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Sample records for clavicle

  1. Pneumothorax complicating isolated clavicle fracture.

    Science.gov (United States)

    Hani, Redouane; Ennaciri, Badr; Jeddi, Idriss; El Bardouni, Ahmed; Mahfoud, Mustapha; Berrada, Mohamed Saleh

    2015-01-01

    Isolated clavicle fractures are among the commonest of traumatic fractures in the emergency department. Complications of isolated clavicle fractures are rare. Pneumothorax has been described as a complication of a fractured clavicle only rarely in English literature. In all the reported cases, the pneumothorax was treated by a thoracostomy and the clavicle fracture was treated conservatively. In our case, the pneumothorax required a chest drain insertion and the clavicle fracture was treated surgically with good result.

  2. Clavicle Fracture (Broken Collarbone)

    Science.gov (United States)

    ... Bahk MS, Kuhn JE, Galatz LM, Connor PM, Williams GR: Acromioclavicular and sternoclavicular injuries and cla- vicular, ... Orthopaedic Surgeons. .org Clavicle Fracture cont. Rehabilitation Specific exercises will help restore movement and strengthen your shoulder. ...

  3. Distal clavicle edema; Distales Klavikulaoedem

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    Vahlensieck, M.; Schmittke, I. [Radiologie Haydnhaus, Bonn (Germany); Schmidt, H.M. [Universitaet Bonn (Germany). Anatomisches Institut

    2006-07-15

    Distal clavicle marrow edema: frequency, MRI in the early stage and macroscopic correlation to the bone marrow distribution and to evaluate frequency and diagnostic criteria of a posttraumatic clavicula disorder with an edema pattern on MRI. An additional macroscopic study of the clavicle should elucidate anatomic pecularities which could explain the reaction of the distal clavicle. 285 MRI of traumatized patients were analyzed for edema pattern of the distal clavicle. Pattern A edema within the clavicle and the acromion was distinguished from pattern B edema within the clavicle only. Dissection in 20 cadavers should reveal vascular pecularities and the bone marrow distribution within clavicle and acromion or vascular pecularities. In 38 patients (13,3%) we found edema within the distal clavicle. Pattern A was found in 28 (9,8%) and pattern B in 10 patients (3,5%). Pattern A was usually associated with swelling of the AC joint (27 out of 28). Other injuries were not evident. 18 cadavers showed hematopoetic marrow within the distal clavicle and fatty marrow within the acromion. The distale clavicle can frequently react with edema pattern after trauma without evidence for another injury. Distinguish in cases with and cases without synovitis of the AC joint could have impact on therapy. A peculier vascular supply of the distal clavicle could not be found. (orig.) [German] Bestimmung der Haeufigkeit und diagnostischer Kriterien einer posttraumatischen Klavikulaerkrankung, die mit einem MR-tomographischen Oedemmuster auffaellt. Makroskopische Besonderheiten der Markhoehle sollten gesucht werden, die die besondere Reaktionsform der distalen Klavikula mit erklaeren koennten. 285 Patienten mit traumaassoziierten, zeitversetzt nach dem Unfallereignis bestehenden Schulterbeschwerden, wurden auf MR-tomographische Oedemmuster in der distalen Klavikula untersucht. Das Oedemmuster wurde in ''Klavikula allein'' (Muster B) und ''mit Beteiligung des

  4. Distal clavicle fractures in children☆

    Science.gov (United States)

    Labronici, Pedro José; da Silva, Ricardo Rodrigues; Franco, Marcos Vinícius Viana; Labronici, Gustavo José; Pires, Robinson Esteves Santos; Franco, José Sergio

    2015-01-01

    Objective To analyze fractures of the distal clavicle region in pediatric patients. Methods Ten patients between the ages of five to eleven years (mean of 7.3 years) were observed. Nine patients were treated conservatively and one surgically. All the fractures were classified using the Nenopoulos classification system. Results All the fractures consolidated without complications. Conservative treatment was used for nine patients, of whom three were in group IIIB, three IIb, two IIa and one IV. The only patient who was treated surgically was a female patient of eleven years of age with a group IV fracture. Conclusion The treatment indication for distal fractures of the clavicle in children should be based on the patient's age and the displacement of the fragments. PMID:26962489

  5. Distal clavicle fractures in children

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    Pedro José Labronici

    2016-02-01

    Full Text Available ABSTRACT OBJECTIVE: To analyze fractures of the distal clavicle region in pediatric patients. METHODS: Ten patients between the ages of five to eleven years (mean of 7.3 years were observed. Nine patients were treated conservatively and one surgically. All the fractures were classified using the Nenopoulos classification system. RESULTS: All the fractures consolidated without complications. Conservative treatment was used for nine patients, of whom three were in group IIIB, three IIb, two IIa and one IV. The only patient who was treated surgically was a female patient of eleven years of age with a group IV fracture. CONCLUSION: The treatment indication for distal fractures of the clavicle in children should be based on the patient's age and the displacement of the fragments.

  6. CONGENITAL PSEUDARTHROSIS OF THE CLAVICLE

    OpenAIRE

    de Figueiredo, Marina Juliana Pita Sassioto Silveira; dos Reis Braga, Susana; Akkari,Miguel; Prado, José Carlos Lopes; Santili, Cláudio

    2015-01-01

    Congenital pseudarthrosis of the clavicle (PCC) is a rare affection, that can be diagnosed at birth and represent a disturbance of union of the ossification centers. It's more common in girls and in the right side. This study objectives to proceed a revision about the subject, that was searched in online database of LILACS and MEDLINE. We found 56 articles till present data. Besides be a bit infrequent, the PCC must not be missed or even forgotten, especially as differential diagnosis with ac...

  7. Congenital pseudoarthrosis of the clavicle with bifurcation

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    Narender Kumar Magu

    2014-01-01

    Full Text Available Congenital pseudoarthrosis of clavicle is a rare clinical entity. It usually presents as a swelling in the clavicular region at birth or soon after birth. Fitzwilliam′s original description of 60 subtypes of congenital pseudoarthrosis of clavicle have addressed several anatomical variants, e.g. association with cervical rib and abnormally vertical and elevated upper ribs. However, congenital pseudoarthrosis of clavicle associated with bifurcation is an atypical anatomic variant. To the best of our knowledge, this variant has never been mentioned in the literature. In the present report, we have described this subtype of symptomatic congenital pseudoarthrosis of the clavicle with bifurcation and its possible management.

  8. Langerhans Cell Histiocytosis of the Clavicle

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    Wang, Shaowu; Zhang, Weisheng; Na, Shengbo; Zhang, Lina; Lang, Zhijin

    2014-01-01

    Abstract We report a rare case of solitary Langerhans cell histiocytosis (LCH) involving the clavicle of an adult female. The patient was a 32-year-old female presenting with 1 month history of progressive pain, swelling, and tenderness in the region near the left sternoclavicular joint. Radiograph, computed tomography, and magnetic resonance imaging showed an osteolytic lesion in the clavicle with tumor extension and soft tissue edema. Surgical curettage of the lesion was performed, and the histopathologic diagnosis was LCH. Because of its rarity and possibly variable presentation, LCH should be included and considered in the differential diagnosis when we encounter a clavicle lesion. PMID:25365405

  9. An application of principal component analysis to the clavicle and clavicle fixation devices.

    LENUS (Irish Health Repository)

    Daruwalla, Zubin J

    2010-01-01

    Principal component analysis (PCA) enables the building of statistical shape models of bones and joints. This has been used in conjunction with computer assisted surgery in the past. However, PCA of the clavicle has not been performed. Using PCA, we present a novel method that examines the major modes of size and three-dimensional shape variation in male and female clavicles and suggests a method of grouping the clavicle into size and shape categories.

  10. Clavicle fractures - incidence of supraclavicular nerve injury

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    Pedro Jose Labronici

    2013-08-01

    Full Text Available OBJECTIVE: To analyze retrospectively 309 fractures in the clavicle and the relation with injury of the supraclavicular nerve after trauma. METHODS: It was analyzed 309 patients with 312 clavicle fractures. The Edinburgh classification was used. Four patients had fractures in the medial aspect of the clavicle, 33 in the lateral aspect and 272 in the diaphyseal aspect and three bilateral fractures. RESULTS: 255 patients were analyzed and five had paresthesia in the anterior aspect of the thorax. Four patients had type 2 B2 fracture and one type 2 B1 fracture. All patients showed spontaneous improvement, in the mean average of 3 months after the trauma. CONCLUSION: Clavicle fractures and/ or shoulder surgeries can injure the lateral, intermediary or medial branches of the supraclavicular nerve and cause alteration of sensibility in the anterior aspect of the thorax. Knowledge of the anatomy of the nerve branches helps avoid problems in this region.

  11. Proximal clavicle excision: an analysis of results.

    Science.gov (United States)

    Acus, R W; Bell, R H; Fisher, D L

    1995-01-01

    Medial clavicle excision has been reported by several authors, but few cases are documented, and long-term follow-up information is lacking. The purpose of this study was to examine the long-term results of medial clavicle excision in regard to function, pain, cosmesis, and complications. Fifteen patients ranging in age from 18 to 64 years (average 43 years) were evaluated an average of 4.6 years (range 1 to 14 years) after proximal clavicle excision. The indications for excision were unstable anterior subluxation/dislocation of the sternoclavicular joint (four cases), unstable posterior dislocation (one case), sternoclavicular osteoarthritis (nine cases), and proximal clavicle osteomyelitis (one case). An average of 2.9 cm of the medial clavicle was excised (range 1 to 4 cm). Fourteen of the 15 patients received significant relief of pain. On a strict grading scale four patients had an excellent result, five a good result, four a fair result, and two a poor result. Regeneration of the clavicle appeared to contribute to a poor result. No operative complications occurred. These findings aid our understanding of surgical options and outcome in the treatment of sternoclavicular joint disease.

  12. Traumatic Floating Clavicle- A case report

    Science.gov (United States)

    Sopu, Alexandra; Green, Connor; Molony, Diarmuid

    2015-01-01

    Introduction: Shoulder injuries after high velocity trauma are common. Clavicle is affected in almost half of these cases. Even so, bipolar dislocation of the clavicle is an unusual injury and seldom reported in the literature. Conservative management is used for almost all the cases and only selected cases will undergo surgical treatment. Case Report: A 52 year old right electrician presented to the emergency department following a fall from a push bicycle. Plain radiographs identified a left first metacarpal (MC) fracture and a bipolar fracture of his right clavicle. Following Fracture Clinic review, significant deformity of the medial clavicle was noted and a CT scan showed anterior dislocation of the medial fragment. Given the degree of deformity and this functional requirement we felt that operative treatment was most appropriate for his unstable medial clavicle fracture dislocation. Conclusion: Surgical treatment of floating clavicle has an important role in the management of fit and active patients. It is important to identify the mechanism of injury and deforming forces in fractures and only after this to plan to neutralise these where appropriate. PMID:27299032

  13. Intraosseous hemangioma arising in the clavicle

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    Matsumoto, Yoshihiro; Haraguchi, Akihisa; Harimaya, Katsumi; Matsunobu, Tomoya; Endo, Makoto; Iwamoto, Yukihide [Kyushu University, Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Higashi-ku, Fukuoka (Japan); Takahashi, Yusuke; Oda, Yoshinao [Kyushu University, Department of Anatomic Pathology, Graduate School of Medical Sciences, Higashi-ku, Fukuoka (Japan); Okamoto, Tatsuro [Kyushu University, Department of Surgery and Science, Graduate School of Medical Sciences, Higashi-ku, Fukuoka (Japan)

    2014-01-15

    Intraosseous hemangioma (IH) is commonly seen in the vertebral column and skull: however, IH occurring in the appendicular skeleton, including the clavicle, is uncommon. We herein report the case of a 69-year-old female presenting with IH of the left clavicle. The findings of preoperative imaging studies, including radiographs, computed tomography (CT), magnetic resonance imaging, fluorine-18-fludeoxyglucose ({sup 18}F-FDG) positron emission tomography (PET)/CT and ultrasonography, are described. In particular, {sup 18}F-FDG PET/CT showed an ill-defined osteolytic lesion with abnormally high FDG uptake. Surgical en bloc resection with preoperative embolization was carried out and a histopathological examination confirmed the presence of an intraosseous cavernous hemangioma in the clavicle. (orig.)

  14. An application of principal component analysis to the clavicle and clavicle fixation devices

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    Fitzpatrick David

    2010-03-01

    Full Text Available Abstract Background Principal component analysis (PCA enables the building of statistical shape models of bones and joints. This has been used in conjunction with computer assisted surgery in the past. However, PCA of the clavicle has not been performed. Using PCA, we present a novel method that examines the major modes of size and three-dimensional shape variation in male and female clavicles and suggests a method of grouping the clavicle into size and shape categories. Materials and methods Twenty-one high-resolution computerized tomography scans of the clavicle were reconstructed and analyzed using a specifically developed statistical software package. After performing statistical shape analysis, PCA was applied to study the factors that account for anatomical variation. Results The first principal component representing size accounted for 70.5 percent of anatomical variation. The addition of a further three principal components accounted for almost 87 percent. Using statistical shape analysis, clavicles in males have a greater lateral depth and are longer, wider and thicker than in females. However, the sternal angle in females is larger than in males. PCA confirmed these differences between genders but also noted that men exhibit greater variance and classified clavicles into five morphological groups. Discussion And Conclusions This unique approach is the first that standardizes a clavicular orientation. It provides information that is useful to both, the biomedical engineer and clinician. Other applications include implant design with regard to modifying current or designing future clavicle fixation devices. Our findings support the need for further development of clavicle fixation devices and the questioning of whether gender-specific devices are necessary.

  15. Locking plate osteosynthesis of clavicle fractures

    DEFF Research Database (Denmark)

    Fridberg, Marie; Ban, Ilija; Issa, Zaid;

    2013-01-01

    PURPOSE: Locking plate osteosynthesis has become the preferred method for operative treatment of clavicle fractures. The method offers stable fixation, and would theoretically be associated with a low rate of fracture-related complications and reoperations. However, this remains to be explored in...

  16. Kingella kingae osteomyelitis of the clavicle.

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    Rotbart, H A; Gelfand, W M; Glode, M P

    1984-08-01

    Kingella kingae is the most recent addition to the list of etiologic agents causing osteomyelitis and septic arthritis in previously well children. A case is presented of a child with K. kingae osteomyelitis of the clavicle--an uncommon site of infection due to any organism. In the hope of facilitating the detection and treatment of this increasingly recognized pathogen, a brief discussion of its microbiologic characteristics and a summary of the patients reported to date with bone and joint infections due to this organism are included. To our knowledge, this is the first discussion of K. kingae in the orthopedic literature.

  17. A Rare Case of Segmental Clavicle Fracture in an Adolescent

    Science.gov (United States)

    Daolagupu, Arup Kumar; Gogoi, Parag Jyoti; Mudiganty, Srikanth

    2013-01-01

    Clavicular fractures commonly occur in adults and children. The usual mechanism of injury is a fall on the outstretched hand or direct trauma. The usual site of these fractures is the mid clavicle with lateral end and medial end clavicular fractures being less common, respectively. Segmental clavicular fractures have been reported in the literature; they usually occur at the medial and lateral ends and tend to occur in adults. Bipolar clavicular injuries involving medial and lateral ends have also been reported rarely but all in adults. We report a very rare case of segmental clavicular fracture involving the mid clavicle and lateral end in an adolescent caused by direct trauma. The management of segmental clavicle fractures has not been clearly outlined although operative intervention is indicated. We report the successful management of segmental fracture clavicle in an adolescent and discuss the relevant literature. PMID:23476850

  18. A Rare Case of Segmental Clavicle Fracture in an Adolescent

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    Arup Kumar Daolagupu

    2013-01-01

    Full Text Available Clavicular fractures commonly occur in adults and children. The usual mechanism of injury is a fall on the outstretched hand or direct trauma. The usual site of these fractures is the mid clavicle with lateral end and medial end clavicular fractures being less common, respectively. Segmental clavicular fractures have been reported in the literature; they usually occur at the medial and lateral ends and tend to occur in adults. Bipolar clavicular injuries involving medial and lateral ends have also been reported rarely but all in adults. We report a very rare case of segmental clavicular fracture involving the mid clavicle and lateral end in an adolescent caused by direct trauma. The management of segmental clavicle fractures has not been clearly outlined although operative intervention is indicated. We report the successful management of segmental fracture clavicle in an adolescent and discuss the relevant literature.

  19. Osteofibrous dysplasia of clavicle clinically mimicking chronic osteomyelitis

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    Nirmal Raj Gopinathan

    2016-01-01

    Full Text Available Osteofibrous dysplasia or ossifying fibroma is an uncommon benign fibro-osseous lesion of childhood, commonly described in the maxilla and the mandible. Among long bones, it usually presents in the tibia as a painless swelling or anterior bowing. Ossifying fibroma of clavicle has never been reported in English literature, to the best of our knowledge. Here, we would like to present an unusual case of osteofibrous dysplasia of clavicle clinically mimicking chronic osteomyelitis.

  20. Clavicle hook plate fixation for displaced lateral-third clavicle fractures (Neer type II): a functional outcome study.

    LENUS (Irish Health Repository)

    Good, Daniel W

    2012-08-01

    Controversy exists with the use of the acromioclavicular hook plate for the treatment of lateral-third clavicle fractures (Neer type II). This is thought to stem from problems associated with the hook plate causing impingement symptoms, which can cause long-term limitation of movement and pain. Our aim was to evaluate the functional outcomes of patients with lateral-third clavicle fractures treated with the hook plate.

  1. Imaging findings of desmoplastic fibroma rarely involoving the clavicle: Case report

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    Kang, Dong Min; Juhng, Seon Kwan; Sohn, Young Jun; Kim, Hun Soo [Wonkwang University School of Medicine and Hospital, Iksan (Korea, Republic of)

    2014-02-15

    Desmoplastic fibroma of bone is a rare locally aggressive, but non-metastatic tumor. In this case report, we present a desmoplastic fibroma in an unusual location, the clavicle. Desmoplastic fibroma involving the clavicle is extremely rare, with only 2 reported cases before 1985. We report the imaging findings of a desmoplastic fibroma of the clavicle with a review of the relevant literature.

  2. Bipolar physeal injuries of the clavicle in a child

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    Vrisha Madhuri

    2012-01-01

    Full Text Available This article reports a type II Salter and Harris injury at either ends of the clavicle in a 13-year-old child with postero-inferior displacement at the lateral and antero-superior displacement at the medial end of the clavicle shaft. He was treated in a shoulder immobilizer. The mechanism of injury is postulated as pivoting of the clavicle on the first rib with shearing at either ends leading to a bipolar injury. The brachial plexus and subclavian vessels are at a risk of damage at the pivot as they lie in close vicinity to the first rib. In view of the intact periosteal sleeve as well as joint articulation at both ends, the fracture healed with no functional loss.

  3. Langerhans cell histiocytosis of the clavicle: a case report

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    Verbist, B.; Geusens, E.; Brys, P.; Verslegers, I.; Baert, A.L. [Department of Radiology, University Hospitals, Leuven (Belgium); Samson, I. [Department of Orthopedic Surgery, University Hospitals, Leuven (Belgium); Sciot, R. [Department of Pathology II, University Hospitals, Leuven (Belgium)

    1998-10-01

    A case of Langerhans cell histiocytosis in a 47-year-old male presenting as an aggressive appearing lesion of the clavicle is reported. It illustrates the difficulties of the radiological diagnosis of a solitary bone lesion. (orig.) (orig.) With 3 figs., 7 refs.

  4. Bilateral congenital pseudoarthrosis of the clavicles in a newborn

    Science.gov (United States)

    Kalagiri, Ram R.; Hemingway, Martha; Beeram, Madhava R.

    2016-01-01

    Bilateral congenital pseudoarthrosis of the clavicles is extremely rare. We report a case of this entity presenting in the neonatal period. We highlight the importance of the differential diagnosis when clavicular fracture shows no evidence of healing or occurs bilaterally. PMID:27695169

  5. A RARE CASE PRESENTATION OF SIMPLE BONE CYST IN CLAVICLE

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    Vittal

    2015-05-01

    Full Text Available Simple bone cyst represent approximately 3% of all primary bone tumors sampled for biopsy and nearly always occur during the first two decades of life. They are common in metaphyseal region of long bones. Clavicle is rare s ite for this lesion and not many have been reported in literature. We report a case of Histopathologically confirmed Simple bone cyst in a 65 yr s old manual laborer who presented with pain and swelling of long duration. The occurrence of this lesion at unu sual age and at unusual location carries a lot of diagnostic dilemma and various differentials like ABC , Eosinophilic granuloma , and enchondroma were considered only to confirm simple bone cyst on HPE . The symptoms were relieved after resection of lesion. Clavicle was reconstructed with tricortical iliac crest bone graft. At 18th month follow up the patient had no recurrences and had a good functional outcome .

  6. Anatomic variation of the clavicle: A novel three-dimensional study.

    LENUS (Irish Health Repository)

    Daruwalla, Zubin J

    2010-03-01

    An understanding of the complex anatomy of the clavicle is helpful in the treatment of clavicular fractures. Using three-dimensional (3D) statistical shape analysis, the author presents a novel method to assess geometric morphology of the clavicle. Fifteen fresh frozen shoulder specimens were scanned using high-resolution computerized tomography (CT) but four were excluded from the study. A further 16 high-resolution CT scans of the clavicle were obtained by searching the hospital database. All 27 scans were reconstructed and subsequently imported into and analyzed using a specifically developed statistical software package. Using statistical shape analysis, geometric parameters were then measured. Both gender as well as side specific geometric morphology were observed. Clavicles in men were longer, wider, and thicker than in women. Right clavicles had a greater medial depth than left clavicles, especially in women. Clavicles in men had a greater lateral depth than in women. The sternal angle in women was larger than in men. Using 3D statistical shape analysis and applying it to the clavicle standardizes the study of its anatomy, rules out any variability, and calculates morphological parameters that are accurate, precise, and reproducible. This unique approach provides information that is useful not only to the clinician but also in the modification of current or design of future clavicle fixation devices. More importantly, from an anatomy standpoint, implementation of this novel approach in anatomical studies would eliminate intra- and interobserver variation and allow all studies to be standardized and thus more comparable.

  7. Operative Cost Comparison: Plating Versus Intramedullary Fixation for Clavicle Fractures.

    Science.gov (United States)

    Hanselman, Andrew E; Murphy, Timothy R; Bal, George K; McDonough, E Barry

    2016-09-01

    Although clavicle fractures often heal well with nonoperative management, current literature has shown improved outcomes with operative intervention for specific fracture patterns in specific patient types. The 2 most common methods of midshaft clavicle fracture fixation are intramedullary and plate devices. Through retrospective analysis, this study performed a direct cost comparison of these 2 types of fixation at a single institution over a 5-year period. Outcome measures included operative costs for initial surgery and any hardware removal surgeries. This study reviewed 154 patients (157 fractures), and of these, 99 had intramedullary fixation and 58 had plate fixation. A total of 80% (79 of 99) of intramedullary devices and 3% (2 of 58) of plates were removed. Average cost for initial intramedullary placement was $2955 (US dollars) less than that for initial plate placement (Pcost for removal was $1874 less than that for plate removal surgery (P=.2). Average total cost for all intramedullary surgeries was $1392 less than the average cost for all plating surgeries (Pcost for all intramedullary surgeries requiring plate placement and removal was $653 less than the average cost for all plating surgeries that involved only placement (P=.04). Intramedullary fixation of clavicle fractures resulted in a statistically significant cost reduction compared with plate fixation, despite the incidence of more frequent removal surgeries. [Orthopedics.2016; 39(5):e877-e882.].

  8. CONDENSING OSTEITIS OF THE CLAVICLE - MAGNETIC-RESONANCE-IMAGING AS AN ADJUNCT METHOD FOR DIFFERENTIAL-DIAGNOSIS

    NARCIS (Netherlands)

    VIERBOOM, MAC; STEINBERG, JDJ; MOOYAART, EL; VANRIJSWIJK, MH

    1992-01-01

    Condensing osteitis of the clavicle is a benign disorder leading to osteosclerosis of the medial end of the clavicle. The differential diagnosis between condensing osteitis of the clavicle and ischaemic necrosis of the medial clavicular epiphysis (Friedrich's disease), osteoid osteoma, and low grade

  9. CASE REPORT OF COMPOUND COMMINUTED FRACTURE CLAVICLE WITH VEIN AND PLEURAL INJURY

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    Vinayak Nerlikar

    2015-01-01

    Full Text Available We report a case of compound segmental comminuted fracture of the Left clavicle , fracture of second rib , comminuted fracture of scapula with subclavian vein laceration and perforation of the parietal pleura and lung contusion that caused massive haemo - pneumothorax. Emergency exploration followed by repair of subclavian vein , pleura and fixation of clavicle were able to salvage the patient.

  10. The Treatment of Mid-shaft Clavicle Fractures

    Institute of Scientific and Technical Information of China (English)

    Qing-Hua Sang; Zhi-Gang Gou; Hua-Yong Zheng; Jing-Tao Yuan; Jian-Wen Zhao; Hong-Ying He; Chuang Liu

    2015-01-01

    Objective:Through reviewing the relevant literature from the past decades,to summarize the assessment and management of fractures of the clavicle,and provide an overview of the clinical results of a range of treatment options.Data Sources:The data analyzed in this review are mainly from articles included in PubMed and EMBASE,published from 1960 to 2015.Study Selection:Studies involving assessment of fractures of the clavicle were reviewed.Further literatures were gathered regarding the conservative and surgical treatment of these fractures,including the methods of fixation and the surgical approaches used.Both conservative and surgical treatments were then compared and contrasted.Results:Through retrieving and reading the abstract,a total of 42 representative articles were selected,which covered all aspects of the conservative treatment and surgical treatment,and compared the advantages and disadvantages of different treatment options.Conclusions:Although the majority of recent data suggest that surgery may be more appropriate as it improves functional outcome and reduces the risk of complications,we recommend that the treatment should be individually assessed.

  11. SEXUAL DIMORPHISM OF CLAVICLE IN SOUTH INDIAN POPULATION: A CROSS SECTIONAL STUDY

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    Bindhu.S

    2015-09-01

    Full Text Available Introduction: Estimation of sex is the ground for an exact identification of unknown human skeletal elements. Methods for sex assessment are based on the existence of morphological features in the skeleton that manifest differently according to sex or statistical differences in skeletal measurements. Due to the specific pattern of ontogeny and age related changes of sterna articular surface during adulthood the clavicle is widely used in the estimation of sex at death and in living people. Objectives: To evolve an easily applied formula to enable the assessment of sex in unknown clavicles and to document the comparative differences between right and left clavicles by using metrical parameters. Materials and Methods: The cross sectional study was conducted in the department of Anatomy, Yenepoya Medical college, Mangalore. The present study was conducted in 50 adult dry clavicle.Maximum clavicular length, maximum breadth of sterna end ,maximum breadth of acromial end and acromial surface area were measured by digital caliper and osteometric board. Results: The maximum length of clavicle ( was statistically significant when compared with the clavicle of females. The other values like breadth of sternal end, breadth of acromial end and acromial surface area were greater in males when compared to females. Conclusion: Determination of sex the clavicle has a great medicolegal importance to the forensic people. And it also help the orthopedic implant manufactures and orthopedic surgeons to decide correct size and shape of plates and intramedullary nails for clavicular fractures in open reduction method.

  12. Early Stent Graft Perforation after Endovascular Repair for Pseudoaneurysm That Was Associated with Clavicle Nonunion

    Science.gov (United States)

    Touma, Masanao; Ohno, Nobuhisa; Yoshikawa, Eiji; Yoshizawa, Kousuke; Fujiwara, Keiichi

    2015-01-01

    We report the case of a 62-year-old man who experienced a left axillary artery pseudoaneurysm that was secondary to nonunion of a 30-year-old left midshaft clavicle fracture. He initially underwent endovascular repair using a self-expanding nitinol stent graft, which was perforated at postoperative day 5. Therefore, we performed open repair with concomitant clavicle resection, and no complications were observed during an approximately 6-year follow-up. We recommend performing clavicle resection with vascular repair to prevent recurrence in similar cases. PMID:26421082

  13. Type IV acromioclavicular joint dislocation associated with a mid-shaft clavicle malunion

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    Khalid D Mohammed

    2016-01-01

    Full Text Available This reports presents the case of a combined clavicle fracture malunion and chronic Type IV acromioclavicular (AC joint dislocation. The patient was seen acutely in the emergency department following a mountain bike accident at which time the clavicle fracture was identified and managed conservatively however the AC dislocation was not diagnosed. The patient presented 25 months following the injury with persistent pain and disability and was treated with clavicle osteotomy and AC stabilization. We document the clinical details, surgical treatment and outcome.

  14. Condensing osteitis of the clavicle in a man: any relationship with tooth decay?

    Science.gov (United States)

    Altiok, Inci Baltepe; Tokmak, Mehmet; Akman, Tarik; Alkan, Bahadir; Cosar, Murat

    2014-05-01

    Condensing osteitis of the clavicle is a rarely seen pathology since its first description in 1974. Although mechanical stress is claimed for aetiology, but remains a dilemma for physicians. The intermittent or steady pain is variable in intensity and generally localised at the medial end of the involved clavicle, supraclavicular fossa, ipsilateral anterior thorax and shoulder. In this report, we present a 28-year-old man with the regression of the condensing osteitis of the clavicle after the extraction of a decayed tooth.

  15. Combined finite element and multibody musculoskeletal investigation of a fractured clavicle with reconstruction plate

    DEFF Research Database (Denmark)

    Cronskar, Marie; Rasmussen, John; Tinnsten, Mats

    2015-01-01

    This paper addresses the various treatment options for clavicle fractures by means of computational models, more precisely cases with a need for internal fixation: non-unions and certain complex fractures. The motivation for the work is that treatment can be enhanced by a better understanding...... of the loading of the clavicle and fixation device. This study aimed to develop a method for realistic simulation of stresses in the bone and fixation device in the case of a fractured clavicle. A finite element (FE) mesh of the clavicle geometry was created from computer tomography (CT) data and imported...... into the FE solver where the model was subjected to muscle forces and other boundary conditions from a multibody musculoskeletal model performing a typical activity of daily life. A reconstruction plate and screws were also imported into the model. The combination models returned stresses and displacements...

  16. Treatment of distal clavicle fracture with distal radius volar locking compression plate

    Institute of Scientific and Technical Information of China (English)

    YU Chao; SUN Yue-hua; ZHAO Chang-qing; SHI Ding-wei; WANG You

    2009-01-01

    Objective: To observe the early clinical outcomes of the internal fixation with distal radius volar locking compression plate (LCP) in treatment of distal clavicle fracture.Methods: Six patients with unilateral distal clavicle fractures, identified as type Ⅱ according to Neer classification system, including 4 males and 2 females, were treated with open reduction and internal fixation using a distal radius volar LCP. Bone union was evaluated by routine X-ray radiography, and shoulder joint function were assessed by Constant score system.Results: All fractures achieved bone union at 6 to 8 weeks postoperatively, and Constant scores ranged from 95 to 100 at the postoperative 10 to 12 weeks.Conclusion: Fixation of distal clavicle fracture with distal radius volar LCP demonstrates excellent effects of bone union with rarely early complications, thus providing a new technique to treat distal clavicle fracture.

  17. ANEURYSMAL BONE CYST OF THE CLAVICLE IN CHILDREN (CLINICAL CASES AND TREATMENT

    Directory of Open Access Journals (Sweden)

    Тимур Фаизович Зубаиров

    2014-09-01

    Full Text Available The purpose. To examine the results of the treatment of children with aneurysmal cyst of the clavicle. Material and methods. The results of examination and treatment of patients aged 16 and 17 years with a diagnosis of aneurysmal cyst of the clavicle. All patients underwent surgical treatment with the ABC stage delimitation. We used a surgical technique, which consists in open removement of the abnormal tissue with replacement of the bone defect with bone-plastic material or autogenous bone from the iliac crest. Conclusions. The method of treatment of aneurysmal bone cyst of the clavicle must be individualized depending on the location, aggressiveness and extent of the lesion. The use bone-plastic material or autogenous bone from the iliac crest restore the structural integrity of a compromised clavicle gives good results in the observation period of up to 2 years.

  18. A case of mediastinal goiter treated surgically using a clavicle-lifting technique

    Directory of Open Access Journals (Sweden)

    Eisaku Ito

    2015-01-01

    Conclusion: Although further study is necessary, it appears that a transcervical approach using the clavicle-lifting technique may be an acceptable treatment for mediastinal goiters that extend to the aortic arch.

  19. Shoulder Impingement, An Uncommon Complication of Distal Clavicle Fracture Treated Arthroscopically: A Case Report

    Directory of Open Access Journals (Sweden)

    CS Wang

    2013-11-01

    Full Text Available Clavicle fracture is commonly treated conservatively. However uncommon complication can arise causing impingement. We report a patient who sustained distal clavicle fracture and was treated conservatively. However he developed persistent shoulder pain that affected his daily life. Shoulder impingement was diagnosed and arthroscopic subacromioclavicular decompression was done. Following early physiotherapy the early recovery was good with full range of motion of the shoulder.

  20. Safety zone for surgical access in the middle third of the clavicle: study on cadavers☆

    Science.gov (United States)

    Ribeiro, Fabiano Rebouças; de Marchi Bosi Porto, Fernanda; Silva, Marcio Vieira Sanches; Tenor Junior, Antonio Carlos; da Costa, Miguel Pereira; Filardi, Cantidio

    2015-01-01

    Objective The aim of this study was to establish a neurovascular safety zone for surgical access in the middle third of the clavicle, by means of dissection on cadavers. Methods Twenty shoulders were dissected in 10 cadavers, with deep dissection of the middle third of the clavicle. The following structures were identified: subclavian vein, upper trunk of the brachial plexus (anterior and posterior divisions) and suprascapular nerve. These structures were marked out in order to measure their distances from the most proximal point of the middle third of the clavicle. Results The mean distances from the middle third of the clavicle to the suprascapular nerve, subclavian vein, upper trunk, anterior division of the upper trunk and posterior division of the upper trunk were respectively, for the right side: 15.92 cm, 10.77 cm, 23.68 cm, 14.60 cm and 15.42 cm; and for the left side: 12.69 cm; 9.82 cm; 22.19 cm; 12.16 cm and 13.46 cm. Conclusion There was a statistical difference in the distances to the suprascapular nerve and anterior division of the upper trunk, in comparing between the right and left sides. The closest neurovascular structures to the middle third of the clavicle were the suprascapular nerve and subclavian vein. PMID:26229929

  1. Posttraumatic nonunion of the clavicle in a 13-year-old boy causing an arteriovenous fistula

    Directory of Open Access Journals (Sweden)

    Feiran Wu

    2013-01-01

    Full Text Available Context: Fractures of the clavicle are one of the most common injuries to the bone in childhood, but posttraumatic nonunion of pediatric clavicle fractures are extremely rare, with only isolated reports in literature. Case Report: We report a case of a posttraumatic painful nonunion of a clavicle fracture in a 13-year-old boy that caused symptomatic compression of the external jugular vein (EJV and the formation of an arteriovenous fistula. The fracture was treated successfully with open reduction and internal fixation with a contoured recon plate 6 months following the injury. The fistula was treated by ligation and closure. Conclusion: The patient made a full recovery 6 months following surgery and was asymptomatic with full range of shoulder movement. Fracture union was confirmed by computed tomography (CT scanning and no residual fistula was found.

  2. Comparative study on developmental stages of the clavicle by postmortem MRI and CT imaging

    DEFF Research Database (Denmark)

    Larsen, Sara Tangmose; Lynnerup, Niels; Jensen, K.E.

    2013-01-01

    Objectives: The developmental stages of the clavicles are important for forensic age estimation purposes in adolescents. This study compares the 4-stage system to evaluate the ossification of the medial end of the clavicle as visualized by magnetic resonance imaging (MRI) and computed tomography...... (CT). As several forensic institutes routinely perform CT scans, the large amount of available data may serve as reference sample for MRI in specific cases. Material and methods: This prospective study included an MRI and CT scan of 47 autopsy cases performed prior to medico-legal autopsy (age range...

  3. Treatment of middle-third clavicle fractures using anterior plating with a dynamic compression plate (DCP).

    Science.gov (United States)

    Subramanian, Padmanabhan; Joshi, Meera; Shilston, Sophie; Wallace, Donald; Pearce, Oliver J

    2013-03-01

    Significantly displaced midshaft clavicle fractures can be managed operatively to restore anatomy and allow early mobilization. Several techniques have described using precontoured anatomically designed plates placed on the superior surface of the bone or reconstruction plates contoured by the surgeon placed either superiorly or anteriorly. We describe the use of the dynamic compression plate placed anteriorly on the clavicle in treating these fractures and discuss the relative advantages of this technique. We have a case series of 8 patients over a 2-year period, who were followed up and all went on to successful fracture union.

  4. Arthroscopic Resection of The Distal Clavicle With Concomitant Subacromial Decompression: A Case Series

    Directory of Open Access Journals (Sweden)

    HZ Chan

    2014-07-01

    Full Text Available Shoulder impingement syndrome and acromioclavicular joint osteoarthritis often occur simultaneously and easily missed. Kay et al. reported excellent results with combined arthroscopic subacromial decompression and resection of the distal end of the clavicle in patients with both disorders. Arthroscopic treatment of these disorders produces more favourable results than open procedures. We report two patients who were not responding to conservative management and were treated with direct arthroscopic distal clavicle excision and subacromial decompression in single setting. Both patients gained good postoperative outcome in terms of pain score, function and strength improvement assessed objectively with visual analogue score (VAS and University of California Los Angeles Score (UCLA.

  5. Fractures of the clavicle and injuries of the sub-clavian artery. Report of 10 cases.

    Science.gov (United States)

    Natali, J; Maraval, M; Kieffer, E; Petrovic, P

    1975-01-01

    During four years, the authors have observed ten lesions of the sub-clavian artery associated with a fracture of the clavicle. The clinical picture in one case out of two was that of an acute ischemia of the upper limb. The surgical repair has been performed in 8 cases. The thoracic approach was necessary three times. The clavicle was resected in most cases. The prognosis of these lesions depends on the rapidity of their recognition, and of their treatment, and on the fact whether the brachial plexus is involved or not

  6. Arthroscopic resection of the distal clavicle in osteoarthritis of the acromioclavicular joint

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    Tae-Soo Park

    2016-01-01

    Full Text Available Background: Symptomatic acromioclavicular joint (ACJ lesions are a common cause of shoulder complaints that can be treated successfully with both conservative and surgical methods. There are several operative techniques, including both open and arthroscopic surgery, for excising the distal end of the clavicle. Here, we present a new modified arthroscopic technique for painful osteoarthritis of the ACJ and evaluate its clinical outcomes. Our hypothesis was that 4- to 7-mm resection of the distal clavicle in an en bloc fashion would have several advantages, including no bony remnants, maintenance of stability of the ACJ, and reduced prevalence of heterotopic ossification, in addition to elimination of the pathologic portion of the distal clavicle. Materials and Methods: 20 shoulders of 20 consecutive patients with painful and isolated osteoarthritis of the ACJ who were treated by arthroscopic en bloc resection of the distal clavicle were included in the study. There were 10 males and 10 females with an average age of 56 years (range 42-70 years. The mean duration of followup was 6 years and 2 months (range 4-8 years 10 months. The results were evaluated using the University of California Los Angeles (UCLA shoulder rating score. Results: The overall UCLA score was 13.7 preoperatively, which improved to 33.4 postoperatively. All subscores were improved significantly ( P < 0.001. There were no specific complications at the latest followup. Conclusion: It is critical in this procedure to resect the distal clavicle evenly from superior to inferior in an en bloc fashion without any small bony remnants and to preserve the capsule and acromioclavicular ligament superoposteriorly. This arthroscopic procedure is a reliable and reproducible technique for painful osteoarthritis of the ACJ lesions in active patients engaged in overhead throwing sports and heavy labor.

  7. Whole clavicle sequestration from chronic osteomyelitis in a 10 year old boy: A case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Agu Thaddeus Chika

    2016-03-01

    Full Text Available Chronic osteomyelitis is a childhood disease and so it is not uncommon to diagnose it in a 10 year old boy who is suffering from pains and discharging sinuses from the left shoulder girdle. What is not common is the involvement of the clavicle in this infective process and even more uncommon is for the whole length of the clavicle to sequester. This case report describes a rare case of chronic osteomyelitis of the left clavicle in which the entire length was removed as a sequestrum during surgery. And despite the removal of an entire length of the clavicle in the patient, there was no functional deficit and there was also no shoulder asymmetry.

  8. Evaluation of usefulness and availability for orthopedic surgery using clavicle fracture model manufactured by desktop 3D printer

    Energy Technology Data Exchange (ETDEWEB)

    Oh, Wang Kyun [Dept. of Diagnostic Radiology, Cheongju Medical Center, Cheongju (Korea, Republic of)

    2014-09-15

    Usefulness and clinical availability for surgery efficiency were evaluated by conducting pre-operative planning with a model manufactured by desktop 3D printer by using clavicle CT image. The patient-customized clavicle fracture model was manufactured by desktop 3D printer of FDM wire laminated processing method by converting the CT image into STL file in Open Source DICOM Viewer Osirix. Also, the model of the original shape before damaged was restored and manufactured by Mirror technique based on STL file of not fractured clavicle of the other side by using the symmetry feature of the human body. For the model, the position and size, degree of the fracture was equally printed out. Using the clavicle model directly manufactured with low cost and less time in Department of Radiology is considered to be useful because it can reduce secondary damage during surgery and increase surgery efficiency with Minimal invasive percutaneous plate osteosynthesis(MIPO)

  9. Post-traumatic and stress-induced osteolysis of the distal clavicle: MR imaging findings in 17 patients

    Energy Technology Data Exchange (ETDEWEB)

    Puente, R. de la [Department of Radiology, University of California San Diego and Veterans Affairs Medical Center, San Diego, CA (United States)]|[Servicio de Radioloxia, CXH Cristal Pinor, Ourense (Spain); Boutin, R.D. [Department of Radiology, University of California San Diego and Veterans Affairs Medical Center, San Diego, CA (United States)]|[Department of Radiology, Veterans Affairs Medical Center, San Diego, CA (United States); Theodorou, D.J.; Hooper, A.; Resnick, D. [Department of Radiology, University of California San Diego and Veterans Affairs Medical Center, San Diego, CA (United States); Schweitzer, M. [Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA (United States)

    1999-04-01

    Objective. To describe the MR imaging findings in patients with osteolysis of the distal clavicle and to compare the MR imaging appearance of clavicular osteolysis following acute injury with that related to chronic stress. Design and patients. MR imaging examinations were reviewed in 17 patients (14 men, 3 women; ages 16-55 years) with the diagnosis of post-traumatic or stress-induced osteolysis of the clavicle. A history of a single direct injury was present in seven patients and a history of weight-lifting, participation in sports, or repetitive microtrauma was present in 10 patients. Results. MR imaging showed edema in the distal clavicle in 17 patients and, of these, eight also had edema in the acromion. The edema was most evident in STIR and fat-suppressed T2-weighted pulse sequences. Other findings about the acromioclavicular (AC) joint were prominence of the joint capsule in 14, joint fluid in eight, cortical irregularity in 12, and bone fragmentation in six patients. No differences in the MR imaging features of post-traumatic and stress-induced osteolysis of the distal clavicle were observed. Conclusion. Post-traumatic and stress-induced osteolysis of the distal clavicle have similar appearances on MR imaging, the most common and conspicuous MR imaging feature being increased T2 signal intensity in the distal clavicle. (orig.) With 5 figs., 1 tab., 19 refs.

  10. Research progress of the fracture treatment in the clavicle medial end%锁骨近端骨折治疗的研究进展

    Institute of Scientific and Technical Information of China (English)

    蒋玮; 祝晓忠

    2015-01-01

    Clavicle fracture is commonly seen in clinic, while clavicle medial end fracture is immensely rare. Clavicle medial end fracture, also called fracture of the inner end of the clavicle, occurs in the inner 1/3 end of the clavicle and is suggested to conduct conservative treatment. Nonetheless, severe complications may occur. With the updating of biomechanics and treatment concepts, improvement of surgical techniques as well as melioration of ifxation devices, it is gradually abundant in treatment methods which contain their own hallmarks, attracting attention and promotion of research from many scholars. The key points lie in the choice of the therapy, comprehension of operation indication together with management of relevant complications. Here is to make a review on the research progress in the treatment of clavicle medial end fracture.

  11. Surgical treatment for unstable distal clavicle fracture with micromovable and anatomical acromioclavicular plate.

    Science.gov (United States)

    Liu, Qingjun; Miao, Jianyun; Lin, Bin; Lian, Kejian

    2012-01-01

    Between 2006 and 2009, 18 patients of distal clavicle fracture were treated with micro-movable and anatomical acromioclavicular plate (MAAP) in our department. According to the Neer's classification, all cases were unstable with type IIA (12 cases) and type IIB (6 cases). Functional outcome was evaluated using the Karlsson's criteria. The mean follow-up was 18 months (range, 12-36months). No postoperative plate screws complication was observed. Osseous union could be achieved at a mean time of 12 weeks after operation in 18 patients (range, 8 -16 weeks). According to Karlsson's criteria, radiographic appearances and postoperative shoulder functional recovery revealed a good and excellent rate in these cases. We conclude that surgical treatment using MAAP seems to be a good option for unstable type II fractures of the distal clavicle. This technique allows for reliable fixation with early functional exercises and functional recovery.

  12. Surgical Treatment for Unstable Distal Clavicle Fracture with Micromovable and Anatomical Acromioclavicular Plate

    Directory of Open Access Journals (Sweden)

    Qingjun Liu, Jianyun Miao, Bin Lin, Kejian Lian

    2012-01-01

    Full Text Available Between 2006 and 2009, 18 patients of distal clavicle fracture were treated with micro-movable and anatomical acromioclavicular plate (MAAP in our department. According to the Neer's classification, all cases were unstable with type IIA (12 cases and type IIB (6 cases. Functional outcome was evaluated using the Karlsson's criteria. The mean follow-up was 18 months (range, 12-36months. No postoperative plate screws complication was observed. Osseous union could be achieved at a mean time of 12 weeks after operation in 18 patients (range, 8 -16 weeks. According to Karlsson's criteria, radiographic appearances and postoperative shoulder functional recovery revealed a good and excellent rate in these cases. We conclude that surgical treatment using MAAP seems to be a good option for unstable type II fractures of the distal clavicle. This technique allows for reliable fixation with early functional exercises and functional recovery.

  13. Langerhans Cell Histiocytosis of the Clavicle in a 13-Year-Old Boy

    Directory of Open Access Journals (Sweden)

    Shital N. Parikh

    2014-01-01

    Full Text Available Langerhans Cell Histiocytosis (LCH is a rare neoplasm characterized by abnormal proliferation of histiocytic cells. In this case report, we describe a unique case of a 13-year-old boy who presented to the clinic with an insidious onset of mid-clavicular pain. The provisional radiologic diagnosis of Langerhans Cell Histiocytosis of the clavicle was confirmed by an incisional biopsy of the left mid-clavicle lesion. The patient’s lesion was treated by curettage, bone grafting, and internal fixation, due to the presence of pathologic fracture. At the 2-year followup, the patient was asymptomatic, and the lesion showed complete resolution without recurrence. The case report highlights the characteristic features of Langerhans Cell Histiocytosis in an unusual location, the knowledge of which would help avoid delayed or missed diagnosis in the future.

  14. Clavicle metastasis from carcinoma thyroid- an atypical skeletal event and a management dilemma.

    Science.gov (United States)

    Krishnamurthy, Arvind

    2015-09-01

    Bone metastases is a well described event in the natural history of thyroid cancers and has the potential to severely impact the quality of life by causing pain, fractures and spinal cord compression. Follicular thyroid carcinomas have a greater propensity for distal metastasis than papillary and anaplastic thyroid carcinomas. The most common sites of skeletal metastasis among thyroid cancer patients are femur followed by humerus, pelvis, radius, and scapula. Clavicle metastasis at initial presentation is exceedingly rare. Although many studies have examined the various prognostic factors for patients with bony metastases from thyroid cancers, very few have actually evaluated the effects of surgical management. We present an unusual case of metastatic papillary carcinoma thyroid presenting with clavicle metastasis and review the role of surgical management of bone metastases. Clavicular resection as a part of the management of metastatic papillary carcinoma thyroid has, to the best of our knowledge never been reported before.

  15. DYNAMICS OF THE FUNCTIONAL STATUS OF PATIENTS IN THE TREATMENT OF CLAVICLE FRACTURES BY TRANSOSSEOUS OSTEOSYNTHESIS

    Directory of Open Access Journals (Sweden)

    V. A. Shchurov

    2013-01-01

    Full Text Available Purpose - assessment of the dynamics of the state, blood supply regenerate bone, muscle contractility of the arm and forearm in patients with clavicle fractures during the treatment with external fixation device. Material and methods. Authors studied 38 patients during the treatment by Ilizarov method. The muscle dynamometry, Doppler ultrasound, psychophysiological study using SF-36 test were performed. Results. The strength of the humeral and forearm muscles on the side of damage was reduced and increased by 50-80% of the conditional baseline during transosseous fixation. The high rate of blood flow in the area of injury was characteristic during the first week in the fixation period. In the process of the treatment and recovery of muscle contractility its value normalized. The treatment of clavicle fractures by Ilizarov method allows in the early period of fixation to restore the ability of patients to self-service, to reduce the influence of pain limiting factor, improves mood and health of patients.

  16. Forensic age estimation from the clavicle using 1.0 T MRI—Preliminary results

    DEFF Research Database (Denmark)

    Larsen, Sara Tangmose; Jensen, Karl Erik; Villa, Chiara;

    2014-01-01

    : Motion artefacts reduced image resolution in living subjects. However, mean age at stage 4 was significantly different from mean age at stage 2 and 3. The minimum age at stage 4 was 19.8 years. Inter-observer agreement was moderate for autopsy cases and slight for living subjects. By contrasting subjects......OBJECTIVES: As forensic age estimations in the living are performed without medical indication, there is a need for the development of non-ionizing methods. This study investigates the use of 1.0T MRI to visualize the ossification status of the medial end of the clavicle. MATERIAL AND METHODS: T2...... of "incomplete fusion" (≤ stage 3 on both sides) against "fused" (at least one stage 4), agreement rate rose to moderate (K=0.414) for living subjects. Despite the low agreement rate, no subject younger than 18 years was assessed as having "fused" clavicles. CONCLUSION: At lower image resolution, a 2-stage...

  17. Arthroscopic evaluation for omalgia patients undergoing the clavicular hook plate fixation of distal clavicle fractures

    OpenAIRE

    2014-01-01

    Background The aim of this study is to investigate the anatomic changes in the shoulder joints responsible for omalgia after the clavicular hook plate fixation under arthroscope. Methods Arthroscopic examination was carried out for 12 omalgia patients who underwent clavicular hook plate fixation due to distal clavicle fractures. Functional outcome of shoulder was measured by the Japanese Orthopaedic Association (JOA) score before and after the withdrawal of the fixation plate. Results The rot...

  18. Posterior sternoclavicular Salter-Harris fracture-dislocation in a patient with unossified medial clavicle epiphysis.

    Science.gov (United States)

    Beckmann, Nicholas; Crawford, Lindsay

    2016-08-01

    Sternoclavicular injuries are relatively rare, composing less than 1 % of all musculoskeletal fractures or dislocations. When sternoclavicular injuries do occur, they typically present as an isolated dislocation of the sternoclavicular joint without associated fracture of the clavicle or manubrium. However, in patients with unfused medial clavicle physis, sternoclavicular joint injuries can present as a fracture-dislocation through the unfused physis. These physeal injuries are important to recognize as the displaced epiphysis can block reduction of the sternoclavicular joint. We present a case of a 15-year-old female basketball player presenting with suspected sternoclavicular joint injury after sustaining a direct blow to the left shoulder. An initial shoulder CT confirmed the presence of the clinically suspected posterior sternoclavicular dislocation without fracture identified. An MRI of the left sternoclavicular joint was then performed for suspected physeal fracture, which confirmed the presence of a fracture through the medial clavicle physis with anterior displacement of the unossified epiphysis, blocking reduction of the metaphysis. Given the findings on MRI, the pediatric orthropedic surgeon was able to counsel the family of the high likelihood of failed closed reduction of the sternoclavicular joint requiring conversion to open reduction and internal fixation. The patient underwent successful open reduction and internal fixation of the medial clavical physeal fracture after an initial gentle attempt at closed reduction was unsuccessful.

  19. Congenital pseudoarthrosis of the clavicle: is operative treatment necessary? A report of four cases and literature review.

    Science.gov (United States)

    Kołodziej, Lukasz; Bohatyrewicz, Andrzej; Kotrych, Daniel

    2008-01-01

    Congenital pseudoarthrosis of the clavicle (CPC) is not a common condition. The exact number of cases reported in literature is fewer than two hundred. We present four well-documented cases of true congenital pseudoarthrosis of the clavicle, including two cases of familial occurrence. None of the patients in this study were treated surgically. Evaluation of upper extremity function was done with use of the Constant-Murley method. In spite of clavicle pseudoarthrosis the score results were similar to the unaffected shoulder. Although vertical elevation of the upper ribs or cervical ribs has been suggested as a cause of congenital clavicle lesions, radiological examination failed to reveal such pathology in any of the patients described here. Clavicle pseudoarthrosis is generally regarded as a benign condition. The majority of patients who underwent surgery because of cosmetic or functional heal well and proceed with a normal, unrestricted life. However, for those patients who are not bothered by the cosmetic appearance of their CPC and are asymptomatic in that they are not functionally limited, non-surgical treatment is a viable option.

  20. Hook plate fixation of acute displaced lateral clavicle fractures: mid-term results and a brief literature overview

    Directory of Open Access Journals (Sweden)

    Tiren Davut

    2012-01-01

    Full Text Available Abstract Background The clavicle hook plate achieves like most other operative techniques, a high percentage of union and a low percentage of complications however concerns about long term complications still exist, particularly the involvement of the acromioclavicular joint. Methods To evaluate the results and long term effects in use of this plate we performed a retrospective analysis with a mean follow up of 65 months (5.4 years of 28 consecutive patients with acute displaced lateral clavicle fractures, treated with the clavicle hook plate. Results Short term functional results in all patients were good to excellent. All but one patient had a united fracture (96%. Nine patients (32% developed impingement symptoms and in 7 patients (25% subacromial osteolysis was found. These findings resolved after plate removal. Twenty-four patients were re-evaluated at a mean follow-up period of 5.4 years. The Constant-Murley score was 97 and the DASH score was 3.5. Four patients (14% developed acromioclavicular joint arthrosis of which one was symptomatic. Three patients (11% had extra articular ossifications of which one was symptomatic. There was no relation between the impingement symptoms, subacromial osteolysis and development of acromioclavicular joint arthrosis or extra articular ossifications. Conclusions The clavicle hook plate is a good primary treatment option for the acute displaced lateral clavicle fracture with few complications. At mid term the results are excellent and no long term complications can be addressed to the use of the plate.

  1. Clinico-radiological Approach to a Rare Case of Early Clavicle Tuberculosis: A Case Discussion Based Review of Differential Diagnosis.

    Science.gov (United States)

    Akhtar, Mohammad Nasim; Agarwal, Sharat; Athar, Rizwan

    2015-06-01

    A patient of 41 years of age presented with insidious onset atraumatic swelling arising from medial end of right clavicle with apparently normal radiograph. Initial computed tomography ascribed it to benign bony pathology requiring no specific treatment but patient did not respond to symptomatic management. FNAC done elsewhere was inconclusive, with no bacteria on Gram's staining and negative bacterial culture and AFB smear examinations. Patient had possible exposure to tuberculosis and Mantoux skin test done which showed significant induration. Possible differential diagnoses related to clavicle including infective, neoplastic, rheumatological, degenerative and idiopathic conditions considered. Magnetic resonance imaging (MRI) showed focal periosteal reaction with marrow signal changes with sparing of sternoclavicular joint. Correlation between patient's history, clinical findings and investigations done and diagnosis of isolated clavicle tuberculosis was made. Patient showed good response to anti-tubercular chemotherapy. Repeat MRI showed resolution of initial imaging findings. At the end of 2 years patient was completely symptom free.

  2. Acute Nontraumatic Clavicle Fracture Associated with Long-Term Bisphosphonate Therapy

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    Shen Hwa Vun

    2014-01-01

    Full Text Available Cases of osteonecrosis of the jaw, insufficiency fractures and atypical low energy or atraumatic fractures of pelvis, femur (subtrochanteric/mid-shaft/distal-third, tibia, fibula, metatarsal, humerus, and ulna related to long-term bisphosphonate therapy have been reported in the literature. We present the case of an acute nontraumatic clavicle fracture, associated with long-term bisphosphonate therapy, which to our knowledge has not been reported previously. This case highlights the need of critical evaluation of patients with atypical fractures during long-term bisphosphonate therapy.

  3. Chondromyxoid fibroma of the clavicle extending to the adjacent joint: a case report.

    Science.gov (United States)

    Aggarwal, Aditya; Bachhal, Vikas; Soni, Ashwani; Rangdal, Sushil

    2012-12-01

    Chondromyxoid fibroma is a rare benign bone tumour usually involving bones of the lower extremity in young adults. We present a case of chondromyxoid fibroma of the left clavicle extending to the adjacent joint in a 84-year-old man. The tumour had breached the hyaline cartilage of acromioclavicular joint. The tumour was excised en bloc, and the humeral head was curetted and grafted with autogenous cancellous bone. Postoperatively, the patient had an uneventful recovery and regained excellent function of the left shoulder without any pain or stiffness. At the 18-month follow-up, there was no sign of recurrence.

  4. Nonbacterial Osteitis of the Clavicle: Longitudinal Imaging Series from Initial Diagnosis to Clinical Improvement

    Directory of Open Access Journals (Sweden)

    E. Roos

    2015-01-01

    Full Text Available Nonbacterial osteitis is a rare autoinflammatory disease. Often it is mistaken for a tumor or osteomyelitis. We present a case of a twelve-year-old girl referred to our hospital because of a lesion of the right clavicle. The differential diagnoses were sarcoma, osteitis, and Langerhans cell histiocytosis. After biopsy the diagnosis nonbacterial osteitis (NBO was established. Treatment of choice is a nonsteroidal anti-inflammatory drug. This case report gives a complete follow-up of the disease, showing the pitfalls of the diagnosis.

  5. Noninflammatory sclerosis of the sternal end of the clavicle: a follow-up study and review of the literature

    Energy Technology Data Exchange (ETDEWEB)

    Jurik, A.G. (Dept. of Diagnostic Radiology, Municipal Hospital, Univ. of Aarhus (Denmark))

    1994-07-01

    The cases of 14 adult females with swelling, tenderness, and sclerosis of the inferomedial part of the clavicle are presented. They were seen during a 16-year period, suggesting that the condition is rare. In ten patients strain at the sternoclavicular joint seemed to be an etiological factor. Eleven patients were followed for periods of 1-13 years (mean 5 years). The clavicular sclerosis regressed and they all developed signs of osteoarthrosis. Based upon available biopsy results and review of reported cases, it is hypothesized that the radiographic changes are due to osteonecrosis of the medial end of the clavicle with subsequent development of osteoarthrosis. (orig.)

  6. The PA projection of the clavicle: a dose-reducing technique.

    LENUS (Irish Health Repository)

    Mc Entee, Mark F

    2010-06-01

    This study compares dose and image quality during PA and AP radiography of the clavicle. The methodology involved a cadaver-based dose and image quality study. Results demonstrate a statistically significant 56.1 % (p clavicle radiography.

  7. Clavicles, scapulae and humeri from the Sima de los Huesos site (Sierra de Atapuerca, Spain).

    Science.gov (United States)

    Carretero, J M; Arsuaga, J L; Lorenzo, C

    1997-01-01

    The scapulae, clavicles and humeri recovered from the Sima de los Huesos (SH) site between 1976 and 1994 are studied. All elements are briefly described anatomically with metrics and compared with other fossil hominids in order to establish the morphological pattern of the SH hominids. A minimum of 13 individuals are represented by the humeri in the SH sample. Almost all of them can be classified as adolescents and young adults. The morphology of the SH hominid shoulder girdle and humeri indicates that much of the shoulder morphology recognized in the later true Neandertal was present in Europe long before they appeared. Thus, this morphological pattern is not exclusive to Neandertals alone. The SH clavicles, scapulae and humeri share with the Neandertals many traits usually considered to be Neandertal specializations. The comparative analysis of the SH evidence suggests that most of the SH and Neandertal shared traits are either primitive features within the genus Homo or even for all hominids, or display high variability within different hominid samples. These traits must be used with caution, or not used at all, in phylogenetic analysis. There are, however, traits that to date have only been detected in the SH hominids and the Neanderials, which could be exclusive to the European phyletic lineage (clade) of Homo.

  8. Fractures of the distal clavicle: comparison between two surgical treatment methods☆

    Science.gov (United States)

    Souza Vilela, José Carlos; de Andrade, Ronaldo Percopi; Jacques Gonçalves, Lucas Braga; Abreu Machado, Thalles Leandro; Correa Filho, Mario Roberto Chaves; de Araujo, Ivana Duval

    2015-01-01

    Objective To compare the clinical and radiographic results from osteosynthesis of fractures of the lateral third of the clavicle, using two methods: T plates or anchors together with Kirschner wires. Methods Fifteen patients of mean age 34.3 years (range: 19–57) and mean follow-up 22.7 months (range: 14–32) were evaluated. In nine cases, a T plate was used; and in six cases, coracoclavicular fixation was used with anchors in the coracoid process and Kirschner wires through the acromioclavicular joint. The evaluation included the Constant score, personal satisfaction and radiographic assessment. Results Both types of treatment achieved consolidation in all cases. Group 1 presented a higher Constant score (83.4) than that of Group 2 (76.4) (p = 0.029). Neither of the techniques presented any severe complications, and mild complications were only observed in Group 2 (80%), mostly consisting of migration of the Kirschner wire and superficial infection. Conclusion Surgical treatment of fractures of the distal clavicle using T plates provided the same consolidation rate as shown by coracoclavicular fixation with anchors in the coracoid process and Kirschner wires through the acromioclavicular joint, and better clinical results. Level of evidence Level III evidence was obtained. Comparative retrospective study and therapeutic study were performed. PMID:26229906

  9. Pseudartrose congênita de clavícula Congenital pseudarthrosis of the clavicle

    Directory of Open Access Journals (Sweden)

    Marina Juliana Pita Sassioto Silveira de Figueiredo

    2012-02-01

    Full Text Available A pseudartrose congênita de clavícula (PCC é uma afecção rara, que representa um distúrbio na união dos núcleos de ossificação e que pode ser diagnosticada ao nascimento. É mais comum em meninas e do lado direito. Este trabalho tem por objetivo proceder a uma revisão bibliográfica sobre o tema, em pesquisa realizada nas bases de dados LILACS e MEDLINE. Foram encontrados 56 artigos publicados até a corrente data. Apesar de pouco frequente, a PCC não deve ser desconhecida ou mesmo esquecida, especialmente como diagnóstico diferencial com a fratura aguda da clavícula por distocia de parto e/ou tocotraumatismo. O diagnóstico é relativamente fácil e o tratamento pode ser apenas expectante ou até mesmo cirúrgico.Congenital pseudarthrosis of the clavicle (PCC is a rare affection, that can be diagnosed at birth and represent a disturbance of union of the ossification centers. It's more common in girls and in the right side. This study objectives to proceed a revision about the subject, that was searched in online database of LILACS and MEDLINE. We found 56 articles till present data. Besides be a bit infrequent, the PCC must not be missed or even forgotten, especially as differential diagnosis with acute fracture of the clavicle at birth by trauma in the childbirth. The diagnostic is relatively easy and the treatment can be just observation or even surgical.

  10. A Study of Heam atogenous Osteomyelitis of the Clavicle in Child en%锁骨血源性骨髓炎

    Institute of Scientific and Technical Information of China (English)

    梁栋; 郑允宜; 史颖奇

    1987-01-01

    Heamatogenous osteomyelitis of the clavicle is seldom seen, especially in children. This paper, however discusses 5 cases of the disease, all being children and their age ranging from 1 month to 10 years after birth. The inner ends of the right clavicle were affected in three, and either end of the left clavicle in two.Usually, osteomyelitis of the clavicle is seen in male adults. The onset is insidious unlike that of other acute suppurative infections. The main signs are swelling and tenderness of inner end of the clavicle.Roentgenogram shows fusiform enlargement of the inner end of the clavicle associated with central destruction and surrounding sclerosing and thickening of the bone. It has often been misdiagnosed as a malignant tumor of the clavicle. There is usually no pathogenic bacteria in the culture of the discharge from the lesion. For treatment, a series of broadspectrum antibiotics should be .used to control trie infection. Continuous using antibiotics has been proved of great help to repair. Segmental or total resection of the clavicle is considered to be harmful to the development of the affected shoulder. Of these 5 cases, one underwent a radical curettage of the lesion, while the other four were given only drug treatment. The result: all of them were cured, follow-up for 1-2 years, no recurrence.%本文报告锁骨血源性骨髓炎5例,其中1例采用抗生素结合病灶清除术治疗,4例采用抗生素保守治疗,均获得良好效果.随诊1~2年无复发.讨论了锁骨骨髓炎的临床表现、诊断及治疗方法等问题.

  11. Clavicles, interclavicles, gastralia, and sternal ribs in sauropod dinosaurs: new reports from diplodocidae and their morphological, functional and evolutionary implications.

    Science.gov (United States)

    Tschopp, Emanuel; Mateus, Octávio

    2013-03-01

    Ossified gastralia, clavicles and sternal ribs are known in a variety of reptilians, including dinosaurs. In sauropods, however, the identity of these bones is controversial. The peculiar shapes of these bones complicate their identification, which led to various differing interpretations in the past. Here we describe different elements from the chest region of diplodocids, found near Shell, Wyoming, USA. Five morphotypes are easily distinguishable: (A) elongated, relatively stout, curved elements with a spatulate and a bifurcate end resemble much the previously reported sauropod clavicles, but might actually represent interclavicles; (B) short, L-shaped elements, mostly preserved as a symmetrical pair, probably are the real clavicles, as indicated by new findings in diplodocids; (C) slender, rod-like bones with rugose ends are highly similar to elements identified as sauropod sternal ribs; (D) curved bones with wide, probably medial ends constitute the fourth morphotype, herein interpreted as gastralia; and (E) irregularly shaped elements, often with extended rugosities, are included into the fifth morphotype, tentatively identified as sternal ribs and/or intercostal elements. To our knowledge, the bones previously interpreted as sauropod clavicles were always found as single bones, which sheds doubt on the validity of their identification. Various lines of evidence presented herein suggest they might actually be interclavicles - which are single elements. This would be the first definitive evidence of interclavicles in dinosauromorphs. Previously supposed interclavicles in the early sauropodomorph Massospondylus or the theropods Oviraptor and Velociraptor were later reinterpreted as clavicles or furculae. Independent from their identification, the existence of the reported bones has both phylogenetic and functional significance. Their presence in non-neosauropod Eusauropoda and Flagellicaudata and probable absence in rebbachisaurs and Titanosauriformes shows a

  12. A Large-Sample Test of a Semi-Automated Clavicle Search Engine to Assist Skeletal Identification by Radiograph Comparison.

    Science.gov (United States)

    D'Alonzo, Susan S; Guyomarc'h, Pierre; Byrd, John E; Stephan, Carl N

    2017-01-01

    In 2014, a morphometric capability to search chest radiograph databases by quantified clavicle shape was published to assist skeletal identification. Here, we extend the validation tests conducted by increasing the search universe 18-fold, from 409 to 7361 individuals to determine whether there is any associated decrease in performance under these more challenging circumstances. The number of trials and analysts were also increased, respectively, from 17 to 30 skeletons, and two to four examiners. Elliptical Fourier analysis was conducted on clavicles from each skeleton by each analyst (shadowgrams trimmed from scratch in every instance) and compared to the search universe. Correctly matching individuals were found in shortlists of 10% of the sample 70% of the time. This rate is similar to, although slightly lower than, rates previously found for much smaller samples (80%). Accuracy and reliability are thereby maintained, even when the comparison system is challenged by much larger search universes.

