锁骨内侧骨折合并同侧肩锁关节脱位漏诊1例

患者,男,50岁,2h前从高约5m屋顶坠落,右侧肩部着地,起立后无法上举、外展右侧上肢,感右肩部、胸部及足部疼痛,就诊我院急诊科,行胸腰部CT检查(仅扫描到一部分锁骨,且患者非严格仰卧位,身体左侧倾斜)示右侧锁骨内侧端骨折,第3-5肋骨骨折(图1a).仰卧位右肩部X线示右锁骨内侧端骨折(图1b).由于患者足部受伤,未予...     

肩锁关节脱位伴对侧锁骨骨折1例报告

<正>1病例资料患者,女,30岁,因骑摩托车与路面的石柱相撞摔倒致双肩疼痛、活动受限8小时入院。行X线检查提示:左锁骨骨折,右肩锁关节脱位(图1)。入院后查体见左肩部处皮肤完整,皮下可触及骨折断端,手掌处可见皮肤擦伤,右肩锁关节处见明显的皮肤擦痕,     

Traumatic lumbosacral fracture dislocation: a case report and review of the literature

Lumbosacral dislocation is uncommon. We report a case of traumatic lumbosacral dislocation which occurred in a 33-year-old pedestrian traffic accident victim. The posterior impact produced lumbar injury with diffuse pain exacerbated at the lumbosacral junction. Ecchymotic diffusion involving the entire lumbar region fluctuated due to the presence of a subcutaneous hematoma. The neurological examination revealed incomplete L5 paraplegia. Standard x-rays revealed L5-S1 spondylolisthesis and fracture of the L5 spinous process as well as fractures of the L3, L4, and L5 transverse processes. Computed tomography disclosed biarticular L5-S1 fracture dislocation and a voluminous herniation of the L5-S1 disc. Emergency surgery was performed and revealed subaponeurotic detachment from T4 to S1 and bald iliac pyramids. After L5 laminectomy and extraction of the voluminous herniation of the L5-S1 disc, a short L5-S1 posteriolateral fusion was achieved using pedicular screws and two rods on either side as well as a posterolateral iliac autograft. The clinical course was satisfactory with nearly complete neurological recovery (persistent levator ani paresis). This clinical case and a review of the literature illustrate the pathogenic, clinical, radiological and therapeutic aspects of lumbosacral fracture dislocation.     

Medial clavicular epiphyseal fracture with ipsilateral acromioclavicular dislocation: a case report of panclavicular fracture dislocation

The authors report a case of a complete posterior dislocation of the acromioclavicular (AC) joint with an ipsilateral medial epiphyseal clavicular fracture in a 20-year-old male. Open reduction was indicated because a maintained closed reduction of the AC joint was unsuccessful, and the described treatment maintained a successful reduction.     

Transscaphoid-transtriquetral perilunate fracture dislocation: report of a case and review of the literature

INTRODUCTION: A transscaphoid and transtriquetral perilunate fracture dislocation is fairly rare among the known cases of perilunate fracture dislocations, and the details of the initial treatment and outcome of this injury have never been reported. MATERIALS AND METHODS: A 21-year-old, right-handed man presented with fractures at the proximal third of the scaphoid and at the mid-body of the triquetrum with an associated dorsal perilunate dislocation after a fall onto his outstretched hand. Under general anesthesia, closed reduction was attempted with 3 kg of traction applied by means of finger traps. After anatomical reduction was achieved, percutaneous fixation was applied to both the triquetrum and scaphoid using cannulated screws. A short arm thumb spica splint was applied for 2 weeks, and part-time splinting was continued for an additional 3 weeks. The patient subsequently underwent 3 months of intensive range-of-motion and muscle-strengthening exercises. RESULTS: At the final follow-up examination 68 months after the initial operation, the arc of motion of the right wrist, 150 degrees (extension plus flexion arc), and grip strength, 41 kg, were 94% and 103% of the values for the unaffected wrist, respectively. Radiographs showed a bony union of the scaphoid and triquetrum, and no sign of avascular necrosis in the proximal scaphoid fragment, as well as other carpi. No midcarpal or radiocarpal degenerative arthritis was observed, and the normal carpal bone relationships were still maintained, with a scapholunate angle of 48 degrees and a scapholunate gap of 2 mm. CONCLUSION: We recommend closed reduction and percutaneous screw fixation of the scaphoid, as well as the triquetrum in this case, to minimize the interruption of the blood supply to the carpus and also to obtain rigid fixation during the procedure.     

