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PubMed2004

Fracture treatment in the elderly.

With an ever increasing percentage of elderly people among the population fracture management in the aged is of increasing importance in the field of traumatology, since people between the ages of 60 and 80 will constitute the largest subpopulation by 2030. Due to relevant interindividual differences concerning physical constitution and comorbidity this group resembles an extremely inhomogenic population of patients. Discrepancies between biologic and chronologic age make a careful selection of suitable therapeutic strategies individually adapted to a single patient's situation necessary. For the biologically younger patient with good compliance conservative treatment or minimal osteosynthetic procedures requiring partial weight bearing might constitute a reasonable and appropriate therapeutic option whereas for biologically older patients with relevant co-morbidity early mobilisation with short hospitalisation periods is of the highest priority. This is why in these cases osteosynthetic procedures with implants that allow full weight bearing initially after surgery should be preferred. Even though in advanced age there is an increasing risk of fractures in general -- due to increasing incidence of falls and decreasing bone mineral density -- the majority of fractures in elderly is located in the proximal femur, the proximal humerus and the distal radius. Therefore, therapy of fractures in these typical locations shall in recognition of the particular characteristics of the advanced age be displayed in this article.

Aged↗
PubMed2005

[Traumatic aortic regurgitation complicating chronic bronchitis; report of a case].

A 61-year-old man with diabetes mellitus and chronic bronchitis was brought to the hospital after falling from a roof accidentally. He received blunt trauma to the left chest wall including left rib fractures, pneumothorax, hemothorax and a fracture of left scapula. After endotracheal intubation and chest drainage, he was transferred to the intensive care unit. Sixteen days later, congestive heart failure appeared. Echocardiography showed a severe aortic valve regurgitation with a prolapse of non-coronary cusp. Eight months after the injury, his heart failure deteriorated. He underwent aortic valve replacement with a mechanical prosthesis. Upon examining the aortic valve, we noted 2 perforations in the non-coronary cusp of the aortic valve. Postoperative course was uneventful.

Accidents, Home↗
PubMedDate not supplied

[Emergencies in shoulder joint surgery].

Emergency in orthopaedics compared to classical surgery presents a completely different issue. Some orthopaedic conditions do not require immediate surgery, but they have to be solved within weeks or months, and are therefore addressed as relatively urgent conditions. If this kind of surgery is delayed, condition may deteriorate, and in some cases it becomes impossible to perform reconstructive surgical procedure. Considering this, some shoulder conditions require urgent and some relatively urgent surgery. When time limits are concerned that means these patients have to be operated on within 3 to 6 weeks, or during first three months after the initial trauma.

Emergencies↗
PubMed2006

[Neer classification of the proximal humerus fractures based on our own material].

INTRODUCTION: About 4-5% of all fractures are localised to the proximal end of the humerus. During the last 30 years a two-time increase has been observed. The cause was ageing of population and a higher incidence of fractures. Treatment improved owing to proper classification based on radiological diagnostics. OBJECTIVE: The principles of diagnostic and classification were presented on the basis of the literature and analysis of the clinical material. MATERIAL: We analysed the ways of the diagnosis and classification of the proximal humerus fractures in 166 patients treated in Traumatologic and Orthopaedics Department of the Bielański Hospital in Warsaw and in Orthopaedics Department of the Medical Postgraduate Medical Education Centre in Otwock during years 1988-2004. RESULTS: The classification suggested in 1970 by Neer has firmly established the way of treatment, is easy to remember, and regarded as the most popular and acceptable practice. It is based on dislocation one or more of the four bone fragments: shaft, head with articular surface, greater and lesser tuberosity of the humerus. Proper assessment of the type of fracture requires precise identification of these elements on radiograms. Correct assessment of dislocations of bone fragments and the way of dislocations is essential matter because specificity of the blood supply that improves heeling of the fracture and efficiency of the affected limb in the future. SUMMARY: It was found that conventional plain radiograms made in AP and Y exposures were sufficient for recognition the type of fracture. When diagnosis was questionable examination had to be broadened by axillar exposure and CT performed in the stated sequence.

