Orthopedics
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Randomized Controlled Trial
Injection in the cervical facet joint for shoulder pain with myofascial trigger points in the upper trapezius muscle.
The goal of this double-blinded, randomized, controlled study was to confirm the effectiveness of the cervical facet joint injection in treating shoulder pain with the myofascial trigger point in the upper trapezius muscle secondary to cervical facet lesion. Eighty-nine patients with chronic unilateral shoulder pain due to myofascial trigger points in the upper trapezius muscle received an injection to the C4-5 facet joint in the experimental group and to the corresponding unilateral multifidi muscle in the control group. Subjective pain intensity and pressure pain threshold of the myofascial trigger point were assessed, and the prevalence of endplate noise in the myofascial trigger point region was measured in 28 patients before, immediately after, and 1 month after the injection. ⋯ Both the decrease in the pain intensity and the increase in pressure pain threshold were significantly more in the experimental group than in the control group either immediately or 1 month after the injection. There was no significant difference in the change of endplate noise prevalence between the 2 groups. This study demonstrates that intra-articular or peri-articular injection into the cervical facet joint region can effectively inactivate the upper trapezius myofascial trigger point secondary to the facet lesion.
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While thigh compartment syndrome is relatively uncommon, it can occur in various situations. Multiple reports document thigh contusions as a cause of acute compartment syndrome; however, compartment syndrome of the thigh presenting primarily in a delayed fashion secondary to a contusion has not been described. This article reports a case of thigh compartment syndrome. ⋯ Contusion-related compartment syndromes are frequently associated with intramuscular bleeding in the involved compartment, which may accumulate slowly or worsen with further activity. Guidelines regarding return to sports need to be established in individuals sustaining severe contusions during sports-related activities to prevent compartment syndrome. Any individual sustaining such an injury should be under surveillance for delayed onset symptoms or signs of this potentially devastating syndrome.
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Case Reports
Ankle arthrodesis using antegrade intramedullary nail for salvage of nonreconstructable tibial pilon fractures.
The treatment of nonreconstructable tibial pilon fractures for which the optimal timing for reduction and fixation has been missed is challenging. Ankle arthrodesis may be a treatment option in such cases. We treated 2 patients with nonreconstructable tibial pilon fractures using ankle arthrodesis with an antegrade intramedullary nail. ⋯ When ankle arthrodesis is performed for a tibial pilon fracture, an intramedullary nail is thought to be superior to a plate, which is bulky and may impede soft tissue healing. Moreover, insertion of an intramedullary nail in an antegrade fashion can preserve the subtalar joint, and is therefore preferred over placement in a retrograde fashion. Ankle arthrodesis using this technique can be a useful salvage procedure for a nonreconstructable tibial pilon fracture.
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Few articles describe the management of postoperative infection occurring after the use of an intramedullary nail in the treatment of femoral intertrochanteric fractures. Implant removal is frequently selected for postoperative infection control, especially in chronic cases. However, removal of the intramedullary nail causes a high rate of femoral neck fractures, challenging surgeons to prevent such fractures with few guidelines for how this can be done. ⋯ The antibiotic cement screw is expected to provide stability and prevent fracture at the femoral neck region, and its more intimate contact with the medullary canal allows a higher concentration of local antibiotics than intravenous application. The antibiotic cement screw is recommended especially for infection after gamma nailing. We also introduce a simple, reproducible method for constructing an antibiotic cement screw large enough to fit the lag screw hole using bone cement, cannulated screw, antibiotics, and a chest tube.
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Hamate fractures, which are classified as fractures of the body or the hook, are rare, representing only 2% to 4% of carpal fractures. Hamate body fractures can occur as isolated injuries, but in a high-energy trauma, associated carpal bone fractures or carpal disruption can be seen. Hamate fractures can be easily underdiagnosed. ⋯ Computed tomography should be used to explain the pain in the wrist and to investigate any associating osseous pathologies. This article describes a case of a rare wrist injury: a fracture of the hamate body and a simultaneous fracture of the scaphoid waist treated nonoperatively. To our knowledge, there is only 1 case report in the literature in which the fracture of the hamate body accompanies the fracture of the distal pole of the scaphoid.