Background Presence of gas in the subcutaneous tissue in a limb is always worrisome. Majority of the cases occur due to infection by gas-forming organism and less commonly due to non-infectious causes. Case report We report a case of 52-year-old male who presented with an acute onset rapidly spreading swelling of the hand and forearm following a minor splinter injury. There was no distal neurovascular compromise. He underwent an emergency fasciotomy. Discussion Here we discuss about non-infective subcutaneous emphysema of the limbs and the need to be aware of this potentially harmless condition. We believe that even in minor injuries resulting in extensive non-infective emphysema, a prophylactic decompression even in the absence of neurovascular compromise would be a prudent action, which does not necessarily lead to increased morbidity.
Introduction Adult long-bone osteomyelitis is relatively uncommon in the developed countries. Ruptured sigmoid diverticulitis can seldom present as an extraperitoneal manifestations in the gluteal area, around the hips, or in the proximal thigh. These extraperitoneal manifestations can present a diagnostic challenge and need a high index of suspicion. Case report We present a case of a 67-year-old male with osteomyelitis of the proximal femur following a ruptured diverticular disease of the sigmoid colon. Discussion The diagnosis was delayed resulting in advanced destruction of the hip necessitating a two-stage hip replacement. We hereby discuss the unusual extraperitoneal presentations of sigmoid diverticulitis and the need to identify them early. Keywords Femoral osteomyelitis . Sigmoid diverticulitis Case reportA 67-year-old male was admitted into the hospital with a history of lower back pain with radiation to the back of the left thigh. Clinical diagnosis of acute discitis/disc prolapse was made. An urgent MRI was performed which revealed no evidence of discitis or significant disc prolapse. As he continued to have intermittent temperature spikes and persistently high CRP, an abdominal and pelvic CAT scan was performed. The scan revealed a severe sigmoid diverticular disease and a small psoas collection. The psoas collection was aspirated under ultrasound guidance followed by a 3-week course of oral antibiotics. Repeat CAT scan after 6 weeks showed improved diverticular disease and no new collection. The areas of the hips and the proximal thigh/ femur were not specifically examined or commented upon in both the CAT scans.He was discharged from the clinic with a plan for followup by his general practitioner. He presented around 6 months later with progressively worsening left-groin pain of few months duration. He had been treated by his practitioner with strong analgesics including morphine patch. Repeat blood tests at this stage revealed a high CRP and ESR. X-rays of the pelvis revealed destruction of the proximal femur with loss of joint space (Fig. 1). An urgent MRI scan of the pelvis revealed proximal femoral osteomyelitis with advanced destruction of the femoral head (Fig. 2). Fig. 1 X-ray showing destruction of left femoral head
Purpose: Clavicle fracture is a common orthopaedic injury. Recent studies suggest a better outcome following open reduction and internal fixation for displaced midshaft clavicle fractures. Standard AP view is used in most hospitals to diagnose and treat midshaft clavicle fracture. The aim of our study was to identify if the second view (30 • caudal tilt) changes the treatment of clavicle fractures.Methods: A prospective study was conducted between March and June 2009. 17 patients attending the fracture clinic with midshaft clavicle fracture were reviewed by 5 orthopaedic trainees with X-rays. The fractures were classified according to Edinburgh Classification and treatment plan was decided after reviewing 1 and 2 views of the clavicle.Results: 84 treatment responses were available for 17 patients with midshaft clavicle fractures. 66 responses (79%) decided conservative treatment and 18 (21%) operative treatment after reviewing 1 view of the clavicle fracture. 34 responses (41%) were changed after reviewing the 2nd view and operative treatment was offered to 47 patients (56%). Fracture classification was also changed for 45 (54%) responses after the 2nd view. 84% responses preferred 2 views of the clavicle for diagnosis and treatment of midshaft clavicle fractures.Conclusions: We looked at the treatment offered to the patients with midshaft clavicle fractures by orthopaedic trainees in the fracture clinic of a teaching hospital after reviewing 1 and 2 views of clavicle X-rays.We found that the treatment changed significantly after reviewing the 2 views. We strongly recommend 2 views of the clavicle to decide the treatment of midshaft clavicle fractures.Proximal humeral fractures previously had been relegated to surgical scrap heap. Over the last two decades, significant interest has been evolved in the surgical fixation of unstable and displaced fractures of the proximal humerus. PHILOS plate fixation is relatively new and effective way to treat these complex fractures.Aim of study: To asses the radiological outcome following fixation of proximal humeral fracture using PHILOS plate.Method: Retrospective review of X-ray from patient with proximal humeral fracture treated with PHILOS plate. Thirty nine (39) patients were reviewed from 2007 to 2010. Patient age, sex, medical background information gathered. Mean follow up time was (6 months). Initial and follow up X-ray reviewed and complications such as screw penetration, avascular necrosis (AVN), non union and malunion were looked at.Outcome: Female to male ratio was 3:1. Majority of the fracture was three part (24, 61.5%) with two cases of fracture dislocation (5.1%).Screw penetration was the main complication following this surgery (8, 20.5%). There were two cases of AVN and (20.3%) malunion (Varus). Majority of complication happened when the fracture was not satisfactory reduced intraoperatively.Conclusion: Fracture proximal humerus can be challenging and there is still controversy regarding optimal management of these injuries. PHILOS plating is relatively new ...
Abstracts / Injury Extra 41 (2010) 131-166 shear mechanical properties which closely and how closely match human rotator cuff tendons. It is hoped that this study will offer additional information for surgeons when selecting appropriate RCT repair grafts.
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