The American journal of orthopedics
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A previously unreported case of plantar dislocation of the medial cuneiform is described. The significance of this injury does not lie in its rarity, but in the amount of force required to cause such an injury. This large force may cause bony disruption, along with significant soft-tissue injury, and even compartment syndrome. Analysis of the preoperative evaluation, including the importance of a computed axial tomographicscan, operative intervention, and postoperative care are discussed.
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Decompression and stabilization have been shown to improve neurologic outcome in cases of cervical spine trauma with proven compression of the spinal cord. This paper reviews experimental and clinical research to clarify the benefits of early surgery for cervical spinal cord injury. ⋯ Additional benefits of early surgery include the clinical advantages of a decreased length of hospitalization and its associated complications and a decreased time to rehabilitation and mobilization. Proper, timely surgical intervention can better the physiologic environment so as to allow for maximum neurologic improvement.
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We retrospectively reviewed the records of 62 patients who sustained serious hand injuries caused by snowblowers between 1981 and 1990. Frequency of injuries to digits tended to correlate with length (i.e., middle, index, ring, or small finger or thumb). Damage to tendons did not seem to follow any particular pattern. ⋯ When patients were further questioned regarding the circumstances and events leading to their injury, a recurring pattern was found. Most patients described a wet, heavy snow having recently fallen. The majority of the patients who were injured by placing their hands into the exit chute admitted that they were aware the machine was running, but thought that they had a greater clearance to the rotating impeller blade.
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Review Case Reports
Paraspinal pyomyositis, a rare cause of severe back pain: case report and review of the literature.
Pyomyositis, a pyogenic infection of skeletal muscle, is rarely reported in temperate climates. A case of pyomyositis within the paraspinal muscles of a 63-year-old man is reported, with details of diagnostic evaluation and medical and surgical treatment of the condition. Failure to recognize this clinical entity can lead to diagnostic delay and inappropriate management.
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To determine the course and anatomic relationships of the musculocutaneous nerve in the arm, we dissected 54 cadaver arms and measured the length of any interconnection between the musculocutaneous nerve and the median nerve (36% of dissections; mean, 1.77 cm) and the distance from the coracoid process to (1) the musculocutaneous nerve (mean, 0.46 cm distal); (2) the median nerve (mean, 1.91 cm distal); (3) the musculocutaneous nerve's entrance to and exit from the coracobrachialis muscle (mean, 4.99 cm and 7.55 cm, respectively); and (4) the musculocutaneous nerve's entrance into the biceps muscle (mean, 11.66 cm). The high percentage of anomalies found emphasizes the complexities and irregularities of this anatomic region with regard to surgical approaches.