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Sample records for clavicle

  1. Pneumothorax complicating isolated clavicle fracture.

    Science.gov (United States)

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

    2015-01-01

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

  2. 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.

  3. 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.

  4. Distal clavicle fractures in children☆

    Science.gov (United States)

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

    2015-01-01

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

  5. 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.

  6. 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.

  7. 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

  8. 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.

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

    LENUS (Irish Health Repository)

    Daruwalla, Zubin J

    2010-01-01

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

  10. Langerhans Cell Histiocytosis of the Clavicle

    Science.gov (United States)

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

    2014-01-01

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

  11. 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.

  12. 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.

  13. Conceptual finite element study for comparison among superior, anterior, and spiral clavicle plate fixations for midshaft clavicle fracture.

    Science.gov (United States)

    Huang, Teng-Le; Chen, Wen-Chuan; Lin, Kun-Jhih; Tsai, Cheng-Lun; Lin, Kang-Ping; Wei, Hung-Wen

    2016-10-01

    Open reduction internal fixation technique has been generally accepted for treatment of midshaft clavicle fractures. Both superior and anterior clavicle plates have been reported in clinical or biomechanical researches, while presently the spiral clavicle plate design has been introduced improved biomechanical behavior over conventional designs. In order to objectively realize the multi-directional biomechanical performances among the three geometries for clavicle plate designs, a current conceptual finite element study has been conducted with identical cross-sectional features for clavicle plates. The conceptual superior, anterior, and spiral clavicle plate models were constructed for virtual reduction and fixation to an OTA 15-B1.3 midshaft transverse fracture of clavicle. Mechanical load cases including cantilever bending, axial compression, inferior bending, and axial torsion have been applied for confirming the multi-directional structural stability and implant safety in biomechanical perspective. Results revealed that the anterior clavicle plate model represented lowest plate stress under all loading cases. The superior clavicle plate model showed greater axial compressive stiffness, while the anterior clavicle plate model performed greater rigidity under cantilever bending load. Three model represented similar structural stiffness under axial torsion. Played as a transition structure between superior and anterior clavicle plate, the spiral clavicle plate model revealed comparable results with acceptable multi-directional biomechanical behavior. The concept of spiral clavicle plate design is worth considering in practical application in clinics. Implant safety should be further investigated by evidences in future mechanical tests and clinical observations. PMID:27423702

  14. 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.

  15. Locking plate osteosynthesis of clavicle fractures

    DEFF Research Database (Denmark)

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

    2013-01-01

    PURPOSE: Locking plate osteosynthesis has become the preferred method for operative treatment of clavicle fractures. The method offers stable fixation, and would theoretically be associated with a low rate of fracture-related complications and reoperations. However, this remains to be explored...... in 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...... weeks. By studying patient files and radiographic material, we assessed complications and reoperations. RESULTS: Overall, there were 31 cases (30 %) of plate removals for discomfort. There were five cases (5 %) of failure of osteosynthesis: two occurred early after approximately six weeks and three late after ten...

  16. Pneumothorax Caused by an Isolated Midshaft Clavicle Fracture.

    Science.gov (United States)

    Feriani, Najla; Ben Ghezala, Hassen; Snouda, Salah

    2016-01-01

    Patients with isolated clavicle fractures are frequent in the emergency department. However, unusual clavicle fractures complications, such as pneumothorax, are rare. Previous reports indicated that all pneumothorax cases were treated via performing thoracostomy. Conservatively, the treatment of the clavicle fracture, like in our case, was successful. Despite the fact that isolated clavicle fractures rarely cause complications and generally heal with immobilization, serious complications may occur requiring urgent treatment. It has been proven that physical examinations, with particular attention to the neurovascular and chest examinations, and radiographs of the clavicle are necessary to prevent overlooking these potentially dangerous complications. PMID:27148462

  17. Pneumothorax Caused by an Isolated Midshaft Clavicle Fracture

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    Najla Feriani

    2016-01-01

    Full Text Available Patients with isolated clavicle fractures are frequent in the emergency department. However, unusual clavicle fractures complications, such as pneumothorax, are rare. Previous reports indicated that all pneumothorax cases were treated via performing thoracostomy. Conservatively, the treatment of the clavicle fracture, like in our case, was successful. Despite the fact that isolated clavicle fractures rarely cause complications and generally heal with immobilization, serious complications may occur requiring urgent treatment. It has been proven that physical examinations, with particular attention to the neurovascular and chest examinations, and radiographs of the clavicle are necessary to prevent overlooking these potentially dangerous complications.

  18. Bilateral Clavicle Fractures: A Report of Three Cases.

    Science.gov (United States)

    Lakhotia, Devendra; Khatri, Kavin; Sharma, Vijay; Farooque, Kamran; Sharma, Swati

    2016-06-01

    Bilateral clavicle fractures are uncommonly reported in the literature with the incidence being less than 0.5% of all the clavicle fractures. Bilateral clavicle fractures are caused either by high-energy transfer of compression forces across both shoulder girdles or by a direct trauma to one clavicle followed by that to the other clavicle. These fractures could be missed due to their association with more severe chest injuries or a more symptomatically displaced fracture on one side or due to inadequate chest radiographs. We report three cases of traumatic bilateral clavicle fractures with three modes of injuries in different age groups. All the fractures were treated conservatively with good functional outcomes without any sequelae. Bilateral clavicle fractures should be actively sought by every trauma team with proper clinical examination and chest radiographs including both shoulder joints in high-energy trauma cases or with bilateral shoulder compression injuries. PMID:27504365

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

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    Fitzpatrick David

    2010-03-01

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

  20. 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

  1. Primary Osteomyelitis of the Clavicle in Children.

    Science.gov (United States)

    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

  2. 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...

  3. 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 ...

  4. 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.)

  5. 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.

  6. 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.

  7. 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.

  8. 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

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

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    Vittal

    2015-05-01

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

  10. 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.

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

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    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

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

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    Siwei Sun

    2016-01-01

    Full Text Available 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.

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

    NARCIS (Netherlands)

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

    1992-01-01

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

  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. The Treatment of Mid-shaft Clavicle Fractures

    Institute of Scientific and Technical Information of China (English)

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

    2015-01-01

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

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

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    Bindhu.S

    2015-09-01

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

  17. 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.

  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. [CLAVICLE FRACTURES IN CHILDREN--CIRCUMSTANCES AND CAUSES OF INJURY].

    Science.gov (United States)

    Antabak, Anko; Matković, Nikša; Papeš, Dino; Karlo, Robert; Romić, Ivan; Fuchs, Nino; Madarić, Miroslav; Stilinović, Marina; Stanić, Lana; Luetić, Tomislav

    2015-01-01

    Clavicle fractures in children occur twice as often as in adults. During a child's growth period they account for 10-15% of all fractures sustained. The questions which should be asked are how these fractures are sustained and under which circumstances are the children injured. In the study 256 children with clavicle fractures treated during the period 2008-2013 were analyzed. The underlying cause and place of injuries were classified using the ICD-10 classification system, using environmental causes of injury. The circumstances were in each case accidental injury. Environmental causes were traffic accidents (V01-V99) or mishaps/accidents (W00-X59). Fracture injuries were caused in traffic accidents in 24 (9.4%), and in mishaps/accidents in 232 (90.6%) children. Of the injuries caused by mishaps/accidents, in 204 children these were caused by falls (W00-W19). In 123 of them the injuries were caused by falls from a ground level, and in 81 were from a greater height. Direct blow injuries, caused by another person or a blunt instrument, weere the causes of fractures seen in 28 children. Place of fracture sustainment was dominantly at home. This was followed by injuries sustained outside in recreational areas, while least were suffered at school or kindergarden facilities. Bicycle riding was the cause of clavicle fractures in 48 children, which was 18.7% of all fractures seen. Sports related injuries and fractures were seen in 47 (18.4%) out of 256 children: 30 in football, 10 in defensive sports (wrestling, judo, karate), three in hockey, while basketball and gymnastics accounted for two each. Preschool children were injured more often while in the care of their parents while school aged children were adaquately protected, but in after-school activities they were often injured. The most common injuries after school were those suffered in traffic accidents and recreational sports activities. In the adolescent period, the most common injuries seen were again those in

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

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    Тимур Фаизович Зубаиров

    2014-09-01

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

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

    Institute of Scientific and Technical Information of China (English)

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

    2009-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Eisaku Ito

    2015-01-01

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

  3. 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.

  4. 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...

  5. 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...

  6. Locking plates for displaced fractures of the lateral end of clavicle: Potential pitfalls

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    Soha Sajid

    2012-01-01

    Full Text Available Roughly a quarter of all clavicle fractures occur at the lateral end. Displaced fractures of the lateral clavicle have a higher rate of nonunion. The management of fractures of the lateral clavicle remains controversial. Open reduction internal fixation with a superiorly placed locking plate is a recently developed technique. However, there are no randomized controlled trials to evaluate the efficacy of this procedure. We present a series of four cases which highlight the technical drawbacks with this method of fixation for lateral clavicle fractures. Two cases show that failure of the plate to negate the displacing forces at the fracture site can lead to plate pullout. Two cases illustrate an unusual complication of an iatrogenic injury to the acromioclavicular joint capsule which led to joint instability and dislocation. We advise caution in using this method of fixation. Recent studies have described the success of lateral clavicle locking plate fixation augmented with a coracoclavicular sling. This augmentation accounts for the displacing forces at the fracture site. We would recommend that when performing lateral clavicle locking plate fixation, it should be reinforced with a coracoclavicular sling to prevent plate failure by lateral screw pullout.

  7. 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

  8. 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

  9. [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

  10. 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.)

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

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    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.

  12. 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

  13. 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

  14. 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.

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

    DEFF Research Database (Denmark)

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

    2013-01-01

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

  16. 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

  17. 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.

  18. 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

  19. Report of two cases of non-union of clavicle treated with nonsurgical management

    Directory of Open Access Journals (Sweden)

    Anupama Gupta

    2010-01-01

    Full Text Available Context : Fractures of the clavicle usually occur at the junction of the medial two third with the lateral one third and usually heal by nonsurgical measures. Radiographs and MRI of the shoulder provide helpful investigations for diagnosis and treatment. In the following cases, an anterior-posterior view revealed non-union of the clavicle on the right side, which is atypical in children. Case Report : Non-union of a clavicular fracture is an extremely rare condition, especially in children. We are reporting two cases in this paper; in the first case; an 8-year-old male child visited the hospital with a history of fracture of the right clavicle one year ago. In the second case, a 26-year-old male patient presented with a history of fracture of the right clavicle six years ago. Conclusion : Careful attention should be paid when obtaining a detailed history and physical examinations, as traumatic arthritis at either clavicular joint may mimic non-union. The explicable evidence of osseous non-union on radiographs may be minor and may not correlate with the clinical symptoms.

  20. 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.

  1. 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

  2. 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...

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

    Directory of Open Access Journals (Sweden)

    Tae-Soo Park

    2016-01-01

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

  4. 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)

  5. 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)

  6. 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...

  7. 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...

  8. 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.

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

    Institute of Scientific and Technical Information of China (English)

    蒋玮; 祝晓忠

    2015-01-01

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

  10. 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...

  11. 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

  12. 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.

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

    Directory of Open Access Journals (Sweden)

    Shital N. Parikh

    2014-01-01

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

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

    DEFF Research Database (Denmark)

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

    2014-01-01

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

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

    Science.gov (United States)

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

    2012-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Qingjun Liu, Jianyun Miao, Bin Lin, Kejian Lian

    2012-01-01

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

  17. 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...

  18. Clavicle length, throwing performance and the reconstruction of the Homo erectus shoulder.

    Science.gov (United States)

    Roach, Neil T; Richmond, Brian G

    2015-03-01

    Powerful, accurate throwing may have been an important mode of early hunting and defense. Previous work has shown that throwing performance is functionally linked to several anatomical shifts in the upper body that occurred during human evolution. The final shift to occur is the inferior reorientation of the shoulder. Fossil scapulae show the earliest evidence of a more inferior glenoid in Homo erectus. However, where the scapula rests on the thorax is uncertain. The relative length of the clavicle, the only skeletal attachment of the scapula to the torso, is quite variable. Depending on which fossils or skeletal measures are used to reconstruct the H. erectus shoulder, either a novel, anteriorly facing shoulder configuration or a modern human-like lateral orientation is possible. These competing hypotheses have led to very different conclusions regarding the throwing ability and hunting behavior of early Homo. Here, we evaluate competing models of H. erectus shoulder morphology and examine how these models relate to throwing performance. To address these questions, we collected skeletal measures from fossil and extant taxa, as well as anthropometric (N = 36) and kinematic (N = 27) data from Daasanach throwers from northwestern Kenya. Our data show that all H. erectus fossil clavicles fall within the normal range of modern human variation. We find that a commonly used metric for normalizing clavicle length, the claviculohumeral ratio, poorly predicts shoulder position on the torso. Furthermore, no significant relationship between clavicle length and any measure of throwing performance was found. These data support reconstructing the H. erectus shoulder as modern human-like, with a laterally facing glenoid, and suggest that the capacity for high speed throwing dates back nearly two million years. PMID:25439706

  19. 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.

  20. 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

  1. 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.

  2. 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

  3. 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.

  4. Treatment of Midshaft Clavicle Fractures: Application of Local Autograft With Concurrent Plate Fixation.

    Science.gov (United States)

    Slette, Erik L; Mikula, Jacob D; Turnbull, Travis Lee; Hackett, Thomas R

    2016-06-01

    Currently, open reduction-internal fixation using contoured plates or intramedullary nails is considered the standard operative treatment for midshaft clavicle fractures because of the immediate rigid stability provided by the fixation device. In addition, autologous iliac crest bone graft has proved to augment osteosynthesis during internal fixation of nonunion fractures through the release of osteogenic factors. The purpose of this article is to describe a surgical technique developed to reduce donor-site morbidity and improve functional and objective outcomes after open reduction-internal fixation with autologous bone graft placement through local autograft harvesting and concurrent plate fixation. PMID:27656378

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

    Science.gov (United States)

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

    2015-01-01

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

  6. 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.)

  7. 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.

  8. 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

  9. 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.

  10. 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.

  11. 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.

  12. 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

  13. 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.

  14. 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

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

    Science.gov (United States)

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

    2015-01-01

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

  16. 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

  17. 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

  18. 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

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

    DEFF Research Database (Denmark)

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

    2016-01-01

    were estimated. RESULTS: Inter-rater reliability of the total CS was excellent (interclass correlation coefficient, 0.94; 95% confidence interval, 0.88-0.97), with no systematic difference between the 2 raters (P = .75). The standard error of measurement (measurement error at the group level) was 4...... and Hand score. CONCLUSIONS: The CS was found to be reliable for assessing patients with clavicle fractures, especially at the group level. With high inter-rater reliability and agreement, in addition to good internal consistency, the standardized CS used in this study can be used for comparison of results...

  20. 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.

