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Sample records for clavicle

  1. Pseudarthrosis of the clavicle.

    Science.gov (United States)

    Galvin, Joseph W; Dannenbaum, Joseph H; Grassbaugh, Jason A; Eichinger, Josef K

    2014-05-01

    A 21-year-old active duty soldier presented with right shoulder pain and prominence over his right clavicle, with no history of trauma. He recalled that the deformity had been present for a long time, but only recently became painful. The onset of shoulder pain coincided with the beginning of his military service and the requirement to wear over-the-shoulder equipment such as back packs and load-bearing equipment. Physical examination revealed a prominence over the right midshaft clavicle with tenderness to palpation, full active range of motion of the shoulder, and that he was neurovascularly intact. PMID:24810809

  2. Congenital pseudarthrosis of the clavicle

    Energy Technology Data Exchange (ETDEWEB)

    Currarino, Guido [Texas Scottish Rite Hospital for Children, Department of Radiology, Dallas, TX (United States); Herring, John A. [Texas Scottish Rite Hospital for Children, Department of Orthopedic Surgery, Dallas, TX (United States)

    2009-12-15

    Congenital pseudarthrosis is an uncommon anomaly poorly referred to in the pediatric literature. To describe congenital pseudarthrosis in children. We discuss the presentation, clinical symptomatology, and treatment. We reviewed the records of four children with congenital pseudarthrosis from 1990 to 2009 at the radiology department of Texas Scottish Rite Hospital for Children. Four girls ages 4 through 14 were identified. Three children presented with a bulge in the mid-clavicle as a chief complaint. The fourth child (14 years old) had bluish discoloration of the right upper extremity with venous distention. Three of the four did not have other abnormalities, while the 14-year-old had exostosis on the left hand. The mid-portion of the right clavicle was involved in all four children. Three of the four were treated surgically. Congenital pseudarthrosis of the clavicle is an uncommon anomaly found mostly in girls and in the mid-right clavicle. (orig.)

  3. Congenital pseudarthrosis of the clavicle

    International Nuclear Information System (INIS)

    Congenital pseudarthrosis is an uncommon anomaly poorly referred to in the pediatric literature. To describe congenital pseudarthrosis in children. We discuss the presentation, clinical symptomatology, and treatment. We reviewed the records of four children with congenital pseudarthrosis from 1990 to 2009 at the radiology department of Texas Scottish Rite Hospital for Children. Four girls ages 4 through 14 were identified. Three children presented with a bulge in the mid-clavicle as a chief complaint. The fourth child (14 years old) had bluish discoloration of the right upper extremity with venous distention. Three of the four did not have other abnormalities, while the 14-year-old had exostosis on the left hand. The mid-portion of the right clavicle was involved in all four children. Three of the four were treated surgically. Congenital pseudarthrosis of the clavicle is an uncommon anomaly found mostly in girls and in the mid-right clavicle. (orig.)

  4. Significant pneumothorax complicating a fractured clavicle.

    OpenAIRE

    Williams, R. J.

    1995-01-01

    Pneumothorax has been described as a complication of a fractured clavicle only three times. It is an important and potentially serious complication. This case report describes a fractured clavicle complicated by a significant pneumothorax which required chest drain insertion.

  5. Nontraumatic disorders of the clavicle.

    Science.gov (United States)

    Beals, Rodney K; Sauser, Donald D

    2006-04-01

    Other than those resulting from trauma and arthritis, disorders of the clavicle are uncommon. Some nontraumatic disorders are found only in infancy and childhood, such as birth fracture, infantile cortical hyperostosis, congenital pseudarthrosis, cleidocranial dysplasia, and short clavicle syndrome. Other nontraumatic disorders occur in both children and adults; these include anterior subluxation of the sternoclavicular joint, Friedrich's disease, hypertrophic osteitis, chronic multifocal periosteitis and arthropathy, and osteomyelitis. Some nontraumatic clavicular disorders are found only in adults, such as distal osteolysis. Because the description and nomenclature of these disorders arise from several medical disciplines, they often are confusing. Until clear, distinguishing features are described, it is advisable to combine some of the entities. This is especially true of the nonsuppurative inflammatory disorders of the clavicle, which appear to fall under the heading of spondyloarthropathy. Treatment varies by disorder and may include symptomatic and expectant management, drug therapy, and nonsurgical or surgical treatment. PMID:16585362

  6. CONGENITAL PSEUDARTHROSIS OF THE CLAVICLE.

    Science.gov (United States)

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

    2012-01-01

    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 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. PMID:27047839

  7. Congenital pseudarthrosis of clavicle, differential diagnosis pathology

    International Nuclear Information System (INIS)

    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 pseudoarthrosis of the right clavicle that they received surgical treatment with satisfactory results.

  8. Conservative Management of Paediatric Clavicle Fractures

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    Barry J. O'Neill

    2011-01-01

    Full Text Available Paediatric clavicle fractures have traditionally been treated nonoperatively. Recent studies have recommended operative management for displaced midshaft fractures. We conducted a retrospective review of all clavicle fractures in children aged one to sixteen over a two-year period. We classified fractures and evaluated followup and clinical outcome. We identified 190 fractures. There were 135 boys and 55 girls. 65% of fractures were displaced and 35% undisplaced. Mean radiographic and clinical followup was 35 days and 44 days, respectively. Clavicle fractures in children heal with nonoperative management. Radiographs of clavicle fractures in children are unnecessary in the absence of clinical symptoms.

  9. Chronic osteomyelitis of the clavicle

    International Nuclear Information System (INIS)

    Osteomyelitis of the clavicle is an uncommon disease, but it should be considered in patients who present with pain, cellulitis, or drainage in the sternoclavicular area following head and neck surgery, irradiation, subclavian vein catheterization, or immunosuppression. An idiopathic presentation is possible. In contrast to primary osteomyelitis of the clavicle, which is occasionally seen in children, secondary osteomyelitis is quite rare. It is often mistaken for a fracture or a possible neoplasm on plain x-rays. Tomograms and CT scanning are confirmatory, and in early cases, technetium-99m bone scanning can be helpful. Treatment must include early, aggressive surgical debridement of all affected tissues, followed by wound coverage with a well-vascularized flap and perioperative antibiotics

  10. 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

  11. Bipolar dislocation of the clavicle

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    Wei Jiang

    2012-01-01

    Full Text Available Bipolar dislocation of the clavicle at acromioclavicular and sternoclavicular joint is an uncommon traumatic injury. The conservative treatments adopted in the past is associated with redislocation dysfunction and deformity. A 41 years old lady with bipolar dislocation of right shoulder is treated surgically by open reduction and internal fixation by oblique T-plate at sternoclavicular joint and Kirschner wire stabilization at acromioclavicular joint. The patient showed satisfactory recovery with full range of motion of the right shoulder and normal muscular strength. The case reported in view of rarity and at 2 years followup.

  12. Bipolar dislocation of the clavicle.

    Science.gov (United States)

    Jiang, Wei; Gao, Shu-Guang; Li, Yu-Sheng; Lei, Guang-Hua

    2012-11-01

    Bipolar dislocation of the clavicle at acromioclavicular and sternoclavicular joint is an uncommon traumatic injury. The conservative treatments adopted in the past is associated with redislocation dysfunction and deformity. A 41 years old lady with bipolar dislocation of right shoulder is treated surgically by open reduction and internal fixation by oblique T-plate at sternoclavicular joint and Kirschner wire stabilization at acromioclavicular joint. The patient showed satisfactory recovery with full range of motion of the right shoulder and normal muscular strength. The case reported in view of rarity and at 2 years followup. PMID:23325981

  13. Conservative treatment of fractures of the clavicle

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    Moretti Lorenzo

    2011-09-01

    Full Text Available Abstract Background In the treatment of clavicle fractures, the choice of procedure depends on the possibility of restoring the anatomical functional integrity of the shoulder. Methods We examined 71 patients (51 males and 20 females, mean age 38.9 years who were affected by clavicle fracture sequelae. Demographic and clinical data and the site of the lesion were recorded for each partecipant. The dissatisfaction of the patient was determined by the presence of 1 or more affirmative answers on the Simple Shoulder Test. The Constant Shoulder Score was also included in the functional and clinical exams. We measured the length of the healthy clavicle and the previously fractured clavicle, and we expressed the difference in length in mm and in percentage shortening. We then examined the correlations between the shortening of the bone and the clinical and functional outcomes of the patients. Results Sixty patients had a lesion of the diaphysis, 8 patients had a lesion of the lateral third of the clavicle, and 3 patients had a lesion of the medial third of the clavicle. The mean Constant Shoulder Score was 77.9, and 51 of the 71 patients were satisfied with their treatment. Radiography showed a mean clavicle shortening of 10 mm (mean percentage 6.5%. In the 20 dissatisfied patients, the mean clavicle shortening was 15.2 mm (9.7%. In these patients, we found a highly significant association between dissatisfaction with treatment and the amount of bone shortening, (p Conclusions In the literature, measurements of the shortening of the bone segment following a fracture range between 15 and 23 mm, and marked shortening is correlated with the failure of conservative treatment. However, these data need to be reinterpreted in light of the physiological variability of the clavicle length, which ranges from 140 to 158 mm in the healthy population. Shortening of the bone by more than 9.7% should be the cut-off for predicting failure of conservative treatment.

  14. 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.

  15. Bilateral Clavicle Fracture in two Newborn Infants

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    Ali Kanik

    2011-12-01

    Full Text Available Background: The fracture of clavicle is the most frequently observed bone fracture as birth trauma and it is usually unilateral. It is seen following shoulder dystocia deliveries or breech presentation of macrosomic newborns.Case Presentation: We report two macrosomic newborns with bilateral clavicle fracture and brachial plexus palsy due to birth trauma. Chest X-rays confirmed bilateral fracture of clavicles. Both patients were recovered without any sequel.Conclusion: Bilateral clavicular fracture should be considered in any neonate with bilateral absent Moro reflexes.

  16. Bilateral Clavicle Fracture in Two Newborn Infants

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    Esra Arun Ozer

    2011-12-01

    Full Text Available Background: The fracture of clavicle is the most frequently observed bone fracture as birth trauma and it is usually unilateral. It is seen following shoulder dystocia deliveries or breech presentation of macrosomic newborns.Case Presentation: We report two macrosomic newborns with bilateral clavicle fracture and brachial plexus palsy due to birth trauma. Chest X-rays confirmed bilateral fracture of clavicles. Both patients were recovered without any sequel.Conclusion: Bilateral clavicular fracture should be considered in any neonate with bilateral absent Moro reflexes.

  17. 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.

  18. Functional outcomes of conservatively treated clavicle fractures

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    Mohd Yazid Bajuri

    2011-01-01

    Full Text Available OBJECTIVE: The main aim of the study was to analyze the outcomes of clavicle fractures in adults treated non-surgically and to evaluate the clinical effects of displacement, fracture patterns, fracture location, fracture comminution, shortening and fracture union on shoulder function. METHODS: Seventy clavicle fractures were non-surgically treated in the Orthopedics Department at the Tuanku Ja'afar General Hospital, a tertiary care hospital in Seremban, Malaysia, an average of six months after injury. The clavicle fractures were treated conservatively with an arm sling and a figure-eight splint for three weeks. No attempt was made to reduce displaced fractures, and the patients were allowed immediate free-shoulder mobilization, as tolerated. They were prospectively evaluated clinically and radiographically. Shoulder function was evaluated using the Constant scoring technique. RESULTS: There were statistically significant functional outcome impairments in non-surgically treated clavicle fractures that correlated with the fracture type (comminution, the fracture displacement (21 mm or more, shortening (15 mm or more and the fracture union (malunion. CONCLUSION: This article reveals the need for surgical intervention to treat clavicle fractures and improve shoulder functional outcomes.

  19. Intraosseous hemangioma arising in the clavicle

    Energy Technology Data Exchange (ETDEWEB)

    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.)

  20. 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 a...... large cohort, and our purpose was to assess the overall rates of complications and reoperations following locking plate osteosynthesis of mid-shaft clavicle fractures. METHODS: We identified all locking plate osteosynthesis of mid-shaft clavicle fractures operated upon in our department from January...... 2008 to November 2010 (n = 114). Nine patients did not attend the follow-up at our institution. The study group of 105 fractures (104 patients, 86 males) had a median age of 36 years (14-75 years). Follow-up ranged from 0.5 to 3.5 years. No patients were allowed to load the upper extremity for six...

  1. Congenital pseudarthrosis of the clavicle: a case report.

    Science.gov (United States)

    Beslikas, T A; Dadoukis, D J; Gigis, I P; Nenopoulos, S P; Christoforides, J E

    2007-04-01

    Congenital pseudarthrosis of the clavicle is a rare entity of unknown aetiology. Its pathogenesis is related to the embryology of the clavicle. We present a 6-year-old girl with congenital pseudarthrosis of the right clavicle. A prominence was noticed at birth between the middle and distal ends of the clavicle that increased in size when the right shoulder was actively mobilised. Radiographic examination revealed a hypertrophic pseudarthrosis of the clavicle. The pseudarthrosis was resected and the clavicular segments were fixed with an external fixator for 2 months until union. Clinical results were excellent at the 7-year follow-up: the right shoulder was pain-free and the appearance satisfactory. Surgical treatment of congenital pseudarthrosis of the clavicle in children using an external fixator provides a better cosmetic outcome with smaller postoperative scars and avoids a second surgical procedure to remove the implants. PMID:17429126

  2. Unicortical versus bicortical locked plate fixation in midshaft clavicle fractures.

    Science.gov (United States)

    Bravman, Jonathan T; Taylor, Michal L; Baldini, Todd; Vidal, Armando F

    2015-05-01

    Higher rates of poor outcomes in displaced midshaft clavicle fractures treated nonoperatively have recently been reported. Along with expanding indications for operative fixation and increasing application of locked plate constructs, it is unknown whether complications related to bicortical penetration of the clavicle can be avoided using unicortical fixation. The purpose of this study is to compare the biomechanical properties of unicortical and bicortical fixation in precontoured vs manually contoured locking clavicle plates. Forty-eight Sawbone composite human clavicle specimens (item #3408; Pacific Research Laboratories, Vashon, Washington) with a midshaft clavicle osteotomy were reduced and plated in 8 specimens each using a bicortical and unicortical fixation for each of 3 locked plate constructs (3.5-mm LCP Reconstruction Plate; 3.5-mm LCP Superior Clavicle Plate; 3.5-mm LCP Superior Anterior Clavicle Plate; Synthes, Inc, West Chester, Pennsylvania). Specimens were tested for stiffness in axial torsion and cantilever bending and then loaded to failure in 3-point bending. Data were analyzed using 2-way analysis of variance and Tukey's test (Pbending, and cross body stiffness. Bicortical fixation was significantly stiffer than unicortical fixation in torsion only for the same plates. Significant differences also existed between plates in torsion. Unicortical locked plate fixation may be a reasonable option in the treatment of displaced midshaft clavicle fracture fixation to avoid complications associated with posteroinferior hardware penetration following clavicle fracture fixation based on the biomechanical performance of these constructs. However, it remains unclear whether these differences will be clinically significant. PMID:25970369

  3. [Outcome of surgically treated lateral clavicle fractures].

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    Krüger-Franke, M; Köhne, G; Rosemeyer, B

    2000-07-01

    This retrospective study presents the results of 41 patients with a lateral clavicle fracture eight years after the treatment at the Staatliche Orthopädische Klinik of the LMU München in the time between 31.10.1979 and 31.10.1994. It could be shown that the lateral clavicle fractures, due to their variety, hold a special position among the clavicle fractures and thus need a differentiated therapeutic procedure. Among the operation methods the K-wire stabilisation with cerclage was the most often chosen operation technique i.e. in 24 cases. The K-wire without cerclage was used in two cases. Twelve fractures were treated with AO-plate-osteosynthesis. Three fractures had to be treated by resection, as they produced two pseudarthrosis and one serious AC-arthrosis during the conservative therapy. 92.7% of the subjective results of the 41 checked up patients were good and very good. The clinical follow-up of 36 and the radiological follow-up of 33 patients revealed in 97% a good and very good outcome in the Boenisch-Score. PMID:10969540

  4. Clavicle fractures--is there a standard treatment?

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    Hübner, E J; Hausschild, O; Südkamp, N P; Strohm, P C

    2011-01-01

    Clavicle fractures, especially of the mid third, are an injury commonly seen in clinical practice, therefore, there is constant earnest discussion of the optimal approach to therapy. Until recently clavicle fractures were solely the domain of non surgical management. Even displaced fractures have been successfully managed without surgery. However, complications have been reported after non surgical treatment, the most frequent being post-traumatic shortening of the clavicle with varying functional consequences for the shoulder joint and range of arm motion as well as pseudarthrosis, especially after more severely displaced fractures. Recent studies have now shown that outcomes after non surgical management of displaced fractures or shortening of the clavicle are worse than had been previously assumed. Surgical techniques for the stable fixation of clavicle fractures have been improved and a wider selection of implants for osteosynthesis of these fractures has become available. Although there is widespread consensus that undisplaced or minimally displaced clavicle fractures respond well to non surgical management, optimal treatment of displaced fractures or severe shortening is under scrutiny with regard to both the basic choice between non surgical or surgical management and implant selection. According to current research findings, surgical management of displaced clavicle fractures has advantages and appears to be superior to non surgical management. Intramedullary nailing has proven suitable for simple straight fractures, and plate fixation for multifragmentary fractures. PMID:21888838

  5. Primary Osteomyelitis of the Clavicle in Children.

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    Ghate, Sushant; Thabet, Ahmed M; Gosey, G Max; Southern, Edward P; Bégué, Rodolfo E; King, Andrew G

    2016-07-01

    Osteomyelitis of the clavicle is a rare entity with a broad differential diagnosis and high potential for complications if not diagnosed promptly and treated appropriately. The threshold for surgical intervention should be low to prevent osteonecrosis and bony resorption. In addition, although rare, life-threatening complications have been reported. This report describes primary osteomyelitis of the clavicle that was diagnosed in a 22-month-old girl on her third clinical evaluation after 4 days of symptoms. She presented to a children's tertiary care emergency department with fever and acute pain and swelling of her right shoulder and arm. The diagnosis was confirmed through clinical, laboratory, and imaging studies including ultrasound; these revealed subperiosteal abscess formation, which may have developed in part as the result of a delayed diagnosis from the 2 prior emergency department visits. The patient was treated initially with intravenous antibiotics and underwent therapeutic as well as diagnostic needle-guided tissue aspiration under ultrasound guidance. This ruled out malignancy but was not curative, and the subperiosteal abscess recurred within 24 hours, prompting formal operative irrigation and debridement. The patient was seen for 12-month follow-up and has had no complications or evidence of recurrence. This case emphasizes the need for a high index of suspicion to prevent diagnostic delays as well as the importance of a low threshold for surgical debridement to minimize the potential for complications that could prolong the treatment course. [Orthopedics. 2016; 39(4):e760-e763.]. PMID:27280623

  6. Krapina and Other Neanderthal Clavicles : A Peculiar Morphology?

    OpenAIRE

    Voisin, Jean-Luc

    2006-01-01

    The clavicle is the less studied element of the shoulder girdle, even if it is a very important bone for human evolution because it permits all movements outside the parasagittal plan. In this work, clavicle curvatures are studied by projecting them on a cranial and a dorsal plan, which are perpendicular. In cranial view, there is no difference within the genus Homo, and Neanderthal clavicles are not more S-shaped than modern human ones. On the contrary, the dorsal view allows to distinguish ...

  7. Pycnodysostosis associated with bilateral congenital pseudarthrosis of the clavicle.

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    Karakurt, Lokman; Yilmaz, Erhan; Belhan, Oktay; Serin, Erhan

    2003-04-01

    We report the case of a 22-year-old woman with pycnodysostosis associated with bilateral congenital pseudarthrosis of the clavicle. The patient was first seen at the age of 19 years and had no symptoms during the 3-year follow-up period. The diagnosis of pycnodysostosis was made by typical clinical and radiological findings. Bilateral painless mid-clavicular mass and plain radiograms confirmed the diagnosis of bilateral congenital pseudarthrosis of the clavicle. Surgery was not performed for pseudarthrosis of the clavicles, just observation was preferred. PMID:12721693

  8. Familial pseudarthrosis of the clavicle: does it need treatment?

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    O'Leary, Edmund; Elsayed, Sherief; Mukherjee, Ashok; Tayton, Keith

    2008-08-01

    The eighth family with multiple cases of congenital pseudarthrosis of the clavicle is described. This usually presents as a clavicular lump and is distinct from more common conditions such as birth fractures, craniocleidal dysostosis and neurofibromatosis. There has so far been no clear indication on whether familial pseudarthrosis of the clavicle should be treated operatively. We recommend that when a suspected case of congenital pseudarthrosis of the clavicle is diagnosed the parents and siblings be examined also. If other family members are affected, we advise that the treatment should be conservative. PMID:18811023

  9. Statistical shape analysis and principal component analysis of the clavicle

    OpenAIRE

    Daruwalla, Zubin J

    2009-01-01

    "The chief use of the clavicle is to hold the shoulder blade at the proper distance from the breastbone, since motion of the shoulder would be hindered if the two came close together, as seen in four-footed animals that can use their forefeet only for walking, and not in the way that men need their hands." - Therselben, 1790 Although anthropometric work on the clavicle by Broca dates as far back as 1869 according to Voisin1, the role of the clavicle has been described more than 200 year...

  10. Stress fracture of the clavicle associated with sternocostoclavicular hyperostosis

    International Nuclear Information System (INIS)

    We report a case of stress fracture of the clavicle associated with sternocostoclavicular hyperostosis. A 60-year-old man sustained a stress fracture of the right clavicle with no history of trauma. On radiography, hyperostosis of the anterior chest wall and ankylosis of the sternoclavicular joint were evident in addition to the fracture. Fracture healing was uneventful after 2.5 months. Ankylosis of the sternoclavicular joint may have caused increased stress at the midshaft of the clavicle by daily activity or minor trauma. Such a fracture is a rare complication of sternocostoclavicular hyperostosis. (orig.)

  11. Distal clavicle osteolysis following fixation with a synthetic ligament

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    Paul M.C Dearden

    2011-01-01

    Full Text Available We present a case of distal clavicle osteolysis following treatment of a chronic acromioclavicular joint dislocation with a synthetic ligament. The relevant literature is reviewed and discussed.

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

    International Nuclear Information System (INIS)

    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.)

  13. 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.

  14. Congenital pseudarthrosis of the clavicle: a rare and challenging diagnosis.

    Science.gov (United States)

    Sung, Tony H T; Man, Eric M W; Chan, Augustine T S; Lee, W K

    2013-06-01

    Congenital pseudarthrosis of the clavicle is a rare clinical entity, first described in 1910. We report on a newborn baby girl who presented with a painless lump over mid-portion of right clavicle at her routine newborn examination, which was subsequently diagnosed as a congenital pseudarthrosis. Here we explore its pathogenesis, elaborate on its differential diagnoses in paediatric patients, and comment on its distinct radiological features. PMID:23732433

  15. Cortical thinning of clavicle bone in renal stone male patients

    International Nuclear Information System (INIS)

    Radiogrametry of the clavicle is the oldest direct method of bone mass measurement. It has offered a better understanding of the in-vivo changes of cortical bone mass during life which accounts for 80% of the skeleton. This study is aimed to find out the effect of bone resorption (bone thinning) on the formation of renal calculi, particularly clavicle bone resorption using radiogrametry method

  16. [Congenital pseudarthrosis of the clavicle in two siblings].

    Science.gov (United States)

    Akman, Y Emre; Doğan, Ahmet; Uzümcügil, Onat; Azar, Nikola; Dalyaman, Erhan; Kabukçuoğlu, Yavuz S

    2008-01-01

    Congenital pseudarthrosis of the clavicle is a rare disorder of unknown etiology. Among nearly 200 cases hitherto reported, only a few cases have familial coexistence, and none are first-degree relatives. A nine-year old girl had complaints of weakness in the right arm and swelling in the right shoulder. On physical examination, a mass-like lesion in the right clavicle, abnormal clavicular movement, and asymmetric shoulders were noted. The range of motion of the shoulder was in normal range on both sides. A plain radiogram showed a defect in the diaphysis of the right clavicle and computed tomography showed discontinuity of the right clavicle. Similar clinical and radiologic findings were also detected in her younger sister who was three years old. None had a history of trauma, difficult delivery, or natal complication, any abnormal findings related to the musculoskeletal system, any abnormality in routine laboratory test results and genetic analysis. The diagnosis was made as congenital pseudarthrosis of the clavicle in both siblings. Since they had normal range of joint movements without pain, they were scheduled for clinical follow-up. To our knowledge, these two siblings are the first to be reported in the literature for having congenital pseudarthrosis of the clavicle. PMID:19158460

  17. Clavicle nonunion in a 10-year-old boy.

    Science.gov (United States)

    Pourtaheri, Neema; Strongwater, Allan M

    2012-03-01

    Posttraumatic clavicle nonunion is rare, particularly in children. Four cases of clavicle fracture nonunion in patients aged 10 years and younger have been reported. A variety of techniques have been used to treat pediatric clavicle nonunions. A 10-year-old boy presented to our institution after a fall, sustaining a right closed midshaft clavicle fracture. No other injuries occurred, and neurovascular examination of the right upper extremity was normal. The fracture was initially treated with a sling for >4 months, and the fracture progressed to a hypertrophic nonunion. Serial radiographs failed to demonstrate progression to union. The patient continued to have pain with activity 4 months after his injury. Clavicle pseudarthrosis was considered; however, radiographs did not have the characteristic appearance of this condition. This fracture nonunion was treated with internal fixation and united with no complication. The patient was back to full activities of daily living 6 months postoperatively. He reported no tenderness at the fracture site or along the hardware. The treating surgeon (A.M.S.) prefers to remove hardware in young children, but the family declined removal. Pediatric posttraumatic nonunion of the clavicle is rare but can be safely treated with plate fixation, with excellent results. PMID:22385461

  18. 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.

  19. Congenital pseudarthrosis of the clavicle and thoracic outlet syndrome in adolescence.

    Science.gov (United States)

    Sales de Gauzy, J; Baunin, C; Puget, C; Fajadet, P; Cahuzac, J P

    1999-10-01

    A 15-year-old girl with thoracic outlet syndrome associated with congenital pseudarthrosis of the clavicle was examined. The indication for treatment of congenital pseudarthrosis of the clavicle is discussed. PMID:10513368

  20. [A case of congenital pseudarthrosis of the clavicle].

    Science.gov (United States)

    Güneş, Taner; Erdem, Mehmet; Sen, Cengiz

    2005-01-01

    Congenital pseudarthrosis of the clavicle is a rare condition of unknown etiology. It usually presents as a painless mass in the clavicular region; however, it may sometimes be associated with pain and weakness in the shoulder. We presented a 21-year-old male patient who had pain and weakness in the right shoulder during sportive and daily vigorous activities due to congenital pseudarthrosis of the clavicle. The patient was successfully treated by excision of the ends of the medial and lateral fragments, reconstruction of the defect with a tricortical iliac crest autograft, and internal fixation of the clavicle with a plate and bone screws. After seven months postoperatively, his complaints disappeared, with a full range of motion and Constant score. PMID:16141735

  1. Partial claviculectomy after non-union of proximal clavicle fracture

    OpenAIRE

    Teng, Hsiu-Gwo; Liu, Andy Li-Jen

    2013-01-01

    Non-union of a proximal clavicle fracture is rare. When it does occur, it poses a difficult problem causing severe pain and shoulder impairment that must be dealt with surgically. We report a 29-year-old woman who suffered a proximal clavicle fracture and received plate and screws fixation. Six months later, after constant pain and a diminished range of shoulder motion, she sought help at our clinic and was diagnosed with symptomatic non-union. Reconstruction with bone graft and interosseous ...

  2. Congenital pseudarthrosis of the clavicle causing thoracic outlet syndrome.

    Science.gov (United States)

    Watson, Hannah Isabella; Hopper, Graeme Philip; Kovacs, Peter

    2013-01-01

    A 7-year-old girl presented with an asymptomatic right supraclavicular swelling. Radiographs were interpreted as showing a non-union of her clavicle. No treatment was given at this time. However, she represented 12 years later with right upper limb pain and altered sensation. Examination revealed a positive Allen's test on the right. Repeat radiographs demonstrated a pseudarthrosis of the clavicle, associated with a secondary complication of thoracic outlet syndrome with vascular and neurological complications present. Non-operative management failed to relieve her symptoms. Operative intervention successfully treated her symptoms. PMID:23975919

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

    Energy Technology Data Exchange (ETDEWEB)

    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. Bone scans in condensing osteitis of the clavicle

    International Nuclear Information System (INIS)

    Two additional cases of condensing osteitis of the clavicle are reported. Technetium /sup 99m/Tc phosphate bone scans were positive in both cases. Clinical and roentgenographic manifestations may allow nonoperative diagnoses of this entity which mimics metastatic disease on bone scans

  5. An examination of practice during radiography of the clavicle

    International Nuclear Information System (INIS)

    Background: Variation in techniques is a well reported phenomenon in Radiography that can lead to dose discrepancies. Radiography of the clavicle is an examination which can result in a scattered extra-focal radiation dose to the radiosensitive organs of the thyroid, breast and eyes. Techniques for imaging the clavicle are examined and causal factors of repeats examined. Given the recent increase of the tissue weighting factor of breast tissue, an increased importance is placed upon dose reduction techniques to this area. Aims: This study aims to investigate the variation in techniques used in imaging of the clavicle and to investigate whether AP or PA position resulted in a higher level of repeat imaging. Method: To investigate current practice amongst hospitals a sample of large teaching hospitals was chosen (n = 5). An interview with radiographers was carried out along with an examination of the stated protocols in each of these hospital plus retrospective analysis of the images produced in each of these hospitals. Results: Variations in practice were established, significant differences in collimation and vertical centring were found. AP coned view of the clavicle was performed by 80% of radiographers interviewed with 20% of radiographers performing an AP shoulder. This variation being 100% correlated with country of training. 60% of radiographers were found to perform AP15o cranial angulation clavicle as a second projection with 28%, 8% and 4% of those interview performing AP25o, AP20o, and AP30o cranial angulation, respectively. The comparison of error and repeat rates study demonstrated a lack of confidence, reduced employment of collimation and reduced accuracy while centring in the PA position and it was deemed necessary to repeat in 30% of cases compared to 40% repeats were necessary. Conclusion: Wide variation exists in technique and PA imaging is not being implemented. The author recommends training and information on PA technique be disseminated and

  6. Congenital pseudarthrosis of the clavicle: a histopathological study in five patients.

    Science.gov (United States)

    Gomez-Brouchet, Anne; Sales de Gauzy, Jérôme; Accadbled, Franck; Abid, Aziz; Delisle, Marie Bernadette; Cahuzac, Jean-Philippe

    2004-11-01

    Congenital pseudarthrosis of the clavicle is usually situated on the right clavicle. Pathological data on pseudarthrosis are scant. The histological analysis of five cases treated by 'en bloc' surgical resection are reported. Enchondral ossification was observed on both sides of the resected pseudarthrosis in two cases. Less characteristic enchondral features were noted in three cases. These findings confirm that the pseudarthrosis is due to the failure of coalescence of the two primary ossification centers of the clavicle. PMID:15599233

  7. Fracture union and complication following internal fixation of clavicle by plate and screw

    OpenAIRE

    Bishnu Prasad Patro; Saroj Kumar Patra; Subrat Mohapatra

    2016-01-01

    Background: Among all long bones clavicle is the only bone placed horizontally and has membranous ossification. Clavicle fractures accounting for about 2.6% of total body fractures and 34% to 45% of total shoulder girdle injuries in adults. Most fractures occur in middle third of clavicle and common in young male patients. It has wide range of management from conservative to variant internal fixation. Each procedure has its own outcome and complications. We tried to find out the outcome and c...

  8. 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.

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

    Directory of Open Access Journals (Sweden)

    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 .

  10. Congenital pseudarthrosis of clavicle: illustrated operative technique and histological findings.

    Science.gov (United States)

    Galanopoulos, Ilias; Ashwood, Neil; Garlapati, Anand Kumar; Fogg, Quentin

    2012-01-01

    Congenital pseudarthrosis of the clavicle is a rare condition present at birth but often diagnosed later in childhood. Indications for surgical treatment include pain, deformity or neurovascular compromise. Reconstruction usually involves resection of the pseudarthrosis, placement of iliac crest bone graft or graft substitute and internal fixation. In this paper, we present a case of congenital pseudarthrosis of the clavicle in a 9-year-old boy who was treated with plate fixation and bone autograft. The majority of patients who undergo surgery because of cosmetic or functional problem heal well and proceed with a normal, unrestricted life. However, for those patients who are not bothered by the cosmetic appearance of the pseudarthrosis and are asymptomatic in that they are not functionally limited, non-surgical treatment is a viable option. PMID:23001106

  11. Cutaneous hypoesthesia following plate fixation in clavicle fractures

    OpenAIRE

    Lushun Wang; Muliang Ang; Keng Thiam Lee; Ganesan Naidu; EBK Kwek

    2014-01-01

    Background: We report the functional impact and natural history of cutaneous hypoesthesia after plate internal fixation for mid shaft clavicle fractures with a horizontal skin incision from year 2009 to 2011. Materials and Methods: 38 patients had complete followup data with an average followup period of 23.2 months (range 8-43 months). The impact of supraclavicular nerve injury was studied by assessment of the incidence, functional impact and natural history of numbness with detailed rev...

  12. Does Subacromial Osteolysis Affect Shoulder Function after Clavicle Hook Plating?

    Science.gov (United States)

    Sun, Siwei; Gan, Minfeng; Sun, Han; Wu, Guizhong; Yang, Huilin; Zhou, Feng

    2016-01-01

    Purpose. To evaluate whether subacromial osteolysis, one of the major complications of the clavicle hook plate procedure, affects shoulder function. Methods. We had performed a retrospective study of 72 patients diagnosed with a Neer II lateral clavicle fracture or Degree-III acromioclavicular joint dislocation in our hospital from July 2012 to December 2013. All these patients had undergone surgery with clavicle hook plate and were divided into two groups based on the occurrence of subacromial osteolysis. By using the Constant-Murley at the first follow-up visit after plates removal, we evaluated patients' shoulder function to judge if it has been affected by subacromial osteolysis. Results. We have analyzed clinical data for these 72 patients, which shows that there is no significant difference between group A (39 patients) and group B (33 patients) in age, gender, injury types or side, and shoulder function (the Constant-Murley scores are 93.38 ± 3.56 versus 94.24 ± 3.60, P > 0.05). Conclusion. The occurrence of subacromial osteolysis is not rare, and also it does not significantly affect shoulder function. PMID:27034937

  13. 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

    BACKGROUND: The Constant score (CS) has been the primary endpoint in most studies on clavicle fractures. However, the CS was not developed to assess patients with clavicle fractures. Our aim was to examine inter-rater reliability and agreement of the CS in patients with clavicle fractures. The se...

  14. Treatment of medial clavicle fractures . A case report and review of the literature

    OpenAIRE

    Aygün, Hayati; Çakar, Albert; Atilla, Halis Atıl

    2013-01-01

    Medial clavicle fractures are seen rarely and can be associated with injuries to the adjacent vital structures. Herein, we described a 15-year-old boy who had a preexisting ventriculoperitoneal shunt and a displaced medial clavicle fracture. We performed a successful surgical treatment using a distal radius locking plate. We discussed the mechanism of injury and treatment options with literature review.

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

    Directory of Open Access Journals (Sweden)

    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.

  16. Surgical fixation of displaced clavicle fracture in adolescents: a review of literature

    Directory of Open Access Journals (Sweden)

    Harish S. Hosalkar

    2013-10-01

    Full Text Available The literature available on patient-orientated outcomes of operative management for clavicle fractures in adolescents is fairly limited. Open surgical treatment of displaced midshaft fractures of the clavicle continues to be a topic of controversy. Traditional treatment of clavicle fractures has been via non-operative methods in both children and adults. Management in adolescent patients remains controversial, and rightly so, as the traditional experience from non-operative methods has been regarded as satisfactory, while the literature on the more recent approach towards fixing some of these fractures is evolving. We present a review of relevant literature.

  17. Bilateral congenital pseudarthrosis of the clavicle report of a case with clinical, radiological and neurophysiological evaluation.

    Science.gov (United States)

    Padua, R; Romanini, E; Conti, C; Padua, L; Serra, F

    1999-09-01

    Congenital pseudarthrosis of the clavicle is a rare condition. Bilateral involvement is extremely rare: only seven cases have been reported in the literature. Although the anatomy of the thoracic outlet can be markedly altered by the hypermobility of the shoulder and although few cases with mild symptoms suggesting brachial plexus impairment have been reported, the neurological status of the brachial plexus in congenital pseudarthrosis of the clavicle has not been well assessed. We report a case of bilateral congenital pseudarthrosis of the clavicle in which clinical, neurophysiological and radiological evaluations were performed. PMID:10546362

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

    Science.gov (United States)

    Mohammed, Khalid D; Stachiw, Danielle; Malone, Alex A

    2016-01-01

    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. PMID:26980988

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

    Directory of Open Access Journals (Sweden)

    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.

  20. Sport related stress fracture of the clavicle with non-union: Case report and review

    Directory of Open Access Journals (Sweden)

    Constantinou Demitri

    2008-01-01

    Full Text Available Stress fractures are relatively uncommon sports injuries and when they do occur, are mostly found in the lower limb. Stress fractures of the clavicle are particularly rare, having been described in a number of non-sport related pathologies, such as nervous tics and post radical neck dissection. In sport, there have only been seven cases reported in the literature. We report on a clavicle stress fracture in a 47-year-old male, partaking in recreational weight lifting activities. This is the first reported case of a non-union stress fracture of the clavicle. The patient underwent an open reduction and internal fixation and made a full recovery.

  1. Trends in the volume of operative treatment of midshaft clavicle fractures in children and adolescents: a retrospective, 12-year, single-institution analysis.

    Science.gov (United States)

    Suppan, Catherine A; Bae, Donald S; Donohue, Kyna S; Miller, Patricia E; Kocher, Mininder S; Heyworth, Benton E

    2016-07-01

    The purpose of this study was to examine institutional trends in the volume of clavicle fractures in children and adolescents. Medical records were retrospectively reviewed to identify patients aged 10-18 years treated for a clavicle fracture between 1999 and 2011 at a single tertiary-care pediatric hospital. There were significant increases in the number of clavicle fractures seen annually, of midshaft clavicle fractures, and of midshaft clavicle fractures treated operatively. The percentage of midshaft clavicle fractures treated with fixation also increased significantly. The volumes of clavicle fractures and midshaft clavicle fractures treated operatively appear to be increasing. Despite a lack of evidence-based support, the frequency of fixation of midshaft clavicle fractures appear to be increasing in the pediatric population. PMID:26990058

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

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    Timur Faizovich Zubairov

    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.

  3. Thoracic Outlet Syndrome Caused by a Pseudoaneurysm After Pseudarthrosis of the Clavicle.

    Science.gov (United States)

    Heyn, Jens; Ozimek, Alexandra; Sadeghi-Azandaryani, Mojtaba; Bürklein, Dominik; Steckmeier, Bernd

    2008-10-01

    Clavicle fractures are common, with the majority treated conservatively. If treated conservatively, pseudarthrosis of the clavicle is reported in up to 3% of the cases. In rare cases, pseudarthrosis of the clavicle may cause pseudoaneurysm formation, resulting in compression of the brachial plexus and the adjoining vessels, which may produce neurological symptoms and circulatory disorders. Here, we describe two cases of the late onset of pseudoaneurysm formation after pseudarthrosis of the clavicle. Both cases were remarkable because they showed clinical symptoms of TOS. Therefore, surgical treatment was performed and included claviculectomy, resection of the pseudoaneurysm and interposition grafting with an artificial prosthesis. One year after the operation, both patients showed excellent upper extremity function without any deficit of vascular, sensorial or motorial function. Patient's history and radiological findings are the keys to diagnosis. Without treatment, the prognosis is poor with spontaneous development of bleeding or gangrene. Therefore, surgical treatment has to be performed, especially when neurological symptoms occur. PMID:26815997

  4. Combination of Interscalene Brachial and Superficial Cervical Plexus Block for Fracture Clavicle Surgery

    OpenAIRE

    Anirban Pal; Nidhi Dawar; Rajarsree Biswas; Chaitali Biswas

    2011-01-01

    We report a case of interscalene brachial plexus block supplemented with superficial cervical plexus block in a patient with dilated cardiomyopathy with ejection fraction of 24% scheduled for surgery of fracture mid-shaft of clavicle.