  13. Langerhans Cell Histiocytosis of the Clavicle in an Adult: A Case Report and Review of the Literature

    Science.gov (United States)

    Udaka, Toru; Susa, Michiro; Kikuta, Kazutaka; Nishimoto, Kazumasa; Horiuchi, Keisuke; Sasaki, Aya; Kameyama, Kaori; Nakamura, Masaya; Matsumoto, Morio; Chiba, Kazuhiro; Morioka, Hideo

    2015-01-01

    Langerhans cell histiocytosis (LCH) usually occurs in children under the age of 10 years with a predilection for the skull, spine, rib and humerus. Solitary LCH occurring in an adult clavicle is uncommon with limited reports to date. The lesion in our patient was curetted with the intent to make a diagnosis, which subsequently lead to the remission of the symptom and the disease. At the final follow-up after 1 year, no local recurrence or metastasis is observed. PMID:26600774

  14. Determining sex with the clavicle in a contemporary Spanish reference collection: A study on 3D images.

    Science.gov (United States)

    Mediavilla, Elena Ruiz; Pérez, Bernardo Perea; González, Elena Labajo; Sánchez, José Antonio Sánchez; Fernández, Enrique Dorado; Sáez, Andrés Santiago

    2016-04-01

    Sexual dimorphism of the clavicle based on metric studies has been determined among different populations from different eras. Due to the need to know about sexual dimorphism in the Spanish population in order to apply the results to the field of Forensic Anthropology, a study has been carried out on a sample in the contemporary Spanish population, made up of the right and left clavicles of 50 males and 50 females. A metric, volumetric and curvature study was performed. To do so, 3D scanning was completed on the entire sample using the Picza 3D Laser Scanner, and the study was performed using reproductions. There were taken 6 metric measurements and 4 volumetric measurements using the Geomagic software, and for the study of curves, an index was calculated which related the direct length of the clavicle and its length as cast onto a surface. The data are presented for all of the variables, distinguishing between the right and left side, and there were processed using the statistical program PASW Statistics 18. The results show that the classification functions which best categorize the sample with an unique variable are volumetric, which classify the sample correctly in 94% of cases based on diaphysis volume, followed by total volume, which provides an accurate classification in 92% of all cases. The sagittal diameter at midshaft provides an accurate classification in 90% of cases and the maximum length in 88% of cases. The curvature index shows that there are no statistically significant differences by side and the only curvature index that shows significant differences by sex is the total anterior curve of the left clavicle being the males curve more pronounced. The validation study performed on a sample of 20 individuals confirms the high discriminatory power of the volume obtaining an accurate classification rate of 85-100% depending on the variable studied.

  15. Radiation-Associated Fracture Nonunion of the Clavicle Treated with Locking Plate Fixation and Autologous Bone Grafting

    Directory of Open Access Journals (Sweden)

    Takahiro Niikura

    2012-01-01

    Full Text Available We describe a case of radiation-associated fracture nonunion of the clavicle, which was treated by locking plate fixation and autologous bone grafting. The patient was a 67-year old man who received 70 Gy radiation therapy to treat nasopharyngeal carcinoma. Eight years later, he suffered a pathological fracture of the right clavicle. One year after the fracture, surgical treatment was performed due to persistent pain and weakness. Radiographs demonstrated atrophic nonunion. Bone scan demonstrated hot uptake at both ends of the fractured bone. MRI demonstrated a formation of pseudoarthrosis with fluid collection and suggested bone marrow edema at both ends of the fracture fragments. In surgery, fibrous pseudoarthrosis tissue was excised and both ends of the fracture fragments were refreshed to identify bleeding. Open reduction and internal fixation using a 7-hole locking plate and autologous bone grafting were performed. Successful bony union was obtained 1 year postoperatively, and no adverse events were observed up to 52 months after the operation. Our case suggests that a locking plate provides sufficient fixation and autologous bone grafting is effective in enhancing bone healing in a radiation-associated fracture nonunion of the clavicle in which it is difficult to achieve bony union.

  16. Risk profile of patients developing nonunion of the clavicle and outcome of treatment-analysis of fifty five nonunions in seven hundred and twenty nine consecutive fractures

    DEFF Research Database (Denmark)

    Ban, Ilija; Troelsen, Anders

    2016-01-01

    PURPOSE: The most common complication following treatment of a clavicle fracture is nonunion. Most nonunions are symptomatic and treatment is mostly operative. The aim of this study was to describe risk profiles of patients developing nonunion and what outcome is observed following operative...... treatment of clavicle nonunions. METHODS: In a consecutive series of 729 clavicle fractures we retrospectively identified 55 that developed nonunion (49 diaphysial and six lateral). All were treated operatively by reconstruction with (n = 28) or without (n = 27) autologous bone graft. Assessment...... was anatomic site, fracture complexity, female gender, smoking habits and initial treatment. A total of eight post-operative complications were found. Remission of symptoms was reported by 29 of the 33. Outright satisfaction with current shoulder condition was reported by 24. The overall median DASH was 8...

  17. Ipsilateral simultaneous fracture of the trochlea involving the lateral end clavicle and distal end radius: a rare combination and a unique mechanism of injury

    Directory of Open Access Journals (Sweden)

    Gupta RK

    2014-07-01

    Full Text Available 【Abstract】Isolated trochlea fracture in adults is a rare surgical entity as compared to its capitellar counterpart. It has been only mentioned sporadically in the literature as case reports. Fracture of the trochlea is accompanied by other elbow injuries like elbow dislocation, capitellum fracture, ulnar fracture and extraarticular condylar fracture. Here we report a unique case of isolated displaced trochlea fracture associated with fractures of the lateral end clavicle and the distal end radius. We propose a unique mechanism for this rare combination of injuries: typical triad of injury, i.e. fracture of the distal end radius with trochlea and fracture of the lateral end of the clavicle. Nonoperative treatment is recommended for undisplaced humeral trochlea fractures; but for displaced ones, anatomical reduction and internal fixation are essential to maintain the congruous trochleacoronoid articulation and hence to maintain the intrinsic stability of the elbow. Key words: Isolated trochlea fracture; Clavicle; Radius fractures

  18. Pseudoarthrosis of the clavicle and copper beaten skull associated with chromosome 10p11.21p12.1 microdeletion.

    NARCIS (Netherlands)

    Shahdadpuri, R.; Vries, B. de; Pfundt, R.P.; Leeuw, N. de; Reardon, W.

    2008-01-01

    Congenital pseudoarthrosis of the clavicle (CPC) has been described in several genetic conditions including Floating-Harbor and Goltz syndromes, but rarely as a prompt to specific cytogenetic abnormalities. We report on a case of a de novo 10p11.21p12.1 microdeletion in a boy with multiple problems

  19. High inter-rater reliability, agreement, and convergent validity of Constant score in patients with clavicle fractures

    DEFF Research Database (Denmark)

    Ban, Ilija; Troelsen, Anders; Kristensen, Morten Tange

    2016-01-01

    standardized CS assessment at a mean of 6.8 weeks (SD, 1.0 weeks) after injury. Reliability and agreement of the CS were determined by 2 raters. The interclass correlation coefficient (ICC2,1), standard error of measurement, minimal detectable change, Cronbach α coefficient, and Pearson correlation coefficient....... The secondary aim was to estimate the correlation between the CS and the Disabilities of the Arm, Shoulder and Hand score and the internal consistency of the 2 scores. METHODS: On the basis of sample sizing, 36 patients (31 male and 5 female patients; mean age, 41.3 years) with clavicle fractures underwent...... were estimated. RESULTS: Inter-rater reliability of the total CS was excellent (interclass correlation coefficient, 0.94; 95% confidence interval, 0.88-0.97), with no systematic difference between the 2 raters (P = .75). The standard error of measurement (measurement error at the group level) was 4...

  20. Anatomical variations of the clavicle and main vascular structures in two pediatric patients: subclavicular vein cannulation with supraclavicular approach

    Directory of Open Access Journals (Sweden)

    Oksuz H

    2009-05-01

    Full Text Available Central venous catheterization is a routine application in the management of patients in critical condition. However, the placement of central venous catheters is not without risk. The standard technique for central venous cannulation includes the use of anatomical landmarks. However, an ultrasound-guided method is recommended for catheterization in high-risk patients. In this report, we present two pediatric cases which had anatomical variations of the clavicles and main vascular structures due to cerebral palsy and were treated with mechanical ventilation because of pneumonia. The subclavian vein cannulation was performed using a supraclavicular approach under ultrasound guidance in both cases. We conclude that central venous catheterization of critical patients who have anatomical variations must be performed under ultrasound guidance as it provides greater safety and a higher success rate.

  1. Stress fracture of the clavicle secondary to coracoclavicular fixation using a multistrand titanium cable: a case report

    Institute of Scientific and Technical Information of China (English)

    YE Tian-wen; CHEN Ai-min

    2010-01-01

    @@ Acromioclavicular (AC) dislocations are common shoulder injuries. The classic mechanism of injury to AC joint is direct trauma caused by falls or blows to acromion with the arm abducted. According to Tossy et al,1 the degrees of AC dislocations are classified into types Ⅰ, Ⅱ, and Ⅲ. Tossy Ⅰ and Ⅱ are incomplete dislocations. Tossy Ⅲ is a complete dislocation with complete disruption of the AC and coracoclavicular (CC)ligaments, accompanied by marked upward migration of the lateral end of the clavicle. Typically, surgical treatment is needed for patients with Tossy Ⅲ. It is the best solution to restore the anatomy of AC joint. There are many surgical techniques that had been described in the preceding articles. Every surgical method has its limitations.

  2. Morphometric Comparison of Clavicle Outlines from 3D Bone Scans and 2D Chest Radiographs: A Short-listing Tool to Assist Radiographic Identification of Human Skeletons

    Energy Technology Data Exchange (ETDEWEB)

    Stephan, Carl N.; Amidan, Brett G.; Trease, Harold E.; Guyomarch, Pierre; Pulsipher, Trenton C.; Byrd, John E.

    2014-03-01

    This paper describes a computerized clavicle identification system, primarily designed to resolve the identities of unaccounted for US soldiers who fought in the Korean War. Elliptical Fourier analysis is used to quantify the clavicle outline shape from skeletons and postero-anterior antemortem chest radiographs to rank individuals in terms of metric distance. Similar to leading fingerprint identification systems, shortlists of the top matching candidates are extracted for subsequent human visual assessment. Two independent tests of the computerized system using 17 field-recovered skeletons and 409 chest radiographs demonstrate that true positive matches are captured within the top 5% of the sample 75% of the time. These results are outstanding given the eroded state of some field-recovered skeletons and the faintness of the 1950’s photoflurographs. These methods enhance the capability to resolve several hundred cold cases for which little circumstantial information exists and current DNA and dental record technologies cannot be applied.

  3. Percutaneous image-guided needle biopsy of clavicle lesions: a retrospective study of diagnostic yield with description of safe biopsy routes in 55 cases

    Energy Technology Data Exchange (ETDEWEB)

    Pressney, I.; Saifuddin, A. [Royal National Orthopaedic Hospital, Department of Radiology, Middlesex (United Kingdom)

    2014-10-21

    To assess the diagnostic yield and diagnostic accuracy of image-guided percutaneous needle biopsy of clavicle lesions and to analyse the diagnostic spectrum of clavicular lesions referred to a tertiary musculoskeletal oncology centre. To further describe safe biopsy routes for biopsy of the unique clavicle bone. A retrospective review of all patients who underwent an image-guided clavicle biopsy during the period from August 2006 to December 2013. A total of 52 patients with 55 consecutive biopsies were identified and included in the study. Image-guided percutaneous biopsy was performed using CT (n = 38) or ultrasound (n = 17). There were 23 males and 29 females, with a mean age of 40 years (range 2 to 87 years). Forty-six of the 55 biopsies (83.6 %) yielded a diagnostic sample and 9 (16.4 %) were non-diagnostic. Thirty of 46 (65.2 %) lesions were malignant and 16 (34.8 %) were benign/non-neoplastic. The most common malignant lesions were metastases, 22 of 30 (73.3 %), followed by primary tumours in 8 of 30 (26.7 %). The most common benign/non-neoplastic lesion was chronic recurrent multifocal osteomyelitis (4 of 16, 25 %) followed by Langerhans cell histiocytosis, epithelioid haemangioma and osteomyelitis (each with 2 of 16, 12.5 %). There was complete agreement between the needle and surgical histology specimen in 12 of 13 subjects (92.3 %). No post-biopsy complications were reported. Image-guided percutaneous biopsy has high diagnostic yield and accuracy and the described approaches are a safe means of biopsy for clavicle lesions. (orig.)

  4. SEUDOARTROSIS CONGÉNITA DE CLAVÍCULA PATOLOGÍA DE ALTA CONFUSIÓN DIAGNÓSTICA CONGENITAL PSEUDARTHROSIS OF CLAVICLE, DIFFERENTIAL DIAGNOSIS PATHOLOGY

    Directory of Open Access Journals (Sweden)

    Enrique Vergara Amador

    2006-07-01

    Full Text Available La seudoartrosis congénita de clavícula es una entidad rara, casi siempre aparece sin asociación a otras patologías y generalmente no ocasiona limitaciones importantes en los niños. Puede confundirse con otras entidades como la fractura de clavícula de origen traumático. La mayoría de los pacientes consultan por defecto estético y pocas veces por dolor. Generalmente el tratamiento es quirúrgico; pero existe controversia sobre la necesidad de realizar cirugía. Presentamos dos casos clínicos con seudoar según los últimos parámetros o leyes y trosis de la clavícula derecha que recibieron tratamiento quirúrgico con resultados satisfactorios.The congenital pseudarthrosis of clavicle is a rare entity, frequently appearing without association to other pathologies and does not cause important limitations in the children. It can confuse with other traumatic pathologies like clavicle fracture. Most of the patients complain about the aesthetics and few times for pain. The treatment is generally surgical there is controversy about of carrying out surgery. We reported two clinical cases with seudoartrosis of the right clavicle that they received surgical treatment with satisfac­tory results.

  5. Biologic fixation through bridge plating for comminuted shaft fracture of the clavicle: technical aspects and prospective clinical experience with a minimum of 12-month follow-up.

    Science.gov (United States)

    Jung, Gu Hee; Park, Chang-Min; Kim, Jae-Do

    2013-12-01

    For comminuted shaft fracture of clavicle, the operative goal, aside from sound bone healing without complications of direct reduction, is maintenance of the original length in order to maintain the normal biomechanics of adjacent joint. Our bridge plating technique utilizing distraction through a lumbar spreader was expected to be effective for restoring clavicular length with soft tissue preservation. However, there are two disadvantages. First, there is more exposure to radiation compared to conventional plating; and second, it is difficult to control the rotational alignment. Despite these disadvantages, our technique has important benefits, in particular, the ability to preserve clavicular length without soft tissue injury around the fracture site.

  6. Clinical evaluation of clavicle disunion with bone graft of ilium and periosteal flap of acromion%髂骨植骨与肩峰骨膜瓣治疗锁骨骨折不愈合的疗效

    Institute of Scientific and Technical Information of China (English)

    宁凡友; 牛素玲; 夏凯; 张作君

    2013-01-01

    目的 分析采用髂骨植骨与肩峰骨膜瓣治疗锁骨骨折不愈合伴骨缺损大于1.5 cm的疗效.方法 2003年1月至2011年4月,洛阳正骨医院上肢损伤科共采用手术治疗锁骨骨折不愈合伴骨缺损大于1.5 cm的患者17例,其中应用髂骨块植骨12例,肩峰骨膜瓣5例.结果 术后随访超过12个月,17例患者均骨性愈合.结论 应用髂骨植骨与肩峰骨膜瓣治疗锁骨骨折不愈合伴骨缺损是合理、有效的治疗方法.%Objective To analyze the curative effect of bone defect exceeding 1.5 cm of clavicle disunion with bone graft of ilium and periosteal flap of acromion.Methods From January 2003 to April 2011,17 patients with the bone defect exceeding 1.5 cm of clavicle disunion were cured by operation.The bone graft included ilium for 12 cases and acromion for 5 cases.Results All the patients obtained postoperative clinical results over 12 months.The clavicle disunion of 17 cases got synostosis.Conclusions The bone graft of ilium and periosteal flap of acromion are reasonable and effective approach of the clavicle disunion with bone defect.

  7. Secondary clavicle fracture after hook plate fixation for acromial clavicular joint dislocation%锁骨钩钢板治疗肩锁关节脱位并发骨折的探讨

    Institute of Scientific and Technical Information of China (English)

    许永康; 舒占坤; 张羽

    2015-01-01

    Background Dislocation of the acromio-clavicle (AC)joint is a common injury, accounting for 12% of shoulder girdle injuries.According to Rockwood classification,type Ⅰ and ⅡAC injuries prefer to conservative treatment;type Ⅳ-Ⅵ injuries are good indications for surgical treatment.Operative treatment for type Ⅲ injury is still controversial.Hook plate has been used by many surgeons as an internal fixation device to maintain the reduced AC joint in place.There are some complications that may occur in some cases,such as implant failure,loss of reduction and secondary clavicle fracture.This study is designed to evaluate the clinical outcome of patients treated by hook plate and explore the cause of secondary clavicle fracture.Methods From January 2008 to January 2014,73 patients who sustained clavicle fracture was operated and fixed by hook plate.The operation was performed under general anesthesia or regional cervical plexus nerve block.The incision was from distal third of clavicle down to corocoid.The acromial clavicular joint,distal third of clavicle,corocoid and corococlavicular ligament were exposed.Debridement of AC joint was performed and cartilage debris was removed.Corococlavicle ligament was explored and sutures were preload in the ligament. Acromial clavicular joint dislocation was reduced and proper hook plate was chosen.The plate was fixed by screws and sutures were tied.The acromial clavicular capsule was repaired.The wound was closed layer by layer.Post-operative care:the shoulder was protected in a sling for 3 weeks.Pendulum exercise began immediately after operation.Passive motion could be started as pain be tolerated. Results Seventy-three patients were included in this study.There were 47 males and 26 females.The patients suffered from fall in 37 cases,traffic accident in 1 7 cases and hit on the shoulder in 1 9 cases. According to Rockwood classification,type Ⅲ in 61 cases,type Ⅳ in 12 cases.The follow up time was from 1 to 34 months

  8. A pathological fracture and a solitary mass in the right clavicle: an unusual first presentation of HCC and the role of immunohistochemistry

    Directory of Open Access Journals (Sweden)

    Mantonakis Eleftherios I

    2012-03-01

    Full Text Available Absrtract Hepatocellular carcinoma (HCC is an aggressive malignant tumor that occurs throughout the world. Μetastases from hepatocellular carcinoma (HCC were generally considered to be rare in the past, because the carcinoma had an aggressive clinical course. In our era, has been reported that extra-hepatic metastases occur in 13.5%-41.7% of HCC patients and this is considered as terminal-stage cancer. The prognosis for patients at this stage continues to be poor due to limited effective treatment. The common sites of extrahepatic metastases in patients with HCC are the lungs, regional lymph nodes, kidney, bone marrow and adrenals. We present here an extremely infrequent case of a patient, without known liver disease, in which the presenting symptom was a pathological-in retrospect-fracture of his right clavicle which wasn't properly evaluated, until he presented a bulky mass in the region 6 months later. For our patient, the added diagnostic difficulty alongside the unknown liver disease, has been that the clavicular metastases was the first presentation of any metastatic disease, rather than the more common sites of HCC spread to adjacent lung or lymph nodes.

  9. Clinical and radiographic delineation of Bent Bone Dysplasia-FGFR2 type or Bent Bone Dysplasia with Distinctive Clavicles and Angel-shaped Phalanges.

    Science.gov (United States)

    Krakow, Deborah; Cohn, Daniel H; Wilcox, William R; Noh, Grace J; Raffel, Leslie J; Sarukhanov, Anna; Ivanova, Margarita H; Danielpour, Moise; Grange, Dorothy K; Elliott, Alison M; Bernstein, Jonathan A; Rimoin, David L; Merrill, Amy E; Lachman, Ralph S

    2016-10-01

    Bent Bone Dysplasia-FGFR2 type is a relatively recently described bent bone phenotype with diagnostic clinical, radiographic, and molecular characteristics. Here we report on 11 individuals, including the original four patients plus seven new individuals with three longer-term survivors. The prenatal phenotype included stillbirth, bending of the femora, and a high incidence of polyhydramnios, prematurity, and perinatal death in three of 11 patients in the series. The survivors presented with characteristic radiographic findings that were observed among those with lethality, including bent bones, distinctive (moustache-shaped) small clavicles, angel-shaped metacarpals and phalanges, poor mineralization of the calvarium, and craniosynostosis. Craniofacial abnormalities, hirsutism, hepatic abnormalities, and genitourinary abnormalities were noted as well. Longer-term survivors all needed ventilator support. Heterozygosity for mutations in the gene that encodes Fibroblast Growth Factor Receptor 2 (FGFR2) was identified in the nine individuals with available DNA. Description of these patients expands the prenatal and postnatal findings of Bent Bone Dysplasia-FGFR2 type and adds to the phenotypic spectrum among all FGFR2 disorders. © 2016 Wiley Periodicals, Inc.

  10. Comment to: Haque S, Khan A, Sharma A, Sundararajan S: Technical tip: tightrope fixation of neer type II distal clavicle fracture supported by a case series. Pol Orthop Traumatol, 2014; 79: 19-22.

    Science.gov (United States)

    Gökkuş, Kemal; Saylik, Murat; Aydin, Ahmet Turan

    2014-04-15

    Additional suture anchor fixation to coracoclaviculer area with precountered distal clavicle locking plate allows an anatomic reduction with bone-bone contact and gives additional neutralisation effect with coracoclavicular suture anchor fixation against the trapezius muscle pulling effect .Event though the effeciency of this technique reported by other authors,still there is a few articles and cases reported.In the terms of proving the efficiency of the combination technique we would like to stress to contribute the published article by Haque et al.

  11. MIPPO技术治疗有楔形骨块的锁骨干骨折%Applying MIPPO technique to treat clavicle shaft fractures with wedge fracture fragment

    Institute of Scientific and Technical Information of China (English)

    杨明; 司徒炫明; 张殿英; 王天兵; 付中国; 张培训; 陈建海; 姜保国

    2016-01-01

    目的探讨 MIPPO 技术治疗有楔形骨块的锁骨干骨折的手术方法及疗效。方法自2011年4月至2014年4月,应用闭合复位、髓内克氏针临时固定并行 MIPPO 技术,治疗有楔形骨块的锁骨干骨折26例患者为试验组(MIPPO 组)。术后定期复查 X 线片,观察骨折愈合情况,并用Constant评分评估患者的肩关节功能。同时以2007年3月至2011年11月收治的传统切开复位板钉固定的29例患者为对照组(ORIF组),进行回顾性随访研究,比较两组的疗效和并发症。结果经过平均15个月的随访,MIPPO 组无1例骨折不愈合,ORIF组有1例骨折不愈合并接骨板失效,两组之间失效率差异无统计学意义。MIPPO 组在手术时间、出血量方面优于 ORIF组,差异有统计学意义。在骨折愈合时间以及 Constant评分方面,两组间差异无统计学意义。MIPPO 组有2例患者因接骨板隆起而坚决要求二次手术取出内固定物。结论 MIPPO 技术治疗有楔形骨块锁骨干骨折,创伤小,可减少手术时间和出血量,提高愈合几率。%Background Because the nonunion rate of conservative treatment was up to 1 5%, midshaft clavicle fractures with wedge-shaped fragments had been mainly treated with operation in recent years.Plate fixation was still one of the mainstream internal fixation methods,although a few scholars advocated various intramedullary fixations.For conventional plate and screw fixation techniques,one of the principles was to fix the free wedge-shaped fragments with lag screws as far as possible.We had ever improved the conventional techniques by intramedullary K-wire assistance in reduction,binding fragments with suture,and bridging plate fixation,which obtained good effects. But we found that the open reduction and bridging plate fixation increased the operation trauma because of the long incisions.We had made further improvement on this basis.From April 2011 to April 2014,26 patients of midshaft clavicular

  12. Tratamiento quirúrgico de las fracturas laterales de clavícula. Un nuevo concepto / Surgical treatment for lateral clavicle fractures. A new concept / Tratamento cirúgico das fraturas laterais da clavícula. Um novo conceito

    Directory of Open Access Journals (Sweden)

    Roberto Joaquín Del Gordo-D´Amato

    2014-11-01

    Full Text Available Introducción: El tercio lateral de la clavícula resulta el segundo de mayor afectación, después del tercio medio en patología fracturaria y el tratamiento de estas lesiones día a día migra hacia el tratamiento quirúrgico en razón a que la mayoría resultan con grandes desplazamientos. Objetivo: Determinar si la reducción abierta y fijación interna de las fracturas de clavícula con placas de extensión lateral representan una alterativa en el tratamiento para este tipo de lesiones. Metodología: Se presenta un estudio de cohorte prospectivo, en el cual 36 pacientes fueron intervenidos quirúrgicamente por fracturas laterales de clavícula en el periodo comprendido entre abril de 2011 y septiembre de 2012, mediante reducción abierta y fijación interna con placa anatómica bloqueada con extensión lateral (LCP para clavícula. De los treinta y seis pacientes intervenidos, fueron realizados seguimientos completos aplicando la escala análoga visual de dolor (VAS y la escala funcional de Constant, a las seis semanas, tres meses, seis meses y al año posoperatorio. Resultados: Se pudo mostrar que hubo cambios progresivos en la mejora del dolor y funcionalidad en cada uno de los periodos de seguimiento a partir de la sexta semana posoperatoria con evidencia significativa (p<0.001 y sin cambios en la calificación del dolor entre el sexto mes y el año de seguimiento (p= 0.083. Conclusiones: Se puede concluir que la reducción abierta y fijación interna de las fracturas de clavícula con placas de extensión lateral representan una excelente alternativa de tratamiento para este tipo de lesiones, con pronta y completa recuperación funcional y baja probabilidad de complicaciones. [Del Gordo RJ, Acuña J, Torres E. Tratamiento quirúrgico de las fracturas laterales de clavícula. Un nuevo concepto. MedUNAB 2015; 17(2:X:X] Introduction. The lateral third of the clavicle is the second most affected, after the third fracture means in pathology

  13. Analysis of Shape Memory Alloy (SMA) Combined with Wire Curative Effect on Clavicle Fracture%记忆合金环抱器结合钢针固定锁骨骨折疗效分析

    Institute of Scientific and Technical Information of China (English)

    吉旭彬; 于学忠; 杜生富; 江善勇; 赵刚

    2011-01-01

    Objective To study and analyze the effect and indication of the shape memory alloy CSMA) combined with wire for treatment of clavicle fracture- Methods 87 cases of clavicle fractures that can be followed up during 2000, 9-2010. 3 in our hospital,in which were treated by shape memory alloy combined with wire. The effect is assessed according to the standard of Han Ping-liang. Results All the cases were followed up from 6~42 months,with an average time of 19. 5 months. The healing time was from 1.5~5. 5 months,with an average time of 3 months. The results showed that 86 cases were excellent,and 1 case was good. The excellent and good rate was 100 percent. Conclusion According to the results,we concluded that treating the clavicle fracture by shape memory alloy combined with wire has the following advantages;rigid fixation,and no significant complication,and it can help to do functional exercise earlier. The function of the shoulder joint is good.%目的 探讨分析记忆合金环抱器结合钢针联合内固定治疗锁骨骨折的临床疗效及适应证.方法 我院2000年9月至2010年3月采用记忆合金环抱器结合钢针联合内固定治疗87例锁骨骨折患者,其中男59例,女28例;年龄18~74岁,平均38岁.横形和斜形骨折5例,粉碎性骨折82例.疗效评定按韩平良等锁骨疗效标准进行评价.结果 全部病例随访6~42个月,平均19.5个月.骨折愈合时间为1.5~5.5个月,平均3个月.优86例,良1例,优良率100%.有1例锁骨骨折患者先单用记忆合金固定后3d发生隐匿骨折再移位,再次给予钢针内固定后15周骨折愈合,治疗效果良.结论 对于锁骨粉碎性骨折,特别是不能排除隐匿骨折时,记忆合金环抱器结合钢针联合内固定具有固定坚强、无明显并发症、可早期进行肩关节功能锻炼、肩关节功能恢复好的优点.

  14. 锁骨钩钢板治疗不稳定性胸锁关节脱位%Treatment of unstable dislocation of sternoclavicular joint with clavicle hook plates

    Institute of Scientific and Technical Information of China (English)

    刘广辉; 赵梓汝; 包国玉

    2008-01-01

    Objective To discuss the clinical treatment of unstable dislocation of the sternoclavicular joint with clavicle hook plates. Methods From April 2005 to October 2007, 19 cases of unstable dislo-cation of stemoclavicular joint were treated with open reduction and internal fixation by clavicle hook plates. There were 17 cases of Grade type Ⅲ and 2 cases of Grade type Ⅱ. After open reduction and internal fixation, all patients received arthroplasty and repair of eostoclavicular and sternoclavicular ligaments. Results None had intraoperative injury to nerves and blood vessels. Follow-ups from 6 to 24 (mean, 8) months showed 16 excellent cases, 2 good cases and 1 fair case by Roekwood criteria, the good to excellent rate being 94.7%. The healing duration lasted 3 to 6 (averaging 4) weeks. No infection, sliding or loosening of internal fixation, nonunion or re-dislocation was found postoperatively. Conclusion The clavicle hook plate is an effective and advanced surgical treatment of sternoclavieular joint injuries, because its easy and mini-invasive operation can provide sturdy fixation and lead to good functional recovery.%目的 探讨锁骨钩钢板切开复位治疗不稳定性胸锁关节脱位的临床意义及疗效. 方法 2005年4月至2007年10月,采用切开复位锁骨钩钢板内固定治疗19例不稳定性胸锁关节脱位患者,根据Grade分型:Ⅱ型2例,Ⅲ型17例.全部采用患侧切开复位锁骨钩钢板内固定术加关节成形术并修补肋锁韧带、胸锁韧带. 结果术后均尤再脱位,钢板尤断裂、松动、脱钩等现象.所有患者均获随访,时间6~24个月,平均8个月;愈合时间3~6周,平均4周.按照Rockwood胸锁关节评分标准:优16例,良2例,可1例,优良率为94.7%.术后患者均恢复解剖结构及外观,功能满意.结论 锁骨钩钢板内固定治疗小稳定性胸锁关节脱位具有操作简便安全、创伤小、固定可靠等优点,并有较好的维持复位和促进恢复作用,术

  15. 建立锁骨个性化锁定接骨板模型及有限元分析%Establishment of personalized locking clavicle plate model and finite element analysis

    Institute of Scientific and Technical Information of China (English)

    尹峰; 王晓东; 梁炜; 任龙韬

    2016-01-01

    BACKGROUND:The finite element analysis method is more accurate and fast to construct the three-dimensional model of the human skeleton and design the bone surgical medical instrument. OBJECTIVE:To establish locking plate model according to the clavicle model, analyze and evaluate stress distribution of locking plate of the finite element model under bending and torsion conditions. METHODS:Chest scan was carried out in a healthy young adult male by adopting 64-row spiral CT and his two-dimensional image data were gotten. The obtained data were analyzed with Mimics 10.0 software to establish the three-dimensional clavicle finite element model. The clavicle locking fixation plate model was established by applying the UG software. The locking fixation plate was evaluated by utilizing the abaqus software when the plate was bent while down to give force of 200 N, and twisted while 200 N•mm, to simulate the force and analyze the stress distribution of the locking plate. RESULTS AND CONCLUSION:Based on the original image parameters provided by CT, this experiment produced a three-dimensional model of the clavical titanium plate which fitted better to bones. This model can obtain a single individual, personalized plate by three-dimensional printing technology. The finite element analysis basical y can simulate the actual stress of the plate. For straight plate and“S”-shape plate, in lateral bending and axial torsion loads, the maximum stress distribution of the seven-hole titanium plate is located in the center of the center hole. During actual surgical procedures, clavicle fracture fragments and middle locking hole had stress superposition. If the titanium plate can avoid the stress concentration, it can effectively avoid the occurrence of the broken plate after implantation, provide theoretical guidance for clinical practice, and provide reference and technical route for biomechanical analysis of other types of titanium plate.%背景:应用有限元分析的方

  16. Fratura extra-articular da extremidade medial da clavícula associada à luxação acromioclavicular tipo IV: relato de caso Extra-articular fracture of the medial end of the clavicle associated with type IV acromioclavicular dislocation: case report

    Directory of Open Access Journals (Sweden)

    Mário Chaves Correa

    2011-10-01

    Full Text Available Ocorrendo isoladamente, as fraturas da clavícula e as luxações acromioclaviculares são lesões muito comuns. A combinação de uma luxação acromioclavicular e de uma fratura do terço lateral da clavícula não é rara. Entretanto, existem muito poucos casos descritos de luxações acromioclaviculares associadas a fraturas do terço médio da clavícula; aquelas associadas a fraturas do terço medial são ainda mais raras. Nós reportamos o caso de um indivíduo adulto do sexo masculino que sofreu uma luxação acromioclavicular (tipo IV associada a uma fratura extra-articular desviada da extremidade medial da clavícula (grupo 3 de Almann em um acidente ciclístico. O paciente foi tratado na fase aguda com redução aberta e fixação interna das duas lesões. Na avaliação clínica, 12 meses após a cirurgia, o paciente apresentava-se assintomático, com mobilidade ativa e passiva completa, força e resistência normais e simetria das cinturas escapulares. As radiografias e a tomografia computadorizada tridimensional mostravam subluxação posterossuperior persistente da articulação acromioclavicular e consolidação anatômica da fratura clavicular.Fractures of the clavicle and acromioclavicular dislocations are very common injuries when they occur separately. The combination of an acromioclavicular dislocation and a fracture of the lateral third of the clavicle is not rare. However, there are very few reported cases of acromioclavicular dislocations associated with fractures of the middle third of the clavicle; those associated with fractures of the medial third are even rarer. We report the case of an adult male who suffered an acromioclavicular dislocation (type IV associated with a displaced extra-articular fracture of the medial end of the clavicle (Almann group 3 in a cycling accident. The patient was treated during the acute phase with open reduction and internal fixation of the two lesions. At the clinical evaluation 12

  17. 锁骨骨折术后格林巴利综合征合并重症肌无力一例报道%Guillain Barré Syndrome Combined with Myasthenia Gravis after Operation for Clavicle Fracture:A Case Report

    Institute of Scientific and Technical Information of China (English)

    王成谋; 费松柏; 马祥铭; 徐蔚; 陈小霞

    2013-01-01

    Guillain Barre syndrome and myasthenia gravis are two different diseases. This paper reports a case of guillain Barre syndrome complicated by myasthenia gravis after operation for clavicle fracture and reviews pertinent literatures to analyze its reasons. Immune factor plays an important role in the occurrence of the two diseases. Surgical procedures induce peripheral nerve autoimmunity. Cross - reactive antibodies may be the cause of damages of peripheral nerve myelin proteins and neuro-muscular junction acetylcholinesterase receptor.%格林巴利综合征和重症肌无力是两种不同的疾病,本文报道1例锁骨骨折术后出现格林巴利综合征合并重症肌无力患者,并查阅相关文献分析其原因.免疫因素在两者的发病中起重要作用,外科手术操作诱发周围神经的自身免疫反应,交叉性反应抗体可能是周围神经髓磷脂蛋白和神经肌肉接头乙酰胆碱受体受损的原因.

  18. 新型锁骨瓣移位术对肱骨头缺血性坏死及近端骨不连的实验研究%The experimental study of new clavicle flap transposition for the repair of ischemic necrosis of femoral head and nonunion of proximal end

    Institute of Scientific and Technical Information of China (English)

    郑和平; 林建华; 许卫红; 张发惠

    2003-01-01

    AIM:To provide a new way of operation for repairing fracture necrosis of proximal humerrus. METHODS:Observing the course,branches and distributions of thoracoacromia artery on 40 sides of adult cadaveric.RESULTS:(1)Sending off 3 to 5 periosteal branches with diameter of 0.3 to 0.5 mm along the acromial branch of thoracoacromial,which distributed at the middle outboard and formed the part of acromial artery net.The acromial length was (5.1± 0.5) cm with diameter of (1.2± 0.2) mm.(2)Sending off 1 to 3 periosteal branches with diameter of (0.2 to 0.5) mm from the clavicular branches of thoracoactomial artery,which distributes at the inside part one second.The length was (2.0± 0.1) cm with diameter of (1.2± 0.2) mm. CONCLUSION: A new operation can be designed for repairing fracture necrosis of proximal humerus by transposing clavicle periosteal(bone) flap with the acromial branch of toracoacromial artery.

  19. Estudo prospectivo randomizado comparativo entre os tratamentos cirúrgico utilizando placa anterior e o não cirúrgico das fraturas do terço médio da clavícula Prospective randomized study comparing surgical treatment using anterior plate to non-surgical treatment of midshaft clavicle fractures

    Directory of Open Access Journals (Sweden)

    Eduardo Antônio de Figueiredo

    2008-10-01

    com o tratamento não cirúrgico.OBJECTIVE: To compare non-surgical treatment and surgical treatment using an anterior plate through a functional evaluation of patients with midshaft clavicle fractures after 12 months of follow-up. METHODS: A prospective study was performed from August 2005 to January 2007, when 50 patients with midshaft clavicle fracture with displacement were randomly divided into two groups. 10 of the patients were excluded from the series because they were lost in follow-up. Group 1 was submitted to surgical treatment with reduction and fixation of the clavicle with an anterior plate. Group 2 was treated using a sling. After the minimum follow-up period of 12 months, a comparative analysis was performed using the AAOS and the UCLA scales as parameters. RESULTS: Mean age was approximately 30 years (ranging from 18 to 58 years, and 77.5% of the patients were male. The right side was most often involved (55% and it was the dominant shoulder in those patients. The trauma mechanisms found most often were traffic accidents (75% of the cases. According to UCLA criteria, group 1 had 91.5% of the patients with results considered satisfactory (good and excellent, whereas group 2 presented 81.25%. Return to work and to daily-life activities was faster in group 1, with a mean of 8.67 weeks, whereas group 2 took 15.13 weeks. As to complications, the authors mention, for group 1, hypertrophic scarring (12.5%, pseudoarthrosis (8.3%, residual pain (8.3%, loosening of the material (4.1%. In group 2, complications were: esthetic deformity (43.75%, adhesive capsulitis (12.5%, and pseudoarthrosis (6.25%. CONCLUSION: After 12 months of follow-up, surgical treatment provided faster return to daily-life activities, with higher percentage of functional results according to the UCLA scale, but this was not statistically significant, compared to the non-surgical treatment.

  20. Massive osteolysis of the right clavicle developing after radiation therapy

    Energy Technology Data Exchange (ETDEWEB)

    Skinner, W.L.; Buzdar, A.U.; Libshitz, H.I.

    1988-07-15

    This report describes an unusual case of clavicular osteolysis, a late complication of radiation therapy for breast cancer, and demonstrates the diagnostic implications that radiotherapy changes can pose. Radiotherapy to the chest wall produces a spectrum of alterations in bone over time, ranging from early roentgenographic findings of osteoporosis and trabecular thickening to spontaneous fractures and changes that may be confused with metastatic disease or postirradiation sarcoma.

  1. Applied anatomy of the anterior approach to 2nd and 3rd thoracic vertebral bodies with osteotomy of the clavicle and partial median stemotomy%劈胸骨柄同时锁骨离断T2、 T3前入路应用解剖学研究

    Institute of Scientific and Technical Information of China (English)

    段洪; 刘宗良; 闵捷; 贺云; 李兴国

    2012-01-01

    目的 探索安全显露和处理T2、T3椎体的理想前入路方式.方法 对30例(60侧)经福尔马林固定、红色乳胶灌注的成人尸体标本采用劈胸骨柄同时锁骨部分切断术模拟脊柱T2、T3椎体前入路手术.在该入路中,寻找不同的间隙,暴露可能的椎体节段.结果 将左颈动脉鞘(左颈总动脉、左颈内静脉、左迷走神经及其颈心支)、左锁骨下动脉、胸导管、颈交感干及左纵隔胸膜一起向外侧牵拉,向内侧牵拉气管、食管、左喉返神经及其分支,向下牵拉左头臂静脉的方式,30例标本均能清楚的显露T1上缘至T3下缘,部分(6例)可达T4中部. 结论 劈胸骨柄和锁骨部分切断入路中,可找到一种显露和处理T2、T3椎体的安全间隙方法.%Objective To explore an ideal method of exposing and treating 2nd and 3rd thoracic vertebral bodies. Methods 30 adult embalmed cadavers (50 sides) were selected and observed. By modeling the anterior approach, the 2nd and 3rd thoracic vertebral bodies were exposed and treated through dissecting a safe space among superior edge of the aortic arch, left subclavian artery, left common carotid, brachiocephalic trunk and brachiocephalic veins. Results Under the standard left anterior approach combined with osteotomy of the clavicle and partial median sternotomy, through the synostosis between the manubrium and body of the sternum, a safe space can be acquired: left carotid sheath (common carotid, internal jugular vein, vagus nerve and its branches), thoracic duct, truncus sympathicus cervicalis, and left pleura mediastinalis were pulled towards lateral; trachea, esophagus, and left recurrent laryngeal nerve were pulled towards internal; left brachiocephalic vein was pulled towards inferior. TrT3 can be easily exposed on the total 30 adult human cadavers and T4 also can be observed on partial cases. Conclusions Adequate exposure of 2nd and 3rd thoracic vertibral bodies can be obtained by the above

  2. [Functional and radiological evaluation of patients with midshaft clavicle fracture surgically treated].

    Science.gov (United States)

    Ojeda-Reyes, Ángel Jesús; Barragán-Hervella, Rodolfo Gregorio; Vallecillo-Velázquez, Hernán; Alvarado-Ortega, Iván; Romero-Figueroa, María Socorro; Montiel-Jarquín, Álvaro José

    2016-01-01

    Introducción: el manejo quirúrgico de las fracturas diafisiarias de clavícula da buenos resultados funcionales y una consolidación radiológica adecuada. El objetivo de este trabajo es describir la evaluación funcional y radiológica de los pacientes con fractura diafisiaria de clavícula operados en el Hospital de Traumatología y Ortopedia del Instituto Mexicano del Seguro Social. Métodos: estudio descriptivo, realizado durante el período de julio 2014 a junio 2015, en el que se incluyeron pacientes sometidos a tratamiento quirúrgico por fractura diafisiaria de clavícula. Se aplicaron las escalas Constant-Murley y Montoya para evaluar la funcionalidad y la consolidación radiológica a los 6 meses. Resultados: fueron 90 pacientes, con edad promedio de 33.63 años, 78.9% fueron hombres, el lado izquierdo estuvo afectado en el 53.3% de los pacientes. A los 6 meses de operados, los resultados funcionales fueron excelentes en el 87.8% de los pacientes, en el 91% hubo desaparición del trazo fracturarlo, independientemente del callo óseo. El grupo de pacientes de edades entre 18 y 40 años presentan mejores resultados funcionales y radiográficos que los otros grupos de edades (p funcionales y consolidación radiográfica. Las edades entre 18 a 40 años y entre 61 a 76 años tienen mejores resultados funcionales con una mayor consolidación del trazo fracturario independientemente del callo óseo.

  3. Tratamiento con placa precontorneada bloqueada de fracturas desplazadas del tercio medio de la clavícula. [Precontoured locking plate treatment for displaced midshaft clavicle fractures].

    Directory of Open Access Journals (Sweden)

    Ruben Edilio Paoletta

    2016-11-01

    Full Text Available Introducción El objetivo de este trabajo es analizar los resultados de un grupo de pacientes con fracturas medio diafisarias desplazadas de clavícula tratadas con placa premoldeada bloqueada. La tasa de consolidación ósea, los resultados funcionales y las complicaciones de la serie fueron analizados. Material y métodos Cuarenta y seis fracturas de clavícula desplazadas tipo 2-B de Edimburgo fueron tratadas con placa bloqueada premoldeada. Treinta y seis fueron varones (uno con fractura bilateral y 9 mujeres. La edad promedio  fue de 33 años (rango 17-56 años. Los pacientes fueron evaluados con  radiología y  el  escore de Constant, el test rápido de dishabilidades del brazo, hombro y mano (Quick- Dash y la escala visual análoga (EVA para dolor.  Resultados El seguimiento promedio fue de 30 meses (rango 12 a 46. Cuarenta y cinco fracturas consolidaron y una no. El Constant promedio fue de 96 puntos (rango 56 a 100 y el Quick-Dash promedio de 2 puntos (rango 0 a 32. El dolor en el seguimiento fue de 0.3 puntos (rango 0 a 6. Se registraron 10 complicaciones en 9 pacientes (21%, aunque solo tres (6.5%  fueron consideradas mayores. En 7 pacientes (15% se retiró la placa por intolerancia (uno de ellos fue el paciente con mala consolidación, registrándose como segunda complicación en el mismo paciente. Conclusiones La reducción y estabilización de las fracturas desplazadas del tercio medio de la clavícula con placas premoldeadas y bloqueadas es un tratamiento efectivo con un bajo índice de complicaciones mayores relacionadas a veces con errores técnicos.

  4. Case report 445: Bilateral acromioclavicular gouty arthritis with pseudo-tumor of the outer end of the right clavicle: Saturnine gout

    Energy Technology Data Exchange (ETDEWEB)

    Podgorski, M.R.; Ibels, L.S.; Webb, J.

    1987-10-01

    An example of extensive, bilateral, distal clavicular erosion due to tophaceous saturnine gout is discussed, including the differential diagnosis of such lesions. The importance of unrecognized chronic lead nephropathy apparently causing primary gout is emphasized.

  5. Displaced midshaft fractures of the clavicle: non-operative treatment versus plate fixation (Sleutel-TRIAL). A multicentre randomised controlled trial

    NARCIS (Netherlands)

    Stegeman, S.A.; Jong, M. de; Sier, C.F.M.; Krijnen, P.; Duijff, J.W.; Thiel, T.P. van; Rijcke, P.A. de; Soesman, N.M.; Hagenaars, T.; Boekhoudt, F.D.; Vries, M.R. de; Roukema, G.R.; Tanka, A.F.; Bremer, J. van den; Meulen, H.G. van der; Bronkhorst, M.W.; Dijkman, B.A. van; Zutphen, S.W. van; Vos, Dieuwke; Schep, N.W.; Eversdijk, M.G.; Olden, G.D.J. van; Brand, J.G. van den; Hillen, R.J.; Frolke, J.P.M.; Schipper, I.B.

    2011-01-01

    BACKGROUND: The traditional view that the vast majority of midshaft clavicular fractures heal with good functional outcomes following non-operative treatment may be no longer valid for all midshaft clavicular fractures. Recent studies have presented a relatively high incidence of non-union and ident

  6. Displaced midshaft fractures of the clavicle: Non-operative treatment versus plate fixation (Sleutel-TRIAL). A multicentre randomised controlled trial

    NARCIS (Netherlands)

    S.A. Stegeman (Sylvia); M. de Jong (Mireille); C.F.M. Sier (Cornelis); P. Krijnen (Pieta); J.W. Duijff (Jan); T.P.H. Thiel (Tom); P.A.R. Rijcke (Piet); N.M.R. Soesman (Nicolaj); T. Hagenaars (Tjebbe); F.D. Boekhoudt (Freek D.); M.R. de Vries (Mark); G.R. Roukema (Gert); A.F.K. Tanka (Andras); J. van den Bremer (Jephta); H.G.W.M. Meulen (Hub); M.W.G.A. Bronkhorst (Maarten); B.A. van Dijkman (Bart); S.W.A.M. van Zutphen (Stephan); D.I. Vos (Dagmar); N.W.L. Schep (Niels); M.G. Eversdijk (Martin); G.D.J. van Olden (Ger); J.G.H. van den Brand (Johan); R. Hillen (Robert); J.P.M. Frölke (Jan Paul); I.B. Schipper (Inger)

    2011-01-01

    textabstractBackground: The traditional view that the vast majority of midshaft clavicular fractures heal with good functional outcomes following non-operative treatment may be no longer valid for all midshaft clavicular fractures. Recent studies have presented a relatively high incidence of non-uni

  7. Displaced midshaft fractures of the clavicle: non-operative treatment versus plate fixation (Sleutel-TRIAL. A multicentre randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Vos Dagmar I

    2011-08-01

    Full Text Available Abstract Background The traditional view that the vast majority of midshaft clavicular fractures heal with good functional outcomes following non-operative treatment may be no longer valid for all midshaft clavicular fractures. Recent studies have presented a relatively high incidence of non-union and identified speciic limitations of the shoulder function in subgroups of patients with these injuries. Aim A prospective, multicentre randomised controlled trial (RCT will be conducted in 21 hospitals in the Netherlands, comparing fracture consolidation and shoulder function after either non-operative treatment with a sling or a plate fixation. Methods/design A total of 350 patients will be included, between 18 and 60 years of age, with a dislocated midshaft clavicular fracture. The primary outcome is the incidence of non-union, which will be determined with standardised X-rays (Antero-Posterior and 30 degrees caudocephalad view. Secondary outcome will be the functional outcome, measured using the Constant Score. Strength of the shoulder muscles will be measured with a handheld dynamometer (MicroFET2. Furthermore, the health-related Quality of Life score (ShortForm-36 and the Disabilities of Arm, Shoulder and Hand (DASH Outcome Measure will be monitored as subjective parameters. Data on complications, bone union, cosmetic aspects and use of painkillers will be collected with follow-up questionnaires. The follow-up time will be two years. All patients will be monitored at regular intervals over the subsequent twelve months (two and six weeks, three months and one year. After two years an interview by telephone and a written survey will be performed to evaluate the two-year functional and mechanical outcomes. All data will be analysed on an intention-to-treat basis, using univariate and multivariate analyses. Discussion This trial will provide level-1 evidence for the comparison of consolidation and functional outcome between two standardised treatment options for dislocated midshaft clavicular fractures. The gathered data may support the development of a clinical guideline for treatment of clavicular fractures. Trial registration Netherlands National Trial Register NTR2399

  8. Displaced midshaft fractures of the clavicle: non-operative treatment versus plate fixation (Sleutel-TRIAL). A multicentre randomised controlled trial

    NARCIS (Netherlands)

    Stegeman, S.A.; de Jong, M.; Sier, C.F.M.; Krijnen, P.; Duijff, J.W.; van Thiel, T.P.H.; de Rijcke, P.A.R.; Soesman, N.M.R.; Hagenaars, T.; Boekhoudt, F.D.; de Vries, M.R.; Roukema, G.R.; Tanka, A.F.K.; van den Bremer, J.; van der Meulen, H.G.W.M.; Bronkhorst, M.W.G.A.; van Dijkman, B.A.; van Zutphen, S.W.A.M.; Vos, D.I.; Schep, N.W.L.; Eversdijk, M.G.; van Olden, G.D.J.; van den Brand, J.G.H.; Hillen, R.J.; Frolke, J.P.M.; Schipper, I.B.

    2011-01-01

    Background: The traditional view that the vast majority of midshaft clavicular fractures heal with good functional outcomes following non-operative treatment may be no longer valid for all midshaft clavicular fractures. Recent studies have presented a relatively high incidence of non-union and ident

  9. 新鲜肩锁关节脱位及锁骨远端骨折的微创治疗%Minimally invasive treatment for fresh acromioclavicular dislocation and the distal clavicle fracture

    Institute of Scientific and Technical Information of China (English)

    张哲; 高兴福; 董丽梅; 徐帅

    2011-01-01

    目的:探索新鲜肩锁关节脱位和锁骨远端骨折的微创治疗方法.方法:采用20套人肩部骨骼标本和10例尸体标本进行基础研究,并用超声引导,在活体上测量、设计,确定了喙突尖至锁骨锥状韧带结节后方骨突连线同锁骨中轴交点的定位方法.2001年1月至2010年1月,采用体表标志定位,微创内固定手术方法,对127例新鲜肩锁关节脱位及锁骨远端骨折进行治疗,男97例,女30例;年龄19-56岁,平均43岁.新鲜肩锁关节脱位93例,根据Rock wood分型,Ⅲ型67例,Ⅳ型11例,V型15例;新鲜锁骨远端骨折34例,均合并喙锁韧带断裂.手术时M在伤后1-8d,疗效评估采用美国加州洛杉矶大学肩关节评分系统(UCLA).结果:全部病例手术固定后,早期均完全复位.随访113例,时间13-15个月,平均14个月.9例螺钉在30d内出现轻度松动,位置仍可接受,功能恢复良好.7例并发肩周炎,半年后恢复.UCLA肩关节评分总平均分(32.0±4.7)分.优87例,良20例,可6例.结论:本方法具有创伤微小、费用低廉的优点,值得在临床推广使用.

  10. 形状记忆合金环抱接骨板治疗锁骨骨折%Clavicle fractures treated with shape memory alloy encircling bone bonding plate

    Institute of Scientific and Technical Information of China (English)

    张淑云; 贺健军

    2004-01-01

    目的探讨形状记忆合金环抱接骨板治疗锁骨骨折的手术方法及疗效.方法采用西脉记忆合金环抱接骨板治疗锁骨骨折54例.结果54例病人全部获得随访,优良率96.3%.结论形状记忆合金环抱接骨板治疗锁骨骨折是一种方便有效的方法,具有手术操作简便、内固定确实等优点,但应加强术后管理.

  11. 对锁骨手术中所需神经阻滞范围的临床研究%Clinical study of nerve block area demanded during operations of clavicle fracture

    Institute of Scientific and Technical Information of China (English)

    周文; 江学成; 胡宁利; 王斌; 王梅

    2003-01-01

    目的:探讨锁骨手术中所需的神经阻滞范围.方法:80例锁骨骨折病人随机分为A、B两组,每组40例.采用不同神经阻滞法均注入1.2%利多卡因+0.3%布比卡因混合液20ml(内含1:20万肾上腺素).据患者主诉和骨科医师评定阻滞效果.记录A、B两组不同阻滞范围时的阻滞效果及人数.结果:在操作深部组织时,C2、3-C7、8阻滞范围的无痛病人数明显多于C2、3-C5及C2、3-C6者(P<0.01):而在切皮时3种阻滞范围的阻滞效果无差异.B组阻滞范围为C2、3-C7、8的病人数明显多于A组(P<0.01).结论:锁骨手术所需的神经阻滞范围为C3-C7.

  12. Open laterale clavicularesectie bij acromioclaviculaire artrose : gunstige resultaten na 1 jaar

    NARCIS (Netherlands)

    Stroet, M.A. te; Schreurs, B.W.; Waal Malefijt, M.C. de

    2010-01-01

    OBJECTIVE: To determine the follow-up outcomes of open lateral clavicle resection 1 year postoperatively in patients with acromioclavicular osteoarthritis. The operation involves resection of a small part of the lateral clavicle. DESIGN: Prospective descriptive. METHOD: Data were collected from all

  13. Unsolved issues in diagnostics and treatment decisions for clavicular fractures

    NARCIS (Netherlands)

    Stegeman, Sylvia Alexandra

    2015-01-01

    Clavicular fractures are among the most common fractures of the shoulder. Displacement or comminution of the fracture fragments may lead to shortening of the clavicle, but could also cause mal-union or non-union of the clavicle and might lead to poor functional outcome. These fracture characteristic

  14. A Posteriorly Displaced Distal Metaphyseal Clavicular Fracture (Type IV AC Joint Dislocation-Like in Children: A Case Report and Literature Review Study

    Directory of Open Access Journals (Sweden)

    Ahmed Kotb

    2016-01-01

    Full Text Available Fractures of the lateral end of the clavicle are common in pediatric patients; most of these fractures occur at the physeal level representing Salter Harris injuries. The vast majority of fractures of the lateral end of the clavicle are managed nonoperatively. In this report, we describe a unique type of fracture of the distal end of the clavicle in the pediatric patients in which the fracture occurs in the metaphyseal lateral clavicle with the proximal edge of the fracture displaced posteriorly through the trapezius muscle causing obvious deformity. It is similar in pathology to type IV AC joint dislocation. In this study we report this injury in eleven-year-old boy. Literature review showed that similar injuries were described before three times (two of them in pediatric patients. Due to the significant clinical deformity of this category with entrapment of the bone through the trapezius muscle, reduction (open or closed of the fracture is the recommended treatment.

  15. Axillary Lymph Nodes and Breast Cancer

    Science.gov (United States)

    ... more likely to affect arm function and cause lymphedema. For this reason, sentinel node biopsy is the ... OR supraclavicular (above the clavicle) nodes have cancer Lymphedema Lymphedema [lim-fa-DEE-ma] is a build- ...

  16. Disease: H00613 [KEGG MEDICUS

    Lifescience Database Archive (English)

    Full Text Available yperostosis mainly affecting long bones, mandible, clavicles, and ribs. It usually affects infants less than...e prenatal form of ICH is lethal in which extensive hyperostosis affects nearly all long bones and the fetus

  17. Aase syndrome: novel radiographic features.

    Science.gov (United States)

    Hing, A V; Dowton, S B

    1993-02-15

    We report on a female with hypoplastic anemia and abnormally digitalized thumbs who presented with growth failure and novel osseous radiologic abnormalities. In addition to thumb anomalies, abnormalities of the clavicles, ilia, distal sacrum, and coccyx and described.

  18. Klavikelduplikation efter traumatisk klavikelepifysiolyse

    DEFF Research Database (Denmark)

    Pedersen, Lasse; Frich, Lars Henrik

    2009-01-01

    A case of a 15-year-old boy with an injury to the distal clavicle resulting in a "banana peel lesion" and subsequent formation of a "neoclavicle" in the empty periostal sleeve is presented and discussed. Udgivelsesdato: Aug-17......A case of a 15-year-old boy with an injury to the distal clavicle resulting in a "banana peel lesion" and subsequent formation of a "neoclavicle" in the empty periostal sleeve is presented and discussed. Udgivelsesdato: Aug-17...

  19. Glenohumeral Joint Kinematics following Clavicular Fracture and Repairs

    Science.gov (United States)

    Walley, Kempland C.; Harlow, Ethan R.; Haghpanah, Babak; Vaziri, Ashkan; Ramappa, Arun J.; DeAngelis, Joseph P.

    2017-01-01

    Background The purpose of this biomechanical study was to determine the effect of shortened clavicle malunion on the center of rotation of the glenohumeral (GH) joint, and the capacity of repair to restore baseline kinematics. Methods Six shoulders underwent automated abduction (ABD) and abbreviated throwing motion (ATM) using a 7-DoF automated upper extremity testing system in combination with an infrared motion capture system to measure the center of rotation of the GH joint. ATM was defined as pure lateral abduction and late cocking phase to the end of acceleration. Torsos with intact clavicle underwent testing to establish baseline kinematics. Then, the clavicles were subjected to midshaft fracture followed by kinematics testing. The fractured clavicles underwent repairs first by clavicle length restoration with plate fixation, and then by wiring of fragments with a 2-cm overlap to simulate shortened malunion. Kinematic testing was conducted after each repair technique. Center of rotation of the GH joint was plotted across all axes to outline 3D motion trajectory and area under the curve. Results Throughout ABD, malunion resulted in increased posterior and superior translation compared to baseline. Plate fixation restored posterior and superior translations at lower abduction angles but resulted in excess anterior and inferior translation at overhead angles. Throughout ATM, all conditions were significantly anterior and superior to baseline. Translation with malunion was situated anterior to the fractured and ORIF conditions at lower angles of external rotation. Plate fixation did not restore baseline anteroposterior or superoinferior translation at any angle measured. Conclusions This study illustrates the complex interplay of the clavicle and the GH joint. While abnormal clavicle alignment alters shoulder motion, restoration of clavicle length does not necessarily restore GH kinematics to baseline. Rehabilitation of the injured shoulder must address the

  20. Pathological clavicular fracture as ifrst presentation of renal cell carcinoma:a case report and literature review

    Institute of Scientific and Technical Information of China (English)

    Yan Kong; Jin Wang; Huan Li; Peng Guo; Jian-Fa Xu; He-Lin Feng

    2015-01-01

    Renal cell carcinoma (RCC) accounts for approximately 3%of all cancer cases. RCCs usually metastasize to the lungs, bones, liver, or brain. Only<1%of patients with bone metastases manifested clavicular RCC metastases. hTus, clavicular metastasis as the initial presentation of RCC is extremely rare. We report a patient with RCC metastasis to the letf clavicle, which was ifrst presented with pain caused by a pathological fracture. Magnetic resonance image revealed a renal tumor, and technetium-99m–methylene diphosphonate bone scintigraphy showed multiple osseous metastases. The patient eventually underwent surgery to remove the lateral end of the letf clavicle and right kidney. Histopathology revealed renal tumor and clear cell carcinoma in the clavicle. Finally, we review 17 cases of clavicular metastases originating from different malignancies.

  1. Cleidocranial dysostosis: case report; Disostose cleidocraniana: relato de caso

    Energy Technology Data Exchange (ETDEWEB)

    Marussi, Victor Hugo Rocha; Mariz, Fernando Eduardo Nunes [Santa Casa da Misericordia, Juiz de Fora, MG (Brazil). Ultrimagem]. E-mail: vhmarussi@hotmail.com; Moraes, Aline Curcio de; Segregio, Camila Aparecida de Souza; Mendonca, Isac Miranda de [Universidade Federal de Juiz de Fora (UFJF), MG (Brazil). Medicina

    2008-07-01

    Cleidocranial dysostosis syndrome is an autosomal dominant condition with generalised dysplasia of bone and teeth. It is characterized by short stature, typical facial features and skeletal anomalies affecting skull and clavicle. The authors refer to the case of a male patient presenting this syndrome, emphasizing clinical and radiologic findings. (author)

  2. Segmentation of anatomical structures in chest radiographs using supervised methods: a comparative study on a public database

    DEFF Research Database (Denmark)

    van Ginneken, Bram; Stegmann, Mikkel Bille; Loog, Marco

    2006-01-01

    observer. Clavicle segmentation is a hard problem for all methods; best results are obtained with active shape models, but human performance is substantially better. As an application, the cardio-thoracic ratio is computed automatically from the segmentation results. Bland and Altman plots indicate...

  3. 49 CFR 572.74 - Thorax assembly and test procedure.

    Science.gov (United States)

    2010-10-01

    ... by a test probe conforming to § 572.77(a) to 20 ±0.3 fps according to the test procedure in paragraph... as follows: (1) Seat and orient the dummy on a seating surface without back support as specified in... inches below the longitudinal center of the clavicle retainer screw, and adjust the dummy so that...

  4. Radiology trainer. Surgical ambulance. 2. rev. and enl. ed.; Roentgen-Trainer. Chirurgische Ambulanz

    Energy Technology Data Exchange (ETDEWEB)

    Ackermann, Ole [Wedau-Kliniken Duisburg (Germany). Klinik fuer Unfallchirurgie; Ruchholtz, Steffen [Universitaetsklinikum Giessen und Marburg GmbH, Marburg (Germany). Klinik fuer Unfall-, Hand- und Wiederherstellungschirurgie; Siemann, Holger [LVR Klinikum Essen (Germany); Barkhausen, Joerg [Universitaetsklinikum Schleswig-Holstein, Luebeck (Germany). Klinik fuer Radiologie und Nuklearmedizin

    2013-08-01

    The radiology trainer for surgical ambulance includes informative X-ray imaging examples for the following issues: zygoma, nasal bone, spinal cord, clavicle, shoulder, upper arms, elbow, forearms, wrist, hand, phalanx, thorax, sternum, pelvis, abdomen, hips, femur, knee, lower leg, ankle, feet.

  5. Corrective Osteotomy for Ipsilateral Distal Clavicular and Coracoid Malunions.

    Science.gov (United States)

    Yoshida, Atsushi

    2015-08-01

    Malunion after double disruption injuries of the superior shoulder suspensory complex accompanied by shoulder pain and dysfunction has been reported infrequently. A 37-year-old man had a double disruption injury (fractures of the distal clavicle and the base of the coracoid process). Conservative treatment resulted in malunion. Twelve months after the injury, pain continued in the coracoclavicular interval, and there was only 125° forward shoulder elevation. Radiographs showed 50° inferior angulation of the distal clavicle and elongated base of the coracoid process. Corrective osteotomy was required; however, the concomitant malunion of the coracoid prevented correction of the deformity with osteotomy of the distal clavicle alone. Therefore, osteotomy of the coracoid was performed. Twelve months postoperatively, successful bone union resulted in loss of pain. Forward elevation had recovered to 160°. Distal clavicular fractures with concomitant coracoid fractures are often significantly displaced, which disrupts physiologic coupling of clavicular and scapular motion and limits forward elevation. In the case of such malunions, excessive movement at the clavicle-scapula junction during mobilization causes pain in the coracoclavicular interval. Correction of this deformity requires osteotomy of both the clavicular and coracoid malunions.

  6. Altered alignment of the shoulder girdle and cervical spine in patients with insidious onset neck pain and whiplash-associated disorder.

    Science.gov (United States)

    Helgadottir, Harpa; Kristjansson, Eythor; Mottram, Sarah; Karduna, Andrew; Jonsson, Halldor

    2011-08-01

    Clinical theory suggests that altered alignment of the shoulder girdle has the potential to create or sustain symptomatic mechanical dysfunction in the cervical and thoracic spine. The alignment of the shoulder girdle is described by two clavicle rotations, i.e, elevation and retraction, and by three scapular rotations, i.e., upward rotation, internal rotation, and anterior tilt. Elevation and retraction have until now been assessed only in patients with neck pain. The aim of the study was to determine whether there is a pattern of altered alignment of the shoulder girdle and the cervical and thoracic spine in patients with neck pain. A three-dimensional device measured clavicle and scapular orientation, and cervical and thoracic alignment in patients with insidious onset neck pain (IONP) and whiplash-associated disorder (WAD). An asymptomatic control group was selected for baseline measurements. The symptomatic groups revealed a significantly reduced clavicle retraction and scapular upward rotation as well as decreased cranial angle. A difference was found between the symptomatic groups on the left side, whereas the WAD group revealed an increased scapular anterior tilt and the IONP group a decreased clavicle elevation. These changes may be an important mechanism for maintenance and recurrence or exacerbation of symptoms in patients with neck pain.

  7. Comparative Analysis of THOR-NT ATD vs. Hybrid III ATD in Laboratory Vertical Shock Testing

    Science.gov (United States)

    2013-09-01

    kinematic performance matched to human impact data, and distinct cervical column and “muscular” load paths • Human-like thoracic structure with clavicle...implemented new joint with continuous resistance in flexion and extension, o improved neck load cells, o the neck springs to include rubber inserts

  8. [Refixation of sternoclavicular luxation with a suture anchor system].

    Science.gov (United States)

    Lehmann, W; Laskowski, J; Grossterlinden, L; Rueger, J M

    2010-05-01

    Luxations of the sternoclavicular joint are rare injuries. We present a case of anterior dislocation which was caused by a minor fall onto the right shoulder. Diagnosis was delayed by 2 weeks which prevented treatment by closed reduction. As an alternative surgical treatment a PDS cord around the clavicle and the first rib was used to stabilize the clavicle at the vertical level. Subsequently, fixation to the medial side was achieved by a suture anchor that was placed into the manubrium. The presented case highlights this simple and safe method to treat dislocations of the sternoclavicular joint in which standard treatment cannot be performed. A detailed description for each operation step is given and our experience in terms of aftercare and outcome is reported.

