Annals of the Royal College of Surgeons of England
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Ann R Coll Surg Engl · May 1999
Case ReportsPosterior sternoclavicular dislocations--a diagnosis easily missed.
Posterior dislocation of the sternoclavicular joint is a relatively rare injury and can be difficult to diagnose acutely. We report 3 cases of posterior dislocation of the sternoclavicular joint who presented to the Accident & Emergency Department within a 3 month period. ⋯ Plain X-rays of the shoulder and chest were reported as normal by junior and senior medical staff. The diagnosis was delayed until CT scans were performed, and once this was established, open reduction and stabilisation was performed.
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Infusion thrombophlebitis is common and is the principal limitation to intravenous nutrition (IVN) via a peripheral vein, yet its precise pathogenesis is unclear. Prospective observations were performed on patients in whom a hypertonic, acidic, nutritional emulsion was infused via fine-bore polyurethane catheters placed in peripheral veins. ⋯ Contrary to previous reports, no evidence of venospasm was observed. It is suggested that previous evidence of venoconstriction is erroneous and that other mechanisms are responsible for thrombophlebitis.