Orthopedics
-
Intraosseous infusion is a valuable technique in the resuscitation of critically ill pediatric patients in whom vascular access has proved otherwise impossible. Although it is well established as a safe and reliable means of emergent access, intraosseous infusion is not without danger, nor complication. One of the rare yet most grave complications of intraosseous access is compartment syndrome. ⋯ Acute compartment syndrome was diagnosed, and through anterolateral and posteromedial incisions, all 4 fascial compartments were released. While the condition of the patient's extremity improved, the overall clinical condition of the patient did not. This case highlights the fundamental principles regarding the use of intraosseous infusion and the diagnosis and management of compartment syndrome in critically ill patients.
-
Septic arthritis of the shoulder in children is a rare condition. The diagnosis may present some difficulties and, consequently, appropriate treatment often is delayed. Main sequelae are humeral shortening, joint instability, premature arthritis and limited range of motion. ⋯ Radiographs showed irregular profile of the humeral epiphysis without any physeal disturbances. Arthroscopic treatment for septic arthritis of the shoulder in children, though rarely reported, represents an adequate procedure for cases without bone involvement and may lead to good results, even in stage IV cases. Open arthrotomy should be reserved for cases with concomitant osseous infection after failure of arthroscopic treatment.
-
Although the Morel-Lavallé lesion was originally described over 150 years ago and is a well known entity about the pelvis and femora, its occurrence in the prepatellar region has only recently been reported. While Tejwani et al asserted that prepatellar MLL and prepatellar bursitis can be readily distinguished clinically, the absence of prepatellar MLL from the literature until recently suggests that it may be under-diagnosed. ⋯ Because both entities are initially treated in the same manner, MRI might be reserved for collections that fail to resolve following conservative therapy or in cases where the diagnosis is questioned. Serial percutaneous aspiration and sclerodesis should be considered in the management of recalcitrant collections or in the initial management of athletes depending on lesion size and range of motion.
-
The infraclavicular brachial plexus block is a routinely used anesthesia technique for orthopedic hand, wrist, and arm surgeries. Although the pulmonary anatomy surrounding the brachial plexus would suggest a theoretical potential for pneumothorax development during infraclavicular brachial plexus blockade, this complication is rarely reported in the literature. We report two occurrences of pneumothorax development following routine infraclavicular brachial plexus blockade performed by physicians at an academic training institution with technical experience. ⋯ Possible preventative strategies to avoid pneumothorax complications during infraclavicular brachial plexus blockade are discussed. This case report indicates there is a risk of iatrogenic injury during infraclavicular brachial plexus blockade. This information could be valuable in determining anesthesia modalities used for orthopedic upper extremity surgeries in patient populations with problematic follow-up or limited access to health care.
-
Reports of spinal subdural hematoma are rare. In the few reported cases, type of onset, symptoms, and course have varied, precluding diagnosis based on simple radiography. Obtaining a definitive diagnosis and deciding on a treatment approach can thus sometimes be difficult. ⋯ With subacute spinal subdural hematoma, progression to paraplegia occurs slowly, over a period of > or =1 week. Although several cases of spontaneous resolution have been described early surgical treatment is commonly required. This article presents a case of an 85-year-old woman with subacute spinal subdural hematoma who regained the ability to walk following surgical treatment.