  9. Treatment of patients with acromioclavicular joint injuries(Rockwood II-VI) with modeled Kirschner wire and cortical screw

    Institute of Scientific and Technical Information of China (English)

    Ivan; Viktorovich; Borozda; Mikhail; Anatolievich; Danilov; Kirill; Sergeevich; Golokhvast

    2015-01-01

    Objective: To propose an original method of surgical treatment for the acromial extremity of the clavicle rupture(Rockwood II-VI) with modeled Kirschner wire and cortical screw. Methods: Anatomical study and a test method were applied to 43 cadavers of both sexes. During the period between 2000 and 2013, 34 patients of both sexes were operated upon using the new method. In the comparison group(n = 120), the fixation of the acromial extremity of the clavicle rupture was performed with hamate plate, Lee hook and Kirschner wires.Results: Its application allows, according to the evaluation scale of Constant and Murley(1987), 10% more preservation of the function of the shoulder compared with traditional methods of surgical treatment, and shortens the required hospital treatment and temporary disability periods.Conclusions: It is shown that the proposed author’s method combines low invasiveness, minimum dimensions of the construction and low-cost treatment.

  10. Treatment of patients with acromioclavicular joint injuries (Rockwood II-VI) with modeled Kirschner wire and cortical screw

    Institute of Scientific and Technical Information of China (English)

    Ivan Viktorovich Borozda; Mikhail Anatolievich Danilov; Kirill Sergeevich Golokhvast

    2015-01-01

    Objective:To propose an original method of surgical treatment for the acromial extremity of the clavicle rupture (Rockwood II-VI) with modeled Kirschner wire and cortical screw. Methods:Anatomical study and a test method were applied to 43 cadavers of both sexes. During the period between 2000 and 2013, 34 patients of both sexes were operated upon using the new method. In the comparison group (n=120), the fixation of the acromial extremity of the clavicle rupture was performed with hamate plate, Lee hook and Kirschner wires. Results:Its application allows, according to the evaluation scale of Constant and Murley (1987), 10%more preservation of the function of the shoulder compared with traditional methods of surgical treatment, and shortens the required hospital treatment and temporary disability periods. Conclusions: It is shown that the proposed author’s method combines low invasiveness, minimum dimensions of the construction and low-cost treatment.

  11. Sclerotic multiple myeloma with an unusual sunburst periosteal reaction occurring in the sternum.

    Science.gov (United States)

    Li, Yuqing; Wu, Wenjuan; Zhang, Zekun; Ding, Yang; Latif, Mahrukh

    2015-05-01

    Multiple myeloma is a disseminated neoplastic monoclonal gammopathy that usually affects the skull, clavicle, rib, pelvis, spinal column, and proximal portions of the humerus and femur. The initial manifestation of multiple myeloma in the sternum is rare. The classic radiological presentations of multiple myeloma are multiple "punched-out" areas of bone destruction, expansile lytic lesions, and generalized osteoporosis. Primary sclerotic presentation is rare and occurs in only 3 % of cases. A sclerotic multiple myeloma with a sunburst periosteal reaction occurring in the sternum has not been reported in the English literature. We report a case of sclerotic multiple myeloma of a 49-year-old woman. In the sternum, the lesion displayed extensive sclerosis mixed with mottled lytic areas with a sunburst periosteal reaction occurring in the periphery, which radiologically mimicked an osteosarcoma. Multiple focal areas of sclerosis were also found in the right clavicle, pelvis, multiple ribs, and vertebrae.

  12. Yunis-Varón syndrome: the first report of two Iranian cases.

    Directory of Open Access Journals (Sweden)

    Zahra Hadipour

    2014-01-01

    Full Text Available The Yunis-Varón syndrome represents a rare autosomal recessive syndrome of easy recognition characterized by defective growth of the cranial bone along with complete or partial absence of the clavicles (cleidocranial dysplasia, absence of thumbs and halluces, distal aphalangia, ectodermal anomalies, growth retardation and poor outcome. The molecular genetic basis is unknown. Here, we report an 8 months old girl with Yunis-Varón syndrome, born to a consanguineously married, with normal parents. She had micrognathia, wide fontanels, prominent eyes, poor sucking, congenital heart diseases, asymmetric face, ambiguous genitalia, reduction anomaly in right hand including thumb, and hypoplastic distal phalanges of 3th fingers, and hypo plastic clavicles. She has glaucoma and lenses opacity. There is another similar case in her family. Karyotype is normal. She is the first Iranian known case of Yunis-Varón syndrome.

  13. Imaging of osteo-articular disorders of the anterior chest wall; Imagerie des affections osteo-articulaires de la paroi thoracique anterieure

    Energy Technology Data Exchange (ETDEWEB)

    Grignon, B.; Prost-Rio, D.; Walter, F.; Rubini, B.; Roland, J. [Centre Hospitalier Universitaire, 54 - Nancy (France); Jan, C.; Gaucher, A.; Regent, D. [Hopital de Brabois-Vandoeuvre, 54 - Nancy (France); Bresson, A. [Centre Hospitalier Regional, 54 - Briey (France)

    1997-09-01

    The purpose of this paper is to present a pictorial display of osseous and articular lesions of the anterior chest wall. The role of CT and MR imaging in such disorders is emphasized. Imaging of the anterior thoracic wall by plain films is particularly difficult. However numerous disorders may be encountered. They include inflammatory hyperostosis and sclerosis of the clavicle and the sternum, condensing osteitis and post-traumatic osteolysis of the clavicle, radiation osteitis of the sternum and the ribs, septic arthritis of the sterno-clavicular joint, primary and secondary tumors of the sternum and the ribs. We illustrate a spectrum of such lesions in which CT and MR imaging provides acute evaluation of both soft tissue and bone details. (authors). 31 refs.

  14. Subclavian Artery Pseudoaneurysm Formation 3 Months after a Game of Rugby Union

    Directory of Open Access Journals (Sweden)

    T. Evans

    2015-01-01

    Full Text Available Pseudoaneurysms of the subclavian artery remain a rare complication after fracture of the clavicle. We report a case of delayed diagnosis of a subclavian artery pseudoaneurysm after a closed fracture of the clavicle in a 15-year-old patient, 3 months after the original injury while playing rugby union. Despite several attendances to the Emergency Department with vague symptoms, the final diagnosis was confirmed by duplex ultrasound and Computed Tomography of the thorax. Surgical repair was indicated due to acute limb ischaemia from distal embolisation from a large pseudoaneurysm, with the patient making a full recovery. This case highlights the need for clinical vigilance when assessing patients, particularly on repeated occasions when their recovery appears to be impaired. A thorough history and clinical examination can raise suspicion of even rare occurrences and aid prompt management.

  15. Cerebral candidiasis. Computed tomography appearance

    Energy Technology Data Exchange (ETDEWEB)

    Chaabane, M.; Ladeb, M.F.; Bouhaouala, M.H.; Ben Hammouda, M.; Ataalah, R.; Gannouni, A.; Krifa, H.

    1989-07-01

    A three year old child who had been suffering from oral candidiasis since the age of 1 year presented with osteitis of the clavicle, 2 cerebral frontal abscesses and an occipital abscess which extended across the calvaria and was associated with osteolysis. Histological and microbiological studies following surgery confirmed the diagnosis of candidiasis in this girl who was found to have IgA immunodefinciency. The authors report the computed tomographic appearance of the cerebral lesions and review the literature. (orig.).

  16. Radiographic findings in liveborn triploidy.

    Science.gov (United States)

    Silverthorn, K G; Houston, C S; Newman, D E; Wood, B J

    1989-01-01

    The detailed radiographic features of triploidy, a fatal congenital disorder with 69 chromosomes, have not previously been reported. Radiographs of ten liveborn infants with chromosomally confirmed triploidy showed six findings highly suggestive of this diagnosis: harlequin orbits, small anterior fontanelle, gracile ribs, diaphyseal overtubulation of long bones, upswept clavicles and antimongoloid pelvis. Sixteen other less specific findings showed many similarities to those found in trisomy 18.

  17. Treatment of Combined Injuries of the Axillary and Suprascapular Nerves with Scapulothoracic Dissociation

    OpenAIRE

    Sano, Kazufumi; Ozeki, Satoru

    2015-01-01

    A 20-year-old man suffered the combined axillary and suprascapular nerve palsies associated with scapulothoracic dissociation by motorcycle accident. The dislocated shoulder girdle was reduced and stabilized with osteosynthesis of the fractured clavicle and reattachment of the trapezius avulsed from the scapular spine for removal of continuous traction force to these damaged nerves. Because of no evidence of recovery on manual muscle test and electromyogram, exploration for these nerves was a...

  18. Gracile bone dysplasias

    Energy Technology Data Exchange (ETDEWEB)

    Kozlowski, Kazimierz [Department of Medical Imaging, The Children' s Hospital at Westmead, Locked Bag 4001, Westmead 2145, NSW (Australia); Masel, John [Department of Radiology, Royal Children' s Hospital, Brisbane (Australia); Sillence, David O. [Department of Paediatrics and Child Health, The University of Sydney (Australia); Arbuckle, Susan [Department of Anatomical Pathology, The Children' s Hospital at Westmead, NSW (Australia); Juttnerova, Vera [Oddeleni Lekarske Genetiky, Hradec Kralove (Czech Republic)

    2002-09-01

    Gracile bone dysplasias constitute a group of disorders characterised by extremely slender bones with or without fractures. We report four newborns, two of whom showed multiple fractures. Two babies had osteocraniostenosis and one had features of oligohydramnios sequence. The diagnosis in the fourth newborn, which showed thin long bones and clavicles and extremely thin, poorly ossified ribs, is uncertain. Exact diagnosis of a gracile bone dysplasia is important for genetic counselling and medico-legal reasons. (orig.)

  19. Bilateral accessory cleidohyoid in a human cadaver

    OpenAIRE

    Stark ME; Wu B; Bluth BE; Wisco JJ

    2009-01-01

    During routine anatomical dissection of the infrahyoid region, a muscle was found bilaterally originating from the sternal end of clavicle and inserting into the hyoid bone. The muscle coursed parallel and lateral to the sternohyoid muscle. The muscle was found in the presence of an intact omohyoid, thus being classified as an accessory cleidohyoid (cleidohyoideus accessorius) muscle. While other authors have reported the presence of a unilateral cleidohyoideus accessorius muscle, to our know...

  20. Arthroscopic Management of Shoulder Osteoarthritis

    OpenAIRE

    George, Michael S

    2008-01-01

    Osteoarthritis (OA) can cause severe pain and dysfunction of the shoulder. When conservative treatment fails and operative treatments such as shoulder arthroplasty and open glenohumeral resurfacing are not advisable, shoulder arthroscopy may be used to treat shoulder OA. Arthroscopic treatment of concomitant pathology in the shoulder including subacromial decompression, labral repair, capsular release, microfracture, and distal clavicle excision have been shown to yield good results when comb...

  1. Clinical results of coracoacromial ligament transfer in acromioclavicular dislocations: A review of published literature

    Directory of Open Access Journals (Sweden)

    Sood Aman

    2008-01-01

    Full Text Available Acromioclavicular joint dislocations are common injuries, which typically occur with trauma in young men. Treatment recommendations for these injuries are highly variable and controversial. There are greater than 100 surgical techniques described for operative treatment of this injury. One of the most widely recommended methods of surgical reconstruction for acromioclavicular joint dislocations is to utilize the coracoacromial ligament for stabilization of the distal clavicle. Several modifications of this procedure have been described which have involved adjunct coracoclavicular fixation or fixation across acromioclavicular joint. Although the literature is replete with descriptive papers, there is paucity of studies evaluating the surgical outcome of this procedure. We systematically reviewed the English language published literature in peer reviewed journals (Medline, EMBASE, SCOPUS and assigned a level of evidence for available studies. We critically reviewed each paper for the flaws and biases and then evaluated the comparable clinical outcomes for various procedures and their modifications. The published literature consists entirely of case series (Level IV evidence with variability in surgical technique and outcome measures. On review there is low level evidence to support the use of coracoacromial ligament for acromioclavicular dislocation but it has been associated with high rate of deformity recurrence. Adjunct fixation does not improve clinical results when compared to isolated coracoacromial ligament transfer. This is in part because of the high incidence of fixation related complications. Similar results are reported with coracoacromial ligament reconstruction for acute and chronic cases. The development of secondary acromioclavicular joint symptoms with distal clavicle retention is poorly reported with the incidence rate varying from 12% to 32%. Despite this, the retention or excision of distal clavicle did not affect overall

  2. Posterior sternoclavicular dislocations: a brief review and technique for closed management of a rare but serious injury

    Directory of Open Access Journals (Sweden)

    Matthew E. Deren

    2014-03-01

    Full Text Available Posterior sternoclavicular dislocations are rare but serious injuries. The proximity of the medial clavicle to the vital structures of the mediastinum warrants caution with management of the injury. Radiographs are the initial imaging test, though computed tomography and magnetic resonance imaging are essential for diagnosis and preoperative planning. This paper presents an efficient diagnostic approach and effective technique of closed reduction of posterior sternoclavicular dislocations with a brief review of open and closed reduction procedures.

  3. Radiographic findings in liveborn triploidy

    Energy Technology Data Exchange (ETDEWEB)

    Silverthorn, K.G.; Houston, C.S.; Newman, D.E.; Wood, B.J.

    1989-05-01

    The detailed radiographic features of triploidy, a fatal congenital disorder with 69 chromosomes, have not previously been reported. Radiographs of ten liveborn infants with chromosomally confirmed triploidy showed six findings highly suggestive of this diagnosis: Harlequin orbits, small anterior fontanelle, gracile ribs, diaphyseal overtubulation of long bones, upswept clavicles and antimongoloid pelvis. Sixteen other less specific findings showed many similarities to those found in trisomy 18.

  4. Brown tumor of the patella caused by primary hyperparathyroidism: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Irie, Tomoko; Mawatari, Taro; Ikemura, Satoshi; Matsui, Gen; Iguchi, Takahiro; Mitsuyasu, Hiroaki [Orthopaedic Surgery, Hamanomachi Hospital, Fukuoka (Japan)

    2015-06-15

    It has been reported that the common sites of brown tumors are the jaw, pelvis, ribs, femurs and clavicles. We report our experience in a case of brown tumor of the patella caused by primary hyperparathyroidism. An initial radiograph and CT showed an osteolytic lesion and MR images showed a mixed solid and multiloculated cystic tumor in the right patella. One month after the parathyroidectomy, rapid bone formation was observed on both radiographs and CT images.1.

  5. Incidence of Clavicular Rhomboid Fossa in Northeastern Thais: An Anthropological Study

    Science.gov (United States)

    Sampannang, Apichakan; Tuamsuk, Panya; Kanpittaya, Jaturat

    2016-01-01

    The rhomboid fossa of clavicle is used to determine the age and sex in anthropology and forensic sciences. The variant types of rhomboid fossa on inferior surface have been reported in many races except in Thais. This study therefore was aimed at classifying the types of the rhomboid fossa in Northeastern Thais. The identified 476 Northeastern Thais dried clavicles (270 males and 206 females) were observed and recorded for the types of rhomboid fossa. The results showed that Thai-rhomboid fossa could be classified into 4 types: Type 1: smooth; Type 2: flat; Type 3: elevated; and Type 4: depressed, respectively. The incidences of rhomboid fossa were as follows: Type 1: 0.21%; Type 2: 19.75%; Type 3: 76.26%; and Type 4: 3.78%, respectively. Additionally, it was found that the percentage of Type 4 (11.84%) was much greater than that of female (1.94%) compared to other types. This incidence of rhomboid fossa types especially Type 4 may be a basic knowledge to be used in sex identification. The high incidence of rhomboid fossa in both sexes of Northeastern Thai clavicles was Type 3 (elevated type). PMID:27648305

  6. Forensic age estimation by the Schmeling method: computed tomography analysis of the medial clavicular epiphysis.

    Science.gov (United States)

    Ekizoglu, Oguzhan; Hocaoglu, Elif; Inci, Ercan; Sayin, Ibrahim; Solmaz, Dilek; Bilgili, Mustafa Gokhan; Can, Ismail Ozgur

    2015-01-01

    The variability of anthropometric measures, such as the degree of ossification, among societies should be taken into account when estimating age. The degree of ossification of the medial clavicle can be determined with thin-section computed tomography (CT), which is one of the methods recommended by the Study Group on Forensic Age Diagnostics of the German Association of Forensic Medicine. The purpose of this retrospective study was to investigate the applicability of thin-section CT analysis of the degree of ossification of the medial clavicle in a Turkish population. We evaluated the CT images (1-mm slice thickness) of 503 patients (362 male, 141 female; age, 10-35 years) using the Schmeling five-stage method. The Spearman's correlation analysis revealed a positive correlation between age and ossification stage in both male and female patients (total group: rho = 0.838, p < 0.001; male: rho = 0.831, p < 0.001; female: rho = 0.856, p < 0.001). The linear regression analysis results indicated that the ossification stage of the medial clavicle is a good predictor when estimating age (r (2) = 0.735 for all patients, 0.734 for male patients, 0.741 for female patients). Sex differences in ossification stages were observed only for stage 1 and 4 ossification. We believe that future research could expand the database on this topic and contribute to improvements in this measurement method.

  7. A modified method of coracoid transposition for the treatment of complete dislocation of acromioclavicular joint

    Institute of Scientific and Technical Information of China (English)

    王世松; 杜敦进; 张鹏程; 杨泗华; 樊亚军

    2002-01-01

    Objective: To report a new method of coracoid transposition for the treatment of complete dislocation of acromioclavicular joint and to evaluate its efficacy. Methods: We modified Dewars surgical method as follows: (1) Two small incisions, a transversal incision on the acromioclavicular joint and a longitudinal incision on the coracoid, were made instead of a conventional large arc incision from the acromion to coracoid. (2) The foreign body in the acromioclavicular joint was cleared out. The chondral surface at the lateral segment of clavicle was resected to form a pseudarthrosis and meanwhile the residual joint capsule and ligaments were repaired. (3) The coracoid was moved to the anteroinferior edge of the clavicle instead of the anterior margin and (4) the coracoid was moved to the lateral border of the clavicle instead of the superior border of the coracoclavicular ligament.Results: The follow-up duration in 30 patients of the series was from 6 to 72 months (mean 41 months). Functional assessment was carried out by the criteria delineated previously by Karkson, in which Grade A was in 24 cases, Grade B in 4cases, and C in 2.Conclusions: This modified technique, having less postoperative complications and less injuries to tissues and according well with the requirement of biomechanics, can achieve a stable reduction of acromioclavicular joint with a good functional and cosmetic result and therefore is preferable to use clinically on a large scale.

  8. 锁骨钩板治疗锁骨远端骨折临床体会

    Institute of Scientific and Technical Information of China (English)

    段英彪

    2014-01-01

    目的:探讨解剖锁定钢板治疗锁骨远端骨折的临床疗效。疗法应用解剖锁定钢板治疗锁骨远端骨折56例。结果本组获随访6-24个月骨折愈合率高,平均愈合时间3个月,肩关节功能评分结果,优48例,良7例,可1例,优良率96.49。结论采用解剖锁定钢板治疗锁骨远端骨折具有固定可靠,并发症少等特点,是目前较理想的内固定物。%To explore anatomical distal locking plate to treat clavicle fracture clinical curative effect. Therapy applied anatomical distal locking plate to treat clavicle fracture 56 cases. Results obtained were fol owed up for 6 to 24 months fracture healing rate is high, the average healing time of 3 months, shoulder joint function score as a result, the optimal 48 cases, 7 cases, and 1 case, is 96.49. Conclusion anatomical distal locking plate treatment of clavicle fractures with a fixed and reliable, and less complications etc, is the ideal internal fixation.

  9. A modified method of coracoid transposition for the treatment of complete dislocation of acromioclavicular joint

    Institute of Scientific and Technical Information of China (English)

    2002-01-01

    Objective:To eport a new method of coracoid transpostiton for the treatment of complete dislocation of acromioclavicular joint and to evaluate its efficacy.Methods:We modified Eewar's surgical method as follows:(1)Two small incisions,a transversal incision on the acromioclavicular joint and a longitudinal incision on the coracoid ,were made instead of a conventional large arc incision from the acromion to coracoid.(2)The foreign body in the acromioclavicular joint was cleared out.Thechondral surface at the lateral segment of clavicle was resected to form a pseudarthrosis and meanwhile the residual joint capsule and ligaments were repaired.(3)The coracoid was moved to the anteroinferior edge of the clavicle instead of the anterior margin and (4)the coracoid was moved to the lateral border of the clavicle instead of the superior border of the coracoclavicular ligament.Results:The follow-up duration in 30patients of the series was from6to 72months(mean41months).Functional assessment was carried out by the criteria delineated previously by Karkson,in which Grade Awas in 24 cases,Grade Bin4cases,and Cin2.Conclusions:This modified technique,having less postoperative complications and less injuries to tissues and according well with the requitement of biomechanics,can achieve a stable reduction of acromioclavicular joint with a good functional and cosmetic result and thereore is preferable to use clinically on a large scale.

  10. Adherence to Head Computed Tomography Guidelines for Mild Traumatic Brain Injury

    Directory of Open Access Journals (Sweden)

    Landon A. Jones

    2014-07-01

    Full Text Available Introduction: Traumatic brain injury (TBI is a significant health concern. While 70-90% of TBI cases are considered mild, decision-making regarding imaging can be difficult. This survey aimed to assess whether clinicians’ decision-making was consistent with the most recent American College of Emergency Physicians (ACEP clinical recommendations regarding indications for a non-contrast head computed tomography (CT in patients with mild TBI. Methods: We surveyed 2 academic emergency medicine departments. Six realistic clinical vignettes were created. The survey software randomly varied 2 factors: age (30, 59, or 61 years old and presence or absence of visible trauma above the clavicles. A single important question was asked: “Would you perform a non-contrast head CT on this patient?” Results: Physician decision-making was consistent with the guidelines in only 62.8% of total vignettes. By age group (30, 59, and 61, decision-making was consistent with the guidelines in 66.7%, 47.4%, and 72.7% of cases, respectively. This was a statistically-significant difference when comparing the 59- and 61-year-old age groups. In the setting of presence/absence of trauma above the clavicles, respondents were consistent with the guidelines in 57.1% of cases. Decision-making consistent with the guidelines was significantly better in the absence of trauma above the clavicles. Conclusion: Respondents poorly differentiated the “older” patients from one another, suggesting that respondents either inappropriately apply the guidelines or are unaware of the recommendations in this setting. No particular cause for inconsistency could be determined, and respondents similarly under-scanned and over-scanned in incorrect vignettes. Improved dissemination of the ACEP clinical policy and recommendations is a potential solution to this problem.

  11. Comparison and analysis of 3 kinds of operation for the treatment of Neer type II distal clavicular fracture%锁骨远端NeerⅡ型骨折3种手术治疗对比分析

    Institute of Scientific and Technical Information of China (English)

    温学理

    2015-01-01

    ObjectiveTo evaluate the effect of kreb pins tension band, reconstruction steel plate and clavicular hook plate in the treatment of NeerⅡ type fracture of clavicle distal.Methods29 cases with clavicle distal fractures were treated by surgical method; among them 9 cases were ifxed by kreb pins tension band, 10 cases by reconstruction steel plate and 10 cases by clavicular hook plate.ResultsThe percent of excellent cases in kreb pins tension band group was about 80%, in reconstruction steel plate and clavicular hook plate group were about 90%.ConclusionReconstruction steel plate and clavicular hook plate’s effects were better than kreb pins tension band in the treatment of NeerⅡ type fracture of clavicle distal.%目的:评价克氏针张力带,重建钢板,锁骨钩钢板治疗锁骨远端NeerⅡ型骨折的效果。方法手术治疗锁骨远端骨折29例,克氏针张力带固定9例,重建钢板固定10例,锁骨钩钢板固定10例。结果克氏针张力带组优良率约80%,重建钢板组,锁骨钩钢板组约90%。结论重建钢板、锁骨钩钢板内固定治疗锁骨远端NeerⅡ型骨折效果较好。

  12. Progressive Brachial Plexus Palsy after Osteosynthesis of an Inveterate Clavicular Fracture

    Directory of Open Access Journals (Sweden)

    Marco Rosati

    2013-07-01

    Full Text Available Introduction: The thoracic outlet syndrome (TOS is a rare complication of clavicular fracture, occurring in 0.5-9% of cases . In the literature from 1965 – 2010, 425 cases of TOS complicating a claviclular fracture were described. However, only 5 were observed ​​after a surgical procedure of reduction and fixation. The causes of this complication were due to the presence of an exuberant callus, to technical surgery errors or to vascular lesions. In this paper we describe a case of brachial plexus plasy after osteosynthesis of clavicle fracture. Case Report: A 48 year old female, presented to us with inveterate middle third clavicle fracture of 2 months duration. She was an alcoholic, smoker with an history of opiate abuse and was HCV positive. At two month the fracture was displaced with no signs of union and open rigid fixation with plate was done. The immediate postoperative patient had signs of neurologic injury. Five days after surgery showed paralysis of the ulnar nerve, at 10 days paralysis of the median nerve, radial and ulnar paresthesias in the territory of the C5-C6-C7-C8 roots. She was treated with rest, steroids and neurotrophic drugs. One month after surgery the patient had signs of complete denervation around the brachial plexus. Implant removal was done and in a month ulnar and median nerve functions recovered. At three months post implant removal the neurological picture returned to normal. Conclusion: We can say that TOS can be seen as arising secondary to an “iatrogenic compartment syndrome” justified by the particular anatomy of the space cost joint. The appropriateness of the intervention for removal of fixation devices is demonstrated by the fact that the patient has returned to her daily activities in the absence of symptoms and good functional recovery in about three months, despite fracture nonunion. Keywords: Brachial plexus palsy, clavicle fractures, outlet thoracic syndrome.

  13. Forensic age estimation in anti-piracy trials in Seychelles: Experiences and challenges faced.

    Science.gov (United States)

    Gunawardena, S A; Liyanage, U A; Weeratna, J B; Mendis, N D N A; Perera, H J M; Jayasekara, R W; Fernando, R

    2017-01-01

    Forensic age estimation (FAE) was conducted using a multifactorial method on thirteen Somali detainees claiming juvenile status during the anti-piracy trials of the Seychelles Supreme Court in 2014/2015. A multidisciplinary team, comprising of four of the authors covering specialties in forensic medicine, forensic odontology and radiology, conducted the FAE using a five-stage protocol. Each detainee was interviewed with an interpreter and examined for disorders affecting dental/skeletal development and for assessment of genital development through Tanner staging. Dental maturity was assessed clinically and radiologically. Eruption stage was assessed using Olze et al. and mandibular third-molar maturity was assessed using Demirjian's classification. Skeletal maturity was assessed from hand-wrist X-rays according to Greulich & Pyle and from CT-clavicle according to Kellinghaus et al. and Schultz et al. Interpretation of findings was done using reference population data from similar ethnic and social backgrounds wherever possible. Final age-ranges were calculated by combining dental and clavicle maturity stages using the regression formula developed by Bassed et al. followed by a 10% correction factor. The team later testified on their findings under cross-examination. The protocol adopted by the authors increased the scientific validity of the findings and was useful in addressing cross-examination queries on exclusion of developmental disorders, ethnic/socioeconomic variability and maintaining chain of custody. Unforeseen jurisdictional and practical limitations were experienced but did not affect the outcome. Combining dental and clavicle developmental data provided the court with a much clearer picture on the likelihood of the detainees' juvenile status which emphasizes the importance of conducting more population studies using combinations of different developmental sites. The authors note that available reference data is mostly from affluent populations whereas

  14. SPECT/CT imaging in bone scintigraphy of a case of clavicular osteoma

    Directory of Open Access Journals (Sweden)

    Yuka Yamamoto

    2014-05-01

    diphosphonate (HMDP. Whole-body image showed a focus of intensely increased uptake in the clavicle. Single photon emission computed tomography/ computed tomography (SPECT/CT images were also acquired and clearly showed intense uptake at the tumor site. Integrated SPECT/CT imaging supplies both functional and anatomic information about bone: the SPECT imaging improves sensitivity compared with planar imaging, the CT imaging provides precise localization of the abnormal uptake, and information on the shape and structure of the abnormalities improves the specificity of the diagnosis.

  15. Generative Interpretation of Medical Images

    DEFF Research Database (Denmark)

    Stegmann, Mikkel Bille

    2004-01-01

    This thesis describes, proposes and evaluates methods for automated analysis and quantification of medical images. A common theme is the usage of generative methods, which draw inference from unknown images by synthesising new images having shape, pose and appearance similar to the analysed image...... fraction from 4D cardiac cine MRI, myocardial perfusion in bolus passage cardiac perfusion MRI, corpus callosum shape and area in mid-sagittal brain MRI, and finally, lung, heart, clavicle location and cardiothoracic ratio in anterior-posterior chest radiographs....

  16. FOUR HEADS OF STERNOCLEIDOMASTOID: A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Sriambika K

    2015-12-01

    Full Text Available During the routine cadaveric dissection, the presence of accessory heads of Sternocleidomastoid was observed on right side. i.e., additional bellies from sternal and clavicle were observed on the right side. These additional slips were innervated by the spinal accessory nerve. These additional slips could have been formed due to unusual splitting in the mesoderm of post-sixth branchial arch during organogenesis. The awareness of variations of sternocleidomastoid muscle is important for Anaesthetists, Plastic surgeons, Orthopaedicians and Dental surgeons while taking muscle flap in reconstructive surgeries and is also important for radiologists while interpreting MR images of this region.

  17. Musculoskeletal Ultrasound in Pediatric Trauma

    Directory of Open Access Journals (Sweden)

    A. Shakeri Bavil

    2008-01-01

    Full Text Available Radiographs are the initial diagnostic modality used in evaluation of trauma, but sonography lacks ionizing radiation risks and allows in depth assessment of no ossified joint areas, soft tissues and superficial bone-to-soft tissue interfaces. Regarding the use of sonography to asses soft tissue injuries, the ultrasonographic evaluation of clavicle fractures, proximal humerus epiphysiolysis and fractures of hip has been well standardized."nThe aim of this review is to present the currently applied clinical ultrasound imaging techniques and to provide guidelines for efficient evaluation of musculoskeletal injuries and disorders in children.

  18. Normal osseous variants presenting as cystic or lucent areas on radiography and CT imaging: a pictorial overview

    Energy Technology Data Exchange (ETDEWEB)

    Wilde, Vally de; Maeseneer, Michel de E-mail: midema@village.uunet.be; Lenchik, Leon; Roy, Peter van; Beeckman, Paul; Osteaux, Michel

    2004-07-01

    We present a number of commonly encountered pseudolesions. These represent areas of the skeleton that are relatively radiolucent simulating an osteolytic or cystic lesion. Such areas discussed in this article include the superolateral humeral head, rhomboid fossa of the clavicle, scapular defect, supratrochlear foramen, biceps tendon insertion, vascular channel of the ulna, distal condylar area of the knee, 'bone in bone' disturbance, dorsal defect of the patella, metadiaphyseal area, 'Wards' triangle', inframalleolar fossa of the fibula, and anterior lytic defect of the calcaneus. We provide an overview of commonly encountered pseudolesions, that may lead to false positive diagnosis of an osteolytic or cystic lesion.

  19. Atypical Clavicular Involvement of Nonbacterial Osteitis: An Orthopaedic Enigma

    Directory of Open Access Journals (Sweden)

    Salil Umrani

    2011-12-01

    Full Text Available Nonbacterial osteitis (NBO is an underdiagnosed and poorly understood condition caused by sterile inflammation. It can mimic the presentation of many other orthopaedic conditions, for example, osteomyelitis, septic arthritis, or malignancy, in particular for those patients who have unifocal presentation. Because NBO is a diagnosis by exclusion, it poses much difficulty and confusion to many orthopaedic surgeons in treating such disease. Clavicular involvement is common but it is typically present at the medial aspect of the clavicle. We report a case of NBO with atypical clavicular involvement who presented to our orthopaedic clinic with painful swelling in the left shoulder. Appropriate investigations and management are discussed together with literature review.

  20. Scapulothoracic and scapholunate dissociation in the ipsilateral upper limb of a trauma victim

    Institute of Scientific and Technical Information of China (English)

    Hitesh Lal; Yashwant Singh Tanwar; Atin Jaiswal; Satya Prakash Singh; Masood Habib

    2014-01-01

    Scapulothoracic dissociation is a rare and complex injury pattern with varied presentation.Here we describe a case of a 32-year-old male who presented with scapulothoracic dissociation associated with brachial plexus injury,along with scapholunate dissociation.We also propose an injury mechanism that might link the two injury patterns,suggesting that the association might be more than by chance.The patient was managed according to established trauma care and resuscitation protocols followed by open reduction and internal fixation of the clavicle fracture,and fixation of scapholunate dissociation and had a successful outcome at follow-up.

  1. Familial multiple exostosis arising from bones of enchondral as well as membranous (in a family affecting seven members

    Directory of Open Access Journals (Sweden)

    Maruti Kambali

    2012-01-01

    Full Text Available Familial multiple exostosis in a family of seven members who are affected found that exostosis was arising both from bones of enchondral as well as membranous ossification, which was sessile as well as pedunculated and was larger in size at the growing ends of the bones. The lesions occur only in bones that develop from cartilage (endochondral ossification. In our study, we have noticed lesions occurring in both endochondral as well as membranous bone. Till now, no article has mentioned about membranous origin (clavicle.

  2. Upper extremity biomechanical model for evaluation of pediatric joint demands during wheelchair mobility.

    Science.gov (United States)

    Paul, Alyssa J; Slavens, Brooke A; Graf, Adam; Krzak, Joseph; Vogel, Lawrence; Harris, Gerald F

    2012-01-01

    Current methods for evaluating upper extremity (UE) dynamics during pediatric wheelchair use are limited. We propose a new model to characterize UE joint kinematics and kinetics during pediatric wheelchair mobility. The bilateral model is comprised of the thorax, clavicle, scapula, upper arm, forearm, and hand segments. The modeled joints include: sternoclavicular, acromioclavicular, glenohumeral, elbow and wrist. The model is complete and is currently undergoing pilot studies for clinical application. Results may provide considerable quantitative insight into pediatric UE joint dynamics to improve wheelchair prescription, training and long term care of children with orthopaedic disabilities.

  3. Bilateral accessory cleidohyoid in a human cadaver

    Directory of Open Access Journals (Sweden)

    Stark ME

    2009-10-01

    Full Text Available During routine anatomical dissection of the infrahyoid region, a muscle was found bilaterally originating from the sternal end of clavicle and inserting into the hyoid bone. The muscle coursed parallel and lateral to the sternohyoid muscle. The muscle was found in the presence of an intact omohyoid, thus being classified as an accessory cleidohyoid (cleidohyoideus accessorius muscle. While other authors have reported the presence of a unilateral cleidohyoideus accessorius muscle, to our knowledge this is the first case of a bilateral cleidohyoideus accessorius muscle in the medical literature. Anatomical variations of the infrahyoid muscles may have functional, diagnostic, surgical and pathological implications.

  4. The influence of early exposure to vitamin D for development of diseases later in life

    DEFF Research Database (Denmark)

    Jacobsen, Ramune; Abrahamsen, Bo; Bauerek, Marta;

    2013-01-01

    Vitamin D deficiency is common among otherwise healthy pregnant women and may have consequences for them as well as the early development and long-term health of their children. However, the importance of maternal vitamin D status on offspring health later in life has not been widely studied. The....... The present study includes an in-depth examination of the influence of exposure to vitamin D early in life for development of fractures of the wrist, arm and clavicle; obesity, and type 1 diabetes (T1D) during child- and adulthood....

  5. Skull-base Osteomyelitis: a Dreaded Complication after Trivial Fall and Inadequate Management

    Directory of Open Access Journals (Sweden)

    Kundan Mittal

    2015-10-01

    Full Text Available Introduction: Skull-based osteomyelitis is bony infection which generally originates from inadequately treated chronic infection, adjoining tissue infection or after trauma.Case: 11 month female child had a trivial fall while standing near a bucket. The child developed fracture of right clavicle and left orbital swelling which was inadequately treated. This resulted in in spread of infection to adjoining tissues, skull bones, sinuses and brain.Conclusion: Cranial base osteomyelitis is rare but dreaded condition which requires early diagnosis and prompt treatment to avoid mortality and morbidity in form of neurological deficits and permanent disability

  6. The Clavicular Hook Plate: Consequences in Three Cases.

    Science.gov (United States)

    Chandrasenan, Jeevan; Badhe, Sachin; Cresswell, Timothy; De Beer, Joe

    2007-10-01

    The small fragment AO clavicular hook plate is indicated for certain fractures of the lateral end of clavicle and for symptomatic acromio-clavicular joint dislocations where there is rupture of the stabilizing ligaments. The complex anatomy and biomechanics of the acromio-clavicular joint can lead to complications that result in damage to the joint itself or acromial erosion. In addition, the rotator cuff complex is at risk of injury when inserting the plate. We report three cases where patients who underwent hook plate fixation subsequently required removal of the implant due to complications previously unreported in current literature.

  7. Heart failure complicating with SAPHO syndrome.

    Science.gov (United States)

    Nishimura, Takeshi; Kikuta, Shota; Ishihara, Satoshi; Nakayama, Shinichi

    2017-02-23

    A 65-year-old man was referred to our hospital with dyspnoea due to acute heart failure. He presented with swelling in the left clavicle and pustulosis on both soles. An antihypertensive drug and non-invasive positive pressure ventilation improved his condition rapidly. Since all his physical symptoms were compatible with the criteria of SAPHO (synovitis, acne, pustulosis, hyperostosis, osteomyelitis) syndrome, we suspected that the SAPHO syndrome might cause acute heart failure. The aetiology between SAPHO syndrome and heart failure is unclear. Further studies are needed to clarify their relationship.

  8. Neanderthal axial and appendicular remains from Moula-Guercy, Ardèche, France.

    Science.gov (United States)

    Mersey, Ben; Brudvik, Kyle; Black, Michael T; Defleur, Alban

    2013-12-01

    Excavations carried out during the 1990s at Moula-Guercy cave Ardèche, France, yielded 108 hominid specimens dating to 100-120 Ka. In this paper, we describe and compare the 39 axial and appendicular specimens not including hand and foot bones. Among these remains are a large adult femur, several clavicles, a likely antimeric pair of radial heads, and a nearly complete superior pubic ramus. Analyses of this material indicate a clear affinity with Neanderthals by the presence of large and robust muscle attachments, thick long bone cortices, a long pubic ramus, and a superoinferiorly flattened clavicle shaft. The recovered remains reveal the presence of a mature male, a smaller mature individual, possibly a reproductive age female, an immature individual of age 10-12, and a second immature individual of age 4. Future analyses on the Moula-Guercy remains will illuminate ties to other known Neanderthal populations and contribute to the ongoing debate over the relative rate of Neanderthal metric growth.

  9. Detection and labeling ribs on expiration chest radiographs

    Science.gov (United States)

    Park, Mira; Jin, Jesse S.; Wilson, Laurence S.

    2003-06-01

    Typically, inspiration is preferred when xraying the lungs. The x-ray technologist will ask a patient to be still and to take a deep breath and to hold it. This not only reduces the possibility of a blurred image but also enhances the quality of the image since air-filled lungs are easier to see on x-ray film. However, inspiration causes low density in the inner part of lung field. That means that ribs in the inner part of lung field have lower density than the other parts nearer to the border of the lung field. That is why edge detection algorithms often fail to detect ribs. Therefore to make rib edges clear we try to produce an expiration lung field using a 'hemi-elliptical cavity.' Based on the expiration lung field, we extract the rib edges using canny edge detector and a new connectivity method, called '4 way with 10-neighbors connectivity' to detect clavicle and rib edge candidates. Once the edge candidates are formed, our system selects the best candidates using knowledge-based constraints such as a gradient, length and location. The edges can be paired and labeled as superior rib edge and inferior rib edge. Then the system uses the clavicle, which is obtained in a same method for the rib edge detection, as a landmark to label all detected ribs.

  10. Case Report: Urgent endovascular treatment of subclavian artery injury after blunt trauma [v1; ref status: indexed, http://f1000r.es/4x8

    Directory of Open Access Journals (Sweden)

    Taka-aki Nakada

    2014-12-01

    Full Text Available Subclavian arterial injury is rare and potentially life-threatening, particularly when it leads to arterial occlusion, causing limb ischemia, retrograde thromboembolization and cerebral infarction within hours after injury. Here we report a blunt trauma case with subclavian arterial injury, upper extremity ischemia, and the need for urgent treatment to salvage the limb and prevent cerebral infarction. A 41-year-old man had a left, open, mid-shaft clavicle fracture and left subclavian artery injury accompanied by a weak pulse in the left radial artery, decreased blood pressure of the left arm compared to the right, and left hand numbness. Urgent debridement and irrigation of the open clavicle fracture was followed by angiography for the subclavian artery injury. The left distal subclavian artery had a segmental dissection with a thrombus. Urgent endovascular treatment using a self-expanding nitinol stent successfully restored the blood flow and blood pressure to the left upper extremity. Endovascular treatment is a viable option for cases of subclavian artery injury where there is a risk of extremity ischemia and cerebral infarction.

  11. The Human Shoulder Suspension Apparatus: A Causal Explanation for Bilateral Asymmetry and a Fresh Look at the Evolution of Human Bipedality.

    Science.gov (United States)

    Osborn, Michelle L; Homberger, Dominique G

    2015-09-01

    The combination of large mastoid processes and clavicles is unique to humans, but the biomechanical and evolutionary significance of their special configuration is poorly understood. As part of the newly conceptualized shoulder suspension apparatus, the mastoid processes and clavicles are shaped by forces exerted by the musculo-fascial components of the cleidomastoid and clavotrapezius muscles as they suspend the shoulders from the head. Because both skeletal elements develop during infancy in tandem with the attainment of an upright posture, increased manual dexterity, and the capacity for walking, we hypothesized that the same forces would have shaped them as the shoulder suspension apparatus evolved in ancestral humans in tandem with an upright posture, increased manual dexterity, and bipedality with swinging arms. Because the shoulder suspension apparatus is subjected to asymmetrical forces from handedness, we predicted that its skeletal features would grow asymmetrically. We used this prediction to test our hypothesis in a natural experiment to correlate the size of the skeletal features with the forces exerted on them. We (1) measured biomechanically relevant bony features within the shoulder suspension apparatus in 101 male human specimens (62 of known handedness); and (2) modeled and analyzed the forces within the shoulder suspension apparatus from X-ray CT data. We identified eight right-handed characters and demonstrated the causal relationship between these right-handed characters and the magnitude and direction of forces acting on them. Our data suggest that the presence of the shoulder suspension apparatus in humans was a necessary precondition for human bipedality.

  12. Intrathecal Spread of Injectate Following an Ultrasound-Guided Selective C5 Nerve Root Injection in a Human Cadaver Model.

    Science.gov (United States)

    Falyar, Christian R; Abercrombie, Caroline; Becker, Robert; Biddle, Chuck

    2016-04-01

    Ultrasound-guided selective C5 nerve root blocks have been described in several case reports as a safe and effective means to anesthetize the distal clavicle while maintaining innervation of the upper extremity and preserving diaphragmatic function. In this study, cadavers were injected with 5 mL of 0.5% methylene blue dye under ultrasound guidance to investigate possible proximal and distal spread of injectate along the brachial plexus, if any. Following the injections, the specimens were dissected and examined to determine the distribution of dye and the structures affected. One injection revealed dye extended proximally into the epidural space, which penetrated the dura mater and was present on the spinal cord and brainstem. Dye was noted distally to the divisions in 3 injections. The anterior scalene muscle and phrenic nerve were stained in all 4 injections. It appears unlikely that local anesthetic spread is limited to the nerve root following an ultrasound-guided selective C5 nerve root injection. Under certain conditions, intrathecal spread also appears possible, which has major patient safety implications. Additional safety measures, such as injection pressure monitoring, should be incorporated into this block, or approaches that are more distal should be considered for the acute pain management of distal clavicle fractures.

  13. Neuromuscular responses during aquatic resistance exercise with different devices and depths.

    Science.gov (United States)

    Colado, Juan C; Borreani, Sebastien; Pinto, Stephanie Santana; Tella, Victor; Martin, Fernando; Flandez, Jorge; Kruel, Luiz F

    2013-12-01

    Little research has been reported regarding the effects of using different devices and immersion depths during the performance of resistance exercises in a water environment. The purpose of this study was to compare muscular activation of upper extremity and core muscles during shoulder extensions performed at maximum velocity with different devices and at different depths. Volunteers (N = 24) young fit male university students performed 3 repetitions of shoulder extensions at maximum velocity using 4 different devices and at 2 different depths. The maximum amplitude of the electromyographic root mean square of the latissimus dorsi (LD), rectus abdominis, and erector lumbar spinae was recorded. Electromyographic signals were normalized to the maximum voluntary isometric contraction. No significant (p > 0.05) differences were found in the neuromuscular responses between the different devices used during the performance of shoulder extension at xiphoid process depth. Regarding the comparisons of muscle activity between the 2 depths analyzed in this study, only the LD showed a significantly (p ≤ 0.05) higher activity at the xiphoid process depth compared with that at the clavicle depth. Therefore, if maximum muscle activation of the extremities is required, the xiphoid depth is a better choice than clavicle depth, and the kind of device is not relevant. Regarding core muscles, neither the kind of device nor the immersion depth modifies muscle activation.

  14. Letter to Editor : Progressive Brachial Plexus Palsy after Osteosynthesis of an Inveterate Clavicular Fracture

    Directory of Open Access Journals (Sweden)

    Hemendra KA

    2014-01-01

    Full Text Available Dear sir, I would like to raise these following points: 1. Illustration of case report in abstract was somehow different from illustration in the description as the case was explained as a 2 month old clavicle fracture in abstract & it was explained as 4 months old in description and different other time intervals also. 2. Itrogenic compartment syndrome manifestating a week after surgery would not happen,as there was no compartment at clavicle bone,and if any local hematoma would present,that might manifest as a wound dehiscence rather that a isolated neurological symptoms. 3. lateral costo-clavicular space cannot be altered by fixing the fracture as the lateral space is maintained by coraco-clavicular ligaments which were intact in this case. 4. There was no indication for implant removal at 70 days for unstabilising the fracture site as practically it will not increase lateral costo-clavicular space. 5. Why the fracture was fixd again after a year as although the fracture fixation had created the problem. these points indicate unreliability of facts explained in the article. Warm regards Hemendra Agrawal Central Institute Of Orthopaedics, V.M.M.C. & Safdarjung Hospital, Newdelhi-110029, INDIA.

  15. Predicting the optimal depth of left-sided central venous catheters in children.

    Science.gov (United States)

    Kim, H; Jeong, C-H; Byon, H-J; Shin, H K; Yun, T J; Lee, J-H; Park, Y-H; Kim, J-T

    2013-10-01

    The aim of this study was to predict the optimal depth for insertion of a left-sided central venous catheter in children. Using 3D chest computed tomography angiography, we measured the distance from a point where the internal jugular vein is at the superior border of the clavicle, and from a point where the subclavian vein is inferior to the anterior border of the clavicle, to the junction of the superior vena cava and the right atrium in 257 children. Linear regression analysis revealed that the distances correlated with age, weight and height. Simple formulae for the depth of a central venous catheter via the left internal jugular vein (0.07 × height (cm)) and the left subclavian vein (0.08 × height (cm)) were developed to predict placement of the central venous catheter tip at the junction of the superior vena cava with the right atrium. Using these fomulae, the proportion of catheter tips predicted to be correctly located was 98.5% (95% CI 96.8-100%) and 94.0% (95% CI 90.8-97.3%), respectively.

  16. A novel technique for the reconstruction of resected sternoclavicular joints: A case report with a review of the literature

    Directory of Open Access Journals (Sweden)

    Waseem M Hajjar

    2013-01-01

    Full Text Available Sternal metastasis in thyroid cancer is an uncommon occurrence with only a handful of cases of chest wall resections being done. Sternal reconstruction for both primary and secondary tumors has been performed using various techniques and materials such as the mesh, methyl acrylate resin, and steel plates; however, this is a case of papillary thyroid cancer involving the sternum in a 50-year-old woman who had resection of the sternum with reconstruction using titanium bars and clips (STRATOS system fixed to the clavicles with an underlying Proceed mesh. STRATOS system showed good recovery postoperatively. The functional results were excellent with the patient being able to perform all daily activities unassisted after 1 month and almost complete range of motion with acceptable limitations in power of the shoulder muscles after 2 months. We have reviewed all the English language publications of the subject by doing Medline search for the last 25 years and we present here the surgical management of this pathology with our novel approach by using the titanium steel bars to stabilize both medial aspects of the resected clavicles as a promising therapy for manubrial reconstruction and clavicular fixation.

  17. Acromioclavicular joint reconstruction with coracoacromial ligament transfer using the docking technique

    Directory of Open Access Journals (Sweden)

    Gobezie Reuben

    2009-01-01

    Full Text Available Abstract Background Symptomatic Acromioclavicular (AC dislocations have historically been surgically treated with Coracoclavicular (CC ligament reconstruction with transfer of the Coracoacromial (CA ligament. Tensioning the CA ligament is the key to success. Methods Seventeen patients with chronic, symptomatic Type III AC joint or acute Type IV and V injuries were treated surgically. The distal clavicle was resected and stabilized with CC ligament reconstruction using the CA ligament. The CA ligament was passed into the medullary canal and tensioned, using a modified 'docking' technique. Average follow-up was 29 months (range 12–57. Results Postoperative ASES and pain significantly improved in all patients (p = 0.001. Radiographically, 16 (94% maintained reduction, and only 1 (6% had a recurrent dislocation when he returned to karate 3 months postoperatively. His ultimate clinical outcome was excellent. Conclusion The docking procedure allows for tensioning of the transferred CA ligament and healing of the ligament in an intramedullary bone tunnel. Excellent clinical results were achieved, decreasing the risk of recurrent distal clavicle instability.

  18. Arthroscopic arthrodesis of the shoulder: Fourteen-year follow-up

    Directory of Open Access Journals (Sweden)

    Antonio Jiménez-Martín

    2011-01-01

    Full Text Available Shoulder arthrodesis is indicated in infections, brachial paralysis, irreparable rotator cuff tears, osteoarthritis without indication of prosthesis, rescue after arthroplasty, or after surgery for cancer. Arthroscopic arthrodesis is exceptional. Our aim is presenting our result after 14 years of follow-up of one patient. We present a case report of a 17-year-old male patient. He suffered fracture of left scapula (type V, Ideberg, fracture of left clavicle (type I, Craig, and fracture of left distal ulna. We realized osteosynthesis of clavicle (plate and screws with the aim of treating this floating shoulder. Electromyography showed partial axonotmesis of axilar nerve. After 7 months of follow-up, axonotmesis was still present. We realized arthroscopic shoulder arthrodesis (three cannulated screws. Fourteen years later, shoulder movement was as follows: Flexion, 0-90°; maximum abduction, 40° with shoulder atrophy; Constant, 47 points; and UCLA, 17 points, without pain. Arthrodesis with screws reaches a subjective benefit in 82% of patients. Percentage of pseudarthrosis is less than in patients treated with plates, although the risks of infections, fractures, and material removal are greater than in patients treated with plates. Shoulder arthroscopic arthrodesis is exceptional, but it allows minimal surgical aggression.

  19. Functional imaging of the thoracic outlet syndrome in an open MR scanner

    Energy Technology Data Exchange (ETDEWEB)

    Smedby, Oe.; Rostad, H.; Klaastad, Oe.; Lilleaas, F.; Tillung, T.; Fosse, E. [National Hospital, Oslo (Norway). Interventional Centre

    2000-04-01

    Symptoms due to thoracic outlet syndrome may present only in abduction, a position that cannot be investigated in conventional MR scanners. Therefore, this study was initiated to test MRI in an open magnet as a method for diagnosis of thoracic outlet syndrome. Ten volunteers and 7 patients with a clinical suspicion of thoracic outlet syndrome were investigated at 0.5 T in an open MR scanner. Sagittal 3D SPGR acquisitions were made in 0 and 90 abduction. In the patients, a similar data set was also obtained in maximal abduction. To assess compression, the minimum distance between the first rib and the clavicle, measured in a sagittal plane, was determined. In the neutral position, no significant difference was found between patients and controls. In 90 abduction, the patients had significantly smaller distance between rib and clavicle than the controls (14 vs 29 mm; p<0.01). On coronal reformatted images, the compression of the brachial plexus could often be visualised in abduction. Functional MR examination seems to be a useful diagnostic tool in thoracic outlet syndrome. Examination in abduction, which is feasible in an open scanner, is essential for the diagnosis. (orig.)

  20. Acute traumatic subclavian artery thrombosis and its successful repair via resection and end-to-end anastomosis

    Institute of Scientific and Technical Information of China (English)

    Saulat H Fatimi; Amna Anees; Marium Muzaffar; Hashim M Hanif

    2010-01-01

    Subclavian artery thrombosis is a rare complication of clavicle fractures. We reported a 20-year-old man who was admitted to the emergency room after a road traffic accident. He was a pedestrian who was initially hit by a bus and after he fell down on the road, he was run over by a car. On evaluation, he was found to have multiple facial and rib fractures, distal right humerus and right clavicle fracture. Significantly, right radial pulse was absent. After further evaluation including Doppler studies and an angiography which revealed complete obstruction of right subclavian artery just distal to its 1st portion, the patient was urgently taken to the operation room. A midclavicular fracture was adjacent to the injured vessel. We established proximal and distal control, removed damaged part. After mobilizing the subclavian artery, an end-to-end anastomosis was made. Then open reduction and internal fixation of right distal humerus was performed. The rest of the postoperative course was unremarkable. To prevent complications of subclavian artery thrombosis, different treatment modalities can be used, including anticoagulation therapy,angioplasty, stenting and bypass procedures.

  1. Recurrent multifocal chronic osteitis in children; Osteite chronique multifocale recurrente de l`enfant

    Energy Technology Data Exchange (ETDEWEB)

    Quelquejay, C.; Hamidou, A.; Benosman, A.; Adamsbaum, C. [Hopital Saint-Vincent-de-Paul, 75 - Paris (France); Job-Deslandre, Ch. [Hopital Cochin, 75 - Paris (France)

    1997-09-01

    We have studied retrospectively a series of 10 children presenting with chronic multifocal osteomyelitis (8 girls, 2 boys, 7 to 16 years). All patients had plain films, bone scintigraphies and histological studies. Three had CT scan and/or MRI. Compared with literature data, we observed only one case of palmo-plantar pustulosis and only 2 cases of lysis of the medial extremity of the clavicle; in addition, we report one case of lateral extremity of the clavicle and 2 vertebral locations. The radiological pattern was typical: at the beginning of the disease, plain films showed lytic areas which became progressively osteosclerotic with enlargement of the bone. In all the cases, bone scintigraphy revealed high uptake areas which were often infra-clinical. The diagnosis was delayed from 3 months to 3 years. This emphasizes the difficulty of the diagnosis which relies on the association of clinical, biological and radiological elements. Biopsies are required to rule out an infectious bacterial osteomyelitis or a tumoral process. The pathogenesis of OCMR remains unknown, but the relation with the SAPHO (synovitis, acne, pustulosis, Hyperostosis, osteitis) syndrome is general accepted because of the similar features of the osteitis. The long term follow up appears to be uncertain: 6 of our patients are still symptomatic after five years despite anti inflammatory treatment. (authors). 22 refs.

  2. Coracoclavicular joint in a patient with cervicobrachialgy

    Directory of Open Access Journals (Sweden)

    Eraclio Delgado Rifá

    2015-11-01

    Full Text Available The coracoclavicular joint is a rare anomaly of the shoulder; it is described as a diarthrosic synovial joint between the clavicle and the coracoid process. This is a case of a 49-year-old dentist patient who came to the hospital complaining of pain on the right shoulder with an X-ray study that showed an anomalous joint between conoid tubercle of the clavicle and the upper surface of the horizontal part of the coracoid apophysis of the scapula. A comparative shoulder view was done and showed the bilateral presence of the anomaly, making inferences that the pain on the shoulder could be caused by this joint anomaly. Subsequent X-rays of cervical spine were done, due to the persistent pain and they showed marked degenerative changes on C5, C6 and C7 spaces. The final diagnosis was cervical spondylosis. The patient was treated with an intensive conservative treatment and the progressing was satisfactory in midterm period. Coracoclavicular joint is a rare anomalous joint and it was an accidental radiological finding, in this case and in most of the patients. The existence of the coracoclavicular joint is a fortuitous radiographic finding, as it is in this case, and the symptomatic variety of this anomaly is exceptional.

  3. Treatment of Rockwood type Ⅲ acromioclavicular joint dislocation with endobutton technique%应用 Endobutton 带袢钢板技术治疗RockwoodⅢ型肩锁关节脱位

    Institute of Scientific and Technical Information of China (English)

    宋哲; 张堃; 朱养均; 李忠; 庄岩; 魏巍; 杨娜

    2015-01-01

    Background Acromioclavicular joint dislocation is a common injury which often occurs in heavy manual workers and young athletes.It is usually caused by collision of the shoulder on the ground.Acromioclavicular joint dislocation of Rockwood type Ⅲ often needs surgical treatment. There are several kinds of operation methods reported in the literature,but no universally accepted technique exists.From June 2010 to June 2013,21 patients of Rockwood type Ⅲ acromioclavicular joint dislocation were treated with Endobutton technique in our hospital,shoulder functional and radiological evaluations were performed and the outcome is encouraging.Methods (1 )General information:Twenty-one patients were included in this study.Patients were 14 males and 7 females. Nine cases were on the left side and 12 cases were on the right side.The age ranged from 1 9 to 52 with an average of 31.2 years.The causes were traffic injury in 8 cases,fall damage in 9 cases,sports injury in 2 cases and heavy object hit injury in 2 cases.All patients were diagnosed as acromioclavicular joint dislocation of Rockwood type Ⅲ without clavicle fracture,multiple fractures,closed chest injury and cerebral injury.The clinical presentations included pain over the lateral side of clavicle with its distal end protruding upward,tenderness and a feeling of floating;X-ray examinations revealed that the distal clavicle was higher than the acromion.21 cases were all fresh dislocations without neurovascular injuries;The operation time was 1-5 days after injury.(2)Operation method:After successful general anesthesia or cervical plexus block,the patient was in supine or “beach chair”position with head turned to the uninjured side.The straight incision was extended longitudinally from coracoid upward to the posterior edge of clavicle.The skin and subcutaneous tissue was incised layer by layer.The deltoid muscle was bluntly separated and the periosteum was stripped to expose acromioclavicular joint

  4. Nairobi fly (Paederus) dermatitis in South Sudan: a case report.

    Science.gov (United States)

    Iserson, Kenneth V; Walton, Emily K

    2012-09-01

    A 28-year-old nursing student working in Juba, South Sudan, suddenly developed a rash over her mid-right clavicle. Beginning as a 10-cm-diameter erythematous patch with an irregular border, within 24 hours it had developed an increasingly gray, necrotic center, appearing similar to a burn. The patient was seen by 2 local physicians without a diagnosis being made. Ultimately, it was diagnosed as being caused by the toxic hemolymph, pederin, from the Nairobi fly (Paederus). The rash usually affects body parts not covered by clothing; healing time ranges from 7 to 28 days, usually with permanent skin discoloration. Preventive measures include typical antivector precautions, including bed nets, long-sleeve clothing, and avoiding fluorescent lights. If the beetles are found on the skin, brushing them off, rather than crushing them, avoids producing dermatitis. Treatment includes rapidly washing the affected area, applying cold, wet compresses, and possibly treating with antibiotics, steroids, and antihistamines.

  5. Tuberculous osteomyelitis/arthritis of the first costo-clavicular joint and sternum.

    Science.gov (United States)

    Patel, Prasan; Gray, Robin R

    2014-12-28

    A young Somali immigrant presents with a two-year history of a large, firm, painful right anterolateral chest wall sternal mass. The patient denied any history of trauma or infection at the site and did not have a fever, erythematous lesion at the site, clubbing, or lymphadenopathy. A lateral chest radiograph demonstrated a low density mass isolated to the subcutaneous soft tissue overlying the sternum, ribs and clavicle. Computed tomography (CT) with contrast demonstrated a cystic lesion in the right anterolateral chest wall deep to the pectoralis muscle. Enhanced CT of the chest demonstrated sclerosis and destruction of the rib and costochondral joint and manubrio-sternal joint narrowing. Ultrasound-guided biopsy and aspiration returned 500 cc of purulent, cloudy yellow, foul-smelling fluid. Acid-fact bacilli stain and the nucleic acid amplification test identified and confirmed Mycobacterium tuberculosis. A diagnosis of tuberculous osteomyelitis/septic arthritis was made and antibiotic coverage for tuberculosis was initiated.

  6. Coracoid Process Avulsion Fracture at the Coracoclavicular Ligament Attachment Site in an Osteoporotic Patient with Acromioclavicular Joint Dislocation

    Directory of Open Access Journals (Sweden)

    Yoshihiro Onada

    2016-01-01

    Full Text Available Coracoid fractures are uncommon, mostly occur at the base or neck of the coracoid process (CP, and typically present with ipsilateral acromioclavicular joint (ACJ dislocation. However, CP avulsion fractures at the coracoclavicular ligament (CCL attachment with ACJ dislocation have not been previously reported. A 59-year-old woman receiving glucocorticoid treatment fell from bed and complained of pain in her shoulder. Radiographs revealed an ACJ dislocation with a distal clavicle fracture. Three-dimensional computed tomography (3D-CT reconstruction showed a small bone fragment at the medial apex of the CP. She was treated conservatively and achieved a satisfactory outcome. CP avulsion fractures at the CCL attachment can occur in osteoporotic patients with ACJ dislocations. Three-dimensional computed tomography is useful for identifying this fracture type. CP avulsion fractures should be suspected in patients with ACJ dislocations and risk factors for osteoporosis or osteopenia.

  7. Complications of shoulder dystocia.

    Science.gov (United States)

    Dajani, Nafisa K; Magann, Everett F

    2014-06-01

    Complications of shoulder dystocia are divided into fetal and maternal. Fetal brachial plexus injury (BPI) is the most common fetal complication occurring in 4-40% of cases. BPI has also been reported in abdominal deliveries and in deliveries not complicated by shoulder dystocia. Fractures of the fetal humerus and clavicle occur in about 10.6% of cases of shoulder dystocia and usually heal with no sequel. Hypoxic ischemic brain injury is reported in 0.5-23% of cases of shoulder dystocia. The risk correlates with the duration of head-to-body delivery and is especially increased when the duration is >5 min. Fetal death is rare and is reported in 0.4% of cases. Maternal complications of shoulder dystocia include post-partum hemorrhage, vaginal lacerations, anal tears, and uterine rupture. The psychological stress impact of shoulder dystocia is under-recognized and deserves counseling prior to home discharge.

  8. Novel utilization of 3D technology and the hybrid operating theatre: Peri-operative assessment of posterior sterno-clavicular dislocation using cone beam CT

    Science.gov (United States)

    Crowhurst, James A; Campbell, Douglas; Whitby, Mark; Pathmanathan, Pavthrun

    2013-01-01

    A patient with a medial and posterior dislocation of the right sterno-clavicular (SC) joint and displacement of the trachea and brachiocephalic artery by the medial head of the clavicle underwent general anaesthetic in the operating theatre for an open reduction procedure. The surgeon initially attempted a closed reduction, but this required imaging to check SC alignment. The patient was transferred to an adjacent hybrid operating theatre for imaging. Cone beam computed tomography (CBCT) was performed, which successfully demonstrated a significant reduction in the dislocation of the SC joint. The trachea and brachiocephalic artery were no longer compressed or displaced. This case study demonstrates an alternative to the patient being transferred to the medical imaging department for multi-slice CT. It also describes a novel use of the hybrid operating theatre and its CBCT capabilities. PMID:26229610

  9. Novel utilization of 3D technology and the hybrid operating theatre: Peri-operative assessment of posterior sterno-clavicular dislocation using cone beam CT

    Energy Technology Data Exchange (ETDEWEB)

    Crowhurst, James A; Campbell, Douglas; Whitby, Mark; Pathmanathan, Pavthrun [The Prince Charles Hospital, Rode Road, Chermside, Queensland (Australia)

    2013-06-15

    A patient with a medial and posterior dislocation of the right sterno-clavicular (SC) joint and displacement of the trachea and brachiocephalic artery by the medial head of the clavicle underwent general anaesthetic in the operating theatre for an open reduction procedure. The surgeon initially attempted a closed reduction, but this required imaging to check SC alignment. The patient was transferred to an adjacent hybrid operating theatre for imaging. Cone beam computed tomography (CBCT) was performed, which successfully demonstrated a significant reduction in the dislocation of the SC joint. The trachea and brachiocephalic artery were no longer compressed or displaced. This case study demonstrates an alternative to the patient being transferred to the medical imaging department for multi-slice CT. It also describes a novel use of the hybrid operating theatre and its CBCT capabilities.

  10. Parathyroid adenoma. Case presentation

    Directory of Open Access Journals (Sweden)

    Daniel Olivera Fajardo

    2016-10-01

    Full Text Available Parathyroid Adenoma is a non-malignant tumor of the thyroid glands, which increases the levels of parathormone. This hormone regulates blood and bone levels of calcium, phosphorus and Vitamin D. Its classic triad is characterized by the increase of the levels of parathormone, hyperkalimia and Hipophosphatemia. This entity affects between 500-1000 inhabitants and is the main cause of primary Hyperparathyroidism in about 80-85% of the patients. It is presented a case of a 69 year old female patient, admitted due to pathologic fractures of hip, clavicle, and fingers, caused by primary hyperparathyroidism originated by parathyroid adenoma. For the low incidence of this entity, its publication is considered of interest for the scientific staff.

  11. Neonatal skeletal fractures. Birth trauma or child abuse?

    Science.gov (United States)

    Cumming, W A

    1979-03-01

    When a fracture is discovered in a newborn infant, it is important to decide whether it occurred at birth or after birth. Calcification around the fracture site gives a useful estimate of the age of the fracture. We reviewed films of 23 patients with fractures resulting from delivery. The fractures occurred at three different sites: the clavicle, the humerus, and the femur. Calcification could be seen as early as seven days after birth and was absent for as long as 11 days after birth. Six of seven femoral fractures occurred in infants with neuromuscular problems. Fracture at an unusual site or absence of calcification after 11 days should alert the radiologist to the possibility of abuse.

  12. Cleidocranial dysplasia: clinico-radiological illustration of a rare case.

    Science.gov (United States)

    Mohan, Ravi Prakash S; Suma, Gundareddy N; Vashishth, Shirin; Goel, Sumit

    2010-03-01

    Cleidocranial dysplasia is an autosomal dominant condition caused by mutation of RUNX2, characterized by generalized dysplasia of the bones and teeth. Affected individuals have short stature, atypical facial features, and skeletal anomalies affecting mainly the skull and clavicle. The dental manifestations are mainly delayed exfoliation of the primary teeth and delayed eruption of the permanent teeth, with multiple impacted supernumeraries, and absence of cellular cementum. The frequency of this disorder is 1 per million individuals. Here we report a rare case of CCD in a 9-year-old male patient having most of the characteristic features of this syndrome. Interestingly, disorganized dentinal tubules were found in the roots of an extracted deciduous first molar, which seems to be a unique feature not reported previously.

  13. Cleidocranial dysplasia: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Han, Jin Won [Kangnung National University College of Medicine, Kangnung (Korea, Republic of)

    2005-12-15

    Cleidocranial dysplasia is a rare, autosomal dominant congenital disorder. A 12-year-old female visited with chief complaint of unerupted permanent teeth. Also her father showed severe class III malocclusion. The extraoral radiography and computed tomography showed delayed closure of the cranial sutures and underdevelopment of maxilla, maxillary sinuses, and frontal sinus. Both clavicles were underdeveloped and thoracic rib cage was bell-shaped. Both zygomatic process appeared as hypoplastic feature. There were many unerupted permanent and supernumerary teeth in the maxilla and mandible. We examined location and number of the unerupted teeth using 3D CT. Finally we could conclude this case was cleidocranial dysplasia based on the clinico-radiologic findings.

