Trauma Case Reports最新文献

Background

Case report

Conclusions

Background

Intraocular foreign bodies pose a significant clinical challenge. The occurrence of an eyelash within the anterior chamber is infrequent, as illustrated by this case. We present a rare case of two eyelashes inside the anterior chamber following penetrating trauma, a scenario with few documented occurrences, especially those not related to surgical interventions.

Case description

A 35-year-old male presented with symptoms of a foreign body sensation, redness, blurred vision, and photophobia two days after sustaining a wire-induced injury. Examination revealed a self-sealing corneal laceration, two eyelashes in the anterior chamber, iridocorneal adhesion, and an irregular iris. The surgical removal of the eyelashes was successfully performed. Postoperatively, the patient's visual acuity improved significantly from 20/50 to 20/20, accompanied by a marked reduction in anterior chamber inflammation.

Conclusion

This case highlights the importance of considering all types of intraocular foreign bodies, including seemingly innocuous materials like eyelashes, to diagnose ocular traumas. It highlights the critical need for prompt diagnosis and intervention to prevent long-term complications and ensure favorable outcomes.

A 45-year-old male prisoner was referred to the orthopedic outpatients clinic after he sustained a blunt palmar injury when he tried to break-up a bag of ice with the volar aspect of his hand. A few months later a pulsatile expansile mass developed at the site of blunt trauma affecting flexion and extension of the fingers and inability to hold objects. A computed tomography angiogram confirmed the mass to be a true aneurysm of the superficial palmar arch 3 cm in size. The patient was referred to the vascular surgery department where the aneurysm was dissected and ligated with removal of the thrombus with no reconstruction of the vessel necessary. The patient had an uneventful recovery with return of full function.

Humeral shaft nonunion is a challenging orthopedic condition that often requires surgical intervention for successful healing. In this case report, we present a 53-year-old male patient who presented with a humeral shaft nonunion, Underlying Systemic Disorders, and Arteriovenous fistula. The patient had a history of a previous humeral shaft fracture managed with open reduction and internal fixation but developed nonunion despite appropriate initial treatment. The complexity of this case was compounded by the patient's preference for a minimally invasive approach and the desire to avoid general anesthesia due to underlying medical conditions.

Background

Chylothorax occurs when chyle from the thoracic duct leaks into the pleural space. While majority of cases are iatrogenic, traumatic chylothorax can occur when rib or vertebral fractures disrupt the thoracic duct. These occurrences are exceedingly rare, particularly following blunt traumatic insult.

Methods

We performed a retrospective review of a case of chylothorax following blunt trauma. Data was extracted from the electronic medical record.

Case

A 60-year-old female presented to the trauma bay after a motor vehicle crash as a restrained driver with bilateral chest pain. Of note, patient had three left rib fractures from fall five days prior. She was neurologically and hemodynamically normal on arrival. Physical exam was notable for chest wall tenderness. Computed tomography revealed the following: bilateral hemopneumothoraces, pneumomediastinum, manubrium fracture, retrosternal hematoma, left 2–10 and right 1–2 rib fractures along with multiple orthopedic injuries. Left tube thoracostomy yielded 150 mL of blood. She was admitted to the intensive care unit. Patient had a 48-h period of cardiogenic shock requiring vasopressors and aggressive fluid resuscitation. On post-injury day (PID) 2, the chest tube drained milky fluid. Pleural fluid sampling was significant for triglyceride levels of 1292 mg/dL. Hemodynamics then improved. Due to low output (<500 mL/day), patient was managed conservatively a fat-restricted diet supplemented with medium-chain fatty acids. Chest tube was removed PID-7 once chyle leak resolved. Repeat chest radiograph PID-10 was negative for effusion. She was discharged to rehabilitation PID-13. At one-week follow-up, repeat CXR showed a small, loculated left lateral pleural effusion. Patient had no complaints and was maintaining adequate oxygen saturations on room air.

Discussion

We present a case of delayed chylothorax after blunt trauma precipitated by increased central venous pressure secondary to right heart failure, aggressive fluid resuscitation and vasopressor use. Traumatic chylothorax should be considered in patients with pleural effusion in the setting of blunt chest trauma as sudden hyperextension of the spine can disrupt the thoracic duct. Delayed diagnosis is not uncommon due to an average latency period of 2–10 days. Pleural fluid with triglyceride level > 110 mg/dL and chylomicrons is diagnostic. Initial management consists of chyle reduction through diet modification (high protein/restricted fat diet). Octreotide can be used as a pharmacological adjunct. Refractory or high-output cases (>1000 mL/day) may require surgical ligation of the thoracic duct. Early identification and intervention are paramount as untreated chylothorax is associated with significant morbidity and mortality rates up to 50 %.

Traumatic thumb amputation is a serious injury that requires replantation or reconstruction. Toe-to-thumb transfers method have great survival and patient satisfaction in thumb reconstruction. Alternative method like Iliac Crest Bone Graft (ICBG) with flaps may help surgeons achieve maximum results. A 32-year-old male presented with occupational traumatic right thumb amputation. After initial debridement and K-wire installation, the thumb became necrotic. An ICBG with radial forearm flap was performed after the patient denied a toe-to-thumb transfer. Follow-up demonstrated viable flap, no infection, good joint mobility, and improved Kapandji and DASH scores. Osteoplastic reconstruction of the thumb using ICBG method is valuable for amputations around the metacarpophalangeal level preserving native anatomy and function. Radial forearm flaps are advantageous due to their thin, pliable and ability to preserve the radial artery. However, donor morbidity and potential complications should be considered. ICBG with radial forearm flap showed promising result.

Level of evidence

Level IV (Therapeutic).

Malignancy is a rare etiology of splenic rupture, with most documented cases resulting from hematologic cancers. There have been very few reports of splenic rupture resulting from invasion or metastasis of adenocarcinoma and even fewer reports resulting from specifically pancreatic adenocarcinoma. In this case report, we outline the clinical course of a 60-year-old male with splenic rupture and hemoperitoneum following a ground level fall who was transferred to the Shock Trauma Center (STC) from a local emergency department. Outside of the ruptured spleen, no other traumatic injuries were found on examination or imaging. Due to the initial concern for traumatic etiology, exploratory laparotomy was performed with splenectomy and distal pancreatectomy. Postoperative pathology results revealed pancreatic adenocarcinoma with splenic invasion staged pT3N0. This report provides a novel example of splenic rupture in the background of locally advanced pancreatic adenocarcinoma and further solidifies the importance of maintaining a broad differential in cases of seemingly innocuous trauma.

Case report

Chopart joint fracture-dislocations are rare injuries. The purpose of this report is to present the management of a high energy trans-cuboid Chopart dislocation. This fracture-dislocation dislocation was treated with closed reduction, provisional fixation, and definitively with a combination of open reduction internal fixation (ORIF) and a lateral column external fixator. Due to persistent pain and Chopart joint collapse, the patient ultimately required a double arthrodesis.

Conclusion

While rare, Chopart joint fracture-dislocations are impactful injuries that require prompt diagnosis and specialized management. The description of this high energy trans-cuboid Chopart dislocation and the stepwise approach for its management may be useful for other surgeons who encounter similar injuries.