Palmar dislocation of the proximal interphalangeal joint--an injury not to be missed.

Palmar dislocations of the proximal interphalangeal (PIP) joint are associated with long term complications if suboptimally treated. Six cases of palmar dislocation of the PIP joint are presented and a systematic approach in the diagnosis and management of such injuries in the accident and emergency department is described.     

Double dislocation of the proximal and distal interphalangeal joints of the little finger

A 32-year-old amateur goalkeeper sustained simultaneous dislocation of the proximal and distal interphalangeal joints following a hyperextension injury. This was reduced under a digital nerve block. Neighbour finger strapping and early mobilisation achieved a full range of movements at both joints when reviewed three weeks after the initial injury.     

Uncommon causes of leg ulceration and lesions not to be missed

While the vast majority of cases of leg ulceration are the result of venous and/or arterial disease, and occur in older people, there are several other, less common conditions that can lead to leg ulceration, often in younger people. This article examines the diagnosis and management of some of these conditions, almost all of which will require referral for specialist assessment and treatment.     

Spontaneous carotid artery dissection presenting as migraine--a diagnosis not to be missed.

Two cases are reported in which the diagnosis of a serious condition was delayed as the symptoms had been attributed to migraine. Spontaneous carotid artery dissection is a serious but treatable cause of headache that may be misdiagnosed as recent onset migraine. The importance of correctly identifying this condition is emphasised.     

应用桡骨远端掌侧锁定钢板治疗胸锁关节脱位和锁骨近端骨折

目的探讨应用桡骨远端锁定钢板内固定治疗胸锁关节脱位和锁骨近端骨折的疗效。方法对3例胸锁关节脱位及7例锁骨近端骨折采用切开复位桡骨远端掌侧锁定钢板内固定治疗。结果 10例患者术后均得到随访,术后X线片检查均无再脱位、内固定失效、骨延迟愈合或骨不连,无血管、神经损伤等并发症。根据Rockwood评分法对术后患者进行评定,优9例,良1例。结论桡骨远端掌侧锁定钢板治疗胸锁关节脱位和锁骨近端骨折,利用锁定钢板的优势,具有固定可靠、风险小、疗效满意的优点。     

漏诊肩关节后脱位的治疗探讨

目的 探讨肩关节后脱位的相关诊断方法的意义和治疗效果。方法 对7例漏诊的肩关节后脱位进行创伤系列X线和CT扫描检查,根据伤后延误时间,临床症状和影像学检查结果选择治疗方法,行早期闭合复位4例;陈旧性脱位的3位显示3例肩关节后脱位;CT和腋窝位X线检查同时显示伴随骨折,随访3-6年,闭合复位者,UCLA评分32-35分,切开复位者,UCLA评分14分;未予复位者,UCLA评分22分,结论 临床对该症认识不足是造成漏诊的主要原因,早期闭合复位可取得肩关节功能恢复的良好效果。     

Ipsilateral compound distal radius fracture with missed elbow dislocation. A rare injury pattern.

A rare injury pattern of compound distal radius fracture associated with a missed posterolateral elbow dislocation in an adult is described. To the best of our knowledge, this has not been previously described in the literature. The probable mechanisms of injury are speculated to include longitudinal compressive force along with valgus and external rotatory stress to the semiflexed elbow leading to elbow dislocation. A continuation of the impact when her hand hit the ground led to her hand deviating radially resulting in compounding on the ulnar side. Early reduction of the dislocation and rigid fixation of the fracture helped to achieve excellent results. We hope that our experience will highlight the need to examine the elbow in severe wrist injuries and to be aware of the possibility of elbow dislocation.     

Minor head injury may not be 'minor'

Trauma to the head and neck can cause minor head injury with a brief alteration in consciousness. Generally, neurologic examination yields normal findings. In some patients, however, postconcussion syndrome marked by headache, dizziness, and neuropsychological deficits (eg, fatigue, cognitive impairment, emotional symptoms) results. This acceleration-deceleration injury with cerebral axonal dysfunction is an organic disease having objective abnormalities that necessitate early neurologic testing and treatment to prevent serious complications.     

Irreducible dislocation of the interphalangeal joint of the thumb: a case report.

A case of open irreducible dislocation of the interphalangeal joint of the thumb with interposed flexor pollicis longus tendon and palmar plate with sesamoid bone is described.