  1. Risk Factors for Non-:union: Fractures of the Clavicle Mid-shift Following the Use of Non-surgical Treatment on Patients Admitted to Poursina Hospital, 2010 - 2012

    Directory of Open Access Journals (Sweden)

    kamran Asadi

    2015-02-01

    Conclusions: Recognition and predicting the risk factors of non-:::union::: in patients with fractures of the middle third of the clavicle could be a clinical guideline for the selection of surgical or non-surgical treatment.

  2. 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.

  3. 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.

  4. 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...

  5. 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.

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

    Institute of Scientific and Technical Information of China (English)

    RK Gupta; Raj Singh; Vinit Verma; Amit Batra; Nishant Setia; Paritosh Gogna; Jeetesh Gawande

    2014-01-01

    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.

  7. 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.)

  8. 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)

  9. 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 ...

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

    Institute of Scientific and Technical Information of China (English)

    许永康; 舒占坤; 张羽

    2015-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Mantonakis Eleftherios I

    2012-03-01

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

  12. Postoperative irradiation for squamous cell carcinomas of the head and neck: analysis of time-dose factors related to control above the clavicles

    Energy Technology Data Exchange (ETDEWEB)

    Marcus, R.B. Jr.; Million, R.R.; Cassissi, N.J.

    1979-11-01

    The combination of radical surgery followed by postoperative irradiation is commonly employed in the treatment of advanced heat and neck cancers. However, there has been little in the literature concerning the dose required to prevent recurrence after operation. A retrospective analysis of 71 patients with squamous cell carcinoma of the oral cavity, oropharynx, pyriform sinus, supraglottic larynx, and glottic larynx who were treated by surgery and postoperative irradiation attempted to define the time-dose relationship required to prevent recurrence. The failure rate above the clavicles decreased with increasing dose up to 7000 rad. The effect on control of positve surgical margins, bone and cartilage invasion, neck staging, perineural extension, perinodal extension, and split-course technique was reviewed; both positive surgical margins and split-course technique were found to be associated with a decrease in local control at every dose level below 6500 rad. The complications of combined therapy were foound to be independent of dose. From these analyses, dose recommendations for various clinical situations are made, as well as recommendations for adjustments in radiation techniques to take advantage of the predictable sites of recurrence.

  13. 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

  14. Application of cervical brachial plexus block in the operation of clavicle fracture%颈臂丛联合神经阻滞在锁骨骨折手术中的应用

    Institute of Scientific and Technical Information of China (English)

    卢秋霞

    2015-01-01

    目的:探讨颈臂丛神经阻滞麻醉在锁骨骨折手术中的麻醉方法及效果。方法:收治锁骨骨折患者90例,随机分为颈臂丛联合阻滞麻醉组、颈丛阻滞麻醉组、臂丛阻滞麻醉组各30例,比较3种麻醉方法的麻醉效果和不良反应。结果:颈臂丛联合组麻醉效果最为满意,而不良反应发生率的差异无统计学意义。结论:颈臂丛联合神经阻滞用于锁骨骨折手术麻醉效果满意,阻滞效果明显优于颈丛、臂丛神经阻滞,不良反应小。%Objective:To explore the anesthetic method and effect of cervical brachial plexus block in the operation of clavicle fracture.Methods:90 patients with clavicle fractures were selected,they were randomly divided into the cervical brachial plexus block anesthesia group,cervical plexus block anesthesia group and brachial plexus block anesthesia group with 30 cases in each, we compared the anesthesia effect and adverse reactions of the three methods.Methods:Anesthetic effect of cervical brachial plexus block was most satisfactory,and the difference of the incidence of adverse reactions was not statistically significant. Conclusion:The anesthetic effect of cervical brachial plexus block in the operation of clavicle fracture was satisfactory,the blocking effect was significantly better than that of cervical plexus block and brachial plexus block,and the side effects were small.

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

    Science.gov (United States)

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

    2014-04-15

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

  16. 臂丛联合颈浅丛阻滞用于锁骨骨折麻醉效果观察%Effect Observation of Brachial Plexus Combined with Superficial Cervical Plexus Block in Anesthesia for Fracture of the Clavicle

    Institute of Scientific and Technical Information of China (English)

    洪顺垣; 江映; 梁惠玲

    2014-01-01

    目的:研究分析采用臂丛联合颈浅丛阻滞用于锁骨骨折术中麻醉的效果。方法选取2011-2012年于本院进行锁骨骨折内固定术患者80例,分为对照组和研究组,对照组采用臂丛阻滞麻醉,研究组采用臂丛联合颈浅丛阻滞麻醉,比较两组麻醉效果和麻醉过程中生命体征变化以及不良反应的发生情况。结果研究组麻醉效果优于对照组,差异有统计学意义(P0.05)。结论臂丛联合颈浅丛阻滞用于锁骨骨折麻醉效果优异,并且患者生命体征稳定,不良反应少,值得临床广泛推广应用。%Objective To study and analyze the effect of brachial plexus combined with superficial cervical plexus block in anes-thesia for fracture of the clavicle. Methods 80 patients underwent clavicle fracture fixation in our hospital from 2011 to 2012 were chosen and divided into the control group and the study group. Control group was given brachial plexus block anesthesia while study group was given brachial plexus combined with superficial cervical plexus block anesthesia. The anesthetic effects and life sign changes during anesthesia and adverse effects of the 2 groups were compared. Results The anesthetic effect of the study group was better than that of the control group, the difference was statistically significant (P0.05). Conclusion Brachial plexus combined with superficial cervical plexus block in anesthesia for fracture of the clavicle has a great effect. It can keep life signs steady and has few adverse effects, so it's worthy of being popularized in clinical work.

  17. 锁骨上神经复合臂丛神经阻滞在锁骨手术中的应用%Application of supraclavicular nerves combined with brachial plexus block in the clavicle surgery

    Institute of Scientific and Technical Information of China (English)

    王锐; 韩凤

    2014-01-01

    目的:观察锁骨上神经复合臂丛神经阻滞在锁骨手术中的麻醉效果。方法选取80例锁骨骨折的患者作为研究对象,随机分成A、B两组,各40例。 A组采用单纯高位肌间沟的臂丛神经阻滞方法,B组采用锁骨上神经复合臂丛神经阻滞的麻醉方法。比较两组的麻醉效果及不良反应。结果 B组的麻醉效果显著优于A组,差异有统计学意义(P<0.05);两组均无明显不良反应。结论锁骨上神经联合臂丛神经阻滞用于锁骨骨折手术,能产生良好的麻醉效果,值得临床推广应用。%Objective To observe the anesthesia effect of supraclavicular nerves combined with brachial plexus block in the clavicle surgery. Methods 80 cases with clavicular fracture were selected and randomly divided into group A and group B,40 cases in each group.Group A was given brachial plexus block,group B was given supraclavicular nerves combined with brachial plexus block.Anesthetic effects and adverse reactions was observed respectively. Results Anes-thetic effect in Group B was better than that in Group A,with statistical difference(P<0.05).There were no significant ad-verse reactions in the two groups. Conclusion The anesthesia effect of supraclavicular nerves combined with brachial plexus block in the clavicle surgery is good,it is worthy of clinical promotion and application.

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

    Institute of Scientific and Technical Information of China (English)

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

    2016-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Roberto Joaquín Del Gordo-D´Amato

    2014-11-01

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

  20. Anatomical basis for nerve block of the brachial plexus via superomedial to midpoint of the clavicle%锁骨中点内上方阻滞臂丛神经的解剖学

    Institute of Scientific and Technical Information of China (English)

    董西安; 李光宗; 郭荣奎; 刘宝梅; 孙静; 鞠晓华; 张志玉

    2011-01-01

    Objective: To provide the morphological basis for blocking the brachial plexus via superomedial to midpoint of the clavicle. Methods:Length of the brachial plexus, diameter of the junction of three cords of the brachial plexus above the first rib were measured on sixteen fixed cadavers, in order to identify the optimal point, direction, angle and depth of needling on account that the subclavian artery was prevented. Results: The length of the brachial plexus was 108. 09 mm±12. 49 mm. The diameter of the junction of three cords of the brachial plexus above the first rib was 16. 40 mm±2. 10 mm. The distance of needling pathway was 25. 45 mm± 0. 42 mm. The optimal angle that could protect the subclavian artery was 12. 85°±0. 59°. Conclusion: The needle can be inserted at the point that 10 mm inwards and 23 mm upwards to the midpoint of the clavicle, and run inferolaterally (meaning at 140° that identify as the angle between the vertical line through the needling point and the needling pathway) toward superior border of the midpoint of the clavicle. The angle is 12. 85° to protect the subclavian artery. This approach is effective to complete block the brachial plexus without complications such as pneumothorax and hemothorax.%目的:为临床麻醉工作者提供锁骨中点上方阻滞人路方法.方法:在经10%甲醛溶液固定的60侧头颈、上肢标本及锁骨中点矢状切断面标本上测量臂丛的长度、第1肋上面臂丛神经3束汇合处的直径,确定臂丛阻滞进针点、进针方向、进针角度、进针深度、确定锁骨下动脉的保护角度.结果:臂丛神经的长度为108.09mm±12.49 mm;第1肋上面臂丛神经3束汇合处的直径为16.40 mm±2.10 mm;进针路径(即进针点至锁骨中点上缘)距离为25.45mm±0.42 mm;保护锁骨下动脉的夹角为12.85°±0.59°.结论:锁骨中点向内10 mm向上23 mm处即为进针点,以140°(即进针点的垂线与进针路径呈的夹角)斜向外下至

  1. 颈丛臂丛阻滞麻醉用于锁骨骨折内固定的临床观察%Clinical Observation of Brachial Plexus and Cervical Plexus Block Anesthesia for Internal Fixation of Clavicle Fracture

    Institute of Scientific and Technical Information of China (English)

    郝永婷; 龚丽娜

    2011-01-01

    Objective: To observe the effect of brachial plexus and cervical plexus block anesthesia for the internal fixation of clavicle fractures. Method: We selected 96 cases of internal fixation of clavicle fractures which were admitted in our hospital from January 2008 to January 2010. The patients were divided into three groups that called A, B, C. Group A took brachial plexus block anesthesia; Group B took cervical plexus block anesthesia; Group C took cervical plexus and cervical plexus block anesthesia. Then compared the effect of three groups and selected the best group of anesthesia. Result: There was no significant difference ( P>0.05 ) between group A and group B. However, Group C were different fromgroup A and group B ( P <0.05 ), which showed that group C was better than group A or B. That showed cervical plexus and cervical plexus block anesthesia had a better effect on the patient than the others. Conclusion: The combined of cervical plexus and brachial plexus block anesthesia is superior to simple cervical or plexus block anesthesia,it is worth to promote the cervical plexus and brachial plexus block anesthesia in the internal fixation of clavicie fracture.%目的:观察颈丛臂丛阻滞麻醉用于锁骨骨折内固定的麻醉效果.方法:选取我院2008年1月到2010年1月锁骨骨折手术患者96例,随机分成A、B、C三组,每组32例,A组采用臂丛阻滞麻醉;B组采用颈丛阻滞麻醉;C组采用先进行臂丛阻滞麻醉,15min后进行颈丛阻滞麻醉的联合麻醉方法,比较三组麻醉效果.结果:A组与B组比较,两者无显著性差异(P>0.05),C的麻醉效果明显优于A组与B组,C组与A和B组均存在显著性差异(P<0.05).结论:颈丛臂丛联合阻滞麻醉优于单纯的臂丛和颈丛阻滞麻醉,值得在锁骨骨折内固定手术中的推广应用.

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

    Institute of Scientific and Technical Information of China (English)

    尹峰; 王晓东; 梁炜; 任龙韬

    2016-01-01

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

  3. 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

  4. 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

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    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.

  5. Carotid Brachial Plexus Nerve Block Anesthesia in the Clinical Application Effect of Operation of the Fracture of the Clavicle%颈臂丛联合神经阻滞麻醉在锁骨骨折手术中的临床应用效果

    Institute of Scientific and Technical Information of China (English)

    张彦东

    2014-01-01

    ObjectiveTo explore the clinical effect of anesthesia in the operation of cervical brachial plexus block of clavicle fracture.MethodsFrom January 2011 to June 2013 year to select 100 cases of clavicle fracture patients, randomly divided into observation group and control group, respectively, the implementation of brachial plexus block and brachial plexus block, block effect and adverse reactions were observed in 2 groups.ResultsThe observation group and the control group with excellent and good rate were 100%, 86% (P0.05). ConclusionCarotid brachial plexus nerve block for operation of clavicular fracture, clinical anesthesia effect is better than that of cervical plexus block, is worth the clinical promotion.%目的:探讨锁骨骨折手术中颈臂丛联合阻滞麻醉在临床应用效果。方法2011年1月至2013年6月选取100例锁骨骨折患者,随机分为对照组和观察组,分别实施臂丛神经阻滞以及颈臂丛联合阻滞,观察2组阻滞效果及不良反应。结果观察组及对照组患者的优良率分别为100%、86%(P0.05)。结论颈臂丛联合神经阻滞用于锁骨骨折手术,临床阻滞效果优于颈丛神经阻滞,值得临床推广。

  6. Reconstruction of coracoclavicular ligament by excision and semi-inversion of conjoined tendon at the distal clavicle and allograft tendon transfer for treatment of acromioclavicular separation%锁骨远端切除联合腱外侧半反转辅助异体肌腱移植重建喙锁韧带治疗肩锁关节脱位

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    孙策勇; 朱以明; 李奉龙; 姜春岩; 彭明学; 王自鸿

    2015-01-01

    目的 探讨锁骨远端切除联合腱外侧半反转辅助异体肌腱移植重建喙锁韧带治疗肩锁关节脱位的术后中长期疗效. 方法 回顾性分析2006年1月至2008年1月间采用锁骨远端切除联合腱外侧半反转辅助异体肌腱移植重建喙锁韧带手术治疗的54例肩锁关节脱位患者资料,男34例,女20例;年龄21.7~64.1岁,平均40.4岁.受伤至手术时间平均为12.2 d(3 ~20 d).肩锁关节脱位按Rockwood分型:Ⅲ型6例,Ⅳ型6例,Ⅴ型42例.末次随访时采用疼痛视觉模拟评分(VAS)、美国肩肘外科医师评分(ASES)评分及Constant-Murley评分评价患者肩关节功能,同时摄肩关节X线片以评估肩锁关节复位是否丢失. 结果 术后54例患者平均随访64.2个月(48.6~92.2个月).末次随访时患者肩关节前屈上举平均为170.0°(160°~ 180°),体侧外旋为57.8°(40°~ 80°),内旋至T8水平(T2~T12).VAS评分平均为0.7分(0~4分),平均ASES评分为90.4分(81.7 ~100.0分),Constant-Murley 评分平均为90.9分(83.0~100.0分).12例(22.2%)患者出现肩锁关节压痛;6例(11.1%)Ⅴ型损伤患者出现部分复位丢失;无一例患者出现完全复位丢失. 结论 采用锁骨远端切除联合腱外侧半反转辅助异体肌腱移植重建喙锁韧带的方法治疗重度肩锁关节脱位,患者的肩关节功能恢复满意,中长期疗效较好,多数患者肩锁关节保持稳定.%Objective To investigate the mid-and long-term outcomes of reconstruction of coracoclavicular ligament by excision and semi-inversion of conjoined tendon at the distal clavicle and allograft tendon transfer in the treatment of acromioclavicular separation.Methods From January 2006 to January 2008,54 patients with acromioclavicular separation were treated by reconstruction of coracoclavicular ligament by excision and semi-inversion of conjoined tendon at the distal clavicle and allograft tendon transfer.They were 34 men and 20 women,with a mean age of 40

  7. 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.

