Fractured heterotopic bone in myositis ossificans traumatica

OBJECTIVE: To discuss the case of a patient with an acute fracture occurring through preexisting, quiescent, posttraumatic heterotopic bone formation of the gastrocnemius muscle. The lesion demonstrated a previously unreported pattern of healing. This case serves to demonstrate an infrequent event with a rare and heretofore unreported sequella. Clinical Features: A 54-year-old man with preexisting, mature heterotopic bone within the left gastrocnemius muscle experienced reinjury to the site. The preexisting heterotopic bone was a result of a sporting injury that had occurred 32 years previously. At the time of the new injury, the patient experienced immediate, severe pain. Radiographs demonstrated a nondisplaced oblique fracture through the preexisting heterotopic bone. Intervention and Outcome: The patient was treated with protective wrapping and physiotherapy modalities. Because only the heterotopic bone was involved, the leg was not placed in a cast. Follow-up radiographs obtained 14 weeks later showed callus formation about the fractured site and evidence of union. CONCLUSION: Fractures occurring through mature heterotopic bone formations, such as those seen in myositis ossificans traumatica, are infrequent; callus formation with union of the fractured fragments is an even rarer occurrence.     

脊髓损伤患者骨化性肌炎的预防及康复护理

骨化性肌炎最早由Guy Patin于1692年提出,1868年由Von Dusch命名.其实质是一种异位性骨化,是发病机制不明的少见的良性局限的骨化的软组织肿块,是肌肉及其邻近结构的局限性的、含有非肿瘤性的钙化和骨化的病变….脊髓损伤后骨化性肌炎据研究[2]报道其发病率为10%-53%,脊髓损伤患者的异位骨化属于神经源性,好发于髋关节前方,也可发生于膝、肩、肘关节等处.严重的骨化性肌炎可以限制关节活动,甚至造成关节强直,使关节丧失活动功能,因而加重了脊髓损伤患者的痛苦,影响其康复治疗的进展和效果.鉴于骨化性肌炎是一种可以防治的并发症,因此在临床护理工作中的预防和康复具有重要的意义.现报道如下.     

Income and risk of mortality after spinal cord injury

Krause JS, Saunders LL, DeVivo MJ. Income and risk of mortality after spinal cord injury.

Objective

To evaluate the association of household income and formal education with risk of mortality after spinal cord injury (SCI).

Design

Cohort study.

Setting

Twenty hospitals designated as Model SCI Systems of care in the United States.

Participants

Adults (N=8027) with traumatic SCI, seen in one of the Model SCI Systems, who had at least 1 follow-up assessment between 1995 and 2006. All participants were at least 1 year postinjury at the time of assessment. There were 57,957 person-years and 1036 deaths. The follow-up period started with the first assessment between 1995 and 2006 and went until either the date of death or March 2009.

Interventions

Not applicable.

Main Outcome Measures

Mortality status was determined by routine follow-up supplemented by using the Social Security Death Index. A logistic regression model was developed to estimate the chance of dying in any given year.

Results

Educational status and income were significantly predictive of mortality after adjusting for age, sex, race, and severity of injury. Compared with those with household income of $75,000 or greater, the odds of mortality was greater for those who had income between $25,000 and $75,000 (1.61) and still higher for those with less than $25,000 a year (2.41). Life expectancy differed more as a function of household income than the economic subscale of the Craig Handicap Assessment and Reporting Technique.

Conclusion

There was a clear gradation in survival based on familial income (high, middle, low), not just an effect of the lowest income.     

Functional paralysis mimicking spinal cord injury resulting in admission to a spinal cord injury center

From 1978 through 1982, five patients with final diagnoses of nonorganic functional paraplegia or quadriplegia were seen and treated at the Northern California Regional Spinal Cord Injury Center. The patients ranged in age from 13 to 26 years and four were males. All had normal bowel and bladder function with otherwise complete motor and sensory paralysis, shifting sensory findings, and normal deep tendon reflexes early after injury. In each patient, a retrospective analysis demonstrated that structural anatomic lesion could be ruled out by a neurologic examination. Clinical and investigatory studies are discussed with respect to the diagnostic process.     

