The American journal of orthopedics
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Review Case Reports
Concurrent treatment of a middle-third clavicle fracture and type IV acromioclavicular dislocation.
Acromioclavicular (AC) dislocation with an associated displaced fracture of the middle third of the clavicle is a rare injury with no established standard treatment. Previous AC fixation techniques described have not included simultaneous internal fixation of the clavicle. We present the case of a 19-year-old man who sustained this combined injury pattern with a type IV AC dislocation. ⋯ The CC screw was removed 3 months after surgery. By 1-year follow-up, the patient had returned to manual labor and normal activities of daily living. In comparison with previously described treatment, his case highlights a unique approach to this rare shoulder entity.
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We sought to determine whether computed tomography (CT) is an accurate tool for evaluation of reduction, prediction of neurologic deficit, and evaluation of need for revision surgery in unstable pelvic ring injuries treated with percutaneous sacroiliac (SI) screw fixation and whether any neural foramen penetration violation is safe. Using medical records and radiographic data, we retrospectively evaluated 46 patients with 51 fractures or widenings of the SI joint that were surgically treated with percutaneous SI screw fixation, either alone or associated with anterior fixation. Using the Young and Burgess classification, there were 3 vertical shear injuries, 13 lateral compression injuries, 17 anterior-posterior injuries, 7 sacral fractures, and 6 combination or unclassifiable pelvic injuries. ⋯ Postoperative CT showing neural foramen penetration was the cause of revision surgery in 2 of 10 patients with postoperative neurologic deficit after percutaneous SI screw fixation. Based on these findings, we recommend postoperative CT only in those cases where there is new neurologic deficit and screw removal if foramen penetration is greater than 2.1 mm. We also describe a new "safe zone" for screw insertion encompassing the superior 2 mm of the sacral foramen with adequate pelvic reduction.
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Pectoralis major ruptures have been increasing in incidence over the past decade, most likely attributable to physical activities, such as sports and weight training. Men account for the vast majority of cases with elderly women making up the remaining small percentage. In this case report, we describe a pectoralis major rupture in a middle-aged woman that has never been documented and provide a brief review of the literature.
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Review Case Reports
Local infiltration of liposome bupivacaine in orthopedic trauma patients: case-based reviews.
Orthopedic trauma surgery is often associated with considerable postoperative pain, which can result in a cascade of direct and indirect clinical consequences. Patients undergoing orthopedic trauma surgery are at risk for the development of chronic postsurgical pain, which may persist for 2 years or longer. Effective approaches to reducing postoperative pain in orthopedic trauma surgery patients include the use of minimally invasive procedures and multimodal analgesia. ⋯ The first case involves repair of a subtrochanteric nonunion in a 63-year-old woman with a history of bisphosphonate use and prior treatment with a cephalomedullary nail. The second case involves a young woman undergoing outpatient surgery for repair of a fractured clavicle. Both patients experienced good control of postsurgical pain, supporting the clinical utility of EXPAREL® in orthopedic trauma surgery.