  5. Operative Treatment of an Atypical Segmental Bipolar Fracture of the Clavicle

    Directory of Open Access Journals (Sweden)

    Varelas

    2015-12-01

    Full Text Available Introduction Clavicle fractures are very common, accounting for approximately 4% of all adult fractures. Segmental bipolar fractures involving the lateral and the medial ends of the clavicle are extremely rare, with only isolated cases reported in the literature. The injury mechanism is often unclear and the management of these fractures remains controversial. Case presentation Here is to report a case of a segmental bipolar fracture of the clavicle with a lateral fracture and a displaced medial fracture without dislocation of the sternoclavicular joint following a low energy fall to the outstretched hand, and discuss its management. Conclusions Stability of the clavicle is crucial for shoulder function and care should be taken not to miss or underestimate segmental bipolar fractures even with a low energy mechanism. Authors believe that operative treatment should be taken into consideration for displaced fractures.

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

    OpenAIRE

    Parikh, Shital N.; Desai, Vishal R.; Anita Gupta; Anton, Christopher G.

    2014-01-01

    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 fixa...

  7. Operative Treatment of Clavicle Midshaft Fractures: Comparison between Reconstruction Plate and Reconstruction Locking Compression Plate

    OpenAIRE

    Cho, Chul-Hyun; Song, Kwang-Soon; Min, Byung-Woo; Bae, Ki-Cheor; Lee, Kyung-Jae

    2010-01-01

    Background To compare the outcomes of reconstruction plate and reconstruction locking compression plate (LCP) for the treatment of clavicle midshaft fractures. Methods Forty one patients with a clavicle midshaft fracture were treated by internal fixation with a reconstruction plate (19 patients) or reconstruction LCP (22 patients). The clinical and radiological results were evaluated according to the Quick Disability of the Arm, Shoulder, and Hand (DASH) score and plain radiographs. Results T...

  8. The Classic: A Dissertation Upon Dislocations and Fractures of the Clavicle and Shoulder-Joint

    OpenAIRE

    Callaway, Thomas

    2011-01-01

    This Classic Article is a reprint of a section on scapula fractures in the original work by T. Callaway, Jr., A Dissertation Upon Dislocations and Fractures of the Clavicle and Shoulder-Joint. An accompanying biographical sketch of Thomas Callaway, Jr. is available at DOI 10.1007/s11999-011-2097-2. The Classic Article is ©1849 and is reprinted from Callaway T. A Dissertation Upon Dislocations and Fractures of the Clavicle and Shoulder-Joint. London: Samuel Highly; 1849.

  9. Cutaneous hypoesthesia following plate fixation in clavicle fractures

    Directory of Open Access Journals (Sweden)

    Lushun Wang

    2014-01-01

    Full Text Available Background: We report the functional impact and natural history of cutaneous hypoesthesia after plate internal fixation for mid shaft clavicle fractures with a horizontal skin incision from year 2009 to 2011. Materials and Methods: 38 patients had complete followup data with an average followup period of 23.2 months (range 8-43 months. The impact of supraclavicular nerve injury was studied by assessment of the incidence, functional impact and natural history of numbness with detailed review of the case records and phone questionnaires. Results: The incidence of postoperative numbness was 55.3% (n = 21. Most patients reported the numbness to be at its worst within the first operative month. At the time of worst numbness, 28.6% (n = 6/21 of patients reported the numbness to be severe while 42.9% (n = 9/21 reported moderate numbness and 28.6% (n = 6/21 reported mild numbness. Fifteen of these patients described increased awareness of numbness during contact with straps or clothes. Two patients were significantly bothered by this numbness; 4 patients stated that it was a moderate bother while 7 patients considered it a mild bother. A total of 8 patients reported that they were not bothered at all by the numbness. An overwhelming majority of affected patients (90.5%, n = 19/21 reported an improvement in the severity of numbness felt over time. At the last followup, the incidence of numbness declined from 55.3% to 36.8% with 7 patients reporting complete resolution of numbness. The numbness however was found to persist in 66.7% of patients. Only 1 patient reported continued severe numbness. The awareness of numbness with straps and clothing was severe in 5 patients. None of the patients were significantly bothered by this numbness. Conclusions: Cutaneous sensory loss is a common occurrence following plate fixation of the clavicle and might have been under reported in the literature. The numbness improves in the vast majority, but commonly persists to

  10. Increased T2 signal intensity in the distal clavicle: incidence and clinical implications

    International Nuclear Information System (INIS)

    Objective. The objectives of the current study were (1) to quantify the incidence of increased T2 signal in the distal clavicle and (2) to assess the clinical significance of this finding in patients with chronic acromioclavicular (AC) joint pain.Design and patients. Eight patients (five male and three female, 15-41 years of age) with disabling shoulder pain localized to the AC joint and marked increased T2 signal in the distal clavicle are presented. These eight patients underwent MR examination over a 25 month period (August 1996 to September 1998). The dictated reports of all shoulder MR examinations conducted over this same time period were reviewed retrospectively for the presence of signal abnormality in the distal cla-vicle. Clinical data and, in five patients, findings at shoulder arthroscopy or open surgery, were correlated with the results of MR imaging. One patient underwent arthroscopy on both shoulders.Results. The selected eight patients each presented clinically with disabling shoulder pain localized to the AC joint. One patient is presented twice, as both shoulders were symptomatic (n=9). Plain film examination (9/9) failed to indicate a structural cause of shoulder pain in any of the patients. MR examination demonstrated abnormally increased T2 signal in the distal clavicle in all nine cases and no other cause for AC joint pain. Three patients responded to a course of conservative therapy. Six experienced refractory pain despite conservative therapy. Resection of the distal clavicle was performed in five of the six cases. All patients who underwent resection of the distal clavicle experienced complete resolution of AC joint pain. A retrospective review of the dictated reports for all shoulder MR imaging examinations performed at out institution over a 25 month period (August 1996 to September 1998; n=761) demonstrated a 12.5% incidence of abnormally increased T2 signal in the distal clav-icle.Conclusions. Increased T2 signal in the distal clavicle

  11. 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

  12. [Post-traumatic bipolar dislocation of the clavicle: is operative treatment reasonable?].

    Science.gov (United States)

    Dudda, M; Kruppa, C; Schildhauer, T A

    2013-02-01

    Bipolar dislocation of the clavicle ("floating clavicle") is extremely rare. It exists no standardised treatment for this trauma and the treatment is often conservative. This is mainly an anterior displacement of the sternoclavicular joint (type III according to Allman) and a posterior dislocation of the acromioclavicular joint (type IV according to Rockwood).We report on a 60 year old male who fell onto the right shoulder. He sustained a 'floating clavicle' and had a massive dislocation, impairment of range of motion and pain. Venous congestion was observable. We stabilised the dislocated acromioclavicular joint with a Balser's plate, the sternoclavicular joint was fixed with PDS cord tension band technique around the first rip and the sternum. In addition we resected the anterior part of the distal clavicle to get a better cosmetic result. Post-operatively the patient had an excellent range of motion without any further symptoms after six weeks and one year. Venous congestion was not more observable.In most of the cases dislocations of both ends of the clavicle are treated conservatively. We recommend an operative treatment especially in young and active patients to avoid re-dislocation and to archive better cosmetic results. PMID:22367519

  13. 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.

  14. The apical oblique view of the clavicle: Its usefulness in neonatal and childhood trauma

    International Nuclear Information System (INIS)

    We analyzed clavicular radiographs of 26 patients with a history of trauma. The apical oblique projection of the clavicle was obtained with the injured side of the patient angled 450 towards the X-ray tube and a 200 cephalad angulation of the X-ray beam. This view proved to be more informative than the routine apical anteroposterior projection. It is especially effective in detecting nondisplaced fractures of the middle third of the clavicle in neonates and children. To verify our findings, we obtained apical anteroposterior and oblique radiographs of a specimen adult of the X-ray beam, the measurements of the projected lengths of the anatomical specimen, especially those of the middle portion of the clavicle, were very close to the corresponding anatomical lengths. (orig.)

  15. Aneurysmal bone cyst of medial end of clavicle in a child, a rare case report.

    Science.gov (United States)

    Yashavntha, Kumar C; Nalini, K B; Menon, Jagdish; Patro, D K

    2014-06-01

    Aneurysmal bone cyst is a locally aggressive benign tumor accounting for 3 % of all benign bone tumors. It most commonly arises from ends of long bones and relatively rare in flat bones. Clavicle is a very rare site for bone tumors with secondaries more common than primaries. Very few cases of aneurysmal bone cyst have been reported in literature. We hereby report interesting and a rare case of aneurysmal bone cyst of medial end of clavicle in a eight year old lady which was treated with extended curettage and calcium sulfate bone grafting. PMID:25114473

  16. 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. PMID:23423233

  17. Plate versus titanium elastic nail in treatment of displaced midshaft clavicle fractures A comparative study

    Directory of Open Access Journals (Sweden)

    Partha Saha

    2014-01-01

    Conclusion: The use of minimally invasive antegrade TEN for fixation of displaced midshaft clavicle fractures is recommended in view of faster fracture union, lesser morbidity, better cosmetic results, easier implant removal and fewer complications; although for comminuted fractures plating remains the procedure of choice.

  18. Post-traumatic osteolysis of the distal clavicle, pubis and ischium in 7 patients

    Institute of Scientific and Technical Information of China (English)

    陶惠民; 陈杰; 季滢瑶; 杨迪生

    2004-01-01

    Post-traumatic osteolysis (PTOL) is a very rare disease occurring after acute trauma or repetitive micro-trauma, which is characterized by persistent pain in the injured site. In this study, we reported 7 patients, in whom osteolysis developed in the distal clavicle, pubis and ischium.

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

    Science.gov (United States)

    Park, Tae-Soo; Lee, Kwang-Won

    2016-01-01

    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 painful osteoarthritis of the ACJ lesions in active patients engaged in overhead throwing sports and heavy labor. PMID:27512219

  20. A biomechanical comparison of four different fixation methods for midshaft clavicle fractures.

    Science.gov (United States)

    Chen, Yang; Yang, Yang; Ma, Xinlong; Xu, Weiguo; Ma, Jianxiong; Zhu, Shaowen; Ma, Baoyi; Xing, Dan

    2016-01-01

    Clavicle fractures may occur in all age groups, and 70%-80% of clavicle fractures occur in the midshaft. Many methods for treating midshaft clavicular fractures have been reported and remain controversial. To provide some guidance for clinical treatment, 30 artificial polymethyl methacrylate models of the clavicle were sewn obliquely at the midshaft to simulate the most common type of clavicular fractures, and the fracture models were divided into five groups randomly and were fixed as follows: the reconstruction plates were placed at the superior position of the fracture model (R-S group), the reconstruction plates were placed at the anteroinferior position of the fracture model (R-AI group), the locking plates were placed at the superior position (L-S group), the locking plates were placed at the anteroinferior position (L-AI group); and the control models were unfixed (control group). The strain gauges were attached to the bone surface near the fracture fragments, and then, the biomechanical properties of the specimens were measured using the compression test, torsion test and three-point bending test. The results showed that plate fixation can provide a stable construct to help with fracture healing and is the preferred method in the treatment of clavicle fractures. The locking plate provides the best biomechanical stability when placed at the anteroinferior position, and this surgical method can reduce the operation time and postoperative complications; thus, it would be a better choice in clinical practice. PMID:26586526

  1. Stress-induced osteolysis of distal clavicle: imaging patterns and treatment using CT-guided injection

    Energy Technology Data Exchange (ETDEWEB)

    Sopov, V.; Groshar, D. [Dept. of Nuclear Medicine, Technion-Israel Inst. of Technology, Haifa (Israel); Fuchs, D. [Dept. of Orthopaedics, Technion-Israel Inst. of Technology, Haifa (Israel); Bar-Meir, E. [Dept. of Radiology, Technion-Israel Inst. of Technology, Haifa (Israel)

    2001-02-01

    Osteolysis of distal clavicle (ODC) may occur in patients who experience repeated stress or microtrauma to the shoulder. This entity has clinical and radiological findings similar to post-traumatic ODC. We describe a case of successful treatment of stress-induced ODC with CT-guided injection of corticosteroid and anesthetic drug into the acromioclavicular joint. (orig.)

  2. Stress-induced osteolysis of distal clavicle: imaging patterns and treatment using CT-guided injection

    International Nuclear Information System (INIS)

    Osteolysis of distal clavicle (ODC) may occur in patients who experience repeated stress or microtrauma to the shoulder. This entity has clinical and radiological findings similar to post-traumatic ODC. We describe a case of successful treatment of stress-induced ODC with CT-guided injection of corticosteroid and anesthetic drug into the acromioclavicular joint. (orig.)

  3. Improved clinical utility in clavicle fracture decision-making with true orthogonal radiographs

    Directory of Open Access Journals (Sweden)

    Joshua D Harris

    2012-01-01

    Full Text Available Operative treatment of displaced clavicle fractures has demonstrated lower rates of nonunion and symptomatic malunion, improved functional outcomes, and earlier return to activities versus nonoperative treatment. Surgical treatment may offer a reduction in the relative risk of nonunion and symptomatic malunion and an earlier return to work or sport. To present an easy and safe method of acquiring orthogonal views of the clavicle without any manipulation of the patient′s upper extremity. Academic medical center and private clinic in the Midwestern United States; retrospective patient cohort. We reviewed records of patients with acute clavicle fractures between January 2010 and August 2011. Thirty-four patients were treated with sling immobilization and 52 patients were treated surgically with superior plate and screw internal fixation. Prior to the introduction of orthogonal views, 19 patients were treated nonoperatively and 22 treated with internal fixation. Addition of orthogonal views increased the number of patients treated surgically: In the same period, 15 patients were treated nonoperatively and 30 with internal fixation. Following surgery, patients were evaluated in the outpatient office at 2 and 6 weeks and 3 and 6 months. Nonoperatively treated patients were evaluated at 1, 2, and 4 weeks and 3 and 6 months postinjury. Standard use of orthogonal views has led to greater utilization of surgical treatment of clavicle fractures at our institution and improved both the understanding and treatment of these injuries.

  4. Clavicle Fracture and Subclavian Vessels Disruption with Massive Haemothorax Mimic Intrathoracic Injury

    OpenAIRE

    Faisham, Wan Ismail; Mohammad, Paiman; Juhara, Haron; Munirah, Nik Mahdi; Shamsulkamaruljan, Hassan; Ziyadi, Ghazali Mohamad

    2011-01-01

    We report a case of open fracture of the clavicle with subclavian artery and vein laceration and perforation of the parietal pleural below the first rib that caused massive haemothorax. Emergency thoracotomy and exploration followed by repair of both vessels were able to salvage the patient and the extremity.

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

    Science.gov (United States)

    Cronskär, Marie; Rasmussen, John; Tinnsten, Mats

    2015-01-01

    This paper addresses the evaluation of clavicle fixation devices, by means of computational models. The aim was to develop a method for comparison of stress distribution in various fixation devices, to determine whether the use of multibody musculoskeletal input in such model is applicable and to report the approach. The focus was on realistic loading and the motivation for the work is that the treatment can be enhanced by a better understanding of the loading of the clavicle and fixation device. The method can be used to confirm the strength of customised plates, for optimisation of new plates and to complement experimental studies. A finite element (FE) mesh of the clavicle geometry was created from computed tomography 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 of plausible magnitudes in all included parts and the result, upon further development and validation, may serve as a design guideline for improved clavicle fixation. PMID:24156391

  6. Case Report: Rare occurrence of Pseudomonas aeruginosa osteomyelitis of the right clavicle in a patient with IgA nephropathy

    Science.gov (United States)

    Damodaran, Aishwarya; Rohit, Anusha; Abraham, Georgi; Nair, Sanjeev; Yuvaraj, Anand

    2014-01-01

    We describe the case of a 47 year old patient with proven primary IgA nephropathy who presented with osteomyelitis of the medial end of the right clavicle. The patient was not on immunosuppressive medications. He underwent aspiration curettage and CT scan of the clavicle which yielded pus that grew Pseudomonas aeruginosa. Following treatment with appropriate antibiotic therapy the patient presented a complete recovery of the lesion with no loss of renal function. This case highlights the importance of positive cultures in the choice of the appropriate therapy in an extremely rare case of an immunocompetent patient with osteomyelitis of the clavicle. PMID:25566352

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

    OpenAIRE

    Agu Thaddeus Chika; Ojiaku Mathew Emeka

    2016-01-01

    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 sur...

  8. Skeletal developmental patterns in the acromial process and distal clavicle as observed by MRI

    Energy Technology Data Exchange (ETDEWEB)

    Kothary, Pratik [Tufts University School of Medicine, Boston, MA (United States); Rosenberg, Zehava Sadka [NYU Hospital for Joint Disease, Radiology Department, New York, NY (United States)

    2014-10-17

    To provide an MRI timeline of normal skeletal developmental patterns in the acromial process and distal clavicle in children up to 18 years of age. Retrospective review of all shoulder MRIs obtained at our institution between January 2003 and March 2012, in children up to age 18, was performed. When available, radiographs and CT scans for these children were also reviewed. The following variables of the distal acromion and clavicle, with attention to morphology and MRI signal, were assessed: (1) Chondro-osseous junction and (2) Development and fusion of the secondary ossification centers. Ninety-eight children with 116 MR studies were identified from the data search. Of these, 13 patients were excluded and the final cohort included 85 children with 102 MRI studies. Forty-one of these patients also had shoulder radiographs. The cartilaginous precursors of the distal clavicle and acromion conformed to the final shape of these structures. The chondro-osseous interphases became progressively more lobulated and notched in the distal acromion and clavicle respectively. Appearance and fusion of the secondary ossification centers was significantly earlier in our study than previously reported. Acromial secondary ossification centers began forming at age 10 and clavicular ones, while uncommon, began forming at age 11. Fusion of acromial primary and secondary ossification centers began at age 14 and was generally complete after age 16. Based on MR imaging the development and fusion of the acromion and distal clavicle in children occur earlier than previously reported. They follow a sequential pattern and can serve as a blueprint for evaluating imaging studies of pediatric shoulders. (orig.)

  9. Skeletal developmental patterns in the acromial process and distal clavicle as observed by MRI

    International Nuclear Information System (INIS)

    To provide an MRI timeline of normal skeletal developmental patterns in the acromial process and distal clavicle in children up to 18 years of age. Retrospective review of all shoulder MRIs obtained at our institution between January 2003 and March 2012, in children up to age 18, was performed. When available, radiographs and CT scans for these children were also reviewed. The following variables of the distal acromion and clavicle, with attention to morphology and MRI signal, were assessed: (1) Chondro-osseous junction and (2) Development and fusion of the secondary ossification centers. Ninety-eight children with 116 MR studies were identified from the data search. Of these, 13 patients were excluded and the final cohort included 85 children with 102 MRI studies. Forty-one of these patients also had shoulder radiographs. The cartilaginous precursors of the distal clavicle and acromion conformed to the final shape of these structures. The chondro-osseous interphases became progressively more lobulated and notched in the distal acromion and clavicle respectively. Appearance and fusion of the secondary ossification centers was significantly earlier in our study than previously reported. Acromial secondary ossification centers began forming at age 10 and clavicular ones, while uncommon, began forming at age 11. Fusion of acromial primary and secondary ossification centers began at age 14 and was generally complete after age 16. Based on MR imaging the development and fusion of the acromion and distal clavicle in children occur earlier than previously reported. They follow a sequential pattern and can serve as a blueprint for evaluating imaging studies of pediatric shoulders. (orig.)

  10. 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)

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

    International Nuclear Information System (INIS)

    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)

  12. Case Report: Rare occurrence of Pseudomonas aeruginosa osteomyelitis of the right clavicle in a patient with IgA nephropathy

    OpenAIRE

    Damodaran, Aishwarya; Rohit, Anusha; Abraham, Georgi; Nair, Sanjeev; Yuvaraj, Anand; Prasad, Kashi Nath; Dakshinamurthy, K. V.

    2014-01-01

    We describe the case of a 47 year old patient with proven primary IgA nephropathy who presented with osteomyelitis of the medial end of the right clavicle. The patient was not on immunosuppressive medications. He underwent aspiration curettage and CT scan of the clavicle which yielded pus that grew Pseudomonas aeruginosa. Following treatment with appropriate antibiotic therapy the patient presented a complete recovery of the lesion with no loss of renal function. This case highlights the impo...

  13. The outcome of surgical fixation of mid shaft clavicle fractures; looking at patient satisfaction and comparing surgical approaches

    OpenAIRE

    Alshameeri, Zeiad A.; Krishnaiah Katam; Mohammed Alsamaq; Paresh Sonsale

    2012-01-01

    Introduction: Clavicle fractures represent 2.5% of fractures in adults and almost 44% of shoulder injuries. The treatment is usually non-surgical with good results; however, significantly displaced fractures can be associated with high non-union rate and therefore many would advocate surgical fixation. This is traditionally carried out by direct approach over the clavicle but an infraclavicular approach has also been used for clavicular fixation. The aim of this study was to identify the main...

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

    International Nuclear Information System (INIS)

    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.)

  15. 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.

  16. Additional bone graft accelerates healing of clavicle non-unions and improves long-term results after 8.9 years: a retrospective study

    OpenAIRE

    Schnetzke, Marc; Morbitzer, Christian; Aytac, Sara; Erhardt, Matthias; Frank, Christian; Muenzberg, Matthias; Studier-Fischer, Stefan; Helbig, Lars; Suda, Arnold J.; Gruetzner, Paul-Alfred; Guehring, Thorsten

    2015-01-01

    Background Clavicle non-unions can occur after both conservative and operative treatment failure. Here, we investigated the outcome of patients with delayed fracture healing or non-unions of the clavicle. Patients underwent revision surgery by plate osteosynthesis of the clavicle with or without bone grafting. Our aim was to determine rates of bone healing and the functional long-term outcome. Methods The study population of 58 consecutive patients was divided into group 1 (n = 25; no bone gr...

  17. Chronic Osteomyelitis of Clavicle in a Neonate: Report of Morbid Complication of Adjoining MRSA Abscess.

    Science.gov (United States)

    Suranigi, Shishir Murugharaj; Joshi, Manoj; Deniese, Pascal Noel; Rangasamy, Kanagasabai; Najimudeen, Syed; Gnanadoss, James J

    2016-01-01

    Osteomyelitis of clavicle is rare in neonates. Acute osteomyelitis of clavicle accounts for less than 3% of all osteomyelitis cases. It may occur due to contiguous spread, due to hematogenous spread, or secondary to subclavian catheterization. Chronic osteomyelitis may occur as a complication of residual adjoining abscess due to methicillin resistant staphylococcus aureus (MRSA) sepsis. We report a newborn female with right shoulder abscess that developed chronic clavicular osteomyelitis in follow-up period after drainage. She required multiple drainage procedures and was later successfully managed with bone curettage and debridement. We report this case to highlight that a MRSA abscess may recur due to residual infection from a chronic osteomyelitis sinus. It may be misdiagnosed as hypergranulation tissue of nonhealing wound leading to inappropriate delay in treatment. High index of suspicion, aggressive initial management, and regular follow-up are imperative to prevent this morbid complication. PMID:27051549

  18. Chronic Osteomyelitis of Clavicle in a Neonate: Report of Morbid Complication of Adjoining MRSA Abscess

    Directory of Open Access Journals (Sweden)

    Shishir Murugharaj Suranigi

    2016-01-01

    Full Text Available Osteomyelitis of clavicle is rare in neonates. Acute osteomyelitis of clavicle accounts for less than 3% of all osteomyelitis cases. It may occur due to contiguous spread, due to hematogenous spread, or secondary to subclavian catheterization. Chronic osteomyelitis may occur as a complication of residual adjoining abscess due to methicillin resistant staphylococcus aureus (MRSA sepsis. We report a newborn female with right shoulder abscess that developed chronic clavicular osteomyelitis in follow-up period after drainage. She required multiple drainage procedures and was later successfully managed with bone curettage and debridement. We report this case to highlight that a MRSA abscess may recur due to residual infection from a chronic osteomyelitis sinus. It may be misdiagnosed as hypergranulation tissue of nonhealing wound leading to inappropriate delay in treatment. High index of suspicion, aggressive initial management, and regular follow-up are imperative to prevent this morbid complication.

  19. Surgical treatment of congenital pseudarthrosis of the clavicle: a report on 17 cases.

    Science.gov (United States)

    Persiani, Pietro; Molayem, Iakov; Villani, Ciro; Cadilhac, Céline; Glorion, Christophe

    2008-04-01

    Congenital pseudarthrosis of the clavicle (CPC) is a rare malformation of uncertain aetiopathogenesis, usually unilateral. Physical examination reveals swelling over the midportion of the clavicle, often asymptomatic; the diagnosis is confirmed by radiology. Treatment is controversial: for many authors the surgical indications are the presence of symptoms, functional impairment or cosmetic deformities. We present a retrospective analysis of 17 children with CPC treated in our institutions: 9 were treated with plate (P) and 8 with Kirschner wire (KW) fixation; a bone graft was used in 12 cases only. Five patients (4 P and 1 KW) needed a second surgical procedure. The surgical treatment led to a very good result in 7 cases, good in 4 cases, fair in 3 cases and poor in 3 other cases. We recommend early treatment of all patients with CPC with resection of the pseudarthrosis, autologous iliac bone grafting and internal fixation with Kirschner wires. PMID:18564469

  20. Congenital pseudarthrosis of the clavicle: the role of CT-scanning.

    Science.gov (United States)

    Sloan, Andrew; Paton, Robin

    2006-06-01

    Congenital pseudarthrosis of the clavicle is a rare entity. It presents on the right side in 90% of the patients, and bilaterally in up to 10%. The authors report the case of a 4-year-old boy who presented with a painful deformity over his right mid-clavicular area. Plain radiographs were inconclusive, although the opposite is true in most cases. A computed tomography (CT) 3-D reconstruction showed a pseudarthrosis of the clavicle, and excluded a neoplastic, infective or traumatic origin. Treatment involved excision of the pseudarthrosis, internal fixation with a contoured reconstruction locking plate, and bone grafting. The authors prefer operative treatment, but this is not universally accepted. PMID:16889151

  1. 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

    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......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...... weighted 3D images were collected from a 1.0T MR system. We prospectively scanned 102 subjects, 47 autopsy cases and 55 living volunteers (12-33 years). Images were scored in blind trials by three observers using a 4-stage system. Observers differed by level of training and radiological expertise. RESULTS...

  2. Using a reconstruction locking compression plate as external fixator in infected open clavicle fracture

    Directory of Open Access Journals (Sweden)

    Norachart Sirisreetreerux

    2013-06-01

    Full Text Available Open clavicle fracture is an uncommon injury mostly caused by severe direct trauma. It is often associated with multiple organ injuries. Generally, surgical intervention with debridement and fracture repair is always indicated in order to prevent infection, non-union, and malalignment. In situations of bony exposure and significant contamination concomitant with severe soft tissue damage, the external fixation is the treatment of choice because of the possibility it offers of providing stable fixation with minimal local tissue damage resulting in excellent union rates and better soft tissue outcome. Nevertheless, traditional external fixation encountered some potential problems as its bulkiness and sharp edges caused discomfort to the patient. In this study, we present an interesting case of a polytraumatized patient with a gunshot injury with complex open clavicle fracture that was successfully treated with external fixation using reconstruction with a locking compression plate as definitive treatment.

  3. Using a Reconstruction Locking Compression Plate as External Fixator in Infected Open Clavicle Fracture

    Science.gov (United States)

    Sirisreetreerux, Norachart; Sa-ngasoongsong, Paphon; Chanplakorn, Pongsthorn; Kulachote, Noratep; Laohajaroensombat, Sukij; Suphachatwong, Chanyut; Phiphobmongkol, Vajara; Wajanavisit, Wiwat

    2013-01-01

    Open clavicle fracture is an uncommon injury mostly caused by severe direct trauma. It is often associated with multiple organ injuries. Generally, surgical intervention with debridement and fracture repair is always indicated in order to prevent infection, non-union, and malalignment. In situations of bony exposure and significant contamination concomitant with severe soft tissue damage, the external fixation is the treatment of choice because of the possibility it offers of providing stable fixation with minimal local tissue damage resulting in excellent union rates and better soft tissue outcome. Nevertheless, traditional external fixation encountered some potential problems as its bulkiness and sharp edges caused discomfort to the patient. In this study, we present an interesting case of a polytraumatized patient with a gunshot injury with complex open clavicle fracture that was successfully treated with external fixation using reconstruction with a locking compression plate as definitive treatment. PMID:23888201

  4. Rheumatoid bursitis extending into the clavicle and to the skin surface.

    OpenAIRE

    Bassett, L W; Gold, R H; Mirra, J M

    1985-01-01

    A woman with rheumatoid arthritis developed persistent sterile drainage from a cutaneous fistula after biopsy of an inflamed supraclavicular mass. Radiographs showed several cavities in the underlying clavicle. Inability to culture a pathogen and failure of the fistula to heal despite empirical courses of antibiotic therapy led to surgical intervention. The final diagnosis, based on careful histological analysis by special staining techniques, was rheumatoid bursitis extending into the clavic...

  5. [Arterial complications of thoracic outlet syndrome and pseudarthrosis of the clavicle: three patients].

    Science.gov (United States)

    Garnier, D; Chevalier, J; Ducasse, E; Modine, T; Espagne, P; Puppinck, P

    2003-04-01

    During a 3-year period, three patients developed arterial complications related to congenital or post-traumatic old pseudarthrosis of the clavicle. Arterial complications of pseudarthrosis of the clavicle presenting as a thoracic outlet syndrome are very rare. Symptoms are variable and occur late. Without treatment, the prognosis is poor with spontaneous development of gangrene. Arterial morphology investigations should be undertaken in patients with pseudarthrosis of the clavicle or isolated arterial symptoms involving the upper limb whose radial pulse disappears during postural tests. Duplex Doppler of the subclavian artery is an excellent screening exam but selective arteriography is the gold standard. It shows proximal arterial lesions (embolytic stenosis of the subclavian artery with post-stenotic dilatation), as well as distal embolic complications. Both static and postural tests must be performed to unmask subclavian restriction by the clavicle, proving its causal effect in the arterial complications. There are four clinical varieties: chronic thrombosis of the subclavian artery, distal arterial micro emboli, acute thrombosis of proximal arteries of the upper limb, and subclavian aneurysm. These lesions are thought to be due to chronic constriction and repeated arterial microtrauma. Congenital or post-traumatic pseudarthrosis, hypertrophic callus, arterial restriction by a screw in a clavicular plate, usually explain the arterial lesions. Bone tumors and Paget's disease are potential but exceptional clavicular etiologies. Surgical treatment is always necessary. Clavicular resection is usually needed in case of pseudarthrosis; there is no functional handicap. Plate fixation and autologous grafting, or open reduction and internal fixation are other valid surgical treatments; The embolytic lesions must be treated to prevent recurrence of distal embolization: graft resection and thromboendarteriectomy have been described. Neurological and venous decompression

  6. Iatrogenic postoperative brachial plexus compression secondary to hypertrophic non-union of a clavicle fracture

    OpenAIRE

    Thavarajah, D; Scadden, J

    2013-01-01

    The brachial plexus is related intimately to the clavicle such that injury can occur primarily and most commonly at the time of trauma through traction or it can occur secondarily, mainly owing to hypertrophic non-union with exuberant callus formation, causing compression of the plexus. The movement-dependent rearrangement of the subclavicular space is restricted with rigid internal fixation, thereby placing inappropriate pressure on the plexus from the deep hypertrophic tissue. This case hig...

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

    OpenAIRE

    Chan, HZ; Ooi, CL; Lim, MY; Ong, EKS; Zulkiflee, O

    2014-01-01

    Abstract 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 disorders1. 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 dir...

  8. Open reduction and internal fixation of displaced clavicle fractures in adolescents

    Directory of Open Access Journals (Sweden)

    Harish S. Hosalkar

    2011-12-01

    Full Text Available The literature available on patient oriented outcomes of operative management for clavicle fractures in adolescents is fairly limited. The purpose of this study was to analyze the potential of open reduction and internal fixation for displaced mid-shaft clavicle fractures in adolescent patients. We reviewed our series of surgical cases performed in 19 adolescents (mean age: 14.6 years with displaced unilateral clavicle fractures. Baseline data acquisition included demographic and radiographic variables. A Synthes® LCP clavicular plate was utilized for fixation in all cases. Follow-up data included functional outcome assessment using the Quick Disability of Arm, Shoulder, and Hand Questionnaire (DASH, the simple shoulder test (SST and additional binary questions. At a mean follow-up of 16 months, quick DASH scores were 4.0 (range: 0-35.5 and mean number of positive yes responses on the SST for all operative patients was 11 (range: 9-12. All cases proved complete radiological union at the 3-month follow-up. All patients returned to full athletics at a mean time of 14 weeks (range: 12-17 weeks. Two patients had minimal hypertrophic scars while no patient was noted with keloid formation or neurovascular deficit. One patient complained of implant prominence and occasional symptoms of discomfort at the 15 month follow-up and opted for implant removal. This was successfully performed with uneventful full recovery. All patients were fully satisfied with their choice for surgical intervention. Anatomical reduction with internal fixation and early mobilization of adolescent displaced clavicle fractures remains a viable treatment option with predictable results and no major complications in reliable hands.

  9. Using a Reconstruction Locking Compression Plate as External Fixator in Infected Open Clavicle Fracture

    OpenAIRE

    Norachart Sirisreetreerux; Paphon Sa-ngasoongsong; Pongsthorn Chanplakorn; Noratep Kulachote; Sukij Laohajaroensombat; Chanyut Suphachatwong; Vajara Phiphobmongkol; Wiwat Wajanavisit

    2013-01-01

    Open clavicle fracture is an uncommon injury mostly caused by severe direct trauma. It is often associated with multiple organ injuries. Generally, surgical intervention with debridement and fracture repair is always indicated in order to prevent infection, non-union, and malalignment. In situations of bony exposure and significant contamination concomitant with severe soft tissue damage, the external fixation is the treatment of choice because of the possibility it offers of providing stable...

  10. 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. PMID:27107998

  11. 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.

  12. Failed operative treatment in two cases of pseudarthrosis of the clavicle using internal fixation and bovine cancellous xenograft (Tutobone).

    Science.gov (United States)

    Elliot, Robin R; Richards, Robert H

    2011-09-01

    The most commonly reported technique of reconstructive surgery for congenital pseudarthrosis of the clavicle involves resection of the pseudarthrosis, insertion of autologous iliac crest bone graft and internal fixation. In an attempt to avoid the potential complications of iliac crest bone graft harvest we used bovine cancellous xenograft (Tutobone). Two cases of pseudarthrosis of the clavicle treated with resection of the pseudarthrosis, Tutobone graft and internal fixation are presented. Both cases resulted in treatment failures, which were associated with significant osteolysis and failure of incorporation of the graft material. This required removal of the loose metal work and debridement of the failed graft material. We would caution surgeons against the use of Tutobone as a graft material in the surgical management of pseudarthrosis of the clavicle. The level of evidence was level IV case series. PMID:21537200

  13. Fracture of the clavicle following radical neck dissection and postoperative radiotherapy: a case report and review of the literature

    Energy Technology Data Exchange (ETDEWEB)

    Strauss, M.; Bushey, M.J.; Chung, C.; Baum, S.

    1982-11-01

    The treatment of head and neck cancer with radiotherapy and radical neck dissection has many recognized complications. Radiotherapy in therapeutic doses can produce devascularization and weakening of bone. Radical neck dissection results in altered mechanics of the shoulder girdle and a disruption of normally balanced forces acting on the clavicle. An unusual case of clavicle fracture which is considered to have resulted from an interaction of the effects of these therapies is discussed. An approach for recognizing and distinguishing this entity by its time course, and radiographic and nuclide bone scan appearance is presented.

  14. Fracture of the clavicle following radical neck dissection and postoperative radiotherapy: a case report and review of the literature

    International Nuclear Information System (INIS)

    The treatment of head and neck cancer with radiotherapy and radical neck dissection has many recognized complications. Radiotherapy in therapeutic doses can produce devascularization and weakening of bone. Radical neck dissection results in altered mechanics of the shoulder girdle and a disruption of normally balanced forces acting on the clavicle. An unusual case of clavicle fracture which is considered to have resulted from an interaction of the effects of these therapies is discussed. An approach for recognizing and distinguishing this entity by its time course, and radiographic and nuclide bone scan appearance is presented

  15. [Congenital pseudarthrosis of the clavicle and thoracic outlet syndrome. Report of a case and review of the literature].

    Science.gov (United States)

    Valette, H

    1995-01-01

    The association pseudarthrosis of the clavicle and the thoracic outlet syndrome is rare. The author describe a case in a 64 years old man, found before embolic complications. Shoulder X-ray and artériography démonstrate the lesion. The etiopathogenic hypothesis are called up. In case of complication, the surgical treatment is made of osteo synthesis or partial or total resection of the clavicle, associated to a vascular repair in case of need. At long term the result is excellent. PMID:7745360

  16. Vibratory perception thresholds at the clavicle in patients with spinal cord injury.

    OpenAIRE

    Herszkowicz, I; Berić, A; Lindblom, U

    1986-01-01

    Vibratory perception thresholds were measured by an electromagnetic device applied over the clavicles of 64 patients with spinal cord injuries. Patients with neurological levels of C5 and below had low threshold values (0.63 +/- 0.23 micron of vibration amplitude; mean +/- SD) which were used as reference values. The patients with a neurological level of C1/2 had very high vibratory thresholds bilaterally (above 11.0 micron). Patients with C2/3-3/4 neurological levels also had significantly e...

  17. 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.

  18. Posttraumatic pseudarthrosis of the clavicle in an 8-year-old girl.

    Science.gov (United States)

    Spapens, Nouchka; Degreef, Ilse; Debeer, Philippe

    2010-03-01

    We describe an 8-year-old girl who developed a posttraumatic pseudarthrosis of the right clavicle. Despite the great periosteal regenerative potential in children, the fracture did not heal at 12 months with a classic conservative treatment. As a result of pain and functional limitations, surgical treatment was required. Excess bone of the hypertrophic nonunion was removed and an open reduction and internal fixation with a compression plate were performed. Cancellous bone chips from the iliac crest were packed into the fracture site. Good remodelling and consolidation was achieved 10 months after the operation. At that stage, the functional outcome was satisfactory. PMID:19952962

  19. Congenital pseudarthrosis of the clavicle: a proposal for early surgical treatment.

    Science.gov (United States)

    Lorente Molto, F J; Bonete Lluch, D J; Garrido, I M

    2001-01-01

    We present a review of six cases of children with congenital pseudarthrosis of the clavicle, treated and followed up at the "La Fe" Hospital for Children. One of them had bilateral involvement. Five of them, including the bilateral case, were surgically treated at ages ranging from 18 months to 4 years. Bone graft and internal fixation with a Kirschner wire were used. Healing of the pseudarthrosis was obtained in all patients in 6-8 weeks. We discuss the suitability of early surgical treatment that, in our opinion, produces very satisfactory results. PMID:11521043

  20. False positive indium-111 white blood cell scan in a closed clavicle fracture

    International Nuclear Information System (INIS)

    Aggressive treatment of the multiply injured patient often requires early fixation of many fractures, some of which may be open. Often, patients develop postoperative fevers requiring a thorough workup to rule out infection. Recently, indium-111 white blood cell (WBC) imaging has become a valuable adjunct in the diagnosis of acute infection. The patient described had a simple, closed clavicle fracture with markedly increased activity on an indium-111 WBC scan obtained for fever workup. This subsequently proved to be a normal, healing, noninfected fracture by other diagnostic techniques. Noninfected, simple closed fractures should be added to the list of causes for a false-positive indium-111 WBC scan

  1. 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. PMID:9300347

  2. Tuberculosis of the sternum and clavicle: imaging findings in 15 patients

    International Nuclear Information System (INIS)

    Objective. To describe the imaging findings in sterno-clavicular tubercular involvement.Design and patients. Fifteen patients with pathologically proven tuberculosis of the sternum and clavicle were retrospectively evaluated. Routine radiography, computed tomography (CT) and magnetic resonance imaging (MRI) were used in some or all of the patients. Clinical information and imaging features were evaluated in each case.Results. Eight patients had sterno-clavicular joint (SCJ) involvement, five had isolated sternal involvement and two had isolated clavicular involvement. Seven patients were evaluated with only CT, six with only MRI and two with both. There were eight male and seven female patients, varying in age between 16 and 78 years. Fever, swelling and pain were common presenting symptoms. Two patients were HIV positive. Radiographs were positive in only eight patients. Destruction and signal intensity (SI) changes of the sternum and clavicle, destruction of the cartilage, soft tissue changes representing granulation tissue/abscess, displacement of the adjacent structures (vessels, trachea, etc.) and inflammatory changes in the adjacent structures in the form of cellulitis and myositis were common imaging features.Conclusions. All imaging methods can provide complementary information regarding sterno-clavicular tubercular involvement that is helpful for determination of the therapy. MRI is useful in determining the extent of the lesion, particularly marrow involvement and soft tissue extent. (orig.)

  3. 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.

  4. Surgical treatment of congenital pseudarthrosis of the clavicle: a report of three cases and review of the literature.