  8. 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

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

    Institute of Scientific and Technical Information of China (English)

    段洪; 刘宗良; 闵捷; 贺云; 李兴国

    2012-01-01

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

  10. 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

  11. 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

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

    NARCIS (Netherlands)

    Stegeman, Sylvia Alexandra

    2015-01-01

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

  13. 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.

  14. 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

  15. 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...

  16. Reconstruction with non-vascularized fibular autograft after resection of clavicular benign tumor.

    Science.gov (United States)

    Cahueque, Mario; Macias, Daniel; Moreno, Guillermo

    2015-12-01

    Chondroblastoma is a rare, benign cartilaginous neoplasm that accounts for approximately 1% of all bone tumors, and approximately 4% of all chondroblastomas arise in the clavicle. Here, we report a case of chondroblastoma in the right clavicle. 27-year-old female patient presented with a 12-month history of shoulder pain. Based on radiological and pathological examination, the diagnosis was compatible with chondroblastoma. After resection of the tumor, 1 cm of the distal clavicle was preserved, 15 cm of the non-vascularized fibula was taken from the contralateral leg and placed on the site of the clavicle and fixed with hook plate at distal clavicle and reconstruction plate attached to the sternum. 13 months of follow-up is scheduled for removal of osteosynthesis material, finding full consolidation of sternoclavicular segment and the distal segment. A good functional outcome was apparent after a limited 14-month follow-up, and the patient was highly satisfied with the result. We found no recurrence or metastasis. PMID:27047232

  17. 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.

  18. 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.

  19. 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.

  20. Acromioclavicular Joint Reconstruction.

    Science.gov (United States)

    Scillia, Anthony J; Cain, E Lyle

    2015-12-01

    Our technique for acromioclavicular joint reconstruction provides a variation on coracoclavicular ligament reconstruction to also include acromioclavicular ligament reconstruction. An oblique acromial tunnel is drilled, and the medial limb of the gracilis graft, after being crossed and passed beneath the coracoid and through the clavicle, is passed through this acromial tunnel and sutured to the trapezoid graft limb after appropriate tensioning. Tenodesis screws are not placed in the bone tunnels to avoid graft fraying, and initial forces on the graft are offloaded with braided absorbable sutures passed around the clavicle. PMID:27284528

  1. 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.

  2. 78 FR 29041 - Sulfoxaflor; Pesticide Tolerances

    Science.gov (United States)

    2013-05-17

    ..., bent clavicles, and hindlimb rotation, likely resulted from skeletal muscle contraction due to activation of the skeletal muscle nAChR in utero. Contraction of the diaphragm, also related to skeletal... Tolerance In the Federal Register of July 25, 2012 (77 FR 43562) (FRL-9353- 6), EPA issued a...

  3. 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.

  4. Age estimation in the living

    DEFF Research Database (Denmark)

    Larsen, Sara Tangmose; Thevissen, Patrick; Lynnerup, Niels;

    2015-01-01

    unbiased age estimates which minimize the risk of wrongly estimating minors as adults. Furthermore, when corrected ad hoc, TA produces appropriate prediction intervals. As TA allows expansion with additional traits, i.e. stages of development of the left hand-wrist and the clavicle, it has a great...

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

    Directory of Open Access Journals (Sweden)

    T. Evans

    2015-01-01

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

  6. 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.

  7. 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.

  8. 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.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1997-09-01

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

  10. 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

  11. 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...

  12. 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...

  13. 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

  14. 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

  15. 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...

  16. Gracile bone dysplasias

    Energy Technology Data Exchange (ETDEWEB)

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

    2002-09-01

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

  17. 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.).

  18. 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.

  19. 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...

  20. 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...

  1. 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.)

  2. 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.

  3. Radiographic findings in liveborn triploidy

    Energy Technology Data Exchange (ETDEWEB)

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

    1989-05-01

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

  4. Radiographic findings in liveborn triploidy.

    Science.gov (United States)

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

    1989-01-01

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

  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. 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...

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

    Science.gov (United States)

    Sampannang, Apichakan; Tuamsuk, Panya; Kanpittaya, Jaturat

    2016-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

    温学理

    2015-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Marco Rosati

    2013-07-01

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

  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. 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.

  12. 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)

  13. 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....... 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....

  14. 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

  15. 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

  16. 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.

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

    DEFF Research Database (Denmark)

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

    2006-01-01

    The task of segmenting the lung fields, the heart, and the clavicles in standard posterior-anterior chest radiographs is considered. Three supervised segmentation methods are compared: active shape models, active appearance models, both first proposed by Cootes et al. and a multi-resolution pixel...... for active shape models is presented and it is shown that this optimization improves performance significantly. It is demonstrated that the standard active appearance model scheme performs poorly, but large improvements can be obtained by including areas outside the objects into the model. For lung field...

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

    Directory of Open Access Journals (Sweden)

    Yuka Yamamoto

    2014-05-01

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

  19. 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

  20. Generative Interpretation of Medical Images

    DEFF Research Database (Denmark)

    Stegmann, Mikkel Bille

    2004-01-01

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

  1. 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)

  2. Coracoclavicular joint in a patient with cervicobrachialgy

    Directory of Open Access Journals (Sweden)

    Eraclio Delgado Rifá

    2015-11-01

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

  3. 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.)

  4. 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.

  5. 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.)

  6. 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.

  7. 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.

  8. 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.

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

    Directory of Open Access Journals (Sweden)

    Hemendra KA

    2014-01-01

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

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

    Science.gov (United States)

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

    2016-04-01

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

  11. 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

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

    Science.gov (United States)

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

    2013-10-01

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

  13. 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.

  14. 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.

  15. 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

  16. 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

  17. 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

  18. 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.

  19. 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.)

  20. Bicycling injuries.

    Science.gov (United States)

    Silberman, Marc R

    2013-01-01

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

  1. [TUBERCULOUS CONSTRICTIVE PERICARDITIS DETECTED ON POSITRON EMISSION TOMOGRAPHY].

    Science.gov (United States)

    Takakura, Hiroki; Sunada, Kouichi; Shimizu, Kunihiko

    2016-02-01

    A 72-year-old man presented with fever, dyspnea, and weight loss. He was referred to our hospital for further examination of the cause of the pleural effusions. Chest computed tomography showed pleural effusions, a pericardial effusion, and enlarged lymph nodes in the carina tracheae. We administered treatment for heart failure and conducted analyses for a malignant tumor. The pericardial effusion improved, but the pericardium was thickened. Positron emission tomography-computed tomography (PET-CT) showed fluorine-18 deoxyglucose accumulation at the superior fovea of the right clavicle, carina tracheae, superior mediastinum lymph nodes, and a thickened pericardium. Because these findings did not suggest malignancy, we assumed this was a tuberculous lesion. Echocardiography confirmed this finding as constrictive pericarditis; therefore, pericardiolysis was performed. Pathological examination showed features of caseous necrosis and granulomatous changes. Hence, the patient was diagnosed with tuberculous constrictive pericarditis. PET-CT serves as a useful tool for the diagnosis of tuberculous pericarditis. PMID:27263228

  2. Ichthyosis vulgaris and pycnodysostosis: an unusual occurrence.

    Science.gov (United States)

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

    2012-01-01

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

  3. 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.

  4. 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

  5. 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)

  6. 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

  7. 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.

  8. 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.

  9. 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

  10. 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)

  11. 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)

  12. [Pneumothorax revealed by postoperative computed tomography].

    Science.gov (United States)

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

    2005-11-01

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

  13. 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

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

    Science.gov (United States)

    Estañol, Bruno; Delgado, Guillermo R

    2014-07-01

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

  15. The acrocallosal syndrome in first cousins: widening of the spectrum of clinical features and further support for autosomal recessive inheritance.

    Science.gov (United States)

    Schinzel, A

    1988-05-01

    First cousins, related through their mothers, showed a pattern of craniofacial, brain, and limb anomalies consistent with the acrocallosal syndrome. Both patients had a defect of the corpus callosum, macrocephaly with a protruding forehead and occiput, hypertelorism, non-horizontal palpebral fissures, a small nose, notched ear lobes, and postaxial polydactyly of the hands. The boy, in addition, had hypospadias, cryptorchidism, inguinal hernias, duplication with syndactyly of the phalanges of the big toe, and a bipartite right clavicle. The girl had an arachnoidal cyst, a calvarian defect, and digitalisation of the thumbs. Motor and mental development was retarded in both patients. This observation provides further evidence of probable autosomal recessive inheritance of the acrocallosal syndrome and widens the spectrum of clinical findings and the variability of features in this rare malformation syndrome. PMID:3385741

  16. 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.

  17. 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.

  18. 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.)

  19. 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

  20. [Surgical procedures for bone neoplasms in children].

    Science.gov (United States)

    Woźniak, W

    1991-01-01

    The treatment of 40 patients with bone tumors have been presented. The primary tumors were located in the following sites: femur (14), tibia (8), fibula (4), humerus (4), scapula (1), clavicle (2), pelvis (5), hand (1). Investigated group were: osteosarcoma (18), Ewing's sarcoma (14), chondrosarcoma (2), fibrosarcoma (1), synovial sarcoma (1), chondroblastoma (4). In the most frequent malignant bone tumors, osteosarcoma and Ewing's sarcoma, unified management was adapted. The treatment was initiated with multidrug chemotherapy and followed by surgery or radiotherapy (Ewing's sarcoma) of the primary site. Surgery was performed in 30 cases: 19 mutilating operations because of the broad local invasion, 11 conservative surgical procedures (limb -- salvage operations). Satisfactory oncological and functional effect can be achieved after limb-salvage surgical procedures in the cases of localized, especially semimalignant bone tumors. PMID:1369876

  1. 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

  2. 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.

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

    Science.gov (United States)

    Cumming, W A

    1979-03-01

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

  4. Osteoradionecrosis of the head and neck: a case of a clavicular-tracheal fistula secondary to osteoradionecrosis of the sternoclavicular joint

    Energy Technology Data Exchange (ETDEWEB)

    Stofman, G.M.; Lowry, L.D.; Cohn, J.R.; Jabourian, Z.

    1988-09-01

    Radiation therapy is an integral part of treatment for head and neck cancer, but its use is not without complications. We describe the first reported sternoclavicular-tracheal fistula resulting from osteoradionecrosis (ORN) at the medial clavicle. This ORN resulted from definitive radiation therapy for a primary pyriform sinus squamous cell carcinoma. The diagnosis of ORN was made by fiberoptic bronchoscopy. The physiologic damage of ORN is based on a compromised blood supply and altered metabolism of bone formation secondary to effects of ionizing radiation. Treatment requires meticulous hygiene, antibiotics, and debridement as conservative therapy. Radical surgery and reconstruction may be indicated in refractory cases. A thorough preirradiation assessment of patients is mandatory to decrease the incidence of radiation-induced ORN.

  5. The anatomic coracoclavicular ligament reconstruction: surgical technique and indications.

    Science.gov (United States)

    Carofino, Brad C; Mazzocca, Augustus D

    2010-03-01

    The anatomic coracoclavicular ligament reconstruction (ACCR) is a surgical procedure to address acriomioclavicular joint instability. The coracoclavicular ligaments are reconstructed using a semitendinosus allograft passed beneath the coracoid and through bone tunnels in the clavicle. The graft is secured with interference screw fixation, and the acromioclavicular joint is retained. Here we describe the authors' surgical technique, indications, and rehabilitation protocol. Also, a preliminary case series of seventeen patients is presented. Patients demonstrated significant improvement in pain levels and function. The mean ASES score increased from 52 preoperatively to 92. The Constant Murley rose from 66.6 to 94.7. There were three failures in this series, and two required revision surgery. PMID:20188267

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

    Science.gov (United States)

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

    2015-05-01

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

  7. 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.

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

    Science.gov (United States)

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

    2016-05-18

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

  9. 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

  10. 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

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

    Institute of Scientific and Technical Information of China (English)

    顾安康; 肖尹; 纪华安

    2012-01-01

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

  12. 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

  13. 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

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

    Directory of Open Access Journals (Sweden)

    Virginie Volpato

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

  15. 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.

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

    Science.gov (United States)

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

    2016-07-01

    Increased fracture risk has been associated with weight loss in postmenopausal women, but the time course over which this occurs has not been established. The aim of this study was to examine the effects of unintentional weight loss of ≥10 lb (4.5 kg) in postmenopausal women on fracture risk at multiple sites up to 5 years after weight loss. Using data from the Global Longitudinal Study of Osteoporosis in Women (GLOW), we analyzed the relationships between self-reported unintentional weight loss of ≥10 lb at baseline, year 2, or year 3 and incident clinical fracture in the years after weight loss. Complete data were available in 40,179 women (mean age ± SD 68 ± 8.3 years). Five-year cumulative fracture rate was estimated using the Kaplan-Meier method, and adjusted hazard ratios for weight loss as a time-varying covariate were calculated from Cox multiple regression models. Unintentional weight loss at baseline was associated with a significantly increased risk of fracture of the clavicle, wrist, spine, rib, hip, and pelvis for up to 5 years after weight loss. Adjusted hazard ratios showed a significant association between unintentional weight loss and fracture of the hip, spine, and clavicle within 1 year of weight loss, and these associations were still present at 5 years. These findings demonstrate increased fracture risk at several sites after unintentional weight loss in postmenopausal women. This increase is found as early as 1 year after weight loss, emphasizing the need for prompt fracture risk assessment and appropriate management to reduce fracture risk in this population. © 2016 American Society for Bone and Mineral Research. PMID:26861139

  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, 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

  18. 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.