  14. [Pneumothorax revealed by postoperative computed tomography].

    Science.gov (United States)

    Ikeda, Shizuka; Katori, Kiyoshi; Fujimoto, Minoru; Nitahara, Keiichi; Higa, Kazuo

    2005-11-01

    We report a case of pneumothorax revealed by postoperative computed tomography. A 39-year-old obese woman (height 153 cm, weight 70 kg) with fractures of the radius, ulna, clavicle, and femur in a traffic accident, was scheduled for osteosynthesis. Anesthesia was induced with thiopental and maintained with 50% nitrous oxide in oxygen and sevoflurane. The Spo2 decreased from 99% to 94% during the surgery. Bilateral chest sounds were symmetrical. The Spo2 increased to 100% after discontinuation of nitrous oxide. Pneumothorax was not evident on a postoperative chest X-ray, but computed tomography of the chest demonstrated right-sided pneumothorax. An ECG electrode had overlapped the fractured rib on the preoperative chest X-ray.

  15. Vascular complications (splenic and hepatic artery aneurysms) in the occipital horn syndrome: report of a patient and review of the literature

    Energy Technology Data Exchange (ETDEWEB)

    Mentzel, H.-J. [Institute of Diagnostic and Interventional Radiology, University of Jena (Germany)]|[Institute of Diagnostic and Interventional Radiology, Bachstrasse 18, D-07 740 Jena (Germany); Seidel, J.; Vogt, L. [Department of Paediatrics, University of Jena, Friedrich-Schiller-Universitaet Jena, Jena/Thueringen (Germany); Vogt, S.; Kaiser, W.A. [Institute of Diagnostic and Interventional Radiology, University of Jena (Germany)

    1999-01-01

    We report an 18-year-old boy with occipital horn syndrome who developed aneurysms of the splenic and hepatic arteries. Occipital horn syndrome, also called X-linked cutis laxa or Ehlers-Danlos syndrome (EDS) type IX, is characterised by a skeletal dysplasia which includes occipital horns, broad clavicles, deformed radii, ulnae and humeri, narrow rib cage, undercalcified long bones and coxa valga. Distinctive features common to all patients are unusual facial appearance, hypermobility of finger joints, limitation of extension of elbows, chronic diarrhoea and genitourinary abnormalities. In this case report we describe the difficulties encountered in the diagnostic management of patients with EDS-related vascular lesions. (orig.) With 5 figs., 2 tabs., 12 refs.

  16. Brown tumor of the maxillary sinus in a patient with primary hyperparathyroidism: a case report

    Directory of Open Access Journals (Sweden)

    Proimos Efklidis

    2009-07-01

    Full Text Available Abstract Introduction Brown tumors are rare focal giant-cell lesions that arise as a direct result of the effect of parathyroid hormone on bone tissue in some patients with hyperparathyroidism. Brown tumors can affect the mandible, maxilla, clavicle, ribs, and pelvic bones. Therefore, diagnosis requires a systemic investigation for lesion differentiation. Case presentation We present a 42-year-old Greek woman, with a rare case of brown tumor of the maxillary sinus due to primary hyperparathyroidism. Primary hyperparathyroidism is caused by a solitary adenoma in 80% of cases and by glandular hyperplasia in 20%. Conclusions Differential diagnosis is important for the right treatment choice. It should exclude other giant cell lesions that affect the maxillae.

  17. Erb's palsy after delivery by Cesarean section. (A medico-legal key to a vexing problem.).

    Science.gov (United States)

    Iffy, Leslie; Pantages, Pamela

    2005-12-01

    Despite impressive progress in perinatology, fetal injuries from arrest of the shoulders at birth have not decreased in recent decades. Based upon sporadic reports of Erb's palsy in neonates born by Cesarean section, some obstetricians embraced the theory recently that brachial plexus lesions often derive from spontaneous forces acting in utero. Having reviewed three hundred malpractice claims involving fetal injuries attributed to shoulder dystocia at birth, the authors found only two cases connected with abdominal deliveries. One followed manual replacement of the already delivered fetal head into the pelvis after sequential vacuum and forceps procedures and failed manual extraction of the body. The other was an elective repeat Cesarean section where extensive adhesions limited the available space for the lower segment transverse uterine incision. Coincidental fracture of the clavicle and absence of contractures or deformities indicated that the brachial plexus injury was acute, having resulted from forceful traction at delivery.

  18. Schwartz-Jampel syndrome and presentation of two cases from Children's Hospital Medical Center

    Directory of Open Access Journals (Sweden)

    Ashrafi M

    1998-06-01

    Full Text Available S-J syndrome is a rare autosomal recessive disorder of short stature, blepharophimosis, puckerd mouth, myotonia, muscular weakness, pectus carinatum and stiff joints. Case report: first case: n.1. A boy aged 7 years. His main abnormalities included puckered lip, blephharophimosis, muscular hypertrophy and weakness, pectus carinatum, short stature, shoulder joint limitation and myopia. Myotonic discharges in EMG and muscular dystrophy in muscle biopsy observed. Hypoplasia of clavicle, generalized osteopenia, mild platyspondyly and delayed bone age were radiologic findings of this patient. Second case: A boy aged 8 years. His cardinal abnormalities were similar to case 1. Hip joint limitation, low set ear, anterior cortical opacity of lens, small testis and coxa valga were the other manifestations of this patient. Both patients have a normal IQ and parental consanguinity was also present. CBZ was used for both patients

  19. Ichthyosis vulgaris and pycnodysostosis: an unusual occurrence.

    Science.gov (United States)

    Kshirsagar, Vinayak Y; Ahmed, Minhajuddin; Nagarsenkar, Suhel; Sahoo, Kulmani; Shah, Kuldeep B

    2012-01-01

    Pycnodysostosis is a rare autosomal recessive disorder whose gene responsible for this phenotype (CTSK), mapped to human chromosome 1q21, code for the enzyme cathepsin K, a lysosomal cysteine protease; with an estimated incidence of 1.7 per 1 million births. This clinical entity includes micromelic dwarfism, increased radiological bone density, dysplasia of the skull, acro-osteolysis, straightening of the mandibular angle and in some cases, dysplasia of the acromial end of the clavicle. Oral and maxillo-facial manifestations of this disease are very clear. Herein we reported a case of pycnodysostosis, showing short stature with widening of the sutures, unfused anterior and posterior fontanelles, crowding of teeth with dental caries and typical radiological features associated with ichthyosis vulgaris and palmoplantar keratoderma.

  20. Bicycling injuries.

    Science.gov (United States)

    Silberman, Marc R

    2013-01-01

    Bicycling injuries can be classified into bicycle contact, traumatic, and overuse injuries. Despite the popularity of cycling, there are few scientific studies regarding injuries. Epidemiological studies are difficult to compare due to different methodologies and the diverse population of cyclists studied. There are only three studies conducted on top level professionals. Ninety-four percent of professionals in 1 year have experienced at least one overuse injury. Most overuse injuries are mild with limited time off the bike. The most common site of overuse injury is the knee, and the most common site of traumatic injury is the shoulder, with the clavicle having the most common fracture. Many overuse and bicycle contact ailments are relieved with simple bike adjustments.

  1. Development of a Finite Element Model of the Human Shoulder to Investigate the Mechanical Responses and Injuries in Side Impact

    Science.gov (United States)

    Iwamoto, Masami; Miki, Kazuo; Yang, King H.

    Previous studies in both fields of automotive safety and orthopedic surgery have hypothesized that immobilization of the shoulder caused by the shoulder injury could be related to multiple rib fractures, which are frequently life threatening. Therefore, for more effective occupant protection, it is important to understand the relationship between shoulder injury and multiple rib fractures in side impact. The purpose of this study is to develop a finite element model of the human shoulder in order to understand this relationship. The shoulder model included three bones (the humerus, scapula and clavicle) and major ligaments and muscles around the shoulder. The model also included approaches to represent bone fractures and joint dislocations. The relationships between shoulder injury and immobilization of the shoulder are discussed using model responses for lateral shoulder impact. It is also discussed how the injury can be related to multiple rib fractures.

  2. Cleidocranial dysplasia presenting with retained deciduous teeth in a 15-year-old girl: a case report

    Directory of Open Access Journals (Sweden)

    C Nagarathna

    2012-01-01

    Full Text Available Abstract Introduction Cleidocranial dysplasia is a rare congenital defect of autosomal dominant inheritance caused by mutations in the Cbfa1 gene, also called Runx2, located on the short arm of chromosome 6. It primarily affects bones which undergo intramembranous ossification. This condition is of clinical significance to dentistry due to the involvement of the facial bones, altered eruption patterns and multiple supernumerary teeth. Case presentation Our patient, a 15-year-old Indian girl, presented with the typical features of prolonged retention of deciduous dentition and delayed eruption of permanent teeth, that is, mandibular prognathism along with other skeletal abnormalities like shrugged shoulder and the absence of clavicles. A multidisciplinary approach was followed, comprising orthodontic, surgical and pedodontic teams for management. Conclusion Successful treatment of such a case lies in a holistic approach that takes care of all aspects, including the primary pathology, the deformity itself and even the psychological angle.

  3. Hand to mouth in a neandertal: right-handedness in Regourdou 1.

    Directory of Open Access Journals (Sweden)

    Virginie Volpato

    Full Text Available We describe and analyze a Neandertal postcranial skeleton and dentition, which together show unambiguous signs of right-handedness. Asymmetries between the left and right upper arm in Regourdou 1 were identified nearly 20 years ago, then confirmed by more detailed analyses of the inner bone structure for the clavicle, humerus, radius and ulna. The total pattern of all bones in the shoulder and arm reveals that Regourdou 1 was a right-hander. Confirmatory evidence comes from the mandibular incisors, which display a distinct pattern of right oblique scratches, typical of right-handed manipulations performed at the front of the mouth. Regourdou's right handedness is consistent with the strong pattern of manual lateralization in Neandertals and further confirms a modern pattern of left brain dominance, presumably signally linguistic competence. These observations along with cultural, genetic and morphological evidence indicate language competence in Neandertals and their European precursors.

  4. On the homology of the shoulder girdle in turtles.

    Science.gov (United States)

    Nagashima, Hiroshi; Sugahara, Fumiaki; Takechi, Masaki; Sato, Noboru; Kuratani, Shigeru

    2015-05-01

    The shoulder girdle in turtles is encapsulated in the shell and has a triradiate morphology. Due to its unique configuration among amniotes, many theories have been proposed about the skeletal identities of the projections for the past two centuries. Although the dorsal ramus represents the scapular blade, the ventral two rami remain uncertain. In particular, the ventrorostral process has been compared to a clavicle, an acromion, and a procoracoid based on its morphology, its connectivity to the rest of the skeleton and to muscles, as well as with its ossification center, cell lineage, and gene expression. In making these comparisons, the shoulder girdle skeleton of anurans has often been used as a reference. This review traces the history of the debate on the homology of the shoulder girdle in turtles. And based on the integrative aspects of developmental biology, comparative morphology, and paleontology, we suggest acromion and procoracoid identities for the two ventral processes.

  5. Acromioclavicular osteoarthritis: a common cause of shoulder pain.

    Science.gov (United States)

    Menge, Travis J; Boykin, Robert E; Bushnell, Brandon D; Byram, Ian R

    2014-05-01

    Osteoarthritis of the acromioclavicular joint is a frequent cause of shoulder pain and can result in significant debilitation. It is the most common disorder of the acromioclavicular joint and may arise from a number of pathologic processes, including primary (degenerative), posttraumatic, inflammatory, and septic arthritis. Patients often present with nonspecific complaints of pain located in the neck, shoulder, and/or arm, further complicating the clinical picture. A thorough understanding of the pertinent anatomy, disease process, patient history, and physical examination is crucial to making the correct diagnosis and formulating a treatment plan. Initial nonoperative management is aimed at relieving pain and restoring function. Typical treatments include anti-inflammatory medications, physical therapy, and injections. Patients who continue to exhibit symptoms after appropriate nonsurgical treatment may be candidates for operative resection of the distal clavicle through either open or arthroscopic techniques.

  6. Giovanni Battista Morgagni in the murals of Diego Rivera at the National Institute of Cardiology of Mexico City.

    Science.gov (United States)

    Estañol, Bruno; Delgado, Guillermo R

    2014-07-01

    The Italian physician Giovanni Battista Morgagni was the founder of the clinico-anatomical method. His masterpiece De sedibus, et causis morborum per anatomen indagatis represented a major breakthrough in the history of medicine. In the murals of Diego Rivera at the National Institute of Cardiology, Morgagni appears at the center of the fresco. With his left index finger points to the chest of a dying patient with a bulging pulsating aortic aneurysm below the left clavicle, and with his right hand, that holds a scalpel, shows the aneurysm found at the autopsy table. With this striking image the clinico-anatomical method is succinctly depicted. Professor Ignacio Chávez, the founder of the National Institute of Cardiology, gave the artist the elements to draw Morgagni, but the disposition and the importance of Morgagni in the fresco were due to the talent of Rivera.

  7. Sex determination using discriminant analysis of upper and lower extremity bones: New approach using the volume and surface area of digital model.

    Science.gov (United States)

    Lee, U-Young; Kim, In-Beom; Kwak, Dai-Soon

    2015-08-01

    This study used 110 CT images taken from donated Korean cadavers to create 3-D models of the following upper and lower limb bones: the clavicle, scapula, humerus, radius, ulna, hip bone (os coxa), femur, patella (knee cap), tibia, talus, and calcaneus. In addition, the bone volume and surface area were calculated to determine sex differences using discriminant analysis. Significant sex differences were found in all bones with respect to volume and surface area (phip bone>tibia>humerus>scapula), although the order of surface area was different. The largest surface area in men was the femur and in women was the hip bone (psex determination (94%). When using the surface area of multiple bones, the maximum accuracy (99.4%) was achieved. The equation was as follows: (discriminant equation of surface area; femalesex determination.

  8. 皮肤霍奇金淋巴瘤%Cutaneous Hodgkin's lymphoma: a case report and review of the literature

    Institute of Scientific and Technical Information of China (English)

    顾安康; 肖尹; 纪华安

    2012-01-01

    报告1例皮肤霍奇金淋巴瘤.患者男,28岁.因右侧锁骨上不规则鲜红色斑块1年就诊,全身系统检查未见肿大淋巴结和内脏肿瘤,经皮损组织病理和免疫组化检查诊断为皮肤霍奇金淋巴瘤.%A case of cutaneous Hodgkin s lymphoma is reported. A 28-year-old male presented with red plaque on his skin over the right clavicle for one year without lymphadenopathy and visceral tumors. The diagnosis is made by histology and immunohistochemistry.

  9. BILATERAL CLEIDOHYOIDEUS ACCESSORIUS MUSCLE-A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Naveen Kumar

    2013-01-01

    Full Text Available ABSTRACT: Accessory muscles are rare anatomical variants whic h may have clinical implications. Variations of the muscles in the infrahyoid region assume clinical significance during diagnostic procedures and surgical operati ons in the region of neck. An unusual muscle “Cleidohyoideus accessorius” was found in th e infra hyoid region bilaterally during routine dissection of neck region in an adult male cadaver. On both the sides muscle had its origin from the superior surface of the middle one third of the clavicle. The muscle coursing upward, lateral to the sternohyoid, was ins erted into the hyoid bone. The other infra hyoid muscles including omohyoid were intact and in their typical form. The accessory muscle received its nerve supply from ansa cervicalis. Here we report a variation of rare occurrence, a case of bilateral accessory muscle “Cleid ohyoideus accessorius”, its embryological and clinical considerations are being reviewed here

  10. Tuberculous osteomyelitis/arthritis of the first costoclavicular joint and sternum

    Institute of Scientific and Technical Information of China (English)

    Prasan; Patel; Robin; R; Gray

    2014-01-01

    A young Somali immigrant presents with a two-year history of a large, firm, painful right anterolateral chest wall sternal mass. The patient denied any history of trauma or infection at the site and did not have a fever, erythematous lesion at the site, clubbing, or lymphadenopathy. A lateral chest radiograph demonstrated a low density mass isolated to the subcutaneous soft tissue overlying the sternum, ribs and clavicle. Computed tomography(CT) with contrast demonstrated a cystic lesion in the right anterolateral chest wall deep to the pectoralis muscle. Enhanced CT of the chest demonstrated sclerosis and destruction of the rib and costochondral joint and manubrio-sternal joint narrowing. Ultrasound-guided biopsy and aspiration returned 500 cc of purulent, cloudy yellow, foul-smelling fluid. Acidfact bacilli stain and the nucleic acid amplification test identified and confirmed Mycobacterium tuberculosis. A diagnosis of tuberculous osteomyelitis/septic arthritis was made and antibiotic coverage for tuberculosis was initiated.

  11. Bent bone dysplasia (BBD)-FGFR2 type: the radiologic manifestations in early gestation

    Energy Technology Data Exchange (ETDEWEB)

    Handa, Atsuhiko; Okajima, Yuka; Kurihara, Yasuyuki [St. Luke' s International Hospital, Department of Radiology, Tokyo (Japan); Izumi, Noriko; Yamanaka, Michiko [St. Luke' s International Hospital, Department of Integrated Women' s Health, Tokyo (Japan)

    2016-02-15

    Bent bone dysplasia-fibroblast growth factor receptor 2 type (BBD-FGFR2) is a recently identified skeletal dysplasia caused by specific FGFR2 mutations, characterized by craniosynostosis and prenatal bowing of the long bones. Only a few cases have been published. We report an affected fetus terminated at 21 weeks of gestation. The clinical and radiologic manifestations mostly recapitulate previous descriptions; however we suggest additional hallmarks of this disorder in early gestation. These hallmarks include distinctive short, thick clavicles and wavy ribs, as well as vertebral bodies that showed striking anteroposterior shortening. Femoral fractures were also present in our case. Although craniosynostosis is a hallmark of the disease, clinicians should be aware that craniosynostosis might not be readily apparent on plain films early in gestation. (orig.)

  12. Benign anlage tumour: a very unusual neck mass.

    Science.gov (United States)

    Parihar, Shivani; Gohil, Rohit; Oparka, Richie; Kennedy, Ceilidh

    2016-05-18

    A 44-year-old woman presented with a slow-growing asymptomatic neck swelling at the left medial clavicle. Haematological and biochemical work up was normal and an ultrasound confirmed the swelling, but needle aspiration was non-diagnostic. As lymphoma was the main differential diagnosis, the swelling was completely excised. Immunohistochemistry yielded a rare lesion, suspected to represent a myoepithelial/mixed cellularity tumour of soft tissue. The extreme rarity of these tumours required a confirmatory secondary opinion, which ultimately led to it being identified as a benign anlage tumour (previously known as an ectopic hamartomatous thymoma) This case highlights the fact that thorough assessment of patients with neck swellings should be undertaken to rule out sinister causes-keeping in mind more rare differentials-helping to guide final management.

  13. Ichthyosis vulgaris and pycnodysostosis: An unusual occurrence

    Directory of Open Access Journals (Sweden)

    Vinayak Y. Kshirsagar

    2012-11-01

    Full Text Available Pycnodysostosis is a rare autosomal recessive disorder whose generesponsible for this phenotype (CTSK, mapped to human chromosome1q21, code for the enzyme cathepsin K, a lysosomal cysteineprotease; with an estimated incidence of 1.7 per 1 million births. This clinical entity includes micromelic dwarfism, increased radiological bone density, dysplasia of the skull, acro-osteolysis, straightening of the mandibular angle and in some cases, dysplasia of the acromial end of the clavicle. Oral and maxillo-facial manifestations of this disease are very clear. Herein we reported a case of pycnodysostosis, showing short stature with widening of the sutures, unfused anterior and posterior fontanelles, crowding of teeth with dental caries and typical radiological features associated with ichthyosis vulgaris and palmoplantar keratoderma.

  14. Long-Term Trend of Bone Development in the Contemporary Teenagers of Chinese Han Nationality

    Institute of Scientific and Technical Information of China (English)

    WANG Ya-hui; YING Chong-liang; WAN Lei; ZHU Guang-you

    2012-01-01

    Objective To further improve the accuracy of bone age identification using the time of secondary ossification center appearance and epiphyseal fusion of 7 joints to estimate the age of living individuals.Methods DR films were taken from 7 parts including sternal end of clavical and the left side of shoulder,elbow,carpal,hip,knee and ankle joints of 1709 individuals who came from eastern China,central China and southern China,whose ages were between 11.0 and 20.0 years.From those 7 joints 24 osteal loci were selected as bone age indexes,which could better reflect age growth of teenagers.The characteristics of secondary ossification center appearance and epiphyseal fusion were observed,and the mean and age range of secondary ossification center appearance and epiphyseal fusion were calculated.Results The fusion time of the 24 epiphyses were advanced at different degrees,the most obvious epiphyses the sternal end of clavicle,scapular acromial end,distal end of the radius,distal end of the ulna,iliac crest,ischial tuberosity,the upper and lower end of tibia and fibula.The appearance time of sternal end of clavicle,scapular acromial end,iliac crest and ischial tuberosity epiphyses were all found to be after the age of 12,and the female's age,approximately 1year ahead of schedule in comparison with the male's.Conclusion The relevant forensic information and data for bone age identification should be updated every 10-15 years so as to provide accurate and objective evidence for court testimony,conviction and sentencing.

  15. Expanding the utility of modified vascularized femoral periosteal bone-flaps: An analysis of its form and a comparison with a conventional-bone-graft

    Science.gov (United States)

    Hamada, Yoshitaka; Hibino, Naohito; Kobayashi, Anna

    2014-01-01

    Background Vascularized medial femoral condyle (MFC) corticoperiosteal bone-flap is a well-accepted technique when dealing with tissue defects or infection. Its role in refractory conditions and in the possible use for options concerning modifications of this bone-flap compared to a conventional iliac bone graft (conventional-graft) are rarely discussed. Methods We reviewed 21 consecutive cases concerning alternatives with some modifications of original MFC bone-flap surgery used to treat refractory conditions with bone defects, necrosis, or infection in the extremities. We present our devised approaches for this boneflap, and especially modifications of the grafted bone (including strut bone, perforator to the vastus medialis muscle, and the use of one vascular pedicle for some bone flaps) as well as the combined use of artificial bone as hybrid bone transplantation. We also compared the clinical results of 21 cases that received a conventional-graft. Results and Conclusions Following flap placement, 100% of the nonunion sites healed in an average of 2 months, which was significantly shorter than 5.5 months for the conventional-graft. The results showed the expanding possibility for options with regard to the form and options of this bone-flap as well as the shortening the duration of treatment, especially at the site of an infected distal tibia, insertion of the Achilles tendon on the posterior aspect of calcaneal osteomyelitis, distal end of the clavicle, clavicle or forearm with a bone defect, small bones with refractory conditions, and a femur without implant failure. However, it was not efficient for treating a forearm without bone defect. PMID:25983463

  16. Increase in Fracture Risk Following Unintentional Weight Loss in Postmenopausal Women: The Global Longitudinal Study of Osteoporosis in Women.

    Science.gov (United States)

    Compston, Juliet E; Wyman, Allison; FitzGerald, Gordon; Adachi, Jonathan D; Chapurlat, Roland D; Cooper, Cyrus; Díez-Pérez, Adolfo; Gehlbach, Stephen H; Greenspan, Susan L; Hooven, Frederick H; LaCroix, Andrea Z; March, Lyn; Netelenbos, J Coen; Nieves, Jeri W; Pfeilschifter, Johannes; Rossini, Maurizio; Roux, Christian; Saag, Kenneth G; Siris, Ethel S; Silverman, Stuart; Watts, Nelson B; Anderson, Frederick A

    2016-07-01

    Increased fracture risk has been associated with weight loss in postmenopausal women, but the time course over which this occurs has not been established. The aim of this study was to examine the effects of unintentional weight loss of ≥10 lb (4.5 kg) in postmenopausal women on fracture risk at multiple sites up to 5 years after weight loss. Using data from the Global Longitudinal Study of Osteoporosis in Women (GLOW), we analyzed the relationships between self-reported unintentional weight loss of ≥10 lb at baseline, year 2, or year 3 and incident clinical fracture in the years after weight loss. Complete data were available in 40,179 women (mean age ± SD 68 ± 8.3 years). Five-year cumulative fracture rate was estimated using the Kaplan-Meier method, and adjusted hazard ratios for weight loss as a time-varying covariate were calculated from Cox multiple regression models. Unintentional weight loss at baseline was associated with a significantly increased risk of fracture of the clavicle, wrist, spine, rib, hip, and pelvis for up to 5 years after weight loss. Adjusted hazard ratios showed a significant association between unintentional weight loss and fracture of the hip, spine, and clavicle within 1 year of weight loss, and these associations were still present at 5 years. These findings demonstrate increased fracture risk at several sites after unintentional weight loss in postmenopausal women. This increase is found as early as 1 year after weight loss, emphasizing the need for prompt fracture risk assessment and appropriate management to reduce fracture risk in this population. © 2016 American Society for Bone and Mineral Research.

  17. The effect of mechanical strains in soft tissues of the shoulder during load carriage.

    Science.gov (United States)

    Hadid, Amir; Belzer, Noa; Shabshin, Nogah; Zeilig, Gabi; Gefen, Amit; Epstein, Yoram

    2015-11-26

    Soldiers and recreational backpackers are often required to carry heavy loads during military operations or hiking. Shoulder strain appears to be one of the limiting factors of load carriage due to skin and underlying soft tissue deformations, trapped nerves, or obstruction of blood vessels. The present study was aimed to determine relationships between backpack weights and the state of loads in the shoulder׳s inner tissues, with a special focus on the deformations in the brachial plexus. Open-MRI scans were used for developing and then verifying a three-dimensional, non-linear, large deformation, finite element model of the shoulder. Loads were applied at the strap-shoulder contact surfaces of the model by pulling the strap towards the shoulder until the desired load was reached. Increasing the strap tensile forces up to a load that represents 35kg backpack resulted in gradual increase in strains within the underlying soft tissues: the maximal tensile strain in the brachial plexus for a 25kg backpack was 12%, and while carrying 35kg, the maximal tensile strain increased to 16%. The lateral aspect of the brachial plexus was found to be more vulnerable to deformation-inflicted effects than the medial aspect. This is due to the anatomy of the clavicle that poorly shields the plexus from compressive loads applied during load carriage, while the neural tissue in the medial aspect of the shoulder is better protected by the clavicle. The newly developed model can serve as a tool to estimate soft tissue deformations in the brachial plexus for heavy backpack loads, up to 35kg. This method will allow further development of new strap structures and materials for alleviating the strains applied on the shoulder soft tissues.

  18. Emergent Median Sternotomy for Mediastinal Hematoma: A Rare Complication following Internal Jugular Vein Catheterization for Chemoport Insertion—A Case Report and Review of Relevant Literature

    Directory of Open Access Journals (Sweden)

    Saptarshi Biswas

    2014-01-01

    Full Text Available Mediastinal hematoma is a rare complication following insertion of a central venous catheter with only few cases reported in the English literature. We report a case of a 71-year-old female who was admitted for elective chemoport placement. USG guided right internal jugular access was attempted using the Seldinger technique. Resistance was met while threading the guidewire. USG showed a chronic clot burden in the RIJ. A microvascular access was established under fluoroscopic guidance. Rest of the procedure was completed without any further issues. Following extubation, the patient complained of right-sided chest pain radiating to the back. Chest X-ray revealed a contained white out in the right upper lung field. She became hemodynamically unstable. Repeated X-ray showed progression of the hematoma. Median Sternotomy showed posterior mediastinal hematoma tracking into right pleural cavity. Active bleeding from the puncture site at RIJ-SCL junction was repaired. Patient had an uneventful recovery. Injury to the central venous system is the result of either penetrating trauma or iatrogenic causes as in our case. A possible explanation of our complication may be attributed to the forced manipulation of the dilator or guidewire against resistance. Clavicle and sternum offer bony protection to the underlying vital venous structures and injuries often need sternotomy with or without neck extension. Division of the clavicle and disarticulation of the sternoclavicular joint may be required for optimum exposure. Meticulous surgical technique, knowledge of the possible complications, and close monitoring in the postprocedural period are of utmost importance. Chest X-ray showed to be routinely done to detect any complication early.

  19. Prevalence of radiological findings among cases of severe secondary hyperparathyroidism

    Directory of Open Access Journals (Sweden)

    Paulo Gustavo Sampaio Lacativa

    Full Text Available CONTEXT AND OBJECTIVE: Patients with end stage renal disease (ESRD and secondary hyperparathyroidism (HPT2 are prone to develop heterotopic calcifications and severe bone disease. Determination of the sites most commonly affected would decrease costs and patients' exposure to X-ray radiation. The aim here was to determine which skeletal sites produce most radiographic findings, in order to evaluate hemodialysis patients with HPT2, and to describe the most prevalent radiographic findings. DESIGN AND SETTING: This study was cross-sectional, conducted in one center, the Hospital Universitário Clementino Fraga Filho (HUCFF, in Rio de Janeiro, Brazil. METHODS: Whole-body radiographs were obtained from 73 chronic hemodialysis patients with indications for parathyroidectomy due to severe HPT2. The regions studied were the skull, hands, wrists, clavicles, thoracic and lumbar column, long bones and pelvis. All the radiographs were analyzed by the same two radiologists, with great experience in bone disease interpretation. RESULTS: The most common abnormality was subperiosteal bone resorption, mostly at the phalanges and distal clavicles (94% of patients, each. "Rugger jersey spine" sign was found in 27%. Pathological fractures and deformities were seen in 27% and 33%, respectively. Calcifications were presented in 80%, mostly at the forearm fistula (42%, abdominal aorta and lower limb arteries (35% each. Brown tumors were present in 37% of the patients, mostly on the face and lower limbs (9% each. CONCLUSION: The greatest prevalence of bone findings were found on radiographs of the hands, wrists, lateral view of the thoracic and lumbar columns and femurs. The most prevalent findings were bone resorption and ectopic calcifications.

  20. 关节镜下喙锁韧带增强术治疗肩锁关节脱位%Arthroscopic treatment of acute acromioclavicular joint dislocations by coracoacromial ligament augmentation and suture

    Institute of Scientific and Technical Information of China (English)

    皇甫小桥; 赵金忠; 何耀华; 杨星光; 刘旭东; 刘闻欣; 王海明

    2013-01-01

    ,nine patients with acute AC joint dislocation type Ⅲ and three patients with type V were treated arthroscopically to augment the reconstructed CC ligaments (conoid ligament and trapezoid ligament ) by the suture plate (ASCULAP Company, Germany,B′Braun)used to reconstruct ligaments of knee joint.Patients were pre and postoperatively evaluated with X-ray examinations,American Shoulder and Elbow Surgeons′Form (ASES)and Constant-Murley Score (CMS).Results All 1 2 patients were followed up for at least 1 2 months (range,1 2 to 1 8 months).The average ASES score significantly increased from 28.7 preoperatively to 86.9 postoperatively, and the mean CMS score from 24 to 91,respectively.X-ray data showed a good reduction of the AC joint in the treated group.9 1 .7% of patients (1 1 patients)obtained an obvious therapeutic effect after operation. 83.3% of patients (10 patients)returned to their pre-injury level of athletics.Acromioclavicular subluxation was only found in one case.Discussion AC joint dislocation usually appears in youth and adults with obvious traumatic history,and often results from the direct violence on the adducted shoulder.The stable structure of AC joint is achieved by the connection between the scapula and the clavicle,and the integrity of the sternoclavicular articulation and the scapulothoracic joint.According to the injury level of acromioclavicular stability,AC joint injuries can be classified into six types by Rockwood,type Ⅲ、Ⅳ、Ⅴ、Ⅵ should be fixed through operation for its disruption of stable structures.The goal of surgical procedure on AC joint dislocation is to reconstruct its anatomy and function. Activity of AC joint and its postoperative rehabilitation training will be inevitably affected by any operation of strict limitation on its flexibility. Arthroscopically assisted augmentation of reconstructed CC ligaments with the suture plate button technique is an effective method in treating AC joint dislocation,which restores its

  1. 浮肩损伤内固定方式选择的生物力学研究%Biomechanics of internal fixation for treating floating shoulder injury

    Institute of Scientific and Technical Information of China (English)

    段连鸿; 黄继锋; 赵卫东; 梁栋柱; 夏平光; 刘新园

    2011-01-01

    目的 对浮肩损伤临床常用的3种内固定术式进行生物力学评价,为手术选择内固定方式提供生物力学依据.方法 7例包含锁骨及肩胛骨的左侧上肢防腐尸体标本,解剖出肩胛上悬吊复合体(SSSC),人为制造浮肩损伤模型,对4种状态进行试验:正常标本、单纯锁骨固定、锁骨加肩胛颈单钢板固定、锁骨加肩胛颈双钢板固定.利用脊柱三维运动分析系统测定不同状态下肩胛颈的运动范围(ROM),比较不同内固定方式对失稳SSSC的稳定作用.结果 生物力学测试表明,单纯锁骨固定的ROM值分别是:前屈(12.60±0.95)°、后伸(8.53±0.60)°、左侧弯(12.47±0.73)°、右侧弯(12.32±0.69)°、左旋(10.17±0.59)°、右旋(11.42±0.62)°,与其他各组相比明显增大(P<0.05);锁骨加肩胛颈双钢板固定的ROM值分别是:前屈(5.50±0.96)°、后伸(2.77±0.67)°、左侧弯(3.61±0.70)°、右侧弯(5.06±0.71)°、左旋(3.28±0.58)°、右旋(3.58±0.92)°,与其他固定组相比明显减小(P<0.05).结论 治疗浮肩损伤的最佳内固定方式为同时固定锁骨及肩胛颈骨折,肩胛颈骨折采取双钢板坚强内固定,以避免肩胛骨畸形愈合而造成肩关节不稳定.%Objective To evaluate biomechanic effects of commonly used internal fixation methods on the treatment of floating shoulder injury. Methods The superior suspensory shoulder complex (SSSC) were dissected for simulating floating shoulder injury in 7 antiseptic upper limb specimens including collarbone and scapula. The testing included the normal specimens, simple clavicle fixation, single plate fixation of clavicle and scapula neck, and double plate fixation of clavicle and scapula neck. The ROMs of scapula neck under different states were measured by spinal motion analysis system, as well, the stability of different fixation methods for instable SSSC was compared. Results The biomechanical testing showed that, the ROMs of simple clavicle

  2. 对新生儿产伤性疾病的临床探讨%The clinical study of the obstetric disease of the newborn

    Institute of Scientific and Technical Information of China (English)

    罗桂芬

    2014-01-01

    Objective:To explore the high risk factors and coping methods of neonatal birth injury diseases.Methods:35 cases with birth injury were selected from February 2011 to February 2014.The clinical data were retrospectively analyzed.Results:Cranial hematoma,intracranial hemorrhage,soft tissue injury,clavicle fracture were the main aspects of birth injury.Cranial hematoma was the most,and clavicle fracture was the least.In the normal birth weight,birth injury rate was significantly lower than the giant infants and low birth weight infants.Natural parturition injury rate was lower than the forceps and breech extraction childbirth, which was higher than that of cesarean section.Conclusion:Maternal prenatal must do comprehensive examination.According to the specific situation of maternal and fetal,doctors can choose the different modes of delivery.We should closely monitor the delivery process,so that it can effectively prevent neonatal injury,and reduce the incidence of neonatal injury.%目的:探讨新生儿产伤性疾病的高危因素和应对手段。方法:2011年2月-2014年2月收治产伤患儿35例,对其临床资料进行回顾性分析。结果:头颅血肿、颅内出血、软组织损伤、锁骨骨折是新生儿产伤的几个主要方面,其中头颅血肿最多,最少的是锁骨骨折;正常体重新生儿的产伤率明显低于巨大儿和低出生体重儿;自然分娩的产伤发生率低于产钳助产和臀位助产分娩,高于剖宫产。结论:产妇产前必须做综合检查,依据产妇和胎儿的具体情况选择不同的分娩方式,严密监测分娩过程,这样能够有效预防新生儿产伤,降低新生儿产伤发生率。

  3. The role of embryo movement in the development of the furcula.

    Science.gov (United States)

    Pollard, A S; Boyd, S; McGonnell, I M; Pitsillides, A A

    2017-03-01

    The pectoral girdle is a complex structure which varies in its morphology between species. A major component in birds is the furcula, which can be considered equivalent to a fusion of the paired clavicles found in many mammals, and the single interclavicle found in many reptiles. These elements are a remnant of the dermal skeleton and the only intramembranous bones in the trunk. Postnatally, the furcula plays important mechanical roles by stabilising the shoulder joint and acting as a mechanical spring during flight. In line with its mechanical role, previous studies indicate that, unlike many other intramembranous bones, furcula growth during development can be influenced by mechanical stimuli. This study investigated the response of individual aspects of furcula growth to both embryo immobilisation and hypermotility in the embryonic chicken. The impact of altered incubation temperature, which influences embryo motility, on crocodilian interclavicle development was also explored. We employed whole-mount bone and cartilage staining and 3D imaging by microCT to quantify the impact of rigid paralysis, flaccid paralysis and hypermobility on furcula growth in the chicken, and 3D microCT imaging to quantify the impact of reduced temperature (32-28 °C) and motility on interclavicle growth in the crocodile. This revealed that the growth rates of the clavicular and interclavicular components of the furcula differ during normal development. Total furcula area was reduced by total unloading produced by flaccid paralysis, but not by rigid paralysis which maintains static loading of embryonic bones. This suggests that dynamic loading, which is required for postnatal bone adaptation, is not a requirement for prenatal furcula growth. Embryo hypermotility also had no impact on furcula area or arm length. Furcula 3D shape did, however, differ between groups; this was marked in the interclavicular component of the furcula, the hypocleideum. Hypocleideum length was reduced by both

  4. Pseudoxanthoma elasticum: clinical, histologic, and genetic studies--a report of two sisters.

    Science.gov (United States)

    Kaimbo, Dieudonne Kaimbo Wa; Mutosh, Anne; Leys, Anita; Parys-van Ginderdeuren, Rita; Bergen, A A B

    2011-01-01

    CASE 1: A 24-year-old black woman was referred to our clinic in September 1999 by the department of dermatology. She was referred to confirm the diagnosis of pseudoxanthoma elasticum (PXE). Her medical history was normal. Dermatologic examination revealed confluent papules that gave the skin a "plucked chicken" appearance on the flexural surfaces in the neck, axillae, clavicle, thigh, and periumbilical area (Figure 1). The patient stated that the changes in her skin had begun in the periumbilical region at about 5 years of age and had since been slowly progressive. Physical examination showed brownish black pigmentation on the left side of the face, left eyelid, and left sclera, which was diagnosed as Nevus of Ota (Figure 2). Her visual acuity was 20/10 in both eyes, with no afferent pupillary defect. Intraocular pressure in both eyes was normal. Slit lamp examination showed no abnormalities. Findings from fundus examination revealed angioid streaks that formed an incomplete ring around the optic disc and anteriorly radiated toward the equator of the globe, multiple calcified drusen-like structures, and "peau d'orange" changes. Skin biopsy (skin tissue from the neck) was taken and the diagnosis of PXE was confirmed. Histopathologic findings revealed calcification of the elastic fibers and abnormalities of the collagen (Figure 3). The patient was not known to have sickle cell anemia or sickle cell trait, and her blood pressure levels had never elevated. Other systemic causes of angioid streaks were excluded by findings from extensive laboratory examination. Her relatives were asked to come in for examination but lived far away. One of the patient's sisters lived in Kinshasa, Africa, however, and is presented in case 2. CASE 2: The 27-year-old sister of the previous patient was examined on April 19, 2000. At examination, she was found to have PXE. Her medical history was significant for systemic hypertension since 1998 and genital hemorrhage. She underwent an

  5. 助产过程中新生儿锁骨骨折的预防及护理%The prevention and nursing of neonatal clavicular fracture in the process of midwifery

    Institute of Scientific and Technical Information of China (English)

    纪玉华

    2015-01-01

    Objective:To analyze the prevention and nursing measures of neonatal clavicular fracture in the process of midwifery. Methods:100 cases of newborns through vaginal delivery were selected.They were randomly divided into the two groups.The nursing staff of the control group did not receive professional training in midwifery,and the nursing staff of the observation group received professional training in midwifery,then we compared the risk of clavicle fractures and nursing satisfaction between the two groups.Results:The incidence of clavicle fractures in the observation group and nursing satisfaction were significantly higher than that of the control group,and the difference was statistically significant(P<0.05).Conclusion:Necessary midwifery skills training for obstetric midwifery care personnel can effectively reduce the incidence of neonatal clavicular fracture and improve the satisfaction of nursing work in maternal and their families.%目的:分析研究助产过程中新生儿锁骨骨折的预防及护理对策。方法:选取经由阴道分娩的新生儿100例,随机平分为两组。对照组护理人员未接受助产专业培训,观察组护理人员接受了助产专业培训,对比两组新生儿的锁骨骨折几率以及护理满意度。结果:观察组新生儿的锁骨骨折发生几率以及护理满意度均较对照组有明显优异性,差异有统计学意义(P<0.05)。结论:对产科助产护理人员进行必要的助产技能培训,可有效降低新生儿锁骨骨折的发生几率,并提高产妇及其家属对护理工作的满意程度。

  6. Langerhans cell histiocytosis: unusual skeletal manifestations observed in thirty-four cases

    Energy Technology Data Exchange (ETDEWEB)

    Hindman, B.W.; Thomas, R.D.; Young, Lionel W. [Loma Linda University Medical Center, 11234 Anderson Street, Loma Linda, CA 92354 (United States); Yu, Leisure [Department of Orthopedic Surgery, Loma Linda University Medical Center, Loma Linda, CA 92354 (United States)

    1998-04-01

    Objective. Unusual manifestations are occasionally encountered in Langerhans cell histiocytosis and may be a source of confusion. The objective of this study was to determine the frequency of occurrence of the unusual manifestations in our case material. Design and patients. Thirty-four children, average age 4.4 years (range 3 months to 16 years) with 262 skeletal lesions of biopsy-proven Langerhans cell histiocytosis (LCH) were retrospectively reviewed to determine the frequency of occurrence of unusual manifestations defined either as an atypical location of a skeletal lesion or an atypical radiographic appearance of the lesion. Results. Twenty-four unusual lesions were found in this retrospective review. Among these were epiphyseal lesions, transphyseal lesions, extracranial `button` sequestra, posterior vertebral arch lesions, dural extension of vertebral lesions, and fluid-fluid levels. The finding of fluid-fluid levels has not previously been described in the radiologic literature. Involvement of unusual sites included clavicles and small bones of the hands and feet. Conclusions. Radiographic, computed tomographic, and magnetic resonance imaging of LCH yield a variety of unusual manifestations. Recognition of these varied appearances of LCH may prevent confusion of such appearances with other pathologic processes. When the unusual manifestation occurs as the initial finding of the disease, LCH should be included in the differential diagnosis. (orig.) With 7 figs., 10 refs.

  7. Radiologic findings of adult pelvis and appendicular skeletal Langerhans cell histiocytosis in nine patients

    Energy Technology Data Exchange (ETDEWEB)

    Song, You Seon; Lee, In Sook; Kim, Do Kyung [Pusan National University Hospital, Medical Research Institute, Department of Radiology, Busan (Korea, Republic of); Pusan National University, School of Medicine, Department of Radiology, Busan (Korea, Republic of); Yi, Jae Hyuck [Kyungpook National University Hospital, Department of Radiology, Daegu (Korea, Republic of); Cho, Kil Ho [Yeungnam University College of Medicine, Department of Radiology, Daegu (Korea, Republic of); Song, Jong Woon [Inje University Haeundae Paik Hospital, Department of Radiology, Busan (Korea, Republic of)

    2011-11-15

    The purpose of this article was to evaluate the radiologic findings of adult pelvis and appendicular skeletal Langerhans cell histiocytosis (LCH), emphasizing the CT and MR findings. The images of nine patients with pathologically proven LCH (five men and four women; mean age, 37.11 years) were retrospectively reviewed. Imaging analysis was confined to the long and flat bones. CT scans were performed in five patients and MR imaging was performed in eight. Images were assessed for the following features on CT and MRI: the location and number of lesions; the presence of cortical destruction, endosteal scalloping, and a periosteal reaction on CT or MRI; the margin of soft tissue masses, the presence of bone marrow edema, and a ''budding'' appearance on MRI; and the presence of sclerotic margins or septations on CT. The involved skeletal sites were the pelvis (seven), femurs (five), humeri (two), tibias (two), fibula (one), clavicle (one), scapula (one), and sternum (one). Endosteal scalloping, a periosteal reaction, and a budding appearance were common on MRI or CT images. Although cortical destruction and the soft tissue lesion formation were rare, soft tissue masses had well-defined margins. Endosteal scalloping and a budding appearance with a periosteal reaction on CT and MRI may be helpful signs for differentiation of LCH from malignant tumors in adults. (orig.)

  8. The fatal wound of Hector, according to a drawing by Peter Paul Rubens designed for tapestry weaving.

    Science.gov (United States)

    Rubino, M; Viale, G L

    2001-02-01

    According to the Iliad(Chapter XXII, Verses 322-329), Hector, while fighting his last duel, was almost entirely protected by bronze armor, with only a small area "where the clavicle marks the boundary between neck and thorax" exposed. It was precisely into this area, "the shorter way to death," that Achilles thrust his lance. This fatal wound, although covering Hector with blood, allowed the victim to pronounce a few words. In designing the Story of Achilles, his fourth and last series of drawings especially designed for tapestry weaving, Rubens depicted Achilles stabbing Hector near the midline of his neck. There is evidence that Rubens was always well acquainted with the literary sources of his pictures. It is also likely that he became familiar with contemporary editions of the Iliad that were enhanced with commentaries. Realizing that the wound depicted in his original drawing should have prevented Hector from speaking, Rubens altered the scene, then showing the lance piercing the cervical vascular bundle. The careful scrutiny for literary accuracy that was typical of Rubens' artistic behavior did not prevent an additional minor imprecision in the final tapestry. Nevertheless, his outstanding expressive power enabled him to give form to a gigantic baroque representation of the death of Hector in masterly fashion.

  9. Blunt traumatic tension chylothorax: Case report and mini-review of the literature.

    Science.gov (United States)

    Idris, Kamal; Sebastian, Michael; Hefny, Ashraf F; Khan, Navidul Haq; Abu-Zidan, Fikri M

    2016-11-16

    Tension chylothorax following blunt thoracic trauma is an extremely rare condition. Here we report such a case and review its management. A 31-year-old man was involved in a road traffic collision. The car rolled over and the patient was ejected from the vehicle. On arrival at the Emergency Department the patient was conscious and haemodynamically stable. Clinical examination of the chest and abdomen was normal. The patient had sustained fractures of the sixth cervical vertebra and the tenth thoracic vertebra, left pleural effusion, haematoma around the descending aorta and fracture of the right clavicle. The left pleural effusion continued to increase in size and caused displacement of the trachea and mediastinum to the opposite side. An intercostal chest tube was inserted on the left side on the second day. It drained 1500 mL of milky, blood-stained fluid. We confirmed the diagnosis of chylothorax by a histopathological examination of a cell block prepared from the left pleural effusion using Oil red O stain. The patient was managed conservatively with chest tube drainage and fat free diet. The chylothorax completely resolved on the eighth day after the injury. The patient was discharged home on day 16.

  10. Multi-Analysis of Non-Thyrogenous Masses of the Neck

    Institute of Scientific and Technical Information of China (English)

    Yong Li; Ming Gao; Yang Yu; Yigong Li; Yan Zhang; Xiaolong Li

    2007-01-01

    OBJECTIVE To systematically analyze and summarize non-thyrogenous masses of the neck (NTMN) by consideration of new areas, a large sample size and multiple-aspect analysis.METHODS Our research involved 3,125 NTMN cases. We summarized the proportion of various NTMN and the distribution of the neck diseases based on the new international classification. The clinical traits such as sexual proportion and age, etc, were analyzed along with the unknown primary cervical metastatic carcinomas (UPCMC), multiple nodular NTMN and tubercular lymphadenitis.RESULTS There were 68 different diseases identified. Among all the NTMN, the percentage of metastatic carcinomas was 63.3%. The neck masses with a focus above the clavicle comprised 62.3% of the metastatic carcinomas whose focuses were clear. Moreover, other results almost supported the "rule of 80%". There was an obvious distribution of traits at every sub level. For example, there were 23 different diseases in level Ⅲ, of which the most common was lymphoma. UPCMC made up 12.3% of all metastatic carcinomas. Multiple NTMN were composed of lymphoma, metastatic carcinoma and tubercular lymphadenitis, etc. For tubercular lymphadenitis patients, the patients without tubercular toxic symptoms comprised 77.1% of all tubercular lymphadenitis patients.CONCLUSION NTMN are complex and various, with a definite distribution in each neck level. Data relating the sex ratio, UPCMC, multiple nodular NTMN and tubercular lymphadenitis to the clinical traits of NTMN will provide support for clinical applications.

  11. Suggestion of Modified Y-View in Supine Position

    Energy Technology Data Exchange (ETDEWEB)

    Shin, Seong Gyu [Dept. of Radiology, Dong A University Medicine Center, Busan (Korea, Republic of); Baek, Seong Min [Dept. of Nuclear Medicine, Kosin University Gospel Hospital, Busan (Korea, Republic of); Lee, Hyo Yeong [Dept. of Nuclear Medicine, Pusan National University Hospital, Busan (Korea, Republic of)

    2012-06-15

    This study was performed to design a modified Y-View as an imaging method for the Y-View in supine position for patients who requires Y-View imaging for the diagnosis of shoulder impingement syndrome but having trouble for the positioning of patients complaining of shoulder pain. On the result of comparative analysis of the images obtained by changing the lateral-medio degree of X-ray tube into 35 degrees, 40 degrees, and 45 degrees while patient is in supine position, 40 degrees of X-ray tube in lateral-medio direction produced the most valuable image for the diagnosis by best describing the shapes of acromion, clavicle space, and coracoacromial arch. Therefore, patients who have difficulty in Y-View position to obtain Y-View image, modified Y-View can be applied as a useful alternative method. By this study, various applications not only in shoulder impingement syndrome but also in diverse omarthralgia diseases are expected.

  12. Reconstruction of chest wall defects after resection of large neoplasms: ten-year experience.

    Science.gov (United States)

    Novoa, Nuria; Benito, Pablo; Jiménez, Marcelo F; de Juan, Ana; Luis Aranda, José; Varela, Gonzalo

    2005-06-01

    We review our experience in the treatment of complex large chest-wall defects needing a multidisciplinary approach due to primary or secondary neoplasms. Non-small cell lung cancer with chest-wall invasion cases are excluded. Fifteen patients underwent whole thickness resection of the chest wall due to lesions affecting at least three ribs, sternum, clavicle or thoracic spine and the surrounding soft tissue. Previously operated breast cancer and sarcoma were the most frequent diagnoses. Partial or total sternectomy plus rib resection was performed in 8 patients. Immediate closure of the defects was performed in all cases: 12 with single prosthesis placement and 3 with a rigid one of methylmethacrylate. Coverage was achieved using myocutaneous flaps in most cases and, in one case, using the greater omentum that supported a free split-thickness skin graft. No 30-days mortality was recorded. Three patients had a post-operative complication. Mean hospital stay was 11.7+/-9 days. All cases of primary tumours were alive at the time of review (range: 6-126 months). In conclusion, resection and immediate reconstruction of large chest wall defects can be accomplished without operative mortality and low morbidity whenever close cooperation between plastic and thoracic teams exists.

  13. Skype: a tool for functional assessment in orthopaedic research.

    LENUS (Irish Health Repository)

    Good, Daniel W

    2012-03-01

    Skype is a free program which enables PC users to make video calls to other users with Internet access. We carried out a prospective review of all acromioclavicular joint hook plates for lateral-third clavicle fractures over a five-year period. Functional assessment with Oxford and Constant shoulder scores were carried out using Skype and compared to outpatient review using the Bland-Altman method. Of 36 patients (mean age 36 years), 33 had a computer with a video camera, all 33 had Internet access and 22 were already users of Skype. In total 29 patients were happy to take part in Skype assessment (83%). In comparison with outpatient review, there was a mean difference in the Oxford score of -0.48 (95% confidence interval -0.84, -0.12); the mean difference for the Constant score was -0.68 (95% confidence interval -1.08, -0.29). These differences were not clinically significant, confirming that Skype can be used as an alternative to goniometry in this clinical setting. A survey showed that 93% of 29 patients surveyed preferred the use of Skype for follow-up, mainly due to the convenience and cost-saving involved. The study demonstrates the potential for this new technique in providing patients with more options for follow-up.

  14. Coraco- or Costoclavicular Paraosteoarthropathies in Patients with Severe Central Neurological Disorders

    Energy Technology Data Exchange (ETDEWEB)

    Lacout, A.; Mompoint, D.; Perrier, Y.; Vallee, C.A.; Carlier, R.Y. (Service de Radiologie, Hopital Raymond Poincare, Garches (France))

    2008-03-15

    Background: Paraosteoarthropathy (POA) is a frequent disabling orthopedic complication after severe central neurological impairment. The hip is the most frequently affected joint (32.1%) followed by the elbow and the shoulder (25%). Purpose: To evaluate coraco- and costoclavicular paraosteoarthropathy in patients with severe central neurological disorders. Material and Methods: We report a series of five consecutive patients with severe central neurological disorders who developed a POA of the clavicular region (coracoclavicular or costoclavicular POA). Every patient underwent a clinical, radiological, and computed tomographic (CT) examination of the shoulder region. Results: Four patients had a history of traumatic brain injury (TBI), and one an acute disseminated encephalomyelitis (ADEM). They developed POA of the clavicular region, although not around the glenohumeral joint. The patients complained of shoulder pain and of moderate limitation of movements. Radiological and CT examinations showed the presence of a bony formation in the coracoclavicular space in four cases and extending from the clavicle to the first rib around the costoclavicular joint in one case. Conclusion: In patients with severe brain lesions suffering from shoulder pain and moderate limitation of joint movements, POAs of the clavicular region are rare but should be considered

  15. Hydatid disease of scapula and upper third of humerus treated by en bloc excision and fibular bone grafting

    Directory of Open Access Journals (Sweden)

    Chari P

    2007-01-01

    Full Text Available 35-year-old male patient presented with gradually increasing painful swelling of the right shoulder, which was incised and drained and wound persisted as a discharging sinus on the anterolateral aspect of the deltoid region with seropurulent discharge. A clinical diagnosis of tuberculosis of the shoulder was made. Plain skiagram of the right shoulder revealed multicystic lesion involving the entire scapula and upper third of the humerus with loss of joint space and pathological fracture at the junction of upper one-third and lower two-thirds of the humerus. A clinico-radiological diagnosis of hydatid disease was made. In view of the extensive involvement of the scapula with stiff shoulder and an active sinus, a two-stage surgical procedure was performed. Stage 1 consisted of en bloc excision of the scapula, upper half of the humerus and lateral end of the clavicle. Stage II surgery, consisting of fibular bone grafting. Tablet albendazole (400 mg, thrice daily was given as systemic scolicidal agent. This case is reported in view of it′s rarity and to highlight the management.

  16. Arthroscopically Assisted Acromioclavicular and Coracoclavicular Ligament Reconstruction for Chronic Acromioclavicular Joint Instability.

    Science.gov (United States)

    Martetschläger, Frank; Tauber, Mark; Habermeyer, Peter; Hawi, Nael

    2016-12-01

    Acromioclavicular (AC) joint injuries are common injuries, especially in the young and active, male population. AC joint injuries account for 12% of all injuries of the shoulder girdle in the overall population. Although conservative treatment is recommended for Rockwood type I and type II injuries, there is controversial debate about optimal treatment for type III injuries. High-grade injuries are typically treated operatively to avoid painful sequelae. A vast number of different surgical methods have been described over the past few decades. Recent advances in arthroscopic surgery have enabled the shoulder surgeon to treat acute and chronic AC lesions arthroscopically assisted. Clinical studies have already shown good and reliable results. Although surgeons agree that a biological augmentation is required to minimize the risk of recurrent instability in chronic cases, a gold standard still needs to be defined. We present an arthroscopically assisted biological augmentation technique to reconstruct the AC and coracoclavicular ligaments, protected by a button-suture tape construct for chronic AC joint instability. The presented arthroscopic biological augmentation technique uses less and/or smaller drill holes in the clavicle and coracoid than previously described, thus reducing weakening of the bony structures. At the same time it enhances both horizontal and vertical stability.

  17. Deciphering the elusive nature of sharp bone trauma using epifluorescence macroscopy: a comparison study multiplexing classical imaging approaches.

    Science.gov (United States)

    Capuani, Caroline; Rouquette, Jacques; Payré, Bruno; Moscovici, Jacques; Delisle, Marie Bernadette; Telmon, Norbert; Guilbeau-Frugier, Céline

    2013-01-01

    Characterization of sharp-force trauma on human bones can be extremely useful in providing information regarding the nature and context of death. Nevertheless, in the identification of weapons used to cause sharp-force trauma and analysis of bone wounds, challenging tasks still remain. Current analysis attempting to dissect bone wound characteristics varied quite a lot and mixed different criteria, thus leading sometimes to conflicting results. In this context, the aim of our study is to clarify qualitative aspects of cut marks induced by sharp weapons on human bones. For that purpose, we analyzed bone samples via an original approach based on bone autofluorescence with an epifluorescence macroscope and compared it to previous existing methods. In this study, we used bone sections from human clavicles on which three different kinds of lesions were manually implemented, using different weapons. The bone wounds were analyzed by three different methodologies, light microscopy, scanning electron microscopy (SEM), and micro-computed tomography, and were compared with epifluorescence macroscopy. We paid attention more significantly to the aspect of walls and floor of the kerf, so as to conclude on the nature and distinguish between weapons used. Among all technologies used in this study, the most precise and efficient methods were epifluorescence macroscopy and SEM. Nonetheless, epifluorescence macroscopy is faster, cheaper, and more accessible than SEM. More significantly, this technique, which has the potential to accurately document the nature of the damage, is nondestructive, and could thus be highly useful in forensic science as anthropology.

  18. Modeling and determination of directionality of the kerf in epifluorescence sharp bone trauma analysis.

    Science.gov (United States)

    Capuani, Caroline; Telmon, Norbert; Moscovici, Jacques; Molinier, François; Aymeric, Andre; Delisle, Marie-Bernadette; Rougé, Daniel; Guilbeau-Frugier, Céline

    2014-11-01

    Characteristics of sharp bone trauma can be extremely useful to determine the origin of cut marks and to provide information regarding the context of death. Using human ribs and clavicle bones, this study analyzes the characteristics of bone kerfs made by different bladed implements, thanks to epifluorescence macroscopy. This technique, which is a nondestructive tool that uses autofluorescence of bones, documents bone damage precisely with high resolution. Both qualitative and quantitative criteria are analyzed. Our results identify unique class characteristics on bone lesions, allowing modeling kerf depending on the weapon, regardless of the type of bone that is wounded. Moreover, we demonstrate for the first time microscopic criteria of directionality, using fluorescence excitation. Orientation of cracks, flakes, and lateral pushing back especially helps in determining the tip and the end of the lesion, leading to the position of the aggressor. Kerf wall characteristics and striation location are also very useful. Epifluorescence macroscopy could be a new tool of choice in anthropology through cut mark analysis in establishing how the blade was used and providing details about the blow.

  19. Skeletal development and adult osteology of Hypsiboas pulchellus (Anura: Hylidae

    Directory of Open Access Journals (Sweden)

    Julio M. Hoyos

    2012-07-01

    Full Text Available Osteological and skeletal characters have long been proven to be particularly informative in taxonomic and systematic research. Furthermore, ossification sequences are assumed to be a potential tool to investigate developmental states and developmental modes of fossil and extant skeletal specimens. Herein, we provide a detailed account on adult osteology and skeletogenesis in the Montevideo treefrog, Hypsiboas pulchellus (Anura: Hylidae based on evaluation of a series of cleared and stained specimens. A consensus sequence of ossification, i.e., the order of appearance of mineralized elements until early metamorphosis could be determined as (parasphenoid, presacral vertebrae I-VII, frontoparietal, exoccipital – transverse processes of presacral vertebrae I-VIII – sacral vertebra – (humerus, radioulna, ilium, femur, tibiofibula, scapula – (cleithrum, clavicle, coracoids, metacarpals, tarsals, metatarsals, phalanges, hypochord – (prootic, angulosplenial, dentary, maxilla, premaxilla, squamosal. Comparing the state of mineralized elements in individual specimens, a number of skeletal elements, including the exoccipital, frontoparietal, parasphenoid and prootic, as well as elements of the shoulder and pelvic girdles, and the phalanges, were found to vary intraspecifically regarding the relative time of their ossification within the ossification sequence.

  20. Complex dental anomalies in a belatedly diagnosed cleidocranial dysplasia patient

    Science.gov (United States)

    Lu, Hui; Zeng, Binghui; Yu, Dongsheng; Jing, Xiangyi; Hu, Bin; Wang, Yiming

    2015-01-01

    Cleidocranial dysplasia (CCD) is a rare congenital disorder, typically characterized by persistently open skull sutures, aplastic or hypoplastic clavicles, and supernumerary teeth. Mutations in the gene encoding the runt-related transcription factor 2 (RUNX2) protein are responsible for approximately two thirds of CCD patients. We report a 20-year-old CCD patient presenting not only with typical skeletal changes, but also complex dental anomalies. A previously undiagnosed odontoma, 14 supernumerary teeth, a cystic lesion, and previously unreported fused primary teeth were discovered on cone-beam computed tomography (CBCT) scans. Mutation analysis identified the causal c.578G>A (p.R193Q) mutation in the RUNX2 gene. At 20 years of age, the patient had already missed the optimal period for dental intervention. This report describes the complex dental anomalies in a belatedly diagnosed CCD patient, and emphasizes the significance of CBCT assessment for the detection of dental anomalies and the importance of early treatment to achieve good outcomes. PMID:26389062

  1. Bioarchaeology of the middle Neolithic: evidence for archery among early European farmers.

    Science.gov (United States)

    Thomas, Aline

    2014-06-01

    This article focuses on Neolithic skeletons associated with the first monumental cemeteries of Western Europe and specifically those of the Cerny culture (Paris Basin, France). While this cultural context is an agrarian one, numerous arrowheads derived from complete hunting equipment are present in numerous graves. The goal of this work is to evaluate the morphological and pathological differences among the individuals according to the presence of arrowheads in their graves. It is postulated that those buried with such artifacts practiced archery, unlike their counterparts. Only adult males were selected for study to limit the effect of non-mechanical factors such as age- and sex-related modifications. The corpus consists of 36 males reliably identified among the 101 Cerny adults currently available. Thirteen men are associated with arrowheads. Variations in morphology and robusticity are evaluated on the basis of the external geometric properties of the appendicular skeleton. Entheseal changes to fibrocartilaginous attachment sites of upper and lower limbs are also examined. Both nonpathological skeletal adaptations and pathological indicators are consistent and reveal significant differences between the two groups compared. Functional adaptation is observed in the forearm bones and the clavicle in response to mechanical loads, and enthesopathies suggest repeated forceful use of upper limb muscles. These osteological changes specifically reflect the higher intensity upper limb activity of the men buried with arrowheads and correspond with the medical data on known archers, suggesting that this specific forceful task is linked to the practice of archery.

  2. Impact injuries and probability of survival in a large semiurban endemic pigeon in New Zealand, Hemiphaga novaeseelandiae.

    Science.gov (United States)

    Cousins, Rachael A; Battley, Phil F; Gartrell, Brett D; Powlesland, Ralph G

    2012-07-01

    The New Zealand Pigeon or kereru (Hemiphaga novaeseelandiae) frequently collides with windows and vehicles. In this study of 146 kereru collected from 1996 to 2009, we used 118 radiographs and 91 necropsies to determine skeletal and soft tissue injuries. Vehicle collisions resulted in more damage to the extremities (wing and femur), whereas collisions with windows resulted in trauma to the head, fractures/dislocations of the coracoids and clavicles, and ruptured internal organs. Soft tissue injuries included damage to the flight muscles and heart ruptures caused by fractured coracoid bones, as well as extensive bruising of pectoral muscles and hemorrhaging of the lungs. Rehabilitation time was not related to number of skeletal injuries sustained, nor was the time until death for those that did not survive. In general, kereru with greater numbers of injuries were less likely to survive rehabilitation. Flight speed and force calculations suggest that a 570-g kereru would collide with 3-70 times the force of smaller birds (5-180 g); this may explain the discrepancies between the injuries characterized here and those reported for North American passerines. The differences in injuries sustained from collisions with windows and cars can be used to inform rehabilitators about the possible nature of injuries if the source of impact is known.

  3. Shoulder impingement syndrome : evaluation of the causes with MRI

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Yong Ho; Song, In Sup; Chung, Hun Young; Yoon, Sang Jin; Kim, Yang Soo; Shim, Hyung Jin; Choi, Young Hee; Lee, Jong Beum; Lee, Yong Chul; Kim, Kun Sang [Chungang Univ. College of Medicine, Seoul (Korea, Republic of); Choi, Yun Sun [Eulji Hospital, College of Medicine, Seoul (Korea, Republic of)

    1999-12-01

    Various mechanical causes which induce shoulder impingement syndrome have been identified with the help of MRI. The aim of this study is to evaluate the incidence of such causes. A total of 54 patients with clinically confirmed shoulder impingement syndrome and a normal control group(n=20) without symptoms were included. We evaluated the incidence of hook shaped acromion, low lying acromion, downward slope of the acromion, subacromial spur, acromioclavicular joint hypertrophy, coracoacromial ligament hypertrophy, high cuff muscle bulk, and os acromiale. Among the 54 patients, the following conditions were present: acromioclavicular joint hypertrophy(n=36), coracoacromial ligament hypertrophy(n=20), subacromial spur(n=18), downward sloping of the acromion(n=16), hook shaped acromion(n=11), relatively high cuff muscle bulk(n=6), low lying acromion relative to the clavicle(n=3), and os acromiale(n=1). In the normal control group there were nine cases of acromioclavicular joint hypertrophy, nine of coracoacromial ligament hypertrophy, nine of downward sloping acromion, and three of low lying acromion, but hook shaped acromion, high cuff muscle bulk, and os acromiale were not found. Among 54 patients, the syndrome was due to five simultancous causes in one patient, four causes in two, three causes in 12, two causes in 22, and one cause in 17. Hook shaped acromion and subacromial spur are the statistically significant causes of shoulder impingement syndrome. In 69% of patients, the condition was due to more than one cause.

  4. Paleopathological description and diagnosis of metastatic carcinoma in an Early Bronze Age (4588+34 Cal. BP) forager from the Cis-Baikal region of Eastern Siberia.

    Science.gov (United States)

    Lieverse, Angela R; Temple, Daniel H; Bazaliiskii, Vladimir I

    2014-01-01

    Extensive osteolytic and osteoblastic lesions were observed on the skeletal remains of an adult male excavated from an Early Bronze Age cemetery dated to 4556+32 years BP, located in the Cis-Baikal region of Siberia (Russian Federation). Lytic lesions ranged in size from several mm to over 60 mm in diameter and had irregular, moth-eaten borders. Many of these lesions destroyed trabecular bone, though a hollowed shell of cortical bone often remained observable. Radiographic analysis revealed numerous lytic lesions within trabecular bone that had not yet affected the cortex. Blastic lesions were identified as spiculated lines, bands, or nodules of mostly immature (woven) bone formed at irregular intervals. Anatomical elements with the greatest involvement included those of the axial skeleton (skull, vertebrae, sacrum, ribs, and sternum) as well as proximal appendicular elements (ossa coxae, proximal femora, clavicles, scapulae, and proximal humeri). Osteocoalescence of destructive foci was observed on the ilium and frontal bone, with the largest lesion found on the right ilium. Differential diagnoses include metastatic carcinoma, mycotic infections, tuberculosis, Langerhan's cell histiocytosis, and multiple myeloma. Based on lesion appearance and distribution, age and sex of the individual, as well as pathogen endemism, the most likely diagnostic option for this set of lesions is metastatic carcinoma. The age and sex of this individual and appearance of the lesions may reflect carcinoma of the lung or, possibly, prostate. This represents one of the earliest cases of metastatic carcinoma worldwide and the oldest case documented thus far from Northeast Asia.