    Science.gov (United States)

    Ettl, V; Wild, A; Krauspe, R; Raab, P

    2005-02-01

    Congenital pseudarthrosis of the clavicle is a rare entity of unknown aetiology with predominance of the right side. Our therapeutic concept is discussed with special reference to surgical therapy, histopathological findings and the most recent literature. Two girls and one boy, aged 4, 6, and 8 years, presenting with congenital pseudarthrosis of the clavicle were surgically treated between 1994 and 2000. A resection of the pseudarthrosis and internal fixation with a small reconstruction plate was performed. A bone graft from the iliac crest was used for restoration of clavicular length. Histological examination revealed a false joint with the ends of the clavicle covered by hyaline cartilage. The patients showed radiographic healing after 12 weeks. At follow-up (mean 44 months), all patients showed excellent clinical and radiological results without functional impairment. The clinical features and histological examination of the resected pseudarthroses clearly proved the diagnosis of a true congenital pseudarthrosis of the clavicle. According to our clinical and radiological results and considering the recent literature, we recommend surgical therapy with resection, bone grafting, and osteosynthesis with a reconstruction plate around the age of 4 - 6 years. PMID:15795830

  5. The outcome of surgical fixation of mid shaft clavicle fractures; looking at patient satisfaction and comparing surgical approaches

    Directory of Open Access Journals (Sweden)

    Zeiad A Alshameeri

    2012-01-01

    Conclusion : Our study showed excellent surgical outcome for displaced clavicle fractures supported by the high union rate, good oxford shoulder score, high return to work rate, and good patient′s satisfaction. The number of minor complications and symptomatic metal work removal was less in the infraclavicular approach.

  6. Strength analysis of clavicle fracture fixation devices and fixation techniques using finite element analysis with musculoskeletal force input.

    Science.gov (United States)

    Marie, Cronskär

    2015-08-01

    In the cases, when clavicle fractures are treated with a fixation plate, opinions are divided about the best position of the plate, type of plate and type of screw units. Results from biomechanical studies of clavicle fixation devices are contradictory, probably partly because of simplified and varying load cases used in different studies. The anatomy of the shoulder region is complex, which makes it difficult and expensive to perform realistic experimental tests; hence, reliable simulation is an important complement to experimental tests. In this study, a method for finite element simulations of stresses in the clavicle plate and bone is used, in which muscle and ligament force data are imported from a multibody musculoskeletal model. The stress distribution in two different commercial plates, superior and anterior plating position and fixation including using a lag screw in the fracture gap or not, was compared. Looking at the clavicle fixation from a mechanical point of view, the results indicate that it is a major benefit to use a lag screw to fixate the fracture. The anterior plating position resulted in lower stresses in the plate, and the anatomically shaped plate is more stress resistant and stable than a regular reconstruction plate. PMID:25850983

  7. A retrospective study of the association between shortening of the clavicle after fracture and the clinical outcome in 136 patients

    DEFF Research Database (Denmark)

    Rasmussen, Jeppe; Jensen, Steen L; Petersen, Jens; Falstie-Jensen, Thomas; Lausten, Gunnar; Olsen, Bo S

    2011-01-01

    The purpose of this retrospective study was to examine the association between shortening of the clavicle after a united midshaft fracture and clinical outcome. Second, the purpose was to compare the results obtained by conservative treatment with either a figure-of-eight bandage or a simple sling....

  8. 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.

  9. Adult Neandertal clavicles from the El Sidrón site (Asturias, Spain) in the context of Homo pectoral girdle evolution.

    Science.gov (United States)

    Rosas, Antonio; Rodriguez-Perez, Francisco Javier; Bastir, Markus; Estalrrich, Almudena; Huguet, Rosa; García-Tabernero, Antonio; Pastor, Juan Francisco; de la Rasilla, Marco

    2016-06-01

    We undertook a three-dimensional geometric morphometric (3DGM) analysis on 12 new Neandertal clavicle specimens from the El Sidrón site (Spain), dated to 49,000 years ago. The 3DGM methods were applied in a comparative framework in order to improve our understanding of trait polarity in features related to Homo pectoral girdle evolution, using other Neandertals, Homo sapiens, Pan, ATD6-50 (Homo antecessor), and KNM-WT 15000 (Homo ergaster/erectus) in the reference collection. Twenty-nine homologous landmarks were measured for each clavicle. Variation and morphological similarities were assessed through principal component analysis, conducted separately for the complete clavicle and the diaphysis. On average, Neandertal clavicles had significantly larger muscular entheses, double dorsal curvature, clavicle torsion, and cranial orientation of the acromial end than non-Neandertal clavicles; the El Sidrón clavicles fit this pattern. Variation within the samples was large, with extensive overlap between Homo species; only chimpanzee specimens clearly differed from the other specimens in morphometric terms. Taken together, our morphometric analyses are consistent with the following phylogenetic sequence. The primitive condition of the clavicle is manifest in the cranial orientation of both the acromial and sternal ends. The derived condition expressed in the H. sapiens + Neandertal clade is defined by caudal rotation of both the sternal and acromial ends, but with variation in the number of acromia remaining in a certain cranial orientation. Finally, the autapomorphic Neandertal condition is defined by secondarily acquired primitive cranial re-orientation of the acromial end, which varies from individual to individual. These results suggest that the pace of phylogenetic change in the pectoral girdle does not seem to follow that of other postcranial skeletal features. PMID:27260174

  10. Congenital pseudarthrosis of the clavicle. Histologic examination for the etiology of the disease.

    Science.gov (United States)

    Hirata, S; Miya, H; Mizuno, K

    1995-06-01

    The etiology of congenital pseudarthrosis of the clavicle remains obscure. The authors treated a 5-year-old boy with this rare disease. Clinical history and radiographs confirmed the diagnosis. Surgical treatment of resection of the pseudarthrosis, autologous bone graft, and internal fixation with a small AO plate led to successful bone union. Histologic analysis of the pseudarthrosis showed that there were cartilaginous caps on the proximal and distal bony ends. The appearance of the cartilaginous caps were equivalent to that of developing physes. They were adding new bone to the bony ends, which also was confirmed by preoperative tetracycline labeling. These observations support the hypothesis that the pseudarthrosis is caused by failure of 2 ossification centers to fuse, as was previously proposed by others. PMID:7634675

  11. 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.

  12. 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

  13. 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. PMID:26908024

  14. Functional outcome of open reduction and internal fixation of clavicle fracture

    Directory of Open Access Journals (Sweden)

    Manju G. Pillai

    2016-08-01

    Results: In 27 patients fracture were united at end of 12 weeks, in 2 patients fracture were united at end of 24 weeks and 1 patient went for non-union. One patient had superficial infection. None had deep infection. One patient had plate loosening at 4week but fracture was united at the end of 24 weeks. 2 patients had persistent pain which is controlled with occasional analgesic but not effecting ordinary work. One patient had gross restriction of shoulder movement. Functional outcome assessed according to near shoulder scoring system. 24 patients had excellent result, 4 patients had satisfactory result, 1 patient had unsatisfactory result and 1patients had failure. Conclusions: The study showed rigid fixation with plate and screw for fresh middle third clavicle fracture especially displaced and comminuted give immediate pain relief and prevent the development of shoulder stiffness and non-union and give good functional outcome. [Int J Res Med Sci 2016; 4(8.000: 3205-3210

  15. Death Due to Intra-aortic Migration of Kirschner Wire From the Clavicle

    Science.gov (United States)

    Tan, Lei; Sun, Da-Hui; Yu, Tiecheng; Wang, Linxiang; Zhu, Dong; Li, Yan-Hui

    2016-01-01

    Abstract Migration of orthopedic fixation wires into the ascending aorta though a rare occurrence can have devastating consequences. Therefore, prompt recognition, with immediate and cautious retrieval of the implant is paramount in averting these complications. We present a case of a 5-year-old boy with the intra-aortic migration of a K-wire used for the treatment of a right clavicle fracture. He was transferred to us with a history of syncope, chest pain, and shortness of breath 7 days after K-wire placement, which was performed at another hospital. On CT scan, the wire was found to be partially inside the ascending aorta, which was associated with massive hemopericardium and cardiac tamponade. The patient was taken up for emergency surgery for the removal K-wire and for the management of cardiac temponade. However, the patient developed cardiac arrest during the induction of intravenous anesthesia and endotracheal intubation. The K-wire was retrieved from the thorax via thoracotomy. However, the patient died 10 days after the surgery. As the migration of wires and pins during orthopedic surgery can cause potentially fatal complications, these should be used very cautiously, especially for percutaneous treatment of shoulder girdle fractures. The patients with such implants should be followed frequently, both clinically and radiographically. If migration occurs, the patient should be closely monitored for emergent complications and the K-wire should be extracted immediately. PMID:27227938

  16. 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

  17. Case Report: Rare occurrence of Pseudomonas aeruginosa osteomyelitis of the right clavicle in a patient with IgA nephropathy [v1; ref status: indexed, http://f1000r.es/37r

    Directory of Open Access Journals (Sweden)

    Aishwarya Damodaran

    2014-11-01

    Full Text Available We describe the case of a 47 year old patient with proven primary IgA nephropathy who presented with osteomyelitis of the medial end of the right clavicle. The patient was not on immunosuppressive medications. He underwent aspiration curettage and CT scan of the clavicle which yielded pus that grew Pseudomonas aeruginosa. Following treatment with appropriate antibiotic therapy the patient presented a complete recovery of the lesion with no loss of renal function. This case highlights the importance of positive cultures in the choice of the appropriate therapy in an extremely rare case of an immunocompetent patient with osteomyelitis of the clavicle.

  18. Case Report: Rare occurrence of Pseudomonas aeruginosa osteomyelitis of the right clavicle in a patient with IgA nephropathy [v1; ref status: indexed, http://f1000r.es/37r

    OpenAIRE

    Aishwarya Damodaran; Anusha Rohit; Georgi Abraham; Sanjeev Nair; Anand Yuvaraj

    2014-01-01

    We describe the case of a 47 year old patient with proven primary IgA nephropathy who presented with osteomyelitis of the medial end of the right clavicle. The patient was not on immunosuppressive medications. He underwent aspiration curettage and CT scan of the clavicle which yielded pus that grew Pseudomonas aeruginosa. Following treatment with appropriate antibiotic therapy the patient presented a complete recovery of the lesion with no loss of renal function. This case highlights the impo...

  19. Ultrasound guided selective cervical nerve root block and superficial cervical plexus block for surgeries on the clavicle

    Directory of Open Access Journals (Sweden)

    Harsha Shanthanna

    2014-01-01

    Full Text Available We report the anaesthetic management of two cases involving surgeries on the clavicle, performed under superficial cervical plexus block and selective C5 nerve root block under ultrasound (US guidance, along with general anaesthesia. Regional analgesia for clavicular surgeries is challenging. Our patients also had significant comorbidities necessitating individualised approach. The first patient had a history of emphysema, obesity, and was allergic to morphine and hydromorphone. The second patient had clavicular arthritis and pain due to previous surgeries. He had a history of smoking, Stevens-Johnson syndrome, along with daily marijuana and prescription opioid use. Both patients had an effective regional block and required minimal supplementation of analgesia, both being discharged on the same day. Interscalene block with its associated risks and complications may not be suitable for every patient. This report highlights the importance of selective regional blockade and also the use of US guidance for an effective and safe block.

  20. 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.

  1. 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.

  2. 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.)

  3. Gorham's disease of scapula and clavicle: case report and two-year follow-up of a rare disorder

    Energy Technology Data Exchange (ETDEWEB)

    Oliveira, Paulo Cesar Rocha; Alcantara, Fabio Peixoto; Judice, Paola Lima Pasini; Batista, Giovani Rodrigues; Teles, Ilailson de Goes [SARAH Network of Rehabilitation Hospitals, Brasilia, DF (Brazil). Diagnostic Imaging Dept.; Antunes, Julio Salgado [SARAH Network of Rehabilitation Hospitals, Brasilia, DF (Brazil). Surgical Pathology Lab.

    2011-09-15

    Gorham's disease is a rare osteolytic disorder of still controversial etiology that may affect any bone. The histopathological substrate for such a condition is the replacement of normal bone by aggressive non-neoplastic expansile vascular tissue. The authors describe radiographic, computed tomography and magnetic resonance imaging findings in a case of this entity initially affecting the left scapula and, two years later, the ipsilateral clavicle. (author)

  4. 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

    OpenAIRE

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

    2013-01-01

    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 ...

  5. Evaluation of the results from surgical treatment of fractures of the lateral extremity of the clavicle, using the double ligature technique☆

    Science.gov (United States)

    Miyazaki, Alberto Naoki; da Silva, Luciana Andrade; do Val Sella, Guilhermel; Checchia, Sergio Luiz; Cândido dos Santos, Sílvia Helena Cavadinha; Chadud, Vitor Schneider

    2015-01-01

    Objective To evaluate the incidence of consolidation in surgical treatment of fractures of the lateral extremity of the clavicle using the double subcoracoid ligature technique, with nonabsorbable No. 5 thread. Methods Between May 1993 and June 2013, the Shoulder and Elbow Group of our service surgically treated 116 patients (116 shoulders) with fractures of the lateral extremity of the clavicle. Among these, we were able to reassess 65 cases. The surgical technique used consisted of double subcoracoid ligature with two nonabsorbable threads. In two patients classified as type III, we had to combine this technique with use of an interfragmentary screw for fixation of the intra-articular portion of the acromioclavicular joint. Results We achieved fracture consolidation in 90%. Fourteen cases (21%) evolved with major complications: four cases of pseudarthrosis, five of adhesive capsulitis, two of delayed consolidation and three of loss of reduction. Two cases (3%) evolved with minor complications of skin granuloma. Conclusion The double ligature technique for fractures of the lateral extremity of the clavicle promotes the stabilization needed for consolidation to take place, without the need for synthesis using metal components. It avoids reoperation for the synthesis material to be removed. Moreover, it is a low-cost procedure with good reproducibility and preservation of the acromioclavicular joint. PMID:26229907

  6. Evaluation of the results from surgical treatment of fractures of the lateral extremity of the clavicle, using the double ligature technique

    Directory of Open Access Journals (Sweden)

    Alberto Naoki Miyazaki

    2015-04-01

    Full Text Available OBJECTIVE: To evaluate the incidence of consolidation in surgical treatment of fractures of the lateral extremity of the clavicle using the double subcoracoid ligature technique, with nonabsorbable No. 5 thread.METHODS: Between May 1993 and June 2013, the Shoulder and Elbow Group of our service surgically treated 116 patients (116 shoulders with fractures of the lateral extremity of the clavicle. Among these, we were able to reassess 65 cases. The surgical technique used consisted of double subcoracoid ligature with two nonabsorbable threads. In two patients classified as type III, we had to combine this technique with use of an interfragmentary screw for fixation of the intra-articular portion of the acromioclavicular joint.RESULTS: We achieved fracture consolidation in 90%. Fourteen cases (21% evolved with major complications: four cases of pseudarthrosis, five of adhesive capsulitis, two of delayed consolidation and three of loss of reduction. Two cases (3% evolved with minor complications of skin granuloma.CONCLUSION: The double ligature technique for fractures of the lateral extremity of the clavicle promotes the stabilization needed for consolidation to take place, without the need for synthesis using metal components. It avoids reoperation for the synthesis material to be removed. Moreover, it is a low-cost procedure with good reproducibility and preservation of the acromioclavicular joint.

  7. 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.

  8. Functional outcome after open reduction and internal fixation for symptomatic delayed union and nonunion after fracture clavicle: A series of 31 cases

    Directory of Open Access Journals (Sweden)

    Mukhopadhaya John

    2007-01-01

    Full Text Available Background: Non-union after clavicular fractures can cause significant disability due to pain, impaired function of the shoulder joint and limitations of certain activities, especially in high-demand patients. Materials and Methods: 31 patients (21 males and 10 females of symptomatic delayed union or nonunion were treated operatively using plate osteosynthesis with bone grafting where required between January 1994 to September 2005. Out of the 31 patients, 14 cases were of delayed union (no evidence of union > six wks and 17 cases were of nonunion (no union > three months. Fracture of the lateral one-third and open fractures of the clavicle were not included in the study. Bone grafting was done in 23 patients. The outcome was assessed with the American Academy of Orthopedic Surgeons (AAOS disabilities of the arm, shoulder and hand (DASH questionnaire. Results: The patients were followed-up for an average of 13 months (range six months to four years. All fractures united with in three months Most of the patients had their DASH scores in the range of 10 to 20, the average being 14.7 in our series. Functionally, this was very much acceptable. Conclusion: Open reduction and internal fixation with a plate in conjunction with an autogenous bone graft where required is a successful procedure with good outcome and most of the patients can return to a near normal level of function.

  9. Death Due to Intra-aortic Migration of Kirschner Wire From the Clavicle: A Case Report and Review of the Literature.

    Science.gov (United States)

    Tan, Lei; Sun, Da-Hui; Yu, Tiecheng; Wang, Linxiang; Zhu, Dong; Li, Yan-Hui

    2016-05-01

    Migration of orthopedic fixation wires into the ascending aorta though a rare occurrence can have devastating consequences. Therefore, prompt recognition, with immediate and cautious retrieval of the implant is paramount in averting these complications.We present a case of a 5-year-old boy with the intra-aortic migration of a K-wire used for the treatment of a right clavicle fracture. He was transferred to us with a history of syncope, chest pain, and shortness of breath 7 days after K-wire placement, which was performed at another hospital. On CT scan, the wire was found to be partially inside the ascending aorta, which was associated with massive hemopericardium and cardiac tamponade. The patient was taken up for emergency surgery for the removal K-wire and for the management of cardiac temponade. However, the patient developed cardiac arrest during the induction of intravenous anesthesia and endotracheal intubation. The K-wire was retrieved from the thorax via thoracotomy. However, the patient died 10 days after the surgery.As the migration of wires and pins during orthopedic surgery can cause potentially fatal complications, these should be used very cautiously, especially for percutaneous treatment of shoulder girdle fractures. The patients with such implants should be followed frequently, both clinically and radiographically. If migration occurs, the patient should be closely monitored for emergent complications and the K-wire should be extracted immediately. PMID:27227938

  10. 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

  11. Finite elementanalysis of clavicle fracture with superior and anterior plate fixation%钢板前置位及上置位固定锁骨骨折的有限元分析

    Institute of Scientific and Technical Information of China (English)

    刘栋; 王建明; 张德刚; 张锴; 杜刚强

    2016-01-01

    背景:不少学者对锁骨中段骨折钢板固定进行了生物力学研究,但有关钢板放置位置的研究不多。目的:采用三维有限元模型观察钢板前置位及上置位固定锁骨骨折的生物力学特点。方法:建立锁骨骨折重建钢板前置位固定和上置位固定的三维有限元模型,分析评价钢板上置位和前置位固定后的应力情况,在压缩、扭转和三点弯曲状况下观察钢板固定锁骨骨折的最大应力和位移情况。结果与结论:①在压缩状况下:钢板螺钉上置位组外固定的最大应力和骨折最大位移与钢板螺钉前置位组基本相同(P>0.05);②顺时扭转状况下:钢板固定锁骨骨折上置位组的外固定最大应力和骨折最大位移均小于前置位组(P0.05);④三点弯曲状况下:钢板固定锁骨骨折上置位组的外固定最大应力与前置位组基本相同(P>0.05);钢板固定锁骨骨折上置位组的骨折最大位移大于前置位组(P 0.05). (2) Under clockwise twist condition, the maximum stress and maximum fracture displacement were smaler in the superior plate fixation group than inthe anterior plate fixation group (P 0.05). (4) Under three-point bending condition, the maximum stress was similar between the superior and anterior plate fixation groups (P> 0.05). The maximum fracture displacement was bigger in the superior plate fixation group than in the anterior plate fixation group (P< 0.05). (5) These findings suggest that superior fixation of clavicle fracture reconstruction plate has more advantages than the anterior plate fixation.

  12. Bilateral clavicle osteomyelitis: A case report

    Directory of Open Access Journals (Sweden)

    Fevzi Saglam

    2014-01-01

    CONCLUSION: In cases of clavicular osteomyelitis where infection continues despite debridement and antibiotic therapy, excision of the sequestered clavicular section is a successful treatment approach and has been seen to improve quality of life without any functional loss.

  13. 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.

  14. Using sternocleidomastoid-clavicle myocutaneous flap to reconstruct compound operative defect of oral carcinoma%胸锁乳突肌—锁骨复合肌骨皮瓣 修复口腔癌术后复合缺损

    Institute of Scientific and Technical Information of China (English)

    赵文权; 朱慧勇; 徐俊华; 王慧明

    2011-01-01

    Objective To study the sternocleidomastoid-clavicle myocutaneous flap (SCMCP) for repairing the compound operative defect after oral carcinoma resection, to observe its clinical effect, prognosis and advantages of SCMCP, and to develop a new operative method that implantation of dental implant can be performed simultaneously. Methods Sixteen patients underwent reconstruction with SCMCP after oral carcinoma resection and neck dissection during 2007 to 2009. Four of them (25.00%) underwent simultaneously implantation of dental implants in the clavicular flaps. Results None of these patients died postoperatively during the follow-up until now. One patient (6.25%) with buccal cancer encountered local recurrence resulting in reoperation, and the flap grows well up to now. A part of the skin paddle underwent necrosis in two patients(12.50%), local fluidity was found in 2 patients (12.50%), fracture of clavicle occurred during the operation in one patient (6.25%). All the patients had good pronunciation and oral diet with no difficulty. Conclusion SCMCP is easy to survive, simple to perform, the clavicular figure and function won't be destroyed significantly. SCMCP is a good operative method to repair the compound operative defect after oral carcinoma resection.%目的 研究口腔癌术后软硬组织复合缺损的重建修复术式,即胸锁乳突肌—锁骨复合肌骨皮瓣(SCMCP),总结其临床应用效果、预后及优点,探索并研究SCMCP联合同期牙种植体植入的新术式.方法 2007-2009年,采用SCMCP修复术后复合缺损患者共16例.该16例患者均在口腔癌局部扩大切除联合颈淋巴结清扫术的同期采用SCMCP修复术后复合缺损,其中4例(25.00%)术中同期于移植的锁骨瓣处植入牙种植体.结果 16例患者随访期间无死亡病例.1例颊癌(6.25%)局部复发,二次手术切除后,局部皮瓣至今生长良好;2例(12.50%)皮瓣边缘部分表皮脱落;2例(12.50%)锁骨处少量积液;1例(6.25%)术

  15. Retrosternal dislocation of the clavicle in children - A case report and review of the literature

    International Nuclear Information System (INIS)

    The esternoclavicular dislocations are so rare that constitute 1% of all dislocations. Currently there are just about 100 cases of retrosternal dislocations reported in world literature. In spite of the low frequency of these lesions, early diagnosis is mandatory in avoid the multiple and occasionally associated disastrous complications and to provide adequate treatment. On the other hand retrosternal displacement occurs in later teenagers or young adults, being extremely rare before age 12. The case presented in this article illustrated sternoclavicular dislocations with posterior displacement in an 11-year-old boy, successfully closer reduced at an early time

  16. 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

    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...

  17. 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

  18. Treatment of posttraumatic midshaft clavicular pseudarthrosis with the Herbert cannulated bone screw and autologous bone grafting. A case report.

    Science.gov (United States)

    Proubasta, I R; Itarte, J P; De Frutos, A G; Cáceres, E P

    1999-01-01

    Pseudarthrosis of the midshaft of the clavicle can be treated successfully using the Herbert cannulated bone screw with no need for a second operation to remove the implant after bone union. PMID:10711373

  19. 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

  20. Biographical Sketch: Thomas Callaway, FRCS (1822–1869)

    OpenAIRE

    Brand, Richard A.

    2011-01-01

    This biographical sketch on Thomas Callaway corresponds to the historic text, The Classic: A Dissertation Upon Dislocations and Fractures of the Clavicle and Shoulder-Joint (1849) available at DOI 10.1007/s11999-011-2098-1.

  1. The cleidosternohyoid: a fifth infrahyoid muscle?

    OpenAIRE

    Wu B; Bluth BE; Stark ME; Wisco JJ

    2010-01-01

    We describe a cleidosternohyoid muscle found bilaterally during routine dissection of a cadaver (92 year-old male of Irish descent). On the right side, the muscle originated from the clavicle with a cleidohyoid muscle. On the left side, the muscle originated from the clavicle and accompanied the inferior belly of an omohyoid muscle. On both sides the muscle inserted into the sternohyoid muscle. Since the muscle variant courses with a cleidohyoid on the right and the inferior belly of an omohy...

  2. 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...

  3. OPERATIVE TR EATMENT OF CLAVICULAR FRACTURES: A PROSPECTIVE STUDY

    Directory of Open Access Journals (Sweden)

    Timma Reddy

    2015-09-01

    Full Text Available BACKGROUND: Fractures of clavicle constitute one of the commonest fractures in orthopaedic practice and till recently most of these fractures were treated conservatively. The advent of various implants for the fixation of these fractures along with safe surgical practices made the surgery more widely accepted and the definite indications for open reduction and internal fixation were formulated. MATERIAL & METHODS: In this prospective study, conducted in the department of orthopedics and Traumatology of Osmania General Hospital, Hyderabad, 4o patients who were operated for fracture clavicle were included. The study period was from September 2012 to September 2014. CONCLUSIONS : Operative treatment of fractu re clavicle offers a definitive method of treatment in some specific instances. It reduces the time of union, stiffness of the adjoining joints and morbidity.

  4. Clavicular stress fracture in a cricket fast bowler: A case report

    Directory of Open Access Journals (Sweden)

    Read Jeremy AF

    2008-09-01

    Full Text Available Abstract Introduction Whilst rare, stress fractures of the clavicle have been described in other sports. To our knowledge, this is the first reported case of a stress fracture of the clavicle occurring in a cricket fast bowler. Case presentation A 23-year-old professional cricket fast bowler presented with activity related shoulder pain. Imaging demonstrated a stress fracture of the lateral third of the clavicle. This healed with rest and rehabilitation allowing a full return to professional sport. Conclusion This injury is treated with activity modification and technique adaptation. In a professional sportsman, this needs to be recognised early so that return to play can be as quick as possible.

  5. 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.

  6. Immediate reconstruction of mandibular defects with a composite sternocleidomastoid musculoclavicular graft

    International Nuclear Information System (INIS)

    The problem of mandibular reconstruction has been approached using many surgical techniques. This article studies one such approach--reconstruction using full-thickness clavicle pedicled on the sternocleidomastoid muscle. Five patients with stage II and stage III carcinoma of the anterior part of the floor of the mouth were treated with mandibular resection and neck dissection. The resulting defects were immediately reconstructed with the clavicle-sternocleidomastoid muscle technique. The patients were observed from one to three years and were examined postoperatively with technetium Tc 99m medronate scans, which demonstrated the grafts to be viable. The technique proved reliable in a limited clinical trial

  7. On the investigation of possible remains of Field Marshal Iosif Gurko and his wife Maria (Salias de Turnemir found in their former estate Sakharovo (Tver Region, Russia

    Directory of Open Access Journals (Sweden)

    Andrei V Zinoviev

    2010-12-01

    Full Text Available Two skeletons, found in the tomb of the former estate Sakharovo near the city of Tver, were investigated. Although fragmentary and lacking skulls, according to age of death and anthropometry they could have belonged to Field Marshal Iosif Vladimirovich Gurko (1828-1901 and his wife Maria Andreevna (Salias de Turnemir (1838-1906. Further investigations are necessary to locate clavicles of the male skeleton. Fused fracture of one of them can strengthen the idea of the male skeleton belonging to Field Marshal, who broke the clavicle during manoeuvres of 1874.

  8. Cleidocranial dysplasia in a 15-month-old boy and a 14-year-old girl: clinical and radiological presentation

    International Nuclear Information System (INIS)

    Cleidocranial dysplasia (CCD) is a rare, autosomal dominant skeletal dysplasia with a relatively mild course. The most characteristic symptoms are clavicle hypoplasia or aplasia, abnormalities in the skull ossification, and a variety of dental pathologies. The clinical course and radiological presentation of two cases (a 15-month-old boy and a 14-year-old girl) of CCD are presented. Among the characteristic phenotype features the patients demonstrated were abnormalities in the skull formation, with wide sutures and large, delayed closure of the fontanelles, additional Wormian bones, and significant dental abnormalities, in both cases with delayed eruption of teeth and, in the girl, intensive caries, cross bite, and impacted teeth. The boy presented hypoplasia of the clavicles, while aplastic clavicles were confirmed in the girl. In both cases clavicle defects resulted in descended shoulders with abnormal movement faculty. Metacarpal and phalangeal defects were also found in both children as well as abnormalities in pelvic structure, with wide pubic symphysis and vertical arrangement of the pelvic bones in the girl. CCD is a skeletal dysplasia with characteristic clinical and radiological presentation. Although the course of the disorder is relatively mild, early orthopedic, dental, and orthodontic care, as well as rehabilitation, are essential in limiting complications resulting from the congenital malformation of the skeletal system. (author)

  9. Left-sided congenital pseudarthrosis of the clavicula.

    Science.gov (United States)

    Sakkers, R J; Tjin a Ton, E; Bos, C F

    1999-01-01

    This a well-documented case of a 13-year-old girl with unilateral pseudarthrosis of the left clavicle without the presence of cervical ribs or dextrocardia. Magnetic resonance imaging could not detect any abnormality that could be related to the left-sided pseudarthrosis. PMID:10709598

  10. Lytic clavicular lesions in fibromatosis colli

    International Nuclear Information System (INIS)

    Two patients with fibromatosis colli (congenital torticollis) presented with lytic lesions in the clavicle at the insertion of the fibrosed clavicular head of the sternocleidomastoid muscle. Biopsy of one lesion showed intraosseous fibrosis. These lesions are probably not uncommon but radiographs are rarely performed in uncomplicated cases. (orig.)

  11. Lytic clavicular lesions in fibromatosis colli

    Energy Technology Data Exchange (ETDEWEB)

    Sartoris, D.J.; Parker, B.R.; Mochizuki, R.M.

    1983-06-01

    Two patients with fibromatosis colli (congenital torticollis) presented with lytic lesions in the clavicle at the insertion of the fibrosed clavicular head of the sternocleidomastoid muscle. Biopsy of one lesion showed intraosseous fibrosis. These lesions are probably not uncommon but radiographs are rarely performed in uncomplicated cases.

  12. Shoulder deformities from obstetrical brachial plexus paralysis

    International Nuclear Information System (INIS)

    Abnormalities are described in the shoulders of 11 patients up to 17 years of age who have chronic brachial plexus paralyses from birth injuries. These abnormalities include a poorly formed and hypoplastic humeral head, a short abnormally formed clavicle, and a hypoplastic elevated scapula with a shallow glenoid fossa, inferiorly directed coracoid process, and abnormally tapered acromion. Four also had subluxated shoulders. (orig.)

  13. Generative Interpretation of Medical Images

    DEFF Research Database (Denmark)

    Stegmann, Mikkel Bille

    2004-01-01

    ventricular ejection 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....

  14. GENERAL ANAESTHESIA FOR A CHILD WITH CLEIDOCRANIAL DYSPLASIA: A CASE REPORT

    OpenAIRE

    Sangeetha; Kevin Koshy; Shabna; Mangesh

    2014-01-01

    We present a case of a child with Cleidocranial Dysplasia (CD) undergoing multiple teeth extraction. This is an autosomal dominant skeletal dysplasia characterized by developmental abnormalities of bony structures such as supernumerary teeth, brachycephalic skull, short stature and hypoplastic or aplastic clavicles. These structural abnormalities may pose challenges to anaesthetic management. However, there are only limited literatures describing anaesthetic implications o...

  15. Cranioplasty Using a Modified Split Calvarial Graft Technique in Cleidocranial Dysplasia

    OpenAIRE

    Jung, Young Taek; Cho, Jae Ik; Lee, Sang Pyung

    2015-01-01

    Cleidocranial dysplasia is a well-documented rare autosomal dominant skeletal dysplasia characterized by hypoplastic/aplastic clavicles, brachycephalic skull, patent sutures and fontanelles, midface hypoplasia, and abnormalities of dentition. Patients with cleidocranial dysplasia often complain about undesirable esthetic appearance of their forehead and skull. Notwithstanding many studies of molecular, genetics and skeletal abnormalities of this congenial disorder, there have been very few wr...

  16. 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.

  17. Reconstruction with a pectoralis major myocutaneous flap after left first rib and clavicular chest wall resection for a metastasis from laryngeal cancer.

    Science.gov (United States)

    Caronia, Francesco Paolo; Fiorelli, Alfonso; Zanchini, Fabio; Santini, Mario; Lo Monte, Attilio Ignazio; Castorina, Sergio

    2016-05-01

    We presented a case of recurrent metastasis from epidermoid cancer that occurred in the left clavicle of a patient with a history of laryngeal cancer treated on April 2005 with extended hemilaryngectomy, neck dissection and chemoradiation therapy. On September 2008, he developed a left clavicular metastasis. The disease was initially well controlled by chemoradiotherapy but it recurred 17 months later. The optimal treatment plan was established by several multidisciplinary meetings and the patient subsequently underwent an en bloc resection of the left clavicle, first rib and all the other involved structures. Coverage of the thoracic defect was achieved using pectoralis major myocutaneous flap. The patient had a successful surgical outcome. At 1-year follow-up, he had no evidence of disease, a good cosmetic result and returned to normal daily activity. He died for bone metastasis with an overall 21 months post-surgical survival. PMID:25319560

  18. Mandibular reconstruction in irradiated patients utilizing myosseous-cutaneous flaps

    International Nuclear Information System (INIS)

    Myosseous-cutaneous flaps were used for mandibular reconstruction in 16 irradiated patients. Three of six sternomastoid-clavicle flaps failed (all in conjunction with a neck dissection), as did one of 10 pectoralis major-anterior-fifth rib flaps. One trapezius-scapular flap was used and it succeeded. We found the blood supply of the sternomastoid-clavicle flap too tenuous for use in conjunction with a neck dissection. The trapezius-scapular flap had too short an arc of rotation to be used for defects other than those in the horizontal ramus. In addition, this flap required a change of position and created an undesirable functional deformity. The pectoralis major-fifth rib flap, in contrast, could be used for a variety of defects, in conjunction with a neck dissection, and did not require a change of position during operation. We found it to be the most versatile and dependable of the flaps employed in this series

  19. Multiple osteochondromata after total body irradiation. A case report

    International Nuclear Information System (INIS)

    We present a rare case of multiple osteochondromata after total body irradiation (TBI) in a bone marrow recipient. The patient was a 9-year-old boy. He had been given 13.2 Gy of TBI before allogeneic bone marrow transplantation (BMT) at the age of one because of acute lymphoblastic leukemia (ALL). He did not have a family history of hereditary multiple osteochondromatosis. Osteochondromata presented at the left clavicle, bilateral scapulae, right distal femur, and right proximal tibia. The lesions of the left clavicle and bilateral scapulae were excised. Histological features of resected specimens were those of osteochondroma, showing no evidence of malignant transformation. Although radiation is recognized to be a cause of osteochondroma, reports of TBI are rare. TBI should be considered as one of the causes of multiple osteochondromata. (author)

  20. 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.

  1. 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.

  2. 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. PMID:25351419

  3. Cleidocranial dysplasia: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jae Duk; Lee, Chang Yul; You, Choong Hyun [Chosun University College of Medicine, Gwangju (Korea, Republic of)

    2004-03-15

    Cleidocranial dysplasia is a rare and autosomal dominant disorder characterized by aplasia or hypoplasia of the clavicles, an open fontanelle, dental abnormalities, and short stature. A 17-year-old female who presented with short stature and subsequent delay in eruption of permanent teeth is described. she showed the abnormal hypermobility of the shoulder, ocular hypertelorism and concave nasal bridge. Radiographs revealed the underdeveloped maxilla, defect of the cranium in the fontanelle region, and aplasia of the clavicles. Characteristically, panoramic view revealed near parallel-sided borders of the ascending ramus and downward curvature of the zygomatic arch with hypoplasia. The prolonged retention of deciduous teeth with delayed eruption of permanent teeth and multiple embedded supernumerary teeth were striking. Radiographic and clinical investigations revealed Cleidocranial dysplasia.

  4. Metastásis en clavícula y ovarios de carcinoma primario desconocido. A propósito de un caso

    Directory of Open Access Journals (Sweden)

    Eddy V Mora

    2006-04-01

    Full Text Available The case of a 30-year-old female patient complaining of a tumor in distal third of right clavicle since October 2004 is presented. In December of the same year she attended a preoperative visit for bony protocol complaining of intense pain in lumbar and sacred region, left hemipelvis and parestesia of inferior members. Spinal RMN revealed tumor in S1-S2. During hospitalization she presented increased abdominal volume with palpable tumor, ascitis, pleural spill with right prevalence which leads to exploratory laparotomy and bone protocol. Definitive biopsy concludes: metastasic adenocarcinoma of clavicle and ovaries. Studies were done in search of primary tumor but no lesion was found. The patient received palliative treatment with spine radiotherapy; she had been scheduled for systemic treatment with chemotherapy, but died six months later. The combination of localization of the metastases of a carcinoma of unknown primary lesion constitutes an interesting case for discussion and literature review

  5. Multiple atypical bone involvement in sarcoidosis.

    Science.gov (United States)

    Mañá, J; Segarra, M I; Casas, R; Mairal, L; Fernández-Nogués, F

    1993-02-01

    We describe a patient with right paratracheal and left hilar lymph nodes detected by chance on chest radiography that followed a spontaneous remission. However, a few months later she complained of multiple scalp nodules. Skull roentgenogram and computerized tomogram scan showed multiple osteolytic lesions with increased uptake in bone and gallium scans. Lytic lesions were also detected in her right mandibular bone and right clavicle. Noncaseating granulomas were demonstrated in skull and cervical lymph node biopsies. PMID:8474084

  6. POSTERIOR STERNOCLAVICULAR JOINT DISLOCATION IN A DIVISION I FOOTBALL PLAYER: A CASE REPORT

    OpenAIRE

    Cruz, Mario F.; Erdeljac, Joe; Williams, Richard(Institut für Theoretische Physik, Justus-Liebig–Universität Giessen, 35392 Giessen, Germany); Brown, Mike; Bolgla, Lori

    2015-01-01

    Posterior dislocation of the sterno‐clavicular (SC) joint is a rare injury in athletes. It normally occurs in high collision sports such as American football or rugby. Acute posterior dislocations of the SC joint can be life‐threatening as the posteriorly displaced clavicle can cause damage to vital vascular and respiratory structures such as the aortic arch, the carotid and subclavian arteries, and the trachea. The potential severity of a posterior SC joint dislocation provides multiple chal...

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

    OpenAIRE

    Kovač Milena; Šerpak Dragoslav; Vučinić Jovanka; Borovčanin Daliborka; Krstić Tatjana

    2002-01-01

    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...

  8. Anatomy of the levator claviculae, with an overview and a literature survey

    OpenAIRE

    Odate, Toru; Kawai, Masataka; Iio, Kazuki; Funayama, Satoshi; Futamata, Haruo; Takeda, Sen

    2012-01-01

    We report here an anatomical study of the levator claviculae discovered during an anatomical dissection course for medical students. The muscle was identified on the left side, and followed a typical topography to previous detections, originating from the transverse process of the fourth cervical vertebra and attaching to the upper facet of the middle part of the clavicle. Innervation to this muscle came from both the third and fourth rami of the cervical spinal nerves. Blood supply to the mu...

  9. A Case of Cleidocranial Dysostosis: Dilemma for a Prosthodontist

    OpenAIRE

    Tripathi, Shuchi; Raghuwar D. Singh; Saumyendra V Singh; Chand, Pooran

    2012-01-01

    Cleidocranial dysostosis (CCD) is an uncommon, generalized skeletal disorder characterized by delayed ossification of the skull, aplastic or hypoplastic clavicles, and complex dental abnormalities such as retention of multiple deciduous teeth, impaction or delayed eruption of permanent teeth and presence of supernumerary teeth. This case report describes a 30-year old male patient of CCD with classical findings and the challenges faced in his prosthodontic rehabilitation. Conventional complet...

  10. 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.

  11. Upper extremity and rib stress fractures in a child

    International Nuclear Information System (INIS)

    Stress fractures in children are rare compared with the incidence in [ults. This report describes an 11-year-old girl with stress fractures of the acromion, clavicle, and first rib on the left and contralateral fractures of the first and second ribs. It was eventually discovered that these fractures were caused by a nervous tic consisting of repetitive, vigorous shrugging and translation of the shoulders. (orig.)

  12. Implantation of customized 3-D printed titanium prosthesis in limb salvage surgery: a case series and review of the literature

    OpenAIRE

    Fan, Hongbin; Fu, Jun; Li, Xiangdong; Pei, Yanjun; Li, Xiaokang; Pei, Guoxian; Guo, Zheng

    2015-01-01

    Background Although modular prosthesis is commercially available to meet requirements in most limb salvage surgeries, customized prosthesis is still needed. In contrast to traditional complicated procedures, rapid prototyping (RP) technique can directly manufacture customized titanium prosthesis. The objectives of this study were to describe the workflow of this technique and show the follow-up results of patients. Methods Three patients with clavicle Ewing’s sarcoma (ES), scapular ES, and pe...