  19. 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

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

    Directory of Open Access Journals (Sweden)

    Saptarshi Biswas

    2014-01-01

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

  1. 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

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

    Science.gov (United States)

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

    2006-02-01

    The task of segmenting the lung fields, the heart, and the clavicles in standard posterior-anterior chest radiographs is considered. Three supervised segmentation methods are compared: active shape models, active appearance models and a multi-resolution pixel classification method that employs a multi-scale filter bank of Gaussian derivatives and a k-nearest-neighbors classifier. The methods have been tested on a publicly available database of 247 chest radiographs, in which all objects have been manually segmented by two human observers. A parameter optimization for active shape models is presented, and it is shown that this optimization improves performance significantly. It is demonstrated that the standard active appearance model scheme performs poorly, but large improvements can be obtained by including areas outside the objects into the model. For lung field segmentation, all methods perform well, with pixel classification giving the best results: a paired t-test showed no significant performance difference between pixel classification and an independent human observer. For heart segmentation, all methods perform comparably, but significantly worse than a human observer. Clavicle segmentation is a hard problem for all methods; best results are obtained with active shape models, but human performance is substantially better. In addition, several hybrid systems are investigated. For heart segmentation, where the separate systems perform comparably, significantly better performance can be obtained by combining the results with majority voting. As an application, the cardio-thoracic ratio is computed automatically from the segmentation results. Bland and Altman plots indicate that all methods perform well when compared to the gold standard, with confidence intervals from pixel classification and active appearance modeling very close to those of a human observer. All results, including the manual segmentations, have been made publicly available to facilitate

  3. 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

  4. 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

  5. Acromioclavicular joint dislocation: a comparative biomechanical study of the palmaris-longus tendon graft reconstruction with other augmentative methods in cadaveric models

    Directory of Open Access Journals (Sweden)

    Sengupta S

    2007-11-01

    Full Text Available Abstract Background Acromioclavicular injuries are common in sports medicine. Surgical intervention is generally advocated for chronic instability of Rockwood grade III and more severe injuries. Various methods of coracoclavicular ligament reconstruction and augmentation have been described. The objective of this study is to compare the biomechanical properties of a novel palmaris-longus tendon reconstruction with those of the native AC+CC ligaments, the modified Weaver-Dunn reconstruction, the ACJ capsuloligamentous complex repair, screw and clavicle hook plate augmentation. Hypothesis There is no difference, biomechanically, amongst the various reconstruction and augmentative methods. Study Design Controlled laboratory cadaveric study. Methods 54 cadaveric native (acromioclavicular and coracoclavicular ligaments were tested using the Instron machine. Superior loading was performed in the 6 groups: 1 in the intact states, 2 after modified Weaver-Dunn reconstruction (WD, 3 after modified Weaver-Dunn reconstruction with acromioclavicular joint capsuloligamentous repair (WD.ACJ, 4 after modified Weaver-Dunn reconstruction with clavicular hook plate augmentation (WD.CP or 5 after modified Weaver-Dunn reconstruction with coracoclavicular screw augmentation (WD.BS and 6 after modified Weaver-Dunn reconstruction with mersilene tape-palmaris-longus tendon graft reconstruction (WD. PLmt. Posterior-anterior (horizontal loading was similarly performed in all groups, except groups 4 and 5. The respective failure loads, stiffnesses, displacements at failure and modes of failure were recorded. Data analysis was carried out using a one-way ANOVA, with Student's unpaired t-test for unpaired data (S-PLUS statistical package 2005. Results Native ligaments were the strongest and stiffest when compared to other modes of reconstruction and augmentation except coracoclavicular screw, in both posterior-anterior and superior directions (p WD.ACJ provided additional

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

    Institute of Scientific and Technical Information of China (English)

    纪玉华

    2015-01-01

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

  7. 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

  8. 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.)

  9. Surgical treatment of disloced fracture of the scapula column and glenoid: A 22-year follow-up

    Directory of Open Access Journals (Sweden)

    Mladenović Desimir

    2015-01-01

    Full Text Available Introduction. Most scapular fractures are caused by highimpact blunt injuries, often as the result of motor vehicle accidents, fall from height, etc. In 80% to 90% of cases, scapula fractures are associated with multiple injuries (clavicle fracture, rib fractures, humeral fracture, pulmonary injury, brachial plexus injury. Case report. We presented scapular fracture in a 27-years-old male who had sustained a workrelated injury when a ground soil brick machine pressed him. Fracture line was identified on radiotherapy and computed tomography scan from the distal scapular angle enclosing scapular neck. The whole lateral part of the scapula was dislocated laterally from the scapular body. Scapular fracture was treated operatively. The posterior approach was used for reposition, while for fixation after reposition we used two Blunt clamps. We presented functional outcome 22 years after the injury and the surgical treatment. The patient can perform all physical activities, still works, and there is no need to remove the ostheosynthetic material as it causes no discomfort nor problems. The strength of the shoulder muscles is estimated as physician as the grade 5. Conclusion. Displaced intraarticular fractures of the scapula should be treated operatively, with open reduction and internal fixation.

  10. 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.

  11. 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.

  12. 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

  13. 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.

  14. 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.

  15. 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.

  16. 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.

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

    Directory of Open Access Journals (Sweden)

    Kovač Milena

    2002-01-01

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

  18. 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. 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)

  20. 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

  1. 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.

  2. 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)

  3. 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.

  4. 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.)

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

    Directory of Open Access Journals (Sweden)

    Julio M. Hoyos

    2012-07-01

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

  6. 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. ...

  7. 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

  8. 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.

  9. 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.

  10. 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.

  11. 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.

  12. 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)

  13. 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

  14. 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

  15. 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.)

  16. 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.)

  17. 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.

  18. Implementation of the three-field electron wraparound technique for extensive recurrent chest wall carcinoma: dosimetric and clinical considerations.

    Science.gov (United States)

    Norris, M

    1991-09-01

    Treatment of extensive recurrent chest wall carcinoma is a challenge for the radiation oncologist as well as the physics team responsible for setup, computer planning, and daily reproducibility. While electron arc therapy is desirable, unfortunately, most sites do not have this capability. The alternative method of treatment discussed here involves the use of a three-field electron wraparound technique for the chest wall when electron arc therapy is not available. This technique yields an excellent alternative treatment modality with flexibility to accommodate multiple electron energies to compensate for varying chest wall thickness. An additional anterior photon beam is used when skin lesions extend superiorly to the clavicle and along the proximal aspect of the arm. Computerized tomography (CT) interfaced radiotherapy computer planning is used to precisely calculate the sequential gantry angles, skin gaps for adjacent electron fields, and the appropriate junction moves to create a feathering effect of all overlap areas. Treatment aids include extensive shaping of electron and photon fields and the application of bolus material on all four fields. A Smithers Medical Products' Alpha Cradle is used to make this intricate setup possible, providing patient comfort and daily reproducibility for a more efficient treatment. PMID:1910473

  19. Bortezomib in treatment of extramedullary plasmacytoma of the pancreas

    Institute of Scientific and Technical Information of China (English)

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

    2009-01-01

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

  20. Acromioclavicular joint injuries: diagnosis and management.

    Science.gov (United States)

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

    2009-04-01

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

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

    Science.gov (United States)

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

    2009-12-01

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

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

    Science.gov (United States)

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

    2015-01-01

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

  3. 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

  4. 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

  5. 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.

  6. [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

  7. [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

  8. Cleidocranial dysplasia: report of six clinical cases.

    Science.gov (United States)

    Martins, Rosemary Baptista; de Souza, Ricardo Salgado; Giovani, Elcio Magdalena

    2014-01-01

    Cleidocranial dysplasia (CCD) is an autosomal-dominant disorder that occurs due to mutations in the Cbfa 1 gene, also called Runx 2, located on the short arm of chromosome 6, affecting osteoblast skeletal-specific bones that have intramembranous ossification. This condition is characterized by hypoplastic clavicles, short stature, and great clinical significance in the stomatognathic complex, with involvement of facial bones, changes in the eruption patterns, including multiple supernumerary and retained teeth. This study reports six subjects of the same family with CCD identified in the Dentistry Clinic of Oral Diagnosis Department, Universidade Paulista, Campus Sorocaba, Sao Paulo State, Brazil. All cases had clinical and radiographic aspects of this important condition, such as short stature, hypertelorism, severe mobility of the shoulders, and supernumerary and retained teeth. Due to the rare incidence and phenotypic manifestations, CCD can be easily misdiagnosed. The oral commitments are one of the main (functional and aesthetic) causes of complaints in these subjects; and a dentist must establish the diagnosis as early as possible, followed by behaviors and practices that can minimize harmful manifestations of the syndrome and improve health associated with oral and multidisciplinary integration offering improvements in quality of life of these subjects. PMID:24712510

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

    Science.gov (United States)

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

    2007-01-01

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

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

    Science.gov (United States)

    Acikgoz, Gunsel; Averill, Lauren W

    2014-08-01

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

  11. Surgical treatment of an aseptic fistulized acromioclavicular joint cyst: a case report and review of the literature.

    Science.gov (United States)

    Murena, Luigi; D'angelo, Fabio; Falvo, Daniele A; Vulcano, Ettore

    2009-01-01

    An acromioclavicular joint cyst is an uncommonly reported condition, which seems to result from a massive rotator cuff tear and degenerative osteoarthritis of the acromioclavicular joint. We present the case of an 81-year-old man affected by an acromioclavicular joint cyst, associated to a massive rotator cuff tear, proximal migration of the humeral head and osteoarthritis of the gleno-humeral joint. The mass was 7 x 2.5 cm in size and the overlying skin presented a fistula that drained clear synovial-like fluid. Plain X-ray examination of the left shoulder showed proximal migration of the humeral head migration and osteoarthritis of the gleno-humeral joint, and further MRI evaluation confirmed the clinical diagnosis of a complete rotator cuff tear and observed a large subcutaneous cyst in communication with the degenerative acromioclavicular joint. The patient underwent surgical excision of the cyst and lateral resection of the clavicle to prevent disease recurrence. To the best of our knowledge, this is the first reported case of an acromioclavicular joint cyst complicated by an aseptic fistula resulting from multiple aspirations. PMID:19918423

  12. 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

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

    Science.gov (United States)

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

    2014-01-01

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

  14. December 2015 pulmonary case of the month

    Directory of Open Access Journals (Sweden)

    Berg ZM

    2015-12-01

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

  15. 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

  16. 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.

  17. BROWN TUMOR OF THE FACIAL BONES

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    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.

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

    Directory of Open Access Journals (Sweden)

    Stella Ioannou

    2015-01-01

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

  19. 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

  20. 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

  1. Bases anatômicas para o bloqueio anestésico do plexo braquial por via infraclavicular Bases anatómicas para el bloqueo anestésico del plexo braquial por vía infraclavicular Anatomical basis for infraclavicular brachial plexus block

    Directory of Open Access Journals (Sweden)

    Luiz Carlos Buarque de Gusmão

    2002-06-01

    proposed measurements from the anterior surface of the clavicle and the angle formed by the deltoid muscle and the clavicle (deltoclavicular angle. The first measurement allows the in-depth location of the site crossed by the brachial plexus. The second determines fascicles projection within the fossa, corresponding to the needle insertion point on the skin. METHODS: Measurements were made between the anterior surface of the clavicle and brachial plexus fascicles, and from the deltoclavicular angle to superficial fascicles projection. Based on the anatomic findings a technique of infraclavicular brachial plexus approach was proposed. RESULTS: A hundred infraclavicular regions in cadavers were analyzed. Infraclavicular fossa was detected in 96 cases where brachial plexus fascicles were totally or partially (97.9% located. The distance between the anterior surface of the clavicle and brachial plexus fascicles was in average of 2.49 cm and from the deltoclavicular angle to superficial fascicles projection was 2.21 cm. CONCLUSIONS: Values obtained allow for the precise location of the needle insertion point which, when perpendicular to the skin, reaches brachial plexus without danger of causing pneumothorax or vascular injury, providing more safety to anesthesiologists and allowing the return to the practice of brachial plexus block below the clavicle.

  2. 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

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

    Institute of Scientific and Technical Information of China (English)

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

    2014-01-01

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

  4. 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

  5. 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

  6. 采用点状电极进行无创性心输出量检测时胸部圆柱模型的适用性%Applicability of the Two-compartment Coaxial Cylindrical Model for Ambulatory Measuring of Cardiac Output with Spot-electrodes

    Institute of Scientific and Technical Information of China (English)

    宋义林; 高树枚; 五十岚朗; 山越宪一

    2013-01-01

    The principle of ambulatory cardiac output (CO) measuring technique is introduced in this paper.Experimental studies about the applicability of the two-compartment coaxial cylindrical model for ambulatory measurement of cardiac output with spot-electrodes have been carried out with using our newly-developed multi-channel impedance mapping system.The key factors using a spot-electrode array instead of a conventional band-electrode array for noninvasive CO measurement are elaborated.The variations of the electric impedance pulsatile component (△Z wave form) and the two kinds of typical modes of △Z distributions measured by six electrodes on the midsternal (midian)line from the medial portion at the level of clavicle to the portion above the xiphisternum are discussed.The applicability of the two-compartment coaxial cylindrical model for ambulatory measurement of CO with spot-electrodes is analyzed.Synthesizing the △Z distributions and their typical changing models on the midsternal (midian) line during blood inflowing into aorta is the optimal positions of a pair of spot-electrodes for voltage pick-up at the level of clavicle for the upper electrode and the position at the level of nipple for the lower electrode when spot-electrode is being used to measure non-invasive CO.%介绍了基于电阻抗法的无拘束心输出量(CO)检测技术与原理.利用开发的多通道电阻抗分布检测装置,对采用点状电极进行无拘束CO检测时胸部圆柱模型的适应性进行了实验研究,阐述了用点状电极替代带状电极进行无创性CO检测的关键因素,探讨了胸部正中线上6个检测电极检测到的从锁骨位置到剑凸位置电阻抗的波动部分(△Z)波形大小的变化规律及其两种典型的分布模式,分析了采用点状电极进行无拘束CO测量时胸部圆柱模型的适用性.综合实验结果中得到的胸廓正中附近血液泵出时所引起的△Z分布规律和变化模式,得出当采用点状电

  7. 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.

  8. Bone-specific alkaline phosphatase and tartrate-resistant acid phosphatase levels in patients with cleidocranial dysplasia: one case report%颅骨锁骨发育不良患者骨特异性碱性磷酸酶和抗酒石酸酸性磷酸酶的水平:1例报告

    Institute of Scientific and Technical Information of China (English)

    李阳飞; 秦晗; 徐宏志

    2011-01-01

    BACKGROUND: Bone-specific alkaline phosphatase and tartrate-resistant acid phosphatase levels are closely related to skeletal development. OBJECTIVE: To observe bone-specific alkaline phosphatase and tartrate-resistant acid phosphatase levels in patients with cleidocranial dysplasia (CCD). METHODS: Clinical data of one case of CCD were collected. The osseous malformation over the entire body was examined by panoramic radiography. A CCD phenotype was defined by the presence of hypoplastic clavicles and delayed closure of the anterior fontanels in addition to the presence of classic eraniofaeial features. Laboratory examination was used to detect the change of bone-specific alkaline phosphatase and tartrate-resistant acid phosphatase levels. RESULTS AND CONCLUSION: The patients had obvious clinical characteristics of CCD, such as clavicle rudiment or absence, delayed closure of cranial fontanels and sutures, supernumerary and late erupting teeth, wide pubic symphysis, and other skeletal anomalies. The skeletal abnormalities as well as oral manifestations of the syndrome were variable within the affected patient. But abnormal chromosome was not found in this patient. Bone-specific alkaline phosphatase and tartrate-resistant acid phosphatase levels were increased. These findings suggest that CCD patients may accompany with the genetic variation of tartrate-resistant acid phosphatase.%背景:骨特异性碱性磷酸酶和抗酒石酸酸性磷酸酶与骨骼的发育密切相关.目的:观察颅骨锁骨发育不良患者骨特异性碱性磷酸酶和抗酒石酸酸性磷酸酶的变化.方法:收集1 例颅骨锁骨发育不良患者临床资料,利用全颌曲面断层片检查全面了解患者的颌骨发育情况;详细进行口腔检查,记录恒牙萌出及乳牙迟萌以及埋伏牙、多生牙等;综合临床资料和实验室检查确定临床诊断,并检测患者骨特异性碱性磷酸酶和抗酒石酸酸性磷酸酶的变化.结果与结论:该患者有

  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. 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)

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

    Directory of Open Access Journals (Sweden)

    Laurent Schibler

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

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

    Science.gov (United States)

    Armand, Stéphane; Sangeux, Morgan; Baker, Richard

    2014-01-01

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

  13. 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.

