Trauma Case Reports最新文献

This case report presents the clinical course and management of a 29-day-old female infant who presented with upper limb trauma secondary to entrapment beneath a sewing machine. Following admission, the patient exhibited clinical signs consistent with arterial injury and compartment syndrome, necessitating prompt diagnostic evaluation and surgical intervention. Despite challenges in arterial visualization via Doppler ultrasound, radiographic imaging confirmed displaced distal humerus fracture of the left upper limb, prompting further evaluation and surgical planning. Surgical decompression and stabilization were performed, followed by successful endovascular intervention utilizing digital subtraction angiography (DSA) to restore arterial perfusion. Subsequent development of compartment syndrome necessitated emergent fasciotomy, followed by wound care and skin grafting. Multidisciplinary rehabilitation facilitated optimal recovery, with the patient demonstrating improved motor function and sensory perception at six-month follow-up. This case underscores the importance of timely recognition, multidisciplinary collaboration, and prompt intervention in managing pediatric upper limb trauma complicated by arterial injury and compartment syndrome.

Pipkin type IV fracture dislocation of the hip is a rare, high-energy injury, that is associated with poor functional outcomes and complications. We report a case of a 20-year old male quarterback who sustained a Pipkin type IV fracture dislocation during a football game. He underwent immediate closed reduction, transfer to a Level I trauma centre, surgical management, and progressive rehabilitation. Clinical and radiographic assessments were carried out periodically for 1 year. At 10 months post-injury, the athlete returned to full-time play as the starting quarterback of his University football team. He completed a pain-free season at 1-year post-injury. Clinical and radiographic evaluations demonstrated appropriate healing with no complications. Despite the high-energy and often devastating nature of Pipkin Type IV injuries, this case report demonstrates that prompt, appropriate management and rehabilitation of this injury in a University quarterback led to positive functional outcomes. Further studies on the treatment and outcomes of this rare sport injury are needed to optimize management.

Background

Distal femur fractures (DFFs) following total knee arthroplasty (TKA) in older patients often require prolonged non-weight-bearing, thereby decreasing their activities of daily living (ADL) and increasing mortality. This report clarifies early weight-bearing safety and utility by using double-plate fixation on medial and lateral sides (LM180 double-plate fixation) for DFFs following TKA.

Case presentation

Three cases of Su Type III periprosthetic, interprosthetic, and interimplant DFFs following TKA, where bone stock was limited, were treated with LM180 double-plate fixation using locking plates through medial and lateral incisions on the distal femur. In interprosthetic and interimplant DFF cases, the proximal section was secured by overlapping the lateral plate +/− medial plate with the proximal femur stem of the intramedullary nail by using monocortical screws and cerclage wires. Early postoperative partial weight-bearing was recommended, and full weight-bearing was allowed 4–5 weeks postoperation. All cases regained independent walking without hardware failure. Average ADL scores, namely, Barthel index (BI) and functional independence measure (FIM), were recovered to 85/100 and 114.7/126, respectively, approaching near-normal values.

Conclusion

LM180 double-plate fixation for DFFs such as Su Type III periprosthetic, Vancouver type C interprosthetic, and interimplant DFFs following TKA with limited bone stock can be used to achieve early weight-bearing without fixation failure and help maintain ADL.

Introduction

Wrist fractures, particularly the distal radius, can result in significant stiffness and hand dysfunction if not mobilized early. The variable immobilization period post-fracture depends on fracture type, location, stability, and surgical intervention. Inadequate early mobilization typically leads to structured stiffness, influenced by patient health, injury mechanism, joint surface involvement, associated tissue injuries, and patient motivation.

Case presentation

A 64-year-old female in good health suffered a distal radius fracture, treated with open reduction and internal fixation. A modified treatment plan, including custom orthosis and active wrist exercises, was initiated after the standard immobilization phase to enhance the range of motion while accommodating the patient's daily activities.

Clinical discussion

The patient underwent 15 evaluations of active range of motion (AROM) using a goniometer, guided by the American Society of Hand Therapists. A Tissue Composition Analysis (TCA) was performed to guide the orthosis-treatment choice. Despite consistent improvement shown in AROM, it was inconclusive whether the modified treatment contributed significantly beyond the standard approach.

Conclusions

While the patient's AROM improved, the treatment's effect on this single case cannot definitively confirm the efficacy of the modified approach. A more extensive study is necessary to evaluate the conservative treatment strategy's validity for such fractures in high-demand patients, considering the biomechanical complexity of the injury and the patient's professional needs.

There are no general guidelines for the treatment of acetabular fractures. Open reduction and internal fixation is advised in young and active patients, while acute total hip arthroplasty (THA) is recommended for elderly patients in order to allow immediate weight bearing. Various THA systems have been reported.

We present four cases, mean age 79 years (range 67–92), of closed acetabular fractures managed with acute cementless THA, comprising a highly-porous multi-hole acetabular cup and a CLS-type femoral stem. After extensive pre-operative planning, autograft was used to fill in the acetabulum defects left by the trauma and the press-fit acetabular cup were implanted. One or more screws were used to improve primary stability and secure bone fragments. Patients were follow-up for mean 1.5 years (range 1.1–2.0). A Brooker III heterotopic ossification was the only complication occurred postoperatively. All the patients were satisfied, with a mean Harris Hip Score of 90 and Postel Merle D'Aubigné score of 16.3. There were no radiolucency lines nor osteolysis, showing that the cups were well osteointegrated and fractures united.

As the bone bed after acetabular fracture might be highly compromised, whenever acute THA is indicated, a highly-porous multi-hole cup could be used to limit radiolucency lines and aseptic loosening. The series is limited by the small number of cases but is significant for the promising results.

