骨盆骨折的急诊处理

骨盆骨折死亡率较高 ,其导致死亡的主要原因为 :出血引起的不可逆性休克、严重的合并伤、脓毒血症以及多器官功能衰竭。骨盆骨折的成功救治取决于正确的诊断和及时的治疗。对于这种致命性损伤的救治 ,要在短时间内做出正确的决断 ,需要制定出条理明确的治疗方案     

Injuries and medical issues in softball

Softball is enjoyed by millions of female and male athletes of all ages and competitive levels. Windmill pitchers are at risk for developing overuse injuries in the throwing arm. Improper mechanics and lack of pitch counts may increase the risk for developing a pitching-related injury. Softball-related overuse injuries include proximal biceps tendinitis, upper extremity stress fractures, and ulnar neuritis. Acute injuries commonly occur in the lower extremity and include both fractures and ligamentous injuries. Sliding injuries account for a significant number of these lower extremity injuries. The addition of breakaway bases and mandatory use of protective headgear by defensive players may decrease acute injuries commonly seen in softball. Off-season programs should stress proper throwing and sliding mechanics, core conditioning, and a lower extremity neuromuscular education program.     

Injuries to dancers. Prevalence, treatment and prevention

Studies from the USA and UK indicate that the back, neck and shoulder and the lower limb (particularly the hip, knee, ankle and foot) are the most frequent sites of injury among dancers. Most injuries are soft tissue injuries. Most dancers experience injuries at some time and about half have chronic injuries. Shoulder injuries appear to be caused by frequent or unaccustomed lifting, and are treated by rest and oral anti-inflammatory medication. Back injuries include sprains, prolapsed or herniated intervertebral discs, and spondylolytic stress fractures. Several risk factors, especially training error, have been identified for overuse injuries. Hip injuries include degenerative changes and osteoarthritis, stress fractures, bursitis and damage to the sciatic nerve. The most common foot injury is an anterior lateral ligament sprain, which may lead to permanent instability in the ankle. More soundly based research into the prevalence, diagnosis and treatment of injuries is needed.     

Diagnostic imaging of pediatric skeletal trauma

Because many injuries to the pediatric skeleton are unique and can present with only subtle radiographic abnormalities, familiarity with their appearance can aid in accurate diagnosis. These include physeal injuries, incomplete fractures, and avulsion injuries. Recognition of characteristic fractures also allows correct identification of a battered child. As illustrated in examples of injury to the elbow, an organized search for clues to abnormal alignment is particularly helpful in the evaluation of pediatric skeletal trauma.     

Determining Clearance During the Preparticipation Evaluation

Posterior cruciate ligament injuries are difficult to detect because patients rarely present with findings that suggest a severe ligament injury. The keys to diagnosis include learning the mechanism of injury and performing a posterior drawer test. A complete knee exam rules out associated injuries. Nonoperative treatment is indicated for low-grade, isolated PCL injuries, but patients should be monitored for any degenerative changes. Combined injuries, high-grade injuries, and avulsion fractures require surgery. Rehabilitation goals for all PCL injuries include regaining full range of motion and quadriceps strength.     

Computed tomographic diagnosis of a “midline package” of abdominal trauma: Two illustrative cases

A “midline package” of abdominal injuries may occur when the anterior mid-abdomen suffers direct blunt trauma. This package may include lacerations of the left lobe of the liver, pancreatic lacerations or fractures, and bowel injuries; if high in location, it may also be associated with sternal fractures and cardiac injuries. A common cause is motor vehicle accidents in which the driver suffers anterior abdominal compression from striking the steering wheel or steering column. Two cases are illustrated that were correctly diagnosed by abdominal computed tomography. The authors recommend an awareness of abdominal injury mechanisms and a knowledge of the expected combinations of abdominal injuries that may result.     

Typische Frakturen und Luxationen am Ellenbogengelenk und deren Behandlung

Diagnosis and treatment of injuries to the elbow joint place high demands on the treating physicians. The complex anatomy of the elbow joint enables a wide range of movement and complex functions in everyday and professional life. These must be restored in the event of injury.Clinical and imaging-based diagnostic procedures serve to classify typical injuries of this joint according to a large variety of different pathologies. These include fractures of the distal humerus, the proximal ulna, and the radial head, as well as dislocations and dislocation fractures.The following article gives an overview of the most common of these injuries.     