Psychosocial adaptation to spinal cord injury as a function of time since injury

The literature on the relationship between time since injury (TSI) and the clinical unfolding of psychosocial adaptation to disability has yielded mixed results. In this exploratory study we have attempted to compare two groups of people who sustained spinal cord injury (SCI)--namely, short-term TSI versus long-term TSI--on the patterns of psychosocial reactions to their medical condition. Using the initial pool of participants (n=317), two "extreme'" TSI groups were created (short-term TSI, composed of people whose injuries occurred within the last 4 years, and long-term TSI, comprising people whose injuries occurred 20 or more years ago). A two-group discriminant function analysis (DFA) applied to the eight subscales of the Reactions to Impairment and Disability Inventory (RIDI) yielded a significant function that was most closely associated with reactions of denial, shock and generalized anger, suggesting a non-acceptance of the condition among the more recently injured. Further analyses were then separately applied to the two groups of civilians and veterans with SCI. The resultant DFAs yielded functions suggesting somewhat different group patterns from the original one. Results are discussed within the context of the literature drawn from the fields of post-traumatic stress disorder (PTSD) and related traumatic experiences.     

Coronary risk in spinal cord injury: assessment following a multivariate approach.

A group of 96 men with spinal cord injury was studied to find out if patients with spinal cord injury were at an increased risk of coronary heart disease. A multivariate approach based on data produced by the Framingham study was used to estimate the probability of developing coronary artery disease within six years. Data obtained from the 96 patients were compared with data obtained from 96 nontrained, able-bodied men matched according to age. The results of this study suggest that patients with spinal cord injury show a risk of coronary artery disease similar to that estimated in non-trained, age-matched, able-bodied individuals. The risk increases with age, but it is of the same order as that found in the normal population and does not appear to be related to the duration of the disease. The results are inconclusive in regard to the level of the lesion as an independent factor of risk.     

Thromboembolic disease presenting as fever in spinal cord injury

A 45-year-old man had complete C5 quadriplegia after sustaining a C6-7 fracture dislocation in a motor vehicle accident. Twenty-six days after injury the patient spiked nightly temperatures of 100.5F to 102.5F. Before a full fever workup could be completed, the patient developed shortness of breath. Thromboembolism was confirmed via venography and Ventilation/Perfusion scan. Other clinical signs of asymmetric swelling or warmth were notably absent throughout the course of the thromboembolic event. The patient became afebrile on the third day of anticoagulant therapy and remained afebrile. This case indicates that thromboembolic disease can present with fever only and the disease should be included in the differential diagnosis for fever in any patient with acute spinal cord injury.     

Munchausen syndrome presenting as acute spinal cord injury

A 30-year-old woman was diagnosed to have Munchausen syndrome, simulating acute spinal cord injury, a rarely reported neurologic presentation. For nearly seven years she traveled widely over two continents, taking serious medical risks in order to prolong her illness. She was discovered after recovering partial voluntary lower extremity function under the influence of Pentothal (thiopental sodium). Information about her personal and medical background was found to be untrue. Confidentiality requirements prevented the transfer of critical medical information and delayed the diagnosis. Corroboration of the details of personal and medical history may lead to earlier diagnosis and prevent unnecessary medical intervention.     

Rehabilitation in spinal cord injury

Caring for the new quadriplegic is an immense undertaking involving multiple health care professionals who must function as a team. The physician in charge must understand rehabilitation principles and be able to communicate with all members of the team caring for the patient. Rehabilitation principles, if considered early, can greatly decrease the length of stay of the patient and allow him to maximize his potential for recovery. A basic knowledge of physicial and occupational therapy in paraplegia and quadriplegia in the acute stage as well as functional expectations in the long term have been presented.     

