on the usefulness of 3D-CT scanning.ResultsThere was synchondrosis between the odontoid and the body of the axis and the cephalad part of the odontoid was detached. Bilateral ischiopubic ossification defects and ischiopubic and odontoid synchondroses were additional abnormalities. 3D-CT scan showed an orthotopic type of os odontoideum associated with an occult axial fracture.ConclusionChildren who are younger than seven years of age are predisposed to develop odontoid fracture. The latter occur because of the presence of physiological odontoid synchondrosis, but fractures can result from trivial injuries as well as from high-energy trauma. The persistence of an infantile odontoid, with a large pre-adulthood head in children with skeletal dysplasias, is a major risk factor for sudden death or significant morbidity. Comprehensive orthopaedic management must follow early identification of these malformations.

SUPERIOR SAGITTAL SINUS THROMBOSIS CAUSED BY CALVARIAL TUBERCULOSIS

Tuberculosis affects the central nervous system in various ways but has not been reported to cause venous sinus thrombosis. In this case report, extensive calvarial tuberculosis caused compression and occlusion of the superior sagittal sinus in an adult man. Early diagnosis combined with surgical and medical treatment resulted in cure of the disease. A 34-year-old man presented with a nonhealing sinus in the frontal area after a trivial injury without any neurological deficits or features of raised intracranial pressure. Magnetic resonance imaging scans showed evidence of extensive bilateral extradural granulations, bone destruction, and thrombosis of the anterior half of superior sagittal sinus. The affected bone and extradural granulations were surgically excised. Histopathology showed tuberculous osteomyelitis, and the patient received anti-tuberculous treatment, after which he had a good recovery. Calvarial tuberculosis as a cause of sagittal sinus thrombosis is a rare condition and is reported here for the first time, to our knowledge. Surgical excision of the compressing granulations followed by medical treatment is curative without sequelae if the intervention is performed before the disease extends intradurally.

Spectrum of Von Willebrand disease and inherited platelet function disorders amongst Indian bleeders

Platelet function disorders (PFD) and Von Willebrand disease (VWD) are among the uncommon causes of bleeding in haematological practice. The inherited variety of PFD includes defects in platelet adhesion, aggregation, secretion and platelet procoagulant activities. VWD is classified into three major categories-type 1 and 3 (quantitative deficiency) and type 2 VWD (qualitative defect). In the present study, the profile and prevalence of inherited PFD and VWD in Indians are described. Two thousand eight hundred patients with history of muco-cutaneous bleeding and other bleeding disorders were investigated. The tests performed included platelet count, bleeding time, PT, APTT, F VIII assay, platelet factor 3 (PF3) availability, platelet aggregation studies, VWF:Ag, VWF:RCo and multimeric analysis. Out of 2,800 patients investigated, a total of 872 (31.1%) were characterized to have either inherited coagulation defects (64.2%) or inherited platelet function disorders (35.8%). Of these 872 patients, 312 (35.8%) cases were characterized to have inherited PFD and 94 (16.8%) patients as VWD. Among 312 inherited PFD patients, isolated PF3 availability defect (48.1%) was most common, followed by unclassified PFD (37.2%). Among 94 VWD patients, type 2 VWD was most common (44.7%), followed by type 3 VWD (34.5%) and type 1 VWD (21.3%), respectively. Bleeding manifestations included easy bruising (46%), undue prolonged bleeding from trivial injuries (50% in PFD and type 1 and type 2 VWD and 100% in type 3 VWD), menorrhagia (31%), gum bleeds (22%), epistaxis (55%), haematuria (6%), GI bleeds (11%) and rarely, haematomas and haemarthoses (4%). In conclusion, VWD and inherited platelet function disorders are not uncommon among Indian population presenting with bleeding disorders.

ISOLATED FRACTURE OF THE CORACOID PROCESS ASSOCIATED WITH UNSTABLE SHOULDER

We report on an unusual case where a seemingly trivial injury in a patient on immunosupressant therapy led to fracture of the coracoid and an unstable shoulder with a subscapularis tear. This was managed with open reduction and internal fixation. One year postoperatively, the patient had regained full function and range of motion.