  5. Diagnosis of Mercurial Teeth in a Possible Case of Congenital Syphilis and Tuberculosis in a 19th Century Child Skeleton

    Directory of Open Access Journals (Sweden)

    Stella Ioannou

    2015-01-01

    Full Text Available Without the presence of “caries sicca,” “sabre shins,” and nodes/expansion of the long bones with superficial cavitation, differential diagnosis of venereal syphilis and tuberculosis (TB may be difficult as various infections produce similar responses. However, congenital syphilis has distinctive features facilitating a diagnosis. A case study of remains of a juvenile European settler (probably male, 8–10 years old (B70 buried in the 19th century and excavated in 2000 from the cemetery of the Anglican Church of St. Marys in South Australia is presented. B70 demonstrated that the two diseases might have been present in the same individual, congenital syphilis and TB. Widespread destruction of vertebral bodies and kyphosis-related rib deformations indicate advanced TB. Severe dental hypoplasia is limited to permanent incisors and first molars; there is pitting on the palate, periosteal reaction on the skull vault, and thinned clavicles. Dental signs are not limited to “screwdriver” central incisors and mulberry molars. Apical portions of the crowns of permanent upper, lower, central, and lateral incisors have multiple hypoplastic-disorganized defects; deciduous canines have severely hypoplastic crowns while possibly hypoplastic occlusal surfaces of lower deciduous second molars are largely destroyed by extensive caries. These dental abnormalities resemble teeth affected by mercurial treatment in congenital syphilitic patients as described by Hutchinson.

  6. Hereditary bone dysplasia with pathological fractures and nodal osteoarthropathy

    Energy Technology Data Exchange (ETDEWEB)

    Arendse, Regan [University of Stellenbosch, Department of Medicine, Tygerberg Hospital, Stellenbosch (South Africa); University of Cape Town, Division of Rheumatology, Groote Schuur Hospital, Cape Town (South Africa); Brink, Paul [University of Stellenbosch, Department of Medicine, Tygerberg Hospital, Stellenbosch (South Africa); Beighton, Peter [University of Cape Town, Division of Human Genetics, Faculty of Health Sciences, Cape Town (South Africa)

    2009-12-15

    A father and daughter both had multiple pathological fractures and nodal osteoarthropathy. The father, aged 50 years, had at least 20 healed fractures of the axial and appendicular skeleton, sustained by minor trauma over his 50-year lifespan, many of which had been surgically fixed prior to his first presentation to us. Fractures of the clavicles, thoracic cage and long bones of the arms and legs, had healed with malalignment and deformity. Healed fractures were complicated by ankylosis of the cervical vertebrae and both elbows. He also had osteoarthritis of the hands, with exuberant osteophytosis, and profound perceptive deafness. His general health was good, his intellect and facies were normal, and his sclerae were white. The daughter, aged 27 years, had sustained at least seven fractures of the axial and appendicular skeleton following trivial injuries, in distribution similar to those of the father. She had also experienced painful swelling of the fingers, which preceded progressive development of nodal osteoarthropathy. Her hearing was normal. In both individuals, biochemical and immunological investigations yielded normal results. It was not possible for molecular studies to be undertaken. Pedigree data were consistent with autosomal dominant transmission, and this disorder appeared to be a previously undocumented heritable skeletal dysplasia. (orig.)

  7. Biomechanical model for evaluation of pediatric upper extremity joint dynamics during wheelchair mobility.

    Science.gov (United States)

    Schnorenberg, Alyssa J; Slavens, Brooke A; Wang, Mei; Vogel, Lawrence C; Smith, Peter A; Harris, Gerald F

    2014-01-03

    Pediatric manual wheelchair users (MWU) require high joint demands on their upper extremity (UE) during wheelchair mobility, leading them to be at risk of developing pain and pathology. Studies have examined UE biomechanics during wheelchair mobility in the adult population; however, current methods for evaluating UE joint dynamics of pediatric MWU are limited. An inverse dynamics model is proposed to characterize three-dimensional UE joint kinematics and kinetics during pediatric wheelchair mobility using a SmartWheel instrumented handrim system. The bilateral model comprises thorax, clavicle, scapula, upper arm, forearm, and hand segments and includes the sternoclavicular, acromioclavicular, glenohumeral, elbow and wrist joints. A single 17 year-old male with a C7 spinal cord injury (SCI) was evaluated while propelling his wheelchair across a 15-meter walkway. The subject exhibited wrist extension angles up to 60°, large elbow ranges of motion and peak glenohumeral joint forces up to 10% body weight. Statistically significant asymmetry of the wrist, elbow, glenohumeral and acromioclavicular joints was detected by the model. As demonstrated, the custom bilateral UE pediatric model may provide considerable quantitative insight into UE joint dynamics to improve wheelchair prescription, training, rehabilitation and long-term care of children with orthopedic disabilities. Further research is warranted to evaluate pediatric wheelchair mobility in a larger population of children with SCI to investigate correlations to pain, function and transitional changes to adulthood.

  8. Thoracic Limb Morphology of the Ring-tailed Lemur (Lemur catta) Evidenced by Gross Osteology and Radiography.

    Science.gov (United States)

    Makungu, M; Groenewald, H B; du Plessis, W M; Barrows, M; Koeppel, K N

    2015-08-01

    There is limited information available on the morphology of the thoracic limb of the ring-tailed lemur (Lemur catta). This study describes the morphology of the thoracic limb of captive ring-tailed lemurs evidenced by gross osteology and radiography as a guide for clinical use. Radiographic findings of 12 captive ring-tailed lemurs are correlated with bone specimens of three adult animals. The clavicle is well developed. The scapula has a large area for the origin of the m. teres major. The coracoid and hamate processes are well developed. The lateral supracondylar crest and medial epicondyle are prominent. The metacarpal bones are widely spread, and the radial tuberosity is prominent. These features indicate the presence of strong flexor muscles and flexibility of thoracic limb joints, which are important in arboreal quadrupedal locomotion. Furthermore, an ovoid ossicle is always seen at the inter-phalangeal joint of the first digit. Areas of increased soft tissue opacity are superimposed over the proximal half of the humerus and distal half of the antebrachium in male animals as a result of the scent gland. Knowledge of the morphology of the thoracic limb of individual species is important for accurate interpretation and diagnosis of musculoskeletal diseases.

  9. Calibration of the Accuscan II IN Vivo System for High Energy Lung Counting

    Energy Technology Data Exchange (ETDEWEB)

    Ovard R. Perry; David L. Georgeson

    2011-07-01

    This report describes the April 2011 calibration of the Accuscan II HpGe In Vivo system for high energy lung counting. The source used for the calibration was a NIST traceable lung set manufactured at the University of Cincinnati UCLL43AMEU & UCSL43AMEU containing Am-241 and Eu-152 with energies from 26 keV to 1408 keV. The lung set was used in conjunction with a Realistic Torso phantom. The phantom was placed on the RMC II counting table (with pins removed) between the v-ridges on the backwall of the Accuscan II counter. The top of the detector housing was positioned perpendicular to the junction of the phantom clavicle with the sternum. This position places the approximate center line of the detector housing with the center of the lungs. The energy and efficiency calibrations were performed using a Realistic Torso phantom (Appendix I) and the University of Cincinnati lung set. This report includes an overview introduction and records for the energy/FWHM and efficiency calibration including performance verification and validation counting. The Accuscan II system was successfully calibrated for high energy lung counting and verified in accordance with ANSI/HPS N13.30-1996 criteria.

  10. Patients with isolated oligo/hypodontia caused by RUNX2 duplication.

    Science.gov (United States)

    Molin, Arnaud; Lopez-Cazaux, Serena; Pichon, Olivier; Vincent, Marie; Isidor, Bertrand; Le Caignec, Cédric

    2015-06-01

    Loss-of-function mutations of RUNX2 are responsible for cleidocranial dysplasia, an autosomal dominant disorder characterized by delayed closure of cranial sutures, aplastic or hypoplastic clavicles, moderate short stature and supernumerary teeth. By contrast, an increased gene dosage is expected for duplication of the entire RUNX2 sequence and thus, a phenotype different from cleidocranial dysplasia. To date, two cousins with a duplication including the entire RUNX2 sequence in addition to MIR586, CLIC5 and the 5' half of SUPT3H have been reported. These patients presented with metopic synostosis and hypodontia. Here, we report on a family with an affected mother and three affected children. The four patients carried a 285 kb duplication identified by array comparative genomic hybridization. The duplication includes the entire sequence of RUNX2 and the 5' half of SUPT3H. We confirmed the duplication by real-time quantitative PCR in the four patients. Two children presented with the association of metopic craniosynostosis and oligo/hypodontia previously described, confirming the phenotype caused by RUNX2 duplication. Interestingly, the mother and one child had isolated hypodontia without craniosynostosis, broadening the phenotype observed in patients with such duplications.

  11. Acromioclavicular joint injuries: diagnosis and management.

    Science.gov (United States)

    Simovitch, Ryan; Sanders, Brett; Ozbaydar, Mehmet; Lavery, Kyle; Warner, Jon J P

    2009-04-01

    Acromioclavicular joint injuries represent nearly half of all athletic shoulder injuries, often resulting from a fall onto the tip of the shoulder with the arm in adduction. Stability of this joint depends on the integrity of the acromioclavicular ligaments and capsule as well as the coracoclavicular ligaments and the trapezius and deltoid muscles. Along with clinical examination for tenderness and instability, radiographic examination is critical in the evaluation of acromioclavicular joint injuries. Nonsurgical treatment is indicated for type I and II injuries; surgery is almost always recommended for type IV, V, and VI injuries. Management of type III injuries remains controversial, with nonsurgical treatment favored in most instances and reconstruction of the acromioclavicular joint reserved for symptomatic instability. Recommended techniques for stabilization in cases of acute and late symptomatic instability include screw fixation of the coracoid process to the clavicle, coracoacromial ligament transfer, and coracoclavicular ligament reconstruction. Biomechanical studies have demonstrated that anatomic acromioclavicular joint reconstruction is the most effective treatment for persistent instability.

  12. Melanotic schwannoma arising in association with nevus of Ota: 2 cases suggesting a shared mechanism.

    Science.gov (United States)

    Trufant, Joshua W; Brenn, Thomas; Fletcher, Christopher D M; Virata, Andrew R; Cook, Deborah L; Bosenberg, Marcus W

    2009-12-01

    Melanotic schwannoma is a rare markedly pigmented peripheral nerve sheath tumor comprising cells with prominent melanization and schwannian features. The psammomatous variety is associated with Carney complex, a multiple neoplasia syndrome with spotty skin pigmentation. We present the first 2 reported cases of melanotic schwannoma arising in patients with a history of nevus of Ota, a rare dermal melanosis believed to represent a failure of melanocyte migration to the epidermis during embryogenesis. Case 1 involves a 40-year-old woman with a 1.8-cm, deeply pigmented, trigeminal nerve mass and pigmentation of the maxillary sinus mucosa and bone. Case 2 involves a 53-year-old woman with a 1.5-cm mass adjacent to the clavicle. Microscopically, both masses consist of partially encapsulated epithelioid and spindle cells with abundant melanin pigment, arising in association with peripheral nerves. Morphological, immunohistochemical, and ultrastructural features support a diagnosis of melanotic schwannoma. No psammoma bodies are noted, and neither patient exhibits any additional features of Carney complex. Melanotic schwannoma is most often benign but has been associated with malignant behavior in some cases. Distinguishing this nerve sheath tumor from malignant melanoma can be difficult but is of great clinical importance due to differences in prognosis and treatment.

  13. Treatment of Combined Injuries of the Axillary and Suprascapular Nerves with Scapulothoracic Dissociation.

    Science.gov (United States)

    Sano, Kazufumi; Ozeki, Satoru

    2015-12-01

    A 20-year-old man suffered the combined axillary and suprascapular nerve palsies associated with scapulothoracic dissociation by motorcycle accident. The dislocated shoulder girdle was reduced and stabilized with osteosynthesis of the fractured clavicle and reattachment of the trapezius avulsed from the scapular spine for removal of continuous traction force to these damaged nerves. Because of no evidence of recovery on manual muscle test and electromyogram, exploration for these nerves was administered 6 weeks after injury. Although neurolysis of both nerves revealed neural continuity, excessive tension still existed on the suprascapular nerve. It was thought that previous operation in which the shoulder girdle had been reduced and stabilized as much as possible could not achieve complete anatomical reduction of the scapula. As an additional treatment, medial walls of the suprascapular and spinoglenoid notches were shaven to relax the suprascapular nerve. After a year, complete recovery of both the axillary and suprascapular nerve was identified. Although scapulothoracic dissociation is commonly recognized as massive injury of the shoulder girdle with poor prognosis because of existence of accompanied severe neurovascular injuries, there are more than a few cases in which partial damage on the infraclavicular brachial plexus is only accompanied. In case of them, there is the possibility of lesions in continuity of the nerves in which good prognosis might be expected with surgical intervention including early reduction of the shoulder girdle for removal of excessive tension to the damaged nerve.

  14. Periostitis secondary to interleukin-11 (Oprelvekin, Neumega). Treatment for thrombocytopenia in pediatric patients

    Energy Technology Data Exchange (ETDEWEB)

    Milman, Edward; Berdon, Walter E.; Ruzal-Shapiro, Carrie [Department of Radiology, Division of Pediatric Radiology, Children' s Hospital of New York-Presbyterian, CHN 3-325; New York, NY 10032 (United States); Garvin, James H.; Cairo, Mitchell S.; Bessmertny, Olga [Division of Pediatric Oncology, Children' s Hospital of New York-Presbyterian, 3959 Broadway, CHN 3-325

    2003-07-01

    Interleukin-11 (Oprelvekin, Neumega) is a newly introduced thrombopoietic growth factor that stimulates production, differentiation, and maturation of megakaryocytes and platelets. Reversible periostitis has been reported as the side effect of the drug in primates and in the phase I/II trials. We report our experience with 5 cases of periostitis, occurring in thrombocytopenic children with three non-malignant and two malignant conditions, out of 24 pediatric patients treated with IL-11 at 75 {mu}g/kg per day for a median of 17 days. The findings were noted in the clavicle or the proximal humerus. Two patients also had forearm and lower-extremity long-bone involvement. All patients had normal bones before IL-11 was given, changes occurred in both non-malignant and malignant diseases, and periostitis disappeared after use of the drug was discontinued. The distribution and appearance of the changes are similar to prostaglandin E1 and hypervitaminosis A. The changes are reversible after termination of treatment and are most noted in younger patients. The exact mechanism is not clear. The detection of periostitis makes it essential for the radiologists to enquire as to what medications patients are receiving. The pediatric doses (75 g/kg/d) are above those recommended for adult patients (50 g/kg/d) and this may account for the pediatric bone changes of periostitis. (orig.)

  15. Periostitis secondary to interleukin-11 (Oprelvekin, Neumega). Treatment for thrombocytopenia in pediatric patients.

    Science.gov (United States)

    Milman, Edward; Berdon, Walter E; Garvin, James H; Cairo, Mitchell S; Bessmertny, Olga; Ruzal-Shapiro, Carrie

    2003-07-01

    Interleukin-11 (Oprelvekin, Neumega) is a newly introduced thrombopoietic growth factor that stimulates production, differentiation, and maturation of megakaryocytes and platelets. Reversible periostitis has been reported as the side effect of the drug in primates and in the phase I/II trials. We report our experience with 5 cases of periostitis, occurring in thrombocytopenic children with three non-malignant and two malignant conditions, out of 24 pediatric patients treated with IL-11 at 75 micro g/kg per day for a median of 17 days. The findings were noted in the clavicle or the proximal humerus. Two patients also had forearm and lower-extremity long-bone involvement. All patients had normal bones before IL-11 was given, changes occurred in both non-malignant and malignant diseases, and periostitis disappeared after use of the drug was discontinued. The distribution and appearance of the changes are similar to prostaglandin E1 and hypervitaminosis A. The changes are reversible after termination of treatment and are most noted in younger patients. The exact mechanism is not clear. The detection of periostitis makes it essential for the radiologists to inquire as to what medications patients are receiving. The pediatric doses (75 g/kg/d) are above those recommended for adult patients (50 g/kg/d) and this may account for the pediatric bone changes of periostitis.

  16. May 2015 pulmonary case of the month: pneumonia with a rash

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2015-05-01

    Full Text Available No abstract available. Article truncated at 150 words. History of Present Illness: A 77-year-old man underwent a thoracic CT scan for follow up of a known thoracic aneurysm. However, he had been feeling tired for about a week with a cough, night sweats and fever. He had no shortness of breath, wheezing or known history of lung disease. Past Medical History, Social History and Family History: He has a history of hypertension and a known thoracic aortic aneurysm. There was a surgical repair of his right clavicle after a motor vehicle accident. He is single and has lived in Arizona for over 50 years. He just returned from a trip to California where he visited Disneyland. He does not smoke. Family history is noncontributory. Current Medications: dutasteride, levothyroxine, atorvastatin. Physical Examination: His physical examination was reported as unremarkable. SpO2 was 95% on room air. Which of the following is appropriate at this time? 1. Begin empiric antibiotics; 2. ...

  17. The significance of early rehabilitation of a severely polytraumatized child: Case report

    Directory of Open Access Journals (Sweden)

    Kovač Milena

    2002-01-01

    Full Text Available Case presentation This is a case presentation of an eight-year-old boy, a traffic accident victim with severe polytrauma. The boy was admitted to hospital with lacerations and contusion injuries of the left basal frontal and left temporal brain region, moderate brain tissue edema and fracture of the left clavicle which were diagnosed by CT (computer tomography. The boy was in coma (Glasgow Coma Scale - 5. Oral feeding and catheter removal were established after one month. Three months later his state of consciousness improved, he could carry out simple orders, started vocalization and visited ambulance by wheel chair. Speech and independent walking were achieved 4 months after the accident. Physical therapy Physical therapy included: neural-stimulation by Vojta and sclerodermal massage from seventh day. Later on, speech and work therapy were applied. Drug therapy Drug therapy included: muscle relaxants and tranquilizers while orthopedic treatment meant plastic immobilization. Control CT revealed chronic subdural hemathoma in the right frontal-parietal region. The boy could walk, talk, have normal diet, and controlled sphincters four months after severe trauma. Now, he is functional and on the level of moderate mental retardation. Early rehabilitation was extremely important in his recovery.

  18. Paediatrician office follow-up of common minor fractures

    Science.gov (United States)

    Koelink, Eric; Boutis, Kathy

    2014-01-01

    BACKGROUND: Evidence suggests that minor paediatric fractures can be followed by primary care paediatricians (PCPs). OBJECTIVES: To determine PCP opinions, knowledge and perceived barriers to managing minor paediatric fractures in the office. METHODS: An online survey was sent between June and September 2013 to all paediatricians who subscribed to the American Academy of Pediatrics PROS-Net Listerv and to those who were registered with the Scott’s Canadian Medical Directory as paediatricians who treated children in a primary care capacity. The primary outcome was the proportion of PCPs who agreed with PCP follow-up of minor paediatric fractures. Secondary outcomes included PCP’s perceived barriers to office follow-up. RESULTS: A total of 1752 surveys were sent; 1235 were eligible and 459 (37.2%) responded to the survey. Overall, 296 (69.5% [95% CI 65.2% to 74.0%]) PCPs agreed that minor paediatric fractures could be followed in a PCP office. The most frequently reported barriers were lack of materials to replace immobilization (58.1%), PCP knowledge deficits (44.8%) and a perceived parental preference for an orthopedic surgeon (38.6%). Finally, 58.8% of respondents believed that further education was necessary if PCPs assumed responsibility for follow-up of midshaft clavicle fractures, while 66.5% and 77.1% (Pmanagement strategy, including a desire for more education on this topic. PMID:25382996

  19. Multiple, supernumerary retained teeth in the course of cleido-cranial dysplasia. A case report.

    Science.gov (United States)

    Lewandowski, Bogumił; Martula-Gala, Katarzyna; Brodowski, Robert; Zych, Barbara

    2015-01-01

    Cleido-cranial dysplasia, often referred to as Scheuthauer-Marie-Sainton syndrome, is an autosomal dominant disorder of the musculo-skeletal system. Patients with cleido-cranial dysplasia are characterized by short stature, frequent varus or valgus hip, kyphoscoliosis, underdevelopment of the scapulas and the sternum, incorrect number of ribs. The most characteristic feature is unilateral or bilateral, partial or total underdevelopment of clavicles. Mental development is not affected in this syndrome. Malocclusion, occlusal irregularities, multiple supernumerary teeth, impacted teeth, and persistent milk teeth are found in the stomatognathic system. Teeth often have abnormal anatomy. Gothic palate, cleft hard and soft palate are diagnosed. The aim of this paper is to present a case of a 12-year-old boy diagnosed with irregularities in the masticatory system involving an additional number of retained teeth. The boy was referred by an orthodontist for surgical and orthodontic team therapy. The case presented confirms the observations of other authors that only the multi-specialty collaboration of a pediatrician, a geneticist, an orthopedist, an orthodontist, a maxillofacial surgeon, an implant prosthetic surgeon and a physiotherapist can provide proper diagnosis and treatment.

  20. [A case report of metal penetrating trauma in maxillo-facial, neck and chest].

    Science.gov (United States)

    Sheng, Guomin; Mo, Zhiyang; Gao, Dongwang

    2015-03-01

    A 21 years old male patient was admitted with a complex trauma of metal penetrating wound in maxillo facial region,neck and chest because of a high falling accident one hour ago. General examination:the vital signs were stable. Specialized examination: metal foreign body penetrated from the front wall of the axilla ,passing left clavicle superficies, through the middle of neck into the posterior pharyngeal wall, then piercing out from the superciliary arch lateral. The patient had apparent tenderness in the right arch,right zygomatic bone and the front of right maxilla. the degree of mouth was about 1. 8cm. X-ray showed the foreign body: from left armpit to right temporal part. The admission diagnosis was : 1. metal penetrating wound in maxillo-facial,neck and chest; 2. right zygomatic maxillary and zygomatic arch fractures. Treatment: the foreign body was removed smoothly through the concurrent operation, and by scendary operation of open reduction and internal fixation of fractures, the finally result of patient was good.

  1. The importance of post-mortem computed tomography (PMCT) in confrontation with conventional forensic autopsy of victims of motorcycle accidents.

    Science.gov (United States)

    Moskała, Artur; Woźniak, Krzysztof; Kluza, Piotr; Romaszko, Karol; Lopatin, Oleksij

    2016-01-01

    Since traffic accidents are an important problem in forensic medicine, there is a constant search for new solutions to help with an investigation process in such cases. In recent years there was a rapid development of post-mortem imaging techniques, especially post-mortem computed tomography (PMCT). In our work we concentrated on a potential advantage of PMCT in cases of motorcycle accident fatalities. The results of forensic autopsy were compared with combined results of the autopsy and PMCT to check in which areas use of these two techniques gives statistically important increase in number of findings. The hypothesis was confirmed in case of pneumothorax and fractures of skull, spine, clavicle, scapula, lower leg bones. As for majority of other bone fractures locations and brain injures there were single cases with pathologies visible only in PMCT, but too few to reach expected level of p-value. In case of injuries of solid organs and soft tissues statistical analysis did not confirmed any advantage of unenhanced PMCT use. On the whole it has been shown that PMCT used as an adjunct to forensic autopsy can cause an increase in information about vitally important regions in case of motorcycle accident fatalities.

  2. Oro-facial considerations in a case of cleidocranial dysplasia–A review of the medical and dental management protocols

    Directory of Open Access Journals (Sweden)

    Uday Kumar UMESAN

    2012-11-01

    Full Text Available Cleidocranial dysplasia (CCD is a rare, hereditary, congenital disorder inherited in an autosomal dominant pattern and is characterised by cranio-facial, skeletal and oro-dental malformations. The typical patient is short, presents a brachiocephalic skull with bossing of the frontal and parietal bones. Cephalic sutures and fontanelles exhibit delayed closure. The mid-face is hypoplastic, giving a misleading appearance of mandibular prognathism. The development of the clavicles is often defective and may range from a small medial gap to total agenesis. Medical issues include delayed attainment of developmental milestones, scoliosis, skeletal, pelvic and thoracic abnormalities. However, oro-dental malformations are important and can be significant. A 17-year-old Malay girl presented to the National Dental centre with complaints of unsightly front teeth. General and radiographic examination revealed features consistent with CCD. Dental clinical findings corroborated radiographically utilising conventional radiography and Cone Beam Computed Tomography uncovered an intact, retained deciduous dentition with multiple unerupted permanent and supernumerary teeth. A diagnosis of CCD was made based on the typical clinical and radiographic features and various management options explored. This condition is of clinical significance to the medical profession and more so for the orthodontist due to involvement of the facial bones, altered teeth eruption patterns and presence of supernumerary teeth. These problems represent a challenge to the clinician who must often seek a multi-disciplinary approach for successful management of this anomaly. Various treatment protocols and their shortcomings with respect to the case are discussed.

  3. A Japanese patient with a mild Lenz-Majewski syndrome.

    Science.gov (United States)

    Dateki, Sumito; Kondoh, Tatsuro; Nishimura, Gen; Motomura, Katsuaki; Yoshiura, Koh-Ichiro; Kinoshita, Akira; Kuniba, Hideo; Koga, Yoshiyuki; Moriuchi, Hiroyuki

    2007-01-01

    We report on a sclerosing bone dysplasia, associated with cutis laxa, enamel dysplasia, and mental retardation. The patient was a 17-year-old Japanese boy of normal height and muscular build. Cutis laxa with prominent veins in the scalp and abdominal wall and delayed eruption of permanent teeth attracted the attention of clinicians in infancy and adolescence, respectively. The clinical manifestations included a progeroid facial appearance with prognathism, wrinkled skin, and interdigital webbing. The intelligence quotient was estimated at 60. Enamel dysplasia was histologically confirmed. Skeletal changes included calvarial hyperostosis, sclerosis of the skull base, an enlarged, sclerotic mandible, broad clavicles and ribs, and diaphyseal undermodeling of the tubular bones. Metaepiphyseal sclerosis or longitudinal striation was found in the long bones. Metaphyseal equivalents of the axial skeleton showed dense osteosclerosis. These clinical and radiological manifestations overlapped with those of Lenz-Majewski syndrome. Unlike the classical phenotype of the disorder, however, he did not show brachymesophalangy with proximal symphalangism or growth failure. The present case may be considered to fall in the mildest end in the phenotypic continuum of Lenz-Majewski syndrome, suggesting that the clinical spectrum of the disorder may be broader than currently thought.

  4. Chronic recurrent multifocal osteomyelitis: typical patterns of bone involvement in whole-body bone scintigraphy.

    Science.gov (United States)

    Acikgoz, Gunsel; Averill, Lauren W

    2014-08-01

    Chronic recurrent multifocal osteomyelitis (CRMO) is an autoinflammatory bone disease of unknown etiology. It affects children and adolescents predominantly and occurs mostly in the female population. It is characterized by the insidious onset of pain and swelling, with a fluctuating clinical course of relapses and remissions. Typically, several bones are affected, either synchronously or metachronously, and bilateral involvement is common. CRMO most commonly affects the metaphysis of long bones, especially the tibia, femur, and clavicle. The spine, pelvis, ribs, sternum, and mandible may also be affected. Although lesions are mostly multiple, patients may present with a single symptomatic focus. Radiographic findings may be negative early in the course of the disease. Bone scintigraphy is useful in determining the presence of abnormality and the extent of disease. The imaging and clinical features of CRMO overlap with those of infectious osteomyelitis, bone malignancy, and inflammatory arthritis. Nonetheless, CRMO can be confidently diagnosed with the recognition of typical imaging patterns in the appropriate clinical setting. This article reviews imaging findings with special emphasis on bone scintigraphy and specific disease sites.

  5. Mandibuloacral dysplasia type A in childhood.

    Science.gov (United States)

    Garavelli, L; D'Apice, M R; Rivieri, F; Bertoli, M; Wischmeijer, A; Gelmini, C; De Nigris, V; Albertini, E; Rosato, S; Virdis, R; Bacchini, E; Dal Zotto, R; Banchini, G; Iughetti, L; Bernasconi, S; Superti-Furga, A; Novelli, G

    2009-10-01

    Mandibuloacral dysplasia type A (MADA) is characterized by growth retardation, postnatal onset of craniofacial anomalies with mandibular hypoplasia, progressive acral osteolysis, and skin changes including mottled pigmentation, skin atrophy, and lipodystrophy. Owing to its slowly progressive course, the syndrome has been recognized in adults, and pediatric case reports are scarce. We present the clinical case of two children in whom the diagnosis of MADA was made at an unusually early age. A 5-year-old boy presented with ocular proptosis, thin nose, and short and bulbous distal phalanges of fingers. A 4-year-old girl presented with round face and chubby cheeks, thin nose, bulbous fingertips, and type A lipodystrophy. In both, a skeletal survey showed wormian bones, thin clavicles, short distal phalanges of fingers and toes with acro-osteolysis. Both children were found to be homozygous for the recurrent missense mutation, c.1580G>A, (p.R527H) in exon 9 of the LMNA gene. Thus, the phenotype of MADA can be manifest in preschool age; diagnosis may be suggested by short and bulbous fingertips, facial features, and lipodystrophy, supported by the finding of acral osteolysis, and confirmed by mutation analysis.

  6. Deformations in the Shoulder Tissues During Load Carriage: A Computational Model.

    Science.gov (United States)

    Hadid, Amir; Belzer, Noa; Shabshin, Nogah; Epstein, Yoram; Gefen, Amit

    2015-11-01

    Shoulder soft tissue deformations seem to be one of the limiting factors of load carriage among soldiers and recreational backpackers that are required to carry heavy loads. Yet, there are no loading limits related to the forces borne by the shoulders, and the backpacks designs are not consistent with providing pressure relief from this sensitive anatomical region. The aim of this study was to develop a model that will enable to study the biomechanical loads that develop in the shoulder under heavy loads and to help in optimizing load carriage systems design. A 3-dimensional, anatomically accurate finite element model of a human shoulder was constructed based on MRI scans. The model was developed to calculate the effective stresses on the skin below the shoulder strap (superficial loads) and the effective strain in the brachial plexus region (inner tissue deformation) for loads of up to 35 kg. The model successfully predicted deformations in the soft tissue surrounding the brachial plexus when compared with deformations measured from load-bearing MRI scans. The model yielded a skin pressure mapping, which showed pressure hotspots in the clavicle region. Inner tissue deformations mapping, as assessed by brachial plexus envelop strains, were found to peak at 30% effective strain at the lateral aspect below the pectoralis muscle. The newly developed model successfully predicted soft tissue deformations in the shoulder related to backpacks. This model can be used to optimize load carriage systems for better distribution of pressure over the shoulders and lower inner tissue deformations.

  7. Bone dosimetry using synthetic images to represent trabecular bones of five regions of the human body

    Energy Technology Data Exchange (ETDEWEB)

    Lima Filho, Jose de M. [Instituto Federal de Educacao, Ciencia e Tecnologia de Pernambuco (IFPE), Recife, PE (Brazil); Vieira, Jose W. [Escola Politecnica de Pernambuco (POLI). Universidade de Pernambuco (UPE), Recife, PE (Brazil); Lima, Vanildo J. de M., E-mail: vjr@ufpe.br [Departamento de Anatomia. Universidade Federal de Pernambuco (UFPE), Recife, PE (Brazil); Lima, Lindeval F., E-mail: lindeval@dmat.ufrr.br [Departamento de Matematica (DMAT). Universidade Federal de Roraima (UFRR), Boa Vista, RR (Brazil); Lima, Fernando R.A., E-mail: falima@cnen.gov.br [Centro Regional de Ciencias Nucleares (CRCN/NE-CNEN-PE), Recife, PE (Brazil); Vasconcelos, Wagner E. de [Departamento de Energia Nuclear (DEN). Universidade Federal de Pernambuco (UFPE), Recife, PE (Brazil)

    2011-07-01

    One of the greatest challenges in numerical dosimetry of ionizing radiation is to estimate the absorbed dose by bone tissue in the human body. The bone tissues of greater radiosensitivity are the red bone marrow (RBM), that consist of the hematopoietic cells, located within the trabecular bones, and the bone surface cells (BSC), called osteogenic cells. The report 70 of the ICRP lists five spongiosa regions with their respective volume percent of trabecular bone: ribs (also contemplating the clavicles and sternum), spine, long bones, pelvis and skull (also contemplating mandible). The Grupo de Pesquisa em Dosimetria Numerica (GDN/CNPq) has been built exposure computational models (ECMs) based on voxel phantoms and EGSnrc Monte Carlo code. To estimate the energy deposited in the RBM and in the BSC of a phantom, the GDN/CNPq has used a method based on micro-CT images of the five trabecular regions mentioned above. These images were provided by other research institutes and were obtained from scan of bone samples of adult. Here is the greatest difficulty in reproducing this method: besides the need for bone images of real people with micrometer resolution, the distribution of bone marrow in the human body, according to ICRP 70, varies with age. This article presents some proposals of the GDN/CNPQ for replacing in the ECMs the micro-CT images by images synthesized by the computer, based on Monte Carlo sampling. (author)

  8. Anatomical feasibility of vagus nerve esophageal branch transfer to the phrenic nerve

    Institute of Scientific and Technical Information of China (English)

    Ce Wang; Jun Liu; Wen Yuan; Xuhui Zhou; Xinwei Wang; Peng Xu; Jian Chen; Guoxin Wu; Sheng Shi

    2012-01-01

    This study measured the vagus and phrenic nerves from 12 adult cadavers. We found that the width and thickness of the vagus and phrenic nerves were different in the chest. The distance from the point of the vagus nerve and phrenic nerve on the plane of the inferior border of portal pulmonary arteries (T point) was approximately 7 cm to the diaphragm and was approximately 10 cm to the clavicle level. The number of motor fibers in the vagus nerves was 1 716 ± 362, and the number of nerve fibers was 4 473 ± 653. The number of motor fibers in the phrenic nerves ranged from 3 078 ± 684 to 4 794 ± 638, and the number of nerve fibers ranged from 3 437 ± 642 to 5 071 ± 723. No significant difference was found in the total number of nerve fibers. The results suggest that width, thickness, and total number of nerve fibers are similar between the vagus and phrenic nerves, but the number of motor fibers is different between them.

  9. Imaging of chronic recurrent multifocal osteomyelitis.

    Science.gov (United States)

    Khanna, Geetika; Sato, Takashi S P; Ferguson, Polly

    2009-01-01

    Chronic recurrent multifocal osteomyelitis (CRMO) is an autoinflammatory disorder of children and young adults that is characterized by nonbacterial osteomyelitis. Patients typically present with multifocal bone pain secondary to sterile osseous inflammation, and the disease has a relapsing and remitting course. The cause of CRMO remains unclear, although the results of several studies have suggested a genetic component. The typical imaging findings of CRMO include lytic and sclerotic lesions in the metaphyses of long bones and the medial clavicles. Other common sites of disease are the vertebral bodies, pelvis, ribs, and mandible. CRMO is often bilateral and multifocal at presentation. Owing to the lack of a diagnostic test, CRMO remains a diagnosis of exclusion. Although generally a self-limiting disease, CRMO can have a prolonged course and result in significant morbidity. Radiologists can be the first to suggest this diagnosis given its characteristic radiographic appearance and distribution of disease. Radiologists should be familiar with the typical imaging findings of CRMO to prevent unnecessary multiple biopsies and long-term antibiotic treatment in children with CRMO.

  10. Interpretation of distant focal accumulations revealed by bone scintigraphy using Tc-99m HMDP in patients with oral malignant tumors

    Energy Technology Data Exchange (ETDEWEB)

    Sato, Tsuyoshi; Morita, Yasuhiko; Iwashita, Youichirou; Kawabata, Yoshihiro; Noikura, Takenori [Kagoshima Univ. (Japan). Dental School

    2000-06-01

    Focal accumulations in the skeleton were analyzed in order evaluate the usefulness of bone scintigraphy in the detection of distant skeletal metastases originating from malignant oral tumors. Of 350 patients who underwent bone scintigraphy, 62 patients who showed distant focal accumulations in the skeleton were selected. Observations were performed on 12 skeletal regions: the skull, facial bone, clavicle, rib, scapula, sternum, cervical spine, thoracic spine, lumbar spine, pelvis, upper, and lower extremities. Distant focal accumulations were classified into 3 degrees: very hot, moderately hot and warm. A diagnosis of metastatic focal accumulation was made with reference to the CT, MR, X-ray and Ga-67 images, clinical features, and laboratory data. Four of the 350 cases showed skeletal metastases (1.1%). Sixty-two of the 350 patients showed 106 distant focal accumulations, with 10 accumulations proving to be skeletal metastases. The common sites of the skeletal metastases were the lumbar spine, rib, cervical spine, and sternum. Patients with skeletal metastases had a tendency to show distant focal accumulations of very hot images in some skeletal sites, and these focal accumulations were usually accompanied by severe pain. The most common cause of distant focal accumulations except metastasis was traumatic injury. The results in the present study indicate that the distant focal accumulations accompanied by severe pain and simultaneously observed in more than one skeletal site can be interpreted as skeletal metastases. (author)

  11. The type specimen (LB1) of Homo floresiensis did not have Laron syndrome.

    Science.gov (United States)

    Falk, Dean; Hildebolt, Charles; Smith, Kirk; Jungers, William; Larson, Susan; Morwood, Michael; Sutikna, Thomas; Jatmiko; Saptomo, E Wahyu; Prior, Fred

    2009-09-01

    The type specimen (LB1) of Homo floresiensis has been hypothesized to be a pathological human afflicted with Laron Syndrome (LS), a type of primary growth hormone insensitivity (Hershkovitz et al.: Am J Phys Anthropol 134 [2007] 198-208). Comparing measurements, photographs and three-dimensional, computed-tomography reconstructions of LB1 with data and diagnoses from the literature on LS, we critically evaluate numerous skull and postcranial traits that Hershkovitz et al. identified as being shared by LB1 and patients with LS. The statements regarding most of these traits are new to the clinical literature and lack quantitative support. LB1 and patients with LS differ markedly in the size and shape of the cranium; thickness and pneumatization of cranial bones; morphology of the face, mandible, teeth, and chin; form of the shoulder, wrist, and pelvis; and general body proportions including relative foot size. Claims that patients with LS are similar to LB1 in displaying protracted scapulae, short clavicles, low degrees of humeral torsion, flaring ilia, and curved tibiae are not supported by data or corroborating images. Some points of similarity (e.g., femoral neck-shaft angle, femoral bicondylar angle, and estimated stature) can be found in other hominins, and cannot be considered diagnostic. From our review and analysis, we conclude that LB1 did not suffer from LS.

  12. Complex dental anomalies in a belatedly diagnosed cleidocranial dysplasia patient

    Energy Technology Data Exchange (ETDEWEB)

    Lu, Hui; Zeng, Bing Hui; Yu, Dong Sheng; Jing, Xiang Yi; Hu, Bin; Zhao, Wei; Wang, Yi Ming [Sun Yat-Sen University, Guangzhou (China)

    2015-09-15

    Cleidocranial dysplasia (CCD) is a rare congenital disorder, typically characterized by persistently open skull sutures, aplastic or hypoplastic clavicles, and supernumerary teeth. Mutations in the gene encoding the runt-related transcription factor 2 (RUNX2) protein are responsible for approximately two thirds of CCD patients. We report a 20-year-old CCD patient presenting not only with typical skeletal changes, but also complex dental anomalies. A previously undiagnosed odontoma, 14 supernumerary teeth, a cystic lesion, and previously unreported fused primary teeth were discovered on cone-beam computed tomography (CBCT) scans. Mutation analysis identified the causal c.578G>A (p.R193Q) mutation in the RUNX2 gene. At 20 years of age, the patient had already missed the optimal period for dental intervention. This report describes the complex dental anomalies in a belatedly diagnosed CCD patient, and emphasizes the significance of CBCT assessment for the detection of dental anomalies and the importance of early treatment to achieve good outcomes.

  13. Anatomy and early development of the pectoral girdle, fin, and fin spine of sturgeons (Actinopterygii: Acipenseridae).

    Science.gov (United States)

    Dillman, Casey B; Hilton, Eric J

    2015-03-01

    Acipenseriformes hold an important place in the evolutionary history of bony fishes. Given their phylogenetic position as extant basal Actinopterygii, it is generally held that a thorough understanding of their morphology will greatly contribute to the knowledge of the evolutionary history and the origin of diversity for the major osteichthyan clades. To this end, we examined comparative developmental series from the pectoral girdle in Acipenser fulvescens, A. medirostris, A. transmontanus, and Scaphirhynchus albus to document, describe, and compare ontogenetic and allometric differences in the pectoral girdle. We find, not surprisingly, broad congruence between taxa in the basic pattern of development of the dermal and chondral elements of the pectoral girdle. However, we also find clear differences in the details of structure and development among the species examined in the dermal elements, including the clavicle, cleithrum, supracleithrum, posttemporal, and pectoral-fin spine. We also find differences in the internal fin elements such as the distal radials as well as in the number of fin rays and their association with the propterygium. Further, there are clear ontogenetic differences during development of the dermal and chondral elements in these species and allometric variation in the pectoral-fin spine. The characters highlighted provide a suite of elements for further examination in studies of the phylogeny of sturgeons. Determining the distribution of these characters in other sturgeons may aid in further resolution of phylogenetic relationships, and these data highlight the role that ontogenetic and comparative developmental studies provide in systematics.

  14. December 2015 pulmonary case of the month

    Directory of Open Access Journals (Sweden)

    Berg ZM

    2015-12-01

    Full Text Available No abstract available. Article truncated at 150 words. History of Present Illness: The patient is a 70-year-old man with a history of a chronic dry cough for 5 years, who presented to the emergency department with worsening cough and shortness of breath. Two weeks prior to symptom onset, was on trip in the United Kingdom, he developed gastroenteritis which spontaneously resolved. Past Medical History, Social History, and Family History: Old healed TB scar with positive PPD at 17 years of age prior to joining Air Force. No treatment given and patient was asymptomatic from a pulmonary point of view since then; Squamous cell carcinoma of the skin on the scalp, status post excision complicated by osteomyelitis, status post surgical graft from hip with prolonged course of IV antibiotics in 2010; Fractured left clavicle, status post repair 20 years ago; Hay fever; Hyperlipidemia; Squamous cell carcinoma removed from left arm; Varicose veins, lower extremity; Married. Retired police officer. Does ...

  15. Transmediastinal and Transcardiac Gunshot Wound with Hemodynamic Stability

    Directory of Open Access Journals (Sweden)

    Leire Zarain Obrador

    2014-01-01

    Full Text Available Cardiac injuries caused by knives and firearms are slightly increasing in our environment. We report the case of a 43-year-old male patient with a transmediastinal gunshot wound (TGSW and a through-and-through cardiac wound who was hemodynamically stable upon his admission. He had an entrance wound below the left clavicle, with no exit wound, and decreased breath sounds in the right hemithorax. Chest X-ray showed the bullet in the right hemithorax and large right hemothorax. The ultrasound revealed pericardial effusion, and a chest tube produced 1500 cc. of blood, but he remained hemodynamically stable. Considering these findings, a median sternotomy was carried out, the through-and-through cardiac wounds were suture-repaired, lung laceration was sutured, and a pacemaker was placed in the right ventricle. The patient had uneventful recovery and was discharged home on the twelfth postoperative day. The management and prognosis of these patients are determined by the hemodynamic situation upon arrival to the Emergency Department (ED, as well as a prompt surgical repair if needed. Patients with a TGSW have been divided into three groups according to the SBP: group I, with SBP >100 mmHg; group II, with SBP 60–100 mmHg; and group III, with SBP <60 mmHg. The diagnostic workup and management should be tailored accordingly, and several series have confirmed high chances of success with conservative management when these patients are hemodynamically stable.

  16. The Emergence of Homo sapiens in South Asia: The Central Narmada Valley as Witness

    Directory of Open Access Journals (Sweden)

    Anek R. Sankhyan

    2013-04-01

    Full Text Available :The emergence of anatomically modern Homo sapiens in South Asia is hotly debated due to a great gap in fossil record. A solitary partial cranium from Hathnora dated around 250 Kya is debated and conveniently interpreted as "evolved" Homo erectus or "archaic" Homo sapiens or Homo heidelbergensis or even Homo indet. Cranial fossils of Pre-Toba or post- Toba anatomically modern Homo sapiens are unknown barring the very late 30 Kya modern human remains from Sri Lanka. The present paper reviews the scenario of human evolution in South Asia with special reference to the cranial and recent postcranial fossil findings by the author in association with the archaeological evidences from Central Narmada valley. It is concluded that the Narmada fossils and archaeological findings support the presence of three hominins- two 'archaic' and one 'early modern'. The Mode 2 Acheulian hominin represented by the calvarium and the femur was a 'large-bodied' species akin to Homo heidelbergensis. It appeared first in the Central Narmada valley and was followed by a 'small-bodied' Mode 3 archaic type represented by two clavicles and the 9th rib, provisionally named here as Homo narmadensis. It likely continued and attained anatomical and behavioural modernity in South Asia as attested by the humerus and bone artifacts, and diversified to various short-bodied indigenous populations of South Asia supported by the genomic evidences.

  17. Endobutton technique for the treatment of acute acromioclavicular joint dislocations

    Directory of Open Access Journals (Sweden)

    Raif Özden

    2014-06-01

    Full Text Available Objective: Acromioclavicular (AC joint dislocation is a common injury frequently affecting young athletes. The aim of this study is to evaluate postoperative functional results in cases diagnosed with acute AC joint dislocation stabilized with endobutton system. Methods: This fixation procedure has been applied on 10 patients. Indications of the technique included: a grade V AC joint dislocation (7 patients, and grade III AC joint dislocation (3 patient according to Rockwood classification. The coracoclavicular (CC interval and AC joint were reduced using two endobuttons. One endobutton was fitted on the clavicle and the second was placed at the undersurface of the coracoid. Outcomes were assessed with the Constant shoulder score and visual analog pain scale. Results: All the patients had powerful intraoperative fixation. Immediately after surgery, and 6 weeks, and 1 year postoperative radiographs showed adequate reduction of the CC distance and the AC joint. The mean Constant shoulder score was 89 (88–92 in the injured shoulder and 90 (88–93 in the uninjured shoulder. There was no statically significant difference between the injured and normal shoulder in terms of Constant shoulder score and there was no complication during the process. Conclusion: This technique is a safe and effective method for providing fixation for the AC joint.

  18. 成人锁骨中段骨折手术治疗与非手术治疗的Meta分析%Comparing the effect of operative and nonoperative treatment in adult mid-shaft clavicular fracture by Meta-analysis

    Institute of Scientific and Technical Information of China (English)

    王琳珏; 马宝通; 李恩琪

    2011-01-01

    目的 应用Meta分析系统总结评价手术治疗与非手术治疗在成人锁骨中段骨折中的疗效及相关优势.方法 通过检索1989至2009年间Cochrane Database、Pub med & Ovid Medline、OTA、AAOS、High Wire Press、Springer Link、中国生物医学文献数据库、中国知网和万方数据库,并且配合手工检索相关领域的杂志,纳入以成人锁骨中段骨折为研究对象,比较手术治疗与非手术治疗的随机对照实验及回顾性队列研究,评价纳入研究质量,并用Rvaman 4.2进行Meta分析.结果 经过筛选初检文献5053篇,共纳入8个研究(519例患者).共有5个研究选用骨折愈合率作为观察指标,结果P<0.00001;4个研究选用畸形愈合率作为观察指标,结果P<0.0001;5个研究选用神经刺激症状作为观察指标,结果P<0.0001;4个研究选用患者满意度作为观察指标,结果P<0.00001;4个研究选用残余痛作为观察指标,结果P=0.56;2个研究选用关节活动障碍作为观察指标,结果P=0.25;3个研究选用再骨折作为观察指标,研究不存在异质性,结果P>0.05.结论 系统评价的结果表明,手术治疗成人锁骨中段骨折较非手术治疗存在优势.%Objective To systematically summarize and compare results and related advantages of different methods in the management of adult mid-shaft clavicle fractures. Methods The data of adult midshaft clavicle fracture from 1989 to 2009 was retrieved. The database were included Cochrane Database,med & Ovid Medline, OTA, AAOS, High Wire Press, Springer Link, CBM, CNKI, WANFANG DATA and with hand-search journals in related fields. Internalizing randomized controlled trials and retrospective cohort studies which compared the operative and nonoperative treatment for adult mid-shaft clavicle fracture. Evaluating the quality of included studies and using the Rvaman 4.2 for Meta-Analysis. Results 5053 literatures had been reviewed. After screening, there were 8 studies brought into

  19. The contributions of anthropology and mitochondrial DNA analysis to the identification of the human skeletal remains of the Australian outlaw Edward 'Ned' Kelly.

    Science.gov (United States)

    Blau, S; Catelli, L; Garrone, F; Hartman, D; Romanini, C; Romero, M; Vullo, C

    2014-07-01

    This paper details the anthropological and genetic analyses that contributed to the identification of the notorious Australian outlaw ('bushranger') Edward ('Ned') Kelly. In 1880 at the age of 25, Kelly was hanged and buried at the former Melbourne Gaol in Victoria, Australia. In 1929, the remains of executed prisoners (including those of Kelly) were haphazardly disinterred following the demolition of parts of the Melbourne Gaol and haphazardly reinterred in three distinct "pits" at the Pentridge Prison. In 1999 the Pentridge Prison was sold for commercial development and subsequently in 2008 and 2009 the human remains of prisoners were recovered. A total of 41 cases of unidentified human skeletal remains from Pentridge were examined using traditional anthropological techniques. At least one representative sample from each of the remains (mostly clavicles) from all three pits was selected for DNA analysis. Comparative ante-mortem reference samples were also located. Given the antiquity and condition of remains recovered from Pentridge, and the 130 years that had passed since Kelly's execution, mitochondrial DNA analysis was chosen as a suitable DNA analysis tool to examine the Pentridge cases to assist in the inclusion or exclusion of remains as being those of Ned Kelly. Only one of the Pentridge cases (Pen14) matched the HV1/HV2 mitochondrial DNA haplotype of the reference sample. Additional anthropological analyses indicated a number of pathological features that provided support that the remains of Pen14 are those of Edward ("Ned") Kelly.

  20. Compare of Saber incision and Supraclavicular incision treatment of clavicular fracture efficacy%Saber切口与锁骨上切口治疗锁骨骨折的临床疗效

    Institute of Scientific and Technical Information of China (English)

    于新忠; 杨恩广; 宋爽; 杨建军; 贾立军

    2011-01-01

    目的 比较Saber切口与锁骨上切口治疗锁骨骨折的临床疗效.方法 选取138例锁骨骨折患者,分为锁骨上切口者56例,Saber切口者82例,观察两组患者术中及术后情况.结果 两组患者的切口长度,手术时间,出血量,并发症比较,差异均有统计学意义(P<0.05),Saber切口组优于锁骨上切口组.结论 锁骨骨折患者术中使用Saber切口优于使用锁骨上切口.%Objective To compare Compare of Saber incision and Supraclavicular incision treatment of clavicular fracture efficacy.Methods 136 patients with Clavicle fracture.divided into Supraclavicular incision group(56cases)and Saber incision group(82cases).observed the condition of two groups’patients during and after operation.Results Saber incision group was higher than the supraclavicular incision group.Conclusion clavicular fracture patiens during operation ues Supraclavicular incision better than ues Saber incision.

  1. Novel Mutation of Cleidocranial Dysplasia-related Frameshift Runt-related Transcription Factor 2 in a Sporadic Chinese Case

    Science.gov (United States)

    Qin, Xue-Yan; Jia, Pei-Zeng; Zhao, Hua-Xiang; Li, Wei-Ran; Chen, Feng; Lin, Jiu-Xiang

    2017-01-01

    Background: Cleidocranial dysplasia (CCD) is an autosomal dominant disease that affects the skeletal system. Common symptoms of CCD include hypoplasia or aplasia of the clavicles, delayed or even absent closure of the fontanels, midface hypoplasia, short stature, and delayed eruption of permanent and supernumerary teeth. Previous studies reported a connection between CCD and the haploinsufficiency of runt-related transcription factor 2 (RUNX2). Here, we report a sporadic Chinese case presenting typical symptoms of CCD. Methods: We made genetic testing on this sporadic Chinese case and identified a novel RUNX2 frameshift mutation: c.1111dupT. In situ immunofluorescence microscopy and osteocalcin promoter luciferase assay were performed to compare the functions of the RUNX2 mutation with those of wild-type RUNX2. Results: RUNX2 mutation was observed in the perinuclear region, cytoplasm, and nuclei. In contrast, wild-type RUNX2 was confined in the nuclei, which indicated that the subcellular compartmentalization of RUNX2 mutation was partially perturbed. The transactivation function on osteocalcin promoter of the RUNX2 mutation was obviously abrogated. Conclusions: We identified a sporadic CCD patient carrying a novel insertion/frameshift mutation of RUNX2. This finding expanded our understanding of CCD-related phenotypes. PMID:28091408

  2. Association between preterm birth and thoracic musculoskeletal static alterations in adolescents

    Directory of Open Access Journals (Sweden)

    Kessey M. B. Garcia

    2015-02-01

    Full Text Available OBJECTIVE: To compare thoracic musculoskeletal static alterations in adolescents born prematurely with those born at term and investigate neonatal and post-neonatal variables associated with thoracic alterations. METHOD: This is a cross-sectional study with 57 adolescents aged 10-15 years born prematurely and 57 adolescents born at term paired by gender and age. Photographs of the head and thorax in the front, back, and right side views were studied using a computer program. The two groups were compared in regards to: elevation of clavicles, elevation of shoulders, protrusion of the head, and anteroposterior and mediolateral thoracic length. Factor associated with thoracic disorders were evaluated by linear regression analysis. RESULTS: The Preterm group had mean gestational age of 32.0±2.8 weeks and the birth weight was 1462±338 and 3342±430 g for the Preterm and Term adolescents, respectively. Preterm adolescents had higher elevation of the left shoulder (22.7±5.4o vs. 20.6±5.3o;sim, p=0.038 and the right shoulder (22.2±4.4o vs. 18.5±5.7o; p5 days (p=0.009. CONCLUSION: Adolescents born prematurely presented greater thoracic musculoskeletal static alterations compared to those born at term. Factors associated with these alterations were: very low birth weight and longer duration of mechanical ventilation in the neonatal unit.

  3. Development of an injectable pseudo-bone thermo-gel for application in small bone fractures.

    Science.gov (United States)

    Kondiah, Pariksha J; Choonara, Yahya E; Kondiah, Pierre P D; Kumar, Pradeep; Marimuthu, Thashree; du Toit, Lisa C; Pillay, Viness

    2017-03-30

    A pseudo-bone thermo-gel was synthesized and evaluated for its physicochemical, mechanical and rheological properties, with its application to treat small bone fractures. The pseudo-bone thermo-gel was proven to have thermo-responsive properties, behaving as a solution in temperatures below 25°C, and forming a gelling technology when maintained at physiological conditions. Poly propylene fumerate (PPF), Pluronic F127 and PEG-PCL-PEG were strategically blended, obtaining a thermo-responsive delivery system, to mimic the mechanical properties of bone with sufficient matrix hardness and resilience. A Biopharmaceutics Classification System (BCS) class II drug, simvastatin, was loaded in the pseudo-bone thermo-gel, selected for its bone healing properties. In vitro release analysis was undertaken on a series of experimental formulations, with the ideal formulations obtaining its maximum controlled drug release profile up to 14days. Ex vivo studies were undertaken on an induced 4mm diameter butterfly-fractured osteoporotic human clavicle bone samples. X-ray, ultrasound as well as textural analysis, undertaken on the fractured bones before and after treatment displayed significant bone filling, matrix hardening and matrix resilience properties. These characteristics of the pseudo-bone thermo-gel thus proved significant potential for application in small bone fractures.

  4. Radiobiological analysis of the field in field technique in breast cancer radiotherapy treatments

    Energy Technology Data Exchange (ETDEWEB)

    Medel B, E.; Vasquez R, M. A. [IMSS, Centro Medico Nacional Manuel Avila Camacho, Calle 2 Nte. 2004, Barrio de San Francisco, 72090 Puebla, Pue. (Mexico); Tejeda M, G., E-mail: marcosalivasquez@gmail.com [Benemerita Universidad Autonoma de Puebla, Facultad de Ciencias Fisico Matematicas, Av. San Claudio y 18 Sur, Ciudad Universitaria, 72570 Puebla, Pue. (Mexico)

    2015-10-15

    Full text: In vivo dosimetry was performed in 6 unilateral breast cancer patients treated with external beam radiation therapy in order to evaluate the dose calculated by the radiotherapy treatment planning system (Xi O, ELEKTA). Results show a maximum difference of 0.473 Gy between the dose calculated by the treatment planning system and the dose measured in vivo using solid state detectors. Based on the DVHs statistics, tumor control probability (Tcp) was obtained using the Target-Poisson model, with the following Tcp parameters: α=0.288/Gy, α{sub s}pread= 0.13 and α/β=4.9 Gy. Tcp average obtained for the Clinical Tumor Volume (Ctv) is 35.1% and for Supra Clavicle Volume (Scv) is 35.345%. Finally using Lyman model Normal Tissue Complication Probability (Ntcp) was obtained for the following endpoints: contralateral breast fibrosis, lung radiation pneumonitis and heart pericarditis. Nonetheless the Ntcp values are not high; the improvement of the Tcp based on this plan makes Ntcp for lung radiation pneumonitis reach the 100% of probability in some cases. (Author)

  5. Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome - A challenging diagnosis not to be missed.

    Science.gov (United States)

    Zimmermann, Petra; Curtis, Nigel

    2016-07-05

    SAPHO syndrome manifests as chronic inflammation of bones and joints, which may or may not be accompanied by skin changes. The term SAPHO is an acronym that stands for synovitis, acne, pustulosis (usually palmoplantar), hyperostosis and osteitis. The bones most commonly affected are those in the anterior chest wall (mainly the sternum, clavicles and sternocostoclavicular joints), the vertebrae and the sacroiliac joints, but peripheral and flat bones may also be involved, especially in children. There are no validated diagnostic criteria for SAPHO, and diagnosis is based on clinical and radiological findings. One of the main challenges in diagnosis is that the clinical features may occur many years apart. Additionally, patients may not develop all manifestations. Delayed diagnosis, as a result of a lack of awareness of SAPHO, can lead to patients suffering ongoing pain and disfiguring skin manifestations. One theory is that Propionibacterium acnes (isolated from bone biopsies in many SAPHO patients) triggers an auto-immune mediated chronic inflammation in genetically predisposed individuals. Treatment involves the use of nonsteroidal anti-inflammatory drugs, intra-articular steroids, bisphosphonates and biologicals. The course of SAPHO is often prolonged but, despite the challenges in diagnosis and treatment, the long-term prognosis is good.

  6. Etanercept in the treatment of SAPHO syndrome: Which place?

    Science.gov (United States)

    Abourazzak, Fatima Ezzahra; Hachimi, Hicham; Kadi, Nadira; Berrada, Khadija; Tizniti, Siham; Harzy, Taoufik

    2014-09-01

    Synovitis, acne, pustulosis, hyperostosis, and osteitis syndrome (SAPHO) is a rare disease combining skin, bone, and joint manifestations. Its treatment remains a debated issue in the absence of a valid therapeutic strategy. The experience with tumor necrosis factor alpha (TNF alpha)-blocking agents is still small but encouraging. This therapy is reserved for refractory cases. The most commonly used agent is infliximab. Only few cases treated by etanercept have been reported in the literature. We report a new case treated by this biologic therapy and discuss its place in the treatment of SAPHO syndrome. A 30-year-old male, with a history of left clavicular osteitis that required surgical bone biopsy to rule out infection and malignancy, was admitted to the rheumatology department because of recurrent anterior chest pain, lower limb arthralgia, and sacroiliac pain. Laboratory findings revealed an inflammatory syndrome. Conventional radiography and computed tomography (CT) scan of the sternocostoclavicular region showed sclerosis and hyperostosis of the left clavicle. Right sacroiliitis was diagnosed based on the radiographic findings. Moreover, the patient reported palmoplantar pustulosis, thereby strengthening the diagnosis of SAPHO syndrome. As conventional treatment based on methotrexate, corticosteroids, and zoledronic acid was not effective, etanercept was initiated with good and rapid clinical and biological improvement. The diagnosis and treatment of SAPHO syndrome are challenging due to the heterogeneity of symptoms and unknown pathogenesis. Etanercept can be an effective therapy, especially in refractory cases. Further studies are needed in order to establish a therapeutic strategy.

  7. The anatomy and ontogeny of the head, neck, pectoral, and upper limb muscles of Lemur catta and Propithecus coquereli (primates): discussion on the parallelism between ontogeny and phylogeny and implications for evolutionary and developmental biology.

    Science.gov (United States)

    Diogo, Rui; Molnar, Julia L; Smith, Timothy D

    2014-08-01

    Most anatomical studies of primates focus on skeletal tissues, but muscular anatomy can provide valuable information about phylogeny, functional specializations, and evolution. Herein, we present the first detailed description of the head, neck, pectoral, and upper limb muscles of the fetal lemuriforms Lemur catta (Lemuridae) and Propithecus coquereli (Indriidae). These two species belong to the suborder Strepsirrhini, which is often presumed to possess some plesiomorphic anatomical features within primates. We compare the muscular anatomy of the fetuses with that of infants and adults and discuss the evolutionary and developmental implications. The fetal anatomy reflects a phylogenetically more plesiomorphic condition in nine of the muscles we studied and a more derived condition in only two, supporting a parallel between ontogeny and phylogeny. The derived exceptions concern muscles with additional insertions in the fetus which are lost in adults of the same species, that is, flexor carpi radialis inserts on metacarpal III and levator claviculae inserts on the clavicle. Interestingly, these two muscles are involved in movements of the pectoral girdle and upper limb, which are mainly important for activities in later stages of life, such as locomotion and prey capture, rather than activities in fetal life. Accordingly, our findings suggest that some exceptions to the "ontogeny parallels phylogeny" rule are probably driven more by ontogenetic constraints than by adaptive plasticity.

  8. Development and evaluation of a vision based poultry debone line monitoring system

    Science.gov (United States)

    Usher, Colin T.; Daley, W. D. R.

    2013-05-01

    Efficient deboning is key to optimizing production yield (maximizing the amount of meat removed from a chicken frame while reducing the presence of bones). Many processors evaluate the efficiency of their deboning lines through manual yield measurements, which involves using a special knife to scrape the chicken frame for any remaining meat after it has been deboned. Researchers with the Georgia Tech Research Institute (GTRI) have developed an automated vision system for estimating this yield loss by correlating image characteristics with the amount of meat left on a skeleton. The yield loss estimation is accomplished by the system's image processing algorithms, which correlates image intensity with meat thickness and calculates the total volume of meat remaining. The team has established a correlation between transmitted light intensity and meat thickness with an R2 of 0.94. Employing a special illuminated cone and targeted software algorithms, the system can make measurements in under a second and has up to a 90-percent correlation with yield measurements performed manually. This same system is also able to determine the probability of bone chips remaining in the output product. The system is able to determine the presence/absence of clavicle bones with an accuracy of approximately 95 percent and fan bones with an accuracy of approximately 80%. This paper describes in detail the approach and design of the system, results from field testing, and highlights the potential benefits that such a system can provide to the poultry processing industry.

  9. Spontaneous corneal perforation in an eye with Peters' anomaly

    Directory of Open Access Journals (Sweden)

    Kim M

    2013-07-01

    Full Text Available Moosang Kim, Seung-Chan Lee, Seung-Jun Lee Department of Ophthalmology, School of Medicine, Kangwon National University, Chuncheon, South Korea Abstract: A premature female infant underwent her first ophthalmologic examination at the age of 4 weeks. The initial examination of the baby was requested for evaluation of a ‘white spot’ on the surface of her right eye. She had been hospitalized in the neonatal intensive care unit because of systemic abnormalities, such as a right clavicle fracture and microcephaly. Slit-lamp examination of the right eye showed a central corneal opacity, corneal thinning, and an iridocorneal adhesion. The lens and fundus of the right eye could not be observed. We observed no pathologic findings in the left eye. The baby's parents were informed of the high risk for spontaneous corneal perforation without external pressure. At 42 days of age, an ophthalmologic examination of the infant was again requested for evaluation of ‘tears’ from her right eye 3 hours previously. Examination revealed corneal perforation, iris protrusion, and a flat anterior chamber. We performed emergent conjunctival flap surgery. Three months following surgery, the patient's right eye was successfully preserved with no sign of inflammation or leakage. Keywords: conjunctival flap, corneal perforation, Peters' anomaly

  10. Bortezomib in treatment of extramedullary plasmacytoma of the pancreas

    Institute of Scientific and Technical Information of China (English)

    Ju-Ying Wei; Hong-Yan Tong; Wei-Fang Zhu; Hui Liu; Feng-Juan Zhang; Wen-Juan Yu; Jie Jin

    2009-01-01

    BACKGROUND: Extramedullary pancreatic plasmacy-toma treated with bortezomib is rarely reported. METHODS: We admitted a 53-year-old woman with an asymptomatic mass above the left clavicle for over three months, then an asymptomatic swelling of the pancreas was found. A biopsy on the mass and a ifne needle aspiration of the pancreas were performed. The diagnosis of extramedullary plasmacytoma (EMP) was made. The patient was initially treated with combination chemotherapy consisting of vincristine, doxorubicin and dexamethasone (VAD regimen). She progressed to painless jaundice during the chemotherapy. Then she was treated with bortezomib and hyper-dose dexamethasone. As a result, she had a near complete remission. RESULTS: The data demonstrated that the diagnosis was EMP of the pancreas. The patient responded very well to bortezomib, while failing to respond to the traditional chemotherapy regimen of VAD. CONCLUSION: EMP of the pancreas is rare. This case gives evidence for an excellent response of EMP of the pancreas to bortezomib.

  11. A comparison of three-dimensional breast displacement and breast comfort during overground and treadmill running.

    Science.gov (United States)

    White, Jennifer; Scurr, Joanna; Hedger, Wendy

    2011-02-01

    Comparisons of breast support requirements during overground and treadmill running have yet to be explored. The purpose of this study was to investigate 3D breast displacement and breast comfort during overground and treadmill running. Six female D cup participants had retro-reflective markers placed on the nipples, anterior superior iliac spines and clavicles. Five ProReflex infrared cameras (100 Hz) measured 3D marker displacement in four breast support conditions. For overground running, participants completed 5 running trials (3.1 m/s ± 0.1 m/s) over a 10 m indoor runway; for treadmill running, speed was steadily increased to 3.1 m/s and 5 gait cycles were analyzed. Subjective feedback on breast discomfort was collected using a visual analog scale. Running modality had no significant effect on breast displacement (p > .05). Moderate correlations (r = .45 to .68, p running modalities. Findings suggest that breast motion studies that examine treadmill running are applicable to overground running.

