Vertically unstable type III odontoid fractures: case report.
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Biomedical subjects
Publications and source records attributed to Demetrios S Korres.
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BACKGROUND CONTEXT: Diving injuries are the cause of potentially devastating trauma, primarily affecting the cervical spine. PURPOSE: Our purpose was to describe our experience with diving injuries treatment. STUDY DESIGN: Retrospective review. PATIENT SAMPLE: Twenty patients with diving injuries. OUTCOME MEASURES: Using the American Spinal Injury Association (ASIA) impairment scales as the primary outcome measure, the patients' neurological status before and after treatment was assessed. In this way we were able to draw conclusions about neurological improvement or deterioration in response to conservative or operative treatment. METHODS: We retrospectively reviewed 20 patients with diving injuries of the cervical spine who were admitted to our institute over a 34-year period from 1970 until 2004. RESULTS: The typical patient profile was of a young, healthy, athletic male who suffered an injury to the cervical spine after diving into shallow water. The number of cases corresponds to 2.6% of all admitted cervical spine injuries. All injures occurred between May and September. The most commonly fractured vertebrae were C5 and C6. Four patients were treated operatively and 16 conservatively. The indications for surgical treatment were posttraumatic instability and persistent neurological deficit. The mean follow-up of the patients was 17 years. Five patients died within the first month of their hospitalization and 1 patient died 1 year after his injury. Of the 14 patients who were available for follow-up 5 years past injury time, 6 improved neurologically and 8 remained unchanged in relation to their neurology upon admission. Of the 11 patients who were available for follow-up 10 years past injury time, 9 remained neurologically unchanged, 1 deteriorated, and 1 improved in relation to their neurology in the 5-year follow-up. CONCLUSION: Diving injuries of the cervical spine demonstrate high mortality and morbidity rates. Recovery depends on the severity of the initial neurological damage. Conservative treatment is justified in specific patients and can lead to improvement of the initial neurological deficit.
STUDY DESIGN: A retrospective study was performed to identify horizontal fractures of the body of the axis, with special attention to their pattern, prevalence, and clinical outcome. OBJECTIVE: The prevalence of this type of injury and the long-term clinical behavior are examined. SUMMARY OF BACKGROUND DATA: Although isolated cases have been reported, horizontal Chance-type fractures of the body of the axis are not common cervical spine injuries. METHODS: The medical records of 674 consecutive patients with fractures of the cervical spine admitted to the authors' institute from 1970 to 2002 were reviewed. Of them, 2 (0.3%) had a horizontal Chance-type fracture of the body of the axis. Neurologic deficits were not diagnosed at admission. Mechanism of injury, treatment, and long-term follow-up were evaluated. RESULTS: Both patients were treated nonoperatively. At the latest follow-up, 3 and 12 years, respectively, both patients had a satisfactory clinical outcome. CONCLUSION: Horizontal fractures of the Chance-type of the body of the axis are rare. Conservative treatment proved to be effective.
High-energy tibial plateau fractures are often the result of blunt trauma and are associated with severe soft-tissue injury. Fixation techniques demand considerable surgical skill and mature judgment. The available surgical options do not always guarantee a favourable outcome. Operative treatment includes internal and external fixation, hybrid fixation and arthroscopically assisted techniques. Operative management of high-energy fractures remains difficult and challenging and may be associated with serious complications, such as knee stiffness, ankylosis, deep infection, post-traumatic arthritis, malunion and nonunion. Prevention of the complications can optimise the clinical outcome in these patients.
BACKGROUND: Infections of the musculoskeletal system are tuberculous in nature in 1-5% of cases. The sacroiliac joint is involved in 3-9.7%. We describe the case of a 32-year-old man with tuberculous sacroiliitis presented as a growing mass on the lateral aspect of his right proximal and mid-thigh. Open biopsy, histology, cultures and PCR established the diagnosis of tuberculosis. RESULTS: After surgical drainage of the abscess, the patient was administrated a triple antibiotic regimen for 12 months. Seven years postoperatively, the patient is disease-free with no functional limitation. This case report highlights the importance of continued awareness for early detection and treatment of a tuberculous sacroiliac joint infection.
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Explore the source record for details and available documents.
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Multiple fractures of the axis are not common lesions. A retrospective study was performed to identify the different fracture patterns and to analyze the incidence of these injuries and their long-term behavior. The medical records of 674 consecutive patients with fractures of the cervical spine were reviewed. Nine (1%) of 674 patients (6 men and 3 women) had multiple fractures of the axis. Mean patient age was 48 years. The most common lesion was a combination of traumatic spondylolisthesis with either an odontoid process or a teardrop fracture of the axis body. All patients were treated conservatively with an excellent or good outcome at mean 12-year follow-up (range: 2-18 years). Computed tomography was the imaging modality of choice for the correct diagnosis of these rare lesions.
The authors present a 45-year-old man with bone marrow edema syndrome (BMES) of the medial condyle of the knee. Early diagnosis of BMES was based upon clinical, bone scintigraphy and magnetic resonance (MRI) findings. After failure of the conservative treatment, core decompression was performed. Histological examination showed no evidence of osteoporosis or osteonecrosis. Within 2 months after the operation, the patient was pain-free and he resumed his previous activities. At 1-year follow-up examination, MRI showed complete resolution of all signal abnormalities; at 3-year follow-up the patient remained symptom-free and with no functional limitations.
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