  14. 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.

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

    Directory of Open Access Journals (Sweden)

    Jack L Conrad

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

  16. 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.

  17. 颈丛臂丛神经阻滞麻醉用于锁骨骨折手术的效果观察%Effect observation of cervical plexus and brachial plexus block anesthesia in operation of clavicular fracture

    Institute of Scientific and Technical Information of China (English)

    王盛华; 杨德军; 黄庆先

    2014-01-01

    Objective:To explore the effect of anesthesia of brachial plexus block anesthesia and cervical plexus combined with brachial plexus block anesthesia in operation of clavicular fracture.Methods:100 patients with clavicle fracture were randomly divided into the A group and the B group,A group was given the interscalene brachial plexus block anesthesia,B group was given cervical plexus combined with brachial plexus block anesthesia,we observed the anesthetic effect to assess the effect of two kinds of nerve block.Results:The effect of anesthesia of A group was better than that of B group(P<0.05).Conclusion:Cervical plexus combined with brachial plexus block anesthesia was used in operation of clavicular fracture,the block effect was obviously better than the brachial plexus block.%目的:观察比较臂丛神经阻滞麻醉和颈丛臂丛神经联合阻滞麻醉两种神经阻滞方法在锁骨骨折手术中的麻醉效果。方法:将100例锁骨骨折患者随机分为A、B两组,A组采用肌间沟臂丛神经阻滞麻醉,B组采用颈丛臂丛神经联合阻滞麻醉,观察比较麻醉效果来评定两种神经阻滞效果。结果:B组麻醉效果优于A组(P<0.05)。结论:颈臂丛神经联合阻滞用于锁骨骨折手术,阻滞效果明显优于臂丛神经阻滞。

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2015-05-01

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

  19. 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)

  20. 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.

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

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    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.

  2. Cervical lymph node metastases of squamous cell carcinoma from an unknown primary.

    Science.gov (United States)

    Jereczek-Fossa, Barbara A; Jassem, Jacek; Orecchia, Roberto

    2004-04-01

    Cervical lymph node metastases of squamous cell carcinoma from occult primary constitute about 2-5% of all patients with carcinoma of unknown primary site (CUP). Metastases in the upper and middle neck are generally attributed to head and neck cancers, whereas the lower neck (supraclavicular area) involvement is often associated with primary malignancies below the clavicles. The diagnostic procedures include physical examination with thorough evaluation of the head and neck mucosa using fiber-optic endoscopy, biopsies from all suspicious sites or blindly from the sites of possible origin of the primary, computer tomography and/or magnetic resonance. A systematic tonsillectomy in the absence of suspicious lesions is often recommended since up to 25% of primary tumors can be detected in this site. The thoracic primary (tracheal, bronchial, lung, esophagus) has to be excluded, especially in the case of lower neck involvement. Positron emission tomography (PET) with fluoro-2-deoxy-D-glucose allows detection of primary tumor in about 25% of cases, but this procedure is still considered investigational. Therapeutic approaches include surgery (lymph node excision or neck dissection), with or without postoperative radiotherapy, radiotherapy alone and radiotherapy followed by surgery. In early stages (N1), neck dissection and radiotherapy seem to have similar efficacy, whereas more advanced cases (N2, N3) necessitate combined approaches. The extent of radiotherapy (irradiation of bilateral neck and mucosa versus ipsilateral neck radiotherapy) remains debatable. A potential benefit from extensive radiotherapy should be weighted against its acute and late morbidity and difficulties in re-irradiation in the case of subsequent primary emergence. The role of other methods, such as chemotherapy and hyperthermia, remains to be determined. PMID:15023433

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

    Directory of Open Access Journals (Sweden)

    Emma eJude

    2014-08-01

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

  4. 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.

  5. 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

  6. A novel homozygous LMNA mutation (p.Met540Ile) causes mandibuloacral dysplasia type A.

    Science.gov (United States)

    Yassaee, Vahid Reza; Khojaste, Arash; Hashemi-Gorji, Feyzollah; Ravesh, Zeinab; Toosi, Parviz

    2016-02-10

    Mandibuloacral dysplasia with type A lipodystrophy (MADA) is a rare genetic disorder inherited in an autosomal recessive fashion characterized by hypoplasia of the mandible and clavicles, acroosteolysis and lipodystrophy due to mutations in the LMNA or ZMPSTE24 genes. In the current study, we have investigated a consanguineous family clinically diagnosed with mandibuloacral dysplasia type A having an affected child for the LMNA gene alteration(s). Mother is now 15weeks pregnant, seeking advice on the health of her fetus. Peripheral blood was obtained from all family members after informed consent was achieved. Genomic DNA was isolated. The sequence of the LMNA gene, including all exons and intron boundaries was analyzed by PCR and Sanger sequencing. Chorionic villus was collected from the placenta to reveal the condition of the fetus. Molecular analysis ascertained a homozygous mutation c.1620G>A (p.M540I) in the proband and heterozygous alteration in the family. Genomic DNA isolated from the CVS was amplified using specific primers for identified deleterious mutation and analyzed by Sanger sequencing. Two pathogenic mutations c.1620G>A and c.1698C>T were identified in the fetus. Genetic counseling as well as justified rapid and sensitive genetic testing can provide reassurance for the families to prevent the high burden of genetic disorders. We have also applied several online tools including PolyPhen2, MUpro, SIFT, PoPMuSiC, Project HOPE and Mutation Taster to predict the impact of p.Met540Ile substitution as a hotspot region within LMNA. All tools showed reduction in the stability of the protein structure. We conclude that p.M540I mutation may causes disease in the homozygous state. PMID:26602028

  7. 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

  8. 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)

  9. 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.)

  10. 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.

  11. The Epidemiology of Incident Fracture from Cradle to Senescence.

    Science.gov (United States)

    Pasco, Julie A; Lane, Stephen E; Brennan-Olsen, Sharon L; Holloway, Kara L; Timney, Elizabeth N; Bucki-Smith, Gosia; Morse, Amelia G; Dobbins, Amelia G; Williams, Lana J; Hyde, Natalie K; Kotowicz, Mark A

    2015-12-01

    To reduce the burden of fracture, not only does bone fragility need to be addressed, but also injury prevention. Thus, fracture epidemiology irrespective of degree of trauma is informative. We aimed to determine age-and-sex-specific fracture incidence rates for the Barwon Statistical Division, Australia, 2006-2007. Using radiology reports, incident fractures were identified for 5342 males and 4512 females, with incidence of 210.4 (95 % CI 204.8, 216.2) and 160.0 (155.3, 164.7)/10,000/year, respectively. In females, spine (clinical vertebral), hip (proximal femoral) and distal forearm fractures demonstrated a pattern of stable incidence through early adult life, with an exponential increase beginning in postmenopausal years for fractures of the forearm followed by spine and hip. A similar pattern was observed for the pelvis, humerus, femur and patella. Distal forearm, humerus, other forearm and ankle fractures showed incidence peaks during childhood and adolescence. For males, age-related changes mimicked the female pattern for fractures of the spine, hip, ribs, pelvis and humerus. Incidence at these sites was generally lower for males, particularly among the elderly. A similar childhood-adolescent peak was seen for the distal forearm and humerus. For ankle fractures, there was an increase during childhood and adolescence but this extended into early adult life; in contrast to females, there were no further age-related increases. An adolescent-young adult peak incidence was observed for fractures of the face, clavicle, carpal bones, hand, fingers, foot and toe, without further age-related increases. Examining patterns of fracture provides the evidence base for monitoring temporal changes in fracture burden, and for identifying high-incidence groups to which fracture prevention strategies could be directed. PMID:26319674

  12. 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.)

  13. 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.)

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

    Science.gov (United States)

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

    2015-10-01

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

  15. 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.

  16. 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)

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

    Science.gov (United States)

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

    2013-10-01

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

  18. 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

  19. 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

  20. 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.

  1. 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.)

  2. Long-term risk of sarcoma following radiation treatment for breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Taghian, A.; de Vathaire, F.; Terrier, P.; Le, M.; Auquier, A.; Mouriesse, H.; Grimaud, E.; Sarrazin, D.; Tubiana, M. (Inst. Gustave Roussy, Villejuif (France))

    1991-07-01

    Between 1954 and 1983, 7620 patients were treated for breast carcinoma at Institut Gustave Roussy (France). Of these patients, 6919 were followed for at least 1 year. Out of these, 11 presented with sarcomas thought to be induced by irradiation, 2 of which were Steward-Treves Syndrome, and 9 of which were sarcomas within the irradiated fields. All histological slides were reviewed and a comparison with those of breast cancer was done. The sites of these sarcomas were: parietal wall, 1 case; second costal cartilage, 1 case; infraclavicular region, 1 case; supraclavicular region, 2 cases; internal third of the clavicle, 2 cases; axillary region 2 cases; and the internal side of the upper arm (Stewart-Treves syndrome), 2 cases. The median age of these 11 patients at the diagnosis of sarcomas was 65.8 (49-83). The mean latent period was 9.5 years (4-24). Three patients underwent radical mastectomy and nine modified radical mastectomy. Only one patient received chemotherapy. The radiation doses received at the site of the sarcoma were 45 Gy/18 fr. for 10 cases and 90-100 Gy for 1 case (due to overlapping between two fields). The histology was as follows: malignant fibrous histiocytoma, 5 cases; fibrosarcoma, 3 cases; lymphangiosarcoma, 2 cases; and osteochondrosarcoma, 1 case. The median survival following diagnosis of sarcoma was 2.4 years (4 months-9 years). Two patients are still alive: one with recurrence of her breast cancer, the other in complete remission, with 7 and 3 years follow-up, respectively. All other patients died from their sarcomas. The cumulative incidence of sarcoma following irradiation of breast cancer was 0.2% (0.09-0.47) at 10 years. The standardized incidence ratio (SIR) of sarcoma (observed n{number sign} of cases (Obs)/expected n{number sign} of cases (Exp) computed from the Danish Cancer Registry for the same period) was 1.81 (CI 0.91-3.23).

  3. A 13-year-old caucasian boy with cleidocranial dysplasia: a case report

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    Kolokitha Olga-Elpis

    2013-01-01

    Full Text Available Abstract Background Cleidocranial dysplasia (CCD is a rare congenital autosomal dominant skeletal disorder. The disorder is caused by heterozygosity of mutations in human RUNX2, which is present on the short arm of chromosome 6p21. The incidence of CCD is one per million births. CCD appears spontaneously with no apparent genetic cause in approximately 40% of affected patients, and one in three patients has unaffected parents. The most prevalent features associated with CCD are aplastic or hypoplastic clavicles, supernumerary teeth, failed eruption of permanent teeth, and a hypoplastic maxilla. Case presentation A 13-year-old Caucasian boy presented with a chief complaint of delayed eruption of the permanent anterior teeth. The patient was subsequently diagnosed with CCD based on the clinical examination, panoramic X-ray, anterior-posterior and lateral cephalogram, and chest radiograph findings. The details of this case are herein reported because of the extremely low incidence of this disorder. Conclusions CCD is of clinical importance in dentistry and medicine because it affects the bones and teeth and is characterized by many changes in skeletal patterning and growth. Particularly in dentistry, CCD is of great clinical significance because is associated with delayed ossification of the skull sutures, delayed exfoliation of the primary teeth, lack of permanent teeth eruption, multiple supernumerary teeth, and morphological abnormalities of the maxilla and mandible. Patients with CCD seek treatment mainly for dental problems. Knowledge of the pathogenesis, clinical characteristics, and diagnostic tools of CCD will enable clinicians to render the appropriate treatment to improve function and aesthetics. Early diagnosis of CCD is crucial for timely initiation of an appropriate treatment approach.

  4. 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.

  5. 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.)

  6. 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.)

  7. 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

  8. 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.

  9. 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.)

  10. 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

  11. 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.

  12. 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.