  12. Analysis of Forensic Injury Characteristics on Death Caused by Motorcycle Traffic Accident%摩托车交通事故所致死亡的法医学损伤特征分析

    Institute of Scientific and Technical Information of China (English)

    张冬先; 洪仕君; 赵丽萍; 李利华

    2012-01-01

    目的 研究摩托车交通事故所致死亡案件的特点,探讨分析伤亡人员的损伤特征.方法 抽取摩托车交通事故鉴定案件资料365例,对其损伤类型、特征、部位分布、死亡原因进行统计分析.结果 死亡原因以颅脑损伤居多,现场死亡占大部分,头颈部、胸部、背部、腹盆部、会阴部损伤在伤亡分组中的发生率有统计学差异(P<0.05),颅骨骨折、胸廓骨折和下肢骨折在伤亡分组中的发生率有统计学差异(P<0.05),锁骨骨折在摩托车驾驶员与摩托车乘员相比有统计学差异(P<0.05).结论 摩托车交通事故所致死亡的死亡原因以颅脑损伤居多,且大部分在现场死亡;损伤部位主要分布在四肢和头颈部;摩托车驾驶员锁骨骨折的发生率明显高于摩托车乘员.%0bjective To study the feature of the dead cases caused by motorcycle traffic accident, and discuss the characteristics of the death and the injured. Methods We collected 365 cases about motorcycle traffic accident judicial expertise to analyse the injury type, characteristics, distribution and the causes of death. Results Craniocerebral injury was the common cause leading to death. Death on accident scene was the most. The incidence rate about injury of head and neck, injury of chest, injury of back, injury of abdominal and pelvic part, injury of perineal region had obvious statistical difference between the death group and the injured group. The incidence rate of craniocerebral fracture, thoracic cage fracture, lower limb fracture had statistical difference between the death group and the injured group. The incidence rate of clavicle fracture had statistical difference between motor-cyclist group and motor-passenger group. Conclusions Craniocerebral injury is the most common cause leading to death in motorcycle traffic accident, and most cases of death took place on the accident scene. Injuries are most localized on extremities, head and neck. The

  13. 经外周静脉穿刺中心静脉置管管末端影像学定位标志及个体相关因素分析%The radiology anatomical landmarks and individual factor of PICC catheter tip position

    Institute of Scientific and Technical Information of China (English)

    包婕; Syed Adnan Syed Mussaddique; 汪玲; 郝光宇; 胡春洪

    2016-01-01

    目的:评估不同人群经外周静脉穿刺中心静脉置管(PICC)管末端位置的解剖定位及影响因素,提高置管的准确性。方法:回顾性分析100例PICC置入患者的胸部CT资料,分别测量并记录上腔静脉-右心房连接点(CAJ)与右锁骨胸骨端、气管隆突的垂直距离(分别为A1、A2值)及其与胸椎椎体高度的比值(V1、V2),分析性别、年龄、身高和BMI等个体因素对上述各值的影响。结果:A1为(94.93±20.33)mm,V1为4.10±0.78。 A2为(38.71±14.9)mm,V1为4.10±0.78,V2为1.70±0.60;性别间A1、A2差异有统计学意义,年龄、身高对A1有显著影响,BMI对A1、A2值无显著影响,V1仅受年龄影响,而V2不受性别、年龄、身高、BMI等因素影响。结论:气管隆突可作为CAJ定位的可靠解剖标志,气管隆突下1.7个胸椎椎体位置为PICC管末端的合理位置。%Objective:To evaluate X-ray anatomical landmarks and influence factor of adult PICC catheter tip position for im-proving catheter tip veracity. Methods:100 patients who underwent CT scans were retrospectively included. The mean vertical distance of CAJ and the sternum of right clavicle (A1),CAJ and carina (A2) was measured using vertebral body units (VBUs) (V1,V2). What’s more,statistics differences were studied in gender,height,age and BMI. Results:The mean vertical distance of CAJ and the sternum of right clavicle was (94.93±20.33)mm (about 4.1 in VBUs),that of CAJ and carina was (38.71±14.9)mm (about 1.7 in VBUs). A1,A2 and V1 had statistics difference in gender,age,height (P0.05). Conclusion:The influencing factors are obviously reduced by the VBUs that standardized by vertebral body. V2 is superior to V1 (CAJ is below the carina in about 1.7 VBUs). It is applicable and accurate that grasping those features to locate adult PICC tip.

  14. Arthroscopic fixation in the treatment of Rockwood Ⅴ acute acromioclavicular joint dislocation%关节镜下四骨道双束固定治疗急性肩锁关节Rockwood Ⅴ型脱位

    Institute of Scientific and Technical Information of China (English)

    陆伟; 王大平; 朱伟民; 欧阳侃; 柳海峰; 彭亮权; 李皓; 冯文哲

    2014-01-01

    优,1例良。患者均对治疗效果满意。结论采用关节镜下四骨道四袢双束固定方法修复急性肩锁关节 Rockwood-Ⅴ型脱位,生物固定牢固,手术创伤小,并且避免了双袢单骨道应力过于集中、拉力线单薄等缺点,是治疗急性肩锁关节 Rockwood Ⅴ型损伤较好的方法。%Background Treatment methods for acromioclavicular joint dislocation of Rockwood type V are numerous.The commonly used is the open surgery with large trauma (by clavicular hook plate fixation).In recent years,some scholars use clavicle-coracoid screws fixation method under arthroscopy,but the screws need to be removed after 6 weeks; there are also scholars using arthroscopic double Endobutton loops single bundle fixation method with good effect,but they found suture rupture between the Endobutton,redislocation or fracture,bone absorption under the loops in some patients. This article investigates the method of arthroscopic procedure with four-tunnel quadruple double-bundle Endobutton double-bundle fixation via self-designed positioning apparatus in the treatment of acute acromioclavicular joint (ACJ)Rockwood Ⅴ degree dislocations and their short-term therapeutic effect.Methods (1)Patient selection:12 patients (9 male and 3 female)with acute acromioclavicular joint dislocation of Rockwood type V were selected from October 2010 to June 2013. Their average age is 28.2 years.with sports injury in 10 cases and fall injury in 2 cases.All patients received surgical repair within 2 weeks after injury.The operations were performed by the same senior surgeon.(2)Preoperative bone tunnel positioning design:All patients had CT scan in the position of 90°internal rotating of bilateral shoulder joint (palm down).Measure the angle of scapular long axis and coronal section (A)separately,make the line in the coracoid neck parallel to the long axis of scapula (S),and then measure the width of parallel line in the part of coracoid neck (P).The midpoint of the

  15. ICU中心静脉导管相关性感染的危险因素分析与护理研究%Risk factors analysis and nursing study of CU central venous catheter associated infection

    Institute of Scientific and Technical Information of China (English)

    李玉楠

    2016-01-01

    Objective:To investigate the risk factors and nursing of the central venous catheter related infection in ICU center..Methods:in our hospital from December 2010 to 2014 December ICU were 30 cases of catheter infection patients in 90 cases of central venous device tube patients as the research object,the relationship of their clinical characteristics,risk factors and nursing were studied.Results:the infection rates of femoral vein,jugular vein and clavicle vein were 33.33%,28.57% and 18.52%,respectively,femoral vein catheterization was the highest,and the lowest was the lowest of clavicle vein..The longer the catheter indwelling,the higher the infection rate..The infection rate of single lumen catheter is 15.87%,which is lower than that of double lumen catheter 40.74%.Conclusion:strict central venous set tube care,improve immunity of patients,shorten the time of catheter,strengthen nurse hand hygiene management and disinfection of puncture site,has a very important role in the occurrence of low central venous catheter related infections.%目的:对ICU中心静脉导管相关性感染的危险因素和护理进行探讨和分析。方法对我院2010年12月-2014年12月ICU病房收治的30例导管感染患者中90例次中心静脉置管患者作为研究对象,对他们的临床特点、危险因素和护理的关系进行研究。结果①股静脉、颈静脉和锁骨下静脉插管的的感染率分别为33.33%、28.57%和18.52%,其中股静脉置管最高,锁骨下静脉最低。②导管留置的时间越长,感染发生率越高。③单腔导管留置感染率为15.87%,低于双腔导管留置的40.74%。结论严格中心静脉置管护理,提高患者机体免疫力,缩短置管时间,加强护士手卫生的管理和穿刺部位消毒,对降低中心静脉置管相关性感染的发生具有非常重要的作用。

  16. MRI and clinical features of Langerhans cell histiocytosis (LCH) in the pelvis and extremities: can LCH really look like anything?

    Energy Technology Data Exchange (ETDEWEB)

    Samet, Jonathan [Northwestern University Feinberg School of Medicine, Department of Medical Imaging, Ann and Robert H. Lurie Children' s Hospital of Chicago, Chicago, IL (United States); Weinstein, Joanna [Northwestern University Feinberg School of Medicine, Departments of Pediatrics, Division of Hematology/Oncology/Stem Cell Transplant, Ann and Robert H. Lurie Children' s Hospital of Chicago, Chicago, IL (United States); Fayad, Laura M. [The Johns Hopkins University School of Medicine, The Russell H. Morgan Department of Radiology and Radiological Science, Baltimore, MD (United States)

    2016-05-15

    To assess clinical and MRI features of Langerhans cell histiocytosis in the pelvis and extremities. The MRI and clinical features of 21 pathologically proven cases of LCH involving the pelvis and extremities were studied. Multiple characteristics of the lesions were evaluated (location, size, T1/ T2/post-contrast features, perilesional bone and soft tissue signal, endosteal scalloping, periosteal reaction, soft tissue mass, pathologic fracture). Pre-biopsy radiologic diagnoses were collected from the original clinical reports. Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), temperature, and white blood cell count (WBC) were collected at the time of diagnosis when available. The locations of the LCH lesions included five humerus, four femur, five ilium, one tibia, one clavicle, and three scapula. Lesional size ranged from 1.8 to 7.1 cm, with a mean of 3.6 cm. All lesions demonstrated perilesional bone marrow edema, periosteal reaction, endosteal scalloping, and post-contrast enhancement. An associated soft tissue mass was present in 15/21 (71.4 %). Clinically, the WBC, ESR, and CRP were elevated in 2/14 (14 %), 8/12 (67 %), and 4/10 (40 %) of cases, respectively. Fever was documented in 1/15 (7 %) patients and pain was reported in 15/15 (100 %). The clinical and radiologic features of LCH in the pelvis and extremities overlap with infection and malignancy, but LCH must be considered in the differential diagnosis, as it routinely presents with aggressive MRI features, including endosteal scalloping, periosteal reaction, perilesional edema, and a soft tissue mass. Furthermore, an unknown skeletal lesion at presentation without aggressive MRI features is unlikely to represent LCH. (orig.)

  17. Localized Energy-Based Normalization of Medical Images: Application to Chest Radiography.

    Science.gov (United States)

    Philipsen, R H H M; Maduskar, P; Hogeweg, L; Melendez, J; Sánchez, C I; van Ginneken, B

    2015-09-01

    Automated quantitative analysis systems for medical images often lack the capability to successfully process images from multiple sources. Normalization of such images prior to further analysis is a possible solution to this limitation. This work presents a general method to normalize medical images and thoroughly investigates its effectiveness for chest radiography (CXR). The method starts with an energy decomposition of the image in different bands. Next, each band's localized energy is scaled to a reference value and the image is reconstructed. We investigate iterative and local application of this technique. The normalization is applied iteratively to the lung fields on six datasets from different sources, each comprising 50 normal CXRs and 50 abnormal CXRs. The method is evaluated in three supervised computer-aided detection tasks related to CXR analysis and compared to two reference normalization methods. In the first task, automatic lung segmentation, the average Jaccard overlap significantly increased from 0.72±0.30 and 0.87±0.11 for both reference methods to with normalization. The second experiment was aimed at segmentation of the clavicles. The reference methods had an average Jaccard index of 0.57±0.26 and 0.53±0.26; with normalization this significantly increased to . The third experiment was detection of tuberculosis related abnormalities in the lung fields. The average area under the Receiver Operating Curve increased significantly from 0.72±0.14 and 0.79±0.06 using the reference methods to with normalization. We conclude that the normalization can be successfully applied in chest radiography and makes supervised systems more generally applicable to data from different sources.

  18. Early evolution of the lungfish pectoral fin endoskeleton: evidence from the Middle Devonian (Givetian Pentlandia macroptera

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    Emma eJude

    2014-08-01

    Full Text Available As the closest living relatives of tetrapods, lungfishes are frequently used as extant models for exploring the fin-to-limb transition. These studies have generally given little consideration to fossil taxa. This is because although lungfish fins are relatively common in the fossil record, the internal structure of these fins is virtually unknown. Information on pectoral-fin endoskeletons in fossil representatives of Dipnomorpha (the lungfish total group is limited to poorly preserved remains in the lungfish Dipterus and Conchopoma and more complete material in the porolepiform Glyptolepis. Here we describe a well-preserved pectoral-fin endoskeleton in the Middle Devonian (Givetian lungfish Pentlandia macroptera from the John O’Groats fish bed, Caithness, northeastern Scotland. The skeleton is in association with a cleithrum and clavicle, and consists of a series of at least eight mesomeres. Extensive series of preaxial and postaxial radials are present. Some of the radials are jointed, but none branch. No mesomere articulates with multiple radials on either its pre- or post-axial face. The first two mesomeres, corresponding to the humerus and ulna, bear well-developed axial processes. Uniquely among dipnomorphs, a distinct ossification centre corresponding to the radius is present in Pentlandia. A review of anatomy and development of the pectoral-fin endoskeleton in the living Neoceratodus is presented based on cleared and stained material representing different size stages. These developmental data, in conjunction with new details of primitive lungfish conditions based on Pentlandia, highlight many of the derived features of the pectoral-fin skeleton of Neoceratodus, and clarify patterns of appendage evolution within the dipnomorphs more generally.

  19. A retrospective study to reveal factors associated with postoperative shoulder imbalance in patients with adolescent idiopathic scoliosis with double thoracic curve.

    Science.gov (United States)

    Lee, Choon Sung; Hwang, Chang Ju; Lim, Eic Ju; Lee, Dong-Ho; Cho, Jae Hwan

    2016-12-01

    OBJECTIVE Postoperative shoulder imbalance (PSI) is a critical consideration after corrective surgery for a double thoracic curve (Lenke Type 2); however, the radiographic factors related to PSI remain unclear. The purpose of this study was to identify the radiographic factors related to PSI after corrective surgery for adolescent idiopathic scoliosis (AIS) in patients with a double thoracic curve. METHODS This study included 80 patients with Lenke Type 2 AIS who underwent corrective surgery. Patients were grouped according to the presence [PSI(+)] or absence [PSI(-)] of shoulder imbalance at the final follow-up examination (differences of 20, 15, and 10 mm were used). Various radiographic parameters, including the Cobb angle of the proximal and middle thoracic curves (PTC and MTC), radiographic shoulder height (RSH), clavicle angle, T-1 tilt, trunk shift, and proximal and distal wedge angles (PWA and DWA), were assessed before and after surgery and compared between groups. RESULTS Overall, postoperative RSH decreased with time in the PSI(-) group but not in the PSI(+) group. Statistical analyses revealed that the preoperative Risser grade (p = 0.048), postoperative PWA (p = 0.028), and postoperative PTC/MTC ratio (p = 0.011) correlated with PSI. Presence of the adding-on phenomenon was also correlated with PSI, although this result was not statistically significant (p = 0.089). CONCLUSIONS Postoperative shoulder imbalance is common after corrective surgery for Lenke Type 2 AIS and correlates with a higher Risser grade, a larger postoperative PWA, and a higher postoperative PTC/MTC ratio. Presence of the distal adding-on phenomenon is associated with an increased PSI trend, although this result was not statistically significant. However, preoperative factors other than the Risser grade that affect the development of PSI were not identified by the study. Additional studies are required to reveal the risk factors for the development of PSI.

  20. Multi-analysis with mathematic model of 3125 non-thyrogenous masses of the neck%3125例颈部非甲状腺肿物疾病多重分析及相关数学模型的建立

    Institute of Scientific and Technical Information of China (English)

    Yong Li; Ming Gao; Yun Niu; Liying Zhang; Yang Yu; Yigong Li; Xiaolong Li

    2008-01-01

    Objective:To systematically analyze and summarize non-thyrogenous masses of the neck(NTMN)by consid eration of new areas a large sample size and multiple-aspect analysis.Methods:Our research involved 3125 NTMN cases.We summarized the proportion of various NTMN and the distribution of the neck diseases based on the new international classification.The clinical traits such as sexual proportion and age,etc,were analyzed along with the unknown primary cervical metastatic carcinomas(UPCMC).and built up a mathematical model based on the data above.Results:There were 68 different diseases identified.Among all the NTMN.1he percentage of metastatic carcinomas was 63.3% The neck masses with a focus above the clavicle comprised 62.3% of the metastatic carcinomas whose focuses were clear.Moreover,other results almost supported the"rule of 80%".There was an obvious distribution of traits at every sub level.For example,there were 23 different diseases in level Ⅲ,of which the most common was lymphoma.UPCMC made up 12.3% of all metastatic carcinomas.The clinic cases could be analyzed by our model even to form a primary diagnosis which showed a high coincident rate with clinic diagnosis.Conclusion:NTMN are complex and various.with a definite distribution in each neck level.Data relating component character,sex ratio and UPCMC ef al to the clinical traits of NTMN will provide vigorous support for clinical applications.The mathematical model could be an efficient method to synthetically analyze complicate data of NTMN.

  1. Septic arthritis and arthropathy of the rotator cuff: remember this association

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    Danilo Sobreira

    2016-08-01

    Full Text Available ABSTRACT OBJECTIVE: To describe occurrences of septic glenohumeral arthritis among patients with arthropathy of the rotator cuff, and to highlight the importance of correct diagnosis and surgical procedures. METHODOLOGy: Eight surgical drains were installed in seven patients with glenohumeral pyoarthritis. All the patients presented arthropathy of the rotator cuff (four males and three females. Six patients presented pyoarthritis in the dominant shoulder. The age range was from 53 to 93 years (mean: 74 years. The mean duration of the symptoms before the surgical lavage was six weeks. Six patients underwent treatment consisting of a combination of arthroscopic irrigation and debridement, and one patient was treated by means of open arthrotomy. All the patients received systemic antibiotic therapy in accordance with their bacterial sensitivity. RESULTS: All seven patients achieved satisfactory results, taking into consideration especially the improvement of pain and the patients' satisfaction. The functional assessment was performed using the University of California Los Angeles (UCLA scale. Only one patient needed to go through another arthroscopic procedure. Staphylococcus aureus was isolated from four cultures and Escherichia coli from one culture. There were two situations in which the patients used empirical antibiotic therapy and the cultures showed negative results. Among the associated procedures, tenotomy of the biceps was performed in four cases, resection of the lateral third of the clavicle due to osteomyelitis in one case and arthrotomy of the knee in one case. CONCLUSION: Surgical treatment was effective in the cases of arthritis associated with arthropathy of the rotator cuff. In patients with arthropathy of the rotator cuff and subclinically altered laboratory signs, the possibility of pyoarthritis should always be suspected.

  2. Frequency, imaging findings, risk factors, and long-term sequelae of distal clavicular osteolysis in young patients

    Energy Technology Data Exchange (ETDEWEB)

    Roedl, Johannes B.; Nevalainen, Mika; Gonzalez, Felix M.; Morrison, William B.; Zoga, Adam C. [Thomas Jefferson University Hospital, Thomas Jefferson University, Division of Musculoskeletal Imaging and Interventions, Department of Radiology, Philadelphia, PA (United States); Dodson, Christopher C. [Thomas Jefferson University Hospital, Rothman Institute, Sidney Kimmel Medical College at Thomas Jefferson University, Division of Sports Medicine, Department of Orthopedic Surgery, Philadelphia, PA (United States)

    2015-05-01

    Atraumatic distal clavicular osteolysis (DCO) has been described in adult male weightlifters. Our purpose was to investigate the frequency, magnetic resonance imaging (MRI) characteristics, risk factors, and long-term sequelae of DCO in young patients. Individuals with atraumatic DCO were identified in a retrospective review of 1,432 consecutive MRI shoulder reports in patients between 13 and 19 years of age. MRI findings of DCO, association with athletic activity, short-term clinical outcome after 3-6 months, and long-term clinical and MRI outcome after 2 years were analyzed. A pre-MRI questionnaire assessed the patients' athletic history including overhead activity and weightlifting. At a mean age of 15.9 years, 6.5 % (93/1432) of patients had atraumatic DCO, and 24 % were females. The combination of an overhead sport (basketball, volleyball, tennis, swimming) and supplemental weight training was a risk factor for DCO (odds ratio = 38, p = 0.01). Ninety-three percent of patients responded to conservative therapy. On follow-up imaging, 71 % of DCO patients had acromioclavicular (AC) joint osteoarthritis (vs. 35 % in controls, p = 0.006); 79 % had flattening of the distal clavicle and interval widening of the AC joint to a mean of 5.0 mm (compared to 2.4 mm in controls, p < 0.001). Severity of DCO edema was associated with pain (p < 0.02) at initial presentation and with AC joint osteoarthritis (p = 0.004) on follow-up. In athletic teenagers, the combination of weightlifting and overhead activity is a risk factor for atraumatic DCO, and females are affected in 24 %. Long-term sequelae include widening of the AC joint and AC joint osteoarthritis. (orig.)

  3. Functional morphology and biomechanics of the cynodont Trucidocynodon riograndensis from the Triassic of Southern Brazil: Pectoral girdle and forelimb

    Directory of Open Access Journals (Sweden)

    Téo Veiga De Oliveira

    2016-06-01

    Full Text Available Non-mammalian cynodonts provide insights on several points about mammalian evolution, such as the postural change and locomotory advances within the group. Unfortunately, complete skeletons of Triassic cynodonts are rather uncommon and where more complete specimens are found they can offer a global vision on some traits not available from partial specimens. This is the case of the cynodont Trucidocynodon riograndensis, from the Triassic of Brazil, that has preserved its forelimbs providing some insights into locomotory properties. The movements between interclavicle and clavicle must have been limited, as such as those occurring between the latter and the scapulocoracoid although the long acromion process of this should have permitted a greater degree of freedom. Some of the more significant movements were those on the shoulder joint, in which the maximum adduction should have been ca. 35º relative to the parasagittal plane and the greater abduction ca. 55º. The maximum adduction occurred when the humerus was in the more retracted position during stride and the variation in the adduction/abduction should have been significant to the limb posture during its recovery stroke. The long olecranon and the distal overlapping between radius and ulna suggest the predominance of simple flexion/extension on the forearm without significant pronation/supination. The poorly preserved hand suggests that Trucidocynodon could have evolved a slight semidigitigrad condition in its forelimbs. All these features give to this cynodont an important role in the evolution of the mammalian locomotory properties indicating that some features, such as the possibility of greater humeral adduction, evolved early in cynodont lineage.

  4. Patrones de osificación en Tupinambis merianae y Tupinambis rufescens (Squamata: Teiidae y patrones generales en Squamata

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    Arias, Federico

    2006-06-01

    Full Text Available Se describe la variación ontogenética del esqueleto de 13 embriones de Tupinambis merianae y 11 de Tupinambis rufescens, detectándose heterocronías entre ambas especies. Los resultados muestran que los elementos dermales (tanto del cráneo como de la cintura pectoral osifican antes que los elementos condrales, siendo los elementos que forman la mandíbula inferior, el paladar (especialmente los palatinos y los pterigoides y la clavícula los primeros en osificarse, mientras que los elementos del dermatocráneo más tardíos en osificarse son los del arco temporal superior (lacrimal, postorbital, postfrontal. Las principales diferencias en los tiempos de aparición y osificación se producen en algunos huesos del cráneo y en el autopodio (carpo/tarso, pero estas heterocronías no alteran la arquitectura final del esqueleto. Los resultados encontrados son comparados y discutidos con el conocimiento existente sobre otros linajes de Squamata. We describe the ontogenetic variation of skeleton of 13 Tupinambis meriane embryos and 11 Tupinambis rufescens embryos. Furthermore heterochronies in ossification sequence between both species are recorded. Results show that dermal elements (belonging to the skull and the pectoral girdle ossify before the chondral elements, being the elements that constitute the lower jaw, the palate (especially the palatine and the pterygoid, and the clavicle the first ones to ossify. The elements belonging to the dermatocranium which ossify later are the ones of the upper temporal arch (lacrimal, postorbital and postfrontal. The main differences present in timing of onset and ossification are produced in some bones of the skull and of the autopodium (carpus / tarsus; though, these heterochronies do not alter the final structure of the skeleton. Results achieved are compared and discussed with the available knowledge of other squamate lineages.

  5. Neonatal injury at cephalic vaginal delivery: a retrospective analysis of extent of association with shoulder dystocia.

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    Cantekin Iskender

    Full Text Available PURPOSE: To describe the risk factors and labor characteristics of Clavicular fracture (CF and brachial plexus injury (BPI; and compare antenatal and labor characteristics and prognosis of obstetrical BPI associated with shoulder dystocia with obstetrical BPI not associated with shoulder dystocia. METHODS: This retrospective study consisted of women who gave birth to an infant with a fractured clavicle or BPI between January 2009 and June 2013. Antenatal and neonatal data were compared between groups. The control group (1300 was composed of the four singleton vaginal deliveries that immediately followed each birth injury. A multivariable logistic regression model, with backward elimination, was constructed in order to find independent risk factors associated with BPI and CF. A subgroup analysis involved comparison of features of BPI cases with or without associated shoulder dystocia. RESULTS: During the study period, the total number of vaginal deliveries was 44092. The rates of CF, BPI and shoulder dystocia during the study period were 0,6%, 0,16% and 0,29%, respectively. In the logistic regression model, shoulder dystocia, GDM, multiparity, gestational age >42 weeks, protracted labor, short second stage of labor and fetal birth weight greater than 4250 grams increased the risk of CF independently. Shoulder dystocia and protracted labor were independently associated with BPI when controlled for other factors. Among neonates with BPI whose injury was not associated with shoulder dystocia, five (12.2% sustained permanent injury, whereas one neonate (4.5% with BPI following shoulder dystocia sustained permanent injury (p = 0.34. CONCLUSION: BPI not associated with shoulder dystocia might have a higher rate of concomitant CF and permanent sequelae.

  6. Loss of ZMPSTE24 (FACE-1) causes autosomal recessive restrictive dermopathy and accumulation of Lamin A precursors.

    Science.gov (United States)

    Navarro, Claire L; Cadiñanos, Juan; De Sandre-Giovannoli, Annachiara; Bernard, Rafaëlle; Courrier, Sébastien; Boccaccio, Irène; Boyer, Amandine; Kleijer, Wim J; Wagner, Anja; Giuliano, Fabienne; Beemer, Frits A; Freije, Jose M; Cau, Pierre; Hennekam, Raoul C M; López-Otín, Carlos; Badens, Catherine; Lévy, Nicolas

    2005-06-01

    Restrictive dermopathy (RD) is characterized by intrauterine growth retardation, tight and rigid skin with prominent superficial vessels, bone mineralization defects, dysplastic clavicles, arthrogryposis and early neonatal death. In two patients affected with RD, we recently reported two different heterozygous splicing mutations in the LMNA gene, leading to the production and accumulation of truncated Prelamin A. In other patients, a single nucleotide insertion was identified in ZMPSTE24. This variation is located in a homopolymeric repeat of thymines and introduces a premature termination codon. ZMPSTE24 encodes an endoprotease essential for the post-translational cleavage of the Lamin A precursor and the production of mature Lamin A. However, the autosomal recessive inheritance of RD suggested that a further molecular defect was present either in the second ZMPSTE24 allele or in another gene involved in Lamin A processing. Here, we report new findings in RD linked to ZMPSTE24 mutations. Ten RD patients were analyzed including seven from a previous series and three novel patients. All were found to be either homozygous or compound heterozygous for ZMPSTE24 mutations. We report three novel 'null' mutations as well as the recurrent thymine insertion. In all cases, we find a complete absence of both ZMPSTE24 and mature Lamin A associated with Prelamin A accumulation. Thus, RD is either a primary or a secondary laminopathy, caused by dominant de novo LMNA mutations or, more frequently, recessive null ZMPSTE24 mutations, most of which lie in a mutation hotspot within exon 9. The accumulation of truncated or normal length Prelamin A is, therefore, a shared pathophysiological feature in recessive and dominant RD. These findings have an important impact on our knowledge of the pathophysiology in Progeria and related disorders and will help direct the development of therapeutic approaches.

  7. The years lived with disability due to road traffic accidents based on the nature of injuries in Kermanshah province (2010

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    Neda Izadi

    2015-03-01

    Full Text Available Background: Traffic accidents, with lots of casualties and injuries, cause a lot of economic loss. This study was conducted to determine the Years Lived with Disability (YLD due to road traffic accidents according to the nature of injuries in Kermanshah province. Methods: following a pilot study, a sample of 3258 people was analyzed in order to calculate the YLD. Then, based on various factors, the age, gender and nature of injury of 10070 people were estimated. The YLD was calculated using the Global Burden of Disease (GBD (2010. The data concerning age and gender of the total population of the province was taken from the Statistical Center of Iran. All calculations were performed based on age and gender in Excel software. Results: The mean age of the injured people was 32.7±17.1. Men constituted 67.7 % of patients. The incidence rate of traffic accidents was 283.6 per 100,000. The highest levels of YLD in outpatients, men and women were reported for patella, tibia, fibula and ankle fractures and fractures of clavicle, scapula, humerus and skull, respectively. The highest rate of inpatient YLDs by nature of injury belonged to the fractures of sternum, ribs and face bone. The years lived with disability was calculated to be 2365.96 years (2.46 per 1000 and 1039.01 years (1.1 per 1000 for men and women, respectively. It was 3404.97 years (1.79 per 1000 in both genders. The highest YLD was in the age group of 15–29. Conclusion: Traffic accidents are high rate of YLD is resulted by traffic accidents. The most affected age group are youngsters and fracture are more frequent.

  8. Karakteristik dan Faktor Risiko Obstetrical Brachial Plexus Palsy pada Bayi Baru Lahir

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    Andreas Vincent Handoyo

    2010-06-01

    Full Text Available Obstetrical brachial plexus palsy (OBPP is an injury of entire or part of brachial plexus correlated with delivery process. Incidence in developing countries is around 0.15%. Risk factors include intrapartum and intrauterine. Three types of OBPP are Duchenne Erb, Klumpke, and whole arm palsy. This was a retrospective study of characteristic and risk factors of OBPP in Hasan Sadikin Hospital, Bandung, period January 2002-April 2007. Data were collected from perinatology ward medical records, and analyzed using binary logistic regression. OBPP incidence was 0.141%. All were Erb palsy and single pregnancy, 68.75% were head-occiput posterior presentation, 50% were spontaneous birth, 18.75% had meconeal staining, 62.5% had birth weight ≥3,500 g, 56.25% were male, 68.75% asphyxia, 12.5% shoulder dystocia, and 6.25% clavicle fracture. Risk factors significantly correlated were foot presentation (OR 9.357; 95%CI, transverse fetal position (OR 5.136; 95%CI, vacuum, forceps, breech/foot extraction (OR 5.240;95%CI, 4.320; 95%CI, 14.411; 95%CI, respectively, birth weight 3,500-3,999 g (OR 4.571;95%CI, birth weight ≥4,500 g (OR 57.759; 95%CI, asphyxia (ORs 5.992; 95%CI, and severe asphyxia (OR 6.094; 95%CI. Sectio cesarea tend to have protective effect {OR 0.244; 95%CI; p=0.062 (>0.05}. The important risk factors of OBPP are foot presentation, breech/foot extraction, and birth weight >4,500 g.

  9. Development of Portable Digital Radiography System with a Device for Monitoring X-ray Source-Detector Angle and Its Application in Chest Imaging

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    Tae-Hoon Kim

    2017-03-01

    Full Text Available This study developed a device measuring the X-ray source-detector angle (SDA and evaluated the imaging performance for diagnosing chest images. The SDA device consisted of Arduino, an accelerometer and gyro sensor, and a Bluetooth module. The SDA values were compared with the values of a digital angle meter. The performance of the portable digital radiography (PDR was evaluated using the signal-to-noise (SNR, contrast-to-noise ratio (CNR, spatial resolution, distortion and entrance surface dose (ESD. According to different angle degrees, five anatomical landmarks were assessed using a five-point scale. The mean SNR and CNR were 182.47 and 141.43. The spatial resolution and ESD were 3.17 lp/mm (157 μm and 0.266 mGy. The angle values of the SDA device were not significantly difference as compared to those of the digital angle meter. In chest imaging, the SNR and CNR values were not significantly different according to the different angle degrees. The visibility scores of the border of the heart, the fifth rib and the scapula showed significant differences according to different angles (p < 0.05, whereas the scores of the clavicle and first rib were not significant. It is noticeable that the increase in the SDA degree was consistent with the increases of the distortion and visibility score. The proposed PDR with a SDA device would be useful for application in the clinical radiography setting according to the standard radiography guidelines.

  10. The iliac crest in forensic age diagnostics: evaluation of the apophyseal ossification in conventional radiography.

    Science.gov (United States)

    Wittschieber, Daniel; Vieth, Volker; Domnick, Christoph; Pfeiffer, Heidi; Schmeling, Andreas

    2013-03-01

    Due to the increasing significance of forensic age estimations in the age of globalisation, novel radiographic criteria besides clavicles and hand bones may provide additional certainty for forensic age expertises. The present study analyses the suitability of the iliac crest apophysis by means of 643 pelvic radiographs of patients between 10 and 30 years of age. Retrospective assessments were carried out according to the forensically established classification and sub-classification systems modified after Kreitner et al. (Rofo 166(6):481-486, 1997) and Kellinghaus et al. (Int J Legal Med 124(4):321-325, 2010). The basic ossification stages range from 1 to 4, and the sub-stages of stage 2 and 3 range from a to c. While stage 3c was first achieved at the age of 15 by both sexes, stage 4 was first observed in females at the age of 16 and in males at the age of 17. This indicates the possibility of a valid diagnosis of both the age of 14 and the age of 16 years which represent legally relevant age thresholds in numerous countries. Applied as targeted radiography on the iliac crest, the exposure to radiation would range between other radiographic techniques recently applied. Therefore, the iliac crest apophysis appears principally suitable as novel possible criterion for forensic age estimation in the living. However, for the establishment of the iliac crest apophysis in routine diagnostics, further studies are needed focussing on the comparison of different grading systems and different radiological techniques.

  11. Postburn neck anterior contracture treatment in children with scar-fascial local trapezoid flaps: a new approach.

    Science.gov (United States)

    Grishkevich, Viktor M; Grishkevich, Max; Menzul, Vasiliy

    2015-01-01

    One of the dramatic consequences of burns is scar contracture and deformities of the neck. Cervical contracture in children is especially dangerous, leading to face disfigurement and kyphosis; therefore, early reconstruction is indicated. Despite the existence of many various surgical techniques, the successful neck contracture treatment in pediatric patients remains a challenge for surgeons. Eleven children (aged 5 to 14 years) with postburn neck anterior contractures were studied to develop a new approach for reconstruction that would employ the use of local scar-fascial flaps. The new approach and technique for postburn pediatric contracture treatment was developed which is especially effective in the treatment of children who cannot undergo complex and long surgical procedures that are aimed at both contracture elimination and neck skin restoration. The technique consists of two trapezoid scar-fascial flaps mobilization which includes all the anterior neck surfaces and consists of scars, fat layer, platysma, and deep cervical fascia. Counter transposition of flaps with tension elongated neck anterior surface was 100 to 200%. The contracture was fully eliminated, and neck contours, mentocervical angle, and head movement were restored. In case of severe contracture, residual wound in submandibular region and above clavicles were skin-grafted. The full range of head motion (functional results) was achieved in all the 11 patients. The flaps continued to grow and the skin grafts shrinkage was moderate. Local trapeze-flap plasty allows neck contracture elimination in children in the cases when a more complex technique is impossible or undesirable to use. Early surgical intervention prevents secondary complications, allotting enough time for patients to mature and be ready for more complex procedures.

  12. RADIOGRAPHIC THORACIC ANATOMY OF THE RED PANDA (AILURUS FULGENS).

    Science.gov (United States)

    Makungu, Modesta; du Plessis, Wencke M; Barrows, Michelle; Groenewald, Hermanus B; Koeppel, Katja N

    2016-09-01

    The red panda ( Ailurus fulgens ) is classified as an endangered species by the International Union for Conservation of Nature and Natural Resources. The natural distribution of the red panda is in the Himalayas and southern China. Thoracic diseases such as dirofilariasis, hypertrophic cardiomyopathy, tracheal obstruction, lung worm infestation, and pneumonia have been reported in the red panda. The aim of this study was to describe the normal radiographic thoracic anatomy of captive red pandas as a species-specific reference for routine health examinations and clinical cases. Right lateral (RL) and dorsoventral (DV) inspiratory phase views of the thorax were obtained in 11 adult captive red pandas. Measurements were made and ratios calculated to establish reference ranges for the mean vertebral heart score on the RL (8.34 ± 0.25) and DV (8.78 ± 0.34) views and the mean ratios of the caudal vena cava diameter to the vertebral body length above tracheal bifurcation (0.67 ± 0.05) and tracheal diameter to the width of the third rib (2.75 ± 0.24). The majority of animals (10/11) had 14 thoracic vertebrae, except for one animal that had 15 thoracic vertebrae. Rudimentary clavicles were seen in 3/11 animals. The ovoid, oblique cardiac silhouette was more horizontally positioned and elongated in older animals. A redundant aortic arch was seen in the oldest animal. The trachea was seen with mineralized cartilage rings in all animals. The carina was clearly seen in the majority of animals (10/11). Variations exist in the normal radiographic thoracic anatomy of different species. Knowledge of the normal radiographic thoracic anatomy of the red panda should prove useful for routine health examinations and in the diagnosis of thoracic diseases.

  13. Reliability and validity of goniometric and photographic measurements of clavicular tilt angle.

    Science.gov (United States)

    Ha, Sung-min; Kwon, Oh-yun; Weon, Jong-hyuck; Kim, Moon-hwan; Kim, Su-jung

    2013-10-01

    The aims of the present study were to assess the reliability of clavicular tilt angle measurement using goniometric and photographic measurements and to test the validity of the measurement by comparing the results with radiographic findings (gold standard). Clavicular tilt angles were measured in 18 healthy subjects (36 clavicles) using goniometric, photographic, and radiographic measurement. Repeated measurements using goniometric and photographic measurements were made in two test sessions conducted on different days by two examiners to assess inter-rater and intra-rater reliability of the two methods. Radiographic measurement was taken once, and the correlation between the radiographic findings and those of the indirect methods was calculated to test the validity of the goniometric and photographic measurement of clavicular tilt angle. No significant difference in clavicular tilt angle measurement was found between test sessions. The reliability of goniometric measurement (inter-rater intraclass correlation coefficients (ICC) = 0.85 (95% CI = 0.72-0.92) - 0.87 (95% CI = 0.77-0.87); intra-rater ICC = 0.80 (95% CI = 0.64-0.89)) and photographic measurement (inter-rater ICC = 0.89 (95% CI = 0.80-0.94) - 0.95 (95% CI = 0.91-0.98); intra-rater ICC = 0.84 (95% CI = 0.71-0.92) - 0.84 (95% CI = 0.69-0.91)) were excellent. The goniometric and photographic measurements of clavicular tilt angle were highly correlated with the radiographic findings (r = 0.83, 0.78, respectively). Goniometric and photographic measurements of clavicular tilt angle obtained by raters in this study may be considered reliable, and data obtained using the goniometric and photographic measurements are representative of radiographic findings of clavicular tilt angle.

  14. Optimal markers' placement on the thorax for clinical gait analysis.

    Science.gov (United States)

    Armand, Stéphane; Sangeux, Morgan; Baker, Richard

    2014-01-01

    Although, several thorax models have been proposed for clinical gait analysis, none has received widespread acceptance nor been subject to any extensive validation work, especially for the marker set to use. The aim of this study was thus to determine the optimal and minimal makers' placement on the thorax for clinical gait analysis. Ten healthy subjects have performed a series of movements (arm, head, trunk) with large amplitude during walking. Reflective markers were taped on the thorax (C7, T2, T4, T6, T8, T10, T12, sternum, clavicles and ribs) and their 3D positions were captured with an opto-electronic system. Each combination of 3 markers has been tested. The global error of each model was computed with the estimated position of the markers considering the thorax segment as a solid segment. Two families of marker sets were identified with the lowest error. The first family was composed by two anterior and one posterior marker on the thorax (incisura jugularis (IJ), xiphoid process, and T8). The second family was composed by two posterior and one anterior maker (IJ, T2 and T8 or T10). Even, if these two families of marker sets presented a similar error for marker position, the angles obtained from these marker sets showed large differences especially for the axial rotation movement of the trunk (up to 40.1°). The optimal and minimal maker set identified with a variety of large movements of the trunk, head and arms was IJ, T2 and T8 or T10.

  15. Bedside prediction of right subclavian venous catheter insertion length

    Directory of Open Access Journals (Sweden)

    Yoon Ji Choi

    2014-12-01

    Full Text Available Background and objective: The present study aimed to evaluate whether right subclavian vein (SCV catheter insertion depth can be predicted reliably by the distances from the SCV insertion site to the ipsilateral clavicular notch directly (denoted as I-IC, via the top of the SCV arch, or via the clavicle (denoted as I-T-IC and I-C-IC, respectively. Method: In total, 70 SCV catheterizations were studied. The I-IC, I-T-IC, and I-C-IC distances in each case were measured after ultrasound-guided SCV catheter insertion. The actual length of the catheter between the insertion site and the ipsilateral clavicular notch, denoted as L, was calculated by using chest X-ray. Results: L differed from the I-T-IC, I-C-IC, and I-IC distances by 0.14±0.53, 2.19±1.17, and -0.45 ±0.68 cm, respectively. The mean I-T-IC distance was the most similar to the mean L (intraclass correlation coefficient = 0.89. The mean I-IC was significantly shorter than L, while the mean I-C-IC was significantly longer. Linear regression analysis provided the following formula: Predicted SCV catheter insertion length (cm = -0.037 + 0.036 × Height (cm + 0.903 × I-T-IC (cm (adjusted r2 =0.64. Conclusion: The I-T-IC distance may be a reliable bedside predictor of the optimal insertion length for a right SCV cannulation.

  16. Earliest example of a giant monitor lizard (Varanus, Varanidae, Squamata.

    Directory of Open Access Journals (Sweden)

    Jack L Conrad

    Full Text Available BACKGROUND: Varanidae is a clade of tiny (600 mm PCL lizards first appearing in the Cretaceous. True monitor lizards (Varanus are known from diagnostic remains beginning in the early Miocene (Varanus rusingensis, although extremely fragmentary remains have been suggested as indicating earlier Varanus. The paleobiogeographic history of Varanus and timing for origin of its gigantism remain uncertain. METHODOLOGY/PRINCIPAL FINDINGS: A new Varanus from the Mytilini Formation (Turolian, Miocene of Samos, Greece is described. The holotype consists of a partial skull roof, right side of a braincase, partial posterior mandible, fragment of clavicle, and parts of six vertebrae. A cladistic analysis including 83 taxa coded for 5733 molecular and 489 morphological characters (71 previously unincluded demonstrates that the new fossil is a nested member of an otherwise exclusively East Asian Varanus clade. The new species is the earliest-known giant (>600 mm PCL terrestrial lizard. Importantly, this species co-existed with a diverse continental mammalian fauna. CONCLUSIONS/SIGNIFICANCE: The new monitor is larger (longer than 99% of known fossil and living lizards. Varanus includes, by far, the largest limbed squamates today. The only extant non-snake squamates that approach monitors in maximum size are the glass-snake Pseudopus and the worm-lizard Amphisbaena. Mosasauroids were larger, but exclusively marine, and occurred only during the Late Cretaceous. Large, extant, non-Varanus, lizards are limbless and/or largely isolated from mammalian competitors. By contrast, our new Varanus achieved gigantism in a continental environment populated by diverse eutherian mammal competitors.

  17. Repair Ununited Clavicular Fracture with Pectoralis Major Periosteal Flap Anatomic Studies%带胸大肌蒂锁骨膜瓣转位治疗锁骨骨折不愈合的解剖学研究

    Institute of Scientific and Technical Information of China (English)

    孙强; 梁庆晨; 郑加法

    2012-01-01

    Objective With pectoralis major periosteal flap transposition treating clavicular fracture nonunion to provide the anatomical basis. Methods In 10 cadavers pectoralis muscle,we observe the clavicular part of greater pectoral muscle. Repair ununited clavicular fracture with pectoralis major periosteal flap is a new method designed by ourselves. Results Deltoid muscle artery which is from thoracoacromial artery support the clavicular part of greater pectoral muscle. Deltoid muscle artery separate 1 - 3 root artery enter the clavicular part of greater pectoral muscle,and support collarbone periosteal vessels. Conclusion Repair ununited clavicular fracture with pectoralis major periosteal flap is a new operation method,which is based on the anatomical characteristics of clavicle and pectoralis muscle.%目的 为带胸大肌蒂锁骨膜瓣转位治疗锁骨骨折不愈合提供解剖学基础.方法 观测10例成人上肢标本胸大肌锁骨部解剖学形态,设计带胸大肌蒂锁骨膜瓣转位治疗锁骨骨折不愈合的新术式.结果 胸大肌锁骨部血供主要来自胸肩峰动脉三角肌支,进入三角肌前发出1~3支进入锁骨部,并参与锁骨骨膜血管的形成.结论 胸大肌蒂锁骨的解剖学研究为该部位的相关手术操作提供了必要的解剖学数据.根据胸大肌锁骨部的解剖特点设计带胸大肌蒂锁骨膜瓣治疗锁骨骨折不愈合的新术式.

  18. Osseous manifestations of SAPHO (synovitis, acne, pustulosis, hyperostosis, osteitis) syndrome.

    Science.gov (United States)

    Reith, J D; Bauer, T W; Schils, J P

    1996-11-01

    The SAPHO (synovitis, acne, pustulosis, hyperostosis, and osteitis) syndrome includes a complex group of disorders characterized by peculiar bone lesions, most commonly involving the anterior chest wall, and sometimes accompanied by dermatologic manifestations. The clinical and radiographic features of this syndrome are well described, but few studies have examined the histologic features of the bone lesions. We describe the clinical, radiographic, and histologic features of the osseous lesions encountered in eight patients with a clinical diagnosis of SAPHO syndrome. The patients included five female and three male patients ranging in age from 5 to 63 years (mean, 35.3 years). The most common clinical presentation was pain related to the sites of osseous involvement. Two patients also had some form of pustular dermatosis. The radiographic features of the osseous lesions varied but often suggested the possibility of a neoplasm. Nine pathologic specimens were available for review, five from the clavicle, two from the first rib, one from the calcaneus/cuboid, and one from the tibia. The histologic features varied but seemed related to the duration of the patients' musculoskeletal symptoms. Early lesions contained acute inflammation, edema, and prominent periosteal bone formation, histologically indistinguishable from ordinary bacterial osteomyelitis, whereas late lesions demonstrated markedly sclerotic bone trabeculae with prominent marrow fibrosis and only mild chronic inflammation; one of these biopsies appeared virtually identical to Paget's disease. One biopsy was performed after an intermediate duration of symptoms and contained prominent chronic inflammation only. The histologic findings in SAPHO are variable and nonspecific and may depend on the duration of disease, but it is important to recognize the spectrum of histologic changes possible in the syndrome and to realize that clinicopathologic correlation is necessary to avoid misdiagnosis and unnecessary

  19. Role of locking plates in treatment of difficult ununited fractures: a clinical study

    Institute of Scientific and Technical Information of China (English)

    Ashok Kumar; Himanshu Gupta; Chandra Shekhar Yadav; Shah Alam Khan; Shishir Rastogi

    2013-01-01

    Objective:To present our experience in treatment of difficult ununited long bone fractures with locking plate.Methods:Retrospective evaluation of locking plate fixation in 10 difficult nonunions of long bone fractures was done.Fixation was done with locking plate for femoral shaft fracture (3 patients),supracondylar fracture of femur (gap nonunion),fracture of clavicle,fracture of both forearm bones (radius and ulna) fracture of ulna,fracture of shaft of humerus,fracture of tibial diaphysis and supracondylar fracture of humerus (one patient each).Five fractures had more than one previous failed internal fixation.One patient had infected nonunion which was managed by debridement with cast immobilization followed by fixation with locking plate at six weeks.Seven fractures were atrophic,two were oligotrophic,and one was hypertrophic.Fibular autograft was used in 2 cases and iliac crest cancellous bone graft used in all the patients.Results:Minimum follow-up was 6 months (range,6 months to 2.5 years).Average rime for union was 3.4 months (range 2.5 to 6 months).None of the patients had platerelated complications or postoperative wound infections.Conclusion:Along with achieving stability with locking compression plate,meticulous soft tissue dissection,acceptable reduction,good fixation technique and bone grafting can help achieve union in difficult nonunion cases.Though locking plate does not by itself ensure bony union,we have found it to be another useful addition to our armamentarium for treating difficult fracture nonunions.

  20. Diagnostic value of whole-body low-dose computed tomography (WBLDCT) in bone lesions detection in patients with multiple myeloma (MM)

    Energy Technology Data Exchange (ETDEWEB)

    Ippolito, Davide, E-mail: davide.atena@tiscalinet.it [School of Medicine, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza (MB) (Italy); Department of Diagnostic Radiology, H. San Gerardo, Via Pergolesi 33, 20900 Monza (MB) (Italy); Besostri, Valeria, E-mail: valeriabesostri@gmail.com [School of Medicine, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza (MB) (Italy); Department of Diagnostic Radiology, H. San Gerardo, Via Pergolesi 33, 20900 Monza (MB) (Italy); Bonaffini, Pietro Andrea, E-mail: pa.bonaffini@gmail.com [School of Medicine, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza (MB) (Italy); Department of Diagnostic Radiology, H. San Gerardo, Via Pergolesi 33, 20900 Monza (MB) (Italy); Rossini, Fausto, E-mail: valeriabesostri@hotmail.it [Department of Hematology, H. San Gerardo, Via Pergolesi 33, 20900 Monza (MB) (Italy); Di Lelio, Alessandro, E-mail: valebeso@libero.it [Department of Diagnostic Radiology, H. San Gerardo, Via Pergolesi 33, 20900 Monza (MB) (Italy); Sironi, Sandro, E-mail: sandrosironi@libero.it [School of Medicine, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza (MB) (Italy); Department of Diagnostic Radiology, H. San Gerardo, Via Pergolesi 33, 20900 Monza (MB) (Italy)

    2013-12-01

    Purpose: To assess the role of whole-body low-dose computed tomography (WBLDCT) in the diagnosis and staging of patients with suspicion of multiple myeloma (MM). Materials and methods: A total of 138 patients (76 male and 62 female; mean age 63.5 years, range 50–81 years), with early MM, underwent WBLDCT protocol study, performed on 16-slice scanner (Brilliance, Philips Medical System, Eindhoven, The Netherlands): tube voltage 120 kV; tube current time product 40 mAs. Diagnosis of osteolytic lesions was performed on the basis of axial and multiplanar reformatted images, whereas the assessment of spinal misalignment and fracture was done by using multiplanar reformatted images. The overall dose delivered to each patient was 4.2 mSv. Every patient gave personal informed consent, as required by our institution guidelines. Results: The diagnosis was established either by histopathology or imaging follow-up (size increase of over a period time). In all 138 patients, image resolution was diagnostic, enabling correct classification of multiple myeloma patients. WBLDCT showed a total of 328 pathologic bone findings in 81/138 patients. CT scanning resulted in complete evaluation of the bone lesions in these areas of the skeleton: skull (42), humerus (15), femur (20), ribs (7), scapulae (13), pelvis (35), clavicle (13), sternum (10), cervical (39), dorsal (65), lombar (48) and sacral rachis (21). In 40/81 bone involvement detected by CT was the only CRAB criterion present. Furthermore, WBLDCT demonstrated pleuro-pulmonary lesions in 20 patients (11 infective, 9 as MM localizations) and 1 renal neoplasia. Conclusion: WBLDCT, detecting bone marrow localizations and demonstrating extra-osseous findings, with a fast scanning time and high resolution images, is a reliable imaging-based tool for a proper management of MM patients.

  1. FEASIBILITY OF WHOLE BODY DIFFUSION WEIGHTED IMAGING IN DETECTING BONE METASTASIS ON 3.0T MR SCANNER

    Institute of Scientific and Technical Information of China (English)

    Xian Xu; Lin Ma; Jins-han Zhang; You-quan Cai; Bai-xuan Xu; Liu-quan Chen; Fei Sun; Xing-gao Guo

    2008-01-01

    Objective To evaluate the feasibility of whole body diffusion weighted imaging (DWI) in bone metastasis detection using bone scintigraphy as comparison.Methods Forty-five patients with malignancy history were enrolled in our study. All the patients received the whole body DWI and bone scintigraphy scan within 1 week. The magnetic resonance (MR) examination was performed on 3.0T MR scanner using embedded body coil. The images were reviewed separately by two radiologists and two nuclear medicine physicians, who were blinded to the results of the other imaging modality. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the two techniques for detecting bone metastasis were analyzed.Results A total of 181 metastatic lesions in 77 regions of 34 patients were detected by whole body DWI, and 167 metastatic lesions in 76 regions of 31 patients were identified by bone scintigraphy. The patient-based sensitivity and PPV of whole body DWI and bone scintigraphy were similar (89.5% vs. 81.6%, 97.1% vs. 91.2%), whereas, the patient-basod specificity and NPV of whole body DW1 were obviously higher than those of bone scintigraphy (85.7% vs. 57.1%, 60.0% vs. 36.4%). Ten regions negative in scintigraphy but positive in whole body DWI, mainly located in spine, pelvis, and femur; nine regions only detected by scintigraphy, mainly located in skull, sternum, clavicle, and scapula. The region-based sensitivity and specificity of whole body DWI were slightly higher than those of bone scintigraphy (89.5% vs. 88.4%, 95.6% vs. 87.6%). Conclusion Whole body DWI reveals excellent concordance with bone scintigraphy regarding detection of bone metastasis, and the two techniques are complementary for each other.

  2. The characteristic clinical symptoms of C-4 radiculopathy caused by ossification of the posterior longitudinal ligament.

    Science.gov (United States)

    Katsumi, Keiichi; Yamazaki, Akiyoshi; Watanabe, Kei; Hirano, Toru; Ohashi, Masayuki; Endo, Naoto

    2014-05-01

    Cervical radiculopathy of the C2-4 spinal nerves is a rare condition and is poorly documented in terms of clinical symptoms, hindering its detection during initial patient screening based on imaging diagnostics. The authors describe in detail the clinical symptoms and successful surgical treatment of a patient diagnosed with isolated C-4 radiculopathy. This 41-year-old man suffered from sleep disturbance because of pain behind the right ear, along the right clavicle, and at the back of his neck on the right side. The Jackson and Spurling tests were positive, with pain radiating to the area behind the patient's ear. Unlike in cases of radiculopathy involving the C5-8 spinal nerves, no loss of upper-extremity motor function was seen. Magnetic resonance imaging showed foraminal stenosis at the C3-4 level on the right side, and multiplanar reconstruction CT revealed a beak-type ossification of the posterior longitudinal ligament in the foraminal region at the same level. In the absence of intracranial lesions or spinal cord compressive lesions, the positive Jackson and Spurling tests and the C3-4 foraminal stenosis were indicative of isolated C-4 radiculopathy. Microscopic foraminotomy was performed at the C3-4 vertebral level and the ossified lesion was resected. The patient's symptoms completely resolved immediately after surgery. To the authors' knowledge, this report is the first to describe the symptomatic features of isolated C-4 radiculopathy, in a case in which the diagnosis has been confirmed by both radiological findings and surgical outcome. Based on this case study, the authors conclude that the characteristic symptoms of C-4 radiculopathy are the presence of pain behind the ear and in the clavicular region in the absence of upper-limb involvement.

  3. Actinomycefc mycetoma caused by Nocardia ninae sp.nov%Nocardia ninae sp.nov.致放线菌性足菌肿1例

    Institute of Scientific and Technical Information of China (English)

    郭芸; 樊应俊; 周晓鸿; 李文华

    2011-01-01

    报道1例Nocardia ninae致放线菌性足菌肿.女性,37岁,上胸部红斑、丘脓疱疹、结节、窦道、斑块20余年.初起于右锁骨中部,逐渐累及前胸部及颈下段,偶有轻微疼痛感.检查:颈下部、上胸部有大片红斑块,其上有散在分布的丘脓疱疹、结节、窦道和结痂,之间有条索状隆起.病理检查:见硫磺颗粒.实验室培养:两种菌生长.经16SrRNA基因全序列测序分析,两株菌分别鉴定为:表皮葡萄球菌及与Nocardia ninae OFN02.72T系统进化关系较近,相似性为98.1%的诺卡菌.诊断:Nocardia ninae 致放线菌性足菌肿.%To report a case of actinomycetic mycetoma caused by Nocardia ninae. A 37-year-old female was admitted for erythema,papulopustule, nodus, sinuses and keloidal scars in the upper thoracic wall for up to 20 years. The first lesion appeared in the middle of right clavicle, and spreaded graduately to the upper thoracic wall and lower neck, with adventitious mild pain. Erythema,papulopustules, nodus, sinuses and keloidal scars were found in the thoracic wall and neck. Sulphur grains were determined by biopsy. Staphylococcus epidermidis and Nocardia sp. , with 98.1% simlarity to Nocardia ninae OFN 02.72r was identified by sequence analysis. The final diagnosis was actinomycetic mycetoma cauesed by Nocardia ninae.

  4. Pulmonary Kaposi Sarcoma with Osseous Metastases in an Human Immunodeficiency Virus (HIV) Patient: A Remarkable Response to Highly Active Antiretroviral Therapy

    Science.gov (United States)

    Dirweesh, Ahmed; Khan, Muhammad Yasir; Hamiz, Shaikh Fawad; Karabulut, Nigahus

    2017-01-01

    Patient: Male, 34 Final Diagnosis: Pulmonary Kaposi’s sarcoma with bony metastatses Symptoms: Cough • weight loss Medication: — Clinical Procedure: — Specialty: Infectious Diseases Objective: Rare disease Background: Kaposi sarcoma (KS) is known to involve the mucocutaneous tissues and the aero-digestive tracts. In acquired immune deficiency syndrome (AIDS) patients, KS has an aggressive course and carries poor prognosis. We present a case of pulmonary KS with osseous metastases as the first presentation of human immunodeficiency virus (HIV) infection in a young male. The lesions impressively decreased in size and numbers following initiation of highly active antiretroviral therapy (HAART). Case Report: A 34-year-old heterosexual male presented with a one month history of cough and 15–20 pound weight loss within six months. Examination revealed oral thrush, decreased breath sounds and crackles on the right lower lung base. Imaging showed a large right perihilar mass with multiple lytic lesions involving thoracic and lumber vertebrae, ribs, sternum, and clavicles. Blood and sputum cultures, smears for acid fast bacilli, and a QUANTIferon gold test were all negative. He tested positive for HIV and his CD4 count was 7 cells/uL. Bronchoscopy with biopsy was unrevealing. Pathology of the right hilar mass was diagnostic of KS. Following initiation of antiretroviral therapy his condition dramatically improved; repeat chest CT scan showed marked regression of the bony and pulmonary lesions. Conclusions: The dual action of HAART on the recovery of the immune system and against human herpes virus 8 (HHV-8) may essentially cause regression of KS lesions. PMID:28216610

  5. Altered chromatin organization and SUN2 localization in mandibuloacral dysplasia are rescued by drug treatment.

    Science.gov (United States)

    Camozzi, Daria; D'Apice, Maria Rosaria; Schena, Elisa; Cenni, Vittoria; Columbaro, Marta; Capanni, Cristina; Maraldi, Nadir M; Squarzoni, Stefano; Ortolani, Michela; Novelli, Giuseppe; Lattanzi, Giovanna

    2012-10-01

    Mandibuloacral dysplasia type A (MADA) is a rare laminopathy characterized by growth retardation, craniofacial anomalies, bone resorption at specific sites including clavicles, phalanges and mandibula, mottled cutaneous pigmentation, skin rigidity, partial lipodystrophy, and insulin resistance. The disorder is caused by recessive mutations of the LMNA gene encoding for A-type lamins. The molecular feature of MADA consists in the accumulation of the unprocessed lamin A precursor, which is detected at the nuclear rim and in intranuclear aggregates. Here, we report the characterization of prelamin A post-translational modifications in MADA cells that induce alterations in the chromatin arrangement and dislocation of nuclear envelope-associated proteins involved in correct nucleo-cytoskeleton relationships. We show that protein post-translational modifications change depending on the passage number, suggesting the onset of a feedback mechanism. Moreover, we show that treatment of MADA cells with the farnesyltransferase inhibitors is effective in the recovery of the chromatin phenotype, altered in MADA, provided that the cells are at low passage number, while at high passage number, the treatment results ineffective. Moreover, the distribution of the lamin A interaction partner SUN2, a constituent of the nuclear envelope, is altered by MADA mutations, as argued by the formation of a highly disorganized lattice. Treatment with statins partially rescues proper SUN2 organization, indicating that its alteration is caused by farnesylated prelamin A accumulation. Given the major role of SUN1 and SUN2 in the nucleo-cytoskeleton interactions and in regulation of nuclear positioning in differentiating cells, we hypothesise that mechanisms regulating nuclear membrane-centrosome interplay and nuclear movement may be affected in MADA fibroblasts.

  6. Median cleft of mandible and lower lip with ankyloglossia and ectopic minor salivary gland on tongue

    Directory of Open Access Journals (Sweden)

    Rana Roshani

    2004-01-01

    Full Text Available Median cleft of lower lip and mandible is a rare anomaly. This Cleft has also been described as Cleft No. 30 of Tessier′s classification. In minor forms only lower lip is cleft. Frequently, the cleft extends into the mandibular symphysis and the tongue is attached to the cleft alveolar margin. At times the tongue may be bifid or absent, hyoid absent, thyroid cartilage underdeveloped, strap muscles atrophic, manubrium sterni absent, clavicles widely spaced etc. The earliest report of this anomaly was by Couronne′ in 1819. Since then very few cases have been reported in literature with variations. We describe a male child who presented at the age of 6 months with an ectopic salivary gland on the dorsum of the tongue in addition to median cleft of lower lip, ankyloglossia and notching of the mandible. Excision of mass on dorsum of tongue, release of ankyloglossia and lip from the alveolus followed by repair was done. No bony work was done since the mandible was only notched. On post-operative follow-up at 18 months, dentition was delayed in both maxillary as well as mandibular teeth and there was a gap between the lower central incisors. At the age of 2 years 4 months, the dentition is still not complete and the gap between the lower central incisors is very apparent. There is a supernumerary upper central incisor on right side. There is no mobility between the two segments of mandible. Speech is normal. A regular follow-up will be done to study the eruption of permanent central incisors at the age of 7 years and till eruption of all permanent teeth to assess the occlusion and to decide whether any bony work is needed or not.

  7. Perinatal and maternal outcomes in planned home and obstetric unit births in women at ‘higher risk’ of complications: secondary analysis of the Birthplace national prospective cohort study

    Science.gov (United States)

    Li, Y; Townend, J; Rowe, R; Brocklehurst, P; Knight, M; Linsell, L; Macfarlane, A; McCourt, C; Newburn, M; Marlow, N; Pasupathy, D; Redshaw, M; Sandall, J; Silverton, L; Hollowell, J

    2015-01-01

    Objective To explore and compare perinatal and maternal outcomes in women at ‘higher risk’ of complications planning home versus obstetric unit (OU) birth. Design Prospective cohort study. Setting OUs and planned home births in England. Population 8180 ‘higher risk’ women in the Birthplace cohort. Methods We used Poisson regression to calculate relative risks adjusted for maternal characteristics. Sensitivity analyses explored possible effects of differences in risk between groups and alternative outcome measures. Main outcome measures Composite perinatal outcome measure encompassing ‘intrapartum related mortality and morbidity’ (intrapartum stillbirth, early neonatal death, neonatal encephalopathy, meconium aspiration syndrome, brachial plexus injury, fractured humerus or clavicle) and neonatal admission within 48 hours for more than 48 hours. Two composite maternal outcome measures capturing intrapartum interventions/adverse maternal outcomes and straightforward birth. Results The risk of ‘intrapartum related mortality and morbidity’ or neonatal admission for more than 48 hours was lower in planned home births than planned OU births [adjusted relative risks (RR) 0.50, 95% CI 0.31–0.81]. Adjustment for clinical risk factors did not materially affect this finding. The direction of effect was reversed for the more restricted outcome measure ‘intrapartum related mortality and morbidity’ (RR adjusted for parity 1.92, 95% CI 0.97–3.80). Maternal interventions were lower in planned home births. Conclusions The babies of ‘higher risk’ women who plan birth in an OU appear more likely to be admitted to neonatal care than those whose mothers plan birth at home, but it is unclear if this reflects a real difference in morbidity. Rates of intrapartum related morbidity and mortality did not differ statistically significantly between settings at the 5% level but a larger study would be required to rule out a clinically important difference between

  8. [Treatment Strategies for Septic Arthritis of the Sternoclavicular Joint].

    Science.gov (United States)

    Kuhtin, O; Schmidt-Rohlfing, B; Dittrich, M; Lampl, L; Hohls, M; Haas, V

    2015-10-01

    Septic arthritis of the sternoclavicular joint (SCJ) is a relatively rare disease. Due to serious complications including mediastinitis and generalised sepsis early diagnosis and rapid onset of treatment are mandatory. The disease often affects immunocompromised patients, diabetics, or patients with other infectious diseases. The therapeutic options range from administration of antibiotics to extended surgery including reconstructive procedures. Apart from rare situations where conservative treatment with antibiotics is sufficient, joint resection followed by plastic surgical procedures are required. We present a retrospective analysis with data from two hospitals. From January 2008 to December 2012 23 patients with radiographically confirmed septic arthritis of various aetiology were included. Fourteen (60.8 %) male, nine (39.2 %) female patients with an average age of 60.3 ± 14.2 years (range: 23-88 years) with septic arthritis of the SCJ were treated. Seven (30.4 %) patients suffered from Diabetes mellitus, nine (39.1 %) had underlying diseases with a compromised immune system. In 14 (60.8 %) out of 23 patients a bacterial focus was detected. Only six (26 %) patients suffered from confined septic arthritis of the SCG, in 17 (73,9 %) patients osteomyelitis of the adjacent sternum, and the clavicle was present. In addition, 15 (65.2 %) patients already suffered from mediastinitis at the time of diagnosis, eight (35 %) patients even from septicaemia. In conclusion, septic arthritis requires an active surgical treatment. Limited incision of the joint and debridement alone is only successful at early stages of the disease. The treatment concept has to include the local joint and bone resection as well as complications like mediastinitis. After successful treatment of the infection, the defect of the chest wall requires secondary reconstructive surgery using a pedicled pectoralis muscle flap.

  9. 解剖型锁定钢板外固定治疗锁骨骨髓炎%Usage of anatomic locking plate as an external fixator for the treatment of clavicular osteomyelitis

    Institute of Scientific and Technical Information of China (English)

    叶文斌; 翟文亮; 丁真奇

    2011-01-01

    目的 探讨解剖型锁定钢板治疗锁骨骨髓炎的效果.方法 对14例锁骨骨髓炎患者进行病灶清除、灌洗,解剖型锁定钢板外固定治疗.根据ASES系统对肩关节功能进行综合评价.结果 14例均获随访,时间6~23(10±2.5)个月.均获得良好的愈合.肩关节功能评分平均为91.3分±3.2分.结论 解剖型锁定钢板可提供良好的外固定,用于锁骨骨髓炎病灶清除后固定确实、可行.%Objective To evaluate the effects of anatomic locking plate as an external fixator for the treatment of clavicular osteomyelitis.Methods 14 patients who had clavicular osteomyelitis and partially bone defect were treated by focus clearance and locking plate external fixation.At the last follow up, the shoulder function was evaluated according to the ASES system.Results Each of 14 patients ohtained healing, and was followed up for 6 ~ 23 months on average of( 10 ±2.5 ) months.and the average ASES score was ( 91.3 ±3.2 ).Conclusions It proves an excellent way hy using of anatomic locking plate as external fixation for clavicle osteomyelitis.