In this case report, we discuss a rare incident of avulsion-type renal injury in a 24-year-old male with no significant medical history. The injury occurred during a traffic accident, where he was involved in a direct impact collision between a motorcycle and a vehicle, leading to altered corticomedullary differentiation in the right kidney, a retroperitoneal hematoma, and free fluid in the cavity. The patient underwent successful emergency abdominal surgery, which involved the removal of the damaged kidney due to the severity of the injury. During his postoperative recovery in the ICU, he received extensive care, including sedation, mechanical ventilation, and vasopressor support. Ultimately, he made a successful recovery and was discharged after rehabilitation.

This case highlights the complexities involved in managing patients with renal injuries resulting from high-energy impact accidents. It emphasizes the importance of a multidisciplinary approach in treatment, the challenges associated with deciding on surgical intervention, and the significance of rehabilitation in patient recovery. The uniqueness of this case, characterized by its distinct mechanism of injury and the severity of the trauma, contributes to our broader understanding of renal trauma management in the field of trauma medicine. It underscores the need for personalized patient care strategies and emphasizes the effectiveness of surgical interventions in severe cases of renal trauma.

In vascular neurosurgery, dural arteriovenous fistulas (DAVFs) are a difficult, challenging condition whose natural history and therapy are still debated. This case report presented a 30-year-old male patient who experienced intermittent headaches for two months, along with gradual weakness in all four limbs, resulting in quadriplegia. Magnetic resonance imaging (MRI), computed tomography (CT), and digital subtraction angiography (DSA) played a significant role in the diagnosis of the patient, in which the final diagnosis was vascular myelopathy due to Dural arteriovenous fistula (DAVF). A successful embolization procedure of arteriovenous fistula using balloon-assisted liquid embolic agents, through branches of the right occipital artery was performed, resulting in complete obliteration of the fistula. In order to improve the neurovascular symptoms that had previously been reported, the patient was effectively undergoing rehabilitation, with notable progress.

Introduction

Patella fractures account for 1 % of all skeletal fractures, and can interrupt the knee's extensor apparatus. They can also be serious if associated with a cutaneous opening. We report the case of a fracture of the tip of the patella with a large loss of cutaneous substance.

Case report

A 22-year-old man was admitted for the management of a left knee trauma following a motorcycle accident. Clinical examination revealed a large loss of skin substance on the anteromedial aspect of the knee, with exposed bone, pain and lack of extension of the left knee. Standard X-ray of the left knee showed an avulsion fracture of the tip of the patella. The patient underwent patellar tendon reconstruction using transosseous stitches, reinforced by a quadricipital tendon reversal plasty, and protected by steel-wire patellotibial cerclage. A medial gastrocnemius flap was used to cover the loss of skin substance. After a functional rehabilitation protocol, the functional results were satisfactory, with a full return to activity after six months.

Conclusion

The stability of osteosynthesis using quadricipital tendon reversal plasty and patellotibial cerclage allows mobilization and immediate weight-bearing. This may lead to better clinical results.

Introduction and importance

Radiocarpal dislocation is a rare and severe injury that demands urgent diagnosis and treatment. In this case report, we present the unique scenario of a 32-year-old male who suffered a traumatic pure unstable radiocarpal dislocation. This dislocation was associated with ulnar impingement syndrome, an extensively arched carpus, and a medially rotated scaphoid. The complexity of this injury underscores the importance of timely intervention and comprehensive management.

Case presentation

The patient had a pre-existing short ulnar head with radial-sided deformity, radioulnar convergence, negative ulnar variance, erosive scalloping of the distal radius, subchondral sclerosis of the ulnar head, scapholunate diastasis, and distal radioulnar joint (DRUJ) diastasis. Following a high-velocity motor vehicle accident, the initial treatment involved closed reduction and radio-metacarpal external fixation. Additionally, surgical intervention was required for an open dislocation of the metatarsophalangeal (MTP) joint of the left hallux.

Clinical discussion

The subsequent management of this complex case included the Sauvé-Kapandji procedure, ulnolunate and ulnotriquetral ligamentoplasty using the palmaris longus tendon, and scapholunate fusion. The patient reported no prior wrist instability or injury upon awakening, but mild mechanical wrist pain persisted after exertion. Follow-up assessments revealed residual pain during prono-supination, along with slightly limited radial inclination. This exceptional case highlights the biomechanical challenges and the need for a multidisciplinary approach in treating such injuries.

Conclusion

To the best of our knowledge, this is the first documented instance of a traumatic pure unstable radiocarpal dislocation associated with ulnar impingement syndrome, an extensively arched carpus, and a medially rotated scaphoid. Despite the complexity, proper bone healing and favorable functional outcomes were achieved through meticulous surgical management. This case underscores the importance of individualized treatment strategies for rare and challenging wrist injuries.

Decision-making regarding limb amputation represents a significant clinical challenge, especially when the initial evaluation does not coincide with the criteria established in scales used worldwide, as is the case of the MESS scale. This article presents the case of a 24-year-old female patient who was transferred to a university hospital after a road traffic accident with severe and large lesions in the left lower limb. Despite a poor initial prognosis and in-hospital complications, including multiple surgical procedures and foot drop, a favorable recovery was achieved with complete anatomical salvage of the limb at risk. The multidisciplinary approach and intensive rehabilitation were instrumental in achieving a satisfactory functional recovery. This case highlights the importance of considering factors beyond amputation scale scores, as well as the need for comprehensive care to improve outcomes in patients with complex extremity injuries.