Angiography in musculoskeletal trauma.
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A case of atherosclerotic axillary artery rupture in closed fracture of the proximal part of the humerus is described. It demonstrates a possible serious arterial injury in elderly persons even in case the fracture of the humeral neck is not dislocated. If there are signs of disturbed circulation in these injuries, angiography is indicated irrespective of the type of fracture and mechanism of injury.
Ten patients who had been treated by limited open reduction and percutaneous stabilization for four-part posterior fracture-dislocation of the shoulder were followed-up for an average of 3.2 years postoperatively. According to the criteria of Neer, the result was excellent in nine patients, with an average Constant score of 95.7. There was one failure who showed complete avascular necrosis. All patients with excellent results had at least 1 mm of the neck portion of the head fragment intact.
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Pathological fractures as a consequence of convulsive seizures without direct trauma occur in 0.3% of cases. Some lesions such as bilateral posterior dislocation of the shoulder, fracture-dislocation of the shoulder or fracture and/or dislocation of the hip strongly suggest a seizure as the aetiology. We report on a patient with simultaneous central dislocation of one hip with fracture of the contralateral femoral neck provoked by spontaneous seizures. Unrecognized associated injuries following a convulsion may result in long-term functional disability and legal consequences.
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Arthroscopic reduction and percutaneous external fixation is a well-known technique for treating selected fractures. This is the first report of a method of treating intra-articular glenoid rim fracture using shoulder arthroscopy and percutaneous external fixation. The surgical trauma associated with open operative treatment of these fractures can be minimized using minimally invasive techniques under arthroscopic control. This technique not only allows for anatomic reduction with minimal surgical trauma but provides a valid diagnostic and treatment alternative for associated injuries. Arthroscopic reduction and percutaneous external fixation yielded excellent results with no complications. The authors describe the principles of the procedure and discuss its advantages compared with traditional surgery.