  10. Anatomical description and morphometry of the skeleton of the common marmoset (Callithrix jacchus).

    Science.gov (United States)

    Casteleyn, C; Bakker, J; Breugelmans, S; Kondova, I; Saunders, J; Langermans, J A M; Cornillie, P; Van den Broeck, W; Van Loo, D; Van Hoorebeke, L; Bosseler, L; Chiers, K; Decostere, A

    2012-04-01

    Callithrix jacchus (common marmoset) is regularly used in biomedical research, including for studies involving the skeleton. To support these studies, skeletons of healthy animals that had been euthanized for reasons not interfering with skeletal anatomy were prepared. The marmoset dental formula 2I-1C-3P-2M of each oral quadrant is atypical for New World monkeys which commonly possess a third molar. Seven cervical, 12-13 thoracic, 7-6 lumbar, 2-3 sacral and 26-29 caudal vertebrae are present, the thoracolumbar region always comprising 19 vertebrae. A sigmoid clavicle connects the scapula with the manubrium of the sternum. Depending on the number of thoracic vertebrae, 4-5 sternebrae are located between the manubrium and xiphoid process. Wide interosseous spaces separate the radius from the ulna, and the tibia from the fibula. A small sesamoid bone is inserted in the m. abductor digiti primi longus at the medial border of the carpus, a pair of ovoid sesamoid bones is located at the palmar/plantar sides of the trochleae of each metapodial bone, and round fabellae articulate with the proximal surfaces of the femoral condyles. Male marmosets possess a small penile bone. Both the front and hind feet have five digits. The hallux possesses a flat nail, whereas all other digits present curved claws. Interestingly, a central bone is present in both the carpus and tarsus. This study provides a description and detailed illustrations of the skeleton of the common marmoset as an anatomical guide for further biomedical research.

  11. BiPOD Arthroscopic Acromioclavicular Repair Restores Bidirectional Stability.

    Science.gov (United States)

    De Beer, Joe; Schaer, Michael; Latendresse, Kim; Raniga, Sumit; Moor, Beat K; Zumstein, Matthias A

    2016-09-19

    Stabilizing the acromioclavicular joint in the vertical and horizontal planes is challenging, and most current techniques do not reliably achieve this goal. The BiPOD repair is an arthroscopically assisted procedure performed with image intensifier guidance that reconstructs the coracoclavicular ligaments as well as the acromioclavicular ligaments to achieve bidirectional stability. Repair is achieved with a combination of 2-mm FiberTape (Arthrex, Naples, Florida) and 20-mm Poly-Tape (Neoligaments, Leeds, England) to achieve rigid repair, prevent bone abrasion, and promote tissue ingrowth. This study is a prospective review of the first 6 patients treated for high-grade acute acromioclavicular injury with the BiPOD technique. The study included 6 men who were 21 to 36 years old (mean, 27 years). At 6-month follow-up, complications were recorded and radiographic analysis was used to determine the coracoclavicular distance for vertical reduction and the amount of acromioclavicular translation on the Alexander axillary view was used to determine horizontal reduction. One patient had a superficial infection over the tape knot. The difference in coracoclavicular distance between the operated side and the uninvolved side was 9±2 mm preoperatively and 0.3±2 mm at 6-month follow-up. On Alexander axillary view, all 6 patients showed stable reduction, which is defined as a clavicle that is in line with the acromion. The findings show that BiPOD acromioclavicular reconstruction restores bidirectional stability of the acromioclavicular joint at 6 months. [Orthopedics. 201x; xx(x):exx-exx.].

  12. Healing patterns of clavicular birth injuries as a guide to fracture dating in cases of possible infant abuse

    Energy Technology Data Exchange (ETDEWEB)

    Walters, Michele M.; Forbes, Peter W.; Buonomo, Carlo; Kleinman, Paul K. [Boston Children' s Hospital, Department of Radiology, Boston, MA (United States)

    2014-10-15

    Dating fractures is critical in cases of suspected infant abuse. There are little scientific data to guide radiologists, and dating is generally based on personal experience and conventional wisdom. Since birth-related clavicular fractures are not immobilized and their age is known, we propose that an assessment of these injuries may serve as a guide for dating inflicted fractures in young infants, acknowledging that patterns observed in the clavicle may not be entirely generalizable to other bones injured in the setting of abuse. One hundred thirty-one radiographs of presumed birth-related clavicular fractures in infants between 0 and 3 months of age were reviewed by two pediatric radiologists with 30 and 15 years' experience. Readers were asked to evaluate images based on several parameters of fracture healing, with a focus on subperiosteal new bone formation (SPNBF) and callus formation. SPNBF and callus were each evaluated with regard to presence, thickness and character. Responses were correlated with known fracture ages. SPNBF was rarely seen in fractures less than 7 days old and was most often present by 10 days. Callus formation was rarely seen in fractures less than 9 days old and was most often present by 15 days. SPNBF thickness increased with fracture age and the character of SPNBF evolved from single-layered to solid/multilayered. Callus thickness decreased with fracture age and callus matrix evolved from soft to intermediate to hard in character. There is an evolution in clavicular fracture healing in young infants that follows a predictable pattern. These findings afford the prospect that predictable patterns of infant clavicular fracture healing can provide an evidence base that may be applicable in cases of suspected infant abuse. (orig.)

  13. [Radiographic manifestations in teeth and jaws in chronic kidney insufficiency].

    Science.gov (United States)

    Scutellari, P N; Orzincolo, C; Bedani, P L; Romano, C

    1996-10-01

    Forty-five patients affected with chronic renal failure (29 men and 16 women; mean age: 47.8 years), treated with hemodialysis for 4 to 245 months (mean: 66.9 months) were examined with panoramic and skeletal radiographs-the latter of the skull, hands, shoulders and clavicles, pelvis and spine. The control group (45 subjects with no renal diseases) was examined only with panoramic radiography. Dental and skeletal radio-graphs were given an 0-6 score and then compared to assess a possible relationship between skeletal and dental changes at radiography. Twenty-six dialysis patients (57.7%) had radiographic abnormalities in the maxillary bones-i.e., osteoporosis (100% of patients), focal osteosclerosis adjacent to the roots (11.5%), lamina dura reduction or loss (26.9%), calcifications of soft tissues or salivary glands (15.3%) and brown tumors (7.6%). In the teeth of dialysis patients, the dental pulp chamber was narrowed in 11.1% and hypercementosis of the roots was observed in 4.5%. Radiographic abnormalities in the hand, shoulder and pelvis were depicted in 51.1% of dialysis patients-in 86.9% of them with maxillary lesions. In the control group, 15.5% had mandibular bone lesions-i.e., osteopenia, cortex reduction at the mandibular angles and cyst-like lesions -but the evidence of caries and periodontal disease did not differ from that in the dialysis group. The diagnosis and follow-up of dialysis patients are currently made with serum biochemistry, radiography and histology. The purpose of skeletal radiology is to monitor the progression or regression of musculoskeletal abnormalities. Panoramic radiography might be useful in monitoring renal osteodystrophy, especially to assess the response to therapy-i.e., parathyroidectomy, calcium or vitamin-D therapy and renal transplant.

  14. New insight on FGFR3-related chondrodysplasias molecular physiopathology revealed by human chondrocyte gene expression profiling.

    Directory of Open Access Journals (Sweden)

    Laurent Schibler

    Full Text Available Endochondral ossification is the process by which the appendicular skeleton, facial bones, vertebrae and medial clavicles are formed and relies on the tight control of chondrocyte maturation. Fibroblast growth factor receptor (FGFR3 plays a role in bone development and maintenance and belongs to a family of proteins which differ in their ligand affinities and tissue distribution. Activating mutations of the FGFR3 gene lead to craniosynostosis and multiple types of skeletal dysplasia with varying degrees of severity: thanatophoric dysplasia (TD, achondroplasia and hypochondroplasia. Despite progress in the characterization of FGFR3-mediated regulation of cartilage development, many aspects remain unclear. The aim and the novelty of our study was to examine whole gene expression differences occurring in primary human chondrocytes isolated from normal cartilage or pathological cartilage from TD-affected fetuses, using Affymetrix technology. The phenotype of the primary cells was confirmed by the high expression of chondrocytic markers. Altered expression of genes associated with many cellular processes was observed, including cell growth and proliferation, cell cycle, cell adhesion, cell motility, metabolic pathways, signal transduction, cell cycle process and cell signaling. Most of the cell cycle process genes were down-regulated and consisted of genes involved in cell cycle progression, DNA biosynthesis, spindle dynamics and cytokinesis. About eight percent of all modulated genes were found to impact extracellular matrix (ECM structure and turnover, especially glycosaminoglycan (GAG and proteoglycan biosynthesis and sulfation. Altogether, the gene expression analyses provide new insight into the consequences of FGFR3 mutations in cell cycle regulation, onset of pre-hypertrophic differentiation and concomitant metabolism changes. Moreover, impaired motility and ECM properties may also provide clues about growth plate disorganization. These

  15. Negative pressure pulmonary oedema: an alarming complication of general anaesthesia in a young healthy male

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    Luis M. Afonso

    2016-12-01

    Full Text Available Negative pressure pulmonary oedema is a rare but potentially harmful event[1,3]. The mechanisms of this pulmonary injury are not totally understood. It is believed that airway obstruction, as caused by laryngospasm after extubation, combined with the attempt of a forced inspiring effort, produce a negative intrathoracic pressure, increasing the venous return with a consequent rise of the hydrostatic pressure, ultimately leading to a leakage of fluid to the extracellular compartment. Nevertheless, it is possible that other factors may contribute to this condition, including hypoxia, cardiogenic and neurogenic mechanisms[2]. We present the case of a healthy 20-years-old male, who underwent a deferred left clavicle osteosynthesis. Immediately after surgery, the patient developed irritative cough and marked dyspnoea. There were no auscultatory anomalies and the plain chest radiograph was normal. He did not show clinical improvement after increasing oxygen supply and bronchodilators, and was then transferred to our hospital for further evaluation. A thoracic Computed Tomography (CT scan was performed (figure 1, revealing multiple areas of ground glass aspect and alveolar filling with centrilobular distribution, suggesting alveolar haemorrhage. The patient remained under observation for 48 hours, with clear signs of clinical improvement and no further complications, with no need for positive pressure ventilation. He was discharged being asymptomatic and with no signs of respiratory distress, after a control CT scan showing radiologic improvement. This case highlights the need to be aware of this diagnosis, that is usually self-limited but can be life-threatening and require specific treatment.

  16. The yield of high-detail radiographic skeletal surveys in suspected infant abuse

    Energy Technology Data Exchange (ETDEWEB)

    Barber, Ignasi [Hospital Vall d' Hebron, Universitat Autonoma de Barcelona, Pediatric Radiology Department, Barcelona (Spain); Perez-Rossello, Jeannette M.; Kleinman, Paul K. [Boston Children' s Hospital, Radiology Department, Boston, MA (United States); Wilson, Celeste R. [Boston Children' s Hospital, Division of General Pediatrics, Boston, MA (United States)

    2014-07-06

    Skeletal surveys are routinely performed in cases of suspected child abuse, but there are limited data regarding the yield of high-detail skeletal surveys in infants. To determine the diagnostic yield of high-detail radiographic skeletal surveys in suspected infant abuse. We reviewed the high-detail American College of Radiology standardized skeletal surveys performed for suspected abuse in 567 infants (median: 4.4 months, SD 3.47; range: 4 days-12 months) at a large urban children's hospital between 2005 and 2013. Skeletal survey images, radiology reports and medical records were reviewed. A skeletal survey was considered positive when it showed at least one unsuspected fracture. In 313 of 567 infants (55%), 1,029 definite fractures were found. Twenty-one percent (119/567) of the patients had a positive skeletal survey with a total of 789 (77%) unsuspected fractures. Long-bone fractures were the most common injuries, present in 145 children (26%). The skull was the site of fracture in 138 infants (24%); rib cage in 77 (14%), clavicle in 24 (4.2%) and uncommon fractures (including spine, scapula, hands and feet and pelvis) were noted in 26 infants (4.6%). Of the 425 infants with neuroimaging, 154 (36%) had intracranial injury. No significant correlation between positive skeletal survey and associated intracranial injury was found. Scapular fractures and complex skull fractures showed a statistically significant correlation with intracranial injury (P = 0.029, P = 0.007, respectively). Previously unsuspected fractures are noted on skeletal surveys in 20% of cases of suspected infant abuse. These data may be helpful in the design and optimization of global skeletal imaging in this vulnerable population. (orig.)

  17. Surgical correction of unsuccessful derotational humeral osteotomy in obstetric brachial plexus palsy: Evidence of the significance of scapular deformity in the pathophysiology of the medial rotation contracture

    Directory of Open Access Journals (Sweden)

    Melcher Sonya E

    2006-12-01

    Full Text Available Abstract Background The current method of treatment for persistent internal rotation due to the medial rotation contracture in patients with obstetric brachial plexus injury is humeral derotational osteotomy. While this procedure places the arm in a more functional position, it does not attend to the abnormal glenohumeral joint. Poor positioning of the humeral head secondary to elevation and rotation of the scapula and elongated acromion impingement causes functional limitations which are not addressed by derotation of the humerus. Progressive dislocation, caused by the abnormal positioning and shape of the scapula and clavicle, needs to be treated more directly. Methods Four patients with Scapular Hypoplasia, Elevation And Rotation (SHEAR deformity who had undergone unsuccessful humeral osteotomies to treat internal rotation underwent acromion and clavicular osteotomy, ostectomy of the superomedial border of the scapula and posterior capsulorrhaphy in order to relieve the torsion developed in the acromio-clavicular triangle by persistent asymmetric muscle action and medial rotation contracture. Results Clinical examination shows significant improvement in the functional movement possible for these four children as assessed by the modified Mallet scoring, definitely improving on what was achieved by humeral osteotomy. Conclusion These results reveal the importance of recognizing the presence of scapular hypoplasia, elevation and rotation deformity before deciding on a treatment plan. The Triangle Tilt procedure aims to relieve the forces acting on the shoulder joint and improve the situation of the humeral head in the glenoid. Improvement in glenohumeral positioning should allow for better functional movements of the shoulder, which was seen in all four patients. These dramatic improvements were only possible once the glenohumeral deformity was directly addressed surgically.

  18. Anatomic research on the transposition of accessory nerve to phrenic nerve%副神经移位膈神经的人体解剖学研究

    Institute of Scientific and Technical Information of China (English)

    王策; 袁文; 周许辉; 王新伟; 史升; 徐贵青; 吴国新; 薄音

    2010-01-01

    Objective To comprehend the anatomic characteristics and correlations between the accessory nerve and the phrenic nerve in the adult corpses. Methods The bilateral accessory nerves,phrenic nerves, and their branches of 20 adult corpses (38 sides ) were underwent exposure. The morphologic data of the accessory nerves and the phrenic nerves above clavicle were measured. In addition,the minimal and maximal distances from several points on the accessory nerve to the full length of the phrenic nerve above clavicle were measased. Then, the number of motor nerve fibers on different locations of the nerves utilizing the method of immunohistochemistry were counted and compared. Result The accessory nerves after sending out the sternocleido-mastoid muscular branches were similar in the morphologic data with the phrenic nerves. Meanwhile, the accessory nerve had a coiled appearance within this geometrical area.The possibly minimal distance between the accessory nerve and phrenic nerve was (3.19±1.23) cm, and the possibly maximal distance between the starting point of accessory nerve and the end of the phrenic nerve above clavicle was (8.71±0.75) cm. Conclusions The accessory nerve and the phrenic nerve are similar in the anatomic evidences and the number of motor nerve fibers. And the length of accessory nerve is sufficiently long to connect with phrenic nerve as needed. It is possible to suture them without strain directly.%目的 了解副神经及膈神经的解剖特点、位置关系及内部运动神经纤维含量,为副神经移位膈神经重建高位颈髓损伤后患者呼吸功能提供解剖学依据.方法 选取20具(38侧)福尔马林固定的成人尸体标本,解剖并观察副神经、膈神经的走形特点,测量副神经及膈神经的长、宽及厚度,副神经舌骨水平至膈神经颈部起点及终点的距离.利用免疫组化方法对膈神经及副神经不同位置进行切片染色,对比纤维含量.结果 副神经发出胸锁乳突

  19. 不同上肢体位对正常人和青少年特发性脊柱侧凸患者站立位脊柱矢状面形态的影响%The influence of different arm position on the spinal sagittal profile in normal adolescents and adolescent idiopathic scoliosis

    Institute of Scientific and Technical Information of China (English)

    殷刚; 邱勇; 孙旭; 王斌; 朱锋

    2008-01-01

    obtained from standing lateral radiographs in two different standing positions:alms forward to 90° with elbows fully flexed versus elbows fully flexed with fists resting on clavicles.The following parameters were measured:(1)Distance parameters:distance between T1 and C7PL,distance between thoracic kyphosis apex and C7PL,distance between L1 and C7PL,distance between lumbar lordosis apex and C7PL,SVA;(2)Angle parameters:T2-5,T5-12,T10-L2,T1-12,L1-S1,upper arc of kyphosis,lower arc of kyphosis,upper arc of lordosis,lower arc of lordosis;(3)Pelvic parameters:pelvic tilt,sacral slope,pelvic incidence.Sagittal plane parameters were analyzed using paired-t test between AIS group and the control group in different arm position.Results In AIS group and the control group,there were more negative SVA,smaller distance between C7 plumb line and apex lumbar lordosis,and minor upper arc of thoracic kyphosis when the ams were in the forward flexed position compared to the fists on clavicles position.Meanwhile,the lower arc of thoracic kyphosis and upper arc of lumbar lordosis were bigger.In AIS group,there were larger lumbar lordosis,sinaller distance between C7 plumb line and the thoracic kyphosis apex and smaller distance between C7 plumb line and L1 when the arms were in the forward flexed position.Conclusion The status on clavicles position for lateral radiograph is more representative of the patient's functional balance with adequate lateral radiographic visualization of the spine.

  20. Transplantation of autogenous palmaris longus tendon combined with suture anchor fixation in the treatment of aromioclavicular dislocations%自体掌长肌移植重建喙锁韧带结合带线锚钉固定治疗肩锁关节脱位的疗效

    Institute of Scientific and Technical Information of China (English)

    罗吉伟; 余斌; 魏宽海; 覃承诃; 胡岩君

    2014-01-01

    Background Clinically,acromioclavicular dislocation is a common disease.Whether surgical treatment should be taken or not depends on the type and degree of the inj ury,as well as the symptoms,ages,occupation,exercise requirements,and other factors of patients.Acromioclavicular dislocation can be classified as six types (degrees)according to Rockwood.The injury with obvious symptoms above Ⅲ degree is generally considered as an important operation indication.The key point in the surgical treatment of acromioclavicular dislocation is to select appropriate methods for the acromioclavicular joint fixation after reduction.There are many choices of the internal fixation to fix the acromioclavicular joint,such as the Kirschner wire and tension band,the clavicular hook plate or anatomical plate for the coracoclavicular joint fixation,and the cannulated screws,steel wires or suture anchors for the coracoclavicular fixation.The selection of these fixations can be combined with debridement of the acromioclavicular joint,the distal clavicle resection,or stitching and reconstruction of the coracoclavicular ligament.Most of these surgical procedures have obtained better results. However,the internal fixation failure,displacement or dislocation after the fixation removal sometimes happened.Considering that the coracoclavicular ligament plays an important role for the acromioclavicular joint stability,researchers has gradually paid more attentions to the reconstruction of the coracoclavicular ligament recently.The repair methods include the direct suture,the partial ligament displacement,the autologous tendon graft,and the tendon graft transplantation.We chose a simple,less traumatic method for the acromioclavicular dislocations,which is autogenous palmaris longus muscle transplant combined with the suture anchor fixation,and achieved satisfactory results. Methods (1)General information:A total of 30 cases aged from 17 to 55 years (mean 31 years)with acromioclavicular

  1. The treatment of the acute acromioclavicular joint dislocation with LARS artificial ligament:a preliminary report%应用LARS人工韧带治疗急性肩锁关节脱位的初步报告

    Institute of Scientific and Technical Information of China (English)

    陈爱民; 鹿楠; 叶添文; 杨鹏; 朱磊; 李菁

    2014-01-01

    Background Currently,the clinical perspectives of surgical treatment for Tossy Ⅲacromioclavicular(AC)joint dislocations are relatively identical.Due to the post-traumatic ruptures of the acromioclavicular ligament and coracoclavicular(CC)ligament which are used to maintain stability of the joint,the clavicle moves backward and upward,and the upper arm and the scapula drops downward for the gravity of the upper arm and the influence of the sternocleidomastoid muscle.Since such complications as reduction difficulties,redislocation after external fixation,pressure ulcers of the skin,and so forth are particularly prone to occur in the conservative therapy,the operative treatment is more inclined to be adopted for the Tossy Ⅲ dislocation of the AC joint.With the single repair and fixation of the CC ligament,redislocation is likely to happen after implant removal because the ruptured ligaments healed as scar tissue.Therefore,this study uses an operative method of reconstructing and augmenting the CC ligament with LARS artificial ligament for the treatment of Tossy Ⅲ AC joint dislocation,and evaluates its clinical effect.Methods From November 2006 to July 2009,8 patients with acute AC joint dislocation of Tossy Ⅲ were admitted into our hospital.Five patients were male and 3 were female,and their ages ranged from 21 to 45.Sides:3 injuries were on the left and 5 were on the right.Seven patients suffered from falling on the ground,and 1 patient was inj ured in a traffic accident.All the patients were treated with LARS artificial ligaments to reconstruct the CC ligament.Constant score and VAS score were adopted in clinical evaluation.Zanca view of the bilateral AC joint and the axillary radiograph of the affected shoulder joint were employed for imaging evaluation.All the patients were simple Tossy Ⅲ dislocation of AC joint with no trauma of other parts and skin breakdown.Regular pre-operative examinations and evaluations were carried out after admission,and LARS

  2. Revisão radiológica de 173 casos consecutivos de paracoccidioidomicose Radiological review of 173 consecutive cases of paracoccidioidomycosis

    Directory of Open Access Journals (Sweden)

    Henrique Simão Trad

    2006-06-01

    involvement in 41 cases, presenting small bowel, viscera, bone lesions, or a combination of these. Most significant radiological findings in cases of pulmonary involvement were bilateral, diffuse reticular and nodular interstitial infiltrate, followed by the diffuse bilateral alveolar form. Visceral and gastrointestinal tract lesions presented predominantly with liver, jejunum and ileum involvement. Lymph nodal involvement was predominantly diffuse, abdominal or peripheral. In bones, osteolytic lesions affected predominantly long bones and clavicle. CONCLUSION: Paracoccidioidomycosis is a granulomatous disease commonly found in Brazil, primarily affecting lungs, caused by inhalation of fungus spores. Other rare or less frequent forms of the disease should be taken into consideration for differential diagnosis.

  3. The Late Mediaeval Necropolis of Lăpuşna (Hânceşti County, Republic of Moldova. Preliminary Anthropological Results

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    Angela Simalcsik

    2015-10-01

    Full Text Available The osteological material was exhumed in 2013 by archaeologists from the Archaeology Department of the Cultural Heritage Institute of the Academy of Science of Moldova, in the mediaeval necropolis of Lăpuşna (Hânceşti County, Republic of Moldova. Thirty graves were fully or partially researched, the deceased having been buried lying on their backs, with the upper limbs placed on the chest or abdomen. Based on the funerary inventory (which includes six mediaeval coins, the graves were chronologically placed between the XVth and the XVIIth centuries. The cemetery belonged to a local Christian rural community. The preservation status of skeletons is satisfactory. Twenty-two human skeletons (seven males, ten females, and five children have been analyzed so far. Sex ratio in the osteological sample from Lăpuşna is subunitary, indicating a higher number of female skeletons, comparatively with the male ones. A quarter of the analysed subjects did not survive after adolescence. The maximum risk of mortality in this sample occurs during early childhood (0–7 years. 32% of deceases appear in the adultus category of age (20–30 years and 45%, respectively, in the matures one (30–60 years. Life expectancy at birth is of 30.7 years. For individuals older than 20 years, life expectancy after this age, calculated separately on sexes, was of 16 years in men and of 19 years in women. At cranial level eight nonmetric traits and only two pathologies were identified. Regarding dentition, seven nonmetric traits and six pathologies were reported. At postcranial level, 14 nonmetric traits were distinguished, most of them classified as occupational markers. The most frequent postcranial pathology is osteoarthritis; this disease is present in nine individuals. The subjects affected with osteoarthritis are mature persons. Traces of osteoarthritis appears especially in the spine, hip joint, lower limb (mainly femurs, upper limb (especially radiuses, and clavicle

  4. The Study of Pattern of Injuries in Fatal Cases of fall from Height

    Directory of Open Access Journals (Sweden)

    C.R. Vasudeva Murthy

    2012-01-01

    Full Text Available Objectives: To study the various pattern of injuries from fall from height. Background: Deaths due to fall from height, form an important area of study due to diversity of the injuries sustained, complexity of the patterns involved and various phenomenon’s associated there with. The medico-legal autopsy aims at deciding whether the death was attribute purely to the height. It also helps in ruling out the various contributing factors like drugs, alcohol and co-existing natural disease. Methods: The present study has been carried out in department of forensic medicine, M.S. Ramaiah medical college and hospital, Bangalore during the period October 2005 to May 2007, of all the cases of fall from height subjected for medico legal autopsy. Results: Fissure fracture of the skull and fracture of cervical spine was noticed when the fall occurred on to concrete from minimum height of 3 feet and on to hard soil from the height of 10 feet. Multiple rib fractures, fracture of clavicle and laceration of liver was noticed when the fall height was 7 feet on to concrete. Spleen and kidneys were damaged when height of fall was more than 20 feet on to hard surface. Fracture of upper limbs were seen in falls occurred on to concrete from height of 6 feet where as the fracture of lower limb was found when the fall height was more than 15 feet on to hard surface. Conclusion: The study of pattern of external and internal injury may together indicate the primary site of impact and height from which the fall has occurred. The determination of actual or probable anatomical site of primary impact may be useful in reconstruction of the events, which led to fatal falls. Presence of multiple blunt force injuries makes it hard to differentiate between falls induced injuries and those that have inflicted before the fall and often disagreement predominates regarding the height at which death results. Thus a careful study of total injury pattern is of vital importance in every

  5. Multifield Optimization Intensity Modulated Proton Therapy for Head and Neck Tumors: A Translation to Practice

    Energy Technology Data Exchange (ETDEWEB)

    Frank, Steven J., E-mail: sjfrank@mdanderson.org [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Cox, James D. [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Gillin, Michael; Mohan, Radhe [Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Garden, Adam S.; Rosenthal, David I.; Gunn, G. Brandon [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Weber, Randal S. [Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Kies, Merrill S. [Department of Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Lewin, Jan S. [Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Munsell, Mark F. [Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Palmer, Matthew B. [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Sahoo, Narayan; Zhang, Xiaodong; Liu, Wei; Zhu, X. Ronald [Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States)

    2014-07-15

    Background: We report the first clinical experience and toxicity of multifield optimization (MFO) intensity modulated proton therapy (IMPT) for patients with head and neck tumors. Methods and Materials: Fifteen consecutive patients with head and neck cancer underwent MFO-IMPT with active scanning beam proton therapy. Patients with squamous cell carcinoma (SCC) had comprehensive treatment extending from the base of the skull to the clavicle. The doses for chemoradiation therapy and radiation therapy alone were 70 Gy and 66 Gy, respectively. The robustness of each treatment plan was also analyzed to evaluate sensitivity to uncertainties associated with variations in patient setup and the effect of uncertainties with proton beam range in patients. Proton beam energies during treatment ranged from 72.5 to 221.8 MeV. Spot sizes varied depending on the beam energy and depth of the target, and the scanning nozzle delivered the spot scanning treatment “spot by spot” and “layer by layer.” Results: Ten patients presented with SCC and 5 with adenoid cystic carcinoma. All 15 patients were able to complete treatment with MFO-IMPT, with no need for treatment breaks and no hospitalizations. There were no treatment-related deaths, and with a median follow-up time of 28 months (range, 20-35 months), the overall clinical complete response rate was 93.3% (95% confidence interval, 68.1%-99.8%). Xerostomia occurred in all 15 patients as follows: grade 1 in 10 patients, grade 2 in 4 patients, and grade 3 in 1 patient. Mucositis within the planning target volumes was seen during the treatment of all patients: grade 1 in 1 patient, grade 2 in 8 patients, and grade 3 in 6 patients. No patient experienced grade 2 or higher anterior oral mucositis. Conclusions: To our knowledge, this is the first clinical report of MFO-IMPT for head and neck tumors. Early clinical outcomes are encouraging and warrant further investigation of proton therapy in prospective clinical trials.

  6. The clinical and radiological observation of congenital syphilis

    Energy Technology Data Exchange (ETDEWEB)

    Nah, Byung Sik; Chung, Ung Ki [Chonnam National University College of Medicine, Kwangju (Korea, Republic of)

    1983-03-15

    Congenital syphilis is transmitted through the placenta by the infected mother after 16 weeks of gestation. Since the incidence of syphilis is again on the increase, syphilis remains at the present time a public problem of major and increasing proportions. Recently, congenital syphilis has different formas of presentation. The authors observed clinically and radiologically 27 cases of congenital syphilis in the neonates and infants treated at the pediatric ward of Chonnam National University Hospital from Jan. 1977 to Mar. 1982. The results are as follows: 1. The number of observed patients was 27 cases, 22 cases in male, 5 cases in female. 2. Onset of first clinical symptoms and signs was within the 4th week life in 14 cases (52%), 1-2 months in 6 cases (22%), 2-3 months in 4 cases (15%), 3-4 months in 3 cases (11%). All cases was within 6 months. 3. The order of the frequency of common clinical manifestations was hepatomegaly (96%), splenomegaly (78%), skin lesion (63%), anemia (63%), nasal snuffle (56%). 4. Of 11 cases with known birth weight, 10 cases were low birth weight. 5. The serologic test (VDRL slide test) of 27 tested caes revealed reactive response in 26 cases, non-reactive response in 1 case, and that of syphilitic mothers except one revealed reactive in 23 cases, non- reactive in 3 cases. 6. Roentgenographic syphilitic bony changes were detected in 26 cases (96%), of 27 studied cases, osteochondritis was present in 24 cases (89%), periostitis in 21 case (78%), osteomyelitis in 11 cases (41%). 7. The most common sites affected were as follows. Radius and ulna were the most frequently affected, the next were in order of tibia and fibula. Considering osteochondiritis only, the distal end of radius and ulna (78% respectively) and proximal end of tibra (67%) were the most frequently affected sites, the proximal end of femur (33%) was least frequently affected site. 8. On chest films of 27 case, osseous changes (mainly periostitis) of clavicle were noted

  7. Age estimation in the living: Transition analysis on developing third molars.

    Science.gov (United States)

    Tangmose, Sara; Thevissen, Patrick; Lynnerup, Niels; Willems, Guy; Boldsen, Jesper

    2015-12-01

    A radiographic assessment of third molar development is essential for differentiating between juveniles and adolescents in forensic age estimations. As the developmental stages of third molars are highly correlated, age estimates based on a combination of a full set of third molar scores are statistically complicated. Transition analysis (TA) is a statistical method developed for estimating age at death in skeletons, which combines several correlated developmental traits into one age estimate including a 95% prediction interval. The aim of this study was to evaluate the performance of TA in the living on a full set of third molar scores. A cross sectional sample of 854 panoramic radiographs, homogenously distributed by sex and age (15.0-24.0 years), were randomly split in two; a reference sample for obtaining age estimates including a 95% prediction interval according to TA; and a validation sample to test the age estimates against actual age. The mean inaccuracy of the age estimates was 1.82 years (±1.35) in males and 1.81 years (±1.44) in females. The mean bias was 0.55 years (±2.20) in males and 0.31 years (±2.30) in females. Of the actual ages, 93.7% of the males and 95.9% of the females (validation sample) fell within the 95% prediction interval. Moreover, at a sensitivity and specificity of 0.824 and 0.937 in males and 0.814 and 0.827 in females, TA performs well in differentiating between being a minor as opposed to an adult. Although accuracy does not outperform other methods, TA provides unbiased age estimates which minimize the risk of wrongly estimating minors as adults. Furthermore, when corrected ad hoc, TA produces appropriate prediction intervals. As TA allows expansion with additional traits, i.e. stages of development of the left hand-wrist and the clavicle, it has a great potential for future more accurate and reproducible age estimates, including an estimated probability of having attained the legal age limit of 18 years.

  8. 64层螺旋CT在急性肺挫伤诊断中的应用价值%The Value of Applying 64 Multi-slice CT(MSCT) to the Diagnosis of Acute Pulmonary Contusion

    Institute of Scientific and Technical Information of China (English)

    殷国生; 张树桐

    2012-01-01

    目的:探讨64层螺旋CT在急性肺挫伤诊断中的应用价值。方法:收集临床怀疑肺挫伤患者461例,所有患者于入院后1 h内行64层螺旋CT胸部平扫,判断有无肺挫伤。结果:诊断肺挫伤113例,双肺广泛性挫伤12例,右肺挫伤61例,左肺挫伤40例;肺不张22例;合并气胸33例,其中血气胸10例;肋骨骨折38例,锁骨骨折4例,肩胛骨骨折2例,胸椎骨折2例,胸骨骨折1例;皮下气肿87例,纵膈积气11例,纵膈血肿3例。结论:64层螺旋CT能有效诊断肺挫伤,尤其对影像学征象较隐蔽的病变更具优势。%Objective: To explore the clinical application of 64-MS CT to acute pulmonary contusion.Methods: A retrospective study was undertaken in 461 cases who were doubted acute pulmonary clinically.They were received CT scan within one hour.Results: 113 cases were diagnosed acute pulmonay contusion including 12 cases with wide-bound pulmonary contusion in pulmones,61 cases with right lung,40 cases with left lung,22 cases with pulmonary atelectasis,33 cases with aeropleura,10 cases with hemopneumothorax,38 cases with fracture of rib,4 cases with fracture of clavicle,2 cases with fracture of shoulder blade,2 cases with thoracic vertebral fracture,1 case with fracture of sternum,87 cases with pneumoderma,11 cases with mediastinal emphesema and 3 cases with mediastinal hematoma.Conclusion: 64-MSCT can effectively diagnose acute pulmonary contusion,especially in diagnosing the larvaceous imaging signs.

  9. Análise dos indicadores de hemorragia letal em vítimas de trauma penetrante de tronco admitidas em choque: um método objetivo para selecionar os candidatos ao "controle de danos" Assessing the risk of death due to hemorrhage in victims of penetrating trauma to the torso admitted in shock: an objective method to select candidates for damage control

    Directory of Open Access Journals (Sweden)

    José Gustavo Parreira

    2002-10-01

    Full Text Available OBJETIVO: Identificar os indicadores de hemorragia letal em vítimas de trauma penetrante de tronco, admitidas com hipotensão arterial sistêmica e analisar sua aplicabilidade na seleção dos candidatos ao "controle de danos". MÉTODO: Foram analisadas informações sobre 74 vítimas de ferimentos penetrantes exclusivamente de tronco, admitidas com hipotensão arterial sistêmica secundária à hemorragia, que sobreviveram até o tratamento definitivo. Os dados foram coletados prospectivamente durante dois anos. A média etária foi 29,5 + 8 anos, e 62 (83% pacientes eram do sexo masculino. Trinta e nove (52% foram vítimas de ferimentos de instrumentos perfurocortantes e 35 (47%, de ferimentos por projéteis de arma de fogo. Houve 23 óbitos (31%, 19 por hemorragia (82,6%. Os que faleceram por hemorragia foram incluídos no grupo H e os outros no grupo O. Foram comparadas diversas variáveis entre os grupos, utilizando-se o teste t de Student (controlado pelo teste de Levene e a correlação de Spearman, considerando p1.200ml. Através de um modelo de regressão logística foi possível calcular o risco de morte por hemorragia baseado na pressão arterial no início da operação e volume de concentrados de hemácias transfundido. CONCLUSÃO: A análise dos indicadores de hemorragia letal fornece dados objetivos para a indicação do "controle de danos".OBJECTIVE: To identify predictors of death due to hemorrhage in patients sustaining penetrating trauma to the torso admitted in shock. METHOD: Data was prospectively collected from Dec 1996 until Dec 1998. Patients presenting penetrating wounds from clavicles to inguinal ligaments, admitted with a systolic blood pressure (SBP 2. CONCLUSION: The risk of death due to hemorrhage can be assessed objectively. Based in this information, the selection of the patients for damage control becomes more objective and reliable.

  10. Difference in the Set-up Margin between 2D Conventional and 3D CT Based Planning in Patients with Early Breast Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Jo, Sun Mi; Chun, Mi Sun; Kim, Mi Hwa; Oh, Young Taek; Noh, O Kyu [Ajou University School of Medicine, Seoul (Korea, Republic of); Kang, Seung Hee [Inje University, Ilsan Paik Hospital, Ilsan (Korea, Republic of)

    2010-11-15

    Simulation using computed tomography (CT) is now widely available for radiation treatment planning for breast cancer. It is an important tool to help define the tumor target and normal tissue based on anatomical features of an individual patient. In Korea, most patients have small sized breasts and the purpose of this study was to review the margin of treatment field between conventional two-dimensional (2D) planning and CT based three-dimensional (3D) planning in patients with small breasts. Twenty-five consecutive patients with early breast cancer undergoing breast conservation therapy were selected. All patients underwent 3D CT based planning with a conventional breast tangential field design. In 2D planning, the treatment field margins were determined by palpation of the breast parenchyma (In general, the superior: base of the clavicle, medial: midline, lateral: mid - axillary line, and inferior margin: 2 m below the inflamammary fold). In 3D planning, the clinical target volume (CTV) ought to comprise all glandular breast tissue, and the PTV was obtained by adding a 3D margin of 1 cm around the CTV except in the skin direction. The difference in the treatment field margin and equivalent field size between 2D and 3D planning were evaluated. The association between radiation field margins and factors such as body mass index, menopause status, and bra size was determined. Lung volume and heart volume were examined on the basis of the prescribed breast radiation dose and 3D dose distribution. The margins of the treatment field were smaller in the 3D planning except for two patients. The superior margin was especially variable (average, 2.5 cm; range, -2.5 to 4.5 cm; SD, 1.85). The margin of these targets did not vary equally across BMI class, menopause status, or bra size. The average irradiated lung volume was significantly lower for 3D planning. The average irradiated heart volume did not decrease significantly. The use of 3D CT based planning reduced the

  11. Clinical Application of New Low Temperature Filling Automatically Open Method Out of Memory Alloy Embracing Fixator%新创低温填充自动张开法取出记忆合金环抱器的临床应用

    Institute of Scientific and Technical Information of China (English)

    马志成; 秦红安; 涂明道; 邵巍; 熊延成

    2014-01-01

    Objective To evaluate the low temperature with memory al oy embracing fixator removal method to automatical y open the value of clinical application. Methods A total of 17 patients, application of TINI shape memory al oy embracing fixator 83 block, using low temperature fil ing devices automatical y spread out method. Results 17 cases of patients with TINI shape memory al oy embracing fixator 83 block, wherein the clavicle embracing 3 block, 80 block ribs embracing fixator, operation complete removal of al . Clavicular embracing fixator removed an average of ten minutes, ribs embracing fixator removed an average of two minutes, without a destructive removal. Conclusion Low temperature fil ing memory al oy embracing open automatical y remove method, the method is simple and convenient operation, does not need to be equipped with special operation equipment, does not increase the patient operation trauma, shorten operation time, reduce the risk of anesthesia and operation complications, is a good method of operation, is worth the clinical promotion.%目的:评价低温填充记忆合金环抱器自动张开取出法的临床应用价值。方法17例患者,总共应用 TINI记忆合金环抱器83块,均采用低温填充环抱器自动张开取出法。结果本组患者17例应用TINI记忆合金环抱器83块,其中锁骨环抱器3块,肋骨环抱器80块,均一次手术完全取出。锁骨环抱器取出时间平均10min,肋骨环抱器取出时间平均2min,无一块进行破坏性取出。结论低温填充记忆合金环抱器自动张开取出法,具有方法简单操作方便,不需要配备特殊手术器械,不增加患者手术创伤,大大缩短了手术时间,降低了麻醉风险及手术并发症的发生,是一种很好的手术方法,值得临床推广。

  12. SU-E-J-06: Additional Imaging Guidance Dose to Patient Organs Resulting From X-Ray Tubes Used in CyberKnife Image Guidance System

    Energy Technology Data Exchange (ETDEWEB)

    Sullivan, A; Ding, G [Vanderbilt University, Nashville, TN (United States)

    2015-06-15

    Purpose: The use of image-guided radiation therapy (IGRT) has become increasingly common, but the additional radiation exposure resulting from repeated image guidance procedures raises concerns. Although there are many studies reporting imaging dose from different image guidance devices, imaging dose for the CyberKnife Robotic Radiosurgery System is not available. This study provides estimated organ doses resulting from image guidance procedures on the CyberKnife system. Methods: Commercially available Monte Carlo software, PCXMC, was used to calculate average organ doses resulting from x-ray tubes used in the CyberKnife system. There are seven imaging protocols with kVp ranging from 60 – 120 kV and 15 mAs for treatment sites in the Cranium, Head and Neck, Thorax, and Abdomen. The output of each image protocol was measured at treatment isocenter. For each site and protocol, Adult body sizes ranging from anorexic to extremely obese were simulated since organ dose depends on patient size. Doses for all organs within the imaging field-of-view of each site were calculated for a single image acquisition from both of the orthogonal x-ray tubes. Results: Average organ doses were <1.0 mGy for every treatment site and imaging protocol. For a given organ, dose increases as kV increases or body size decreases. Higher doses are typically reported for skeletal components, such as the skull, ribs, or clavicles, than for softtissue organs. Typical organ doses due to a single exposure are estimated as 0.23 mGy to the brain, 0.29 mGy to the heart, 0.08 mGy to the kidneys, etc., depending on the imaging protocol and site. Conclusion: The organ doses vary with treatment site, imaging protocol and patient size. Although the organ dose from a single image acquisition resulting from two orthogonal beams is generally insignificant, the sum of repeated image acquisitions (>100) could reach 10–20 cGy for a typical treatment fraction.

  13. 有静脉注射海洛因病史患者30例中心静脉穿刺置管体会%Experience of central venous catheterization on 30 patients with a history of heroin injection

    Institute of Scientific and Technical Information of China (English)

    何吉飞

    2016-01-01

    目的:探讨有静脉注射海洛因病史的患者行中心静脉穿刺置管术的方法。方法:对30例有静脉注射海洛因病史的患者行中心静脉穿刺置管术。结果:30例中心静脉穿刺置管均成功,其中1次穿刺成功23例,更换部位后穿刺成功7例。穿刺部位:右侧锁骨下19例,右侧颈内8例,左侧颈内3例。结论:静脉注射海洛因患者中心静脉穿刺置管较困难,通过积累经验,充分准备,熟练操作,才能提高对该类患者中心静脉穿刺置管成功率。%Objective:To investigate the method of central venous catheterization in patients with a history of heroin injection. Methods:30 patients with a history of heroin injection were treated with central venous catheterization.Results:All of those 30 cases with central venous catheterization were successful,in which there were 23 cases successful puncture at once,another 7 cases were successful puncture after changing the puncture site.Puncture site:19 cases on the right side of the clavicle,8 cases on the right side of the neck,3 cases on the left side of the internal carotid.Conclusion:Central venous catheterization on patient with a history of intravenous injection of heroin is more difficult,need to accumulate experience,fully prepared and skilled operation,to improve the success rate of the central vein puncture catheter.

  14. Percutaneous subclavian artery stent-graft placement following failed ultrasound guided subclavian venous access

    Directory of Open Access Journals (Sweden)

    Szkup Peter

    2006-05-01

    Full Text Available Abstract Background Ultrasound guidance for central and peripheral venous access has been proven to improve success rates and reduce complications of venous cannulation. Appropriately trained and experienced operators add significantly to diminished patient morbidity related to venous access procedures. We discuss a patient who required an arterial stent-graft to prevent arterial hemorrhage following inadvertent cannulation of the proximal, ventral, right subclavian artery related to unsuccessful ultrasound guided access of the subclavian vein. Case presentation During pre-operative preparation for aortic valve replacement and aorto-coronary bypass surgery an anesthetist attempted ultrasound guided venous access. The ultrasound guided attempt to access the right jugular vein failed and the ultrasound guided attempt at accessing the subclavian vein resulted in inappropriate placement of an 8.5 F sheath in the arterial system. Following angiographic imaging and specialist consultations, an arterial stent-graft was deployed in the right subclavian artery rather than perform an extensive anterior chest wall resection and dissection to extract the arterial sheath. The patient tolerated the procedure, without complication, despite occlusion of the right internal mammary artery and the right vertebral artery. There were no neurologic sequelae. There was no evidence of hemorrhage after subclavian artery sheath extraction and stent-graft implantation. Conclusion The attempted ultrasound guided puncture of the subclavian vein resulted in placement of an 8.5 F subclavian artery catheter. Entry of the catheter into the proximal subclavian artery beneath the medial clavicle, the medial first rib and the manubrium suggests that the operator, most likely, did not directly visualize the puncture needle enter the vessel with the ultrasound. The bones of the anterior chest impede the ultrasound beam and the vessels in this area would not be visible to ultrasound

  15. Imaging features of SAPHO syndrome%SAPHO综合征的影像表现

    Institute of Scientific and Technical Information of China (English)

    刘记存; 陈勇; 崔建岭

    2011-01-01

    Objective To explore the imaging features of patients with synovitis, acne, pustulosis, hyperostosis and osteitis (SAPHO) syndrome. Methods Imaging features of 20 patients with SAPHO syndrome were retrospectively analyzed. Results Nineteen patients had anterior chest wall involvement, which showed bone sclerosis, hyperostosis, costal cartilage sclerotic hyperostosis, joint destruction and ankylosis on plain X-ray films and CT images. The medial end of clavicle, ma-nubrium and the first costal cartilage were affected in 19 cases. Among them, bilaterally asymmetrical involvements were found in 8 cases, bilaterally symmetrical in 7 cases and unilateral in 4 cases, respectively. Manubriosternal junctions and the second costal cartilages were affected in 10 and 6 cases, respectively. Five patients had spinal involvement which showed endplate erosion, sclerosis, paravertebral ossification, narrowed disc space, wedged body on plain film and CT, in-homogeneous long Tl and long T2 signal intensities on MRI. Three patients also had sacroiliac joint involvement which showed joint destruction and ankylosis on plain film and CT. Conclusion Anterior chest wall lesions are the typical imaging features of SAPHO syndrome.%目的 探讨SAPHO综合征的影像学表现.方法 回顾性分析20例SAPHO综合征患者的影像学表现.结果 19例病变累及前上胸壁,X线、CT表现为骨及肋软骨硬化、肥厚,关节破坏、强直,胸骨柄、锁骨近端和第1肋软骨受累,其中双侧不对称受累8例,双侧对称性受累7例,单侧受累4例.10例柄胸联合受累,6例第2肋软骨受累.5例伴有脊柱病变,X线、CT表现为多发椎体终板侵蚀、硬化,椎旁骨化,椎间隙变窄,椎体楔形变;MRI表现为椎体不均匀长T1长T2信号.3例伴骶髂关节受累,X线和CT表现为关节破坏、强直.结论 前上胸壁病变是SAPHO综合征最具特征性的影像学表现.

  16. An epidemiological study on pattern of thoraco-abdominal injuries sustained in fatal road traffic accidents of Bangalore: Autopsy-based study

    Directory of Open Access Journals (Sweden)

    N Bayapa Reddy

    2014-01-01

    Full Text Available Background: The statistical profile reflects a global estimate of 5.1 million deaths in 2000, which was due to injuries that accounted for 10% of deaths due to all causes. Out of this, a quarter of injury-related deaths occurred in the South-East Asian region. Road Traffic Accident (RTA is one among the top 5 causes of morbidity and mortality in South-East Asian countries. Most common cause of blunt abdominal trauma in India is road traffic accident followed by pedestrian accidents, abdominal blows, and fall from heights. Aims: To analyze the epidemiology and pattern of fatal thoraco-abdominal injuries in road traffic accidents. Materials and Methods: An autopsy-based cross-sectional study conducted. A purposive sampling technique was applied to select the study sample of 100 post-mortems of road traffic accident between November 2008 and May 2010 subjected to medico-legal autopsy at the department of Forensic Medicine, KIMS Hospital Bangalore. Results: The majority of the victims were aged 21 to 40 years, 50 (50.0%, most of the victims were male 92 (92.0%; and male/female ratio was 11.5:1. Commonest offending agents in heavy motor vehicles were 54 (54.0%. Bony cage sustained injuries were observed in 71; out of this, fractures of ribs were observed in 45 (63.3% victims, clavicle in 14 (19.7%, sternum was 6 (8.4%, and vertebrae 6 (8.4% of fatal road traffic accidents. Internal thoracic injuries were observed in 26 cases. Among internal thoracic injuries, lungs were the most commonly involved organ 24 (92.3% followed by the heart 2 (7.6%. Lung sustained more lacerations 19 (79.1% than contusions 5 (20.8%. Internal abdominal injuries were observed in 49 cases. In road traffic accidents, the most commonly injured abdominal organs were solid organs such as liver 16 (32.6% followed by spleen 9 (18.3%. Conclusions: Majority of the times in road traffic accidents, young and productive males were injured or lost their life. This study may help the

  17. Effects of unprotected perineum midwifery method on the neonatal clavicular fracture%无保护会阴助产法对新生儿锁骨骨折的影响

    Institute of Scientific and Technical Information of China (English)

    李桂友; 陈彩儿; 黎少萍; 原绮霞

    2014-01-01

    目的:探讨无保护会阴助产法对新生儿锁骨骨折的影响。方法选取2010年5月-2013年6月在妇产科自然分娩的产妇700例,随机分为对照组和观察组各350例。对照组采用常规的助产法,观察组采用无保护会阴助产法,观察2组新生儿锁骨骨折发生率。结果观察组产妇会阴侧切率明显低于对照组,2组软产道损伤、产后出血及会阴预后情况比较,差异无统计学意义。观察组新生儿锁骨骨折比例(1.43%)低于对照组(4.29%)。观察组产妇对助产的满意程度明显高于对照组。结论无保护会阴助产法可降低新生儿锁骨骨折发生率,符合自然分娩的规律。%Objective To explore the influence of unprotected perineum midwifery method for neonatal clavicular fracture .Methods Seven hundred pregnant women with natural labor in obstet-rics-gynecology of our hospital from May 2010 to June 2013 were randomly divided into control group (n= 350)and observation group(n= 350) .The control group was given conventional midwifery method ,the observation group was given unprotected perineum midwifery method . The rate of neonatal clavicular fracture in 2 groups were observed .Results Episiotomy rate in the observation group was higher than that in the control group .There was no significant difference of birth canal injuries , postpartum hemorrhage , prognosis between 2 groups . Clavicle fracture rate in the observation group was lower than that in the control group (1.43% vs 4 .29% ) ,and the satisfaction degree was significanfly higher than that in the control group . Conclusion The method of unprotected perineum midwifery can reduce the incidence of neonatal clavicular fracture ,it′s worthy of clinical promotion .

  18. The effect of feeding calcium- and phosphorus-deficient diets to broiler chickens during the starting and growing-finishing phases on carcass quality.

    Science.gov (United States)

    Driver, J P; Pesti, G M; Bakalli, R I; Edwards, H M

    2006-11-01

    There is considerable data on the effect of reducing inorganic Ca and P in broiler finisher diets on carcass quality. However, there is limited information on the effect of reducing dietary Ca and P during the different phases of growout. Two experiments were conducted from 0 to 35 d in floor pens. In both experiments, at least 4 replicates per treatment (50 chicks per replicate) were used. Corn-soybean meal and soybean oil-based diets deficient in Ca and P were fed. During the starter phase (ST), from 0 to 18 d, chicks were fed a 23% CP diet containing 0.60% Ca and 0.47% total P (tP). During the grower-finisher phase (GF), from 19 to 35 d, birds were fed a 19% CP diet containing 0.30% Ca and 0.37% tP. A combination of 1,000 phytase units/kg of Natuphos phytase and 5 microg/kg of 1alpha-hydroxycholecalciferol (P + 1alpha) was supplemented to some of the feed during the ST and GF. Diets containing adequate Ca and P were also fed during the ST (0.90% Ca and 0.68% tP) and GF (0.80% Ca and 0.67% tP). The level of tibia ash and the incidence of bone disease were measured at 18 and 35 d. At the end of the experiments, birds were processed and evaluated for muscle hemorrhages and broken bones. In both experiments, broilers fed diets that were not P + 1alpha supplemented demonstrated poor bone mineralization, considerable leg problems, and a high incidence of broken bones after processing. Broilers fed P + 1alpha throughout had more broken clavicles and femurs compared with birds fed the adequate diets. Day-18 tibia ash was significantly correlated to broken tibias and femurs during processing. Day-35 tibia ash was better correlated to bloody breast meat than to broken bones. It is concluded that carcass quality depends on the levels of Ca and P fed and the age of the bird. Tibia ash, traditionally used as an indication of bone strength, was better correlated to the incidence of bloody breasts.

  19. Implant fixationversus conservative treatment for Rockwood type III acromioclavicular dislocation:a systematic review%植入物内固定与保守疗法修复Rockwood Ⅲ型肩锁关节脱位的系统评价

    Institute of Scientific and Technical Information of China (English)

    孙根文; 帕拉提•阿巴伯艾力; 李涛; 苏来曼; 阿布都萨拉木; 塔依尔•阿不都哈德尔

    2016-01-01

    BACKGROUND:Although there is a general consensus with regard to the treatment of Rockwood types I, II, IV, V and VI injuries, the treatment of type III injury is inconsistent. OBJECTIVE: The aim of this systematic review was to evaluate the efficacy and safety of implant fixation and conservative treatment for Rockwood type III acromioclavicular dislocation. METHODS:Studies were identified from databases (PubMed, Embase, Cochrane Library, China Biological Medicine, VIP, CNKI and Wanfang Database) up to May 2015. Eligible studies that investigated and compared the effectiveness and/or complications of implant fixation and conservative treatment for Rockwood type III acromioclavicular dislocation and provided sufficient data were included. RESULTS AND CONCLUSION:In total, eight studies were included. Implant fixation (n=207) included the Bosworth technique, Clavicle Hook Plate technique, the TightRopeTM system (titanium plate and Arthrex fiber suture), Weaver-Dunn technique (coracoacromial ligament displacement, instead of coracoclavicular ligament fixation), Phemister technique (Kirschner wire fixation) and the use of a poly dioxanone sutures cord. The conservative treatments (n=137) consisted of immobilisation management with a sling, Kenny-Howard brace, or with a sling and clavicle fastening taping tape or a simple brake, or with a sling or tape. There were no significant differences in the Constant score (P=0.90) and infection rate (P=0.07) between the two groups. The rate of satisfaction with aesthetic outcomes was higher in the implant fixation group (P < 0.000 01), although the incidence of coracoclavicular ligament calcification was also higher (P=0.03) in this group. The time to resumption of normal work and normal activities was shorter after conservative treatment than that after implant fixation treatment. However, implant fixation could return to the game faster. These results indicate that both implant fixation and conservative treatments can result in

  20. 肩锁关节脱位重建:金属植入物的选择%Reconstruction of acromioclavicular joint dislocation: Selection of metal implants

    Institute of Scientific and Technical Information of China (English)

    蔡宇; 王凯; 梁晶峰

    2011-01-01

    OBJECTIVE: To introduce the metal implant internal fixation methods and implant selection of acromioclavicular joint dislocation,to evaluate the efficacy of clavicular hook plate in treatment of acromioclavicular joint dislocation.METHODS: Using "clavicular hook plate; acromioclavicular joint dislocation; internal fixation" as the key words, a computer-based online search of PubMed database and VIP database from 1996 to 2010 was performed for articles about metal implants fixation for the dislocation of acromioclavicular joint, focusing on the acromioclavicular joint dislocation treatments and the choice of internal fixation implant, and clinical validation was conducted. Patients who were treated with AO/ASIF clavicular hook plate for acromioclavicular joint dislocation and distal clavicle fractures in accordance with type Ⅲ- Ⅴ of Rockwood classification, were involved. Lazzcano score was applied to determine function.RESULTS : The present method of treating acromioclavicular joint dislocation includes a simple Kirschner wire internal fixation,Kirschner wire and tension band fixation, Bosworth method, coracoclavicular fixation between the wire, titanium wire cable instead of the wire fixation method, modified Weaver method, tendon or artificial ligament for coracoclavicular ligament reconstruction,clavicular hook plate and so on, each has their advantages and disadvantages. Clinical validation showed that, 34 patients after treatment of AO/ASIF clavicular hook plate were visited for 12 months as a follow-up. No plate or screw loosed and broken. At 6-12 months, the implants were taken out, 2 cases exhibited acromioclavicular subluxation, coracoclavicular ligament repair was not performed. Assessment criteria was in accordance with Lazzcano scores, 30 cases were excellent and 4 cases were good.CONCLUSION: The clavicular hook plate for acromioclavicular joint dislocation and distal clavicle fracture is a simple operation,with reliable fixation, less trauma, rapid

  1. Study of Three Cases of Hutchinson - Gilford Progeria Syndrome in A Guangxi Han Family:Analysis of Imaging Featu re%广西汉族早老症家系三例病例研究--影像学特征分析

    Institute of Scientific and Technical Information of China (English)

    吴华裕; 林有坤; 方玲; 覃霞; 舒艳; 张伟峰; 李福记; 舒伟; 马军; 胡启平; 袁志刚

    2015-01-01

    Objective To study the imaging data of three cases of Hutchinson - Gilford Progeria Syndrome(HGPS) in Guangxi Han family,and to explore the patients' imaging features. Methods We collected the clinical data,CT,X - ray and MRI of three HGPS patients in Guangxi and made a summary of the imaging features. Results The proband was a 7 - year- old girl,and the other two patients were her younger sister(3 years old)and brother(1 years old). The proband neck radiograph showed abnormal scale between the calvarium and the mandible,mandibular hypoplasia,clavicle disappearing and pear shaped chest. The X - ray of 3 patients' hands showed that all the 3 cases were with flexion deformity in digintal joints and osteoporosis,and two older patients showed retardation of bone age and obvious osteolysis in distal phalanx. The lung CT scaning results of the 3 patients did not show lung fibrosis,but the chest and lung of the proband were smaller than normal children,and the fat thickness of the chest was thinner than normal girls. The brain MRI imaging of the proband showed the proportion of cerebral cranium became larger,but the pituitary size was normal. Conclusion The characteristic changes of the imaging occur in HGPS patients,including osteoporosis,mandibular hypoplasia,clavicle and distal phalanx disappearing and shortening, flexion deformity of digital joints and pear shaped chest. The findings have great significance on the diagnosis and differential diagnosis of progeria.%目的:分析广西汉族1个罕见早老症家系3例患者的影像学资料,探讨该家系早老症患者的影像学特征。方法收集广西汉族1个早老症家系3例患者的临床资料及 CT、X 线、MRI 影像学检查资料,对其影像学特点进行总结。结果先证者为7岁女孩,另2例患者分别为先证者的妹妹(3岁)和弟弟(1岁)。先证者颈部正侧位片示颅盖骨与下颌骨比例不协调,下颌骨发育不全,锁骨消失,梨形胸。3例患

  2. Imaging findings of synovitis-acne-pustulosis-hyperostosis-osteomylitis syndrome%获得性骨肥大综合征的影像表现

    Institute of Scientific and Technical Information of China (English)

    田军; 巩武贤; 刘立成; 徐爱德; 王世山

    2011-01-01

    Objective To explore the imaging characteristics of SAPHO syndrome in 11 cases.Methods Clinical features and imaging findings from 11 patients (6 male,5 female, 28 to 68 years old)with SAPHO syndrome were analyzed retrospectively Including DR in 9 cases, CT in 10 cases, MRI and radioisotope scanning in 3 cases. Results Multi-bones of anterior chest wall disorders were shown in 9cases on DR images including superior sternum , anterior first rib and clavicle hyperostosis. Bony fusion and bony bridge were also seen in these cases. Hyperostosis osteosclerosis, bone destruction and bony fusion of sternoclavicular articulation and first rib were shown on CT images in 9 cases. Osteosclerosis of the joint between manubrium and midsternum was seen in 1 case on CT image. Thc sign of flying sea gull was seen in 2 cases on axial anterior chest wall CT images. The disorders of anterior chest wall were bilateral in 8 cases and unilateral in 2 cases. Sacroiliitis and osteomyelitis of ilium were found accompanied in 1 case.Osteomyelitis of thoracic vertebrae were found in 2 cases, while sclerosing osteitis of lumbar vertebrae and ostearthritis of bilateral hands were observed respectively in 1 case. The thicken soft tissue surround clavicle head, thoracic vertebra disease with long T1 ,jumbly T2 and high fat suppression signal ,long T1 and short T2signal under sacroiliac joint were shown on MRI. Radioisotope scanning displayed higher radioactive uptake of radionuclides, with T shape in sternoclavicular area in 3 cases. Conclusions Multi-bones of anterior chest wall involvement was the common imaging characteristics in 11 patients. Sacroiliitis, osteomyelitis of vertebrae and ilium, sclerosing osteitis, ostearthritis of hand could be seen in some cases.%目的 分析获得性骨肥大(SAPHO)综合征的影像表现.方法 回顾性分析11例SAPHO综合征的影像资料,男6例、女5例,年龄28~68岁,平均51岁,X线平片检查9例、CT检查10例、MR检查3

  3. Arthroscopic button plate fixation therapy for instable distal clavicular fracture%关节镜下纽扣钢板固定术治疗不稳定锁骨远端骨折

    Institute of Scientific and Technical Information of China (English)

    陈建海; 党育; 付中国; 姜保国

    2015-01-01

    age of 42.6 years;according to Robinson clavicular fracture classification,all fracture cases are of type 3B fracture.Inclusion criteria:(1)Diagnosed as unstable distal clavicular fracture; (2 ) Received arthroscopic button plate fixation treatment. Exclusion criteria:(1)Diagnosed as unstable distal clavicular fracture,but has not received arthroscopic button plate fixation treatment,including open reduction Clavicle hook plate fixation,anatomic locking plate fixation and open button plate fixation;(2 )Old distal clavicular fracture.Ⅱ.Operative method:operation was performed under general anesthesia.Allow the patient to take sand beach chair posture, with head leaning to the other side.Draw shoulder joint anatomic marks under shoulder arthroscopy, and perform conventional disinfection on affected shoulder and upper limbs.The arthroscope enters the joint cavity from posterior portal;Under direct vision,establish the anterior working portal located in rotator interval. perform intra-articular routine inspection, pay particular attention to inspect whether there is structural damage to glenoid labrum and rotator cuff.If intra-articular injury is discovered during operation,immerely treat it.Under direct vision,establish the anterolateral second observation portal under arthroscope through anterior supraspinatus tendon,and transfer the arthroscope to the second observation portal through exchange rod.Along the upper edge of musculus subscapularis,inward expose the lower surface of coracoid,and use a feller to determine the madial and lateral edges of coracoid.Perform C-arm X-ray machine fluoroscopy to demine the vertical projection position of coracoid on clavicular surface,namely the conical ligament attachment position;open skin by 2 cm,and expose the clavicular upper surface.Place the anterior cruciate ligament guider on the central location of coracoid lower surface,drive guide pin into coracoid through clavicle;perform fluoroscopy to validate that the position of

  4. 胸部双能量减影摄影对气胸的诊断价值%The value of dual-energy subtraction with direct digital radiography in diagnosis of pneumothorax

    Institute of Scientific and Technical Information of China (English)

    赵钊; 陈立鹏; 王秀河; 黄力; 刘文华

    2012-01-01

    目的 探讨双能量减影摄片技术对气胸的诊断价值.方法 收集在本院行双能量胸部摄影,经CT检查证实为气胸的42例患者,由1位高年资放射科医师及1位高年资胸外科医生共同阅片,对其标准数字化摄影(DR)图像与双能量数字减影(DES)软组织图像进行分析,评价两者对气胸的显示情况.结果 对于大、中量气胸(13例,肺压缩≥20%),标准DR图像及DES软组织图像均能清楚显示(100%),但对于少量气胸(肺压缩<20%),尤其肺压缩边缘与肋骨、锁骨、肩胛骨重叠者,DES软组织图像比标准DR图像检出率更高,对肺压缩边缘的显示更清晰,差异有统计学意义.结论 双能量减影摄片技术能提高气胸的诊断率,降低漏诊率,是对DR图像诊断气胸的有效补充.%Objective To evaluate the ability of DR dual-energy subtraction(DES) in diagnosing pneumothorax.Methods 42 patients with pneumothorax confirmed by CT underwent dual-energy subtraction radiography of the chest in our hospital.The chest films were analysed by one senior radiologist and one surgeon.The detection of pneumothorax was evaluated with both DR and DES.Results The magnanimous or moderately pneumothorax (13 cases,pulmonary compression≥20% (could be detected by DR images and DES soft tissue images (100%) ,but for slight pneumothorax (pulmonary compression<20% ) , especially when pneumothorax line overlap with costa,clavicle and scapula,DES soft tissue images could detect it more sensitively than regular DR images,and the pneumothorax lines were showed more clearly, there was statistical difference between these two images.Conclusion Dual-energy subtraction technique is superior to regular DR images in showing the pneumothorax line,so it can improve the diagnosis of pneumothorax and reduce the rate of misdiagnosis.Dual energy subtraction images can act as an effective complement for the original DR images in diagnosing pneumothorax.

  5. Versatility of the Novalis system to deliver image-guided stereotactic body radiation therapy (SBRT) for various anatomical sites.

    Science.gov (United States)

    Teh, Bin S; Paulino, Arnold C; Lu, Hsin H; Chiu, J Kam; Richardson, Susan; Chiang, Stephen; Amato, Robert; Butler, E Brian; Bloch, Charles

    2007-08-01

    Stereotactic radiosurgery (SRS) and fractionated stereotactic radiotherapy (FSRT) programs to treat brain tumors were implemented when we first acquired the Brainlab Novalis system in 2003. Two years later, we started an extra-cranial stereotactic radio-ablation or more appropriately a stereotactic body radiation therapy (SBRT) program using the Brainlab Novalis image-guided system at The Methodist Hospital in Houston, Texas. We hereby summarize our initial experience with this system in delivering image-guided SBRT to a total of 80 patients during our first year of clinical implementation, from February 2005 to January 2006. Over 100 lesions in more than 20 distinct anatomical sites were treated. These include all levels of spine from cervical, thoracic, lumbar, and sacral lesions. Spinal lesions encompass intramedullary, intradural, extradural, or osseous compartments. Also treated were lesions in other bony sites including orbit, clavicle, scapula, humerus, sternum, rib, femur, and pelvis (ilium, ischium, and pubis). Primary or metastatic lesions located in the head and neck, supraclavicular region, axilla, mediastinum, lung (both central and peripheral), abdominal wall, liver, kidney, para-aortic lymph nodes, prostate, and pelvis were also treated. In addition to primary radiotherapy, SBRT program using the Brainlab Novalis system allows re-irradiation for recurrence and "boost" after conventional treatment to various anatomical sites. Treating these sites safely and efficaciously requires knowledge in radiation tolerance, fraction size, total dose, biologically equivalent dose (BED), prior radiotherapy, detailed dose volume histograms (DVH) of normal tissues, and the radiosensitive/radioresistant nature of the tumor. Placement of radio-opaque markers (Visicoil, Radiomed) in anatomical sites not in close proximity to bony landmarks (e.g., kidney and liver) helps in measuring motion and providing image guidance during each treatment fraction. Tumor/organ motion

  6. Mastopexia de aumento, técnica de quinta generación Augmentation mastopexy, fifth generation technique

    Directory of Open Access Journals (Sweden)

    R. Navarro

    2008-06-01

    traditional marks. If breasts were small, implants were positioned by submuscular way, and if bigger, the way was retroglandular. For recidivism prevention, it was positioned 2 internal straps; if the gland-implant was bigger and heavier an immobile strap from the breast to the clavicle periostium and to the 3rd rib, was realized; if it would result smaller or median size only were fixed to the third ribs with a dermal flap. Controls were realized between 1 month to 3 years. Ptosis was corrected between 5 to 12cm without any recidivism, neither post surgery pseudo-ptosis. With the support of an elastic brassier, physical exercise is recommended after 15 days. The scarring was highly satisfactory. Complications were partial disruptions in 2 patients and ardors, tautness sensation and areolar enlargement in patients with more than 12cm ptosis and wide areola. Because of the execution simplicity and security, surgery was ambulatory. We propose this technique called 5th generation that precludes the periareolar, the inframamary, the vertical and the T scar; partial elimination of both upper breasts quadrants lessen the possibility of breast cancer in this upper area and ptosis recidivism by the use of the internal straps.