影响脊髓损伤患者排尿功能的多因素分析

目的:分析影响脊髓损伤患者排尿的因素,构建其Logistic预警模型.方法:2017年1月-2019年6月在山东大学齐鲁医院康复中心住院的脊髓损伤患者,采用简易膀胱尿压测定评定系统测量膀胱安全容量、初始尿意膀胱内压力值、膀胱内最终压力值等指标,利用Logistic回归分析筛选排尿的影响因素.结果:骶以上损伤者,有排尿的...     

Colostomy as treatment for complications of spinal cord injury

We reviewed our experience with colostomy performed in 20 spinal cord injury (SCI) patients to determine the effectiveness and safety of colostomy when it is performed for a late complication of SCI. Objective evaluation of gastrointestinal function, ie, colonic transit time and anorectal manometry, was performed in six patients with chronic gastrointestinal complaints to identify the site and severity of bowel dysfunction. Twelve patients had colostomy performed for chronic gastrointestinal problems, seven as an adjunct in the treatment of perineal pressure ulcers, and one for rectal cancer. When patients with difficult bowel evacuation or incontinence were considered, colostomy reliably simplified bowel care, relieved abdominal distention, and prevented fecal incontinence. The amount of time spent on bowel care decreased from an average of 98.6 min/day to 17.8 min/day (p less than .05) after colostomy. When performed as an adjunct in the treatment of pressure ulcers, colostomy provided a dry, clean environment, and seven of seven ulcers healed. Colostomy was well accepted by all patients; all patients with chronic gastrointestinal complaints reported that colostomy improved the quality of their lives. Objective testing differentiated between failure of the colon to adequately transport material to the rectum and inability to adequately evacuate the rectum. Testing was useful in choosing the level at which a colostomy was created, and, in one instance, it identified a specific syndrome (ischemic proctitis) which required colostomy.     

Ischemic injury to the spinal cord as a cause of transient paraplegia

Spinal cord ischemia presenting as acute paraplegia is an uncommon occurrence not previously reported in the emergency medicine literature. Paraplegia due to spinal ischemia is seen most commonly after intraoperative aortic manipulation; however, acute hypotension and prolonged cardiopulmonary resuscitation are also reported settings. The differential diagnosis of acute, non-traumatic paraplegia includes mechanical spinal cord compression, acute transverse myelitis, and polyneuritis.     

Closed head injury in acute traumatic spinal cord injury: incidence and risk factors

Investigators estimate that 15% to 50% of all patients with spinal cord injury (SCI) also incur a closed head injury (CHI), but studies have been hampered by design flaws, including retrospective assessment and inconsistent definition of CHI. We conducted a prospective study of combined CHI and SCI among 82 SCI patients consecutively admitted at two hospitals within 24 hours of injury. The purpose of the study was to determine the incidence and duration of loss of consciousness and posttraumatic amnesia (PTA), and to establish the risk factors for combined CHI and SCI. The overall incidence of CHI as defined by the presence of PTA of any duration was 49%. There was a significantly increased risk of CHI for patients involved in traffic accidents (risk ratio = 3.7; 95% confidence interval 1.8 to 7.2). There was no increased risk associated with level of injury (quadriplegic vs paraplegic; risk ratio = 1.2; 95% confidence interval = 0.8 to 1.8). All SCI patients, regardless of level of injury, deserve systematic evaluations for CHI in their acute care evaluations.     

Growing up with a spinal cord injury

Much of what we need to know to be independent adults is learned in the first five years of life. In the toddler, instead of reteaching learned skills, as we do with older spinal cord injury persons, we are teaching skills for the first time. It is therefore imperative to have a creative therapeutic team who can teach skills which were never acquired and encourage the child's cognitive growth as well as growth towards independence. This paper will include a case report of a 2 year-old C3-4 quadriplegic child rehabilitated through an interdisciplinary family-centered model of care. We will share some of the issues our team has encountered when "rehabilitating" very young children with spinal cord injuries based on the observations of the team members as well as the scant literature available. This will also include a parent's reflections of modification needed in family structure and roles.