Trauma Case Reports最新文献

Background

Cervical injuries due to hanging have a high mortality rate. Survivors may present for care with subtle symptoms that belie potentially life-threatening injuries to vital structures of the neck.

Case report

We report a case of a 39-year-old male admitted to the Intensive Care Unit following attempted self-strangulation. Alert and clinically stable, his primary symptoms were pain and voice changes. His external exam was remarkable only for a cervical ligature mark and subcutaneous emphysema on palpation. CT imaging demonstrated disruption of the infrahyoid strap muscles and displacement of the hyoid and epiglottis superiorly. Subsequent flexible laryngoscopy by the Otolaryngology-Head & Neck Surgery (OTO-HNS) team revealed avulsion of the epiglottis from the thyroid cartilage and disruption of the aryepiglottic folds/false cord mucosa, resulting in an open wound into the soft tissues of the anterior neck. The airway was secured in the operating room via fiberoptic nasotracheal intubation. A tracheostomy was performed. Neck exploration revealed transection of the anterior strap muscles and thyrohyoid membrane. The wound was repaired in layers via a modified thyrohyoidopexy. At one-month follow-up, the patient was successfully decannulated and tolerating a regular diet.

Conclusion

Evaluation and management of head and neck trauma requires a systematic approach and thorough evaluation, as potentially life-threatening injuries can present subtly. Swift establishment of safe airway, when needed, and prompt repair of laryngeal injuries is essential to optimal functional recovery.

Although dual implant constructs have recently been explored with promising results in very distal periprosthetic femur fractures (PPKF), the gold standard treatment of Rorabeck and Taylor type III PPKF remains a distal femur replacement or a highly constrained rotating hinge implant. However, this surgery is very aggressive and expensive for functionally low-demanding elderly patients. A new surgical technique using locking plates with polymethyl methacrylate cement augmentation is described to retain the femoral component avoiding its replacement. Four patients were treated and followed up for more than one year postoperative without any complications, their femoral component was retained without any loosening and the mobility in the Barthel Index remained unchanged.

Total wrist arthroplasty (TWA) is indicated in select low demand patients with pan-carpal arthritis to decrease pain and preserve motion. Complications of TWA are well described including aseptic loosening, superficial and deep infection, wound issues, component dislocation, stiffness, and both intraoperative and post-operative fracture. With 4th generation implant designs, the incidence of many of these complications have decreased, but these complications remain challenging to address. In particular, sparse literature is available for the treatment of periprosthetic radius fractures after TWA. This report describes the management of an open, periprosthetic distal third radius fracture 18 months after index TWA in a medically complex 53-year-old female with lag screw fixation and a dorsal wrist spanning plate (DSP).

Defects in femoral bone segments represent a reconstructive challenge; they are caused secondary to multiple and extensive debridement in cases of patients with infections, tumors or high-energy trauma. Different treatments have been proposed to address this problem, however, these are limited when it comes to large defects that generate instability of the implants in the native bone as well as loss of functionality and length of the extremities. In the proximal femur, allograft prosthesis composites have been described in the management of extensive tumor resections, but they are not yet widely used in the management of bone defects due to osteomyelitis. The case of a 51-year-old male patient with post-traumatic pan-osteomyelitis of the femur Cierny-Mader IV with a 30-centimeter defect in whom limb salvage was achieved through the application of a femoral alloprosthesis is presented, exhibiting this surgical technique as an alternative in ample resections secondary to infectious processes in young patients, furthermore, offering a solution to the shortage of some prosthetic components in our surrounding.

Background

Fracture nonunion is a major concern among an orthopaedic patient population, especially in those who have sustained traumatic fractures involving the tibia. Strong risk factors for nonunion include age, smoking history, and a poor diet. The incidence of nonunion also increases with each additional failed surgical intervention.

Methods

Our retrospective case study involved 56-year-old woman with a history of chronic low back pain, osteopenia, malnutrition, smoking, marijuana use, and alcohol use, who presented with a proximal tibia fracture after a fall, initial treatment included temporization with multiplanar external fixation and subsequent internal fixation. Five weeks later, she presented with atrophic nonunion. She subsequently underwent multiple unsuccessful surgeries to address her nonunion, including open repair with bone grafting and multiplanar external fixation for bone transport. Ultimately, the nonunion was addressed by proximal tibia replacement with megaprosthesis with excellent clinical results.

