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PubMed1986

[Intrathoracic dislocation of the head of the humerus].

Intrathoracic displacement of the proximal humerus following axillary luxation is a rare injury; but with ipsilateral serial costal fracture and/or single costal fracture with contused lung it has to be included in the considerations concerning differential diagnosis and the tactics of surgical approach. The primary measures are determined by the extent of pulmonary damage; the further course is marked by aseptic necrosis of the head of the humerus. On the basis of our study case we are describing a typical course, and discussing its problems taking into consideration the individual publications available so far.

Adult↗
PubMedDate not supplied

Arterial supply of the glenoid: an anatomic study.

Surgery is performed on the glenoid for a variety of pathologic conditions, and an adequate blood supply is required to achieve good healing of soft tissue and bone. The objective of this investigation was to study the arterial supply of the glenoid in 24 fresh human cadaveric specimens. The vascular supply originates from branches of the anterior and posterior circumflex arteries and the suprascapular artery and branches directly from the infraspinatus and teres minor muscles. The antero-superior portion of the glenoid is poorly vascularized, with a specific area that is completely devoid of blood supply. In addition, circumferentially around the glenoid rim, there is an area of approximately 5 mm from the edge that is completely devoid of vascularity. Adequate bone and soft-tissue healing in the glenoid, particularly in its anterosuperior portion, after fracture repair, osteotomy, total shoulder arthroplasty, and capsular procedures may be compromised by the demonstrated hypovascularity.

Aged↗
PubMed1984

Luxatio erecta.

Explore the source record for details and available documents.

Adolescent↗
PubMed1998

Risk of avascular necrosis following short term megadose methylprednisolone treatment.

We conducted a prospective cohort study to determine whether administration of large doses of the corticosteroid methylprednisolone following spinal cord injury as recommended in the National Acute Spinal Cord Injury Study-2 (NASCIS-2) protocol results in an increased incidence of avascular necrosis (AVN) of the femoral or humeral head. All subjects were patients treated by a spinal cord injury physician in an Acute Spinal Cord Injury Unit between 1989 and 1996 where some received the megadose steroids while others did not. Patients younger than 15 years and older than 75 years were excluded, as were those with any hip or shoulder disease, with pelvic fracture, or with a history of predisposition to AVN by hip dislocation, excessive alcohol consumption, previous high dose steroid use, or systemic lupus erythematosus. Screening for AVN of the femoral and humeral heads was performed at a minimum of 6 months following injury, using magnetic resonance imaging (MRI). The films were read by a radiologist blinded to the treatment protocol received by the individual subject. Among the 59 spinal cord injured patients who received steroids (age 15-64 years (mean 32 years)), five were female. Among the 32 spinal cord injured subjects who did not receive steroids (age 16 to 65 years (mean 34 years)), seven were female. There was no case of AVN found in either group. Using binomial distribution, we conclude that the true incidence of AVN among the methylprednisolone treated group is less than 5% (alpha < 0.05) and therefore continue to recommend short term (24 h) methylprednisolone therapy.

Adolescent↗
PubMed2006

[Nordic pole walking injuries--nordic walking thumb as novel injury entity].

BACKGROUND: Nordic pole Walking (NW) as trend sport is associated with beneficial effects on the cardiovascular system. Data regarding the injury and overload injury rates are pending. METHODS: 137 athletes (74 % females, 53 +/- 12 years, weight 73 +/- 13 kg, height 169 +/- 11 cm) were prospectively ask using a two-sided questionnaire. Mean NW experience was 212.8 weeks with 2.9 +/- 1.8 hours/week. The overall exposure was 29 160 h. RESULTS: NW injury rate was 0.926/1000 h. Falls were evident in 0.24/1000 h. The upper extremity was involved more frequently (0.549/1000 h) than the lower extremity (0.344/1000 h). The most severe injury was a concomitant shoulder dislocation and luxation of the proximal interphalangeal joint of the index finger after a fall. The most frequent injury in NW was a distorsion of the ulnar collateral ligament of the thumb (0.206/1000 h) after fall. Shoulder injuries account for 0.171/1000 h with 0.069/1000 h shoulder dislocations. Distal radius fractures were rare as ankle sprains and shinspints (0.034/1000 h). Muscle injuries were encountered only at the gastrocnemius muscle (0.137/1000 h). No knee ligament injuries were noted. In 5%, NW injuries caused interruption of the performance, with all patients returning to sport within 4 weeks on the same level as before. DISCUSSION: Nordic Walking is safe. Most frequently, a Nordic walking thumb is encountered during a fall with the athlete holding on to the NW pole until the very last moment before the hand hits the ground with the pole handle as hypomochlium that forces the thumb into abduction and extension. Modifications of the grip construction as well as information of the athlete and behaviour changes may be preventive measures.

Accidental Falls↗
PubMed2005

Family members do not disrupt care when present during invasive procedures.

OBJECTIVE: To determine whether family members (FMs) remaining with pediatric patients during invasive procedures interfere with delivery of care. METHODS: The authors conducted a prospective observational study of consecutive patients <18 years of age undergoing invasive procedures in the emergency department (ED) over a one-year period. Behaviors of FMs remaining during invasive procedures were recorded as any of six categorical descriptions (stood quietly, asked questions, soothed patient, helped restrain patient, interfered with care, other). All observations were made through direct observation by two study attending physicians on FMs of patients under their direct care, or during their supervision of resident care. RESULTS: Fifty-four FMs were observed during the ED care of 37 patients [mean age 1.5 years (+/-0.25), median age 0.4 years]. Invasive procedures included: lumbar puncture (n = 28), endotracheal intubation (n = 5), fracture reduction (n = 2), shoulder reduction (n = 1), and tube thoracostomy (n = 1). Seventy-one FM activities were recorded: stood bedside, 22 (31%); soothed child, 21 (30%); asked questions, 11 (16%); helped restrain, 5 (7%); interfered with care, 2 (3%); and other, 10 (15%). The two "interfered with care" events were minor and did not significantly alter patient management. One mother experienced a near-syncope event standing during a lumbar puncture of her child and was seated without further incident. One mother stopped reduction of a shoulder dislocation because she felt the pain control was inadequate even though the child was deeply sedated with propofol. Expected patient behavior was described to the mother and reduction was completed. CONCLUSIONS: In this study, family members remaining with children during invasive procedures were not a risk for disruption of patient care.

Adult↗