  13. Infantile cortical hyperostosis and COL1A1 mutation in four generations

    OpenAIRE

    Cerruti-Mainardi, Paola; Venturi, Giacomo; Spunton, Marianna; Favaron, Elena; Zignani, Michela; Provera, Sandro; Dallapiccola, Bruno

    2011-01-01

    Infantile cortical hyperostosis (ICH, OMIM 114000) is a rare familial disorder which affects infants. It spontaneously heals in the first years of life. The disease is characterized by regressive subperiosteal hyperosteogenesis mainly affecting long bones, mandible, clavicles, and ribs which are remarkably swollen and deformed on X-rays. But it is also important to take into consideration the autosomal dominant pattern of inheritance to detect it. In 2005 Gensure et al. detected 3040C→T mutat...

  14. Injury patterns to other body regions and load vectors in nearside impact occupants with and without shoulder injuries.

    Science.gov (United States)

    Yoganandan, Narayan; Stadter, Gregory W; Halloway, Dale E; Pintar, Frank A

    2013-01-01

    CIREN and NASS-CDS databases were used to analyze nearside impact injuries. Front seat occupants with and without shoulder injuries were examined on an individual basis in both databases. All vehicles were from model year 2000 or newer. Variables such as the type of collision, change in velocity, principal direction force, demographics, injuries scored by the MAIS and ISS metrics, and injuries to the head, thorax, abdomen and pelvis were included. Shoulder injuries included fractures to the humerus, scapula and clavicle, and associated joint traumas. The median changes in velocities for occupants with and without shoulder injuries were 36 and 32 km/h in CIREN and 29 and 32 km/h in NASS databases. Approximately two-thirds of all cases occurred below 40 km/h. In both databases, the clavicle, scapula and humerus fractures, and AC joint dislocations were found, and the scapula fracture was associated with the clavicle, AC joint, acromion and humerus injuries in few occupants. The clavicle fracture was associated with AC joint and humerus injuries only in the NASS database. Thorax, abdomen and pelvic injuries and skull fractures increased with the presence of shoulder injuries in both databases, albeit not at the same rate. Anterior oblique loading was more frequent than pure lateral loading in both databases suggesting the importance of the oblique vector in side impact trauma. These findings underscore a need for detailed examinations of shoulder load-sharing using biomechanical studies to better understand its role in side impact traumas, shoulder biofidelity and injury assessments in dummies. PMID:24406953

  15. GENERAL ANAESTHESIA FOR A CHILD WITH CLEIDOCRANIAL DYSPLASIA: A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Sangeetha

    2014-12-01

    Full Text Available We present a case of a child with Cleidocranial Dysplasia (CD undergoing multiple teeth extraction. This is an autosomal dominant skeletal dysplasia characterized by developmental abnormalities of bony structures such as supernumerary teeth, brachycephalic skull, short stature and hypoplastic or aplastic clavicles. These structural abnormalities may pose challenges to anaesthetic management. However, there are only limited literatures describing anaesthetic implications of CD patients. Characteristics of this genetic disorder and implications for the anaesthesiologist are discussed.

  16. ENDOVASCULAR CORRECTION OF A POST-TRAUMATIC FALSE ANEURYSM OF THE RIGHT SUBCLAVIAN ARTERY. A CASE REPORT

    OpenAIRE

    Kvashin, A.; Atamanov, S.; Melnik, Alexey; Bykov, A.; Pomkin, A.; Shirkin, M.; Kyshtymov, S.

    2011-01-01

    False aneurysm of the subclavian artery is an uncommon complication. Most frequently this pathology is caused by fracture of clavicle, however other causes also can exist. We present a case of diagnosis and endovascular treatment of a false aneurysm of the right subclavian artery in a 31-years-old man, heroin addict, who performed multiple injections into the right subclavian artery. At admission he had paresis and decreased sensitivity in the right arm due to compression neuritis of the brac...

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

    OpenAIRE

    Lu, Hui; Zeng, Binghui; Yu, Dongsheng; Jing, Xiangyi; Hu, Bin; ZHAO Wei; 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 supernu...

  18. Ichthyosis vulgaris and pycnodysostosis: An unusual occurrence

    OpenAIRE

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

    2012-01-01

    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...

  19. Metastásis en clavícula y ovarios de carcinoma primario desconocido. A propósito de un caso

    OpenAIRE

    Eddy V. Mora; Ricardo González D; Nery Uzcategui M; Antonio Gómez M,; Nestor Gutiérrez M; Vilma Rebolledo P

    2006-01-01

    The case of a 30-year-old female patient complaining of a tumor in distal third of right clavicle since October 2004 is presented. In December of the same year she attended a preoperative visit for bony protocol complaining of intense pain in lumbar and sacred region, left hemipelvis and parestesia of inferior members. Spinal RMN revealed tumor in S1-S2. During hospitalization she presented increased abdominal volume with palpable tumor, ascitis, pleural spill with right prevalence which le...

  20. Cerebral candidiasis. Computed tomography appearance

    International Nuclear Information System (INIS)

    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.)

  1. 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.).

  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. Lateral Clavicular Autograft for Repair of Reverse Hill-Sachs Defect

    OpenAIRE

    Shenoy, Ravikiran; Kamineni, Srinath

    2011-01-01

    Posterior dislocations of the shoulder joint can result in an impression fracture over the anteromedial humeral head, termed the reverse Hill-Sachs lesion, the presence of which can contribute to recurrent dislocations. Methods described to repair this defect include using allografts, iliac crest and coracoid process autografts, and bone graft substitutes. We describe a novel technique using the lateral end of the ipsilateral clavicle as an autograft in a 78 year old man with a reverse Hill S...

  4. Modified Weaver-Dunn Procedure Versus The Use of Semitendinosus Autogenous Tendon Graft for Acromioclavicular Joint Reconstruction

    Science.gov (United States)

    Hegazy, Galal; Safwat, Hesham; Seddik, Mahmoud; Al-shal, Ehab A.; Al-Sebai, Ibrahim; Negm, Mohame

    2016-01-01

    Background: The optimal operative method for acromioclavicular joint reconstruction remains controversial. The modified Weaver-Dunn method is one of the most popular methods. Anatomic reconstruction of coracoclavicular ligaments with autogenous tendon grafts, widely used in treating chronic acromioclavicular joint instability, reportedly diminishes pain, eliminates sequelae, and improves function as well as strength. Objective: To compare clinical and radiologic outcomes between a modified Weaver-Dunn procedure and an anatomic coracoclavicular ligaments reconstruction technique using autogenous semitendinosus tendon graft. Methods: Twenty patients (mean age, 39 years) with painful, chronic Rockwood type III acromioclavicular joint dislocations were subjected to surgical reconstruction. In ten patients, a modified Weaver-Dunn procedure was performed, in the other ten patients; autogenous semitendinosus tendon graft was used. The mean time between injury and the index procedure was 18 month (range from 9 – 28). Clinical evaluation was performed using the Oxford Shoulder Score and Nottingham Clavicle Score after a mean follow-up time of 27.8 months. Preoperative and postoperative radiographs were compared. Results: In the Weaver-Dunn group the Oxford Shoulder Score improved from 25±4 to 40±2 points. While the Nottingham Clavicle Score increased from 48±7 to 84±11. In semitendinosus tendon graft group, the Oxford Shoulder Score improved from 25±3 points to 50±2 points and the Nottingham Clavicle Score from 48±8 points to 95±8, respectively. Conclusion: Acromioclavicular joint reconstruction using the semitendinosus tendon graft achieved better Oxford Shoulder Score and Nottingham Clavicle Score compared to the modified Weaver-Dunn procedure. PMID:27347245

  5. 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

  6. Comparison of Shoulder Muscles Activation for Shoulder Abduction between Forward Shoulder Posture and Asymptomatic Persons

    OpenAIRE

    Yoo, Won-gyu

    2013-01-01

    [Purpose] This study investigated the differences in shoulder muscles activities during shoulder abduction between a forward shoulder posture group and asymptomatic group. [Subjects] Seven males with forward shoulder posture (FHS) and seven asymptomatic males were recruited. [Methods] We measured the upper and middle trapezius (UT and MT), serratus anterior (SA), and clavicle portion of the pectoralis major (cPM) in the right side during shoulder abduction. [Results] The activities of the UT ...

  7. Management of stage T3 and T4 glottic carcinomas

    International Nuclear Information System (INIS)

    Between 1959 and 1979, 242 patients with T3 and T4 lesions of the vocal cords were treated at our institution. Treatment consisted of total laryngectomy in all patients. Different modalities of regional node dissections were performed on 187 patients. In addition, 50 patients received irradiation with cobalt-60 postoperatively for specific features of the disease. In the group of 192 patients whose treatment consisted of surgery alone, 28 (14 percent) had recurrence in the neck and 10 (5 percent) had stomal recurrence. Of the patients treated with combined therapy, three (6 percent) had ipsilateral neck recurrences and one (2 percent) had stomal recurrence. For lesions staged N0, failure rates above the clavicles were 16 percent and 31 percent for patients with T3 and T4 lesions, respectively, in the group treated by surgery alone, 9 percent and 6 percent for patients with T3 and T4 lesions, respectively, in the combined therapy group. The rate of failure above the clavicles for lesions staged N+ was 32 percent in the group treated with surgery alone and 8 percent in the combined therapy group. In this study, a correlation was made between the failure rates above the clavicles and different clinical and histologic characteristics of the tumor, surgical findings, and the different modalities of cervical node dissection used. From analysis of the data, recommendations have been made for the selective treatment of patients with advanced glottic carcinomas

  8. Management of stage T3 and T4 glottic carcinomas

    Energy Technology Data Exchange (ETDEWEB)

    Yuen, A.; Medina, J.E.; Goepfert, H.; Fletcher, G.

    1984-10-01

    Between 1959 and 1979, 242 patients with T3 and T4 lesions of the vocal cords were treated at our institution. Treatment consisted of total laryngectomy in all patients. Different modalities of regional node dissections were performed on 187 patients. In addition, 50 patients received irradiation with cobalt-60 postoperatively for specific features of the disease. In the group of 192 patients whose treatment consisted of surgery alone, 28 (14 percent) had recurrence in the neck and 10 (5 percent) had stomal recurrence. Of the patients treated with combined therapy, three (6 percent) had ipsilateral neck recurrences and one (2 percent) had stomal recurrence. For lesions staged N0, failure rates above the clavicles were 16 percent and 31 percent for patients with T3 and T4 lesions, respectively, in the group treated by surgery alone, 9 percent and 6 percent for patients with T3 and T4 lesions, respectively, in the combined therapy group. The rate of failure above the clavicles for lesions staged N+ was 32 percent in the group treated with surgery alone and 8 percent in the combined therapy group. In this study, a correlation was made between the failure rates above the clavicles and different clinical and histologic characteristics of the tumor, surgical findings, and the different modalities of cervical node dissection used. From analysis of the data, recommendations have been made for the selective treatment of patients with advanced glottic carcinomas.

  9. Side effects and complication of Port-A-Cath.

    Science.gov (United States)

    Iannarone, Claudio; Sacco, Fabrizio; Micozzi, Marco; Fegiz, Alessandra; Fiorelli, Silvia; Vendittelli, Vincenza; Pinto, Giovanni

    2012-01-01

    Central venous catheter techniques find at present use for administering of NPT, for the drug injection ( especially chemiotherapeutic drugs) because of the possible damage of a few substances when perfused in a peripheral way. At present port-a-cath find their most extensive use: these are systems which can be set up and tolerated for many months. For the access to subclavian vein must be necessary put in supine decubitus, with light Trendelenburg position, with the opposite arm along the body and the head turned on the opposite side. In this way the clavicle is in perpendicular position with regard to the sternal handlebar, except for patient affected with bpco, kypho-scoliosis, scapular-homeral arthrosis. In these patients the clavicle can put on a particular course, oblique and upper as to the sternal articular face. So there is a serious obstacle to the passage to the metal needle under the clavicle. KEY WORDS: Chemiotherapy, CVC, NPT, Port-a-Cath. PMID:23103553

  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. The sternoclavicular joint: can imaging differentiate infection from degenerative change?

    International Nuclear Information System (INIS)

    The purpose of this study was to determine if there are imaging and clinical findings that can differentiate a septic sternoclavicular joint from a degenerative one. Search of radiology reports from 2000-2007 revealed 460 subjects with imaging of the sternoclavicular joint, of whom 38 had undergone aspiration or biopsy. The final study group consisted of nine subjects with pathologic proof of sternoclavicular joint infection and ten subjects with pathologic and clinical findings excluding infection consistent with degenerative change. Available ultrasound, computed tomography (CT), and magnetic resonance (MR) images were retrospectively reviewed, and echogenicity, capsular distention, erosions, cysts, hyperemia or enhancement, and intensity of bone marrow signal were recorded. Clinical data were also reviewed. The findings significantly associated with sternoclavicular joint infection included degree and extent of capsular distention. With infection, average joint distention was 14 mm (range 10-20 mm) and extended over the sternum and clavicle in 60% compared to 5 mm (range 3-8 mm) with degeneration only extending over the clavicle. Other findings significantly associated with infection included bone marrow fluid signal on magnetic resonance imaging (MRI), elevated Westergren red blood cell sedimentation rate, and fever. The two findings significantly associated with degeneration were subchondral cysts on CT and female gender. Other imaging and clinical variables showed no significant differences between infection and degenerative change. The clinical and imaging findings significantly associated with sternoclavicular joint infection included joint capsule distention of 10 mm or greater, extension over both the clavicle and sternum, adjacent fluid signal bone marrow replacement, elevated Westergren red blood cell sedimentation rate, and fever. (orig.)

  12. The sternoclavicular joint: can imaging differentiate infection from degenerative change?

    Energy Technology Data Exchange (ETDEWEB)

    Johnson, Mark C.; Jacobson, Jon A.; Fessell, David P.; Kim, Sung Moon; Brandon, Catherine; Caoili, Elaine [University of Michigan, Department of Radiology, Ann Arbor, MI (United States)

    2010-06-15

    The purpose of this study was to determine if there are imaging and clinical findings that can differentiate a septic sternoclavicular joint from a degenerative one. Search of radiology reports from 2000-2007 revealed 460 subjects with imaging of the sternoclavicular joint, of whom 38 had undergone aspiration or biopsy. The final study group consisted of nine subjects with pathologic proof of sternoclavicular joint infection and ten subjects with pathologic and clinical findings excluding infection consistent with degenerative change. Available ultrasound, computed tomography (CT), and magnetic resonance (MR) images were retrospectively reviewed, and echogenicity, capsular distention, erosions, cysts, hyperemia or enhancement, and intensity of bone marrow signal were recorded. Clinical data were also reviewed. The findings significantly associated with sternoclavicular joint infection included degree and extent of capsular distention. With infection, average joint distention was 14 mm (range 10-20 mm) and extended over the sternum and clavicle in 60% compared to 5 mm (range 3-8 mm) with degeneration only extending over the clavicle. Other findings significantly associated with infection included bone marrow fluid signal on magnetic resonance imaging (MRI), elevated Westergren red blood cell sedimentation rate, and fever. The two findings significantly associated with degeneration were subchondral cysts on CT and female gender. Other imaging and clinical variables showed no significant differences between infection and degenerative change. The clinical and imaging findings significantly associated with sternoclavicular joint infection included joint capsule distention of 10 mm or greater, extension over both the clavicle and sternum, adjacent fluid signal bone marrow replacement, elevated Westergren red blood cell sedimentation rate, and fever. (orig.)

  13. 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

  14. Paracoccidioidomycosis in children. Report of two cases studied with 67 Ga

    International Nuclear Information System (INIS)

    Two cases of paracoccidioidomycosis in children are reported, aged 6 years, males,in the subacute clinical form (juvenile type). The first showed generalized lymph nodes involvement and was treated with sulfonamide; the 67 Ga images permitted follow-up until the disease inactivity. The second, besides lumph nodes, had lung and bone (clavicle) involvement characterized by 67 Ga scintigraphy, with normal radiologic study. The 67 Ga images have utility to evaluate the mycoses extension, to monitore the response to specific treatment and to show its inactivity. (author)

  15. Craniometadiaphyseal dysplasia, wormian bone type.

    Science.gov (United States)

    Santolaya, J M; Hall, C M; García-Miñaur, S; Delgado, A

    1998-05-18

    We report on a 4-year-old boy with craniometadiaphyseal dysplasia (CMDD), wormian bone type. Component manifestations include a large head with prominent forehead, skull changes showing multiple wormian bones, wide long tubular bones without the usual metaphyseal flare, wide and short tubular bones without the normal diaphyseal constriction, and wide ribs and clavicles. In addition to these findings, the propositus, his brother, his father, and a paternal aunt all have parietal protuberances, which seem not related to CMDD. Parental consanguineity supports the autosomal recessive transmission of the condition. PMID:9605592

  16. Congenital disorders of the hand and upper extremity.

    Science.gov (United States)

    Van Heest, A E

    1996-10-01

    This article summarizes normal formation and growth of the upper limb as a basis for understanding malformation. Shoulder anomalies, including Sprengel's undescended scapula, clavicle pseudarthrosis, cleidocraniodystostosis, and Poland's syndrome, are presented. Classification and examples of limb malformations are discussed as well as neuromuscular disorders, such as obstetric brachial plexopathy, cerebral palsy, and arthrogryposis. The author hopes that this article provides a basic understanding of the evaluation necessary for appropriate counseling and referrals for treatment of the child with hand and upper extremity congenital deformities. PMID:8858076

  17. 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.

  18. FIRST RECORD OF SIMOSAURUS (SAUROPTERYGIA, NOTHOSAUROIDEA FROM THE CARNIAN (LATE TRIASSIC OF ITALY

    Directory of Open Access Journals (Sweden)

    FABIO M. DALLA VECCHIA

    2008-07-01

    Full Text Available The nothosauroid sauropterygian Simosaurus is reported for the first time both from Italy and from the early Carnian (earliest Late Triassic. Diagnostic dorsal neural arches and clavicles as well dorsal ribs have been collected in the Rio dal Lago Formation near Dogna (Friuli. Purported Simosaurus remains from the Ladinian of Austria cannot be attributed to this genus with certainty and the presence of additional articular structures in the dorsal neural arch ("infraprezygapophyses" and infrapostzygapophyses cannot distinguish Simosaurus from Bobosaurus if the craniocaudal polarity or other vertebral features are unknown. 

  19. 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.

  20. 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.

  1. Cranioplasty Using a Modified Split Calvarial Graft Technique in Cleidocranial Dysplasia.

    Science.gov (United States)

    Jung, Young Taek; Cho, Jae Ik; Lee, Sang Pyung

    2015-07-01

    Cleidocranial dysplasia is a well-documented rare autosomal dominant skeletal dysplasia characterized by hypoplastic/aplastic clavicles, brachycephalic skull, patent sutures and fontanelles, midface hypoplasia, and abnormalities of dentition. Patients with cleidocranial dysplasia often complain about undesirable esthetic appearance of their forehead and skull. Notwithstanding many studies of molecular, genetics and skeletal abnormalities of this congenial disorder, there have been very few written reports of cranioplasty involving cleidocranial dysplasia. Thus, we report a rare case of successful cranioplasty using a modified split calvarial graft technique in patient with cleidocranial dysplasia. PMID:26279819

  2. Regional surveillance program for the detection of fatal infant abuse

    International Nuclear Information System (INIS)

    From 1984 to 1986, a regional surveillance program for the detection of infant abuse was carried out. Infants dying of uncertain cause were studied with a protocol designed to identify possible cases of infant abuse. At autopsy, resection of selected osseous material was performed, followed by meticulous specimen radiography and histopathologic analysis. Characteristic injuries involving the metaphyses, posterior rib arcs and spine, as well as less specific fractures of the long bone shafts and clavicles, were identified in eight abused infants. The authors believe that this multidisciplinary approach to unexplained infant death enhances detection of abuse and provides valuable documentary evidence for criminal prosecution

  3. Humerus Diaphysis Fracture in a Newborn during Vaginal Breech Delivery.

    Science.gov (United States)

    Kaya, Baris; Daglar, Korkut; Kirbas, Ayse; Tüten, Abdullah

    2015-01-01

    While most obstetricians are familiar with fracture of the clavicle in newborns during birth, an unlucky minority of obstetricians has encountered long-bone fractures in newborns as well. This complication is traumatic not only for the neonate, but also for the family and the obstetrician; it is also difficult to explain. Fortunately, the long-term prognosis for fracture of the long bones is excellent. Both vaginal and cesarean breech deliveries and maneuvers can be responsible for birth traumas, including long-bone fractures. This case report presents a newborn with breech presentation delivered vaginally that resulted in humerus diaphysis fracture. PMID:26770851

  4. Recurrent multifocal chronic osteitis in children

    International Nuclear Information System (INIS)

    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)

  5. Homo floresiensis and the evolution of the hominin shoulder.

    Science.gov (United States)

    Larson, Susan G; Jungers, William L; Morwood, Michael J; Sutikna, Thomas; Jatmiko; Saptomo, E Wahyu; Due, Rokus Awe; Djubiantono, Tony

    2007-12-01

    The holotype of Homo floresiensis, diminutive hominins with tiny brains living until 12,000 years ago on the island of Flores, is a partial skeleton (LB1) that includes a partial clavicle (LB1/5) and a nearly complete right humerus (LB1/50). Although the humerus appears fairly modern in most regards, it is remarkable in displaying only 110 degrees of humeral torsion, well below modern human average values. Assuming a modern human shoulder configuration, such a low degree of humeral torsion would result in a lateral set to the elbow. Such an elbow joint would function more nearly in a frontal than in a sagittal plane, and this is certainly not what anyone would have predicted for a tool-making Pleistocene hominin. We argue that Homo floresiensis probably did not have a modern human shoulder configuration: the clavicle was relatively short, and we suggest that the scapula was more protracted, resulting in a glenoid fossa that faced anteriorly rather than laterally. A posteriorly directed humeral head was therefore appropriate for maintaining a normally functioning elbow joint. Similar morphology in the Homo erectus Nariokotome boy (KNM-WT 15000) suggests that this shoulder configuration may represent a transitional stage in pectoral girdle evolution in the human lineage. PMID:17692894

  6. Chest pain due to Pinch-off syndrome: radiological findings and endovascular rescue.

    Science.gov (United States)

    Viviani, E; Giribono, A M; Ferrara, D; Santagata, A; Narese, D; Midiri, F; Albano, D; Porcellini, M

    2016-01-01

    Port-a-cath is widely used as a route for administration of drugs in hematology and oncology patients and, recently, has been adapted also for hemodialysis patients. Major complications include infection, thrombosis, arrhythmia, and embolization. The Pinch-off-syndrome (POS) means the clavicle and the first rib compress the long-term central venous catheter. The reported incidence rate ranges from 1.4% to 4.1%. This syndrome can be recognized on chest radiography by observing a thinning of the catheter lumen through the passage between the clavicle and the first rib. Catheter fracture is a rare but potentially life-threatening complication that must be recognized and treated promptly. Management of dislodged ports includes percutaneous transcatheter retrieval, open thoracotomy retrieval and oral anticoagulant therapy. Among these techniques, percutaneous transcatheter retrieval is an easy, safe and efficient method. We report the successful percutaneous endovascular retrieval of dislodged intracardiac catheter, separated from its port, in a 58 year-old male patient who presented with chest pain. PMID:26980633

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

    Science.gov (United States)

    Jiménez-Martín, Antonio; Pérez-Hidalgo, Santiago

    2011-04-01

    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. PMID:21897586

  8. 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.

  9. Clavicular eosinophilic granuloma causing adult shoulder pain

    Directory of Open Access Journals (Sweden)

    Lawrence R. Menendez

    2013-02-01

    Full Text Available Though rarely reported, neoplasms of the clavicle occur, and their symptoms can be mistaken for more common shoulder conditions. We present the case of a benign clavicular neoplasm, rarely seen in adults, presenting with pain, and eventual pathologic fracture in a 49 year-old. A 49 year-old male firefighter underwent arthroscopic rotator cuff repair for shoulder pain after magnetic resonance imaging revealed supraspinatus tendon tear. The patient’s pain persisted after surgery, and was described as routine until he developed severe pain after minor blunt trauma. A local Emergency Room performed the first x-rays, which revealed a pathologic fracture of the distal clavicle through a destructive lesion. The patient was referred to an orthopedic oncologist, who performed incisional biopsy, which initially diagnosed osteomyelitis. The patient was subsequently taken to surgery for debridement. Pathology then yielded the diagnosis of eosinophilic granuloma. The patient was taken back to surgery for formal curettage with open reduction and internal fixation. The patient’s pain resolved, the pathologic fracture fully healed, and the patient returned to full time work as a firefighter. Though workup for common shoulder conditions often identifies incidental benign lesions of bone, the converse can be true. Persistent pain despite intervention should raise concern for further investigation. An x-ray alone can reveal a destructive bone lesion as the source of shoulder pain.

  10. 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.)

  11. 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.

  12. 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.

  13. Acromioclavicular joint reconstruction using the LockDown synthetic implant: a study with cadavers.

    Science.gov (United States)

    Taranu, R; Rushton, P R P; Serrano-Pedraza, I; Holder, L; Wallace, W A; Candal-Couto, J J

    2015-12-01

    Dislocation of the acromioclavicular joint is a relatively common injury and a number of surgical interventions have been described for its treatment. Recently, a synthetic ligament device has become available and been successfully used, however, like other non-native solutions, a compromise must be reached when choosing non-anatomical locations for their placement. This cadaveric study aimed to assess the effect of different clavicular anchorage points for the Lockdown device on the reduction of acromioclavicular joint dislocations, and suggest an optimal location. We also assessed whether further stability is provided using a coracoacromial ligament transfer (a modified Neviaser technique). The acromioclavicular joint was exposed on seven fresh-frozen cadaveric shoulders. The joint was reconstructed using the Lockdown implant using four different clavicular anchorage points and reduction was measured. The coracoacromial ligament was then transferred to the lateral end of the clavicle, and the joint re-assessed. If the Lockdown ligament was secured at the level of the conoid tubercle, the acromioclavicular joint could be reduced anatomically in all cases. If placed medial or 2 cm lateral, the joint was irreducible. If the Lockdown was placed 1 cm lateral to the conoid tubercle, the joint could be reduced with difficulty in four cases. Correct placement of the Lockdown device is crucial to allow anatomical joint reduction. Even when the Lockdown was placed over the conoid tubercle, anterior clavicle displacement remained but this could be controlled using a coracoacromial ligament transfer. PMID:26637681

  14. A PROSPECTIVE STUDY OF SURGICAL MANAGEMENT OF DISPLACED MIDDLE THIRD CLAVICAL FRACTURE BY PLATE OSTEOSYNTHESIS

    Directory of Open Access Journals (Sweden)

    Sivananda

    2015-10-01

    Full Text Available BACKGROUND: Clavicle fractures are usually known for its conservative treatment, but for displaced middle third comminuted fractures (Robinson type 2B plate osteosynthesis is a promising option. AIM: To evaluate the functional outcome of middle third clavicular frac ture (2B1, and B2 Robinson classification in 30 patients managed with Open reduction and internal fixation with plate and screw. METHODS AND MATERIAL: We performed a prospective study between Jan 2009 to May 2012 of 30 acute displaced comminuted middle th ird clavicle fractures in adults which were treated with plate osteosynthesis. There were 22 males, 8 females, the mean age of the patient was 35.6 years and 10 patients had associated injuries and average follow up was 18 month, minimum of 6 months. RESU LTS: Union was achieved in 12 - 16 weeks. Post operatively 2 patients had superficial infection, 3 patients had scar hypertrophy, 3 Patients had hard ware prominence, no patients had hardware failure and none of the patients had deep infection. The average c onstant score was 96 and patients were relatively satisfied with the treatment. CONCLUSION: Plate Osteosynthesis for displaced middle third shaft fracture in adults gives excellent results

  15. 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.

  16. Traumatic bone and cartilage injuries of the shoulder; Traumatische Knochen- und Knorpelverletzungen der Schulter

    Energy Technology Data Exchange (ETDEWEB)

    Scheurecker, G. [CT- und MRT-Institut am Schillerpark, Linz/Donau (Austria)

    2015-03-01

    Traumatic injuries to the shoulder joint occur both as isolated, especially to the humerus and clavicle, as well as accompanying glenohumeral dislocations. To give an overview of the main approach of diagnostic imaging of the more common traumatic injuries to bone and/or cartilage of the shoulder joint. Only the scapula, proximal humerus and lateral clavicle are covered. In this overview radiography (RG), computed tomography (CT) and magnetic resonance imaging (MRI) are considered. Sonography is not included. The radiological report has to correctly identify injuries and describe their extent but the use of classification schemes is strongly dependent on local procedural practices. (orig.) [German] An der Schulter treten Verletzungen von Knochen bzw. Knorpel sowohl eigenstaendig auf - bei Frakturen speziell des Humerus oder der Klavikula - haeufig aber auch begleitend bei v. a. glenohumeralen Luxationen. Darstellung der bildgebenden Diagnostik der typischen traumatischen Verletzungen von Knochen und/oder Knorpel der Schulter. Beruecksichtigt werden der proximale Humerus, die Skapula und das laterale Klavikuladrittel. An bildgebenden diagnostischen Methoden wird auf die konventionelle Radiographie (RG), die Computertomographie (CT) und die Magnetresonanztomographie (MRT) eingegangen. Die Sonographie wird nicht behandelt. Der radiologische Befund soll moeglichst korrekt Verletzungen feststellen und das Ausmass beschreiben, Klassifikationen und ihre Angabe sind aber stark von jeweils lokalen Verfahrensweisen abhaengig. (orig.)

  17. Multiple myeloma

    International Nuclear Information System (INIS)

    Multiple myeloma is a malignant plasma cell tumor that is thought to originate proliferation of a single clone of abnormal plasma cell resulting production of a whole monoclonal paraprotein. The authors experienced a case of multiple myeloma with severe mandibular osteolytic lesions in 46-year-old female. As a result of careful analysis of clinical, radiological, histopathological features, and laboratory findings, we diagnosed it as multiple myeloma, and the following results were obtained. 1. Main clinical symptoms were intermittent dull pain on the mandibular body area, abnormal sensation of lip and pain due to the fracture on the right clavicle. 2. Laboratory findings revealed M-spike, reversed serum albumin-globulin ratio, markedly elevated ESR and hypercalcemia. 3. Radiographically, multiple osteolytic punched-out radiolucencies were evident on the skull, zygoma, jaw bones, ribs, clavicle and upper extremities. Enlarged liver and increased uptakes on the lesional sites in RN scan were also observed. 4. Histopathologically, markedly hypercellular marrow with sheets of plasmoblasts and megakaryocytes were also observed.

  18. Relationship between MRI and clinical findings in the acromioclavicular joint

    International Nuclear Information System (INIS)

    Objective: To determine the relationship between the magnetic resonance (MR) appearance of the acromioclavicular (AC) joint and the physical findings. Design: A total of 116 consecutive patients underwent routine MR imaging (MRI) of the shoulder over an 18-month period. All MR studies were interpreted by a blinded, experienced musculoskeletal radiologist. Eleven variables were studied: the presence of osteophytes; fluid in the joint; fluid outside the joint; high signal in the clavicle or in the acromion; fluid in the subacromial bursa; irregularity of the joint margins; bulging of the capsule; widening of the joint; the age of the patient; and the presence of a rotator cuff tear. The clinical information was supplied by an experienced shoulder surgeon blinded to the MRI findings. A control group of 23 normal volunteers was also studied. Results: The only statistically significant correlation (P=0.0249) was between high signal in the distal clavicle and degenerative changes found clinically. A weaker relationship existed between fluid in the joint and the clinical examination and between increasing degenerative changes and advancing age. Otherwise, no material relationship was found between any of the other MR abnormalities and the clinical picture. Conclusion: There appears to be no real correlation between the MR appearances and the clinical findings in the AC joint. (orig.)

  19. 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.

  20. 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.

  1. 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

  2. Minimum 2-Year Outcomes after Resection Arthroplasty of the Sternoclavicular Joint

    Science.gov (United States)

    Katthagen, Jan Christoph; Tahal, Dimitri S.; Menge, Travis; Horan, Marilee P.; Millett, Peter J.

    2016-01-01

    Objectives: Injuries of the sternoclavicular (SC) joint are rare and are usually caused by high energy mechanisms, such as collision sports or motor vehicle accidents. The aims of this study were to assess functional outcomes and return to sport following resection arthroplasty for osteoarthritis of the sternoclavicular joint. Methods: 20 SC joints (18 patients) had undergone resection arthroplasty of up to a maximum of 10 mm of the medial end of the clavicle for painful osteoarthritis, without instability, between November 2006 and November 2013. Patients at least two years out from surgery and living in the U.S. were included in the study. This was an IRB-approved retrospective outcomes study with prospectively collected data. Preoperative and postoperative function and pain levels were assessed with the ASES, SF-12 PCS, QuickDASH and SANE scores. Additionally, the level of sport intensity and the pain levels during activities of daily living, work and recreation were assessed pre- and postoperatively. The results of the functional outcome scores were normally distributed and were compared with the paired sample t-test. The results of pain level assessment were not normally distributed and were compared with the paired Wilcoxon signed-rank test. Results: 19 SC joints in 17 patients (9 female, 8 male; mean age at time of surgery 39.5±17.1 years) met inclusion criteria. One patient refused participation in the study. Two patients (10.5%) were considered failures as they required additional SC joint surgery (one patient with revision resection of the medial clavicle for persistent symptoms and one patient with secondary figure-of-eight graft stabilization for instability). Minimum 2-year outcomes data were available for 14 of the remaining 16 SC joints (88%). The mean time to follow-up was 3.1 years (range, 2.0-8.8 years). The ASES score, QuickDASH, and pain levels demonstrated significant improvement postoperatively (p0.05; Table 1). All patients (100%, n=11) that

  3. THE EFFICACY OF SURGERY FOR FLOATING SHOULDER INJURY%浮肩损伤的手术治疗效果

    Institute of Scientific and Technical Information of China (English)

    乔光曦; 王丽君; 刘海飞; 叶发刚; 季爱玉

    2011-01-01

    Objective To assess the outcome of surgery for floating shoulder injury (FSI). Methods A review of nine cases of FSI was done. Of those, right-side five cases, and left-side fours six cases suffered from fracture of neck of scapula complicating ipsilateral clavicular fracture. And three complicating acromioclavicular dislocation. All the patients underwent open reduction and internal fixation. For those with fractures of clavicle and scapula, a realignment plate fixation was performed; for those with acromioclavicular dislocation, a clavicle hook plate was applied. Results All the nine patients were followed for (mean) six months-five years (26 months), the fractures of clavicle and shoulder blade healed at 3 -5 months after operation, six patients experienced basically normal motion of their shoulder joint; three were slightly limited; two with mild pain while moving the joint. The average CONSTANT score of shoulder function was 88. 6 points. Conclusion Open reduction and internal fixation, and early functional exercise in the treatment of FSI can achieveagood effect.%目的 探讨浮肩损伤(FSI)的手术治疗效果.方法 FSI病人9例,肩胛颈骨折合并同侧锁骨骨折6例,合并肩锁关节脱位3例;右侧5例,左侧4例.均行切开复位内固定治疗,锁骨和肩胛骨骨折采用重建钢板固定,肩锁关节脱位采用锁骨钩钢板固定.结果 9例病人均得到6个月~5年(平均26个月)的随访,锁骨和肩胛骨骨折均于术后3~5个月愈合,6例病人肩关节活动基本正常,3例病人肩活动范围轻度受限,2例病人肩关节活动时有轻度疼痛.肩关节功能CONSTANT评分平均为88.6分.结论 切开复位内固定早期功能锻炼治疗FSI效果良好.

  4. FUNCTIONAL OUTCOME IN MIDSHAFTCLAVICLE FRACTURE PLATING: OUR EXPERIENCE

    Directory of Open Access Journals (Sweden)

    Sunirmal

    2014-08-01

    Full Text Available : INTRODUCTION: Fracture of the clavicle constitute approximately up to 44% of injuries to the shoulder girdle most of which (upto 80% occur in the middle one-third of clavicle shaft. Poor outcomes associated with mal-union and non-union (15% following middle third clavicle fracture has been observed after conservative treatment of severely displaced fractures. In past few years, many have suggested operative treatment as an alternative to conservative treatment. AIM: To analyze the outcomes of the operative management using plate to fix mid-shaft fractures compared to conservative treatment. MATERIALS AND METHODS: 33 patients of clavicular fractures were treated conservatively (n=17 and surgically (n=16 according to fracture pattern and patient demands between June 2011 to June 2013 with 1 year of follow- up. Fractures were classified according to Robinson’s classification and Constant and Murley shoulder score was used to access functional outcome. All patients were followed up weekly for 4 weeks then at 8 wks, 12 wks, 6 months and 1 year. Local examination, shoulder movements were assessed and check x-rays were done at each visit. RESULT: Our study showed statistically significantly better union time in operative group (~7.8 weeks compared to conservative group (~9.4 weeks. Malunion was seen in 11 (64.7% of conserved patients with 1 (5.8% going into non-union. 81.5% patients in operative group (13 out of 16 had good to excellent functional outcome compared to 58.8% in conservative group (10 out of 17. 4 (23.5% had poor outcome in conservative group compared to only 1 (6.25% in operative group. CONCLUSION: Our study concludes that operative treatment i.e. Open reduction and internal fixation with plating gives better functional outcome in both short and long term period compared to conservative treatment and the same should be preferred especially for type B variety fracture. Complications seen following surgery were infection (1 patient

  5. 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.

  6. 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.

  7. 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 Jadwiga;

    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...... 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.......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...

  8. 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.)

  9. Congenital abdominal dumbbell fashion neuroblastoma with invasion of spinal canal detected by ultrasonography - case report

    International Nuclear Information System (INIS)

    A case of congenital abdominal dumbbell fashion neuroblastoma with invasion of the spinal canal detected by ultrasonography (US) is presented. A 3-week-old male neonate was admitted to the hospital with a palpable mass in the left lumbar region. Ultrasound examination was performed on the same day. It disclosed a pathologic mass filling the left side of the retroperitoneal space - displacing laterally and inferiorly the left kidney. The second part of the tumor was located above the Gerot's fascia in the muscles and infiltrated the tomography scanning confirmed the presence of solid masses in these locations. Urinary excretion of vanillin-mandelic acid (VMA) was within normal range, ferritin level was elevated (447 μg/ml). Bone scintigraphy showed metastases to the left clavicle. There were no changes in bone marrow. Diagnosis of an undifferentiated malignant neuroblastoma was established in histopathological examination. Spinal ultrasonography is highly recommended in neonates and infants with retroperitoneal tumors. (author)

  10. Systematic review of the surgical treatment for symptomatic os acromiale

    Directory of Open Access Journals (Sweden)

    Joshua D Harris

    2011-01-01

    Full Text Available The optimal surgical treatment for symptomatic os acromiale that has failed nonoperative management is unclear in the literature. We conducted a systematic review of multiple medical databases for level I-IV evidence. Both radiographic and clinical outcomes were analyzed. Nine studies met the inclusion criteria (118 subjects, 125 shoulders. One hundred and fifteen subjects were treated surgically (122 shoulders. The mean age of the subjects was 49±11 years. The mean preoperative duration of symptoms was 12±8.6 months. Mesoacromiale was the most common type treated (94%. Internal fixation was the most common surgical technique used (60%, followed by excision (27% and acromioplasty (13%. Rotator cuff repair was the most common concurrent surgical technique (performed in 59% of the surgically treated shoulders, followed by distal clavicle excision (25%. All surgical techniques resulted in improvement in clinical outcomes. Surgical management of symptomatic os acromiale that has failed nonoperative measures may predictably lead to improved outcomes.

  11. 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.

  12. The statistical observation of the coracoclavicular joint in Korea

    International Nuclear Information System (INIS)

    The coracoclavicular joint is a rare genetical anatomic variants. The joint occurs at the junction of a bony projection extending inferiority from the outer third of the clavicle at the site of the conoid tubercle and a bony projection extending superiority from the coracoid process of the scapula. In our study we reviewed the radiological incidence of the coracoclavicular joint in Korean adults. The materials consists of 4,625 routine chest films, 9,250 sides. Sex distribution were 3,000 males and 1,625 females. The authors observed coracoclavicular joint on 17 persons (0.37 %) and 25 sides (0.26%) and among them, 8 persons (47%) were bilateral and in 9 (53%) it was unilateral. The joint when unilateral occurs frequently on left side, and there was no significant sex difference. There were statistically significant differences in the incidence of coracoclavicular joints among Korean, Japanese and Chinese

  13. 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.