Common Pediatric Sports Injuries

This article reviews the common acute and overuse injuries encountered in the pediatric athlete. Acute injuries are usually physeal or avulsion fractures relating to a single traumatic event. Overuse injuries are the result of repetitive stress and include the common traction apophysitis, osteochondritis dissecans, and stress fractures. Sports-related injuries most frequently involve the lower extremity with injury patterns and frequencies relative to the athlete's age, size, and type of sport. Indeed, an alternative title for this review might be òthe adolescent athlete as the changing biomechanics and psychosocial stresses of adolescence are inherent risk factors for sports-related injuries. An estimated seven million adolescents currently play high school sports with an increasing number becoming interested in extreme sports. It is hoped that this review will assist your future encounters with the injured pediatric athlete or òweekend warrior.     

Arterial bleeding in pelvic trauma: priorities in angiographic embolization

Vascular injuries are a major source of morbidity and mortality in patients with blunt pelvic trauma. Up to 40% of patients with pelvic fractures related to blunt traumatic injury experience intra-abdominal or intrapelvic bleeding, which is the major determining factor of mortality. Sources of hemorrhage within the pelvis include injuries to major pelvic arterial and venous structures and vascular damage related to osseous fractures. Among patients with pelvic fractures, up to 20% require emergent transcatheter embolization, depending on the type of injury. Angiography is the gold standard for the treatment of pelvic arterial hemorrhage associated with pelvic fractures. Transcatheter techniques provide direct identification of sources of bleeding. Selective catheterization and flow-directed particulate emboli can control bleeding from small arteries at sites of injury.     

Injuries in Whitewater Paddling

Whitewater paddlers have very few injuries other than bruises and minor scrapes, and major injuries are the exception rather than the rule. Many of the injuries occur to capsized boaters, who are susceptible to hematomas, contusions, and abrasions from bumping into unseen rocks and obstructions as the river current carries them downstream. Two major chronic complaints are tendinitis of the wrist extensors and low back pain. Major injuries include head injuries, fractures, and shoulder dislocations and subluxations. As with other water sports, drowning is the major cause of fatalities.     

Imaging pediatric sports injuries: lower extremity

Injuries to pediatric athletes, which are becoming increasingly common, take the form of acute injuries and chronic overuse injuries. Acute injuries of the lower extremity include avulsions of the pelvic apophyses, muscle-tendon injuries, transient dislocation of the patella, ankle sprains, and acute tears of the anterior cruciate ligament and menisci. Magnetic resonance (MR) imaging of the latter 2 injuries should approach the accuracy of MR imaging of the adult knee. Chronic overuse injuries of the lower extremity in this age group include stress fractures, which are most common in the tibia; ankle impingement syndromes; osteochondritis dissecans of the knee and osteochondral lesions of the talus; and traction apophysitis, most commonly presenting as Osgood-Schlatter disease and Sinding-Larsen-Johannson disease, affecting the patellar tendon. Imaging findings of all these lesions are characteristic, and allow radiologists to assist their clinical colleagues in diagnosing and treating pediatric athletic injuries.     

Basketball injuries

Basketball injuries are most prevalent in the lower extremity, especially at the ankle and knee. Most basketball injuries are orthopedic in nature and commonly include ligament sprains, musculotendinous strains, and overuse injuries including stress fractures. By virtue of its excellent contrast resolution and depiction of the soft tissues and trabecular bone, magnetic resonance imaging has become the principal modality for evaluating many basketball injuries. In this article, commonly encountered basketball injuries and their imaging appearances are described. The epidemiology of basketball injuries across various age groups and levels of competition and between genders are reviewed.     