  7. Torcicolo congênito: avaliação de dois tratamentos fisioterapêuticos Congenital torticollis: evaluation of two physiotherapeutic approaches

    Directory of Open Access Journals (Sweden)

    Luciane Zanusso Pagnossim

    2008-09-01

    Pediatric Surgery Services of the Clinical Hospital of Campinas University. The following data were retrospectively collected: maternal and neonatal history, clinical presentation and physiotherapeutic treatment classified according to the frequency of the exercises. Intensive treatment was defined as sessions performed at the daycare clinic by the physiotherapist plus daily sessions performed by parents at home. Minimal treatment was defined as weekly sessions performed only by the physiotherapist at the daycare clinic, without participation of the parents. RESULTS: The demographic characteristics of the studied patients were: mean maternal age=26 years; first gestation=35 (75%; vaginal delivery=40 (85%; mean age at diagnosis =50 days. A sternomastoid nodule was felt seen in 46 (98% patients. Diseases associated with congenital torticollis were: congenital hip dislocation=4 (8%; fracture of clavicles=2 (4%; and club feet=1 (2%. Intensive treatment was performed in 34 (72% patients for an average of 74 days and the cure was achieved in 100%. Minimal treatment was performed in 13 (28% for an average of 130 days and ten (77% patients achieved cure. CONCLUSIONS: Congenital torticollis had favorable outcome in both groups. The intensive treatment was followed by higher rates of cure in smaller period of time.

  8. Reconsiderações sobre o tempo de consolidação das fraturas na picnodisostose Reconsiderations regarding time of fracture healing in Pycnodysostosis

    Directory of Open Access Journals (Sweden)

    Flávio Dorcilo Rabelo

    2010-01-01

    evaluation of medical records were made on the basis of determining the total number of fractures for each patient to determine which of these were viable for this study. The group of patients is composed of three women and two men aged 51.4 years. The tibia was the bone most affected, followed by the femur. Fractures the follow-up for which had been done in another facility were excluded. RESULTS: Of the 12 fractures fully considered for the study, nine occurred in femurs (six in the femur E and three in the femur D; one in the tibia (D; one in the clavicle (D; and one in the ulna (E. Among the 12 fractures, eight developed pseudoarthrosis at an average of 29.25 months, three consolidated well in an average of 5.83 months, and one patient progressed with delayed consolidation in just 2 months. CONCLUSION: In combination with genetic and micromorphological studies, we await further studies to reconfirm the diagnosis of such a rare clinical entity.

  9. [Evolution of tetrapod locomotion].

    Science.gov (United States)

    Gambarian, P P

    2002-01-01

    disadvantageous in each of the locomotory types. In the pronatory locomotory type, adduction (lateral mobility) at the elbow joint is employed. It leads to special changes in morphology of the elbow joint due to which humeral condyle becomes spherical and promotes both adduction and rotation of the entire antebrachium. In the retractory locomotory type, amplification of pronation is to be limited in order to provide step elongation, so certain morphological adaptations occur in the elbow joint which prevent adduction at this joint. For step elongation, retraction at the shoulder joint is usually more advantageous than pronation, therefore historical emergence of the pronatory type could be considered as inadaptive. However, transversal horizontal axis of rotation at the shoulder joint appeared to be a prerequisite of the subsequent appearance of the most perfect locomotion in the therian mammals with their parasagittal limbs. Transition to the parasagittal limb construction was associated with adaptation to jumping asymmetric locomotion. It caused elongation of the shoulder bone downward which lead to widening of rotation cone of the humerus and, at the same time, to reduction of the coracoid portion of the glenoid fossa, the latter became horizontal rather than lateral. As a part of this process, the longitudinal axis of the scapula was displacing caudally with destruction of the suture-like articulation of the acromion process with the clavicle. The latter became articulated with the sternum directly or via much reduced interclavicle (or via procoracoid rudiment). This increases amortisatory function of the shoulder girdle during landing at the final stage of jump.

  10. Estudio comparativo de la eficacia del bloqueo supraclavicular en la artroscopia de hombro Comparative study of the efficacy of the supraclavicular block for arthroscopic shoulder surgery

    Directory of Open Access Journals (Sweden)

    C. Morales Muñoz

    2010-12-01

    postoperative acute pain unit, during a 6-months period. Cases of shoulder arthroscopies carried out during this period were selected and the patients were distributed in 2 groups depending on the anesthetic technique used: group I consisted of patients treated with locoregional anesthesia (interscalene and inter-sternocleidomastoid block combined with general anesthesia. Group II was general anesthesia cases with intravenous analgesia. The recorded variables were the following: postoperative pain, both at rest and during exercise in the first 24h, using a simple verbal scale (SVS; the presence of side effects, need of analgesic rescue and duration of hospital stay. In the cases where the patients were discharged from hospital in the first 24h, a telephone consultation was carried out for the evaluation of the abovementioned variables. Statistical analysis: Student-t and Chi-square tests. A P.05. In the group of combined anesthesia the average duration of hospital stay was 36h, compared to the 60h average duration in the group of General Anesthesia. (P<.05. Discussion: The blockade of the brachial plexus over the clavicle combined with general anesthesia has shown greater efficacy in the control of perioperative pain, both at rest and during exercise than the general anesthesia with intravenous analgesia. In addition, the incidence of undesirable effects, the need of rescue and the duration of hospital stay were lower in the group of patients with the combined technique, without significant effects on the duration of operating room occupation.

  11. Tratamento artroscópico da tendinite calcária do manguito rotador Arthroscopic treatment of calcifying tendinitis of the rotator cuff

    Directory of Open Access Journals (Sweden)

    Arnaldo Amado Ferreira Neto

    2010-01-01

    six (43% male. The right side was affected in 10 (71% and the left in four (29% cases. Nine cases (64% had calcification in the tendon above the supraspinatus, two (14% in the infraspinatus, and three (21% involved the two tendons. RESULTS: In all cases, the resection of calcium deposits was performed with a needle (Jelco® No. 14 in combination with curettage (mini-curette. Two shoulders (14% were submitted to sub-acromial decompression, and one (7% to excision of the distal clavicle. A suture tendon-tendon was performed in three shoulders (21%. Transosseous suture was not necessary for any patient. According to UCLA scale, an average of 33 points (26-35 was obtained, indicating that a majority of patients had good results. In the final radiographic evaluation, no patients showed signs of calcification. CONCLUSION: Arthroscopic treatment of calcifying tendinitis of the rotator cuff safely allows for the excision of the calcification, leading to good results in relation to shoulder pain and function.

  12. 基层医院临时心脏起搏器的安装%Temporary pacemaker installed in primary hospital

    Institute of Scientific and Technical Information of China (English)

    陈志红; 张红英

    2013-01-01

    Objective To utilize Seldinger technique via the right subclavian vein puncture install temporary pacemaker in primary hospital. Methods Applied Medtronic5318 temporary pacemaker,utilized Seldinger technique,entered the superior vena cava from the inside and lower 1/3 of the right clavicle under the X-ray intermittent exposure time monitoring, after that, placed J-shaped guide wire,the pacing catheter through the right atrioventricular valve into the right ventricular apex,and Installed temporary pacemaker when contacted with endocardial. Results 15 patients were all successfully placed temporary pacing catheter,temporary pacemaker pacing, postoperative ECG. 1 case of poor pacing, the other 14 cases of satisfactory pacing.There were no complications. Conclusion Under the X-ray intermittent exposure time monitoring,right subclavian vein puncture and catheterization installing temporary cardiac pacing, patients and operators accept less X-ray dose, this method is intuitive, accurate, safe, minimally invasive, high success rate,it's fit for primary hospital to install temporary pacemaker, worthy for primary hospital clinical practice.%目的:基层医院采用Seldinger技术经右锁骨下静脉穿刺安装临时起搏器。方法应用Medtronic5318临时心脏起搏器,采用Seldinger技术法,在X线间断曝光实时监视下,经右锁骨内侧中下1/3处进入上腔静脉,然后置入J形导丝,将起搏导管通过右房室瓣送入右心室心尖部并接触心内膜安装临时心脏起搏器。结果15例患者均顺利置入临时起搏导管,接临时起搏器起搏,术后心电监护。其中1例起搏效果差,其余14例起搏效果满意。本组无并发症发生。结论 X线间断曝光实时监视下右锁骨下静脉穿刺及导管植入安装临时心脏起搏,患者及操作者接受X线剂量少,此法直观、准确、安全,微创,成功率高,适合基层医院临时心脏起搏器的安装,值得基层医院临床推广。

  13. Clinical Analysis of ICU in the Treatment of Pregnant and Lying in Pregnant Women With Severe Disease%产科联合ICU救治孕产妇危急重症临床分析

    Institute of Scientific and Technical Information of China (English)

    吴海芳

    2015-01-01

    Objective To investigate the clinical effect of the treatment of acute severe maternal, observing the obstetric combined ICU (intensive care unit). Methods 48 cases of severe and severe cases in our hospital from 2006 to 2014were selected. For the treatment of patients with obstetric combined ICU. A retrospective analysis was carried out on the clinical data of the patients. Results In all patients, 22 cases of postpartum hemorrhage caused by uterine contraction fatigue, 16 cases of severe preeclampsia, 6 cases of patients with placenta placenta, 4 cases of patients with placenta. After entering the ICU, the patients were treated with the necessary organ support therapy and effective monitoring. The patients were treated with the treatment of the patients with shock, and the clinical choice was carried out with the clavicle vein puncture. In 48 patients, 40 patients were selected to carry out cesarean section, and 8 cases of vaginal delivery were selected. Conclusion In the treatment of severe and severe pregnant women, the clinical choice of obstetrics with ICU clinical treatment method for treatment, can effectively ensure the safety of pregnant women, the maternal mortality rate is effectively reduced.%目的:探讨针对危急重症孕产妇,观察产科联合 ICU(重症监护室)完成治疗后获得的临床效果。方法选择我院2006~2014年危急重症孕产妇48例。针对所有患者选择产科联合 ICU 对患者救治的方法。针对患者的临床资料实施回顾性分析。结果在所有患者中,属于子宫收缩乏力造成产后出血的患者22例,属于重度子痫前期的患者16例,属于前置胎盘的患者6例,属于胎盘早剥的患者4例。患者进入到 ICU 后,对患者进行必要的脏器支持治疗以及有效监护,患者表现出休克症状后,临床选择实施锁骨下静脉穿刺,最终获得显著效果,所有产妇全部成功完成治疗。在48例患者中

  14. Analysis of posterior pedicle screw-only constructs in surgical treatment of adolescent idiopathic scoliosis with a minimum three-year follow-up%后路全椎弓根螺钉系统治疗青少年特发性脊柱侧凸疗效分析

    Institute of Scientific and Technical Information of China (English)

    李明; 赵颖川; 朱晓东; 贺石生; 王传锋; 杨长伟

    2010-01-01

    Objective To evaluate clinical outcomes of a group of adolescent idiopathic scoliosis ( AIS) patients undergoing posterior pedicle screw-only instrumentations. Methods Between April 2002 and July 2006,121 AIS patients (93 female and 28 male, average age at operation was 15.5 years which ranged from 10 to 20 years) received posterior pedicle screw-only instrumentation and fusion. All the patients were evaluated by the various-parameters measured in X-ray films before and after surgery, including Cobb angle on coronal plane, Cobb angle on sagittal plane, clavicle angle and shoulder height difference, lowest instrumented vertebrae (LIV) angulation, proximal junction kyphotic angle, the distances of central scaral vertical line (CSV!.) to the LIV,to the apical vertebra and to the C_7 plumb line respectively. Complications were followed. Results An average of (11.0 ± 1.5) levels was fused. An average coronal correction of proximal thoracic curve was 41. 8% , of thoracic curve was 70. 8% , of thoracolumbar/lumbar curves was 74. 0%. No significant change was found in sagittal alignment. Shoulder balance and apex vertebral to central sacral line were restored well. There were no pseudoarthroses and loss of correction during the follow-ups. One adding-on, 4 proximal thoracic decompensation and 15 proximal junction kyphosis were found during the follow-ups. Conclusion Posterior pedicle screw-only instrumentation and fusion has excellent radiographic and clinical results with minimal complications in the surgical treatment of AIS.%目的 探讨采用单纯后路全椎弓根螺钉系统治疗青少年特发性脊柱侧凸(AIS)的疗效.方法 2002年4月至2006年7月,连续收治121例AIS患者,其中男性28例,女性93例;年龄10~20岁,平均15.5岁.全部患者采用后路全椎弓根螺钉系统治疗.手术前后在脊柱X线片上测量冠状位Cobb角,矢状面胸椎后凸和腰椎前凸角,最下端融合椎冠状面成角,锁骨角及双肩高度差.骶骨中

  15. 重建钢板上置和前置治疗老年锁骨中段骨折的疗效分析%Superior versus anterior reconstruction plate internal fixation for middle clavicular fractures in old patients: a comparative study

    Institute of Scientific and Technical Information of China (English)

    卢旻鹏; 王群波; 赵波; 何超; 焦春艳; 饶小华; 张铭华

    2011-01-01

    Objective To compare the effect of anterior and superior reconstruction plate internal fixation in treatment of middle clavicular fractures in the old patients.Methods Thirty-nine old patients with middle clavicular fractures received anterior and superior reconstruction plate internal fixation treatment,respectively.There were 19 males and 20 females at average age of 66.7 years.The operation time,intraoperative blood loss and healing time were observed and compared in two groups.According to the Constant scoring system,shoulder functional evaluation was made at half a year after operation and the latest follow-up.Results All the patients were followed up for 10-32 months (average 18.7 months).Of the two groups,there was no statistical significance in aspects of healing time and Constant score at half a year after operation and the latest follow-up ( P >0.05 ).The complication of superior reconstruction plate internal fixation group was significant higher than that of anterior reconstruction plate internal fixation group,while the anterior reconstruction plate internal fixation group had shorter operation time and less intraoperative blood loss in comparison with the superior reconstruction plate internal fixation group ( P < 0.05).Conclusion As for the middle clavicular fractures in the old patients,both anterior and superior reconstruction plate internal fixation can obtain satisfactory curative effect.With shorter operation time,less intraoperative bleeding and less complications,anterior reconstruction plate internal fixation is a much reliable treatment for middle clavicle fractures in the old patients and deserves wider application.%目的 比较重建钢板上置和前置治疗老年锁骨中段骨折的疗效.方法 分别用重建钢板上置法、重建钢板前置法治疗锁骨中段骨折39例,其中男19例,女20例;平均年龄66.7岁.记录并比较两组手术时间、术中出血量、骨折愈合时间;术后半年

  16. Hipercalcemia e lesões osteolíticas múltiplas em criança com paracoccidioidomicose disseminada e tuberculose pulmonar Hypercalcemia and multiple osteolytic lesions in a child with disseminated paracoccidioidomycosis and pulmonary tuberculosis

    Directory of Open Access Journals (Sweden)

    Antonia T. Tresoldi

    2005-08-01

    osteolytic lesions. DESCRIPTION: A 6-year-old boy was admitted with a one-month history of fever and hepatosplenomegaly. On admission, he looked sick, pale, and had disseminated lymphadenopathy and hepatosplenomegaly. The laboratory findings included anemia (hemoglobin = 6.8 g/dl, eosinophilia (1,222/mm³, thrombocytopenia (102,000/mm³, and hypoalbuminemia (serum albumin = 2.2 g/dl. Paracoccidioides brasiliensis was identified in bone marrow examination. In the second week after admission, the patient presented joint pain, poor activity and difficulty in walking. He presented hypercalcemia (maximum value = 14.9 mg% and reduction in renal function, which lasted for two weeks. On the 42nd day after admission, his chest X-ray showed lytic lesions in clavicle, scapula, ribs, and humerus, with bilateral slipped capital humeral epiphysis. The patient presented nephrocalcinosis and nephrolithiasis, reduction in creatinine clearance and evidence of tubular lesions. At the end of the second month after admission, Mycobacterium tuberculosis was isolated in gastric lavage. The child received treatment for paracoccidioidomycosis and tuberculosis and has not had any sequelae for 3 years. COMMENTS: The development of symptomatic hypercalcemia leading to renal lesion, associated with multiple osteolytic lesions, had never been described in paracoccidioidomycosis. Although pulmonary tuberculosis was diagnosed and could be related to hypercalcemia, the sudden onset of hypercalcemia and its normalization without specific treatment for tuberculosis suggests that bone lysis was the most important factor in the genesis of hypercalcemia.

  17. 颈肩痛的病因及相关应用解剖研究%Neck and shoulder pain anatomy etiology and related applications

    Institute of Scientific and Technical Information of China (English)

    郭佩勤

    2014-01-01

    目的:从解剖学角度研究和探讨颈肩痛病因,为临床治疗提供解剖学资料。方法对7具经福尔马林溶液固定成人尸体标本肩胛神经分布特点解剖特点、走向以及与软组织的毗邻关系进行研究。结果肩胛上神经通过肩胛上横韧带下方进入冈上窝,行于肩胛骨和冈上肌之间,在肩胛上孔发出1至3支肩关节关节支和冈上肌肌支及肩锁骨关节支,肩胛上神经皮支出现较少,少数皮支出现在近肩峰尖位置通过三角肌在腋神经的支配部位,部分肌支有细小分支,肩胛神经在肌筋包裹,与肌肉结合较紧密。结论在肩胛痛诊断中,不应局限于肩胛上神经在肩胛上切迹的卡压,还应注意到由于肩胛上神和肌肉结合紧密,肌肉收缩可导致神经牵长并导致损伤,应综合考虑何种因素,科学选择治疗措施。%Objective: To study and explore the anatomy cause neck and shoulder pain , provide anatomical information for clinical treatment . Methods: 7 formalin -fixed adult cadavers dissected special scapular nerve distribution , to the adjacent soft tissue as wel as to study the relationship . Results: suprascapular nerve through superior transverse scapular ligament below into the supraspinatus fossa, the line in the scapula and the supraspinatus muscle , between the suprascapular holes emit 1-3 shoulder articular branch and the supraspinatus muscle branch of the articular branch of the clavicle and shoulder , suprascapular nerve cutaneous branches appear less spending a few leather shoulder tip position is now nearly through the domination of the axilary nerve in the deltoid area , some muscular branches with tiny branches wrapped scapular nerve in the muscles and tendons , and muscles combine more closely . CONCLUSION: In the diagnosis of shoulder pain , should not be limited suprascapular nerve in the suprascapular notch entrapment , it should be noted on the shoulders of God and

  18. [In case of fetal macrosomia, the best strategy is the induction of labor at 38 weeks of gestation].

    Science.gov (United States)

    Rozenberg, P

    2016-11-01

    Macrosomic fetuses are at increased risk of obstetric complications, and notably shoulder dystocia, responsible for a severe neonatal morbidity. In case of fetal macrosomia, three options are: (i) the elective cesarean delivery, but this is recommended only when the estimated fetal weight is≥4500g for diabetic women and 5000g for non-diabetic women; (ii) the expectative management, but children with birth weight≥4500 had significantly increased risk of perinatal mortality, neonatal asphyxia, trauma, and cesarean delivery; (iii) the induction of labor which, reducing the possibility of fetal growth, reduce the risk of cesarean delivery for cephalopelvic disproportion and shoulder dystocia. As 2 former trials did not show maternal or neonatal benefit with induction of labor for fetal macrosomia, it was therefore not recommended. However, these 2 studies had small sample size (273 and 40 women) and a methodology limiting their ability to show a difference, justifying to achieve a large multicentre randomized controlled trial. This trial was performed by Boulvain et al. and the results published in 2015 in the Lancet. Inclusion criteria were: a singleton pregnancy in cephalic presentation and a suspected fetal macrosomia defined by an ultrasound estimated weight>95th percentile between 36 and 38 weeks. Women were randomly assigned to receive induction of labor within 3 days between 37(+0) and 38(+6) weeks of gestation, or expectant management. Expectant management continued until either spontaneous labour or diagnosis of a condition necessitating induction. The primary outcome was a composite of clinically significant shoulder dystocia, fracture of the clavicle, brachial plexus injury, intracranial haemorrhage, or death. Baseline characteristics were similar between groups. The mean birth weight (±SD) was 3831 (±324) g in the induction group 4118 (±392) g in the expectant group. Induction of labor significantly reduced the risk of shoulder dystocia or

  19. Bloqueio do plexo braquial pela via posterior com uso de neuroestimulador e ropivacaína a 0,5% Bloqueo del plexo braquial por la vía posterior con el uso de neuroestimulador y ropivacaína a 0,5% Posterior brachial plexus block with nerve stimulator and 0.5% ropivacaine

    Directory of Open Access Journals (Sweden)

    Lúcia Beato

    2005-08-01

    ícula y húmero proximal. El objetivo de este estudio fue mostrar los resultados observados en pacientes sometidos a bloqueo del plexo braquial por la vía posterior con el uso del neuroestimulador y ropivacaína a 0,5%. MÉTODO: Veintidós pacientes con edad entre 17 y 76 años, estado físico ASA I y II, sometidos a cirugías ortopédicas envolviendo el hombro, clavícula y húmero proximal fueron anestesiados con bloqueo de plexo braquial por la vía posterior utilizando neuroestimulador desde 1 mA. Lograda la contracción deseada, la corriente fue disminuida para 0,5 MA y, permaneciendo la respuesta contráctil, fueron inyectados 40 mL de ropivacaína a 0,5%. Fueron evaluados los siguientes parámetros: latencia, analgesia, duración de la cirugía, duración de la analgesia y del bloqueo motor, complicaciones y efectos colaterales. RESULTADOS: El bloqueo fue efectivo en 20 de los 22 pacientes; la latencia media fue de 15,52 min; la duración media de la cirugía fue de 1,61 hora. La media de duración de la analgesia fue de 15,85 horas y del bloqueo motor 11,16 horas. No fueron observados señales y síntomas clínicos de toxicidad del anestésico local y ningún paciente presentó efectos adversos del bloqueo. CONCLUSIONES: En las condiciones de este estudio el bloqueo del plexo braquial por la vía posterior con el uso del neuroestimulador y ropivacaína a 0,5% demostró que es una técnica efectiva, confortable para el paciente y de fácil realización.BACKGROUND AND OBJECTIVES: There are several approaches to the brachial plexus depending on the experience of the anesthesiologist and the site of the surgery. Posterior brachial plexus block may be an alternative for shoulder, clavicle and proximal humerus surgery. This study aims at presenting the results of patients submitted to posterior brachial plexus block with 0.5% ropivacaine and the aid of nerve stimulator. METHODS: Participated in this study 22 patients aged 17 to 76 years, physical status ASA I and II

  20. 手术治疗创伤致神经源性单纯肩外展功能障碍%The diagnosis and treatment of suprascapular nerve combined with axillary nerve injuries following the shoulder trauma

    Institute of Scientific and Technical Information of China (English)

    李峰; 王树锋; 栗鹏程; 薛云浩

    2015-01-01

    Objective To expore the effect of nerve repair for patients with traumatic suprascapular nerve combined with axillary nerve injuries.Methods Data of 13 cases with traumatic suprascapular nerve combined axillary nerve injuries treated by surgery from June 2003 to September 2011 were retrospectively analyzed.All the cases were males,and the average age was 28 years old.There were 2 cases of neck of scapula fracture combined with clavicle fracture,3 of floating shoulder injury,1 of humerus neck fracture combined with glenoid cavity fracture,3 of clavicle fracture,1 of acromion fracture,2 of shoulder blade fracture and 1 of atlanto-axial vertebral fractures.All the 13 cases performed isolated lost of the function of shoulder abduction and external rotation completely,and the muscle strength of deltoid,the supraspinatus and infraspinatus was M0.The electrophysiological examination showed complete denervation of axillary nerve and suprascapular nerve.The suprascapular nerve was broken in 10 cases in which 6 cases were repaired by 1 band sural nerve graft and 1 case was repaired by 1 band superficial cervical plexus,and 3 cases were irreparable because of the distal avulsion injury from the target muscle,and 3 cases were performed with neurolysis.The axillary nerve ruptured in 12 cases,in which 10 cases was repaired by 2-3 bands sural nerve graft,and fascicles selected from the median nerve were used to neurotize axillary nerve in 2 cases.The neurolysis of axillary nerve was performed at the quadrilateral space in 1 case.10 of the 13 cases had both the suprascapular nerve and axillary nerve ruptured.Results 13 cases were followed up,the follow up period was 36 to 134 months.In 7 cases,the functional recovery of shoulder abduction were 180° and the average external rotation was 56° and the muscle strength of deltoid attained M4.In 5 cases,the average shoulder abduction was 38°;the range of external rotation was-40°-30°,and the muscle strength of deltoid achieved M4 in

  1. SAPHO综合征18F-FDG PET/CT显像和临床分析%18F-FDG PET/CT imaging and clinical features of SAPHO syndrome

    Institute of Scientific and Technical Information of China (English)

    郝新忠; 武志芳; 武萍; 鄢敏; 刘建中; 李思进

    2015-01-01

    Objective To analyze the 18F-FDG PET/CT imaging and the clinical features of patients with synovitis,acne,pustulosis,hyperostosis,and osteitis (SAPHO) syndrome and improved the diagnosis and awareness level about the disease.Methods This study retrospectively analyzed the PET/CT images and clinical features of five patients (including 3 females and 2 males; age range:59-74 years old; average age:67.2 years old) with SAPHO syndrome,as well as reviewed relevant literature.The PET/CT examinations were performed from March 2011 to August 2013.SAPHO syndrome was diagnosed through biopsy,imaging,follow-up results,and according to the Kahe Standard.Results (1) Clinic:Five patients sought treatment in the hospital for bone joint pain or skin lesions.Two of the five patients had no skin lesions,three patients exhibited elevated serum CRP and ESR levels,and one patient was positive for HLA-B27.Rheumatoid factor,extractable nuclear antigen peptide antibody spectrum and antineutrophil cytoplasmic antibodies were negative in 5 patients.The average diagnosis period was 3.78 years.(2)PET/CT imaging:Five patients showed anterior chest wall and spine involvement.Anterior chest wall involvement included 11 bone joints,such as the sternoclavicular joint,sternocostal joint,and sternal-body joint.One patient showed hypertrophy and osteomyelitis of the clavicle.Only one patient showed an involvement of a single vertebra,whereas the others showed an involvement of multiple sites of the spine,including 35 vertebra and 58 vertebral disc connections.The CT revealed the worm-eaten and hole-shaped bone destruction on the articular surface of the anterior chest wall and intervertebral disc junction.They were surrounded by relatively extensive osteosclerosis,even involving the entire vertebral body.The partially involved joints also showed joint space narrowing and even joint bone fusion.In addition,swelling,thickening,and calcification of periarticular soft tissues were observed.The PET

  2. Evaluation of modified Judet approach in the treatment of scapula fractures%经改良 Judet 入路手术治疗肩胛骨骨折的疗效

    Institute of Scientific and Technical Information of China (English)

    赵良瑜; 陈爱民; 李永川

    2015-01-01

    Background The scapula locates in the posterior wall of chest.It is an irregular bone with a triangular shape.The scapula connects clavicle and humerus with its structure including the acromion,coracoid and scapular glenoid,forming an important combination of upper limbs and trunk. Various injury factors can cause fracture damage to the scapula,leading to obstacles to the movement of the upper limb.In history,scapular fractures used to be treated conservatively.While in recent years,with the improvement of operative techniques and development of surgical conditions and related devices and equipment,more and more scapular fracture patients accepted surgical treatments and achieved good results.There are different approaches to scapular fractures including anterior approach, the lateral straight incision approach,Judet approach and so on.In this study,modified Judet approach was evaluated as the treatment of some subgroup of scapular fracture cases.Methods From July,2004 to July 2014,71 cases of scapular fractures accepted surgical treatment,with 17 cases underwent Judet approach.The age of the 1 6 males and 1 female case ranged 29 - 62 years with the mean age 47.1 years old.The causes of injury included automobile accident in 8 cases,falls from height in 6 cases, fall,sports injuries and other causes of 3 cases.There were scapular neck fracture involving scapular spine or medial border of scapula in 13 cases,fracture involving the scapula glenoid fractures in 3 cases,combined fracture of scapular and ipsilateral clavicle in 1 case.41% (7 out of 17 cases)patients had associate injuries,including 6 cases of rib fracture,1 case of craniocerebral injury,3 cases of contusion of lung and pleural effusion,5 cases of spine fractures,1 case of cervical spinal cord hyperextension injury,1 cases of maxillary sinus fracture,1 case of proximal humerus fracture,1 case of first metacarpal fracture,and 1 case of brachial plexus injury.Bilateral scapular fractures occurred in 1 case

  3. 关节外整块切除肩胛带恶性肿瘤的手术及术后功能研究%Limb-sparing resections for malignant tumors of shoulder girdle:11-year experience of classical or modified tikhoff-linberg procedures in a single institution

    Institute of Scientific and Technical Information of China (English)

    谢璐; 郭卫; 汤小东; 杨荣利

    2015-01-01

    to 82 y).All patients were followed up for a mean of 34 months (range,6 to 109 months).The pathologic diagnosis obtained by needle or open biopsies included 10 metastatic tumors (4 from lung cancer,3 from breast cancer,1 from thyroid cancer and 2 from unknown origin),7 chondrosarcomas,4 osteosarcomas,3 Ewing sarcoma/PNET,3 synovial sarcomas,2 malignant peripheral nerve sheath tumors,1 malignant fibrous histocytoma,1 fibrous sarcoma,1 liposarcoma and 1 malignant hemangiopericytoma.The stage and extent of the tumor were evaluated according to the Enneking system.Neoadjuvant chemotherapy was administered to patients with osteosarcoma,Ewing's sarcoma/PNET and partial malignant soft tissue sarcoma.As for other anatomical sites,limb salvage procedures for bone tumors of the shoulder girdle comprise three steps:complete resection of tumors,reconstruction of bone defects and good soft tissue covering.According to the surgical classification system proposed by Linberg and Malawer et al,classical Tikhoff-Linberg resection (also called shoulder girdle resection Malawer type Ⅳ )contained extraarticular en bloc resection of proximal humerus or humeral head,glenohumeral joint,the whole scapular and lateral clavicle.While modified Tikhoff-Linberg procedure (Malawer type Ⅴ)meant extra-articular resection of proximal humerus,glenohumeral joint,lateral clavicle and the neck of scapular glenoid.The surgical margins of the resected tumor were grossly and microscopically evaluated by two different experienced pathologists respectively.If they disagreed in opinion,the margins would be judged by another doctor who usually would be a senior pathologist.Results All those 33 patients survived the perioperative period and were followed up clinically after surgery (mean follow-up time 34 m,range 6 to 109 m).At the final follow-up,6 patients were alive without evidence of disease,2 patients remained alive but with disease,and 25 had died of their disease.In patients with metastatic bone

  4. Selected Abstracts of the 6th International Congress of UENPS; Valencia (Spain; November 23rd-25th 2016; Session “Neonatology and NICU clinical care and practices”

    Directory of Open Access Journals (Sweden)

    --- Various Authors

    2016-11-01

    Full Text Available Selected Abstracts of the 6th International Congress of UENPS; Valencia (Spain; November 23rd-25th 2016; Session “Neonatology and NICU clinical care and practices”ABS 1. BILATERAL CLAVICLE FRACTURE: A RARE CAUSE OF PERSISTENT CRYING • P. Cruz, P. Mendes, M. Anselmo, L. GonçalvesABS 2. NEONATAL TRANSPORT DURATION AND SHORT-TERM OUTCOME IN VERY-LOW-GESTATIONAL-AGE NEONATES • A. Matic, M. Gavrilovic LatinovicABS 3. PEMPHIGOID GESTATIONIS – A RARE CASE IN TWIN PREGNANCY • L. Gonçalves, E. Scortenschi, P. Cruz, P. Mendes, M. AnselmoABS 4. DEVELOPMENT OF A CLINICIAN-REPORTED OUTCOME (ClinRO MEASURE TO ASSESS READINESS FOR DISCHARGE FROM NEONATAL CARE AMONG EXTREMELY PRETERM INFANTS • M. Turner, R. Ward, J. Higginson, I. Hansen-Pupp, M. Vanya, E. Flood, G. Quiggle, A. Tocoian, A. Mangili, N. Barton, S. SardaABS 5. THE EFFECT OF THYROID HORMONES ON NICU ADMISSION DUE TO TRANSIENT TACHYPNEA OF NEWBORN IN LATE PRETERM AND TERM INFANTS • T. Gursoy, S. Ercin, P. Kayiran, B. GurakanABS 6. IMPROVING THE QUALITY OF PROLONGED JAUNDICE WORK-UPS IN THE OUTPATIENT DEPARTMENT IN A TERTIARY NEONATAL CENTRE • C.M. Moore, J. O’Loughlin, B.C. HayesABS 7. SAVE THE DATE? CORRECT RECORDING OF DAY OF LIFE AND CORRECTED GESTATIONAL AGE IN NICU • C.M. Moore, A.F. El-KhuffashABS 8. PARENTS IN NICU: THE IMPORTANCE OF INTEGRATION BETWEEN THE CURE AND THE CARE • G. De Bernardo, M. Svelto, M. Giordano, D. SordinoABS 9. THE PREVALENCE OF HEREDITARY HEARING LOSS IN 41,152 NEWBORNS DURING THE PERIOD 2011-2015 • S.T. Hsu, C.C. Hung, Y.N. Su, C.Y. Chen, H.C. Chou, W.S. Hsieh, C.C. Wu, P.N. TsaoABS 10. DEFICIENCY OF MULTIPLE acyl-CoA DEHYDROGENASE OR GLUTARIC ACIDURIA TYPE II • M. Torres, L. Geronès, J. Herrero, M.C. Cèspedes, F. Camba, J.A. Arranz, M. del Toro, F. CastilloABS 11. TEN YEARS OF EXPERIENCE IN CARRIER SCREENING FOR SPINAL MUSCULAR ATROPHY IN TAIWAN • C.Y. Chuang, C.C. Hung, Y.N. Su, P.N. TsaoABS 12. REDUCING MEDICATION ERRORS ON THE

  5. Tratamento cirúrgico da fratura instável do anel pélvico em pacientes esqueleticamente imaturos Surgical treatment of unstable pelvic ring fracture in skeletally immature patients

    Directory of Open Access Journals (Sweden)

    João Antonio Matheus Guimarães

    2010-01-01

    March 2004 and January 2008. The study was retrospective, based on clinical and radiographic evaluations. RESULTS: The mean age at the time of trauma was 8.8 years (2 to 13 years. Seven patients were female and three male. The cause of the trauma was being run over in eight cases, and one case each of a motorcycle accident and falling from a height. Five patients had other associated injuries such as fractures of the clavicle, femur diaphysis, proximal humerus, fibula, olecranon, and bladder injury. All patients showed an excellent clinical outcome. The pelvic asymmetry before surgery ranged from 0.7 to 2.9 cm (mean 1.45 cm, and dropped to values between 0.2 and 0.9 cm (mean 0.39 cm after reduction. In no cases was a change observed in pelvic asymmetry measured in the immediate postoperative period and at the end of follow-up. CONCLUSION: Pelvic ring fractures in skeletally immature patients is rare and surgical treatment is not usual. Several authors have questioned conservative treatment due to the complications encountered. Bone remodeling is not enough to improve pelvic asymmetry, a factor that justifies the choice of surgical treatment for the reduction and correction of pelvic ring deformities.

  6. Imaging analysis of osteoid osteoma%骨样骨瘤的影像学分析

    Institute of Scientific and Technical Information of China (English)

    张雷; 郁万江; 汪敬群

    2011-01-01

    目的 分析骨样骨瘤的X 线、CT 及MRI 影像表现.方法 搜集2000 年~2005 年经病理证实的骨样骨瘤21 例,男13 例,女8 例,年龄6~59 岁.所有病例均行X 线平片;17 例行CT 平扫;MRI 平扫12 例,增强扫描5例(动态MRI 增强扫描3 例),完成三项检查10 例.病灶位于股骨8 例,胫骨7 例,髋臼、胸椎各2 例,锁骨及距骨各1例.分析X 线、CT 及MRI 对瘤巢及其周围组织改变的显示能力.结果 X 线、CT 及MRI 对瘤巢显示率分别为57.1%、76.5%、75.0%,X 线、CT 上瘤巢为一小圆形或卵圆形透亮区,中心有/无钙化和骨化,边缘有不同程度骨硬化;MRI 上瘤巢为一小圆形异常信号区,T1WI 呈低至中等信号,T2WI 呈低至高信号,边缘为低信号骨硬化,瘤周不同程度骨髓及软组织水肿;Gd-DTPA 增强扫描瘤巢明显强化,动态MRI 增强瘤巢呈高灌注表现,时间-信号强度曲线为快速上升后缓慢持续下降(C 型曲线).结论 CT 为诊断骨样骨瘤最佳方法,MRI 能够增加瘤巢可见度并能敏感显示骨髓及周围软组织水肿,一定程度上反映病理组织特点,对骨样骨瘤有较高的诊断价值,可作为CT 的补充检查手段.%Objective To analyze the findings of osteoid osteoma on radiographs, CT and MRI. Methods 21 patients (13 male, 8 female; age range: 6-59 years) with pathologically confirmed osteoid osteoma from 2000 to 2005 underwent radiograph(21) ,CT(17) ,and MRI(12 unenhanced, 2 enhanced, 3 dynamic contrast-enhanced) examinations. Ten patients were investigated with all three modalities. The tumors were located in the femur (8), tibia (7), acetabulum (2), thoracic spine (2), clavicle (1) and talus (1). The radiographs, CT and MRI were retrospectively analyzed. Results Tumor nidus was depicted on radiographs (57.1%), CT (76.5%), and MRI (75.0%). On X-ray and CT, the tumor nidus was a small round or oval translucency with calcification or ossification center and variable degrees of surrounding

  7. Analysis of Variation of Han Male Adolescent Bone Development in Hainan, Henan and Zhejiang Provinces%海南、河南及浙江地区汉族男性青少年骨发育差异性分析

    Institute of Scientific and Technical Information of China (English)

    万雷; 应充亮; 夏文涛; 王亚辉; 朱广友

    2012-01-01

    Objective To study the difference of bone development of the Han male adolescents in Hainan, Henan and Zhejiang provinces. Methods All radiographs including sternal end of clavicle, pelvis and six main bone joints taken from 877 Han male adolescents aged between 12.00 and 20.00 in Hainan, Henan and Zhejiang provinces were reviewed. Twenty-four indices of skeletal development were analyzed based on "The Grading Standards" of skeletal growth of teenagers and then the bone age were calculated using mathematical model functions. The ratios of the bone age and the chronological age were then analyzed by statistical software. Results The development of Hainan male adolescents' skeleton were about 1.09 years and 1.26 years earlier than that in Henan and Zhejiang at the age group of 12.00-12.99 years. The development of Hainan male adolescents' skeleton were about 0.70 years and 1.38 years earlier than that in Henan and Zhejiang at the age group of 13.00-13.99 years, while the development of Henan male adolescents' skeleton were about 0.68 years earlier than that in Zhejiang in this age group. The development of Hainan male adolescents' skeleton were about 0.79 years later than that in Henan at the age group of 18.00-18.99 years. The development of Hainan male adolescents' skeleton were about 0.70 years and 0.95 years later than that in Henan and Zhejiang at the age group of 19.00-20.00 years. Conclusion There are significant differences in the skeleton development of Han male adolescents between the provinces of Hainan, Henan and Zhejiang. These results provide potential value for the practice of forensic medicine, anthropology and clinical medicine.%目的 探讨海南、河南、浙江地区之间汉族男性青少年骨发育的差异性.方法 收集海南、河南及浙江3地877例12.00~20.00周岁汉族男性青少年锁骨胸骨端、骨盆及肢体六大关节X线片.依据青少年骨发育分级标准24项骨骼发育指标进行阅片,并通过数学

  8. 颅锁骨发育不良的三个RUNX2基因新突变%Identification of three novel frameshift mutations in the RUNX2 gene in three sporadic Chinese cases with cleidocranial dysplasia

    Institute of Scientific and Technical Information of China (English)

    齐展; 杨威; 孟岩; 刘雅萍

    2014-01-01

    目的 通过对3例散发的颅锁骨发育不良患者进行RUNX2基因编码区的扩增及测序,寻找RUNX2基因突变,为家系进行遗传咨询和产前诊断提供依据.方法 抽取患者及其父母外周血,提取基因组DNA,PCR扩增RUNX2基因的7个编码外显子并测序;并对患者突变所在外显子的PCR产物经T-A克隆后再次测序.结果 例1的RUNX2第1外显子发生了1个80bp的c.227_306del杂合性缺失突变,引起读码框移位并提前出现终止密码(p.Ala76GlyfsX58);例2的RUNX2第2外显子发生了1个c.471_472dupGG杂合重复突变,亦导致读码框改变及提前出现终止密码(p.Ala158GlyfsX19);例3的R UNX2第17显子发生了1个c.1321dupT杂合重复突变,同样导致读码框改变和提前出现终止密码(p.Ser370PhefsX13).这三个移码突变经查询HGMD突变数据库及国内外文献均未见报道.结论 发现了3种新的导致颅锁骨发育不良的RUNX2基因突变,新的突变扩展了RUNX2基因的突变谱,可为这些家系提供准确可靠的遗传咨询和产前诊断.%Objective To investigate the molecular etiology of three patients with sporadic cleidocranial dysplasia (CCD) and to provide genetic counseling and prenatal diagnosis for the family members based on the identified mutations.Methods Genomic DNA was extracted from peripheral blood samples using a standard method.All 7 coding exons of the RUNX2 gene and their flanking intronic sequences were amplified by PCR and sequenced directly.The PCR products of the exons with mutations from the three patients were cloned into a T-vector.Positive clones were sequenced.Results The three patients who have the typical CCD phenotypes involving clavicles,calvarium,stature,and teeth have carried various frameshift mutations in the RUNX2 gene.Patient 1 has a gross deletion of 80 nucleotides in exon 1 (c.227_306del),which caused a frameshift beginning at the Q/A repeat of the polypeptide and a premature termination (p.Ala76GlyfsX58).Patient

  9. 腹腔镜胆总管探查一期缝合术中经胆囊管输尿管导管胆道引流607例%Biliary Drainage with Ureteral Catheter in Laparoscopic Common Bile Duct Exploration with Primary Suture:Report of 607 Cases

    Institute of Scientific and Technical Information of China (English)

    肖宏; 索运生; 尹思能; 易斌; 陈先林; 孙科; 王征夏; 张胜龙

    2015-01-01

    Objective To investigate the feasibility of application of ureteric catheter for biliary drainage in laparoscopic common bile duct exploration with primary suture through cystic duct remnant. Methods From June 1992 to October 2014, we performed 607 cases of laparoscopic exploration of common bile duct with primary suture.At the subcostal level on the midline of clavicle, an ureteral catheter was inserted via the cystic duct stump for biliary drainage. Results Of the 607 cases, the bile duct drainage was successful in 598 cases (98.5%).Ureteral catheter intubation failed in 6 cases (1.0%), 2 of which were given conversion to nasobiliary drainage and 4 of which were given T-tube drainage.Folded or blocked ureteral catheter due to no liquid outflow occurred in 2 cases (0.3%).Biliary peritonitis caused by ureteral catheter detachment happened in 1 case (0.2%), who was given a reoperation of laparoscopic ureteral catheter insertion and abdominal drainage.Mild stenosis after primary suture was seen in 3 cases (0.5%) , which were given no intervention.Postoperative cholangiography via ureteral catheter at 3-14 days after surgery in the 598 cases found no residual stones.Extubation was conducted at 2-4 weeks after surgery in 588 cases and at 4-6 weeks after surgery in 10 cases.Follow-up for 6-60 months (average, 18.5 months) in 588 cases showed no bile leakage, severe complications, or death. Conclusion For suitable patients, application of ureteric catheter for biliary drainage in laparoscopic common bile duct exploration with primary suture of bile duct is effective for preventing postoperative bile leakage.%目的:探讨腹腔镜胆总管探查一期缝合术中留置输尿管导管作胆管引流的可行性。方法1992年6月~2014年10月,在607例腹腔镜胆总管探查一期缝合术中,经右锁中线肋下穿刺置入输尿管导管经胆囊管残端置入胆总管行胆道引流术。结果598例(98.5%)胆管引流获得成功。插管失败6

  10. 带线铆钉治疗Tossy Ⅰ、Ⅲ型肩锁关节脱位%Treatment of Tossy Ⅱ & Ⅲ dislocation of acromioclavicular joint using rivets with thread

    Institute of Scientific and Technical Information of China (English)

    张克刚; 陆芸

    2011-01-01

    them was combined fracture.Mitek 3.0 mm rivet with thread was embedded to coracoid,with nonabsorbable thread connected with the rivet passing through the clavicle for fixation,and meanwhile ligament coracoclaviculare was restored or acromiocoracoid ligament displaced.Among them,12 patients assisted Kieschner wire fixation.The treatment effect was evaluated using Japanese Orthopaedic Association(JOA)scoring system and acromioclavicular joint dislocation scoring system.Results All patients were followed up 11-23 months(mean,17 months).In the patients without Kieschner wire fixation,JOA shoulder score was 65-95,excellent for 8 cases,good for 9,fine for 1,poor for 1,excellent and good rate was 89.47%(17/19);In the patients with Kieschner wire assisted fixation,JOA shoulder score was 74-97,excellent for 5,good for 4,fine for 3; the excellent and good rate was 75.00%(9/12).With acromioclavicular joint dislocation scoring system,the overall excellent and good rate was 94.74%(18/19),and 91.67%(11/12)respectively.No complication that affected joint function was found.Conclusion Rivets with thread can be used for treating Tossy Ⅱ & Ⅲ dislocation of acromioclavicular joint.This surgical technique is characterized by small operation wound,fewer complications,no secondary operation,and satisfactory treatment effect.

  11. CT and MRI features of malignant peripheral nerve sheath tumor of children%儿童恶性外周神经鞘瘤的CT和MRI表现

    Institute of Scientific and Technical Information of China (English)

    刘志敏; 宋蕾; 高军; 于彤; 尹光恒; 蒋玲; 彭芸; 胡克非

    2015-01-01

    cases at waist and back,3 cases at abdominal and pelvic, 2 cases at foot, 1 case at left clavicle, 1 case at right mediastinum, 1 case at right orbit. Fifteen cases appeared as solid masses and 1 case showed a diffuse growth. CT plain scan showed 8 cases were solid-appearing masses and 7 cases were cystic-solid mass. Enhanced CT showed enhancement of solid component was moderate to marked and gradually delayed enhanced while cystic component had no any enhancement. One was located on the left side of the neck and appeared as diffuse growth. Two cases of solid mass type appeared as hypo-intensity on T1WI and hyper-intensity on T2WI, and obviously high signal intensity of cystic component on T2WI, and with significantly heterogeneous enhanced.One case with diffuse growth appeared as hypo-intensity on T1WI and slightly hyper-intensity on T2WI, and with significantly enhanced. Sixteen cases appeared as invasive growth, 11 caseswith multiple organic metastases and recurrences, and 4 cases with neurofibromatosis type I and scoliosis.Conclusion CT and MR appearances of MPNST have certain characteristic features, and can demonstrateaggressive performance and multiple organic metastases, which is helpful for definite diagnosis and treatment plan.

  12. 全身MR扩散加权成像与骨扫描探测骨转移灶的初步对比研究%Comparison of whole body MR diffusion weighted imaging and skeletal scintigraphy In detecting bone metastasis

    Institute of Scientific and Technical Information of China (English)

    徐贤; 马林; 张金山; 蔡幼铨; 徐白萱; 程流泉; 郭行高

    2008-01-01

    detected by whole body MR DWI while 156 lesions in 68 regions of 29 patients were identified by skeletal seintigraphy.There were two cases negative in scintigraphy but positive in whole body MR DWI and one case positive in scintigraphy only.There were eight lesions negative in scintigraphy but positive in whole body MR DWI,mainly located in the spine.pelvis and femur.Seven 1esions were only detected by scintigraphy,mainly located in the skull.sternum.clavicle and scapula.Conclusion The whole body MR DWI reveals excellent consistency with skeletal scintigraphy regarding bone metastasis.and the two modalities are complementary for each Other.

  13. Applicaiotn of modified pectoralis major myocutaneous island flap in head and neck surgeries%改良的胸大肌岛状肌皮瓣在头颈外科的应用

    Institute of Scientific and Technical Information of China (English)

    陈晓红; 韩德民; 黄志刚; 房居高; 倪鑫; 周维国; 王琪; 李平栋

    2009-01-01

    hypopharynx cancer, three cases with base of tongue cancer, two cases with recurrence of maxillary cancer, one case with tonsillar cancer and one case with pharygeal fistula after hypopharyngeal cancer surgery. Before operation, ultrasound was used to mark the projection of the pectoral branches of thoracoacromial artery, and the pectoralis major myocutaneous were designed according to the axle between lowest entering muscle point of the artery and the fourth intercostals pedorator spot of mammary artery; the incision was designed to turn laterally in an oriental direction at the top of the flap and upward along the anterior axillary line; the internal pectoral nerve was reserved, as well as the partial lateral pectoral nerve. The flaps were transferred to recipient site either above or below the clavicle on the premise of the integrity of clavicular part. Results The distance of the lowest entering muscle point of pectoral blanche measuring during operation, which was all in stemocostal part, to the midpoint of inferior clavicula margin was (4.9±1.2) cm(x±s), and in 76.5% (13/17) of the patients, the location was coincidence by ultrasound. The length between entering muscle point and the fourth intercostals perforator spot of mammary artery was (1.8±0.5) cm. All the myocutaneous flaps were alive except one case. The flap was given up as a result of the vessel pedicel injure. The distal end of the flap was dehisced from the residual tongue in one case with base of tonque cancer and healed with changing dressing. Two pharyngeal fistulas in another two cases were healed with conserved treatment. The rate of the flap survival was 94.1% (16/17). Functions as adduction and adtorsion of major pectoral muscle were integrated within 4 weeks to 3 months. Also, the good looking of the neck and upper chest was maintained. Conclusions The location of pectoral branches of horacoacromial artery and the site of the lowest entering muscle point marked by ultrasound detection could help

  14. The surgical treatment of musculo- skeletal tumors in dangerous region%危险区骨骼肌肉系统肿瘤的外科治疗

    Institute of Scientific and Technical Information of China (English)

    张杏泉; 李开华; 陈刚; 刘军; 蔡平; 方仁义; 王民政; 范清宇

    2012-01-01

    , at the same time protecting the pleura after cutting a 6cm - clavicle, and then disconnect the lesion for excision of tumors completely and safely. While for the tumors in fibular head and neck as well as its surrounding region, to dissect first the common peroneal nerve and preserve its muscular branches. Results: Using this method, we treated 11 patients. All cases had no recurrence and limbs disturbance after follow — up. Conclusion: Dissecting first the normal vascular nerve of tumors distantly and proximally and then disconnecting the lesion for excision of tumors is a better choice for the large tumors of the innocent or low - degree malignant musculo — skeletal tumors especially adhering tightly with important nerves and vessels because of avoiding recurrence and limbs disturbance caused by injury of vascular nerve.

  15. Analysis of a case with typical Hutchinson-Gilford progeria syndrome with scleroderma-like skin changes and review of literature%伴硬皮病样改变的典型Hutchinson-Gilford早老综合征一例并文献复习

    Institute of Scientific and Technical Information of China (English)

    黄姗; 梁雁; 吴薇; 付溪; 廖立红; 罗小平

    2014-01-01

    subcutaneous fat.LMNA gene analysis showed that the affected-infant carried typical heterozygous mutation:c.1824C >T (p.G608G),while his parents were normal.At the age of 13 months,X-rays showed short distal phalanges and clavicles with acroosteolysis.After following up for 15 months,his appearance of progeria became more apparent.As far as we know,there are only 2 cases of classical HGPS confirmed by gene analysis in China.Conclusion Classical HGPS should be considered when infants appeared with sclerodermatous skin.Genetic analysis could help to diagnose classical HGPS as early as possible and avoid unnecessary investigations.In addition,affectedinfants need to be long term followed-up and provided genetic counseling.

  16. CURBSIDE CONSULTATION IN FRACTURE MANAGEMENT: 49 CLINICAL QUESTIONS

    Directory of Open Access Journals (Sweden)

    Walter W. Virkus

    2008-12-01

    Full Text Available DESCRIPTION: A user-friendly, unique resource for the treatment of fractures designed in a casual questions and answers format which provides basic knowledge, current information and evidence based expert advices enhanced by images and diagrams and supported by ref-erences.PURPOSE: Designing this book the editor has aimed to prepare not only a source of current knowledge and opin-ions by experienced authors in fracture management for decision making in daily practice but also a brief refer-ence and useful educational resource in orthopedic trauma surgery.FEATURES: Three Sections are composed of 49 sub-jects in a form of the answers of frequently asked ques-tions richly illustrated by images and diagrams and in-cluding references at the end of each subject.The Section I is “UPPER EXTREMITIES” including: Neck fracture; Humerus shaft fracture; Management of radial nerve palsy associated with humeral fracture; Clavicle fractures; Elbow fractures in children; Fasciot-omy technic of the forearm; Distal radius fracture; Indica-tions of radial head replacement, Femur and humeral shaft fractures; Treatment of posterolateral elbow dislocation; The Section II is “LOWER EXTREMITIES” including : Femur fractures; Pelvic fractures; Life threatening pelvic fractures; Decision for surgical treatment in pelvic frac-tures; Treatment of anterior fracture of femoral head and hip joint incongruity; Management of a displaced femoral neck fracture in young patient in ER; Elder patients with displaced femoral head fracture; Patella and tibial plateau fractures; Criteria for compartment syndromes in the tibia; Tricks in nailing proximal and distal tibial fractures; Surgical management of distal tibia spiral fracture in middle aged women; Pilon fracture; Management of syn-desmotic screws in adult patient; The management of minimally displaced posterior malleol in three malleolar fractures; Postoperative management of bimalleolar frac-tures; Management of minimally

  17. Applied anatomy of cervicothoracic spine anterior approach operation%颈胸段脊柱前方入路手术的应用解剖

    Institute of Scientific and Technical Information of China (English)

    王险峰

    2013-01-01

    Objective To explore the anatomical basis of cervicothoracic spine anterior operation.Methods A total of 39 bodies were selected.Through simulating the steps of exposure of the vertebral body by sternal and clavicular resection of cervicothoracic spine anterior surgery,rehional anatomy method was used to observe the C5-T3 vertebral body must be retracted and important structures of several protection in anterior approach from outside to inside,from the shallower to the deeper,then some important parameters were measured.Results The left brachiocephalic vein length was (67.8±11.2) mm,the vertical distance and brachiocephalic trunk node from the suprasternal notch was (52.6±21.3) mm,the horizontal distance of left venous angle and anterior midline was (43.3±8.8) mm.Vertical distance from the peak of pleura to 1/3 superior border of left clavicle was (8.1±2.2) mm,while,(13.1±2.9) mm on the right,the distance between left and right had significant difference (P < 0.05).The vertical distance and the horizontal dis tance from the peak of arch of thoracic duct to cricoid cartilage level and anterior midline were (19.2±4.3) mm and (34.1±2.1) mm.6 cases of right recurrent laryngeal nerve penetrated the visceral fascia located in G7-T1 intervertebral level,accounting for 15.38%,33 cases located in the upper T1 vertebral level,accounting for 84.62%.The crossing points of right recurrent laryngeal nerve and medial border of carotid artery located in T1 upper level were 9 cases,located in T1 lower level were 30 cases,accounting for 23.08% and 76.92% respectively.Conclusion Application of sternal and clavicular resection in the cervicothoracic spine anterior approach operation can make the C5-T3 fully exposed,only familiar with local anatomy can make the anterior operation normally developed,in order to decrease the incidence of iatrogenic complications.%目的 探讨颈胸段脊柱前路手术的解剖学依据.方法 选取39具尸体,通过模拟胸骨柄和

  18. 99Tcm-MDP核素骨扫描评估继发性肥大性骨关节病%Imaging observation of secondary hypertrophic osteoarthropathy by 99Tcm-methylene diphosphonate bone scans

    Institute of Scientific and Technical Information of China (English)

    徐海峰; 张王峰; 周润锁; 穆继珍

    2001-01-01

    AIM To evaluate the characteristic findings of the secondary hypertrophic osteoarthropathy (or called hypertrophic pulmonary osteoarthropathy, HPO) and differentiate the bone metastases or some osteoarthropathy diseases from HPO. METHODS Fifty-five tumor cases were confirmed on HPO with 99Tcm-MDP the whole body bone scintigraphy combined X-ray imaging and clinical manifestation. It was observed to grading scale and distribution of radionuclide in extremities, scapulae, clavicles, skull, ribs, pelvis, patella and joints referring to Ali's method. At the same time, 11 cases with HPO were followed after operation, radio-therapy and/or chemical therapy. RESULTS Double stripe sign mainly in long bones was found in all 55 cases. Involvement of the extremities was invariably present, 44 cases (87%) almost always appeared more active in the lower than in the upper extremities. There was a symmetrical , regular increase of activity along cortical margins in 46 cases (84%) and uniformity involvement in 49 cases (89%). There was also an abnormally increased activity in and around the joints in 31 cases. Whereas the observation of curative effects on HPO, there were some changes of clinical symptoms, signs and bone scan within 6~24 mo after appropriate therapy of the associated disease process, such as a complete remission or subsided in 6 cases, a fluctuating intensity of uptake in 2 cases, no improved in 1 case and aggravating in 2 cases. CONCLUSION Double stripe sign is a main characteristic findings for HPO. The distribution of the activity between bone metastases and HPO is entirely different. The follow up for HPO by bone scan will make for observation and evaluation of curative effect.%目的评价继发性肥大性骨关节病(HOA)放射性核素显像的特点与鉴别. 方法放射性核素99Tcm-MDP全身骨显像结合临床表现,对继发性HOA的肿瘤患者55例进行了核素闪烁显像分析. 参照Ali分级方法,观察了四肢骨

  19. Metastatic Brachial Plexopathy in a Case of Recurrent Breast Carcinoma Demonstrated on {sup 18}F-FDG PET/CT

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    Tripathi, Madhavi; Das, Chandan J.; Srivastava, Anurag; Bal, ChandraSekhar; Malhotra, Arun [All India Institute of Medical Sciences, New Delhi (India)

    2014-03-15

    This case highlights the importance of recognition of the pattern of metastatic brachialplexopathy in breast cancer patients undergoing {sup 18}F-fluorodeoxyglucose ({sup 18}F-FDG) positron emission tomography/computed tomography (PET/CT) for evaluation of recurrent disease.This pattern can be appreciated on maximum intensity projection (MIP) and coronal {sup 18}F-FDG PET/CT images as a linear extension of tracer activity from superomedial aspect(supra/infraclavicular) to lateral aspect of the axilla closely related to the subclavian/axillary vessels). A 35-year-old woman diagnosed with infiltrating ductal carcinoma of the right breast had undergone six cycles of neoadjuvant chemotherapy, followed by wide local incision and radiotherapy. She had local recurrence, for which she was operated upon and given chemotherapy. She presented to her oncologist with pain and swelling in the right breast, nodules in the right axilla and restriction of movement of the right upper limb. The patient was referred for {sup 18}F-FDG PET/CT to evaluate the extent of recurrent/metastatic disease. Whole-body PET/CT was acquired 1 h following the intravenous injection of 296 MBq of {sup 18}F-FDG on a Biograph mCT scanner (Siemens). Evaluation of the MIP image revealed abnormal FDG accumulation at multiple sites in the thorax, along with a linear pattern of FDG uptake in the right lateral aspect of the upper chest (Fig. 1a, arrow). The coronal fused PET/CT image revealed a linear pattern of FDG uptake corresponding to an ill-defined mass extending from just behind the right clavicle into the right axilla (arrow). In addition, abnormal FDG accumulation was seen in a soft tissue density mass in the upper outer quadrant of the right breast, skin of the right breast laterally, both pectoral muscles (discrete foci) and in a few subpectoral nodes. Soft tissue nodular opacities in both lungs showed FDG accumulation suggestive of pulmonary metastasis (Fig. 1b, thick arrow). The patient was

  20. The 50 most cited Chinese articles in shoulder and elbow surgery%我国肩肘外科被引用最高的50篇文献

    Institute of Scientific and Technical Information of China (English)

    季伟; 姚聪良; 贾治伟; 唐勇; 何勍; 阮狄克

    2015-01-01

    published the most number of articles that we identified.Only Qiang Huang,as the first-author,published more than one article in this top 50 list.Trauma was the main content of the 50 most cited articles.The most discussed topic was clavicle fracture (1 1 ).Conclusions Analyzing the most cited articles helps to provides the main characteristics of Chinese classic articles in shoulder and elbow surgery,and to understand the history of shoulder and elbow researches in China and to lead the future studies.This top cited list could be referred to read the classic articles for young surgeons.

  1. The clinical study of reconstruction of traumatic brachial plexus root avulsion injury in children%儿童创伤性臂丛神经撕脱伤的屈指功能重建

    Institute of Scientific and Technical Information of China (English)

    王树锋; 栗鹏程; 薛云皓; 李玉成; 陆健; 郑炜; 孙燕琨

    2010-01-01

    suffered side was exposed through the union incision superior and inferior to the clavicle.The lower trunk was identified and dissected proximally to the C_8 and T_1 nerve root which were severed at the lateral margin of anterior scalenus.and then the dorsal division and anterior medial pectoral nerve of lower trunk were severed.The median nerve,ulnar nerve and medial antebrachial cutaneout;nerve were identitled from the Origin and dissected distally continue to the midpoint of upper arm,and lateral head of the median nerve was severed so that the lower trunk.medial cord and median nerve,ulnat nerve and medial antebrachial cutaneous nerve can be fully mobilized.Anteriorly flexion and adduction of the should at 0°and flexion elbow at 90°,this could allow cousiderable length to he gained when pulling the lower trunk proximally,direct anastomosis of contralaterul C_7 with lower trunk wag performed.If there was any tension exist,the appropriate humerous shorten osteotomy should be performed.From August 2004 to December 2008.20 children including 13 cases with total brachial plexus nerve root avulsion injury and 7 cages with middle and lower trunk avulsion injury were repaired by this procedure.Twenty cases including 16 males and 4 females, the average age was 13 years with a range of 5 to 18 years.The interval from injury to operation ranged l to 11 months with a mean of 4.6 months.Eleven patients were performed the humeral shorten osteotomy,the length of the humeral shorten was 2.0-4.5 cm.with the mean of(3.1±0.7)cm Results The follow up period was 12 to 51 months.with the average of 26 months.The muscle strength of finger flexion attained M 4 in 18 cases,M 2 in 2 cases.The motor function of thumb flexion gained M 4 in 10 cases.M 3 in 8 cases, M2.in 2 cases.Of the 2 cases achieved motor function of intrinsic muscles of the hand of M3.Conclusions The direct anastomosis of contralateral C,with lower trunk in children with traumatic brachial plexus avulsion injury can improve

  2. Análise de fatores associados à lesão do nervo laríngeo recorrente em cirurgias de discectomia cervical via anterior Análisis de factores asociados a la lesión del nervio laríngeo recurrente en cirugías de discectomía cervical por vía anterior Analysis of factors associated with laryngeal nerve injury in anterior disc herniation surgery

    Directory of Open Access Journals (Sweden)

    Erasmo Abreu Zardo

    2011-01-01

    (incisiones de halo craneano. CONCLUSIÓN: El abordaje por el lado derecho presentó mayor índice de complicaciones con el NLR. A pesar de que el número limitado de pacientes no permite conclusiones estadísticas significativas, factores anatómicos intrínsecos del paciente como cuello corto y diámetro aumentado, bien como tiempo quirúrgico y dificultades técnicas que puedan aumentarlo, pueden estar asociados a lesiones en el NLR. Nuevos estudios evaluando las variables arriba estudiadas deben ser considerados.OBJECTIVE: To study other possible factors associated with RLN injury after anterior approach for treatment of disc herniation. METHODS: Between June 2009 and July 2010, we evaluated 30 patients underwent anterior approach for treatment of disc herniation in Hospital Sao Lucas, PUC-RS. At preoperative period, we evaluated the measure of neck circumference (at the level of the cricoid cartilage and cervical height (angle of the jaw to the upper edge of the clavicle. At perioperative period, we evaluated the time and difficulty in endotracheal intubation, surgical time, the approach side , the number of levels operated, and the type of incision (transverse / longitudinal and the use of the cranial halo. An endoscopic evaluation of the larynx was performed preoperatively. In the first 10 days after surgery, it was performed a second evaluation. The patients who had a normal second examination were considered without RLN injury. Patients who showed injuries were followed monthly until a period of six months when injuries were considered as definitive. RESULTS: We found 3/30 (10% cases of temporary RLN injury which recovered to up to 120 days post operate. Related to patients with no RLN injury, these patients had a neck circumference greater than average, their surgical time was above average, as well the number of levels operated, and the neck length was shorter than average. Two injuries occurred in the approach through the right side and one in the left side. All

  3. Study on the consistency of CT classification system evaluating coracoid fragment absorption after Latarjet operation%评估 Latarjet 手术后移位喙突骨块吸收情况的 CT 分型系统的一致性研究

    Institute of Scientific and Technical Information of China (English)

    朱以明; 姜春岩

    2015-01-01

    faced to the observer with the method described by Sugaya.The assessment of bone defect size on the glenoid was performed in enface view,and the open Latarjet operation would be selected if the size is over 25%.Operation method:Patient position and surgical incision.After successful general anesthesia,the patient was in the beach chair position with the affected shoulder placed out of the operating table border and mobilized freely in all directions.The incision was made downward from the coracoid tip and the coracoid was exposed through the deltoid and pectoralis major muscle interval.Coracoid process preparation:The shoulder was in abduction and external rotation to expose the coracoacromial ligament.The coracohumeral ligament,pectoralis minor and coracoacromial ligament were released from coracoid.The coracoid was osteotomized just anterior to coraco-clavicle ligament.Two holes were drilled on the coracoid with enough space between them and the coracoid was put deep behind the pectoralis major muscle for further operation.Exposure of the glenoid:The affected limb was in external rotation and the glenoid was fully exposed with the subscapularis tendon split and the anterior joint capsule opened vertically.Preparations of glenoid and fixation of coracoid:The bone bed of anterior glenoid rim and neck was prepared.One hole was drilled at 5 o′clock in front of scapula for fixation through the lower hole on the coracoid with a 4.0 mm half thread canulated screw.The fragment should not protrude over glenoid surface.The other hole on the scapula was drilled through the upper pre-drilled hole on the coracoid fragment and a 4.0mm half thread canulated screw was inserted.The coracoacromial ligament attached to coracoid fragment was sutured with anterior capsule with shoulder in extreme external rotation.The wound was closed in layers.Rehabilitation programme:The shoulder was immobilized with a sling for 3 weeks after operation.Passive exercises of the affected limb were