  14. A family with cleidocranial dysplasia and crossed ectopic kidney in one child.

    Science.gov (United States)

    Suresh, Saraswathivilasam S

    2009-08-01

    Cleidocranial dysplasia or dysostosis (CCD) is a condition characterised by failure of membranous ossification resulting in absence or pseudarthrosis of the clavicle, open fontanelles, wormian bones and supernumerary teeth. The aetiology though not completely known is thought to be due to a CBFA1 (core binding factor activity 1) gene defect on the short arm of chromosome 6p21. CBFA1 is essential for differentiation of stem cells into osteoblasts, so any defect in this gene will cause defects in membranous and endochondral bone formation. Since the first description, over 700 cases have been reported in literature. The authors report a family with mother and her four sons affected with CCD and Crossed Renal Ectopia (CRE) in one child, which has not been reported in CCD before. PMID:19774820

  15. Isolated congenital pseudoarthrosis of the fibula.

    Science.gov (United States)

    Yang, Kuang-Ying; Lee, Eng-Hin

    2002-10-01

    Congenital pseudarthrosis of the limb most commonly involves the tibia, although various combinations of bones including fibula, radius, ulna, clavicle and humerus have all been described. Isolated congenital pseudarthrosis of the fibula is a very rare entity with only 12 cases reported in the English literature. We report three cases of this condition treated in our institution. The first child had a varus ankle deformity at the age of 4 months. The other two children presented with valgus ankle deformity after they started to walk. Two patients were treated conservatively while the third had a distal tibio-fibular fusion in view of severe valgus deformity. All three patients showed good early results after 1 to 2 years. We advocate early distal tibio-fibular fusion to prevent valgus deformity in these children. PMID:12370580

  16. Now you see it, now you don't - a case of 'vanishing bone'

    International Nuclear Information System (INIS)

    Vanishing bones - no, not the movie fantasy of the 'Invisible Man' but a case of a rare disease which causes massive osteolysis or progressive bone dissolution. The idiopathic disease, which causes bone to be replaced by angiomatous tissue, has resulted in the disappearance of this patient's right clavicle and glenoid. Diagnostic evaluation can sometimes prove difficult but ironically in this age of higher technology, plain radiography has demonstrated to be more effective for a definitive diagnosis than Nuclear Medicine, MRI, CT, etc. The rate of progress of the disease is as unpredictable as the prognosis. While a variety of treatments have been tried, the results have been inconsistent and as yet there is still no consensus on successful patient treatment. Copyright (2004) Australian Institute of Radiography

  17. Atlantoaxial rotatory subluxation as a cause of torticollis in a 5-year-old girl.

    Science.gov (United States)

    Bagouri, Elmunzar; Deshmukh, Sandeep; Lakshmanan, Palaniappan

    2014-01-01

    Many patients present to the emergency department complaining of a sore or stiff neck and lateral flexion of the neck with contralateral rotation. Under the pressure of the breaching time and busy shifts some of the patients are discharged to the care of their general practitioners without adequate investigations. While most of the cases are due to benign causes, torticollis can be due to many congenital and acquired pathologies, some of which may need further investigation and urgent management. Atlantoaxial subluxation (AAS), tumours of the base of the skull and infections are among these causes. Delayed diagnosis may lead to worsening neurology and complicate the management. We report a case of a 5-year-old girl who presented to our fracture clinic with a fractured clavicle and torticollis; her subsequent investigations confirmed the diagnosis of AAS. Our patient responded to non-operative treatment and improved with no neurological complications. PMID:24832710

  18. MR imaging of the brachial plexus

    International Nuclear Information System (INIS)

    Determining the cause of brachial plexopathy is often difficult. MR imaging allows for direct visualization of this region in multiple planes with high soft-tissue contrast. This paper defines the normal anatomy of the brachial plexus and demonstrates the ability of MR imaging to evaluate varied pathology in this region. Fifty-five patients with brachial plexopathy were evaluated with either a 1.5-T (General Electric, Milwaukee) or a 0.35-T (Diasonics, South San Francisco) superconducting MR system. Multiplanar, multiecho spin-echo images were obtained with either dual-coil imaging or a body coil. Individual fascicles to the brachial plexus were clearly separated from the subclavian artery and vein, clavicle, and surrounding musculature. Abnormalities well seen with MR imaging included primary tumors in the region of the brachial plexus, tumors metastatic to the brachial plexus, direct extension of pancoast tumors, postradiation fibrosis, and posttraumatic lesions, including fracture and edema

  19. Supraclavicularis proprius muscle associated with supraclavicular nerve entrapment.

    Science.gov (United States)

    Raikos, A; English, T; Agnihotri, A; Yousif, O K; Sandhu, M; Bennetto, J; Stirling, A

    2014-11-01

    Entrapment neuropathy of the supraclavicular nerve is rare and, when it occurs, is usually attributable to branching of the nerve into narrow bony clavicular canals. We describe another mechanism for entrapment of this nerve with the aberrant muscle; supraclavicularis being found during the routine dissection of an embalmed 82-year-old cadaver. Our report details a unique location for this rare muscular variation whereby the muscle fibres originated posteriorly on the medial aspect of the clavicle before forming a muscular arch over the supraclavicular nerve and passing laterally towards the trapezius and acromion. We recommend that in clinical instances of otherwise unexplained unilateral clavicular pain or tenderness, nerve compression from the supraclavicularis muscle must be borne in mind. PMID:25448916

  20. Distribution of injected plutonium in the skeleton and certain soft tissues

    International Nuclear Information System (INIS)

    The burden and macrodistribution of plutonium in the skeleton and its concentration in certain soft tissues have been determined in the remains of a woman who received plutonium by injection. The method of analysis was alpha spectrometric--isotopic dilution. The skeletal burden was 54 +- 2% of the amount injected. As expected, the concentrations in bones that are primarily trabecular were much higher than those that are primarily cortical; the ratio of the concentration in the bodies of the thoracic vertebrae to that in the diaphysis of the tibia was 40. The bones of the skull and the clavicle are quite representative of the entire skeleton. The concentrations in soft tissue are a factor of about 100 lower than those in bone. The concentration in hair increases markedly with the distance from the scalp

  1. The value of bone scintigraphy in the diagnosis and follow-up of Langerhans' cell histiocytosis

    International Nuclear Information System (INIS)

    Objective: To investigate the clinical value of bone scintigraphy in the diagnosis and follow-up of Langerhans' cell histiocytosis (LCH). Methods: Whole-body bone scintigraphy was performed on 23 LCH patients. Results: Nineteen of 23 patients (82.6%) showed positive in their bone scan. Eight cases were with cranial abnormal uptake, clavicle, rib and pelvis involvements were seen and each was of 3 cases, respectively, upper limb, lower limb and spinal abnormal uptakes were seen in 2, 4 and 5 patients, respectively, and 1 child had photon deficient area in the lower part of the sternum. Among 19 positive scintigrams, solitary bone lesion was shown in 9 patients (47.4%). Conclusion: Characters of bone scintigraphy in LCH are useful in the diagnosis and follow-up of this disease. (authors)

  2. Autosomal dominant inheritance Caffey-Silverman disease hyperostosis corticalis infantum

    International Nuclear Information System (INIS)

    A case of Caffey-Silverman disease is described in an infant aged 4.5 months. The case was erroneously diagnosed in the initial stage of the disease as osteitis. The correct diagnosis was established after radiological examination of the skeleton. The pathological lesions involved the mandible, both clavicles, all ribs, left shoulder blade, both radial bones and left ulna. Follow-up radiological examination after 12 months demonstrated nearly complete disappearance of the previously observed skeletal changes. At the age of 18 months the condition of the child was good and its development was normal. Radiological changes indicating past Caffey-Silverman disease were disclosed in the mother and maternal grandmother of the child. This indicates an autosomal dominant type of inheritance of the disease. (Author)

  3. Cloverleaf skull associated with unusual skeletal anomalies

    International Nuclear Information System (INIS)

    A male infant which cloverleaf skull and multiple other birth defects born to unrelated, healthy, young parents is presented. Radiologic findings in addition to the cloverleaf skull configuration included short, wide clavicles, winged scapulae, unusual shapes of ribs with abnormal spacing between them and with prominent costovertebral junctions, and widely separated ischia. Ulnae appeared angular with probable fusion to the midportion of the radial bones bilaterally. There was polydactyly of the hands and feet with grossly abnormal metacarpal and metatarsal bones. Skeletal maturation was normal. Computed tomography of the skull showed dilated lateral and third ventricles as well as agenesis of the corpus callosum. The mother denies any teratogenic exposure during the pregnancy. The findings in this infant do not seem to fit into any previously described syndrome. (orig.)

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

    Science.gov (United States)

    Onada, Yoshihiro; Umemoto, Takahisa; Fukuda, Kimitaka; Kajino, Tomomichi

    2016-01-01

    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. PMID:27493819

  5. Physes around the shoulder girdle: normal development and injury patterns.

    Science.gov (United States)

    Anwar, I; Amiras, D; Khanna, M; Walker, M

    2016-07-01

    Traumatic injuries involving the scapula and clavicle in skeletally immature patients have unique characteristics that distinguish them from similar injuries in the mature skeleton. Fractures involving unossified cartilage and unfused epiphyses are difficult to appreciate on plain radiographs and computed tomography (CT) imaging. Knowledge of the developmental anatomy and normal radiological appearances during different stages of development of these bones is an essential prerequisite for the radiologist tasked with interpreting the imaging of such injuries in order to avoid potential diagnostic pitfalls. With increased availability and improved resolution of magnetic resonance imaging (MRI), we are now better able to distinguish between true joint dislocations and epiphyseal injuries. Making this distinction is important because it can have implications with regards to how the patient is managed and the prognosis. PMID:27114286

  6. 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

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

    International Nuclear Information System (INIS)

    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

  8. Otofaciocervical syndrome and metachondromatosis in a girl: Presentation of a novel association and remarks on clinical variability of branchial-arch disorders.

    Science.gov (United States)

    Salinas-Torres, Victor M; Salinas-Torres, Rafael A

    2016-06-01

    Otofaciocervical syndrome (OFCS) is a rare disorder characterized by facial, ear, branchial, and musculoskeletal anomalies, along with hearing loss and mild intellectual disability. Clinically, its distinction from branchiootorenal syndrome can be difficult. To date, the coexistence of OFCS and metachondromatosis has not been reported. Here, we describe a sporadic patient with both OFCS and metachondromatosis. This novel association prompts us to do some remarks on the clinical variability of branchial-arch disorders; in fact, our observations are consistent with the highly variable expressivity of OFCS and illustrate the need of a more accurate characterization of these branchial-arch disorders. In the meantime, involvement of clavicles, scapulae and shoulders remains a distinctive feature of OFCS. PMID:27240490

  9. 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.

  10. 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.

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

    Science.gov (United States)

    Umemoto, Takahisa; Fukuda, Kimitaka; Kajino, Tomomichi

    2016-01-01

    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. PMID:27493819

  12. 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.

  13. Sterno-costo-clavicular hyperostosis. A case report with a review of the literature

    Energy Technology Data Exchange (ETDEWEB)

    Hallas, J.; Olesen, K.P.

    The clinical and radiologic findings in a case of sterno-costo-clavicular hyperostosis are reported and compared with the findings in the 23 Caucasian and about 300 Japanese cases reported in the literature. The main complaints are pain in the upper anterior chest wall and sometimes limited mobility of the shoulders. Radiologically, the clavicles, the sternum and the first ribs are grossly enlarged with complete fusion between them. As reported in previous cases, our patient had conspicuous congestion of the external jugular veins, but no other signs of compression in the thoracic inlet. There was asymptomatic compression of both subclavian veins, but none of the previously reported skin manifestations and no complaints from other parts of the locomotive system. The patient was HLA-B27 negative.

  14. Kinematics of chiropteran shoulder girdle in flight.

    Science.gov (United States)

    Panyutina, A A; Kuznetsov, A N; Korzun, L P

    2013-03-01

    New data on the mechanisms of movements of the shoulder girdle and humerus of bats are described; potential mobility is compared to the movements actually used in flight. The study was performed on the basis of morphological and functional analysis of anatomical specimens of 15 species, high speed and high definition filming of two species and X-ray survey of Rousettus aegyptiacus flight. Our observations indicate that any excursions of the shoulder girdle in bats have relatively small input in the wing amplitude. Shoulder girdle movements resemble kinematics of a crank mechanism: clavicle plays the role of crank, and scapula-the role of connecting rod. Previously described osseous "locking mechanisms" in shoulder joint of advanced bats do not affect the movements, actually used in flight. The wing beats in bats are performed predominantly by movements of humerus relative to shoulder girdle, although these movements occupy the caudal-most sector of available shoulder mobility. PMID:23381941

  15. Multielemental analysis of osseous remains by x-ray fluorescence to determine types of diets from the Cultura Lima (II B.C. - VIII A.C)

    International Nuclear Information System (INIS)

    The multielemental analysis of 29 human bone samples and sediments from the Lima Culture (III c. BC to IX c. AC) were analyzed by x-ray fluorescence technique with Cd-109 excitation source Si(Li) detector, Canberra associated electronic and PCA-II nucleus multichannel card, in order to determine to determine the diet type of these antique inhabitant. The elements found in bone rests were Ca, Sr, Zn, Mn, Fe, Ni, Cu, Rb, Zn and Pb, and As in one of the clavicles. In sediment samples we obtained a major quantity of elements. According to the Sr an Zn obtained values in osseous rest and the developed regression model, we can conclude that the ancient inhabitants of Lima Culture had an omnivorous feeding with a carnivore tendency due to its geographic location. (author). 35 refs., 9 figs., 10 tabs., 6 ills

  16. Imaging findings of synovitis-acne-pustulosis-hyperostosis-osteomyelitis syndrome

    International Nuclear Information System (INIS)

    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 9 cases 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. The 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 osteoarthritis 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 T2 signal 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. (authors)

  17. 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. PMID:26861139

  18. 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, A; 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; Coen Netelenbos, J.; Nieves, Jeri W.; Pfeilschifter, Johannes; Rossini, Maurizio; Roux, Christian; Saag, Kenneth G.; Siris, Ethel S.; Silverman, Stuart; Watts, Nelson B.; Anderson, Frederick A.

    2016-01-01

    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 following 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 following 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 following 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 seen as early as 1 year following weight loss, emphasizing the need for prompt fracture risk assessment and appropriate management to reduce fracture risk in this population. PMID:26861139

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

    Science.gov (United States)

    Rosati, Marco; Andreani, Lorenzo; Poggetti, Andrea; Zampa, Virna; Parchi, Paolo; Lisanti, Michele

    2013-01-01

    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. PMID:27298912

  20. Limitation of 1999 image-based nodal classification of the neck in nasopharyngeal carcinoma

    International Nuclear Information System (INIS)

    Objective: To evaluate the limitation of image-based classification and delineation of cervical nodes proposed in 1999. Methods: 259 consecutive nasopharyngeal carcinoma patients received contrast-enhanced transverse CT scan from July to November in 2003, the scanning range extended from the skull base to the inferior border of the clavicle, with thickness set at 5 mm per slice from the skull base to the oropharynx, and 1 cm per slice from the oropharynx to the clavicle. Interpretation of the images and assessment of the involved nodes distribution were performed by both radiation oncologists together with diagnostic radiologists according to 1999 image-based classification and delineation of the neck. Then we evaluated whether this classification could fully cover all the lymphatic drainage areas of the neck. Results: 218 cases had nodal involvements. Nodal distributions were 0 in level IA , 6 in level IB, 136 in level IIA, 171 in level IIB, 78 in level III, 20 in level IV, 33 in level VA, 27 in level VB, 0 in level VI and VII, 5 in supraclavicle and 102 in retropharyngeal space, respectively. Among another 57 cases who belonged to none of the above levels, 2 cases had lesions in the preauricular area, the rest 55 medial to the border of internal carotid artery, 2 cm from inferior to the skull base to the hyoid bone. Conclusions: The 1999 image-based classification of the neck nodes, being essentially rational, did not fully cover the retropharyngeal space. It would be better to shift the inferior boundary of the retropharyngeal space to the level of the hyoid bone. (authors)

  1. 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.

  2. Acute Shoulder Injuries in Adults.

    Science.gov (United States)

    Monica, James; Vredenburgh, Zachary; Korsh, Jeremy; Gatt, Charles

    2016-07-15

    Acute shoulder injuries in adults are often initially managed by family physicians. Common acute shoulder injuries include acromioclavicular joint injuries, clavicle fractures, glenohumeral dislocations, proximal humerus fractures, and rotator cuff tears. Acromioclavicular joint injuries and clavicle fractures mostly occur in young adults as the result of a sports injury or direct trauma. Most nondisplaced or minimally displaced injuries can be treated conservatively. Treatment includes pain management, short-term use of a sling for comfort, and physical therapy as needed. Glenohumeral dislocations can result from contact sports, falls, bicycle accidents, and similar high-impact trauma. Patients will usually hold the affected arm in their contralateral hand and have pain with motion and decreased motion at the shoulder. Physical findings may include a palpable humeral head in the axilla or a dimple inferior to the acromion laterally. Reduction maneuvers usually require intra-articular lidocaine or intravenous analgesia. Proximal humerus fractures often occur in older patients after a low-energy fall. Radiography of the shoulder should include a true anteroposterior view of the glenoid, scapular Y view, and axillary view. Most of these fractures can be managed nonoperatively, using a sling, early range-of-motion exercises, and strength training. Rotator cuff tears can cause difficulty with overhead activities or pain that awakens the patient from sleep. On physical examination, patients may be unable to hold the affected arm in an elevated position. It is important to recognize the sometimes subtle signs and symptoms of acute shoulder injuries to ensure proper management and timely referral if necessary. PMID:27419328

  3. 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. PMID:26542788

  4. Differing risk profiles for individual fracture sites: evidence from the Global Longitudinal Study of Osteoporosis in Women (GLOW).

    Science.gov (United States)

    FitzGerald, Gordon; Boonen, Steven; Compston, Juliet E; Pfeilschifter, Johannes; LaCroix, Andrea Z; Hosmer, David W; Hooven, Frederick H; Gehlbach, Stephen H

    2012-09-01

    The purposes of this study were to examine fracture risk profiles at specific bone sites, and to understand why model discrimination using clinical risk factors is generally better in hip fracture models than in models that combine hip with other bones. Using 3-year data from the GLOW study (54,229 women with more than 4400 total fractures), we present Cox regression model results for 10 individual fracture sites, for both any and first-time fracture, among women aged ≥55 years. Advanced age is the strongest risk factor in hip (hazard ratio [HR] = 2.3 per 10-year increase), pelvis (HR = 1.8), upper leg (HR = 1.8), and clavicle (HR = 1.7) models. Age has a weaker association with wrist (HR = 1.1), rib (HR = 1.2), lower leg (not statistically significant), and ankle (HR = 0.81) fractures. Greater weight is associated with reduced risk for hip, pelvis, spine, and wrist, but higher risk for first lower leg and ankle fractures. Prior fracture of the same bone, although significant in nine of 10 models, is most strongly associated with spine (HR = 6.6) and rib (HR = 4.8) fractures. Past falls are important in all but spine models. Model c indices are ≥0.71 for hip, pelvis, upper leg, spine, clavicle, and rib, but ≤0.66 for upper arm/shoulder, lower leg, wrist, and ankle fractures. The c index for combining hip, spine, upper arm, and wrist (major fracture) is 0.67. First-time fracture models have c indices ranging from 0.59 for wrist to 0.78 for hip and pelvis. The c index for first-time major fracture is 0.63. In conclusion, substantial differences in risk profiles exist among the 10 bones considered. PMID:22550021

  5. Mid-term results after operative treatment of rockwood grade III-V Acromioclavicular joint dislocations with an AC-hook-plate

    Directory of Open Access Journals (Sweden)

    Kienast B

    2011-02-01

    Full Text Available Abstract Acromioclavicular joint dislocations often occur in athletic, young patients after blunt force to the shoulder. Several static and dynamic operative procedures with or without primary ligament replacement have been described. Between February 2003 and March 2009 we treated 313 patients suffering from Rockwood III-V lesions of the AC joint with an AC-hook plate. 225 (72% of these patients could be followed up. Mean operation time was 42 minutes in the conventional group and 47 minutes in the minimal invasive group. The postoperative pain on a scale from 1 to 10 (VAS-scale was rated 2.7 in the conventional group and 2.2 in the minimal invasive group. Taft score showed very good and good results in 189 patients (84%. Constant score showed an average of 92.4 of 100 possible points with 89% excellent and good results and 11% satisfying results. All patients had some degree of pain or discomfort with the hookplate in place. These symptoms were relieved after removal of the plate. The overall complication rate was 10.6%. There were 6 superficial soft tissue infections, 1 fracture of the acromion, 7 redislocations after removal of the hook-plate. We observed 4 broken hooks which could be removed at the time of plate removal, 4 seromas and 2 cases of lateral clavicle bone infection, which required early removal of the plate. We can conclude that clavicle hook plate is a convenient device for the surgical treatment of Rockwood Grade III-V dislocations, giving good mid-term results with a low overall complication rate compared to the literature. Early functional therapy is possible and can avoid limitations in postoperative shoulder function.

  6. Radiographic changes in the operative treatment of acute acromioclavicular joint dislocation – tight rope technique vs. K-wire fixation

    International Nuclear Information System (INIS)

    Operative treatment of higher degree acromioclavicular joint luxation is common. A new option is made available by the tight rope technique. It claims to provide adequate outcome with the use of a minimally invasive technique. First clinical studies justified its medical use, but the equivalence to established surgical methods remains unclear. We therefore analyzed radiographic data from patients that were treated with the tight rope system (TR) and compared them to those treated with K-wires (KW) fixation. Retrospective study with inclusion criteria: surgery for acromioclavicular joint luxation between 2004 and 2011, classified as Rockwood type III, no concomitant injury, first event injury. We compared pre- and post-operative X-rays with those taken at the end of treatment. Clinical data from follow-ups and radiographic data were evaluated. The main outcome variable was the remaining distance between the acromion and clavicle (ACD), as well as the coracoid process and clavicle (CCD). 27 patients (TR: n=16; KW: n=11) with comparable demographics and injury severity were included. Surgery reduced ACD (TR: p=0.002; KW: p<0.001) and CCD (TR: p=0.001; KW: p=0.003). Heterotopic ossification or postoperative osteolysis was not significantly associated with either one of the procedures. Three patients (18.75%) in the TR group showed impaired wound healing, migrating K-wires were recorded in 2 patients (18.2%) and impingement syndrome occurred in 1 patient (9.1%) with K-wires. Posttraumatic arthritis was not seen. There was a loss of reduction in 2 cases within the TR-group (12.51%) and 1 in the KW-group (9.1%). At last follow up, ACD and CCD were wider in both groups compared to the healthy side. This study shows that the Tight rope system is an effective alternative in the treatment of higher degree acromioclavicular luxation and comparable to the established methods

  7. 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

  8. Results of spinal accessory to suprascapular nerve transfer in 110 patients with complete palsy of the brachial plexus.

    Science.gov (United States)

    Bertelli, Jayme Augusto; Ghizoni, Marcos Flávio

    2016-06-01

    OBJECTIVE Transfer of the spinal accessory nerve to the suprascapular nerve is a common procedure, performed to reestablish shoulder motion in patients with total brachial plexus palsy. However, the results of this procedure remain largely unknown. METHODS Over an 11-year period (2002-2012), 257 patients with total brachial plexus palsy were operated upon in the authors' department by a single surgeon and had the spinal accessory nerve transferred to the suprascapular nerve. Among these, 110 had adequate follow-up and were included in this study. Their average age was 26 years (SD 8.4 years), and the mean interval between their injury and surgery was 5.2 months (SD 2.4 months). Prior to 2005, the suprascapular and spinal accessory nerves were dissected through a classic supraclavicular L-shape incision (n = 29). Afterward (n = 81), the spinal accessory and suprascapular nerves were dissected via an oblique incision, extending from the point at which the plexus crossed the clavicle to the anterior border of the trapezius muscle. In 17 of these patients, because of clavicle fractures or dislocation, scapular fractures or retroclavicular scarring, the incision was extended by detaching the trapezius from the clavicle to expose the suprascapular nerve at the suprascapular fossa. In all patients, the brachial plexus was explored and elbow flexion reconstructed by root grafting (n = 95), root grafting and phrenic nerve transfer (n = 6), phrenic nerve transfer (n = 1), or third, fourth, and fifth intercostal nerve transfer. Postoperatively, patients were followed for an average of 40 months (SD 13.7 months). RESULTS Failed recovery, meaning less than 30° abduction, was observed in 10 (9%) of the 110 patients. The failure rate was 25% between 2002 and 2004, but dropped to 5% after the staged/extended approach was introduced. The mean overall range of abduction recovery was 58.5° (SD 26°). Comparing before and after distal suprascapular nerve exploration (2005-2012), the

  9. Morphometric Study of Clavicular Facet of Coracoclavicular Joint in Adult Indian Population

    Science.gov (United States)

    Mahajan, Anita; Vasudeva, Neelam

    2016-01-01

    Introduction Anthropologists have used Coracoclavicular Joint (CCJ), a non-metric anatomical variant in population, as a marker for population migration from prehistoric times to present. Aim The aim of this osteological study was to determine the incidence and morphometry of articular facet of CCJ on conoid tubercle of clavicle in Indian population, as Indian studies are scanty and incomplete. Materials and Methods The study was done on 144 adult human clavicles (76 right and 68 left; 93 males and 51 females) collected from osteology museum in Department of Anatomy, Maulana Azad Medical College, New Delhi, India. The presence of articular facet on the conoid tubercle was determined and Maximum Antero-Posterior (MAPD) and maximum transverse diameter (MTD) was measured by digital vernier calliper. The incidence was compared on the basis of sex, side and with other osteological studies in the world. Statistical analysis was done using the Chi-Square test for nominal categorical data and student’s t-test for normally distributed continuous variables in Microsoft Excel 2007 to assess the relationship between the examined variables. Results Articular facet on conoid tubercle was found in 8 cases (5.6%). Seven (9.2%) were present on the right side and one (1.5%) on the left side. Seven cases (7.5%) were present in males and one case (2%) was found in females. The facets were generally oval, with MAPD and MTD of 12.28 and 17.17 mm respectively. A significant side variation was present with right sided facet being more common. The left sided facet was more transversely elongated than right. In males, the facets were more elongated antero-posteriorly than in females. Conclusion The Indian population showed an incidence of 5.6%, which was comparable to other ethnic groups in world population. The morphometric and side differences could be attributed to the occupational factors and range of movements associated with the CCJ. The CCJ should be borne in mind as a differential

  10. Complications following arthroscopic fixation of acromioclavicular separations: a systematic review of the literature

    Directory of Open Access Journals (Sweden)

    Woodmass JM

    2015-04-01

    Full Text Available Jarret M Woodmass,1 John G Esposito,1 Yohei Ono,1,2 Atiba A Nelson,1 Richard S Boorman,1 Gail M Thornton,1,3 Ian KY Lo1 1Department of Surgery, Section of Orthopaedic Surgery, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada; 2Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan; 3Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada Purpose: Over the past decade, a number of arthroscopic or arthroscopically assisted reconstruction techniques have emerged for the management of acromioclavicular (AC separations. These techniques provide the advantage of superior visualization of the base of the coracoid, less soft tissue dissection, and smaller incisions. While these techniques have been reported to provide excellent functional results with minimal complications, discrepancies exist within the literature. This systematic review aims to assess the rate of complications following these procedures. Methods: Two independent reviewers completed a search of Medline, Embase, PubMed, and the Cochrane Library entries up to December 2013. The terms “Acromioclavicular Joint (MeSH” OR “acromioclavicular* (text” OR “coracoclavicular* (text” AND “Arthroscopy (MeSH” OR “Arthroscop* (text” were used. Pooled estimates and 95% confidence intervals were calculated assuming a random-effects model. Statistical heterogeneity was quantified using the I2 statistic. Level of evidence: IV Results: A total of 972 abstracts met the search criteria. After removal of duplicates and assessment of inclusion/exclusion criteria, 12 articles were selected for data extraction. The rate of superficial infection was 3.8% and residual shoulder/AC pain or hardware irritation occurred at a rate of 26.7%. The rate of coracoid/clavicle fracture was 5.3% and occurred most commonly with techniques utilizing bony tunnels. Loss of AC joint reduction occurred in 26

  11. Relationship of weight, height, and body mass index with fracture risk at different sites in postmenopausal women: the Global Longitudinal study of Osteoporosis in Women (GLOW).

    Science.gov (United States)

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

    2014-02-01

    Low body mass index (BMI) is a well-established risk factor for fracture in postmenopausal women. Height and obesity have also been associated with increased fracture risk at some sites. We investigated the relationships of weight, BMI, and height with incident clinical fracture in a practice-based cohort of postmenopausal women participating in the Global Longitudinal study of Osteoporosis in Women (GLOW). Data were collected at baseline and at 1, 2, and 3 years. For hip, spine, wrist, pelvis, rib, upper arm/shoulder, clavicle, ankle, lower leg, and upper leg fractures, we modeled the time to incident self-reported fracture over a 3-year period using the Cox proportional hazards model and fitted the best linear or nonlinear models containing height, weight, and BMI. Of 52,939 women, 3628 (6.9%) reported an incident clinical fracture during the 3-year follow-up period. Linear BMI showed a significant inverse association with hip, clinical spine, and wrist fractures: adjusted hazard ratios (HRs) (95% confidence intervals [CIs]) per increase of 5 kg/m(2) were 0.80 (0.71-0.90), 0.83 (0.76-0.92), and 0.88 (0.83-0.94), respectively (all p ankle fractures, linear weight showed a significant positive association: adjusted HR per 5-kg increase 1.05 (1.02-1.07) (p arm/shoulder and clavicle fractures, only linear height was significantly associated: adjusted HRs per 10-cm increase were 0.85 (0.75-0.97) (p = 0.02) and 0.73 (0.57-0.92) (p = 0.009), respectively. For pelvic and rib fractures, the best models were for nonlinear BMI or weight (p = 0.05 and 0.03, respectively), with inverse associations at low BMI/body weight and positive associations at high values. These data demonstrate that the relationships between fracture and weight, BMI, and height are site-specific. The different associations may be mediated, at least in part, by effects on bone mineral density, bone structure and geometry, and patterns of falling. PMID:23873741

  12. Visualization of the Origin of the Vertebral Arteries with Color Doppler Sonography

    International Nuclear Information System (INIS)

    Atherosclerotic disease at the origin of the vertebral arteries is one of the risk factors for vertebrobasilar ischemic disease. Assessment and visualization of the origin of the vertebral arteries with color doppler sonography is a non-trivial task. The aim of this study is to increase the visualization rate of the origin of the vertebral arteries with color doppler sonography. Color doppler sonography for the vertebral arteries included carotid arteries was performed to 198 patients. We first examined the vertebral artery in the upper neck in the direction of the subclavian artery to distinguish its origin more easily. If the vertebral artery origin was not visualized in natural position, the examiner pushed the transducer toward a clavicle or pushed the shoulder of patient by the other hand. The technical methods for visualization of the vertebral artery origin were classified into three grades: natural position, pushing the transducer, and pushing the shoulder of patient according to the depth (3.0 cm and shallower, deeper than 3.0 cm) of the origin. The origin of the vertebral arteries could be visualized in 97% on the right and in 92% on the left. The origin of the vertebral arteries could be visualized in 98.6%, 1.4%, and 0.0% in natural position, pushing the transducer, and pushing the shoulder of patient, respectively, at shallower than 3.0 cm on the right side. The origin of the vertebral arteries could be visualized in 81.2%, 14.6%, and 4.2% in natural position, pushing the transducer, and pushing the shoulder of patient, respectively, at deeper than 3.0 cm on the right side. The origin of the vertebral arteries could be visualized in 85.4%, 10.7%, and 3.9% in natural position, pushing the transducer, and pushing the shoulder of patient, respectively, at shallower than 3.0 cm on the left side. The origin of the vertebral arteries could be visualized in 55.7%, 30.4%, and 13.9% in natural position, pushing the transducer, and pushing the shoulder of

  13. A new species of flea-toad (Anura: Brachycephalidae) from southern Atlantic Forest, Brazil.

    Science.gov (United States)

    Condez, Thais Helena; Monteiro, Juliane Petry De Carli; Comitti, Estevão Jasper; Garcia, Paulo Christiano De Anchietta; Amaral, Ivan Borel; Haddad, Célio Fernando Baptista

    2016-01-01

    We describe a new species of Brachycephalus that is morphologically similar to the flea-toads B. didactylus, B. hermogenesi, and B. pulex. The new species occurs from the sea level up to 1000 m and it is widely distributed throughout southern Atlantic Forest. Brachycephalus sulfuratus sp. nov. is distinguished from all of its congeners by the combination of the following characters: (1) small body size (SVL of adults: 7.4-8.5 mm for males and 9.0-10.8 mm for females); (2) "leptodactyliform" body; (3) pectoral girdle arciferal and less robust compared to the Brachycephalus species with "bufoniform" body; (4) procoracoid and epicoracoid fused with coracoid but separated from the clavicle by a large fenestrae; (5) toe I externally absent; toes II, III, IV, and V distinct; phalanges of toes II and V reduced; (6) skin smooth with no dermal ossifications; (7) in life, general background color brown with small dark-brown spots; skin of throat, chest, arms, and forearms with irregular yellow blotches; in ventral view, cloacal region of alive and preserved specimens surrounded by a dark-brown inverted v-shaped mark outlined with white; (8) advertisement call long, composed of a set of 4-7 high-frequency notes (6.2-7.2 kHz) repeated regularly. PMID:27394218

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

    Science.gov (United States)

    Zimmermann, Petra; Curtis, Nigel

    2016-07-01

    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. PMID:27263075

  15. Plasma cell myeloma associated with Epstein-Barr virus infection in an 11-year-old girl.

    Science.gov (United States)

    García-Álvarez, Karla Gisela; Garibaldi-Covarrubias, Roberto; Flores-Márquez, María Rosa; Ortiz-Hidalgo, Carlos

    2012-01-01

    Multiple myeloma is extremely rare in children and represents fewer than 1% of all patients with myeloma. We report a case of multiple myeloma in an 11-year-old girl, who presented with a well-differentiated immunoglobulin A/kappa plasmacytoma at the base of the skull at 9 years of age; at that time, the bone marrow biopsy was negative. Two years later, the patient experienced generalized bone pain with multiple lytic bone lesions that affected the skull, long bones, ribs, and clavicle. The bone marrow biopsy showed a well-differentiated (Marschalko-type) multiple myeloma that was positive for CD138 and immunoglobulin A, with kappa light chain restriction. Interestingly, the Epstein-Barr virus (EBV) was detected by in situ hybridization for EBV-encoded RNA (EBER) in the majority of the neoplastic cells from both biopsy specimens. The patient responded favorably to treatment with dexamethasone, thalidomide, and zoledronic acid and is scheduled for bone marrow transplantation. PMID:22670629

  16. 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.

  17. 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)

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

    Science.gov (United States)

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

    2015-09-01

    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

  19. [The corvette "Nordstjernen's" voyage to the opening of the Suez Canal--naval medicine in 1869].

    Science.gov (United States)

    Ongre, Aksel; Pettersen, Jan Sommerfelt; Munch, Johan Storm

    2002-06-30

    When the Norwegian corvette Nordstjernen was in the North Sea bound for Port Said to be present at the opening of the Suez Canal on 17 November 1869, an officer suffered a rupture of m. triceps brachii when he was drawn into the machinery during a storm. He was put ashore in Harwich; four days after the injury he was hospitalized in Colchester. The voyage was eventful in other ways too. Another officer died from typhoid fever in Ismailia. On the Swedish frigate Vanadis, also present at the opening of the Suez Canal, one of the doctors died from lung infection and was buried in Smyrna; a twelve-feet high column of white marble was taken from the ruins of Aesculap's temple and put on his grave. Denmark was represented by the frigate Sjaelland. During a storm in the North Sea, one seaman fell down on the deck from the foresail yard and suffered contusions and a fracture of the left clavicle. These cases illustrate challenges that faced our ancestors. The accident happened when the ship was in the Netherlands sector of the North Sea as we know it today. Today the Coast Guard could have arranged transport by helicopter and hospitalized the patient in about two hours. PMID:12555606

  20. Chest X-rays in detecting injuries caused by blunt trauma

    Science.gov (United States)

    Agladioglu, Kadir; Serinken, Mustafa; Dal, Onur; Beydilli, Halil; Eken, Cenker; Karcioglu, Ozgur

    2016-01-01

    BACKGROUND: The appropriate sequence of different imagings and indications of thoracic computed tomography (TCT) in evaluating chest trauma have not yet been clarified at present. The current study was undertaken to determine the value of chest X-ray (CXR) in detecting chest injuries in patients with blunt trauma. METHODS: A total of 447 patients with blunt thoracic trauma who had been admitted to the emergency department (ED) in the period of 2009–2013 were retrospectively reviewed. The patients met inclusion criteria (age>8 years, blunt injury to the chest, hemodynamically stable, and neurologically intact) and underwent both TCT and upright CXR in the ED. Radiological imagings were re-interpreted after they were collected from the hospital database by two skilled radiologists. RESULTS: Of the 447 patients, 309 (69.1%) were male. The mean age of the 447 patients was 39.5±19.2 (range 9 and 87 years). 158 (35.3%) patients were injured in motor vehicle accidents (MVA). CXR showed the highest sensitivity in detecting clavicle fractures [95%CI 78.3 (63.6–89)] but the lowest in pneuomediastinum [95%CI 11.8 (1.5–36.4)]. The specificity of CXR was close to 100% in detecting a wide array of entities. CONCLUSION: CXR remains to be the first choice in hemodynamically unstable patients with blunt chest trauma. Moreover, stable patients with normal CXR are candidates who should undergo TCT if significant injury has not been ruled out. PMID:27006740

  1. 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.

  2. 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.)

  3. 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.)

  4. Implantation of a new access device for hemodialysis (Dialock): initial experience in 5 patients

    International Nuclear Information System (INIS)

    A new hemodialysis access port system was implanted. Methods: The DialockTM consists of a port-like double-valve, implanted subcutaneously below the clavicle, which is attached to two catheters, placed in the right atrium via the jugular vein. The device has been implanted in 5 patients (4 female, 1 male). Results: In all 5 patients the implantation of the catheters and the port was technically successful. Total average duration of dialysis was 3.6 months. Two patients developed a port pocket hematoma 10-14 days post implantation, one of them required surgical revision. One port was explanted due to septicemia, whereas a port infection was not confirmed. One patient showed a thrombotic occlusion of both catheter tips 8 days after implantation, fixed by catheter exchange. Another patient presented with slight migration of the port catheters, which was managed by refixation of the port within the pocket. Beside these complications, the devices were working well. Conclusion: The Dialock system offers an interesting alternative to external catheters for hemodialysis. With respect to the complications it deserves further studies to determine its future role in the field of vascular access. (orig.)

  5. Osteoblastic bone metastases from renal cell carcinoma

    International Nuclear Information System (INIS)

    RCC accounts for only 2–3% of all cancers. Due to its’ non-specific symptoms disease is often diagnosed in advanced stage. Disseminated RCC frequently produces bone metastases that are almost always highly destructive, hyper vascularized and purely osteolytic. In this article we describe a case of a 71-year old male patient with disseminated osteoblastic bone metastases from renal cell carcinoma (RCC), and present a short review of published literature reporting cases of osteoblastic bone metastases from RCC. Our patient presented with thoracic pain aggravated by movement. He was diagnosed with predominantly osteoblastic bone metastases in the skeleton of thoracic and lumbar vertebra along with metastases in iliac bones, ribs, humerus and clavicles. Initially, origin of bone metastases was unknown, but later a small tumor in patient’s right kidney was identified. Microscopic evaluation of the open bone biopsy showed clear cell RCC with sarcomatoid differentiation. Although, due to its’ rarity, RCC is not included in the primary differential diagnosis in patients with osteoblastic metastases, such rare cases suggest that RCC may be considered in the diagnosis when there no other primary tumor is found

  6. Structures of bats; Komori no kozo

    Energy Technology Data Exchange (ETDEWEB)

    Natori, M. [Institute of the Space and Astronautical Science,Tokyo (Japan); Kishimoto, N. [The University of Tokyo, Tokyo (Japan)

    1999-12-05

    This paper gives an outline of the structures of bats. Unlike birds, bats have a wing membrane structure. The membrane constituted of the skin is spread between five fingers to form the wing. The wing membrane is seen in the forelimbs and the tail. In the chest and the shoulder, the ligament sheet supports the muscles. The wing membrane is about 0.5mm in thickness, with a fiber net woven through reflecting a tension field in flying. The fiber net is composed of compound materials of elastin and collagen. The shoulder joints consists of the clavicle, scapula and humerus, which is close to human beings. The elbow joints rotate only inside the plane of the wings. The leg joints are hook-shaped, with the tendon sheath provided with ruggedness. The carpus is made up of eight bones and is characterized by the ability of spreading and storing the wings. At the time of storing the wing membrane, the finger joints are stored and, during the flight after the wings are spread, it forms the flapping wing plane. Lightweight and formation of the sturdy front edge are characteristics common to other flying creatures. The spreading and the storing are possible through the direct motion of the hands. The shoulder joints and the carpus of the human beings are closer to those of bats than to those of birds. (NEDO)

  7. 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

  8. Relationship of Height to Site-Specific Fracture Risk in Postmenopausal Women.

    Science.gov (United States)

    Armstrong, Miranda Eg; Kirichek, Oksana; Cairns, Benjamin J; Green, Jane; Reeves, Gillian K

    2016-04-01

    Height has been associated with increased risk of fracture of the neck of femur. However, information on the association of height with fractures at other sites is limited and conflicting. A total of 796,081 postmenopausal women, who reported on health and lifestyle factors including a history of previous fractures and osteoporosis, were followed for 8 years for incident fracture at various sites by record linkage to National Health Service hospital admission data. Adjusted relative risks of fracture at different sites per 10-cm increase in height were estimated using Cox regression. Numbers with site-specific fractures were: humerus (3036 cases), radius and/or ulna (1775), wrist (9684), neck of femur (5734), femur (not neck) (713), patella (649), tibia and/or fibula (1811), ankle (5523), and clavicle/spine/rib (2174). The risk of fracture of the neck of femur increased with increasing height (relative risk [RR] = 1.48 per 10-cm increase, 99% confidence interval [CI] 1.39-1.57) and the proportional increase in risk was significantly greater than for all other fracture sites (pheterogeneity < 0.001). For the other sites, fracture risk also increased with height (RR = 1.15 per 10 cm, CI 1.12-1.18), but there was only very weak evidence of a possible difference in risk between the sites (pheterogeneity = 0.03). In conclusion, taller women are at increased risk of fracture, especially of the neck of femur. PMID:26572496

  9. 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.