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

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    Melcher Sonya E

    2006-12-01

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

  14. Clinical and imageological features, and identification of pathogenic gene mutation of two cleidocranial dysplasia families%锁骨颅骨发育不全二家系的临床和影像学特点及致病基因突变检测

    Institute of Scientific and Technical Information of China (English)

    王广新; 马丽霞; 徐万峰; 宋凤玲; 孙若鹏

    2010-01-01

    Objective Cleidocranial dysplasia (CCD) is a dominantly inherited skeletal dysplasia caused by mutations in the osteoblast-specific transcription factor-encoding gene, core binding factor α1 (CBFA1). Over 90 mutations in CBFA1 gene have been published to date in 500 independent cases of CCD, including missense mutations, deletions, insertions, frameshift, and splice mutations. However,mutational screening of the CBFA1 gene is still far from saturation, and more novel mutations will be identified to enrich the insights into the molecular basis for the pathogenesis of CCD. The aim of this study was to explor the clinical and imageological features and detect the mutations of CBFA1 gene in two CCD families. Method In this study, the clinical features were investigated in two CCD families, radiological and CT examinations regarding osseous malformation were carried out over the entire body of these patients with CCD. Blood (2 ml ) was drawn from all affected individuals, unaffected family members and one hundred unrelated normal controls, Genomic DNA was extracted from whole blood with PureGene DNA extraction kit and PCR was performed with eight pairs of PCR primers for exons 0 to 7 of the CBFA1 gene.The mutations of CBFA1 gene were screened in these two CCD families. Result ( 1 ) The clinical features of patients with CCD include delayed closure of fontanelles, frontal bossing, dysplasia of clavicles, late tooth eruption, and other skeletal anomalies. X-ray and CT examination showed the bulging calvarium, patent fontanelles, wide cranial sutures, multiple Wormian bones, dental dysplasia or aplasia of clavicles. (2) Two mutations were identified, one is novel missense mutation (c. 1259C > T[p. T420I] ) in CBFA1 gene exon 7,other (c. 577C > T[p. R193X] ) was reported in Chinese cases with CCD for the first time. Conclusion (1) The clinical and imageological features of patients in two CCD families include delayed closure of fontanelles, frontal bossing, dysplasia of

  15. 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

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

    Institute of Scientific and Technical Information of China (English)

    罗吉伟; 余斌; 魏宽海; 覃承诃; 胡岩君

    2014-01-01

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

  17. 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

  18. 骨嗜酸性肉芽肿的影像诊断%Imaging diagnosis of bone eosinophilic granuloma

    Institute of Scientific and Technical Information of China (English)

    王龙胜; 郑穗生; 江安红; 赵红; 宫希军

    2012-01-01

    目的 探讨骨嗜酸性肉芽肿的影像表现特点.方法 回顾性分析10例经手术病理证实的骨嗜酸性肉芽肿的X线、CT及MRI表现.10例患儿均接受CT检查,3例同时接受患部X线平片检查,5例同时接受患部MR检查,其中4例接受MR增强扫描.结果 病变单发8例,多发2例.累及颅面骨4例,长骨3例(肱骨1例,胫骨1例,股骨1例),髂骨2例,锁骨2例,椎体1例,肩胛骨1例.不同部位病变影像学表现有差异,主要表现为骨质破坏,形成软组织肿块,边缘清楚、无硬化.结论 综合影像学检查能显示骨嗜酸性肉芽肿的病变形态、范围、特点,有助于诊断及鉴别诊断.%Objective To discuss the imaging features of bone eosinophilic granuloma. Methods X-ray, CT and MR1 manifestations of 10 patients with bone eosinophilic granuloma confirmed by pathology after operation were reviewed retrospectively. All 10 patients underwent CT examination, 3 underwent X-ray examination, 5 underwent MR examination, 4 of them underwent enhanced MR examination. Results Single lesion was found in 8 patients and multiple lesions were in 2. Craniofacial involvement was observed in 4 cases, long bone involvement in 3 (humerus in 1, tibia in 1, femur in 1), iliac bone in 2, clavicle in 2, vertebral body in 1, scapula in 1 case. The radiographic characteristics of the lesions appeared different according to the location. Common radiographic findings included serious bone destruction and soft tissue mass with clear edge without hardening. Conclusion Integrated imaging can display the lesions of eosinophilic granuloma, the involvement scope and characteristics, therefore contributing to the diagnosis and differential diagnosis.

  19. 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.

  20. North Caucasian helmets from the Crimean Tatar Nobility from the Museum of Topkapi Palace (Istanbul, Turkey. Design Features, Design and Combat Use

    Directory of Open Access Journals (Sweden)

    Leonid A. Bobrov

    2016-06-01

    slips and falls from the smooth crown of agolove. In this case, the high dome of the helmet No. 1/810 absorbs shock and convex faces helmet No. 1/811 perform the function of reinforcing ribs. In some cases, the blade is sliding by inertia at the clavicle the defending warrior, but brings them no significant harm, as the blade meets the double layer segmented armor (blade aventails and shoulder part of the vessel shell ring.

  1. Age estimation in the living: Transition analysis on developing third molars.

    Science.gov (United States)

    Tangmose, Sara; Thevissen, Patrick; Lynnerup, Niels; Willems, Guy; Boldsen, Jesper

    2015-12-01

    A radiographic assessment of third molar development is essential for differentiating between juveniles and adolescents in forensic age estimations. As the developmental stages of third molars are highly correlated, age estimates based on a combination of a full set of third molar scores are statistically complicated. Transition analysis (TA) is a statistical method developed for estimating age at death in skeletons, which combines several correlated developmental traits into one age estimate including a 95% prediction interval. The aim of this study was to evaluate the performance of TA in the living on a full set of third molar scores. A cross sectional sample of 854 panoramic radiographs, homogenously distributed by sex and age (15.0-24.0 years), were randomly split in two; a reference sample for obtaining age estimates including a 95% prediction interval according to TA; and a validation sample to test the age estimates against actual age. The mean inaccuracy of the age estimates was 1.82 years (±1.35) in males and 1.81 years (±1.44) in females. The mean bias was 0.55 years (±2.20) in males and 0.31 years (±2.30) in females. Of the actual ages, 93.7% of the males and 95.9% of the females (validation sample) fell within the 95% prediction interval. Moreover, at a sensitivity and specificity of 0.824 and 0.937 in males and 0.814 and 0.827 in females, TA performs well in differentiating between being a minor as opposed to an adult. Although accuracy does not outperform other methods, TA provides unbiased age estimates which minimize the risk of wrongly estimating minors as adults. Furthermore, when corrected ad hoc, TA produces appropriate prediction intervals. As TA allows expansion with additional traits, i.e. stages of development of the left hand-wrist and the clavicle, it has a great potential for future more accurate and reproducible age estimates, including an estimated probability of having attained the legal age limit of 18 years.

  2. 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.

  3. 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.

  4. 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

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

    Energy Technology Data Exchange (ETDEWEB)

    Frank, Steven J., E-mail: sjfrank@mdanderson.org [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Cox, James D. [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Gillin, Michael; Mohan, Radhe [Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Garden, Adam S.; Rosenthal, David I.; Gunn, G. Brandon [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Weber, Randal S. [Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Kies, Merrill S. [Department of Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Lewin, Jan S. [Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Munsell, Mark F. [Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Palmer, Matthew B. [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Sahoo, Narayan; Zhang, Xiaodong; Liu, Wei; Zhu, X. Ronald [Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States)

    2014-07-15

    Background: We report the first clinical experience and toxicity of multifield optimization (MFO) intensity modulated proton therapy (IMPT) for patients with head and neck tumors. Methods and Materials: Fifteen consecutive patients with head and neck cancer underwent MFO-IMPT with active scanning beam proton therapy. Patients with squamous cell carcinoma (SCC) had comprehensive treatment extending from the base of the skull to the clavicle. The doses for chemoradiation therapy and radiation therapy alone were 70 Gy and 66 Gy, respectively. The robustness of each treatment plan was also analyzed to evaluate sensitivity to uncertainties associated with variations in patient setup and the effect of uncertainties with proton beam range in patients. Proton beam energies during treatment ranged from 72.5 to 221.8 MeV. Spot sizes varied depending on the beam energy and depth of the target, and the scanning nozzle delivered the spot scanning treatment “spot by spot” and “layer by layer.” Results: Ten patients presented with SCC and 5 with adenoid cystic carcinoma. All 15 patients were able to complete treatment with MFO-IMPT, with no need for treatment breaks and no hospitalizations. There were no treatment-related deaths, and with a median follow-up time of 28 months (range, 20-35 months), the overall clinical complete response rate was 93.3% (95% confidence interval, 68.1%-99.8%). Xerostomia occurred in all 15 patients as follows: grade 1 in 10 patients, grade 2 in 4 patients, and grade 3 in 1 patient. Mucositis within the planning target volumes was seen during the treatment of all patients: grade 1 in 1 patient, grade 2 in 8 patients, and grade 3 in 6 patients. No patient experienced grade 2 or higher anterior oral mucositis. Conclusions: To our knowledge, this is the first clinical report of MFO-IMPT for head and neck tumors. Early clinical outcomes are encouraging and warrant further investigation of proton therapy in prospective clinical trials.

  6. 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

  7. 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

  8. 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

  9. 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

  10. 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.

  11. 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。

  12. 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

  13. Imaging features of SAPHO syndrome%SAPHO综合征的影像表现

    Institute of Scientific and Technical Information of China (English)

    刘记存; 陈勇; 崔建岭

    2011-01-01

    Objective To explore the imaging features of patients with synovitis, acne, pustulosis, hyperostosis and osteitis (SAPHO) syndrome. Methods Imaging features of 20 patients with SAPHO syndrome were retrospectively analyzed. Results Nineteen patients had anterior chest wall involvement, which showed bone sclerosis, hyperostosis, costal cartilage sclerotic hyperostosis, joint destruction and ankylosis on plain X-ray films and CT images. The medial end of clavicle, ma-nubrium and the first costal cartilage were affected in 19 cases. Among them, bilaterally asymmetrical involvements were found in 8 cases, bilaterally symmetrical in 7 cases and unilateral in 4 cases, respectively. Manubriosternal junctions and the second costal cartilages were affected in 10 and 6 cases, respectively. Five patients had spinal involvement which showed endplate erosion, sclerosis, paravertebral ossification, narrowed disc space, wedged body on plain film and CT, in-homogeneous long Tl and long T2 signal intensities on MRI. Three patients also had sacroiliac joint involvement which showed joint destruction and ankylosis on plain film and CT. Conclusion Anterior chest wall lesions are the typical imaging features of SAPHO syndrome.%目的 探讨SAPHO综合征的影像学表现.方法 回顾性分析20例SAPHO综合征患者的影像学表现.结果 19例病变累及前上胸壁,X线、CT表现为骨及肋软骨硬化、肥厚,关节破坏、强直,胸骨柄、锁骨近端和第1肋软骨受累,其中双侧不对称受累8例,双侧对称性受累7例,单侧受累4例.10例柄胸联合受累,6例第2肋软骨受累.5例伴有脊柱病变,X线、CT表现为多发椎体终板侵蚀、硬化,椎旁骨化,椎间隙变窄,椎体楔形变;MRI表现为椎体不均匀长T1长T2信号.3例伴骶髂关节受累,X线和CT表现为关节破坏、强直.结论 前上胸壁病变是SAPHO综合征最具特征性的影像学表现.

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

    Institute of Scientific and Technical Information of China (English)

    李桂友; 陈彩儿; 黎少萍; 原绮霞

    2014-01-01

    目的:探讨无保护会阴助产法对新生儿锁骨骨折的影响。方法选取2010年5月-2013年6月在妇产科自然分娩的产妇700例,随机分为对照组和观察组各350例。对照组采用常规的助产法,观察组采用无保护会阴助产法,观察2组新生儿锁骨骨折发生率。结果观察组产妇会阴侧切率明显低于对照组,2组软产道损伤、产后出血及会阴预后情况比较,差异无统计学意义。观察组新生儿锁骨骨折比例(1.43%)低于对照组(4.29%)。观察组产妇对助产的满意程度明显高于对照组。结论无保护会阴助产法可降低新生儿锁骨骨折发生率,符合自然分娩的规律。%Objective To explore the influence of unprotected perineum midwifery method for neonatal clavicular fracture .Methods Seven hundred pregnant women with natural labor in obstet-rics-gynecology of our hospital from May 2010 to June 2013 were randomly divided into control group (n= 350)and observation group(n= 350) .The control group was given conventional midwifery method ,the observation group was given unprotected perineum midwifery method . The rate of neonatal clavicular fracture in 2 groups were observed .Results Episiotomy rate in the observation group was higher than that in the control group .There was no significant difference of birth canal injuries , postpartum hemorrhage , prognosis between 2 groups . Clavicle fracture rate in the observation group was lower than that in the control group (1.43% vs 4 .29% ) ,and the satisfaction degree was significanfly higher than that in the control group . Conclusion The method of unprotected perineum midwifery can reduce the incidence of neonatal clavicular fracture ,it′s worthy of clinical promotion .

  15. 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

  16. 纵隔粒细胞肉瘤一例报告并文献复习%Mediastinal Granulocytic Sarcoma: A Case Report and Literature Review

    Institute of Scientific and Technical Information of China (English)

    张葆勋; 曲波

    2012-01-01

    目的 探讨纵隔粒细胞肉瘤(granulocytic sarcomas,GS)的临床特点及诊疗措施,提高对其认识.方法 回顾性分析我院确诊的1例纵隔GS的临床资料并复习相关文献.结果 患者因左上肢肿胀2周入院,胸部CT检查示下颈部左侧、左侧锁骨及左侧前上纵隔多处不规则软组织肿块影,进一步行淋巴结B超检查、纵隔肿瘤活检术、骨髓活检及流式细胞检测确诊纵隔GS.予MA(米托蒽醌+阿糖胞苷)方案化疗,病情缓解.结论 纵隔GS十分罕见,易误诊为淋巴瘤,病理组织学检查是其诊断金标准,MPO和CD68是诊断G5敏感的标志物.%Objective To discuss the clinical characteristics and treatment of mediastinal granulocytic sarcoma (CS). Methods Clinical data of one case with mediastinal GS was retrospectively analyzed. We also reviewed pertinent literatures. Results The patient was admitted for left upper extremity tumescence for 2 weeks. Chest CT revealed left lower neck, left clavicle and left anterosuperior mediastinum with multiple irregular soft tissue mass. The patient underwent further examination of the lymph nodes type-B ultrasonic, the mediastinal tumor biopsy, bone marrow biopsy, flow cytomerric analysis, and mediastinal GS was confirmed. The patient recovered quickly after chemotherapy with MA ( Mitoxantrone + Cytarabine). Conclusion Mediastinum GS is rare, and may be easily misdiagnosed as lymphoma. Histopathologic examination is the golden standard in mediastinum GS diagnosis. MPO and CD68 are the susceptible markers for diagnosing GS.

  17. 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

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

    Directory of Open Access Journals (Sweden)

    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

  19. 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.

