Journal of surgical orthopaedic advances
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Traumatic axial dislocation of the carpus in a 20-year-old man is described. This injury was accompanied by a crushing injury to the hand. ⋯ Despite the restoration of painless wrist motion postoperatively, grip strength remained below normal. Early accurate reduction, fixation, and range of motion exercise are the treatments of choice in such complex injuries.
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Traumatic injuries to the cervical spine are often difficult to detect and are associated with substantial morbidity and mortality. Along with standard trauma radiographs, a thorough physical examination and meticulous documentation are of the utmost importance because many neurologic injuries evolve over time. ⋯ It is crucial to recognize injuries to the cervical spine and the different treatment options. Computed tomography can be very helpful in defining the bony injury and evaluating the spinal canal, whereas magnetic resonance imaging can better evaluate the spinal cord and assess ligamentous injury.
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Four patients with acromioclavicular joint injuries (one type II, two type III, one type V), two patients without acromioclavicular joint injury, and a fresh-frozen cadaver underwent magnetic resonance imaging (MRI) and plain radiographs. The normal conoid and trapezoid ligaments were easily identified in the cadaver and the two uninjured patients. ⋯ Thus, the grade of injury, as determined by the change in the coracoclavicular interval onplain radiography and defined by the Rockwood classification system, failed to correlate with the pathoanatomy seen on MRI in two of the four injured patients. These findings suggest that improvements in the classification of these injuries may be necessary.
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Case Reports
Concomitant sacroiliac joint pain in patients with lumbar disc herniation: case series.
Recent studies have shown that not all lumbar disc herniations are symptomatic and that when followed longitudinally, these patients develop back pain independent of the previous imaging study. This is a case report of two patients with radicular symptoms and lumbar disc herniations that underwent diagnostic injections to locate their pain generator. Both patients failed to respond to transforaminal epidural steroid injections. ⋯ They were both treated conservatively for sacroiliac joint pain and did well. One remained pain free after several months and the second remained with minimal pain until she presented again in her 3rd month of pregnancy with return of her pain. The differential diagnosis of lumbar radicular pain is discussed as well as the authors' experience in using diagnostic injections.
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Comparative Study
Hip arthroplasty after extracapsular hip fracture: a matched pair cohort analysis.
Eighteen patients with a prior intertrochanteric or basicervical hip fracture had a total or bipolar hip arthroplasty. The clinical and radiographic results of these patients were compared to a control group of patients (matched for age, gender, associated diagnoses, and length of follow-up) who had a primary total hip arthroplasty. ⋯ There was no notable difference in the rates of radiographic loosening or heterotopic ossification between the two groups. The results of this study suggest that patients should be counseled preoperatively that the functional outcome of hip arthroplasty after internal fixation of extracapsular hip fractures is decreased compared to control patients with a primary total hip arthroplasty.