Unfall oder Misshandlung? Radiologische Befunde beim nichtakzidentiellen Trauma

The focus of this review article is on child abuse and the radiographic pattern of X?ray findings. The radiologist should be able to recognize typical injuries resulting from child abuse. In some cases the findings are highly specific for abuse and these include metaphyseal corner fractures of the long bones in children aged up to 24 months. In other cases the fractures are not specific but highly indicative of child abuse: rib fractures, for example can be associated with child abuse in more than 50?% of the cases; however, maltreatment is difficult to diagnose without taking the entire pattern of skeletal findings into consideration so that a radiological screening of the entire skeleton is often necessary. The concept of sentinel injuries might be helpful for deciding in which cases a complete skeletal screening should be performed. In the age group up to 24 months old a complete skeletal status (with some exceptions) is recommended if one of the three sentinel injuries of rib fractures, intracranial bleeding and abdominal trauma is present.     

An unusual stress fracture in a multiple sport athlete

Most overuse injuries are a direct result of repetitive stresses which may create a condition of maltraining. Young athletes are no exception to this rule. Swimming and baseball both create stresses to the humerus which may result in injuries to the shoulder and upper extremity. Stress fractures (fatigue fractures) are usually limited to the lower extremity (i.e., tibia or metatarsal). Upper extremity stress fractures, especially of the humerus, are very uncommon. Precipitating factors include repetitive stresses, low grade external forces, rapid application of muscular force to the bone, or an underlying disease or pathologic weakness of the bone. The majority of these fractures are primarily due to abnormal and repetitive stresses to bones. This case study examines the mechanism of injury, clinical presentation, and treatment of a clinically apparent stress fracture which ultimately converted to an overt humerus fracture in a 14-yr-old cross-trained athlete.     

The os supranaviculare and navicular stress fractures

Tarsal navicular stress fractures are injuries more commonly observed in athletes involved in sprinting and jumping sports. Known risk factors for the development of navicular stress fractures include pes cavus, metatarsus adductus, limited subtalar or ankle motion, medial narrowing of the talonavicular joint, as well as a short first metatarsal. The presence of an os supranaviculare has yet to be described as a predisposing factor in the occurrence of navicular stress fractures. We present two cases of navicular stress fractures in patients with an os supranaviculare and discuss possible reasons for such an association.     

Acute tibial tubercleavulsion fractures

Acute tibial tubercle avulsion fractures are commonly seen in athletes involved with jumping sports, especially basketball. These injuries typically occur in well-muscled, mature-appearing boys, 15 to 16 years of age, who generate high tensile forces at the tubercle junction. Possible associated injuries include patellar and quadriceps tendon avulsions, as well as collateral and cruciate ligament and meniscal damage. Treatment is based on the magnitude of injury. Recovery is rapid and the outcome is usually excellent, even in type III injuries.     

Upper extremity injuries in the paediatric athlete

Injuries to the upper extremity in paediatric and adolescent athletes are increasingly being seen with expanded participation and higher competitive levels of youth sports. Injury patterns are unique to the growing musculoskeletal system and specific to the demands of the involved sport. Shoulder injuries include sternoclavicular joint injury, clavicle fracture, acromioclavicular joint injury, osteolysis of the distal clavicle, little league shoulder, proximal humerus fracture, glenohumeral instability and rotator cuff injury. Elbow injuries include supracondylar fracture, lateral condyle fracture, radial head/neck fracture, medial epicondyle avulsion, elbow dislocation and little league elbow. Wrist and hand injuries include distal radius fracture, distal radial physeal injury, triangular fibrocartilage tear, scaphoid fracture, wrist ligamentous injury thumb metacarpalphalangeal ulnar collateral ligament injury, proximal and distal interphalangeal joint injuries and finger fractures. Recognition of injury patterns with early activity modification and the initiation of efficacious treatment can prevent deformity/disability and return the youth athlete to sport.     

Thoracic spine trauma

Thoracic spine fractures are most commonly flexion injuries resulting from vehicular accidents or falls. The initial evaluation of any multiple trauma victim should include AP and cross-table lateral radiographs of the thoracic spine. Conventional and computed axial tomography can add additional information regarding posterior element integrity and spinal canal encroachment. MRI can also be useful in that it directly images the effects of fractures on the spinal cord.