The American journal of sports medicine
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Traumatic acromioclavicular separation in the skeletally immature patient is frequently overdiagnosed and overtreated. Fifty-eight children, aged 5 to 16 years, who presented over a 15 year period with injuries to the distal clavicle, were reviewed retrospectively. ⋯ Long-term followups of these patients demonstrate excellent results with conservative management. "Pseudodislocation" involves a clavicular fracture of the lateral metaphysis or metaphyseal epiphyseal separation and not an acromioclavicular disruption. This pseudodislocation of the acromioclavicular joint in the skeletally immature patient must be differentiated from the adult counterpart to avoid unnecessary operative intervention.
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Pulmonary edema secondary to postextubation laryngospasm is a potentially life-threatening problem, demanding early diagnosis and prompt treatment. We believe that this problem has been grossly underestimated in its incidence, as only seven adults have been reported in the English literature, whereas seven adults have been observed at our institution in only a 24 month period. All were young, healthy, athletic adult males (average weight, 218 pounds) who underwent relatively minor, uncomplicated surgical procedures under general anesthesia. ⋯ The etiology of pulmonary edema following upper airway obstruction represents an interplay between several factors: cardiogenic and neurogenic mechanisms, as well as hypoxia contribute. In this group, excessive negative intrathoracic pressure generated by forced inspiration against a closed glottis is the most likely, consistent, and logical explanation. This study suggests that young, healthy, athletic males may be at increased risk for this complication.(ABSTRACT TRUNCATED AT 250 WORDS)
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Reflex response times of the vastus medialis obliquus and vastus lateralis were evaluated in 41 normal subjects and 16 patients with extensor mechanism dysfunction. The reflex response times for both muscles to a patellar tendon tap were evaluated by electromyography. The latencies of the muscles were statistically analyzed in both groups. ⋯ This increase in vastus lateralis reflex response time may indicate a motor control problem in the patient with extensor mechanism dysfunction. Results indicate that there is a reversal of the normal muscular firing order between the two muscles in these patients. Patients with extensor mechanism dysfunction may be demonstrating a neurophysiologic motor control imbalance that may account for or contribute to their anterior knee pain.
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Case Reports
Axial loading injuries to the middle cervical spine segment. An analysis and classification of twenty-five cases.
Injuries to the cervical spine at the C3-C4 level involving the bony elements, intervertebral disks, and ligamentous structures are rare. We present 25 cases of traumatic C3-C4 injuries sustained by young athletes and documented by the National Football Head and Neck Injury Registry. Review of the cases reveals that the response of energy inputs at the C3-C4 level differ from those involving the upper (C1-C2) and lower (C4-C5-C6-C7) cervical segments. ⋯ The other four patients, two who underwent an open reduction and laminectomy and two treated closed with skeletal traction, remained quadriplegic. In the four instances of bilateral facet dislocation where reduction was achieved by either closed or open methods, although there was no neurologic recovery, all four patients survived their injuries. However, the three patients who were not successfully reduced died.