  20. 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

  1. Bloqueio do plexo braquial pela via posterior com uso de neuroestimulador e ropivacaína a 0,5% Bloqueo del plexo braquial por la vía posterior con el uso de neuroestimulador y ropivacaína a 0,5% Posterior brachial plexus block with nerve stimulator and 0.5% ropivacaine

    Directory of Open Access Journals (Sweden)

    Lúcia Beato

    2005-08-01

    ícula y húmero proximal. El objetivo de este estudio fue mostrar los resultados observados en pacientes sometidos a bloqueo del plexo braquial por la vía posterior con el uso del neuroestimulador y ropivacaína a 0,5%. MÉTODO: Veintidós pacientes con edad entre 17 y 76 años, estado físico ASA I y II, sometidos a cirugías ortopédicas envolviendo el hombro, clavícula y húmero proximal fueron anestesiados con bloqueo de plexo braquial por la vía posterior utilizando neuroestimulador desde 1 mA. Lograda la contracción deseada, la corriente fue disminuida para 0,5 MA y, permaneciendo la respuesta contráctil, fueron inyectados 40 mL de ropivacaína a 0,5%. Fueron evaluados los siguientes parámetros: latencia, analgesia, duración de la cirugía, duración de la analgesia y del bloqueo motor, complicaciones y efectos colaterales. RESULTADOS: El bloqueo fue efectivo en 20 de los 22 pacientes; la latencia media fue de 15,52 min; la duración media de la cirugía fue de 1,61 hora. La media de duración de la analgesia fue de 15,85 horas y del bloqueo motor 11,16 horas. No fueron observados señales y síntomas clínicos de toxicidad del anestésico local y ningún paciente presentó efectos adversos del bloqueo. CONCLUSIONES: En las condiciones de este estudio el bloqueo del plexo braquial por la vía posterior con el uso del neuroestimulador y ropivacaína a 0,5% demostró que es una técnica efectiva, confortable para el paciente y de fácil realización.BACKGROUND AND OBJECTIVES: There are several approaches to the brachial plexus depending on the experience of the anesthesiologist and the site of the surgery. Posterior brachial plexus block may be an alternative for shoulder, clavicle and proximal humerus surgery. This study aims at presenting the results of patients submitted to posterior brachial plexus block with 0.5% ropivacaine and the aid of nerve stimulator. METHODS: Participated in this study 22 patients aged 17 to 76 years, physical status ASA I and II

  2. 闭合复位空心钉内固定治疗Ideberg Ⅲ型肩胛盂骨折的近期疗效%Closed reduction and cannulated screws fixation of Ideberg Ⅲ type glenoid fractures

    Institute of Scientific and Technical Information of China (English)

    杨国跃; 贾健; 张银光; 张海彬; 江汉

    2013-01-01

    Objective To explore the recent clinical efficacy of closed reduction and cannulated screws internal fixation for the treatment of Ideberg Ⅲ type glenoid fractures.Methods From October 2005 to January 2012,9 cases of Ideberg Ⅲ type gleuoid fractures with closed reduction and cannulated screws internal fixation were studied retrospectively,including 6 males and 3 females,4 cases on the left and 5 on the right,with the average age of 42.2 years (range,28-56).There were three cases combined with clavicle fractures,take S-shaped incision reset for clavicle reconstruction and plate fixation.Three cases combined with acromioclavicular joint dislocation were used the hook plate fixation,and 3 cases with combined acromion fracture were used tension band wire fixation.Suspension structures in the reconstruction of the shoulder glenoid fracture underwent closed reduction and cannulated screw internal fixation.After giving adjustable shoulder abduction brace,rehabilitation exercises were performed under the guidance of doctors.After 1,6 weeks,and 3,6,12 months,X-ray examinations at anteroposterior shoulder view were conducted.By X-ray and clinical examination to determine the fracture healing time,to assess shoulder function with the American Shoulder and Elbow Society (ASES) scoring system,and recorded complications and corresponding outcome.Results Nine cases were obtained from 12 to 46 months,the average (30.8±9.1) months follow-up all fractures healed,with an average healing time of X-rays 12 to 24 weeks,mean (16.8±4.8) weeks.After 12 months surgery,row ASES scores was 82.3 (range,57-95),compared with the preoperative difference was statistically significant.ASES scores were excellent in 5 cases,good in 2,fair in 1 and poor in 1.One patient with traumatic arthritis obtained satisfactory clinical results through oral nonsteroidal drugs and intra-articular injection of sodium hyaluronate.No screw loosening,fracture fixation failure complications were observed

  3. 关节外整块切除肩胛带恶性肿瘤的手术及术后功能研究%Limb-sparing resections for malignant tumors of shoulder girdle:11-year experience of classical or modified tikhoff-linberg procedures in a single institution

    Institute of Scientific and Technical Information of China (English)

    谢璐; 郭卫; 汤小东; 杨荣利

    2015-01-01

    to 82 y).All patients were followed up for a mean of 34 months (range,6 to 109 months).The pathologic diagnosis obtained by needle or open biopsies included 10 metastatic tumors (4 from lung cancer,3 from breast cancer,1 from thyroid cancer and 2 from unknown origin),7 chondrosarcomas,4 osteosarcomas,3 Ewing sarcoma/PNET,3 synovial sarcomas,2 malignant peripheral nerve sheath tumors,1 malignant fibrous histocytoma,1 fibrous sarcoma,1 liposarcoma and 1 malignant hemangiopericytoma.The stage and extent of the tumor were evaluated according to the Enneking system.Neoadjuvant chemotherapy was administered to patients with osteosarcoma,Ewing's sarcoma/PNET and partial malignant soft tissue sarcoma.As for other anatomical sites,limb salvage procedures for bone tumors of the shoulder girdle comprise three steps:complete resection of tumors,reconstruction of bone defects and good soft tissue covering.According to the surgical classification system proposed by Linberg and Malawer et al,classical Tikhoff-Linberg resection (also called shoulder girdle resection Malawer type Ⅳ )contained extraarticular en bloc resection of proximal humerus or humeral head,glenohumeral joint,the whole scapular and lateral clavicle.While modified Tikhoff-Linberg procedure (Malawer type Ⅴ)meant extra-articular resection of proximal humerus,glenohumeral joint,lateral clavicle and the neck of scapular glenoid.The surgical margins of the resected tumor were grossly and microscopically evaluated by two different experienced pathologists respectively.If they disagreed in opinion,the margins would be judged by another doctor who usually would be a senior pathologist.Results All those 33 patients survived the perioperative period and were followed up clinically after surgery (mean follow-up time 34 m,range 6 to 109 m).At the final follow-up,6 patients were alive without evidence of disease,2 patients remained alive but with disease,and 25 had died of their disease.In patients with metastatic bone

  4. 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

  5. SAPHO综合征18F-FDG PET/CT显像和临床分析%18F-FDG PET/CT imaging and clinical features of SAPHO syndrome

    Institute of Scientific and Technical Information of China (English)

    郝新忠; 武志芳; 武萍; 鄢敏; 刘建中; 李思进

    2015-01-01

    Objective To analyze the 18F-FDG PET/CT imaging and the clinical features of patients with synovitis,acne,pustulosis,hyperostosis,and osteitis (SAPHO) syndrome and improved the diagnosis and awareness level about the disease.Methods This study retrospectively analyzed the PET/CT images and clinical features of five patients (including 3 females and 2 males; age range:59-74 years old; average age:67.2 years old) with SAPHO syndrome,as well as reviewed relevant literature.The PET/CT examinations were performed from March 2011 to August 2013.SAPHO syndrome was diagnosed through biopsy,imaging,follow-up results,and according to the Kahe Standard.Results (1) Clinic:Five patients sought treatment in the hospital for bone joint pain or skin lesions.Two of the five patients had no skin lesions,three patients exhibited elevated serum CRP and ESR levels,and one patient was positive for HLA-B27.Rheumatoid factor,extractable nuclear antigen peptide antibody spectrum and antineutrophil cytoplasmic antibodies were negative in 5 patients.The average diagnosis period was 3.78 years.(2)PET/CT imaging:Five patients showed anterior chest wall and spine involvement.Anterior chest wall involvement included 11 bone joints,such as the sternoclavicular joint,sternocostal joint,and sternal-body joint.One patient showed hypertrophy and osteomyelitis of the clavicle.Only one patient showed an involvement of a single vertebra,whereas the others showed an involvement of multiple sites of the spine,including 35 vertebra and 58 vertebral disc connections.The CT revealed the worm-eaten and hole-shaped bone destruction on the articular surface of the anterior chest wall and intervertebral disc junction.They were surrounded by relatively extensive osteosclerosis,even involving the entire vertebral body.The partially involved joints also showed joint space narrowing and even joint bone fusion.In addition,swelling,thickening,and calcification of periarticular soft tissues were observed.The PET

  6. Arthroscopic button plate fixation therapy for instable distal clavicular fracture%关节镜下纽扣钢板固定术治疗不稳定锁骨远端骨折

    Institute of Scientific and Technical Information of China (English)

    陈建海; 党育; 付中国; 姜保国

    2015-01-01

    age of 42.6 years;according to Robinson clavicular fracture classification,all fracture cases are of type 3B fracture.Inclusion criteria:(1)Diagnosed as unstable distal clavicular fracture; (2 ) Received arthroscopic button plate fixation treatment. Exclusion criteria:(1)Diagnosed as unstable distal clavicular fracture,but has not received arthroscopic button plate fixation treatment,including open reduction Clavicle hook plate fixation,anatomic locking plate fixation and open button plate fixation;(2 )Old distal clavicular fracture.Ⅱ.Operative method:operation was performed under general anesthesia.Allow the patient to take sand beach chair posture, with head leaning to the other side.Draw shoulder joint anatomic marks under shoulder arthroscopy, and perform conventional disinfection on affected shoulder and upper limbs.The arthroscope enters the joint cavity from posterior portal;Under direct vision,establish the anterior working portal located in rotator interval. perform intra-articular routine inspection, pay particular attention to inspect whether there is structural damage to glenoid labrum and rotator cuff.If intra-articular injury is discovered during operation,immerely treat it.Under direct vision,establish the anterolateral second observation portal under arthroscope through anterior supraspinatus tendon,and transfer the arthroscope to the second observation portal through exchange rod.Along the upper edge of musculus subscapularis,inward expose the lower surface of coracoid,and use a feller to determine the madial and lateral edges of coracoid.Perform C-arm X-ray machine fluoroscopy to demine the vertical projection position of coracoid on clavicular surface,namely the conical ligament attachment position;open skin by 2 cm,and expose the clavicular upper surface.Place the anterior cruciate ligament guider on the central location of coracoid lower surface,drive guide pin into coracoid through clavicle;perform fluoroscopy to validate that the position of

  7. 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

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

    Directory of Open Access Journals (Sweden)

    R. Navarro

    2008-06-01

    traditional marks. If breasts were small, implants were positioned by submuscular way, and if bigger, the way was retroglandular. For recidivism prevention, it was positioned 2 internal straps; if the gland-implant was bigger and heavier an immobile strap from the breast to the clavicle periostium and to the 3rd rib, was realized; if it would result smaller or median size only were fixed to the third ribs with a dermal flap. Controls were realized between 1 month to 3 years. Ptosis was corrected between 5 to 12cm without any recidivism, neither post surgery pseudo-ptosis. With the support of an elastic brassier, physical exercise is recommended after 15 days. The scarring was highly satisfactory. Complications were partial disruptions in 2 patients and ardors, tautness sensation and areolar enlargement in patients with more than 12cm ptosis and wide areola. Because of the execution simplicity and security, surgery was ambulatory. We propose this technique called 5th generation that precludes the periareolar, the inframamary, the vertical and the T scar; partial elimination of both upper breasts quadrants lessen the possibility of breast cancer in this upper area and ptosis recidivism by the use of the internal straps.

  9. 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

  10. Estudio comparativo de la eficacia del bloqueo supraclavicular en la artroscopia de hombro Comparative study of the efficacy of the supraclavicular block for arthroscopic shoulder surgery

    Directory of Open Access Journals (Sweden)

    C. Morales Muñoz

    2010-12-01

    postoperative acute pain unit, during a 6-months period. Cases of shoulder arthroscopies carried out during this period were selected and the patients were distributed in 2 groups depending on the anesthetic technique used: group I consisted of patients treated with locoregional anesthesia (interscalene and inter-sternocleidomastoid block combined with general anesthesia. Group II was general anesthesia cases with intravenous analgesia. The recorded variables were the following: postoperative pain, both at rest and during exercise in the first 24h, using a simple verbal scale (SVS; the presence of side effects, need of analgesic rescue and duration of hospital stay. In the cases where the patients were discharged from hospital in the first 24h, a telephone consultation was carried out for the evaluation of the abovementioned variables. Statistical analysis: Student-t and Chi-square tests. A P.05. In the group of combined anesthesia the average duration of hospital stay was 36h, compared to the 60h average duration in the group of General Anesthesia. (P<.05. Discussion: The blockade of the brachial plexus over the clavicle combined with general anesthesia has shown greater efficacy in the control of perioperative pain, both at rest and during exercise than the general anesthesia with intravenous analgesia. In addition, the incidence of undesirable effects, the need of rescue and the duration of hospital stay were lower in the group of patients with the combined technique, without significant effects on the duration of operating room occupation.

  11. Torcicolo congênito: avaliação de dois tratamentos fisioterapêuticos Congenital torticollis: evaluation of two physiotherapeutic approaches

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    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. 臂从神经阻滞加浅颈从神经阻滞在锁肩部损伤术中运用%Brachial plexus block combined with superficial cervical plexus block in a shoulder injury during use

    Institute of Scientific and Technical Information of China (English)

    和耀琦; 才仲权; 郭志娟

    2013-01-01

    目的:比较臂丛神经阻滞加浅颈丛神经阻滞用于锁肩部损伤术中的麻醉效果。方法选择单侧锁骨骨折的手术患者70例,肩锁关节脱位16例,ASA I 或 II 级,年龄17~50岁,体重40~70Kg,随机平均分为 A.B 两组,A 组行肌问沟臂丛神经阻滞加浅颈丛神经阻滞,B 组行单纯肌间沟臂丛神经阻滞,记录阻滞15min 后神经所支配区域的阻滞情况,麻醉效果和并发症情况。结果两组患者麻醉效果优良率 A 组明显高丁 B 组(P<0.05),B 组并发症明显高于 A 组(P<0.01)。结论对锁肩部损伤手术采用肌间沟臂丛神经阻滞加浅颈丛神经阻滞,操作简单安全,神经支配区域完善率高。%Objective To appraise the effect after using the brachial plexusnerve block and brachial plexus block to tyeat patients.Brachial plexus block Superficial cervical plexus block A shoulder injuryMethod To choose 70 patients who.suffered unilateral clavicle fracture.and 16 paints who suffered acromioclavicular dislocation,ASAI or IIlevel.The ages are from 17 to 50.The weiqht is 40 to 70kg.I divide them into two grounps.In the group A,I used the brachial plexus nerve block and brachial plexus block.In the group BI only used the brachial plexus nerve block.I observe them for 15 mins.Them I get the effect and some complicating disease.Results The anesthetic effect of group A is better than group B(P<0.05).The complicating diseases in group B are more in group(P<0.01).Conclusions When 1 was doing an operation about the in jury on acromioclavicular joint, I used the brachial plexus nerre block and brachial plexus block.It is easy,safe and perfect nerve area rate is high.

  14. 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.

  15. 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

  16. Hipercalcemia e lesões osteolíticas múltiplas em criança com paracoccidioidomicose disseminada e tuberculose pulmonar Hypercalcemia and multiple osteolytic lesions in a child with disseminated paracoccidioidomycosis and pulmonary tuberculosis

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    Antonia T. Tresoldi

    2005-08-01

    osteolytic lesions. DESCRIPTION: A 6-year-old boy was admitted with a one-month history of fever and hepatosplenomegaly. On admission, he looked sick, pale, and had disseminated lymphadenopathy and hepatosplenomegaly. The laboratory findings included anemia (hemoglobin = 6.8 g/dl, eosinophilia (1,222/mm³, thrombocytopenia (102,000/mm³, and hypoalbuminemia (serum albumin = 2.2 g/dl. Paracoccidioides brasiliensis was identified in bone marrow examination. In the second week after admission, the patient presented joint pain, poor activity and difficulty in walking. He presented hypercalcemia (maximum value = 14.9 mg% and reduction in renal function, which lasted for two weeks. On the 42nd day after admission, his chest X-ray showed lytic lesions in clavicle, scapula, ribs, and humerus, with bilateral slipped capital humeral epiphysis. The patient presented nephrocalcinosis and nephrolithiasis, reduction in creatinine clearance and evidence of tubular lesions. At the end of the second month after admission, Mycobacterium tuberculosis was isolated in gastric lavage. The child received treatment for paracoccidioidomycosis and tuberculosis and has not had any sequelae for 3 years. COMMENTS: The development of symptomatic hypercalcemia leading to renal lesion, associated with multiple osteolytic lesions, had never been described in paracoccidioidomycosis. Although pulmonary tuberculosis was diagnosed and could be related to hypercalcemia, the sudden onset of hypercalcemia and its normalization without specific treatment for tuberculosis suggests that bone lysis was the most important factor in the genesis of hypercalcemia.