  10. 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.

  11. Hereditary bone dysplasia with pathological fractures and nodal osteoarthropathy

    International Nuclear Information System (INIS)

    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.)

  12. Thermal Tomography Imaging in Photonic Traditional Chinese Medicine Information Therapy with Holistic Effect for Health Whole Nursing

    Directory of Open Access Journals (Sweden)

    Binggang Ye

    2015-01-01

    Full Text Available A photonic traditional Chinese medicine (TCM information therapy was developed that has applications in whole health nursing including the prevention and treatment of ischemic cardiovascular and cerebrovascular diseases as well as the conditioning of the subhealth state. This therapy utilizes the beam of a 630 nm LED light to irradiate the oropharynx, while simultaneously employing two beams of 650 nm LED light to irradiate corresponding acupuncture points resulting in a synergistic outcome. This method was named “1 + 2 phototherapy.” The principle mechanism of the therapy is a series of photon induced biological effects that are triggered by stimulating the photosensitive tissues of the oropharynx. This tissue includes the oral mucosa, capillaries, lymph nodes, saliva glands, nerves, and Jingluo and is stimulated by light beams of certain photon energy and imitative acupuncture information. Thermal tomography imaging shows that the average temperature of the upper-body was improved significantly after oropharyngeal irradiation under irradiation of “Futu point”: the heat radiation of the spine, as well as chest, shoulders, arms, and clavicle, increased under irradiation of “Hoku,” whereas the overall average temperature was below the temperature before irradiation. The experiment indicates that this therapy can promote blood circulation, regulate varied physiological parameters, and have holistic effects in whole health nursing.

  13. Developmental ossification sequences of the appendicular and axial skeleton in Kuttanad duck embryos (Anas platyrhynchos domesticus

    Directory of Open Access Journals (Sweden)

    A.D. Firdous

    2016-01-01

    Full Text Available The processes of ossification sequences are poorly investigated for birds in general, even for domestic and experimental species and when it comes to the waterfowl it is almost negligible. Such sequences constitute a rich source of data on character evolution, and may even provide phylogenetic information. A pre-hatch developmental study on ossification sequences of axial and appendicular skeletal system in Kuttanad duck embryos was undertaken using 78 viable embryos. From day 3 to day 7 of incubation no ossification densities were seen both by alizarin red staining and computerized radiography. The first indication of ossification as small ossification centers in skull bones, clavicle, scapula, humerus, radius and ulna in forelimb and ilium, pubis femur and fibula in hind limb were observed on the 9th day of incubation. The ossification of the body of the ribs started at the 11th day of incubation towards the proximal extremity. On day 13th the ossification process of vertebrae was started from cervical end. The variation in appearance of the ossification centers in different bones at different stages of incubation period suggests relative importance of phylogeny to the sequences.

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

    International Nuclear Information System (INIS)

    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, αspread= 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)

  15. The treatment of femoral bone loss by axial external fixation and susbequent locking plate application: a case report.

    Science.gov (United States)

    Boero, Emanuele; Mogollo, Maria del Amparo Paredes

    2015-12-01

    A 20-year-old man was admitted to our hospital having sustianed bilateral high-energy femoral fractures. The right femoral fracture was an open grade 3B with OTA grade 3 bone loss. The patient had also a brain contusion with a subdural haematoma and a closed fracture of the left clavicle. Initial management included temporarily stabilisation of the femoral fractures wth external fixators and prompt transfer to the intensive care unit. Three weeks later the external fixator of the right femur was converted to an hybrid system, and the fixator of the left side was removed and a reamed intramedullary locking nail was applied. Two months after the accident the patient underwent bone transport (11 cm long) of the right femur with an monolateral external fixation. When the final length was achieved there were knee stiffness (ROM 0° to 30°) and non-union of the docking site. Therefore, the patient underwent a Judet's procedure to treat the knee stiffness and stabilisation of the non united femur with a locking plate (LISS). After the operation the patient started progressive weight bearing. A year after trauma and following union of the femur, the patient underwent soft tissue reconstruction of the anterior side of the thigh with a free vascularised flap. At final follow upo the patient had a good functional recovery with return to his previous occupation. PMID:26738458

  16. 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 ...

  17. 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. PMID:26506178

  18. 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)

  19. [Routine examination of the mature newborn infant. Incidence of frequent "minor findings"].

    Science.gov (United States)

    Rosegger, H; Rollett, H R; Arrunàtegui, M

    1990-05-11

    From 1st January to 31st August 1989 2,248 healthy, mature infants were delivered at the Department of Obstetrics and Gynaecology in Graz, Austria. They were routinely examined on day 1 and before discharge from hospital on day 4. Attention was paid to the presence or absence of minor abnormalities such as skin lesions, eruptions or rashes, cephalhaematoma, tongue tie, undescended testis, increased physiological jaundice, heart murmurs, talipes calcaneo-valgus, hip click, fracture of the clavicle and other common abnormalities and limb deformities. 20.9% of the investigated babies had no such findings whatsoever. In 79.1% of the subjects with one or more abnormalities, minor lesions due to birth trauma dominated with 24.2%, followed by postural deformities of the lower extremities in 20.5% and hip clicks and/or asymmetric skin-folds in 12.9%. Dislocation of the hip, however, was found in only 17%. Elevated serum bilirubin levels were noted in 33.0%, and in many of the jaundiced infants bruising or haematoma due to birth trauma was evident. Traumatic lesions were much rarer in infants delivered by caesarean section than in infants born vaginally. PMID:2356618

  20. 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.

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

    International Nuclear Information System (INIS)

    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.)

  2. 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.

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

    International Nuclear Information System (INIS)

    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.)

  4. An analysis of anatomic landmark mobility and setup deviations in radiotherapy for lung cancer

    International Nuclear Information System (INIS)

    Purpose: To identify thoracic structures that exhibit little internal motion during irradiation and to determine setup variations in patients with lung cancer. Methods and Materials: Intrafractional images were generated with an electronic portal-imaging device from the AP fields of 10 patients, during several fractions. To determine the intrafractional mobility of thoracic structures, visible structures were contoured in every image and matched with a reference image by means of a cross-correlation algorithm. Setup variations were determined by comparing portal images with the digitized simulator films using the stable structures as landmarks. Results: Mobility was limited in the lateral direction for the trachea, thoracic wall, paraspinal line, and aortic notch, and in the craniocaudal direction for the clavicle, aortic notch, and thoracic wall. Analysis of patient setup revealed random deviations of 2.0 mm (1 SD) in the lateral direction and 2.8 mm in the craniocaudal direction, while the systematic deviations were 2.5 and 2.0 mm (1 SD) respectively. Conclusions: We have identified thoracic structures that exhibit little internal motion in the frontal plane, and recommend that these structures be used for verifying patient setup during radiotherapy. The daily variation in the setup of lung cancer patients at our center appears to be acceptable

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

    International Nuclear Information System (INIS)

    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 μg/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.)

  6. 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.)

  7. 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.

  8. 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.

  9. 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.

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

    International Nuclear Information System (INIS)

    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

  11. Suggestion of Modified Y-View in Supine Position

    International Nuclear Information System (INIS)

    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. 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. ...

  13. [Verrucous epidermal nevus of the face].

    Science.gov (United States)

    Larroque, G; Cantaloube, D; Ndiaye, B; Jouen, F; Combemale, P

    1991-01-01

    The authors report a case of extensive verrucous epidermal naevus of the face in a 15 year old Senegalese boy. This is the second reported case in Western Africa following the case presented to the French Language African Medical Society in 1984 (B. Ndiaye). The skin lesion in the form of a naevus of variable dimensions is an essential manifestation of the epidermal naevus syndrome described by Solomon, Fretzin and Dewald in 1968. This syndrome consists of a variable but inconstant association of dysembryoplastic abnormalities affecting the central nervous system (epilepsy, mental retardation, hydrocephalus, localized central deficits), the eye (fibrous conjunctival tumours, corneal opacities, colobomas) and the bones (spine, clavicle, pelvis, limb bones). The bones may be affected by malformations or hypoplasia. The epidermal naevus generally has a linear verrucous appearance, but it is not exceptional to find Jadassohn's sebaceous naevus or even localized erythroderma ichthyosiformis. Mucosal lesions, especially oral, well described in 1960 by Brown and Gorlin, correspond to a particular localization of epidermal naevus and must be differentiated histologically from white sponge naevus, which has a fairly similar clinical appearance. This non-hereditary disease must be systematically investigated looking for visceral abnormalities which are very common. Lastly, in terms of therapy, surgery may be justified when the facial lesions are unsightly, extensive or disabling. Various techniques may be applied depending on the extent and the site of these naevi. PMID:1718208

  14. Primary adenocarcinoma of cervical esophagus.

    Science.gov (United States)

    Alrawi, S J; Winston, J; Tan, D; Gibbs, J; Loree, T R; Hicks, W; Rigual, N; Lorè, J M

    2005-06-01

    Most upper esophageal malignancies are squamous cell carcinomas, rarely adenocarcinomas arising from Barrett's esophagus and very rarely adenocarcinomas from heterotopic gastric mucosa without evidence of Barrett's especially in the cervical part of the esophagus. We report a case of adenocarcinoma of the polypoid type in the upper esophagus (cervical esophagus) arising from ectopic gastric mucosa, in a 60 year-old man who presented with progressive dysphagia. Accurate diagnosis by esophagogram revealed a large mass in the cervical esophagus; CAT scan showed intraluminal mass at the level of thoracic inlet, esophagogastroscopy showed a fleshy polyp (3.2cm x 3.0cm) at 20 cm from the incisors with a biopsy confirming moderately differentiated adenocarcinoma with no evidence of Barrett's esophagus. Through a left cervical approach and resection of medial third of clavicle, the tumor was removed by partial esophagectomy followed by lymph node dissection, and proved to be T1NOMO, stage I (AJCC staging 6th ed.). Post operatively, the patient received chemoradiation with no evidence of recurrence or metastasis in six years of follow up. It seems this tumor has a much better prognosis than adenocarcinomas arising from Barrett's. To our knowledge only 19 cases have been reported in literature so far. PMID:16110768

  15. 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.

  16. Desmoid tumour of the thoracic outlet in a 70 year-old man successfully removed through cervico-thoracic Dartevelle approach.

    Science.gov (United States)

    Stella, Franco; Dell'amore, Andrea; Nizar, Asadi; Cassanelli, Nicola; Caroli, Guido; Luciano, Giulia; Greco, Domenico; Dolci, Giampiero; Pirini, Giulia; Bini, Alessandro

    2013-03-01

    Desmoid tumours have a strong tendency for local invasion and recurrence. A 70 year-old male presented with cervical and left shoulder pain associated with a supraclavicular mass. The computed-tomography showed an expansive lesion measuring 10 cm × 6 cm × 5.5 cm in the left supraclavicular space. At magnetic resonance imaging the subclavian vessels and the brachial plexus were dislocated anteriorly but not infiltrated. An incisional biopsy suggested a desmoid tumour. An anterior cervicothoracic approach was used to remove the tumour. The chest wall was reconstructed with titanium bars and a polytetrafluoroethylene-patch. The clavicle was fixed using a titanium clip. The post-operative course was uneventful. The patient was treated with adjuvant radiation therapy. After six months the patient is in good clinical condition free from disease recurrence. In conclusion, desmoid tumour of the thoracic outlet is a challenging situation. Wide radical resection should be attempted whenever possible. The Dartevelle approach gives an optimal surgical field with direct control of vessels and nerve roots facilitating tumour dissection and radical resection en-bloc with the chest wall. The chest wall reconstruction with titanium bars and clips is a simple and effective method to guarantee good respiratory function and to stabilise the shoulder girdle. PMID:22824346

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

    International Nuclear Information System (INIS)

    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)

  18. Complete acromioclavicular joint dislocation treated with reconstructed ligament by trapezius muscle fascia and observation of fascial metaplasia

    Directory of Open Access Journals (Sweden)

    Wang Chaoliang

    2015-01-01

    Full Text Available We evaluated the long-term clinical results of acute complete acromioclavicular dislocations treated by reconstruction of the acromioclavicular and coracoclavicular ligament using trapezius muscle fascia. Open reduction and internal fixation was performed using the clavicular hook plate in 12 patients with acute complete acromioclavicular joint dislocation, and the acromioclavicular and coracoclavicular ligaments were reconstructed using trapezius muscle fascia. Radiographic evaluations were conducted postoperatively. We evaluated the functional results with constant scoring system and radiological results at the final follow-up visit. The mean Constant score at the final follow-up visit was 91.67 (range, 81 to 100. The results were excellent in eight patients (66.7% and good in four patients (33.3%. Three patients with scores from 80 to 90 had mild pain during activity, but this did not affect the range of motion of the shoulder. All patients have returned to their preoperative work without any limitations. Compared with the contralateral side, radiography showed anatomical reposition in the vertical plane in all cases. The hook-plate fixation with ligament reconstruction was successful in treating AC dislocations. The acromioclavicular and coracoclavicular ligament were reconstructed by trapezius muscle fascia that keep the distal clavicle stable both vertically and horizontally after type III injuries.

  19. Epidemiology of Isolated Acromioclavicular Joint Dislocation

    Directory of Open Access Journals (Sweden)

    Claudio Chillemi

    2013-01-01

    Full Text Available Background. Acromioclavicular (AC joint dislocation is a common shoulder problem. However, information about the basic epidemiological features of this condition is scarce. The aim of this study is to analyze the epidemiology of isolated AC dislocation in an urban population. Materials and Methods. A retrospective database search was performed to identify all patients with an AC dislocation over a 5-year period. Gender, age, affected side and traumatic mechanism were taken into account. X-rays were reviewed by two of the authors and dislocations were classified according to the Rockwood’s criteria. Results. A total of 108 patients, with a mean age of 37.5 years were diagnosed with AC dislocation. 105 (97.2% had an isolated AC dislocation, and 3 (2.8% were associated with a clavicle fracture. The estimated incidence was 1.8 per 10000 inhabitants per year and the male-female ratio was 8.5 : 1. 50.5% of all dislocations occurred in individuals between the ages of 20 and 39 years. The most common traumatic mechanism was sport injury and the most common type of dislocation was Rockwood type III. Conclusions. Age between 20 and 39 years and male sex represent significant demographic risk factors for AC dislocation.

  20. 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. PMID:24796642

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

    International Nuclear Information System (INIS)

    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

  2. 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.

  3. BROWN TUMOR OF THE FACIAL BONES

    Directory of Open Access Journals (Sweden)

    Violeta Trandafir

    2010-11-01

    Full Text Available Brown tumor arises as a direct result of the effect of parathyroid hormone on bone tissue in some patients with hyperparathyroidism. The lesion localizes in areas of intense bone resorbtion, and the bone defect becomes filled with fibroblastic tissue that can deform the bone and simulate a neoplastic process. Brown tumors can affect the mandible, maxilla, clavicle, ribs and pelvic bones. Most patients with hyperparathyroidism are asymptomatic. Skeletal changes may represent the first manifestations of the disease. Radiologically, brown tumor in the jaws presents as a well-defined radiolucent osteolytic lesion, making it hard to differentiate it from other maxillary expansive lesions that can present with a similar imaging. Brown tumors exhibit no pathognomonic histologic changes. Differentiating between a brown tumor and other giant-cell tumors may be very difficult, even with histology. A final diagnosis can be defined only by evaluating the radiological findings with histopathological, laboratory and clinical data. At present, brown tumor is considered as a reparative cellular process rather than a real neoplasia. This phenomenon is considered as pathognomonic of hyperparathyroidism secondary to renal failure, especially in patients on long-term hemodialysis. The initial treatment of brown tumor involves control of hyperparathyroidism, regardless of whether it is primary or secondary. The clinical management of brown tumor aims primarily to reduce the elevated parathyroid hormone levels by pharmacological treatment. Surgical treatment is reserved to nonresponders or to patients with painful symptomatology or alteration of normal function. Brown tumor can recur if hyperparathyroidism persists or recurs.

  4. Luxo fractura esternoclavicular. Tratamiento quirúrgico. Reporte de un caso

    Directory of Open Access Journals (Sweden)

    Roberto Joaquín del Gordo D´Amato

    2013-10-01

    Full Text Available ResumenLas lesiones de la articulación esterno clavicular son poco frecuentes y generalmente se producen por traumas contundentes en esta región anatómica. Se reporta caso clínico de un paciente masculino víctima de accidente de tránsito quien presenta luxo fractura esterno clavicular. Se presenta técnica quirúrgica y método de fijación mediante osteosíntesis con placa y tornillos de pequeños fragmentos con excelente resultado post operatorio y rehabilitación funcional completa. (DUAZARY 2011 No. 2, 232 - 236AbstractThe esterno clavicular joint injuries are rare and usually caused by blunt trauma in this anatomic region. Reported case of a male patient clinical victim of accident of transit who presents accommodations esterno clavicular fracture. It issurgical technique and method of fixation by osteo synthesis with plate and screws of small fragments with excellent result post-operative and functional rehabilitation complete.Keywords: fracture; clavicle; surgery.

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

    International Nuclear Information System (INIS)

    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

  6. 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

  7. The neuropathic joint.

    Science.gov (United States)

    Sequeira, W

    1994-01-01

    Neuropathic arthritis is a destructive arthropathy frequently associated with loss of proprioception. A third of patients, however, may have no demonstrable neurological deficit. Patients with diabetes, syphilis, syringomyelia and other neuropathies are particularly prone to developing this joint disease. The diagnosis of Charcot's joints should be considered in anyone who develops what appears to be a severe osteoarthritis or a transverse fracture of the tibia or fibula after minor trauma. Scoliosis with particularly destructive changes on radiography should prompt a search for syringomyelia or syphilis. The most common radiographic abnormalities are those of distension in 3D (Dislocation, Destruction and Degeneration). An atrophic form with resorption of the proximal humerus, most frequently described in syringomyelia, has been observed in diabetes. Loss of the distal end of the clavicle has not been described before in the neuropathies. These changes coupled with speckled calcification or shards of bone in the periarticular soft tissue confirm the diagnosis. Infection and CPPD crystal disease can be difficult to exclude. The joint fluid may be inflammatory and infection may be a complication. Treatment includes anti-inflammatories and splinting. Indications for surgery are limited. PMID:8070170

  8. Arthroscopic coracoclavicular ligament reconstruction for Rockwood type Ⅲ acromioclavicular joint dislocations%肩关节镜下喙锁韧带重建术治疗 RockwoodⅢ型肩锁关节脱位的疗效研究

    Institute of Scientific and Technical Information of China (English)

    李奉龙; 姜春岩

    2015-01-01

    advantage of minimally invasive,quick recovery after operation,but at present the arthroscopic operation therapy for type Ⅲ acromioclavicular joint dislocation is still comparatively rare domestically.The purpose of this study was to evaluate the clinical outcomes of the arthroscopic coracoclavicular ligament reconstruction for the treatment of Rockwood type Ⅲ AC joint dislocations through a retrospective study.Methods (1)General data:Iinclusion criteria:patients of type Ⅲ dislocation with a high level require of sports;patients who received arthroscopic reconstruction of the coracoclavicular ligament injury in our hospital;fresh injury (no more than 3 weeks );not complicated with vessel and nerve injury;the postoperative follow-up time is greater than or equal to 12 months.Exclusion criteria:chronic injury (more than 3 weeks between injury and operation);bilateral injury;the ipsilateral shoulder operation history;fracture with other parts of shoulder;patients with fracture of the coracoid base treated with clavicular hook plate.From February 2013 to January 2014,21 consecutive patients with type Ⅲ AC joint dislocations who were treated with arthroscopic coracoclavicular ligament reconstruction were retrospectively reviewed after the final follow-up.There were 1 7 men and 4 women with a mean age of 42.8 years.The mean time from injury to surgery was 1 1.1 days.(2 ) Operative method:The operations were performed under general anesthesia.Patients were in beach chair position.The posterior portal was viewing portal,routine gleno-humeral joint examination was performed first.Then the scope was put into subacromial space,the anterior lateral portal was established.Subacromial decompression was done and the coracoid and coracoclavicle ligament was exposed and examined.The anterior medial portal was between coracoid and clavicle.it was created under direct vision.The remnant attached on coracoid should be carefully protected.The brachial plexus and vessel were very near

  9. Shoulder dystocia: guidelines for clinical practice from the French College of Gynecologists and Obstetricians (CNGOF).

    Science.gov (United States)

    Sentilhes, Loïc; Sénat, Marie-Victoire; Boulogne, Anne-Isabelle; Deneux-Tharaux, Catherine; Fuchs, Florent; Legendre, Guillaume; Le Ray, Camille; Lopez, Emmanuel; Schmitz, Thomas; Lejeune-Saada, Véronique

    2016-08-01

    Shoulder dystocia (SD) is defined as a vaginal delivery in cephalic presentation that requires additional obstetric maneuvers to deliver the fetus after the head has delivered and gentle traction has failed. It complicates 0.5-1% of vaginal deliveries. Risks of brachial plexus birth injury (level of evidence [LE]3), clavicle and humeral fracture (LE3), perinatal asphyxia (LE2), hypoxic-ischemic encephalopathy (LE3) and perinatal mortality (LE2) increase with SD. Its main risk factors are previous SD and macrosomia, but both are poorly predictive; 50-70% of SD cases occur in their absence, and most deliveries when they are present do not result in SD. No study has proven that the correction of these risk factors (except gestational diabetes) would reduce the risk of SD. Physical activity is recommended before and during pregnancy to reduce the occurrence of some risk factors for SD (Grade C). In obese women, physical activity should be coupled with dietary measures to reduce fetal macrosomia and weight gain during pregnancy (Grade A). Women with gestational diabetes require diabetes care (diabetic diet, glucose monitoring, insulin if needed) (Grade A) because it reduces the risk of macrosomia and SD (LE1). Only two measures are proposed for avoiding SD and its complications. First, induction of labor is recommended in cases of impending macrosomia if the cervix is favorable at a gestational age of 39 weeks or more (professional consensus). Second, cesarean delivery is recommended before labor in three situations and during labor in one: (i) estimated fetal weight (EFW) >4500g if associated with maternal diabetes (Grade C), (ii) EFW >5000g in women without diabetes (Grade C), (iii) history of SD associated with severe neonatal or maternal complications (professional consensus), and finally during labor, (iv) in case of fetal macrosomia and failure to progress in the second stage, when the fetal head station is above +2 (Grade C). In cases of SD, it is recommended to

  10. An analysis of anatomic landmark mobility and setup errors in radiotherapy for lung cancer

    International Nuclear Information System (INIS)

    Purpose: To identify visible structures in the thorax which exhibit little internal motion during irradiation and, to determine random and systematic setup deviations in lung cancer patients with the use of these structures. Methods: Ten patients with lung cancer were set up in the supine position, and aligned using lasers. No immobilization devices were used. With an electronic portal imaging device (Siemens Beam ViewPLUS), 12 sequential images (exposure 0.54 sec.; processing time 1.5 sec.) were obtained during a single fraction of radiotherapy. These 'movie loops' were generated for the A-P fields during each of 3-5 fractions. In order to determine the mobility of internal structures during each fraction, visible structures such as the trachea, carina, the upper chest wall, aortic arch, clavicle and paraspinal line were contoured manually in each image and matched with the first image of the corresponding movie loop by means of a cross-correlation algorithm. Translations in the cranial and lateral directions and in-plane rotations were determined for each structure separately. As the reference image represents a random position, relative movements were determined by comparing the translations and rotation for every image to the calculated means per movie-loop. Standard deviations of the relative movements were determined for each structure and each patient. Patient setup was evaluated for 15 patients with lung cancer. Setup was not corrected at any time during the treatment. The electronic portal images of each fraction were matched with the digitized simulator films by using a combination of the structures which had been determined to be relatively stable in the infra-fractional analysis. Results: In the infra-fractional analysis 120 to 380 matches were made per structure (a total of 1400). The standard deviation (SD) of translations in the lateral direction was small (≤1 mm) for the trachea, thoracic wall, paraspinal line and aortic arch. This was also the

  11. Tratamento artroscópico da luxação acromioclavicular aguda com âncoras Arthroscopic treatment of acute acromioclavicular joint dislocation using suture anchors

    Directory of Open Access Journals (Sweden)

    Leonardo Muntada Cavinatto

    2011-01-01

    nonabsorbable-braided sutures, which were passed through the holes drilled in the clavicle and tied to the upper surface of the clavicle. The coracoclavicular distance was measured and compared to the opposite side using radiographic evaluation. Constant and UCLA scores were used to determine clinical and functional evaluation after 6 months. RESULTS: Of the initial twenty cases, six were submitted to a new surgical procedure and were excluded from the study. Of the fourteen patients remaining, only two maintained the initial reduction, while the remainder presented some degree of reduction loss. The Constant and UCLA score averages were 94.79 (82-100 and 32.64 (26-35 respectively. CONCLUSION: The technique had a high incidence of reduction loss after 6 months of follow up. The clinical and functional evaluation was satisfactory, with a high average score. Level of Evidence: Level III, retrospective study.

  12. Axial and tangential views of the acromioclavicular joint: the introduction of new projections

    Institute of Scientific and Technical Information of China (English)

    CHEN Wei; ZHAGN Qi; SU Yan-ling; ZHANG Ze-kun; HOU Zhi-yong; PAN Jin-she; ZHANG Xiao-lin; ZHANG Ying-ze

    2012-01-01

    Background Routine anteroposterior radiographs of the acromioclavicular (AC) joint with or without weight bearing have limitations in demonstrating the AC joint.Transarticular fixation with Kirschner wire is a treatment choice for AC dislocations.However,percutaneous fixation of the AC joint is technically demanding.The C-arm fluoroscopy can be used as routine intraoperative guidance to facilitate this procedure.The current study aims to introduce new projections,the axial and tangential views of AC joint,to help evaluate the severity of the injury and facilitate the percutaneous procedure.Methods Three shoulder specimens were used to find the projection directions of the axial and tangential views of the AC joint by using the digital radiography (DR) unit.The axial and tangential views were taken of 20 adult volunteers by referencing the projection directions determined in the shoulder specimens.The angles showed on the DR system and the angles between the coronal plane of the body and the vertical plane of the flat panel detector (FPD) during taking these radiographs were recorded.The C-arm fluoroscopy unit was used to take the axial and tangential views referencing the angles measured on the DR system.Routine anteroposterior radiographs of the AC joint were taken on the volunteers.The minimal distances from the distal clavicle to the acromion were measured on both tangential and anteroposterior radiographs.The data was statistically analyzed.Results The clear axial and tangential radiographs of AC joints of the volunteers were obtained using both DR and C-arm fluoroscopy units.The angles demonstrated on the DR window are (20.8±2.4)° for male and (18.3±2.3)° for female.During taking the axial views,the angles between the coronal plane of the body and vertical plane of FPD are (23.3±3.2)° for male and (20.1±2.4)° for female.During taking tangential views,the corresponding angles are (117.5±3.7)° for male and (113.1±3.3)° for female.On the tangential

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

    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

    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 coracoid neck is the center between the two preparatively drilled bone tunnels.Make the cross line vertical to line P,and the bone tunnels are located in the I and II quadrant.The distance between two bone tunnels is 6 mm.(3 )Surgical techniques:According to the data of preoperative measurement of bone tunnel,the self

  14. 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

  15. In vivo organ mass of Korean adults obtained from whole-body magnetic resonance data

    International Nuclear Information System (INIS)

    In vivo organ mass of the Korean adult, male and female were presented for the purpose of radiation protection. A total of 121 healthy volunteers (66 males and 55 females), whose body dimensions were close to that of average Korean adults, were recruited for this study. Whole-body magnetic resonance (MR) images were obtained, and contours of 15 organs (brain, eye, gall bladder, heart, kidney, liver, lung, pancreas, stomach, spleen, testes, thymus, thyroid, urinary bladder and uterus) and 9 bones (femur, tibia + fibula, humerus, radius + ulna, pelvis, cervical spine, thoracic and lumber spine, skull and clavicle) were segmented for organ volume rendering by anatomists using commercial software. Organ and bone masses were calculated by multiplying the Asian reference densities of the corresponding organs and bones by the measured volumes. The resulting organ and bone masses were compared with those of the International Commission of Radiological Protection (ICRP) and the Asian reference data. Significantly large standard deviation was shown in the moving organs of the respiratory and circulatory systems and in the alimentary and urogenital organs that are variable in volume in a single person. Gall bladder and pancreas showed unique Korean organ masses compared with those of ICRP and the Asian reference adults. Different from anatomical data based on autopsy, the in vivo volume and mass in this study can more exactly describe the organ volume of a living human subject for radiation protection. A larger sample size would be required for obtaining statistically more reliable results. It is also needed to establish the reference organ mass of younger age groups for which it is difficult to recruit volunteers and to immobilise the subjects for long-time MR scanning. At present, the data from this study will contribute to the establishment of a Korean reference database. (authors)

  16. Intramedullary nailing of clavicular midshaft fractures in adults using titanium elastic nail

    Directory of Open Access Journals (Sweden)

    CHEN Qing-yv

    2012-02-01

    Full Text Available 【Abstract】 Objective: Studies showed elastic stable intramedullary nailing (ESIN of displaced midclavicular fractures has excellent outcomes, as well as high complication rates and specific problems. The aim was to discuss ESIN of midshaft clavicular fractures. Methods: Totally 60 eligible patients (aged 18-63 years were randomized to either ESIN group or non-operative group between January 2007 and May 2008. Clavicular shortening was measured after trauma and osseous consolidation. Radiographic union and complications were assessed. Function analysis including Constant shoulder scores and disabilities of the arm, shoulder and hand (DASH scores were performed after a 15-month follow-up. Results: ESIN led to a signifcantly shorter time to union, especially for simple fractures. In ESIN group, all patients got fracture union, of which 5 cases had medial skin irritation and 1 patient needed revision surgery because of implant failure. In the nonoperative group, there were 3 nonunion cases and 2 symptomatic malunions developed requiring corrective osteotomy. At 15 months after intramedullary stabilization, patients in the ESIN group were more satisfied with the appearance of the shoulder and overall outcome, and they benefited a lot from the great improvement of post-traumatic clavicular shortening. Furthermore, DASH scores were lower and Constant scores were significantly higher in contrast to the non-operative group. Conclusion: ESIN is a safe minimally invasive surgical technique with lower complication rate, faster return to daily activities, excellent cosmetic and better functional results, restoration of clavicular length for treating mid-shaft clavicular fractures, resulting in high overall satisfaction, which can be regard as an alternative to plate fixation or nonoperative treatment of mid-shaft clavicular fractures. Key words: Clavicle; Fracture fixation intramedu- llary; Outcome assessment

  17. 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.

  18. 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.

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

    Directory of Open Access Journals (Sweden)

    ZerinaJohanson

    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.

  20. Modified trapezius transfer technique for restoration of shoulder abduction in brachial plexus injury

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    Singh Arun

    2007-01-01

    Full Text Available Aims and Objectives: Shoulder stability and restoration are very important in providing greater range of motion to the arm and forearm. When brachial plexus repair does not have the desired outcome and in patients with long standing denervation, the trapezius muscle is frequently used for transfer to restore the shoulder abduction and external rotation. We propose a modified simple technique for trapezius muscle transfer. Materials and Methods: From February 2004 to February 2006, eight patients with posttraumatic brachial plexus injury with insufficient shoulder abduction were treated by trapezius muscle transfer. All patients with brachial plexus palsy were posttraumatic, often resulted from motor cycle accidents. Before operation a full evaluation of muscle function in the affected arm was carried out. All patients were treated with trapezius muscle transfer performed by the modified technique. S-shaped incision from the anterior border of the trapezius just above the clavicle to the Deltoid up to its insertion was made. The accessory nerve and its branches to the trapezius were secured. The trapezius was dissected and detached from its insertion along with the periosteum and sutured to the insertion of the Deltoid muscle. Results: All patients had improved functions and were satisfied with the outcome. The average increase in active abduction of shoulder was from 13.7 degrees (0 to 35 degrees preoperatively to 116 degrees (45 to 180 degrees postoperatively and of shoulder flexion from 24.3 degrees (15 to 30 degrees to 107 degrees (90 to 180 degrees. Conclusion: The modified technique proposed here for trapezius transfer is safe, convenient, simple and reliable for restoration of shoulder abduction and stability with clear subjective benefits.

  1. Computed tomography of nasopharyngeal carcinoma

    International Nuclear Information System (INIS)

    Axial CT findings of 56 patients with biopsy-proven nasopharyngeal carcinoma (NPC) were reviewed retrospectively to evaluate the region of origin of the tumor and the sites of spread of the disease. In all patients asymmetry of the mucosal airway contour with blunting of the fossa of Rosenmueller was seen, usually associated with infiltration of the levator palatini muscle. The earliest lesion of NPC arose in this region, and in 64% of cases the tumor had infiltrated into the adjacent parapharyngeal space with loss of its normal fat density. Superior intracranial extension was the most common site of deep infiltration from here (45% of patients) with opacification of the sphenoid sinus in 41% and bony destruction of the skull base in 29%. Invasion into the retropharyngeal space (38%) and carotid space (23%) were the next most common sites of infiltration. Invasion into the prevertebral space was seen in 14%. Anterior spread to the masticator space including the infratemporal fossa was an uncommon finding (14%). T-staging of these patients by CT was also done using both the AJC and Ho classification systems. Lymph node metastases were found in many patients (38%), most commonly in the retropharyngeal nodes, internal jugular nodes including jugular-digastricus nodes and the spinal assessory nodes, respectively. CT remains the most reliable technique for staging and assessing the extent of NPC, both prior to and after radiotherapy, and should be used not only for T-staging of the disease, but also for N-staging. It is recommended that axial scans should be routinely extended down the neck to the clavicles in all patients with NPC. (orig.)

  2. Mathematical development of a 10 years old child phantom for use in internal dosimetry

    International Nuclear Information System (INIS)

    The main objectives of this work are: 1) to develop a project of a mathematical phantom representing as far as possible a child of 10 years old and 2)to use this phantom as a base for the specific absorbed fractions (SAF) calculations in the internal organs and skeleton due to the radioisotopes most used in nuclear medicine. This phantom was similar in shape to the Fisher and Snyder one, but several changes were introduced to make the phantom more realistic. Those changes included the addition of a neck region, puting the arms outside the trunk region, changes in the trunk, head and genitalia regions shapes. Several modifications were also done in the skeleton. For instance, the head bones, rib cage, pelvis, vertebral column, scapula, clavicles and the arms and legs bones were made very close to the real anatomic shapes. Some internal organs as the brain, lungs, liver, small and large intestines were also changed as a consenquence of the above modifications. In all those cases, the changes were made not only in the shapes but also in the organs and bones position in such a way to be more representative of the 10 years old anatomic age. Estimates of the SAF obtained by the use of this phantom, resulted, as expected, significantly different from those obtained by the use of a simpler model. In other words, the ratio between the SAF in the organs of the phantom developed in this project and the SAF in the organs of the phantom similar to the adult (obtained by reducing each region of the adult phantom by the use of appropriate factor) vary from 0.37 to 5. Those differences and their meaning are also discussed. (author)

  3. Nonbacterial osteitis. A clinical, histopathological, and imaging study with a proposal for protocol-based management of patients with this diagnosis

    International Nuclear Information System (INIS)

    Nonbacterial osteitis (NBO), a term referring to sterile bone lesions with nonspecific histopathological features of inflammation, may be either unifocal or multifocal, acute (≤6 months) or chronic, and recurrent. Only when the condition is chronic, recurrent, and multifocal is it appropriate to use the term chronic recurrent multifocal osteomyelitis (CRMO). We present our clinical experience as the largest reported series of children with NBO to date. We report a retrospective clinical, histopathological, and radiological study of 41 children with nonbacterial osteitis. Of 41 children (2-16 years of age) diagnosed with NBO in our institution over the last 6 years, 21 (51%) had recurrent disease and 18 (44%) had multifocal disease. The most common bones affected were the clavicle, femur, and tibia (in order of decreasing prevalence) accounting for 44 (63%) of a total of 70 lesions. Only one individual had synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome (synovitis, acne, pustulosis, hyperostosis, osteitis) and no other patients had evidence of bowel or skin disease. In the absence of evidence for an infective etiology, we recommend nonsteroidal anti-inflammatory agents as the first-line therapy and bisphosphonates only in cases of resistant disease. On the basis of our findings, we propose using a patient questionnaire and protocol for investigating and managing patients who present with NBO to orthopedic surgeons. We predict that this will benefit patients with this disorder by improving our knowledge of the presenting signs and symptoms and related disorders, rationalizing the therapeutic approach, and allowing us to learn about the natural history of the disease. (author)

  4. The macrosemiiform fish companion of the Late Jurassic theropod Juravenator from Schamhaupten, Bavaria, Germany

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    G. Arratia

    2012-01-01

    Full Text Available A new neopterygian fish, Voelklichthys comitatus n. gen. n. sp., is described. The fish was found during the preparation of the theropod Juravenator starki Göhlich & Chiappe, 2006 in the same rock. The fish possesses numerous autapomorphies. The combination of autapomorphies is unique among Jurassic fishes and makes its taxonomic assignment difficult. The following characters are few examples demonstrating some of the peculiarities of the fish: The fish is small, oblong-shaped and has a large triangular head that is deeper than long; deepest point is at the level of the postparietal bone [parietal of traditional terminology] and the ventral end of the cleithrum. The skull roof is almost vertically oriented, with a strongly ossified and developed antero-dorsal orbital margin. Premaxilla and dentary possess very small conical teeth. The opercular apparatus is markedly narrow and deep. A clavicle is present. Both dorsal and ventral postcleithra are almost as deep as the maximum depth of the head; the dorsal postcleithrum is two times deeper than the ventral one. The vertebral centra are of arcocentral-type formed mainly by the development of the dorsal arcocentra. Pectoral and pelvic fins possess long rays that extend onto the pelvic and anal fins, respectively, whereas the rays of the dorsal and anal fins extend onto the caudal fin. The fish is interpreted as a macrosemiiform because it presents two of the three synapomorphies of the group (e.g., an incomplete circumorbital ring because the lateral edge of parietal bone [frontal of traditional terminology] makes up part of orbital margin and absence of a supramaxillary bone. The third macrosemiiform synapomorphy cannot be determined in the new fish because the coronoid bones and their dentition are not observed due to condition of preservation. The new fish shares a few characters with members of the families Macrosemiidae and the Uarbryichthyidae but lacks others so that presently, we place it

  5. Morphological variation in adult chimpanzees (Pan troglodytes verus) of the Taï National Park, Côte d'Ivoire.

    Science.gov (United States)

    Zihlman, Adrienne L; Stahl, Daniel; Boesch, Christophe

    2008-01-01

    Twenty five adult chimpanzee skeletons (Pan troglodytes verus) of known age and sex (15 females, 10 males) from a long-term study site in Taï National Park, Cote d'Ivoire present new data on variation. These skeletons provide a rare opportunity to measure the cranium and postcranium from the same individuals. We compare measurements and indices of the Taï sample with those of relatively complete Pan troglodytes schweinfurthii skeletons from Gombe National Park, Tanzania. Measurements of Pan paniscus are included as an outside comparison. The Taï and Gombe samples are analyzed by sex; combined sex samples are compared between the two groups, and the two sexes to each other. Taï females and males do not differ in most long bone lengths or in pelvic dimensions, but do differ significantly in cranial capacity, facial measurements, clavicle length, scapular breadth, and femur length. Gombe females and males differ significantly in some facial measurements and in scapular breadth. In combined sex samples, Taï individuals have lower cranial capacity, longer palate and mandible, and greater dimensions in the trunk and limb lengths. Taï females account for most of the variation; males differ from each other only in greater length of humerus and femur. The Taï skeletons provide new data for assessing individual variation and sexual dimorphism within and between populations and species. The combination of cranial and postcranial data provides a clearer picture of chimpanzee intraspecific and interspecific variation than can be gained from either data set alone. PMID:17786999

  6. The Sonographic Correlation between The Sternocleidomastoid Muscle Thickness and the Prognosis of Congenital Muscular Torticollis

    International Nuclear Information System (INIS)

    We wanted to predict the prognosis of patients with CMT by the A/N ratio of the thickness and the circumference of the SCM muscle on ultrasonography, and we wanted to correlate the echogenecity of the affected muscle and the prognosis. Ultrasonography was performed on 24 patients from June 2004 to March 2007. We measured the thickness and the cross sectional circumference of the SCM muscle at three levels; below the mastoid process, at the level of the carotid artery bifurcation and at the level of the sternum and clavicle. The ratio of the affected side to the normal side (the A/N ratio) of the SCM muscle was calculated. We performed followed up ultrasonography at 2 months intervals until the end of treatment. The Wilcoxon signed-rank test was used to correlate the A/N ratio before and after the treatment. Spearman's rank test was used to correlate the A/N ratio and the total treatment duration. Paired T-tests were used to correlate the echogenecity of the SCM muscle and the treatment duration divided by less than or greater than 12 months. With measuring the thickness of the SCM muscle, the A/N ratio after treatment (1.36) was decreased compared with the initial A/N ratio (2.31) (p<0.05). The correlation between the A/N ratio of the thickness with the total treatment duration was statistically significant (p<0.05). The echogenecity of the affected SCM muscle was not correlated with the duration of treatment. The A/N ratio of the thickness of the SCM muscle is useful to predict the prognosis of patients with CMT

  7. The Sonographic Correlation between The Sternocleidomastoid Muscle Thickness and the Prognosis of Congenital Muscular Torticollis

    Energy Technology Data Exchange (ETDEWEB)

    Lim, Dae Keon; Kwon, Woo Cheol; Cha, Seung Whan; Yoo, Ho Seok; Lim, Sang Hyeok; Park, Jeong Mee; Kim, Myung Soon [Yonsei University Wonju College of Medicine, Wonju Christian Hospital, Wonju (Korea, Republic of)

    2009-02-15

    We wanted to predict the prognosis of patients with CMT by the A/N ratio of the thickness and the circumference of the SCM muscle on ultrasonography, and we wanted to correlate the echogenecity of the affected muscle and the prognosis. Ultrasonography was performed on 24 patients from June 2004 to March 2007. We measured the thickness and the cross sectional circumference of the SCM muscle at three levels; below the mastoid process, at the level of the carotid artery bifurcation and at the level of the sternum and clavicle. The ratio of the affected side to the normal side (the A/N ratio) of the SCM muscle was calculated. We performed followed up ultrasonography at 2 months intervals until the end of treatment. The Wilcoxon signed-rank test was used to correlate the A/N ratio before and after the treatment. Spearman's rank test was used to correlate the A/N ratio and the total treatment duration. Paired T-tests were used to correlate the echogenecity of the SCM muscle and the treatment duration divided by less than or greater than 12 months. With measuring the thickness of the SCM muscle, the A/N ratio after treatment (1.36) was decreased compared with the initial A/N ratio (2.31) (p<0.05). The correlation between the A/N ratio of the thickness with the total treatment duration was statistically significant (p<0.05). The echogenecity of the affected SCM muscle was not correlated with the duration of treatment. The A/N ratio of the thickness of the SCM muscle is useful to predict the prognosis of patients with CMT.

