J Trauma
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Case Reports
The off-profile proximal radial epiphysis: another potential pitfall in the X-ray diagnosis of elbow trauma.
If the elbow is filmed in flexion in a pubertal age child, the proximal radial epiphyseal line may be projected through the articular surface of the radial head on standard or oblique AP views. This can theoretically mimic a fissure or chisel-type fracture. Fractures involving the articular surface of the radial head, however, are extremely rare in children and the true fissure fractures that occur in the adult are notably different in specific radiographic features.
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Comparative Study
Comparison of double indicator thermodilution measurements of extravascular lung water (EVLW) with radiographic estimation of lung water in trauma patients.
The availability for clinical use of a simple reliable method of determining extravascular lung water (EVLW) provided us with the opportunity to evaluate the accuracy of the plain chest roentgenogram in estimating EVLW in patients with severe trauma. Twelve patients who sustained blunt trauma in motor vehicular accidents were studied. Interval measurements of EVLW were made utilizing the thermal-green dye, double-indicator dilution technique and the results compared in a blind manner to estimation of lung water content on standard chest roentgenograms. ⋯ The random comparison of a change in measured EVLW with a change in radiographic density indicated that there were opposite changes in 23% of the comparisons. However, in selected patients with progressive improvement (decrease) in EVLW or gradual deterioration (increase) in EVLW over time there was good correlation between improvement or deterioration in the chest radiographic appearance with the decrease or increase in EVLW. There is some ability to ascertain in trauma patients interstitial fluid accumulation from chest radiographs, but attempts at quantitation would be fraught with considerable error.
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Prehospital blunt trauma care in one community was characterized retrospectively by the use of clinical and anatomic indices of injury severity. The predicted number of deaths derived from anatomic indices (Anatomic Index and Injury Severity Score) for patients found alive at the scene was statistically greater than observed. ⋯ All such patients received an intravenous attempt and were taken to the hospital by the paramedics rather than by commercial ambulance as was the paramedics' option. Survival correlated with the absence of clinical deterioration during the prehospital phase.
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Pulmonary vein to artery missile embolus is extremely rare. Only one other case could be found in the world's literature and the present case appears to be the only reported survivor. ⋯ Extraction of the foreign body is secondary and becomes an absolute necessity only when it interferes with distal perfusion. Catheter embolectomy is contraindicated because of possible intimal damage, so that direct arteriotomy is preferred.
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A case of volar radio-carpal dislocation with complete anterior dislocation of the lunate is reported. The injury was caused, unusually, by forced hyperflexion. The mechanism by which this dislocation is produced and the possible order of events in this injury are discussed by reference to the radiological and operative findings. Successful treatment by closed reduction of the radiocarpal dislocations and open reduction of the lunate is reported, and the relevant literature is briefly reviewed.