Thirteen cases with radiographic evidence of injury to the ulnar side of the hand are reviewed. These injuries included intraarticular fractures and/or dislocations of the fourth and fifth carpometacarpal joints and associated bones collectively discussed here as the ulnar carpometacarpal region. In nine the extent of the injury was not appreciated on first presentation. Injuries to this region are often difficult to assess clinically and radiographically even in experienced hands. In our experience computerized tomography (CT) scans in the longitudinal and longitudinal oblique axis best display the ulnar carpometacarpal joint surfaces and their relationship to each other. We recommend CT of the ulnar carpometacarpal region where clinical evidence of an injury to this region is not in keeping with the plain radiographic findings, and when planning surgery on a complex injury in this region.
Background: Acute childhood strabismus is often a clinical conundrum faced by ophthalmologists. Currently, there are no clear clinical guidelines on how to investigate a child presenting with acute strabismus. Furthermore, there is no consensus as to whether to initially perform neuroimaging of a child to rule out the small but serious risk of intracranial pathology, or to pursue a careful observational approach. This paper aims to outline a standardised approach to investigating acute strabismus in paediatric patients.Methods: A retrospective chart review of all paediatric patients that presented over a 10-year period to the ophthalmology departments at two tertiary level hospitals in New Zealand was conducted. Patients under 18 years of age with an acute presentation of strabismus, who underwent neuroimaging, were included.Results: A total of 500 patient records were reviewed. Seventy patients met the study inclusion criteria. Of these patients, 17 (24.3%) had non-isolated strabismus while 53 patients (75.7%) had isolated strabismus. Twelve patients (70.6%) who presented with a non-isolated strabismus had abnormal neuroimaging. Of those who presented with an isolated strabismus, 4 (7.5%) had abnormal neuroimaging. Conclusions: Acute onset non-isolated strabismus is a significant predictor of underlying neurological abnormality in children and requires urgent neuroimaging. However, a cautious approach in which there is close observation, along with general paediatric and/or paediatric neurology input, may be appropriate for children presenting acutely with an isolated strabismus.
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