  8. Segmentation of ribs in digital chest radiographs

    Science.gov (United States)

    Cong, Lin; Guo, Wei; Li, Qiang

    2016-03-01

    Ribs and clavicles in posterior-anterior (PA) digital chest radiographs often overlap with lung abnormalities such as nodules, and cause missing of these abnormalities, it is therefore necessary to remove or reduce the ribs in chest radiographs. The purpose of this study was to develop a fully automated algorithm to segment ribs within lung area in digital radiography (DR) for removal of the ribs. The rib segmentation algorithm consists of three steps. Firstly, a radiograph was pre-processed for contrast adjustment and noise removal; second, generalized Hough transform was employed to localize the lower boundary of the ribs. In the third step, a novel bilateral dynamic programming algorithm was used to accurately segment the upper and lower boundaries of ribs simultaneously. The width of the ribs and the smoothness of the rib boundaries were incorporated in the cost function of the bilateral dynamic programming for obtaining consistent results for the upper and lower boundaries. Our database consisted of 93 DR images, including, respectively, 23 and 70 images acquired with a DR system from Shanghai United-Imaging Healthcare Co. and from GE Healthcare Co. The rib localization algorithm achieved a sensitivity of 98.2% with 0.1 false positives per image. The accuracy of the detected ribs was further evaluated subjectively in 3 levels: "1", good; "2", acceptable; "3", poor. The percentages of good, acceptable, and poor segmentation results were 91.1%, 7.2%, and 1.7%, respectively. Our algorithm can obtain good segmentation results for ribs in chest radiography and would be useful for rib reduction in our future study.

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

    Directory of Open Access Journals (Sweden)

    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.

  10. Management of acute displaced midshaft clavicular fractures using Herbert cannulated screw: Technique and results in 114 patients

    Directory of Open Access Journals (Sweden)

    Martin Richardson

    2013-01-01

    Full Text Available Purpose: A new and simple operative technique has been developed to provide internal fixation for midshaft clavicle fractures. This involves the use of a large fragment Herbert Screw that is entirely embedded within the bone. Screw fixation is combined with bone grafting from intramedullary reamings of the fracture fragments. The purpose of this report is to assess the outcomes following treatment of midshaft clavicular fracture using this method. Materials and Methods: One hundred and fourteen patients with acute displaced midshaft fracture were identified between 2002 and 2007. All patients were followed until fracture union. Patients′ medical records were reviewed. Disability of the Arm, Shoulder, and Hand questionnaire (DASH, and American Shoulder and Elbow Surgeons Elbow form (ASES were posted to all patients. Outcome measures included union rate, time to union, implant removal rate, DASH, and ASES scores. Results: Patients′ median age was 29.5 years (interquartile range, 19-44 years. The most common injury mechanism was sports injury (28%. The median time from injury to surgery was 5 days (interquartile range, 2-9 days. Union occurred in an average of 8.8 weeks. Non-union occurred in three cases (2.6%. The re-operation rate for symptomatic hardware prominence screw was 1.7%. The median DASH score was 0.83 and the median ASES was 100 (n = 35. Conclusions: Intramedullary fixation using cannulated Herbert screw can be used as an effective approach for operative management of midshaft clavicular fractures. Using this method, an appropriate outcome could be achieved and a second intervention for implant removal could be avoided in great majority of cases. Level of Evidence: Level III

  11. Ankle and shoulder joint reconstruction using soft tissue allografts

    International Nuclear Information System (INIS)

    Full text: Lateral Collateral Ligament Insufficiency is a common complication of injury to the ankle joint. This needs reconstruction of the torn ligament as the joint instability gives rise to frequent giving way at the ankle joint. It can be reconstructed using autologous peroneus brevis tendon. The authors prefer to reconstruct using deep frozen (-80 degree C) non-gamma irradiated tibialis anterior or tibialis posterior tendon allograft procured by NUH Tissue Bank. The graft must be at least between 18-22 cm long. The procedure employed is a first stage Brostrom Procedure repairing the anterior talo-fibula ligament using Mitek sutures. In the second stage the Calcaneofibular ligament is reconstructed using a figure of eight tendon reconstruction via drill holes in the fibular above and the calcaneum below. Twelve cases have been reconstructed this way with good results. When injury is sustained to the Acromia-clavicular (AC) Joint, for type 3 to 5 AC Joint Dislocation and in manual labourers, reconstruction is needed. The author's preferred method is a 2 stage procedure using deep frozen (-80 degree C), non gamma-irradiated fascia lata allografts procured by NUH Tissue Bank. In the first stage the dislocated AC Joint is reduced and held in position by transfixation using 2 baby Steinmann Pins and repair of torn corac clavicular ligaments. The second stage consisted of reconstruction with rolled-up fascia lata figure of eight allograft tendon between the clavicle and the coracoid process. The 2 pins are removed after 6 weeks and the shoulder mobilised. 10 cases have been done with good results. Two cases showed mild subluxation of the AC joint due to slight loss of the reduction performed during the operation. (Author)

  12. Radiation injuries to bones of the thorax after irradiation of carcinoma of the breast and lung

    International Nuclear Information System (INIS)

    An analysis of the state of 396 patients undergoing radiotherapy for carcinoma of the breast and carcinoma of the lung gave the following results. During treatment of carcinoma of the breast, radiation injuries, mainly of the ribs and clavicle, were found in 11 of 158 patients treated (7.0 +/- 2.0 percent), more frequently after x-ray therapy (in nine of 70 cases, 12.9 +/- 4.0 percent). In the case of x-ray therapy, the minimal focal dose causing radiation injury to bone was 4,500 rads. The larger the dose and the shorter the course of treatment, the more frequently these changes were found. During treatment of carcinoma of the lung, radiation injuries were discovered in the ribs in ten patients and in the spine in one (of 238 patients treated). The frequency was 4.6 +/- 1.4 percent. They occurred after treatment on a linear accelerator with a frequency of 5.1 +/- 1.6 percent, and after treatment on the γ-ray apparatus in 1 of 27 patients. The minimal focal dose causing injury to bone when a linear accelerator was used was 5,000 rad. If the skin above the region of injury remained intact, clinical manifestations of the lesion were minimal. Repeated observations over a course of several years showed that the changes developed slowly and that consolidation of a radiation fracture can take place. On the whole, the course of the process is directly dependent on the size of the dose given

  13. 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.

  14. The value of bone scintigraphy in diagnosing of langerhans cells histiocytosis

    International Nuclear Information System (INIS)

    Purpose: To investigate the clinical value of bone scintigraphy in the diagnosis of Langerhans cells histiocytosis (LCH). Methods: Whole-body bone scintigraphy was performed in 23 patients, 16 males and 7 females, average age was 4.5+1.4, with histologic diagnosis of LCH. The clinical presentation varied from local mass (10 cases), tenderness (12 cases), othemorrhea (1 case), limb fatigue (3 cases), restriction of spinal activity (2 cases) to irregular fever, cough and rash (4 cases). 99Tcm-MDP was injected intravenously , the dose modified as age, according to the formula of [ adult dosage x [(age+l)/(age+7)] ] , and sedation was given to the young children who could not cooperate well. After 3 hours of administration whole-body bone scan was performed. Images were acquired using GE Millennium SPR, with a high-resolution low-energy collimator, 8 min/m sweep speed, matrix 1024 x 256, zoom 1. Results: 19 of 23 patients (82.6%) showed positive in their bone scan. 8 cases with cranial abnormal uptake, some of them exhibited peripheral high and central low uptake; clavicle, rib and pelvis involvements were 3 respectively; 2 cases in upper limb, 4 in lower limb, most lesions of limb were located in the diaphysis; spinal abnormal uptakes were seen in 5 patients, and 1 child had photon deficient area in the lower of sternium. Among 19 positive scintigram, single bone lesion was shown in 9 patients (47.3%), the most common lesion located in cranium (5 cases). Conclusion: Some characters of bone scintigraphy in LCH are useful in the diagnosis of this disease, and accompanied with comprehensive sensation of clinical manifestation of LCH, the diagnostic accuracy will be promoted. (authors)

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

    International Nuclear Information System (INIS)

    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.)

  16. 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.

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

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    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

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

    International Nuclear Information System (INIS)

    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.)

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

    International Nuclear Information System (INIS)

    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.)

  20. Tramline sign in bone scan in Ca lung patient: a case report

    International Nuclear Information System (INIS)

    Full text: A male patient of age 44 yrs having H/O Bidi smoking. Complains weakness and loss of appetite since 3-4 months, cough since 2-3 months. He feels dyspnoea on exertion for 1 week. Whole Body Bone Scan Patient was referred for radionuclide bone scan. Skeletal scintigraphy was performed with 20 mCi 99mTc -Methylene Diphosphonate. Whole body static imaging was done in anterior and posterior projections 3 hrs after dose administration. Scan reveals Hypertrophic pulmonary osteoarthropathy. Characteristic pericortical uptake. The cortical 'strips' of activity ('tramline sign') are evident as an irregular pattern in the long bones of the lower limbs, but are virtually absenting those of the upper limbs. Discussion Non-metastatic manifestations in Ca lung In patients with cancer of the lung, a frequent incidental observation will be the changes associated with hypertrophic pulmonary osteoarthropathy. In 48 cases reviewed by Ali et al 1 the extremities were invariably involved, although with asymmetry in 17% with the exception of the humerus, the proximal and distal portions of each long bone were involved with equal frequency. Involvement is also seen in the skull, scapulae, patellae and clavicles. The characteristics alteration in the long bones is intense pericortical uptake, the 'tremline sign' as shown in figure. Changes in the hands may be obvious in the absence of clinical evidence of clubbing. After treatment of the associated disease, there is usually rapid regression of the scintigraphic changes. Normalization of the scan abnormalities has been reported with in 1 month of successful therapy

  1. 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.)

  2. 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.

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

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    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.

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

    International Nuclear Information System (INIS)

    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.)

  5. The analysis of spatial relationship between the rotator cuff and the subacromial space in different arm positions

    International Nuclear Information System (INIS)

    Objective: To explore the distance between the acromion and the humerus head at different arm abduction to observe whether it changes or not, to determine at which position the distance is smallest, and to evaluate the relationship between the subacromial space and the rotator cuff. Methods: Fifteen normal volunteers were examined with MRI in six arm positions, and the coronal thin images were obtained with a spin echo sequence. Using a special positioning device, the arm was placed at 0 degree, 30 degree, 60 degree, 90 degree, 120 degree and 150 degree arm abduction, respectively. Of them, 0 degree-90 degree positions were not rotated, while 120 degree and 150 degree positions were slight internal rotated. The minimal distance of acromion-humerus (A-H) and clavicle-humerus (C-H), and the spatial relationship between the rotator cuff and the subacromial space were measured and observed. Results: The values of A-H and C-H at 60 degree - 150 degree arm abduction were obviously smaller than those at 0 degree-30 degree arm abduction (P0.05). The rotator cuff (mainly supraspinatus tendon) just went through between the acromion and the humerus at 60 degree - 120 degree arm positions but not at 0 degree, 30 degree and 150 degree arm positions. So at 60 degree - 120 degree arm positions, rotator cuff between the humerus and the acromion was often impinged. Conclusion: The closest contact between the supraspinatus tendon and subacromial space occurs at 60 degree - 120 degree abduction. The findings testify that the patients with impingement syndrome have shoulder pain at 60 degree - 120 degree abduction in clinic from etiology and pathology. In the future, MRI-based analyses should allow investigating the morphological basis of the impingement syndrome, choosing the appropriate therapy, and minimizing failure rates of surgery

  6. Retrosternal abscess after trigger point injections in a pregnant woman: a case report

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    Shujaat Adil

    2011-08-01

    Full Text Available Abstract Introduction Although retrosternal abscess is a well known complication of sternotomy and intravenous drug abuse, to date it has not been described as a consequence of trigger point injections. There are reported cases of serious complications as a result of this procedure including epidural abscess, necrotizing fasciitis, osteomyelitis and gas gangrene. Case presentation A 37-year-old African-American woman, who was 20 weeks pregnant, presented to our emergency room with complaints of progressively worsening chest pain and shortness of breath over the course of the last two months. She was undergoing trigger point injections at multiple different sites including the sternoclavicular joint for chest pain and dystonia. Two years previously she had developed a left-sided pneumothorax as a result of this procedure, requiring chest tube placement and subsequent pleurodesis. Her vital signs in our emergency room were normal except for resting tachycardia, with a pulse of 100 beats per minute. A physical examination revealed swelling and tenderness of the sternal notch with tenderness to palpation over the left sternoclavicular joint. Laboratory data was significant for a white blood count of 13.3 × 109/L with 82% granulocytes. A chest radiograph revealed left basilar scarring with blunting of the left costophrenic angle. A computed tomography angiogram showed a 4.7 cm abscess in the retrosternal region behind the manubrium with associated sclerosis and cortical irregularity of the manubrium and left clavicle. Conclusion Trigger point injection is generally considered very safe. However, there are reported cases of serious complications as a result of this procedure. A computed tomography scan of the chest should strongly be considered in the evaluation of chest pain and shortness of breath of unclear etiology in patients with even a remote history of trigger point injections.

  7. Infantile Cortical Hyperostosis:A Report of 24 Cases%婴儿骨皮质增生症(附24例报告)

    Institute of Scientific and Technical Information of China (English)

    贾和庚; 潘少川; 易蕙生; 傅大正

    1982-01-01

    @@ 婴儿骨皮质增生症是一种可自愈的疾病.本症首先由Caffey等于1945年报导,命名为婴儿骨皮质增生症,又称Caffey病.本症比较少见.北京儿童医院自1974~1982年4月诊治24例,现结合本组病儿情况进行讨论与介绍.%This paper reported 24 cases admitted to Beijing Children's Hospital in 1974-1982.Male 12 and female 12.The onset of the diseaese varied from 10 days to 15 weeks of post-natal life.All of them came to hospital before 4 months of age.Main symptoms were hyperirritability,crying,local mass,tenderness and limitation of the limb.Persisting fever occurred in 6 cases complicated by pneumonia.Misdiagnosis had been made as pneumonia,septicemia,fracture,scurvy,osteomyelitis and brachial plexus palsy at the first visit.Besides,one baby died of pneumonia and cardiac failure,while cortical hyperostosis of right humerus was found at autopsy.5 cases were followed up to 1/2-2 years,and all of them were living and well.The original roentgenographic alterations disappeared.X-ray data:1) number of lesions-single 13,multiple 11,2) site of lesions-humerus 12(occasions),ulma 7,radius 6,femur 6,mandible 3,scapula 10,clavicle 6,rib 4.The roentgenographic characteristic finding reveals abundant new bone formation from periosteum,making the shaft thicker.There is no specific treatment.Some were treated with corticosteroids and resulted in lowering of the lasting fever.

  8. [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. PMID:9045243

  9. A case of radiation induced carcinoma of the cervical esophagus

    International Nuclear Information System (INIS)

    A patient with carcinoma of the cervical esophagus who visited a hospital with a complaint of difficulty in swallowing was reported. This patient was a 50 year old woman. It was 32 years since she had had external irradiation with x- ray over the neck for Basedow's disease at the age of 18. From the age of 30, she had had hypothyroidism and had used thyroid. She became aware of difficulty in swallowing in October, 1976. Then this symptom progressed gradually, and she also had hoarseness. She visited a hospital in August, 1977. At the first medical examination, pigmentation and atrophic changes in the neck induced by radiation were observed, and some lymphnodes with the size of a red bean were palpated. Esophageal roentogenography revealed circular and spiral type lesion in the cervical esophagus, which was 4 cm in length and had a clear boundary. Endoscopic examination revealed circular stenotic lesion. This lesion was diagnosed as squamous cell carcinoma by biopsy. Total of 3,000 rad of Linac x-ray was irradiated over the neck and the clavicle before operation. Operation findings revealed fibrosis, atrophy, and hardening of the thyroid gland caused by radiation. Carcinoma with the size 35 mm x 18 mm was limited to the cervical esophagus, and the degree of the progress was A2, N2, M0 (Pl0). Histological findings revealed moderately differentiated squamous cell carcinoma and its metastases to the right supraclaviclar lymphnodes. This carcinoma was diagnosed as radiation-induced carcinoma of the cervical esophagus, because this patient had had irradiation over the neck, locally marked atrophic changes and scar remained, and carcinoma occurred in the area which had been irradiated with x-ray. (Tsunoda, M.)

  10. 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.)

  11. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

  13. Pulsatile blood flow in human bone assessed by laser-Doppler flowmetry and the interpretation of photoplethysmographic signals

    International Nuclear Information System (INIS)

    Human bone blood flow, mean blood speed and the number of moving red blood cells were assessed (in arbitrary units), as a function of time, during one cardiac cycle. The measurements were obtained non-invasively on five volunteers by laser-Doppler flowmetry at large interoptode spacing. The investigated bones included: patella, clavicle, tibial diaphysis and tibial malleolus. As hypothesized, we found that in all bones the number of moving cells remains constant during cardiac cycles. Therefore, we concluded that the pulsatile nature of blood flow must be completely determined by the mean blood speed and not by changes in blood volume (vessels dilation). Based on these results, it is finally demonstrated using a mathematical model (derived from the radiative transport theory) that photoplethysmographic (PPG) pulsations observed by others in the literature, cannot be generated by oscillations in blood oxygen saturation, which is physiologically linked to blood speed. In fact, possible oxygen saturation changes during pulsations decrease the amplitude of PPG pulsations due to specific features of the PPG light source. It is shown that a variation in blood oxygen saturation of 3% may induce a negative change of ∼1% in the PPG signal. It is concluded that PPG pulsations are determined by periodic ‘positive’ changes of the reduced scattering coefficient of the tissue and/or the absorption coefficient at constant blood volume. No explicit experimental PPG measurements have been performed. As a by-product of this study, an estimation of the arterial pulse wave velocity obtained from the analysis of the blood flow pulsations give a value of 7.8 m s−1 (95% confidence interval of the sample mean distribution: [6.7, 9.5] m s−1), which is perfectly compatible with data in the literature. We hope that this note will contribute to a better understanding of PPG signals and to further develop the domain of the vascular physiology of human bone. (note)

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

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    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.)

  15. Radiological aspects of prenatal-onset cortical hyperostosis [Caffey Dysplasia

    International Nuclear Information System (INIS)

    Objective: Cortical hyperostosis is a bone disease that may, at times, occur with a prenatal onset. This study seeks to present the characteristic patterns of prenatal-onset cortical hyperostosis (PCH) with regard to the radiographic features, and tries to ascertain whether PCH is a separate entity from infantile cortical hyperostosis (ICH), known as classic Caffey Disease. Materials and methods: This retrospective study identified cases with PCH based upon abnormal radiographic and chondro-osseous morphological and clinical findings, as available, from the International Skeletal Dysplasia Registry between 1987 and 2009. Outcomes and clinical information were also identified from medical records. Results: Based upon radiographic results, we found 20 individuals with PCH, of whom 10 neonatally survived, and 10 died. Hyperostosis of the mandible was found in 18/20, and of the skull base in 16/20 cases. Hyperostosis of the ribs was found in 17/20 cases, of the scapulae in 14/20, and of the clavicles in 4/20. Hyperostosis of the ileum was found in 11/20 cases, and of the long bones in all 20/20 cases, of which three cases had fibula sparing. No hyperostosis of the hands, feet, and spine was found. Conclusions: Our results suggest that, based upon clinical features and radiographic expression, ICH and PCH represent two separate entities, and that ICH should continue to be referred to as Caffey Disease and that PCH should be called Caffey Dysplasia. The findings of symmetrical hyperostosis of the mandible, ribs, scapulae, ilea, and long bones in any combination should suggest the diagnosis of PCH.

  16. ED-12WIDESPREAD SYSTEMIC METASTASES FROM MEDULLOBLASTOMA WITHOUT EVIDENCE OF ACTIVE CNS INVOLVEMENT: A CASE SERIES

    Science.gov (United States)

    Kumthekar, Priya; Singh, Simran; Smiley, Natasha Pillay; Lulla, Rishi

    2014-01-01

    This case series describes two patients with previously treated medulloblastoma who present with systemic metastases without evidence of central nervous system (CNS) disease. Patient #1 is male who presented at age 29 with pathology confirmed medulloblastoma treated with complete surgical resection followed by radiation (36 Gy craniospinal plus posterior fossa boost). Subsequently, he received cisplatin, cytoxan, and vincristine. One year later, he developed back pain and urinary retention. Imaging of his spine showed widespread bony metastases without parenchymal CNS disease. Biopsy of the left acetabulum confirmed metastatic medulloblastoma. He is currently enrolled on study with LDE225 versus temozolomide. Surveillance imaging to date is negative for intracranial metastasis, but does show extensive bony metastases involving the total spine, pelvis, ribs, sternum, clavicles, humeri, and femurs. Patient #2 is a female who presented at 32 years with severe headaches, nausea and vomiting found to have pathology confirmed medulloblastoma. She was lost to follow up temporarily, but presented again months later with headaches. She had a recurrent mass and underwent repeat resection. MRI of the spine showed nodular enhancement of the sacral nerve roots compatible with leptomeningeal spread. She underwent craniospinal radiation 36 Gy with a boost to the lumbar region and posterior fossa. One year after initial diagnosis, she presented with hypotension, tachycardia, and fatigue. Neuroimaging showed improved enhancement of the sacral nerve roots and brain imaging showed stable postsurgical changes. Systemic imaging, however, revealed widespread metastatic disease in the lymphatic system, liver, lung, and bones. The patient passed away a few months later. Medulloblastoma can metastasize outside the central nervous system (CNS), however typically does so concurrently with CNS progression. Here we present two adult patients with widely metastatic medulloblastoma systemically

  17. 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.)

  18. 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

  19. An epidemiological study on pattern of thoraco-abdominal injuries sustained in fatal road traffic accidents of Bangalore: Autopsy-based study

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    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

  20. Comparing different post-mortem human samples as DNA sources for downstream genotyping and identification.

    Science.gov (United States)

    Calacal, Gayvelline C; Apaga, Dame Loveliness T; Salvador, Jazelyn M; Jimenez, Joseph Andrew D; Lagat, Ludivino J; Villacorta, Renato Pio F; Lim, Maria Cecilia F; Fortun, Raquel D R; Datar, Francisco A; De Ungria, Maria Corazon A

    2015-11-01

    The capability of DNA laboratories to perform genotyping procedures from post-mortem remains, including those that had undergone putrefaction, continues to be a challenge in the Philippines, a country characterized by very humid and warm conditions all year round. These environmental conditions accelerate the decomposition of human remains that were recovered after a disaster and those that were left abandoned after a crime. When considerable tissue decomposition of human remains has taken place, there is no other option but to extract DNA from bone and/or teeth samples. Routinely, femur shafts are obtained from recovered bodies for human identification because the calcium matrix protects the DNA contained in the osteocytes. In the Philippines, there is difficulty in collecting femur samples after natural disasters or even human-made disasters, because these events are usually characterized by a large number of fatalities. Identification of casualties is further delayed by limitation in human and material resources. Hence, it is imperative to test other types of biological samples that are easier to collect, transport, process and store. We analyzed DNA that were obtained from body fluid, bone marrow, muscle tissue, clavicle, femur, metatarsal, patella, rib and vertebral samples from five recently deceased untreated male cadavers and seven male human remains that were embalmed, buried for ∼ 1 month and then exhumed. The bodies had undergone different environmental conditions and were in various stages of putrefaction. A DNA extraction method utilizing a detergent-washing step followed by an organic procedure was used. The utility of bone marrow and vitreous fluid including bone marrow and vitreous fluid that was transferred on FTA(®) cards and subjected to autosomal STR and Y-STR DNA typing were also evaluated. DNA yield was measured and the presence or absence of PCR inhibitors in DNA extracts was assessed using Plexor(®)HY. All samples were amplified using

  1. 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

  2. Implantation of a new access device for hemodialysis (Dialock): initial experience in 5 patients

    Energy Technology Data Exchange (ETDEWEB)

    Schmitz-Rode, T.; Buecker, A.; Tacke, J.; Wingen, M.; Guenther, R.W. [Dept. of Diagnostic Radiology, Universitaetsklinikum der RWTH Aachen (Germany); Noah, M. [Dept. of Plastic Surgery, Universitaetsklinikum der RWTH Aachen (Germany); Ketteler, M. [Dept. of Nephrology, Universitaetsklinikum der RWTH Aachen (Germany)

    2001-06-01

    A new hemodialysis access port system was implanted. Methods: The Dialock{sup TM} consists of a port-like double-valve, implanted subcutaneously below the clavicle, which is attached to two catheters, placed in the right atrium via the jugular vein. The device has been implanted in 5 patients (4 female, 1 male). Results: In all 5 patients the implantation of the catheters and the port was technically successful. Total average duration of dialysis was 3.6 months. Two patients developed a port pocket hematoma 10-14 days post implantation, one of them required surgical revision. One port was explanted due to septicemia, whereas a port infection was not confirmed. One patient showed a thrombotic occlusion of both catheter tips 8 days after implantation, fixed by catheter exchange. Another patient presented with slight migration of the port catheters, which was managed by refixation of the port within the pocket. Beside these complications, the devices were working well. Conclusion: The Dialock system offers an interesting alternative to external catheters for hemodialysis. With respect to the complications it deserves further studies to determine its future role in the field of vascular access. (orig.) [German] Ein neues Haemodialyse-Portsystem wurde klinisch erprobt. Methoden: Das Dialock{sup TM}-System besteht aus einem Doppelventil-Port, der subkutan unterhalb der Klavikel implantiert wird. An den Port sind zwei Katheter angeschlossen, die subkutan getunnelt transjugulaer im rechten Vorhof platziert werden. Das System wurde in 5 Patienten implantiert (4 Frauen, 1 Mann). Ergebnisse: Bei allen 5 Patienten war die Katheter- und Portimplantation technisch erfolgreich. Die bisherige mittlere Dialyse-Dauer betraegt 3,6 Monate. Bei zwei Patienten bildete sich ein Haematom der Porttasche 10-14 Tage nach der Implantation. In einem Fall war eine operative Ausraeumung erforderlich. Ein Patient entwickelte eine Sepsis, worauf das Portsystem explantiert wurde. Eine Portinfektion

  3. CT manifestations of adrenal trauma: experience with 73 cases.

    Science.gov (United States)

    Sinelnikov, Alex O; Abujudeh, Hani H; Chan, David; Novelline, Robert A

    2007-03-01

    Adrenal injuries, although an uncommon consequence of abdominal trauma, are important to recognize. If bilateral, adrenal trauma could result in life-threatening adrenal insufficiency. Furthermore, in the setting of trauma, adrenal injury can point to other concomitant injuries and has been associated with overall increased morbidity and mortality. In the past, before the advent of computed tomography (CT), detection was difficult, and the diagnosis was often made only at surgery or postmortem. Today, the diagnosis of adrenal injuries can be quickly and accurately made with CT. This retrospective review was carried out to identify, describe, and analyze different CT appearances of adrenal injuries and correlated with associated injuries and observed clinical context and outcomes. A patient cohort of CT-detected adrenal injuries was identified through a radiology software research tool by searching for keywords in radiology reports. The identified CT scans were reviewed and correlated with the patients' available clinical chart data and follow-up. Between April 1995 and October 2004, 73 cases of CT-detected adrenal injuries were identified, including 48 men and 25 women, with an age range 6 to 90 years and a mean age of 42.7 years. Of the cases, 77% were right-sided, 15% were left-sided, and 8% were bilateral. The causes of injuries were motor vehicle collisions (75%), falls (14%), sports related (4%), and miscellaneous causes (7%). Associated trauma included injuries of the liver (43%), spleen (23%), lung (19%), and kidney (18%), as well as pneumothoraces/hemothoraces (22%). Skeletal injuries included fractures of the ribs, clavicles, and/or scapulae (39%), pelvis and hips (30%), and the spine (23%). Isolated adrenal trauma was seen in only 4% of the cases. The CT findings of adrenal trauma were focal hematoma (30%), indistinct (27%) or enlarged (18%) adrenal gland, gross (15%) or focal (7%) adrenal hemorrhage, and adrenal mass (11%). Associated CT findings

  4. Post mastectomy linac IMRT irradiation of chest wall and regional nodes: dosimetry data and acute toxicities

    International Nuclear Information System (INIS)

    Conventional post-mastectomy radiation therapy is delivered with tangential fields for chest wall and separate fields for regional nodes. Although chest wall and regional nodes delineation has been discussed with RTOG contouring atlas, CT-based planning to treat chest wall and regional nodes as a whole target has not been widely accepted. We herein discuss the dosimetric characteristics of a linac IMRT technique for treating chest wall and regional nodes as a whole PTV after modified radical mastectomy, and observe acute toxicities following irradiation. Patients indicated for PMRT were eligible. Chest wall and supra/infraclavicular region +/−internal mammary nodes were contoured as a whole PTV on planning CT. A simplified linac IMRT plan was designed using either integrated full beams or two segments of half beams split at caudal edge of clavicle head. DVHs were used to evaluate plans. The acute toxicities were followed up regularly. Totally, 85 patients were enrolled. Of these, 45 had left-sided lesions, and 35 received IMN irradiation. Planning designs yielded 55 integrated and 30 segmented plans, with median number of beams of 8 (6–12). The integrated and segmented plans had similar conformity (1.41±0.14 vs. 1.47±0.15, p=0.053) and homogeneity indexes (0.13±0.01 vs. 0.14±0.02, p=0.069). The percent volume of PTV receiving >110% prescription dose was <5%. As compared to segmented plans, integrated plans typically increased V5 of ipsilateral lung (p=0.005), and heart (p=0.001) in patients with left-sided lesions. Similarly, integrated plans had higher spinal cord Dmax (p=0.009), ipsilateral humeral head (p<0.001), and contralateral lung Dmean (p=0.019). During follow-up, 36 (42%) were identified to have ≥ grade 2 radiation dermatitis (RD). Of these, 35 developed moist desquamation. The median time to onset of moist desquamation was 6 (4–7) weeks from start of RT. The sites of moist desquamation were most frequently occurred in anterior axillary fold

  5. 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

  6. X-ray fluorescence in IAEA Member States: Peru

    International Nuclear Information System (INIS)

    The application of the XRF technique performed in our laboratories in the field of archaeology began in 1994. It started with the analysis of different samples, as an incisive tooth, a fragment of occipital, a rib fragment, a segment of dorsal vertebra and small glasses found in the internal surface of a Nazca Culture mummy. In the paleopathological study performed by Dr. Guido Lombardi a 109Cd excitation source and an X ray spectrometry system were used. The elemental concentrations of Ca, Fe, Zn, and Sr were determined for the paleonutricion studies by using the relationships of Zn/Ca and Sr/Ca. The XRF technique also contributed to the mycobacterium tuberculosis detection in a mummy, supplementing other non destructive tests carried out previously. In recent years, 29 right clavicles belonging to mature individuals were analyzed out of 143 found in the Villa El Salvador area. Sr and Zn concentrations were used to determine the relative proportion of vegetable and animal foods in the population's diet under study. It was concluded that the old residents of this town manifested an omnivorous feeding with carnivorous tendency, due to consumption of products of marine origin. Ceramics have also been analyzed to determine the chemical composition of the paste which was used in the production process. 39 fragments of ceramic from the place called Lomo de Corvina of Villa El Salvador, low valley in Lurin town were analyzed. The analysis of these samples was focused on quantitative determination of Ti, Fe, Rb, Sr, Y, Zr and Nb, to complement the results obtained by neutron activation analysis. Identification of the pigments used for production of art objects is of great importance for its characterization, authentication and/or restoration. For this reason, we are currently working on identification of pigments used in the decoration of archaeological ceramics. This work started from construction of a portable XRF spectrometer based on a small size, low power X ray tube

  7. Cervicothoracic multisegmental transpinal evoked potentials in humans.

    Directory of Open Access Journals (Sweden)

    Jonathan Einhorn

    Full Text Available The objectives of this study were to establish the neurophysiological properties of the transpinal evoked potentials (TEPs following transcutaneous electric stimulation of the spine (tsESS over the cervicothoracic region, changes in the amplitude of the TEPs preceded by median nerve stimulation at group I threshold, and the effects of tsESS on the flexor carpi radialis (FCR H-reflex in thirteen healthy human subjects while seated. Two re-usable self-adhering electrodes, connected to function as one electrode (cathode, were placed bilaterally on the clavicles. A re-usable electrode (anode was placed on the cervicothoracic region covering from Cervical 4-Thoracic 2 and held under constant pressure throughout the experiment. TEPs were recorded bilaterally from major arm muscles with subjects seated at stimulation frequencies of 1.0, 0.5, 0.33, 0.2, 0.125, and 0.1 Hz, and upon double tsESS pulses delivered at an inter-stimulus interval of 40 ms. TEPs from the arm muscles were also recorded following median nerve stimulation at the conditioning-test (C-T intervals of 2, 3, 5, 8, and 10 ms. The FCR H-reflex was evoked and recorded according to conventional methods following double median nerve pulses at 40 ms, and was also conditioned by tsESS at C-T intervals that ranged from -10 to +50 ms. The arm TEPs amplitude was not decreased at low-stimulation frequencies and upon double tsESS pulses in all but one subject. Ipsilateral and contralateral arm TEPs were facilitated following ipsilateral median nerve stimulation, while the FCR H-reflex was depressed by double pulses and following tsESS at short and long C-T intervals. Non-invasive transpinal stimulation can be used as a therapeutic modality to decrease spinal reflex hyper-excitability in neurological disorders and when combined with peripheral nerve stimulation to potentiate spinal output.