Results and conclusion

Replacement of a proximal tibia with megaprosthesis is a viable option for limb salvage, especially when all alternative treatments have been unsuccessful.

Angiography using carbon dioxide (CO₂) has gained attention as a method of inducing active bleeding in patients for whom bleeding cannot be detected with iodine contrast medium (ICM). We experienced a case in which CO₂ angiography was performed during transarterial embolization (TAE) for severe liver injury with active bleeding. A woman in her 40s was struck by a minitruck while crossing the road and rushed to our hospital. Upon admission, she was in shock vital with blood pressure of 75/38 mmHg and pulse rate of 130 bpm. Blood transfusion was promptly started after arrival and her blood pressure increased. Abdominal ultrasonography showed echo free space in Morrison's pouch. Contrast-enhanced CT showed deep liver laceration in the right lobe and intra-abdominal hemorrhage with active bleeding. We selected TAE for hemostasis. ICM angiography showed extravasation of contrast medium from the anterior and posterior segmental branches, which was embolized with a gelatin sponge. After embolization, CO₂ angiography revealed new extravasation that could not be detected by ICM, which was additionally embolized. There was no rebleeding or pseudoaneurysm after embolization. In TAE for deep liver injury, ICM alone may underestimate active bleeding. CO₂ angiography may lead to better outcomes when injured vessels are reliably identified and TAE is performed.

We present a rare case of traumatic maternal gunshot wound (GSW) that resulted in fetal death due to direct fetal injury. A 21-year-old 25 week G3P1011 female with no past medical history (PMH) presented to the Emergency Department (ED) after sustaining a GSW wound to her left buttock while sitting in a car. She presented with an acute comminuted fracture of the left iliac bone, and passage of a bullet through the fetal cranium terminating near the placenta. Management consisted of immediate resuscitation, imaging, and emergent abdominal exploration leading to delivery of a non-viable fetus.

Cortical blindness is characterized by unilateral or bilateral vision loss despite an intact pupillary reflex, full extraocular movements, and normal fundoscopic examination. Common causes include stroke, cardiac emboli, head trauma or rarely, a hypoxic-ischemic event which results to decreased perfusion to the occipital lobes supplied by the posterior cerebral artery. Imaging with computed tomography is usually diagnostic documenting stroke or embolization as well as ensuring an intact cerebral circulation. Prognosis largely depends on the etiology as most reports document an irreversible condition or at least the patient is left with some residual visual symptoms.

We present a case of a 25-year-old male who underwent brachial artery repair with reverse saphenous vein graft interposition after sustaining a right upper arm laceration associated with massive hemorrhage and shock due to delayed consult. He presented with profound bilateral loss of vision 12 h after surgery characterized as right homonymous hemianopsia. Computed tomography of the brain demonstrated ischemic infarcts in the occipital lobes. Close observation was instituted, and his symptom resolved spontaneously within a week. This case highlights the importance of considering atypical causes of perioperative vision loss as early recognition and timely diagnosis are essential to improve patient outcomes. To our knowledge, this is the first report of transient cortical blindness after peripheral vascular trauma.

Background

Hirschsprung disease, a developmental disorder affecting the neuronal ganglion cells in distal colon, is the leading cause of intestinal obstruction in newborns, predominantly males, although the diagnosis can be made lately in rare cases. We describe an adult Hirschsprung disease case found intraoperatively.

Case description

He is a 20-year-old male patient with past medical history of epilepsy, psychomotor delay and recently a perineal perforating injury, admitted in the emergency room with initial diagnosis of peritonitis by perforated viscus with Frankel grad B spinal cord injury. Among his initial signs and symptoms were abdominal distension, rebound tenderness, decreased bowel sounds and diffuse pain. Laboratory tests revealed increased Hb, decreased white cells count and increased creatinine level. Initial management included: fluid resuscitation, analgesics, antibiotics and laxatives. After becoming hemodynamically unstable, the patient was introduced to the operating room where a highly dilated rectum with areas of necrosis at the base was discovered after access to the abdominal cavity. While doing the intervention, the patient experienced 3 cardiac arrests following by successful ressucitation and blood transfusion; leading to the decision to delay the definitive closure using the Bottega technique. The surgical course was unfavorable as the patient died around 4 hour post-surgery.

Conclusion

Hirschsprung disease in adult, due to its rarity and its overlapping features with many other conditions that can affect the GI system, can be misdiagnosed or discovered lately. A thorough evaluation by an appropriate specialist is essential for adequate diagnosis and management.