  17. 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

  18. 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

  19. 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

  20. 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.

  1. 重建钢板上置和前置治疗老年锁骨中段骨折的疗效分析%Superior versus anterior reconstruction plate internal fixation for middle clavicular fractures in old patients: a comparative study

    Institute of Scientific and Technical Information of China (English)

    卢旻鹏; 王群波; 赵波; 何超; 焦春艳; 饶小华; 张铭华

    2011-01-01

    Objective To compare the effect of anterior and superior reconstruction plate internal fixation in treatment of middle clavicular fractures in the old patients.Methods Thirty-nine old patients with middle clavicular fractures received anterior and superior reconstruction plate internal fixation treatment,respectively.There were 19 males and 20 females at average age of 66.7 years.The operation time,intraoperative blood loss and healing time were observed and compared in two groups.According to the Constant scoring system,shoulder functional evaluation was made at half a year after operation and the latest follow-up.Results All the patients were followed up for 10-32 months (average 18.7 months).Of the two groups,there was no statistical significance in aspects of healing time and Constant score at half a year after operation and the latest follow-up ( P >0.05 ).The complication of superior reconstruction plate internal fixation group was significant higher than that of anterior reconstruction plate internal fixation group,while the anterior reconstruction plate internal fixation group had shorter operation time and less intraoperative blood loss in comparison with the superior reconstruction plate internal fixation group ( P < 0.05).Conclusion As for the middle clavicular fractures in the old patients,both anterior and superior reconstruction plate internal fixation can obtain satisfactory curative effect.With shorter operation time,less intraoperative bleeding and less complications,anterior reconstruction plate internal fixation is a much reliable treatment for middle clavicle fractures in the old patients and deserves wider application.%目的 比较重建钢板上置和前置治疗老年锁骨中段骨折的疗效.方法 分别用重建钢板上置法、重建钢板前置法治疗锁骨中段骨折39例,其中男19例,女20例;平均年龄66.7岁.记录并比较两组手术时间、术中出血量、骨折愈合时间;术后半年

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

    Directory of Open Access Journals (Sweden)

    João Antonio Matheus Guimarães

    2010-01-01

    March 2004 and January 2008. The study was retrospective, based on clinical and radiographic evaluations. RESULTS: The mean age at the time of trauma was 8.8 years (2 to 13 years. Seven patients were female and three male. The cause of the trauma was being run over in eight cases, and one case each of a motorcycle accident and falling from a height. Five patients had other associated injuries such as fractures of the clavicle, femur diaphysis, proximal humerus, fibula, olecranon, and bladder injury. All patients showed an excellent clinical outcome. The pelvic asymmetry before surgery ranged from 0.7 to 2.9 cm (mean 1.45 cm, and dropped to values between 0.2 and 0.9 cm (mean 0.39 cm after reduction. In no cases was a change observed in pelvic asymmetry measured in the immediate postoperative period and at the end of follow-up. CONCLUSION: Pelvic ring fractures in skeletally immature patients is rare and surgical treatment is not usual. Several authors have questioned conservative treatment due to the complications encountered. Bone remodeling is not enough to improve pelvic asymmetry, a factor that justifies the choice of surgical treatment for the reduction and correction of pelvic ring deformities.

  3. 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

  4. 颅锁骨发育不良的三个RUNX2基因新突变%Identification of three novel frameshift mutations in the RUNX2 gene in three sporadic Chinese cases with cleidocranial dysplasia

    Institute of Scientific and Technical Information of China (English)

    齐展; 杨威; 孟岩; 刘雅萍

    2014-01-01

    目的 通过对3例散发的颅锁骨发育不良患者进行RUNX2基因编码区的扩增及测序,寻找RUNX2基因突变,为家系进行遗传咨询和产前诊断提供依据.方法 抽取患者及其父母外周血,提取基因组DNA,PCR扩增RUNX2基因的7个编码外显子并测序;并对患者突变所在外显子的PCR产物经T-A克隆后再次测序.结果 例1的RUNX2第1外显子发生了1个80bp的c.227_306del杂合性缺失突变,引起读码框移位并提前出现终止密码(p.Ala76GlyfsX58);例2的RUNX2第2外显子发生了1个c.471_472dupGG杂合重复突变,亦导致读码框改变及提前出现终止密码(p.Ala158GlyfsX19);例3的R UNX2第17显子发生了1个c.1321dupT杂合重复突变,同样导致读码框改变和提前出现终止密码(p.Ser370PhefsX13).这三个移码突变经查询HGMD突变数据库及国内外文献均未见报道.结论 发现了3种新的导致颅锁骨发育不良的RUNX2基因突变,新的突变扩展了RUNX2基因的突变谱,可为这些家系提供准确可靠的遗传咨询和产前诊断.%Objective To investigate the molecular etiology of three patients with sporadic cleidocranial dysplasia (CCD) and to provide genetic counseling and prenatal diagnosis for the family members based on the identified mutations.Methods Genomic DNA was extracted from peripheral blood samples using a standard method.All 7 coding exons of the RUNX2 gene and their flanking intronic sequences were amplified by PCR and sequenced directly.The PCR products of the exons with mutations from the three patients were cloned into a T-vector.Positive clones were sequenced.Results The three patients who have the typical CCD phenotypes involving clavicles,calvarium,stature,and teeth have carried various frameshift mutations in the RUNX2 gene.Patient 1 has a gross deletion of 80 nucleotides in exon 1 (c.227_306del),which caused a frameshift beginning at the Q/A repeat of the polypeptide and a premature termination (p.Ala76GlyfsX58).Patient

  5. 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

    Institute of Scientific and Technical Information of China (English)

    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

  6. 黏多糖贮积症Ⅶ型1例患儿的临床与GUSB基因分析及其同胞的产前诊断%Clinical and GUSB gene analysis of a patient with mucopolysaccharidosis type Ⅶ and prenatal diagnosis for her sibling

    Institute of Scientific and Technical Information of China (English)

    丁圆; 李东晓; 刘玉鹏; 李溪远; 宋金青; 叶锦棠; 秦炯; 杨艳玲

    2016-01-01

    .Peripheral blood leukocytes β-glucuronidase assay and genetic studies were performed.The mother of the patient visited us at second trimester pregnancy seeking for prenatal diagnosis.GUSB gene mutation analysis of amniocytes was performed for prenatal diagnosis.Results Osteodysplasty had been noticed in the patient at the age of 1 owing to presence of costal margin valgus and pigeon breast.The patient had generally normal intelligence with easy fatigue,progressive skeletal changes,coarse facial features and macrocephaly.Her physical growth was retarded.Her body height was 147 cm (-1 SD) at the age of 12 years.X-ray examination revealed bilateral clavicle and ribs slightly thicker,spine slightly S-shaped bending,some vertebrae flat and lumbar L3 center protrusion deformity,L3 and L4 vertebral showed beak-like changes.Ultrasonic cardiogram examination revealed aortic valve leaf thickening with poor closure function and the mitral valve slightly thickened,cusps poor pointed.Significantly deceased β-glucuronidase activity in peripheral leucocytes [0.2 nmol/(g · min)] supported the diagnosis of mucopolysaccharidosis type Ⅶ.In her GUSB gene,2 novel mutations,c.1832G > C (p.R611P) and c.1244 +3G > C (splicing) were identified,and each parent carried 1 mutation.One heterozygous mutation (c.1832G > C) was detected from cultured amniocytes indicating that the fetus was a carrier of mucopolysaccharidosis type Ⅶ like the father.Conclusions Mucopolysaccharidosis type Ⅶ is a severe progressive degenerative disease with poor prognosis and there is not effected treatment.Diagnosis depends upon enzyme assay and gene testing.In this study,a Chinese family affected by mucopolysaccharidosis type Ⅶ middle type was reported.Two novel mutations on GUSB gene were identified.Prenatal diagnosis to the fetus of this family was performed through amniocytes gene analysis.

  7. 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

  8. The surgical treatment of musculo- skeletal tumors in dangerous region%危险区骨骼肌肉系统肿瘤的外科治疗

    Institute of Scientific and Technical Information of China (English)

    张杏泉; 李开华; 陈刚; 刘军; 蔡平; 方仁义; 王民政; 范清宇

    2012-01-01

    , at the same time protecting the pleura after cutting a 6cm - clavicle, and then disconnect the lesion for excision of tumors completely and safely. While for the tumors in fibular head and neck as well as its surrounding region, to dissect first the common peroneal nerve and preserve its muscular branches. Results: Using this method, we treated 11 patients. All cases had no recurrence and limbs disturbance after follow — up. Conclusion: Dissecting first the normal vascular nerve of tumors distantly and proximally and then disconnecting the lesion for excision of tumors is a better choice for the large tumors of the innocent or low - degree malignant musculo — skeletal tumors especially adhering tightly with important nerves and vessels because of avoiding recurrence and limbs disturbance caused by injury of vascular nerve.

  9. 99Tcm-MDP核素骨扫描评估继发性肥大性骨关节病%Imaging observation of secondary hypertrophic osteoarthropathy by 99Tcm-methylene diphosphonate bone scans

    Institute of Scientific and Technical Information of China (English)

    徐海峰; 张王峰; 周润锁; 穆继珍

    2001-01-01

    AIM To evaluate the characteristic findings of the secondary hypertrophic osteoarthropathy (or called hypertrophic pulmonary osteoarthropathy, HPO) and differentiate the bone metastases or some osteoarthropathy diseases from HPO. METHODS Fifty-five tumor cases were confirmed on HPO with 99Tcm-MDP the whole body bone scintigraphy combined X-ray imaging and clinical manifestation. It was observed to grading scale and distribution of radionuclide in extremities, scapulae, clavicles, skull, ribs, pelvis, patella and joints referring to Ali's method. At the same time, 11 cases with HPO were followed after operation, radio-therapy and/or chemical therapy. RESULTS Double stripe sign mainly in long bones was found in all 55 cases. Involvement of the extremities was invariably present, 44 cases (87%) almost always appeared more active in the lower than in the upper extremities. There was a symmetrical , regular increase of activity along cortical margins in 46 cases (84%) and uniformity involvement in 49 cases (89%). There was also an abnormally increased activity in and around the joints in 31 cases. Whereas the observation of curative effects on HPO, there were some changes of clinical symptoms, signs and bone scan within 6~24 mo after appropriate therapy of the associated disease process, such as a complete remission or subsided in 6 cases, a fluctuating intensity of uptake in 2 cases, no improved in 1 case and aggravating in 2 cases. CONCLUSION Double stripe sign is a main characteristic findings for HPO. The distribution of the activity between bone metastases and HPO is entirely different. The follow up for HPO by bone scan will make for observation and evaluation of curative effect.%目的评价继发性肥大性骨关节病(HOA)放射性核素显像的特点与鉴别. 方法放射性核素99Tcm-MDP全身骨显像结合临床表现,对继发性HOA的肿瘤患者55例进行了核素闪烁显像分析. 参照Ali分级方法,观察了四肢骨

  10. 全身MR扩散加权成像与骨扫描探测骨转移灶的初步对比研究%Comparison of whole body MR diffusion weighted imaging and skeletal scintigraphy In detecting bone metastasis

    Institute of Scientific and Technical Information of China (English)

    徐贤; 马林; 张金山; 蔡幼铨; 徐白萱; 程流泉; 郭行高

    2008-01-01

    detected by whole body MR DWI while 156 lesions in 68 regions of 29 patients were identified by skeletal seintigraphy.There were two cases negative in scintigraphy but positive in whole body MR DWI and one case positive in scintigraphy only.There were eight lesions negative in scintigraphy but positive in whole body MR DWI,mainly located in the spine.pelvis and femur.Seven 1esions were only detected by scintigraphy,mainly located in the skull.sternum.clavicle and scapula.Conclusion The whole body MR DWI reveals excellent consistency with skeletal scintigraphy regarding bone metastasis.and the two modalities are complementary for each Other.

  11. 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

  12. Imaging analysis of osteoid osteoma%骨样骨瘤的影像学分析

    Institute of Scientific and Technical Information of China (English)

    张雷; 郁万江; 汪敬群

    2011-01-01

    目的 分析骨样骨瘤的X 线、CT 及MRI 影像表现.方法 搜集2000 年~2005 年经病理证实的骨样骨瘤21 例,男13 例,女8 例,年龄6~59 岁.所有病例均行X 线平片;17 例行CT 平扫;MRI 平扫12 例,增强扫描5例(动态MRI 增强扫描3 例),完成三项检查10 例.病灶位于股骨8 例,胫骨7 例,髋臼、胸椎各2 例,锁骨及距骨各1例.分析X 线、CT 及MRI 对瘤巢及其周围组织改变的显示能力.结果 X 线、CT 及MRI 对瘤巢显示率分别为57.1%、76.5%、75.0%,X 线、CT 上瘤巢为一小圆形或卵圆形透亮区,中心有/无钙化和骨化,边缘有不同程度骨硬化;MRI 上瘤巢为一小圆形异常信号区,T1WI 呈低至中等信号,T2WI 呈低至高信号,边缘为低信号骨硬化,瘤周不同程度骨髓及软组织水肿;Gd-DTPA 增强扫描瘤巢明显强化,动态MRI 增强瘤巢呈高灌注表现,时间-信号强度曲线为快速上升后缓慢持续下降(C 型曲线).结论 CT 为诊断骨样骨瘤最佳方法,MRI 能够增加瘤巢可见度并能敏感显示骨髓及周围软组织水肿,一定程度上反映病理组织特点,对骨样骨瘤有较高的诊断价值,可作为CT 的补充检查手段.%Objective To analyze the findings of osteoid osteoma on radiographs, CT and MRI. Methods 21 patients (13 male, 8 female; age range: 6-59 years) with pathologically confirmed osteoid osteoma from 2000 to 2005 underwent radiograph(21) ,CT(17) ,and MRI(12 unenhanced, 2 enhanced, 3 dynamic contrast-enhanced) examinations. Ten patients were investigated with all three modalities. The tumors were located in the femur (8), tibia (7), acetabulum (2), thoracic spine (2), clavicle (1) and talus (1). The radiographs, CT and MRI were retrospectively analyzed. Results Tumor nidus was depicted on radiographs (57.1%), CT (76.5%), and MRI (75.0%). On X-ray and CT, the tumor nidus was a small round or oval translucency with calcification or ossification center and variable degrees of surrounding

  13. Metastatic Brachial Plexopathy in a Case of Recurrent Breast Carcinoma Demonstrated on {sup 18}F-FDG PET/CT

    Energy Technology Data Exchange (ETDEWEB)

    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

  14. 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.

  15. 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

  16. 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