Floating clavicle after a high velocity biking accident: A case report of an acromioclavicular dislocation with simultaneous proximal clavicle fracture managed surgically

IntroductionClavicle fractures and acromioclavicular joint dislocations are very common injuries. However, the combination of both, known as “floating clavicle” is extremely rare, with approximately 40 cases reported.Presentation of caseWe report a case of a healthy 51-year-old male who suffered a high-velocity biking accident, with a bipolar clavicle injury (type IV acromioclavicular joint dislocation and proximal clavicle fracture), with concomitant rib fractures and pulmonary contusion. He received early surgical treatment by open reduction and osteosynthesis of the proximal clavicle (distal ulna plate, Protean®) and open reduction and stabilization with a MINAR® implant for the acromioclavicular joint. After an initial one-month immobilization, he started physical therapy. In the 10-month follow-up he presented with a pain-free full range of motion, a good cosmetic result, and radiological consolidation.DiscussionBipolar clavicle injury is a rare clinical entity that encompasses a spectrum of combined clavicle fractures, acromioclavicular or sternoclavicular joint dislocations. They are sustained in a high-energy context, and accompanying injuries must be sought. Diagnosis is made through X-Ray and CT. Despite the lack of clinical guidelines, most authors agree on surgical management of at least one of the injuries, with multiple surgical techniques available. There is an emphasis in surgical treatment of the young and active patient. Conservative treatment is associated with poorer results.ConclusionIt is advisable to have a high index of suspicion for floating clavicle in a high-energy trauma patient, given possible life-threatening injuries, and long-term shoulder sequelae. Surgery should be considered in a young and active patient.     

Posterior fracture through the sternoclavicular physis associated with a clavicle fracture: a case report and literature review.

Three reported cases of fractures in teenagers of the medial clavicle associated with a posterior disruption at the sternoclavicular joint have similar findings. The medial fragment is rotated 90 degrees to the coronal plane. The medial fragment is usually stripped of its periosteum. Treatment requires open reduction and internal fixation of the clavicle fracture. We are reporting similar findings in a fourth case.     

Open anterior fracture dislocation of the hip: a case report and review of literature

Open anterior fracture dislocation of the hip is an extremely rare injury and is the result of a violent trauma. Such a case is being reported in a 15-year-old female, who also had other adjacent bony injuries. In spite of early treatment, necrosis and infection could not be controlled, resulting in permanent disability in this young girl.     

Ipsilateral posterior sternoclavicular dislocation and fracture of the medial third clavicle: a case report

Ipsilateral fracture of the medial third clavicle and posterior dislocation of Sternoclavicular joint is an extremely rare presentation. This case report illustrates an 11-year-old male patient with ipsilateral fracture of the medial third clavicle and posterior Dislocation of the sternoclavicular joint sustained after a fall while playing at school. The diagnosis of this condition requires a high incidence of suspicion in view of the potential for associated neurovascular injury.     

Ipsilateral mid-third clavicle fracture with grade V acromioclavicular joint dislocation

We report the case of a 20-year-old man with an ipsilateral mid-third clavicle fracture with grade V acromioclavicular joint (ACJ) dislocation. The combination of these two injuries is rare. A literature search produced various treatment algorithms. In this case, the patient was successfully treated with a Bosworth screw.This work was carried out in the Department of Orthopaedics, William Harvey Hospital, Ashford, Kent, UK     