  8. Intra-arterial port implantation for intraarterial chemoinfusion

    International Nuclear Information System (INIS)

    The purpose of this study is to evaluate, using various port systems, the technique and complications of intra-arterial port implantation in visceral (mainly hepatic) arteries for intra-arterial chemoinfusion. We retrospectively evaluated 30 cases of intra-arterial port implantation in 29 patients. Angiography was performed in all cases, and insertion of an implantable polyurethane port catheter was followed by angiographic exchange which, utilizing a .035'' hydrophilic guide wire, targeted the artery. If a change in the direction of flow was required, arterial flow control was performed, using an enbolie coil. In order to insert the subcutaneous tissue was dissected. The port chamber was inserted into the subcutaneous pocket and fixed with a black-silk tagging suture. When the femoral artery was punctured, the port chamber was inserted into the supra-or infrainguinal area; when the left subclavian artery was used, the port chamber was inserted into the lateral one third of the left clavicle. The port systems used in the procedure were as follows: 5.8F port-A-Cath (SIMS, Deltec, U.S.A.) (n=20); 5.2F A-port (Therex, U.S.A.)(n=5); 5F PU-Anthron (Deny, Japan)(n=4); 5.2F R-Port (Therex, U.S.A.)(n=1). The subcutaneous chambers were inserted into the infrainguinal (n=22), suprainguinal (n=6) or subclavian area (n=2). The procedure was technically successful in all 30 cases. Port catheter tips were located in the hepatic artery proper (n=11), the right hepatic (n=9) or subclavian area (n=2). The procedure was technically successful in all 30 cases. Port catheter tips were located in the hepatic artery proper (n=11), the right hepatic (n=9), gastroduodenal (n=6), common hepatic (n=2), inferior mesenteric (n=1) and internal iliac artery (n=1). In 12 cases, flow was controlled using embolic coils. Follow up study was performed in 23 cases, with a mean follow-up period of 55.8(11-161) days. Complications were noted in four cases; two were procedure related and two were

  9. The clinical and radiological observation of congenital syphilis

    International Nuclear Information System (INIS)

    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

  10. Long bone non-unions treated with the diamond concept: a case series of 64 patients.

    Science.gov (United States)

    Giannoudis, Peter V; Gudipati, Suri; Harwood, Paul; Kanakaris, Nikolaos K

    2015-12-01

    The aim of this retrospective study with prospectively documented data was to report the clinical results of treatment of long bone non-unions using the "diamond concept". Over a 4-year period, patients that presented with a long bone non-union and were managed with the diamond conceptual framework of bone repair were evaluated. Exclusion criteria were hypertrophic, pathological, and infected non-unions. Fixation was revised as it was indicated whilst biological enhancement included the implantation of RIA graft, BMP-7 and concentrated bone marrow aspirate. Data recorded included patient demographics, initial fracture pattern and type of stabilisation, number of previous interventions, time to reoperation, time to union and functional outcome. Painless full weight bearing defined clinical union. Radiological union was defined as the presence of mature callous bridging to at least 3 bone cortices. The minimum follow up was 12 months (range 12-32). In total 64 patients (34 males) with a mean age of 45 years (17-83) were evaluated. Anatomical distribution of non-unions included the femur (54.68%), tibia (34.38%), humerus (4.68%), radius (3.13%) and clavicle (3.13%). The median number of previous interventions was 1 (range 1-5). The majority of patients (82.62%) underwent revision of fixation whereas only bone grafting was performed 9.38% of patients. Three patients developed superficial wound infection (one was MRSA), 1 had deep vein thrombosis and 1 developed heterotopic bone formation. Union was successful in 63/64 (98.4%) non-unions at a mean time of 6 months (range 3-12). All patients were mobilising pain free and returned to their daily living activities at the final follow up. The application of the "diamond concept" in this cohort of patients was associated with a high union rate by providing an optimal mechanical and biological environment. Such an approach should be considered in the surgeon's armamentarium particularly in such cases where difficulty of bone

  11. Plasmablastic lymphoma: Does prognosis differ with HIV status and site of disease?

    Directory of Open Access Journals (Sweden)

    K. Govind babu

    2014-06-01

    Full Text Available Background: Apart from its common occurrence in the oral cavity in HIV - positive patients, plasmablastic lymphoma (PBL has also been described at extraoral sites and among immunocompetent individuals. There is sparse data quoting prognostication of PBL depending on the site of occurrence and HIV status of patients. Aims: The present study was carried out at a tertiary oncology center to address the issue whether PBLs occurring at oral and extraoral sites differ prognostically and whether HIV status of patient has any impact on prognosis. Materials and Methods: This was a retrospective observational study conducted at our center on consecutive patients diagnosed with PBL, from January 2008 to December 2012. Results: We had four patients with oral PBL; three male and one female. Sites of involvement were oral tongue and buccal mucosa. Two patients died within 6 months of diagnosis due to disease progression while on treatment. One patient was lost to follow - up after achieving complete remission (CR after chemotherapy. Only one patient completed the prescribed schedule of chemotherapy and radiotherapy and is in CR with 33 months follow - up. There were four extraoral PBL patients; three female and one male. Extraoral sites were ileocaecal region, ovary, clavicle and rectum. Three patients died within 6 months due to progressive disease during treatment. Only one patient has completed chemotherapy and is in CR with18 m onths follow - u p. Among all these eight oral and extraoral PBL patients, four were HIV positive. Two of them are in CR after treatment (18 months and 33 months follow - up. One patient died during treatment and one patient was lost to follow - up after being in CR. Unfortunately, none of the other four HIV - negative patients could survive for more than 6 months after diagnosis. Conclusion: Both oral and extraoral PBLs have aggressive clinical course and an overall unfavorable outcome. Prognosis of HIV - associated PBL seems to

  12. DNA extraction: an anthropologic aspect of bone remains from sixth- to seventh-century ad bone remains.

    Science.gov (United States)

    Di Nunno, Nunzio; Saponetti, Sandro Sublimi; Scattarella, Vito; Emanuel, Patrizia; Baldassarra, Stefania Lonero; Volpe, Giuliano; Di Nunno, Cosimo

    2007-12-01

    In the archeological site of the early Christian Episcopal complex of Saint Peter, in Canosa di Puglia (Bari, Italy), during the operations of archaeological excavations, tombs were discovered. They were dated between the sixth and seventh centuries ad with carbon 14 methodology. Five skeletons were found in the 5 tombs: 28A: male individual, 43 years old. The height was 170 cm; the biomass was 65.7 kg. The analysis of the bones indicated several noteworthy pathologies, such as a number of hypoplasia lines of the enamel, the presence of Schmorl hernias on the first 2 lumbar vertebrae, and the outcome of subacromial impingement syndrome. 28E was a male individual, with a biologic age of death of between 44 and 60 years. The height was 177 cm. He had a posttraumatic fracture callus of the medial third of the clavicle, with an oblique fracture rima. 29B was a female individual, 44-49 years old. The height was 158.8 cm; the biomass was 64.8 kg. There was Wells bursitis on the ischial tuberosity on both sides. 29E was a male individual, 45-50 years old. The height was 169.47 cm; the biomass was 70.8 kg. The third and the fourth vertebrae showed Baastrup syndrome (compression of the vertebral spine). There were radiologic signs of deformity on the higher edge of the acetabula and results of frequent sprains of the ankles. 31A was a male individual, 47-54 years old. The height was 178.65 cm; the biomass was 81 kg. The vertebral index showed a heavy overloading in the thoracic lumbar region. There were bony formations under the periosteum on both on the higher and medium facets of the first metatarsus and on the higher and lateral facets of the fifth metatarsus on both sides. As the topography indicates, these small ossifications coincided with the contact points between the back of the foot and parts of the upper shoe. From the osseous remains, in particular from the teeth (central incisors), the DNA was extracted and typed to identify potential family ties among all the

  13. 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

  14. 颈肩峰区跨区供血轴型扩张皮瓣修复颈部瘢痕挛缩%Expanded cervico-acromial skin flap of crossing supply axial pattern for the repair of cervical cicatricial contracture

    Institute of Scientific and Technical Information of China (English)

    胡春梅; 李养群; 唐勇; 杨喆; 赵穆欣; 陈文; 刘媛媛; 许砾思

    2013-01-01

    Objective To investigate the blood supply of an expanded skin flap from cervico-acromial region and its application in the repair of cervical cicatricial contracture.Methods The expanded skin flap pedicled was prepared with arteries of lateral neck,blood supply crossing and abundant anastomotic branchea of the neck-should blood vessels,the frontal bound of which is clavicle,the underneath bound of which is spine of scapula,and the lateral bound of which is acromion,to repair the large soft tissue defects on neck.Results All the 19 flaps of 15 patients were survived.The maximum size was 23 cm × 16 cm.Postoperative follow-up showed that the cervico-mandibular function and the external appearance of the flaps were satisfactory.And the scar in donor sites seemed to be neglectable.Conclusions The blood supply of the cervico-acromial flap is abundant,the subcutaneous fat and skin is quite thin after expended.We can harvest a large expanded skin flap.Reparation of cervical cicatricial contracture with expanded cervico-acromial flap pedicled with arteries of lateral neck could be recommended.%目的 探讨颈肩峰区跨区供血轴型扩张皮瓣的解剖学特征及应用于修复颈部瘢痕挛缩的临床效果.方法 应用颈横动脉分支和胸肩峰动脉吻合支跨区供血,形成前界为锁骨、后界为肩胛岗、外界为肩峰的颈肩峰区的扩张皮瓣,以颈侧为蒂转移修复较大面积的颈部软组织缺损.结果 15例患者的19个颈肩峰扩张皮瓣(面积最大为23 cm× 16 cm)全部成活,颈部畸形矫正良好.结论 颈肩峰区跨区供血的吻合支丰富,于深筋膜浅层进行扩张后皮下脂肪层及皮肤较薄,可以形成较大面积的扩张皮瓣,以颈横动脉颈段皮支为轴型血管,转移修复颈部较严重的瘢痕挛缩畸形,是一个良好的手术方法.

  15. 无保护会阴分娩技术的临床应用及护理%Clinical Application and Nursing of no Protection of Perineum Delivery Technology

    Institute of Scientific and Technical Information of China (English)

    李洁; 韦睿源

    2015-01-01

    目的:观察无保护会阴分娩方法的临床应用效果,并提出具体的护理措施。方法随机将接诊的有阴道试产条件的300例产妇分为观察组和对照组,每组各150例。对照组宫口开全后采用传统会阴保护法分娩,观察组宫口开全后行无保护会阴分娩技术。结果观察组产妇第二产程时间、产后出血量均明显低于对照组,阴道分娩率(96.67%)明显高于对照组,新生儿窒息率(0.67%)、肩难产率(0.67%)、锁骨骨折率(1.33%)明显低于对照组( P<0.05)。结论无保护会阴分娩技术可以加快第二产程进展,促进自然分娩,降低新生儿并发症。%Objective To observed clinical application effect of no protection of perineum delivery technology, and putforwardspecificnursingmeasures.Methods 300casespuerperaweredividedintoobservationgroupandcontrol group, control group given traditional perineal delivery, observation group given no protection of perineum delivery tech-nology.Results Observation group second time labor, postpartum haemorrhage amount were significantly lower than the control group, vaginal births ( 96.67%) is significantly higher than the control group, the newborn asphyxia rate (0.67%), shoulder dystocia rate (0.67%), clavicle fracture rate (1.33%), were significantly lower than the control group ( P<0.05 ) .Conclusions No protection of perineum delivery technology can speed up the second labor pro-gress, promote natural delivery, reduce the neonatal complications.

  16. 无保护会阴助产法对新生儿锁骨骨折的影响%Effects of unprotected perineum midwifery method on the neonatal clavicular fracture

    Institute of Scientific and Technical Information of China (English)

    李桂友; 陈彩儿; 黎少萍; 原绮霞

    2014-01-01

    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 .%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。

  17. Creation of two tomographic voxel models of paediatric patients in the first year of life

    International Nuclear Information System (INIS)

    Tomographic computational models, based on regional segmentation of CT or MRI medical images, have increasingly been proposed as replacements for current stylized mathematical models of human anatomy used in radiation dosimetry studies. While much effort has been devoted towards the creation of adult models, few research studies have been initiated to address the need for models supporting paediatric radiology dosimetry. In this study, two tomographic models were created using a combination of automatic and manual segmentation via a program created in-house using IDL version 5.5. The first model is of a normal 6 day female newborn, and consists of a 512x512x485 data array. The CT slices of this model were obtained every 1 mm, and 66 different anatomic regions were defined. The second model is of a patient developmentally equivalent to a 2 month male, and was saved as a 512x512x438 data array. This subject had severe tissue oedema within the gut, kidneys, liver and spleen. The model is thus considered representative of a critically ill child, from a patient subpopulation expected to receive a larger than normal number of diagnostic x-ray exams. The voxel volumes for the two models are 0.35 mm3 and 0.30 mm3, respectively, thus making these models the most detailed in existence for paediatric dosimetry applications. Ratios of organ masses for the UF newborn model to those within the reference ORNL/MIRD model range from highs of 1.2 to 1.7 for the oesophagus and small intestine/colon, respectively, to lows of 0.18 to 0.27 for the mandible and humeri, respectively. For the UF 2 month model, ratios of organ masses in the UF model to those in the 8 week GSF BABY model ranged from highs of 3.7 to 5.2 for the clavicles and spleen, respectively, to lows of 0.2 to 0.3 for the adrenals and scapulae, respectively. (author)

  18. Distribution of Proliferating Bone Marrow in Adult Cancer Patients Determined Using FLT-PET Imaging

    International Nuclear Information System (INIS)

    Purpose: Given that proliferating hematopoietic stem cells are especially radiosensitive, the bone marrow is a potential organ at risk, particularly with the use of concurrent chemotherapy and radiotherapy. Existing data on bone marrow distribution have been determined from the weight and visual appearance of the marrow in cadavers. 18F-fluoro-L-deoxythymidine concentrates in bone marrow, and we used its intensity on positron emission tomography imaging to quantify the location of the proliferating bone marrow. Methods and Materials: The 18F-fluoro-L-deoxythymidine positron emission/computed tomography scans performed at the Peter MacCallum Cancer Centre between 2006 and 2009 on adult cancer patients were analyzed. At a minimum, the scans included the mid-skull through the proximal femurs. A software program developed at our institution was used to calculate the percentage of administered activity in 11 separately defined bony regions. Results: The study population consisted of 13 patients, 6 of whom were men. Their median age was 61 years. Of the 13 patients, 9 had lung cancer, 2 had colon cancer, and 1 each had melanoma and leiomyosarcoma; 6 had received previous, but not recent, chemotherapy. The mean percentage of proliferating bone marrow by anatomic site was 2.9% ± 2.1% at the skull, 1.9% ± 1.2% at the proximal humeri, 2.9% ± 1.3% at the sternum, 8.8% ± 4.7% at the ribs and clavicles, 3.8% ± 0.9% at the scapulas, 4.3% ± 1.6% at the cervical spine, 19.9% ± 2.6% at the thoracic spine, 16.6% ± 2.2% at the lumbar spine, 9.2% ± 2.3% at the sacrum, 25.3% ± 4.9% at the pelvis, and 4.5% ± 2.5% at the proximal femurs. Conclusion: Our modern estimates of bone marrow distribution in actual cancer patients using molecular imaging of the proliferating marrow provide updated data for optimizing normal tissue sparing during external beam radiotherapy planning.

  19. SU-E-J-06: Additional Imaging Guidance Dose to Patient Organs Resulting From X-Ray Tubes Used in CyberKnife Image Guidance System

    International Nuclear Information System (INIS)

    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

  20. 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.

  1. 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.

  2. Nodal recurrences after exclusive brachytherapy for T1-T2 N0 cancer of the oral tongue

    International Nuclear Information System (INIS)

    INTRODUCTION: Exclusive brachytherapy represents the treatment of choice in small volume cancer of the oral tongue. In this neoplasm however the incidence of subclinical metastasis in neck nodes is not negligible, and prophylactic neck dissection is advocated by some Authors after interstitial irradiation. We have thus reviewed the incidence of nodal recurrences in a group of pts treated with brachytherapy alone for tongue cancer. PATIENTS METHODS AND RESULTS: From 1982 to 1994 44 pts (27 males, 17 females, age 35-84 years, median 63,3 years) were treated with 192 Ir interstitial irradiation alone for clinically N0 epidermoid cancer of the oral tongue (T1: 19 pts, T2: 25 pts). Brachytherapy was performed with hairpins or plastic tubes, according to the rules of the Paris system. Dose ranged from 60-70 Gy with a dose rate of 0.38-0.62 Gy/h (median: 63.8 and 0.52 respectively). Local recurrences were observed in 8 pts (18.1 %), 3 of whom are free from disease after salvage surgery. Neck nodes metastasis appeared after 3-11 months (mos) from primary treatment (median 6,3 mos) and represented the first site of failure in 16 pts (36,3 %; T1 (6(19)): 31,5 %. T2(10(25)) : 40 %; volume 3cc.: 55.5 %). After neck dissection and external radiotherapy 10 of them were rendered free from disease and are still alive at 12-123 mos. Definitive control above the clavicles was thus 75 % ((33(44)) pts). DISCUSSION AND CONCLUSION: Exclusive brachytherapy can obtain excellent local control rates in T1 T2 oral tongue cancer (81.9 % in our experience). Nodal recurrences are however frequent after interstitial irradiation in large volume cancers and salvage of pts relapsed in the neck is not easily achievable. Prophylactic neck dissection could be advisable to enhance regional control rate in these pts. The role of newer methods to evaluate neck nodes during follow up (ultrasonography and fine needle aspiration of suspicious nodes) is now being investigated in our centre

  3. Surgical treatment of congenital muscular torticollis in children over 5 years old%年龄大于5岁儿童先天性肌性斜颈的手术治疗

    Institute of Scientific and Technical Information of China (English)

    苏涛; 王晓东

    2011-01-01

    Objective To examine the surgical treatment of congenital muscular torticollis in the children aged over 5 years old. Methods A total of 37 patients with congenital muscular torticollis were treated surgically in this study. The distal portion of the sternoeleidomastoid muscle clavicle head and sternal head was cut, the sternocleidomastoid insertion tendon in the mastoid process was incised, and the contraeture tissue was released. The oeeipito - mandibular traction treatment was performed after the operation. Results All the patients were followed up for 2 to 5 years with an average of 2.6 years. All the children's function and appearance were improved. The clinical efficacy was excellent in 28 patients(75.7% )and good in 9 patients(24. 3% ). Conclusion Incision of amphi - sternocleidomastoid muscle in combination with post - operative traction is the treatment of choice for congenital muscular tortieollis in children over 5 years old.%目的 观察大年龄儿童(年龄大于5岁)先天性肌性斜颈的手术治疗效果.方法 手术治疗大年龄肌性斜颈患儿37例,切断胸锁乳突肌锁骨头、胸骨头,于乳突处切断胸锁乳突肌止点腱,并充分松解挛缩组织,术后均作枕颌牵引.结果 所有病例均获随访,随访时间2~5年,平均随访2.6年,所有患儿的功能和外观均有改善,其中优28例(75.7%),良9例(24.3%).结论 胸锁乳突肌上、下端切断术加术后牵引是治疗大龄儿童先天性肌性斜颈的首选手术治疗方式.

  4. 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.

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

    International Nuclear Information System (INIS)

    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. Biclonal gammopathy in multiple myeloma: a case report.

    Science.gov (United States)

    Bakta, I M; Sutarka, I N

    2000-05-01

    Monoclonal gammopathy is a group of B-cell disorders which result in the production of a specific and unique monoclonal immunoglobulin (M-component). Biclonal gammopathy is characterized by the simultaneous appearance of two different M-components. The incidence is about 1% of all monoclonal gammopathy. This paper reports on a 48-year-old male who had a chief complaint of back-pain beginning 7 months earlier. A physical examination was unremarkable, except for anemia and tenderness in the back. Hemoglobin was 5.4 g/dl, white blood cells 4.5 x 10(3)/microliter, platelets 157 x 10(3)/microliter, and reticulocytes 0.9%. Serum iron was 79 mg/dl, and total iron-binding capacity was 210 mg/dl. A blood smear showed the formation of rouleaux, but no plasma cells were found. Serum creatinine was 5.4 mg/dl, with a creatinine clearance of 18.1 ml/min. Serum electrolytes were normal except for serum calcium which was 14.4 mg/dl. The urinalysis showed strongly positive proteinuria (+2), with negative Bence Jones protein. Serum protein electrophoresis showed an increase and a spike pattern of beta-2 globulin (2.8 g/dl) and alpha-2 globulin (1.5 g/dl), with normal gamma globulin. By nephelometry technique, serum IgG was normal (1388 mg/dl), IgA was high (900 mg/dl), and IgM was also high (517 mg/dl). Advanced and extensive osteolytic lesions were found in the clavicle, ribs, skull, humerus, femur, and columna vertebralis. Plasma cells (myeloma cells) in bone marrow were 32%. The clinical diagnosis was multiple myeloma (biclonal gammopathy) stage IIIB (Durie and Salmon staging system). Clinical response was good after two series of conventional chemotherapy, with normal serum electrophoresis, decreasing serum creatinine and serum calcium. Based on the above data, the diagnosis of multiple myeloma with biclonal gammopathy was confirmed. This is a rare case with a combination of IgA and IgM M-components. PMID:10895208

  7. 广西汉族早老症家系三例病例研究--影像学特征分析%Study of Three Cases of Hutchinson - Gilford Progeria Syndrome in A Guangxi Han Family:Analysis of Imaging Featu re

    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

  8. 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

  9. 全关节镜下治疗肩锁关节脱位%Arthroscopic treatment of acromioclavicular joint dislocation

    Institute of Scientific and Technical Information of China (English)

    汪国友; 沈骅睿; 曾胜强; 徐平; 邓凯; 扶世杰

    2014-01-01

    .05 ).Autologous ligament group arthroscopic semitendinosus tendon reconstruction of coracoclavicular ligament coracoclavicular ligament.All patients underwent operation under general anesthesia with endotracheal intubation.Patients were placed at 75°beach chair position.Bony landmarks were marked.The ipsilateral semitendinosus tendon was harvested first.Glenohumeral examination was first done through posterior viewing portal.Then the under surface of coracoid was exposed by shaver.Then establish the bone tunnel of clavicle,basal part of coracoid and acromial,transplant and fix the grafted tendon,wash the wound, suture the wound layer by layer.Ethibond suture group arthroscopic double Endobutton plate and Ethibond reconstruction of coracoclavicular ligament.The arthroscopic explosion and tunnel reconstruction is the same with the group mentioned above,use double Endobutton plate and Ethibond suture to reconstruct coracoclavicular ligament.Make sure the button completely stuck in the upper surface of the coracoid clavicle and underlying surface,abduct the shoulder joint,press the clavicle to get the acromioclavicular joint reduced,tighten Ethibond tail and fix the knot,close the wound.Two groups of patients were immobilized by neck wrist sling for 6 weeks.The immediate postoperative activity of elbow and wrist joint were demanded,shoulder joint passive exercise beginning at 2 weeks, then start the shoulder joint initiative and resistance strength training after 6 to 8 weeks.After 6 months the patients were allowed to engage in some contact sports activities. Through clinical examination,X-ray and CC-Dist measurements,then calculate the improvement rate,(CC-Dist value:the vertical distance between coracoid plane and the subclavian plane on the shoulder joint radiograph) and the Constant score was used to evaluate the curative effect.The Constant score,composed of the following 8 parts:the shoulder pain (1 5 points),daily activities (20 points),range of motion of the shoulder joint

  10. An analysis of factors influencing the outcome of postoperative irradiation for squamous cell carcinoma of the oral cavity

    International Nuclear Information System (INIS)

    Purpose: To analyze factors influencing outcome in patients who received postoperative irradiation for advanced squamous cell carcinoma of the oral cavity. Methods and Materials: Between October 1964 and November 1993, 134 patients with 135 previously untreated primary invasive squamous cell carcinomas of the oral cavity (excluding the lip) were treated postoperatively with continuous courses of external-beam irradiation at the University of Florida. All patients had a minimum follow-up of 2 years (analysis, December 1995). No patient was lost to follow-up. Results: The 10-year actuarial rates of primary site, neck, and local-regional control were 79%, 88%, and 71%, respectively. Recurrence of cancer above the clavicles developed in 35 patients. Ninety-four percent of the recurrences were within the primary field of irradiation (anterior to the plane of the spinal cord); there were 24 recurrences at the primary site and nine in the upper neck alone. There were no failures in the neck area behind the plane of the spinal cord (i.e., the 'posterior strip'). Two failures occurred in the low neck below the level of the thyroid notch. In univariate analyses, factors that affected local-regional control included pathologic stage (I-II vs. III-IV, p = 0.04), margin status (invasive cancer at the margin vs. other, p = 0.0007), multifocal tumor (p = 0.05), peri neural invasion (p 0.04), and number of indications for postoperative irradiation (p = 0.05). Extracapsular nodal extension was marginally significant (p = 0.07). In multivariate analysis, positive margins and number of indications remained significant. These factors were used to define relatively favorable (< 4 indications, margins not positive) and unfavorable (≥ 4 indications and/or margins positive for invasive cancer) groups. For both favorable and unfavorable groups, there were nonsignificant trends toward improved local-regional control for patients who began irradiation within 45-50 days, compared with those

  11. 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.

  12. 颈肩峰区跨区供血轴型皮瓣的应用解剖%Applied anatomy of cervico-acromial crossing skin flap

    Institute of Scientific and Technical Information of China (English)

    胡春梅; 王乃利; 杨喆; 李养群; 唐勇; 赵穆欣

    2012-01-01

    目的 探讨颈肩峰区跨区供血轴型皮瓣的解剖学基础及临床应用可行性.方法 在北京协和医学院基础研究所解剖形态实验室提供的5具(10侧)新鲜成人尸体及10具(20侧)防腐成人标本上,应用医用红色乳胶灌注动脉,蓝色乳胶灌注静脉,在直视或手术显微镜下,解剖颈肩峰区动静脉、皮动脉以及真皮下血管网、深筋膜浅层血管网,对前界为锁骨、后界为肩胛冈、外侧界为肩峰、内侧为颈根部的颈肩峰区主要血供进行巨微解剖学观察.结果 ①皮动脉穿出点集中在斜方肌前缘及其延伸线的区域,宽度约4 cm的范围;②斜方肌前缘及其延伸线为轴心的中间部位,吻合支最为丰富,血管吻合多为网状,其次是肩胛冈上区.在众多的吻合支中可观察到每侧颈肩峰区均有2~3支明显的贯穿颈根至肩峰全长的吻合支,多位于中轴位置及后侧,在深筋膜浅层至真皮下血管网之间有丰富的交通支相连.结论 颈肩峰区皮动脉穿出点位置恒定,深筋膜浅层血管吻合支丰富,可形成颈肩峰区跨区供血轴型皮瓣.%Objective To investigate the applied anatomy of the blood supply of the cervicoacromial crossing flap and its feasibility in clinical application.Methods 5 fresh adult and 10 forman fixed adult cadaver specimens were used.The arteries,veins,cutaneous arteries,subdermal vascular network,and vascular network of the superficial layer of deep fascia in the cervico-acromial area were observed and studied under the microscope.The frontier border of the cervico-acromial area is clavicle,the posterior border is the spine of scapula,the outer border is acromion and the inner border is cervical base.Results ① The perforator branches concentrate at the front edge of trapezius muscle; ②The vessel network around the front edge of trapezius muscle is abundant.Among the anastomosis,two or three anastomosis which across the area from the base of the neck to

  13. 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.

  14. 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.

  15. 上腔静脉X线投影测量与患者相关因素的探讨%Studying and analyzing the relationship between X-ray cephalometry of superior vena cava and patient-related factors

    Institute of Scientific and Technical Information of China (English)

    耿才正; 陈姬雅; 王建铭

    2012-01-01

    Objective The aim of this study was to explore the relationship between the variables (age, sex, height, weight) and the lower segment of superior vena cava on the posteroanterior thorax radiograph, and to improve the in-vitro measurements accuracy of beside PICC. Methods The data of 100 cases adults physical examination were collected in Tai-Zhou hospital. We measnred the distance between the middle of the lower segment of superior vena cava to the inner side of the right clavicle, observed the front rib units which was projected the middle of the lower segment of superior vena cava, and then analyzed the correlation between the data (distance between vertical segment, the front rib units) and the variable (age, sex, height, weight) with IBM SPSS Statistics vl9 software. Results The front rib units planes was no significant correlation with sex. age, height and weight ( r =0. 196~0. 130, P =0. 051~0. 936). The distance between vertical segment was obvious correlation with body height and sex ( r =0. 197, -0. 339, P =0. 049,0. 001) and no significant correlation with age and body weight( r =0. 052, -0. 066, F =0. 604, 0. 512). Conclusion The projection of the lower segment of superior vena cava has the individual differences, which is affected by many factors besides age, sex, height and weight. Thus, it is difficult to improve the in-vitro measurements accuracy of beside PICC by analyzing the age. sex, height and weight of the patient.%目的 探讨成人上腔静脉下段后前位胸片投影是否与性别、年龄、身高、体重相关,以期提高床旁PICC体外测量的准确性.方法 成人体检资料100份,在后前位胸片上测量上腔静脉下段中点至右锁骨内端下缘距离(即横L体外测量法垂直段距离,以下简称“垂直段距离”),上腔静脉下段中点所在前肋肋单元平面,各数据会同性别、年龄、身高、体重,利用IBM SPSS Statistics v19统计软件作Pearson相关分析.结果 上腔静脉下段中点

  16. Reconsiderações sobre o tempo de consolidação das fraturas na picnodisostose Reconsiderations regarding time of fracture healing in Pycnodysostosis

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    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.

  17. Mastopexia de aumento, técnica de quinta generación Augmentation mastopexy, fifth generation technique

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    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.

  18. Tratamento artroscópico da tendinite calcária do manguito rotador Arthroscopic treatment of calcifying tendinitis of the rotator cuff

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    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.

  19. Imaging diagnosis and differential diagnosis of primary bone lymphoma%原发性骨淋巴瘤影像学诊断及鉴别诊断

    Institute of Scientific and Technical Information of China (English)

    罗泽斌; 陈晓东; 黄泽光

    2012-01-01

    Objective To explore the imaging diagnosis and differential diagnosis of primary bone lymphoma (PBL). Methods X- ray, CT and MRI findings of 12 cases with PBL proved by clinical and pathology( including immunohistochemistry) were retrospectively analysed. Results Among 12 cases of PBL, single lesion was detected in 11 cases (2 in femur, 1 in radius, 1 in clavicle, 2 in pelvis, 3 in craniofacial bone and 2 in vertebra) , while multiple bone infiltration was found in 1 case (sacral vertebrae). 10 cases underwent X-ray and CT examination. Bone destruction appeared as osteolytic type in 8 cases, including mouse biting-like in 5 and permeability in 3, and mixed type in 2 cases, including mixed bone dissolving and sclerosis type in one, cystic expansion type in one. There were 9 cases with bone cortex interruption and 2 cases with periosteum reaction, which appeared as layer in 1 and Codman triangle in 1. Bone sequestrum was found in 1 case and soft tissue masses were found in 9 cases. 6 cases underwent MR examination. MR imaging showed that the lesions were iso- or slight hypointense contrast to muscle on T1WI and slight to moderate hyperintense on T2WI, especially on T2 fat suppressuion sequence. Multi-vertebral bodies involved and extended into the spinal canal in 1 case. Soft tissue masses were seen in all cases with slight to medium homogeneous or heterogeneous enhancement, the extents of the soft tissue masses were wider than that of osseous destruction. Conclusion PBL has certain imaging characteristics, combined X-ray, CT and MRI findings can get more informations, which may be helpful for diagnosis.%目的 探讨原发性骨淋巴瘤(primary bone lymphoma,PBL)的影像学特点及鉴别诊断.方法 回顾性分析12例本院经临床和病理(包括免疫组化)证实的PBL病例的X线、CT和MRI表现.结果 单骨发病11例(股骨2例,桡骨1例,锁骨1例,骨盆2例,颅面骨3例,胸腰椎各1例),多骨发病1例(骶骨),共12例.X线和CT检查10

  20. 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

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    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.

  1. Compare of 3 different types of closed reduction and internal fixation for the fresh complete acromioclavicular dislocation%3种闭合复位内固定法治疗新鲜肩锁关节全脱位的疗效比较

    Institute of Scientific and Technical Information of China (English)

    聂伟志; 谭远超; 杨茂清; 朱惠芳

    2011-01-01

    目的:比较3种闭合复位内固定法治疗新鲜肩锁关节全脱住的疗效.方法:136例新鲜肩锁关节全脱位患者,闭合复位后采用经皮"肩峰-锁骨"双枚钢针固定治疗31例(A组),采用经皮"肩峰-锁骨"双枚钢针固定+经皮缝合肩锁关节囊治疗45例(B组),采用经皮"肩峰一锁骨"双枚钢针固定+经皮"锁骨一喙突"空心螺钉固定+经皮缝合肩锁关节囊治疗60例(c组,"三联固定"组),参照Karlsson评价标准比较3组疗效.结果:3组疗效之间的差异有统计学意义(x2=21.623,P=0.002),C组疗效优于B组(u=2.014,P=0.002),B组疗效优于A组(u=2.781,P=0.006).结论:经皮"肩峰-锁骨"双枚钢针固定+经皮"锁骨-喙突"空心螺钉固定+经皮缝合肩锁关节囊治疗新鲜肩锁关节全脱位,疗效优于经皮"肩峰-锁骨"钢针固定+经皮缝合肩锁关节囊,更优于单纯"肩峰-锁骨"钢针固定.%Objective: To compare the curative effect of 3 different types of closed reduction and internal fixation on fresh complete acromioclavicular dislocation. Methods: 136 patients sustained complete acromioclavicular dislocation were divided into 3 groups. 31 cases in Group A were treated with acromioclavicular closed reduction and acromioclavicular internal fixation by 2 steel - wire per cutem. 45 cases in Group B were treated with acromioclavicular closed reduction and acromioclavicular internal fixation by 2 steel - wire per cutem and suturation of the capsula articularis acromioclavicularis per cutem. 60 cases in Group C were treated with acromioclavicular closed reduction and acromioclavicular internal fixation by 2 steel - wire per cutem and suturation of the capsula articularis acromioclavicularis per cutem and fixation with a hollowed screw between the clavicle and the coracoid (three point fixation). The curative effects were evaluated according to Karlsson' s standard. Results: There was statistical difference in the curative effects between the 3 groups(x2 = 21. 623

  2. CURBSIDE CONSULTATION IN FRACTURE MANAGEMENT: 49 CLINICAL QUESTIONS

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    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

  3. A comparison of two treatments of Rockwood type Ⅲ acromioclavicular dislocation%Rockwood Ⅲ型肩锁关节脱位两种治疗方法分析

    Institute of Scientific and Technical Information of China (English)

    郭丹; 周海斌

    2013-01-01

    目的 探讨Rockwood Ⅲ型肩锁关节脱位手术及保守两种方法治疗后效果及对肩关节功能恢复的影响.方法 苏北人民医院和苏州大学附属第二医院骨科自2008年2月-2010年2月66例Rockwood Ⅲ型肩锁关节脱位病人,其中女性29例,男性37例,平均41.6岁,分锁骨钩钢板手术治疗和背带式锁骨固定带保守治疗,按调整的Constant-Murley评分系统随访观察各病例肩关节恢复情况.结果 Rockwood Ⅲ型肩锁关节脱位中,35例锁骨钩钢板手术治疗病例中3例出现肩关节活动受限、肩痛症状,背带式锁骨固定带保守治疗组31例病人中3例出现肩关节活动受限、肩痛症状,统计检验手术治疗组与保守治疗组之间评分差异无统计学意义(P>0.05).结论 Rockwood Ⅲ型肩锁关节脱位手术治疗与保守治疗对功能恢复影响差异不明显.%Objective To evaluate two treatment methods in Rockwood type Ⅲ acromioclavicular dislocation patients,and to evaluate the influence of trement methods on shoulder function. Methods From February,2008 to February,2010,66 Rockwood type Ⅲ acromioclavicular dislocation patients( 37 male and 29 female,average age 41. 6 )were treated in the Northern Jiangsu People' s Hospital and the Second Affiliated Hospital of Soochow University, with operation used hook plate and conservative treatment by clavicle sling immobilization respectively. Adjusted Constant-Murley Scale was used to evaluate shoulder function. Results In Rockwood type Ⅲ acromioclavicular dislocation. There were 3 cases with shoulder painful and restricted symptoms in the 35 patients treated with operation. There were 3 cases with shoulder painful and restricted symptoms in the 31 patients treated with conservative treatment patients. The difference between operation and conservative treatment was not significant P >0.05 ). Conclusion In Rockwood type Ⅲ acromioclavicular dislocation,for operation and conservative treatment,we could not

  4. 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

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    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

  5. 骨嗜酸性肉芽肿的影像学表现%Imaging findings of eosinophilic granuloma of bone

    Institute of Scientific and Technical Information of China (English)

    陈勇; 郑红伟; 徐海青; 薛鹏

    2013-01-01

    Objective:To study the imaging,clinical and pathology findings of eosinophilic granuloma (EG) of bone. Methods: The clinical and imaging findings of 25 patients with pathology proven eosinophilic granuloma of bone were retro-spectively analyzed. Results:Of the 25 cases with EG, there were solitary (23 patients) or multiple osteal lesions (2 pa-tients) , totally 27 lesions were found. The location of osteal lesions were skull (n=11) , vertebrae (n=2) ,clavicle (n=2) , scapula (n=l), pelvis (n=2) and long bone (n=9). All lesions showed round or oval osteolytic destruction, with neither sequestration nor calcification. Of the 10 skull lesions,penetrative osteolytic destruction manifested as "double line sign" on radiography. No intervertebral space narrowing or destruction was seen in the 2 vertebral lesions. Of the other 11 lesions, there were accompanied periosteal reaction (6 lesions) , marginal sclerosis (4 lesions) , expansively osteolytic bony destruc-tion (3 lesions). On CT,the lesions presented as high-density or slightly low-density nodus or mass. On MRI,the lesions showed slightly low-signal on T1WI, slightly high-signal on T2WI, accompanied with intra-tumoral necrosis and peri-tumor-al bone marrow and soft tissue edema. Of the 11 patients had Gd-DTPA enhanced MRI,mild (n=22) , morderate (n=4) and marked (n=5) enhancement could be assessed. Conclusion:EG often occurred in children and adolescents,characteristic imaging features could be seen, pathology characteristics including granuloma accompanied with peri-lesional inflammatory edema could be identified by MRI, accurate diagnosis could be obtained by comprehensive analysis of imaging in combination with clinical materials,yet the final diagnosis still depends on pathology.%目的:探讨骨嗜酸性肉芽肿(EG)的临床、病理及影像学表现.方法:回顾性分析经病理证实的25例骨EG患者的临床及影像学资料.结果:25例骨EG 中,23例单发病灶,2例多发病灶,共27

  6. Tratamento cirúrgico da fratura instável do anel pélvico em pacientes esqueleticamente imaturos Surgical treatment of unstable pelvic ring fracture in skeletally immature patients

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    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.

  7. 颈横动脉颈段皮支皮瓣修复颈部瘢痕挛缩%Repair of cervical scar contracture with flaps containing cervical cutaneous branch of the transverse cervical artery

    Institute of Scientific and Technical Information of China (English)

    马显杰; 李杨; 王璐; 李威扬; 董立维

    2012-01-01

    Objective To observe the therapeutic effect of repairing cervical scar contracture using flaps carrying cervical cutaneous branch of the transverse cervical artery. Methods Sixty-six patients with scar contracture after burn in anterior region of neck hosptalized from 1988 to 2011.The scars were excised and repaired with flaps containing the cervical cutaneous branch of transverse cervical artery.They included 55 island flaps (with 9 flaps pre-expanded) and 11 non-island flaps (with 1 flap pre-expanded).After removing the scar and releasing the contracture,flaps with the cervical cutaneous branch of transverse cervical artery were designed and raised in the supraclavicular and infraclavicular regions and the anterior thoracic region.The axial vessel of the flap was the cutaneous artery,which perforated in the crossing area of sternocleidomastoid muscle and omohvoid muscle and originated from the transverse cervical artery.The posterior borderline of the flap reached the anterior border of the trapezius muscle.Its exterior borderline reached the middle part of deltoid muscle,and its interior borderline ended at the midsternal line.The lower borderline was located 3.0-4.0 cm below the nipple.The incisions at the interior,lower,and exterior borders of the flap were first made.Then after sharp dissection to the clavicle,blunt dissection was performed to the pedicle to allow the flaps to be able to cover the wound after rotation without undue tension.The pre-expanded donor sites were sutured directly,while the un-expanded ones were covered with skin graft. Results Out of the 66 flaps,64 flaps survived.Two flaps showed partial necrosis at the distal end due to sub-flap hematoma,and they healed after skin grafting. All the donor sites healed. The color and texture of all flaps matched well with the surrounding skin tissue.The flaps regained sensation pertaining to the chest in the early stage,and complete sensation pertaining to the neck appeared 6 months after surgery

  8. 三种固定方式治疗肱骨大结节骨折的生物力学研究%Biomechanical research of three fixation methods for treatment of greater tuberosity fractures of humerus

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    钟树栅; 白波; 陈艺; 吴梅祥; 吴景明

    2015-01-01

    Objective To compare the biomechanical strength of three different fixation methods in the management of greater tuberosity ( GT) fractures: double suture anchor fixation, absorbable suture fixation, and two-screw fixation.Methods Nine pairs of fresh-frozen shoulder specimens of human cadavers were used.The skin, subcutaneous tissue, muscles, ligaments, tendons, scapula, and clavicles were resected, retaining only the humerus and supraspinatus.The distal humeral condyle was removed, leaving a 20 cm long humeral shaft.Standardized osteotomy oriented 50°to the humeral shaft was performed at the base of the GT using a thin blade reciprocating saw.The fracture samples were randomly assigned to three groups of three fixation methods:the AS group ( absorbable suture fixation) , the TS group ( two-screw fixation) and the DS group ( double suture anchor fixation) , six specimens in each group.The specimens simulated 0°abduction of the shoulder joint.The loading forces of the three fixation methods were determined at the yield and at the displacements of 3 mm and 5 mm.Results The mean loading force at the yield, at the displacement of 3 mm and the displacement of 5 mm in the AS group were as follows:(287.78 ±20.22) N, (348.67 ±12.62) N, (374.69 ±13.68) N; the data in the TS group were (146.03 ±13.73) N, ( 206.67 ±23.74 ) N, ( 250.42 ±22.27 ) N; the data in the DS group were (256.26 ±5.21 ) N, ( 337.59 ±6.18 ) N, ( 367.92 ±9.67 ) N.There were significant differences between the DS and TS groups as well as the AS and TS groups (P0.05 ) .Conclusions The results suggest that the absorbable suture fixation and suture anchor fixation may be stronger than the fixation using screws in the treatment of the humeral GT fracture.Absorbable suture fixation can effectively restore the mechanical stability of the fractures of greater tuberosity of humerus.%目的:比较可吸收缝线(AS)、双螺钉(TS)及双股锚钉(DS)三种固定方式治疗肱骨大结节

  9. 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

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    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.

  10. ANDREAE VESALII: THE BONES AND MUSCLES ANDREA VESALII: LOS HUESOS Y LOS MÚSCULOS

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    Henrique Ayres de Vasconcellos

    2004-01-01

    Full Text Available The historical references are taken from Aristoteles (384-322 a C considered the father of Kinesiology, and Claudius Galenus from Pergamon (131-201, the first team doctor. Both men´s studies shared the same objective: functional-anatomic aspects related to the Locomotive System. Although there were several descriptive anatomic studies of bones and muscles, it was Andreas Vesalius (1514-1564, whom most significantly contributed to the development of a new methodology for the lectures of Anatomy, with the setting up of skeletons and dissection of bodies during his lessons. Objectives: the aim of this paper is study the description of bones and muscles from the Vesalius works. We search Vesalius´s publications, specially "De Humani Corporis Fabrica Liber Septem (1543. Results: Bones and muscles were studied by Vesalius in 1st and 2nd chapters of his Fabrica. He described: scapula; incus and malleus; pre-maxillar; mandible; hyoid; vertebrae; sphenoid; clavicle; bones of the carpus; sternum (with three bones; os vesalianum. The author defines the muscles shown in the Fabrica as "full of life" . These are contracted muscles, giving the presentation a anatomic-functional aspects, which is referred as an essential contribution payed by Vesalius. He described the muscles choanoides and the rectus of abdomen, and determined the action of tendons and muscles. It ´s evident the interest of Vesalius by bones and muscles. The artistic aspects were realized by Johann Stephan Kalkar which is able to show bones and muscles in action. We can conclude the importance of the findings of Vesalius to the modern Human Anatomy even though some of the descriptions and definitions have changed over timeRelatos históricos mencionan a Aristóteles (384-322 a C, padre de la Kinesiología y Claudio Galeno (131-201, 1. Médico de equipo como los primeros en dedicarse al estudio del Aparato Locomotor. Sin embargo, la descripción anatómica de los huesos y de los m

  11. 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

  12. 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.

  13. 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

  14. 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