Fracture Fixation, Internal↗
PubMed1991

[Role of arthroscopy in complex sports injuries].

Shoulder lesions caused by accident are often of complex nature. In most cases, different structures are involved, which cannot be distinguished and individualized clinically with certainty. Arthroscopy permits far more differentiated diagnosis with systematic revision of traumatized structures. Besides the possibility of comprehensive repair (e.g. in part arthroscopic, in part open), the faster rehabilitation attained by minimal exposures is also of importance.

Arthroscopy↗
PubMed1990

[Sports pathology of the shoulder: its imaging diagnosis].

Success and diffusion of various sports have produced more frequent capsular-ligamentous lesions of the shoulder. Diagnosis up to now has relied on traditional radiology using many projections to demonstrate extremity lesions and their congruences; however for capsular-ligamentous lesions, arthrography in used successfully. Since the last few years new investigating methods are used (U.S., C.T., M.N.R.). After examining benefits of each diagnosing method compared to traditional radiology, the authors conclude that traditional radiology still has a pre-eminent role in diagnosing sports pathology of the shoulder.

Arthrography↗
PubMed1990

Axillary artery damage from shoulder trauma--a report of 2 cases.

Various shoulder injuries can give rise to axillary artery complications. Two such cases were admitted to Tan Tock Seng Hospital late last year. Both were young adult males, who had developed axillary artery thrombosis secondary to shoulder injuries. The following is a short discussion on the common types of shoulder injuries, how they result in axillary artery compromise and a short section on their management and treatment.

Adult↗
PubMed1989

[A case of delayed postanoxic encephalopathy with bilateral lesions of the corpus striatum].

Delayed neurological deterioration following anoxia is known to result from carbon monoxide exposure. However, it may also occur with anoxia of other types as well. The present report describes a case of delayed postanoxic encephalopathy with bilateral striatal lesions demonstrated by magnetic resonance imaging. A 27-year-old man exhibited anoxic anoxia caused by upper airway obstruction following general anesthesia for shoulder fracture surgery. Initially he was delirious and markedly excited for one day and became apparently normal for the following three days. Then he relapsed into delayed neurological deterioration with speech and gait disturbance, clumsiness of hand, pyramidal signs and metamorphopsia. Thereafter, he became bed-ridden and fell into semicomatose state with marked motor restlessness, involuntary movement of the tongue and decorticate posture. Twenty-five days later he had a second recovery period after hyperbaric oxygenation that lead to the sequelae with speech and motor disturbances and mild mental changes. I examined the present case as an expert witness in a civil suit eleven years after initial anoxia. The patient showed slight intellectual impairment and personality change. Impairment in figure-ground differentiation and disorders of spatial thought were also observed. Neurological examination revealed anisocoria, dysarthria with acquired stuttering, disturbances of fractionated movement of fingers, writer's cramp and Babinski's sign bilaterally. Postural dystonia of both hands and fingers, rigidity and spasticity of all extremities were also present. Magnetic resonance imaging (MRI) showed bilateral lesions of the corpus striatum, especially of the putamen. Some portion of the caudate nucleus was also involved. Cerebral cortices and white matter were slightly atrophic. From the above clinical course and neurological findings, we diagnosed the present case as delayed postanoxic encephalopathy. Ginsberg (1979) noted that in cases of anoxia not related to carbon monoxide, diffuse demyelinative changes of cerebral hemispheral white matter tended to be associated with relapsing clinical course, and gray matter injury was only seen in a few cases. MRI findings in the present case suggest that main site of the lesion to be in gray matter of the corpus striatum. In this respect, the present case is considered to be noteworthy.

Adult↗
PubMed1988

The value of axial view in the radiography of shoulder girdle--experiences with a new modification of positioning.

A series of 117 patients underwent radiography of the shoulder girdle, performed using a modification which allowed the examination of also severely injured patients in the axial view. The findings in the frontal and axial views were compared. A total number of 161 pathological findings were discovered; out of them 30 were visible only in the frontal view and 49 only in the axial view. The series indicates that the axial view can be taken painless in patients with recent injury, and that the frontal and axial views considerably supplement each other.

Arthritis↗