新鲜肩锁关节脱位及锁骨远端骨折的微创治疗

目的:探索新鲜肩锁关节脱位和锁骨远端骨折的微创治疗方法。方法:采用20套人肩部骨骼标本和10例尸体标本进行基础研究,并用超声引导,在活体上测量、设计,确定了喙突尖至锁骨锥状韧带结节后方骨突连线同锁骨中轴交点的定位方法。2001年1月至2010年1月,采用体表标志定位,微创内固定手术方法,对127例新鲜肩锁关节脱位及锁骨远端骨折进行治疗,男97例,女30例;年龄19～56岁,平均43岁。新鲜肩锁关节脱位93例,根据Rockwood分型,Ⅲ型67例,Ⅳ型11例,Ⅴ型15例;新鲜锁骨远端骨折34例,均合并喙锁韧带断裂。手术时间在伤后1～8d,疗效评估采用美国加州洛杉矶大学肩关节评分系统(UCLA)。结果:全部病例手术固定后,早期均完全复位。随访113例,时间13～15个月,平均14个月。9例螺钉在30d内出现轻度松动,位置仍可接受,功能恢复良好。7例并发肩周炎,半年后恢复。UCLA肩关节评分总平均分(32.0±4.7)分。优87例,良20例,可6例。结论:本方法具有创伤微小、费用低廉的优点,值得在临床推广使用。     

Ipsilateral fracture dislocation of the shoulder and elbow: A case report and literature review

Ipsilateral dislocation of the shoulder and elbow is an uncommon injury. A literature review identified nine previously described cases. We are reporting a unique case of ipsilateral posterior shoulder dislocation and anterior elbow dislocation along with concomitant intra-articular fractures of both joints. This is the first report describing this combination of injuries. Successful treatment generally occurs with closed reduction of ipsilateral shoulder and elbow dislocations, usually reducing the elbow first. When combined with a fracture at one or both locations, closed reduction of the dislocations in conjunction with appropriate fracture management can result in a positive functional outcome.     

胸锁关节脱位合并肩锁关节脱位伴肩胛骨喙突骨折漏诊1例

<正>患者,女,55岁,因跌伤致右肩疼痛活动受限2 h收住入院。患者2 h前骑车时跌倒,右侧头面部及右肩着地,急诊摄X线片示右胸锁关节脱位。入院查体:右锁骨胸骨端局部隆起、压痛,可及弹性固定,平卧时隆起变小,坐起时明显,右手各指感觉活     

Osteochondral flap fracture of the coronoid in pediatric elbow dislocation: a case report and literature review

European Journal of Orthopaedic Surgery & Traumatology - Osteochondral flap fractures of the coronoid are rare occult fractures, often diagnosed in delay, in pediatric patients who underwent...     

Proximal tibiofibular dislocation: a case report and review of literature

An isolated dislocation of the proximal tibiofibular joint is uncommon. The mechanism of this injury is usually sports related. We present a case where initial X-rays did not show the tibiofibular joint dislocation conclusively. It was diagnosed after comparative bilateral AP X-rays of the knees were obtained. A closed reduction was performed and followed by unrestricted mobilization after 1 week of rest. A review of the literature was conducted on PubMed MEDLINE. Thirty cases of isolated acute proximal tibiofibular joint dislocations were identified in a search from 1974. The most common direction of the dislocation was anterolateral, and common causes were sports injury or high velocity accident related. More than 75 % of the cases were successfully treated by closed reduction. Complaints, if any, at the last follow-up (averaging 10 months, range 0–108) were, in the worst cases, pain during sporting activities. We advise comparative knee X-rays if there is a presentation of lateral knee pain after injury and diagnosis is uncertain. Closed reduction is usually successful if a dislocation of the proximal tibiofibular joint is diagnosed. There is no standard for after-care, but early mobilization appears safe if there are no other knee injuries.     

Coracoid fracture associated with acromioclavicular dislocation. A case report.

When a fracture of the coracoid process is identified by clinical examination and X-rays, one should always be aware of a possible acromioclavicular dislocation. Clinical exam and X-rays of the shoulder with weights in the patient's hand will help substantiate the diagnosis. Reduction of the acromioclavicular dislocation (by whatever means desirable) seems to reduce the coracoid fracture well. Obviously, this combination of injuries precludes the use of coracoclavicular methods of fixation as a method of treatment. Acromioclavicular joint reduction and secure internal fixation generally provides adequate coracoid fracture reduction and allows subsequent healing.