J Trauma
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The objective of this study was to (1) determine the incidence of diaphragmatic injuries in penetrating left thoracoabdominal trauma and (2) evaluate the role of laparoscopy in detecting clinically occult diaphragmatic injuries. ⋯ (1) The incidence of diaphragmatic injuries in association with penetrating left thoracoabdominal trauma is high. (2) The clinical and roentgenographic findings are unreliable at detecting occult diaphragmatic injuries. (3) Laparoscopy is a vital tool for detecting occult diaphragmatic injuries among patients who have no other indications for formal celiotomy.
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Seventeen femoral nonunions after intramedullary nail internal fixation were treated with augmentative plate internal fixation. Six of them were initially managed with a Küntscher nail internal fixation; the other 11 fractures were managed with a locked nail internal fixation. All the femoral nonunions were caused by insecure fixation of the intramedullary nailing, in which a rotational instability of the fracture site was verified in all cases during operation. ⋯ From our experience, we have found this method is a useful treatment for the nonunion of the femoral shaft fracture after an intramedullary nail internal fixation. The technique is simple and does not require any special instrument. It facilitates an early weight bearing and gives a quick recovery from nonunion.
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Case Reports
Posterior fracture-dislocation of the shoulder with infraspinatus interposition: the buttonhole phenomenon.
We present a case with a posterior fracture-dislocation in which interposition of the infraspinatus precluded closed reduction by means of standard manipulation. The fractured greater tuberosity included the lesser tuberosity, allowing the infraspinatus to dislocate anterior to the dislocated humeral head and interpose between the humeral head and the glenoid cavity. ⋯ Traction in the zero-position was thus required for resolution of constriction and subsequent reduction. Computed tomography was useful to demonstrate interposition of the infraspinatus and to plan the treatment.
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As nonoperative management of blunt abdominal trauma has become more popular, reliable models for predicting the likelihood of concomitant hollow viscus injury in the hemodynamically stable patient with a solid viscus injury are increasingly important. ⋯ A model of organ injury scaling predicted hollow viscus injury. Multiple solid viscus injuries, particularly pancreatic, or abdominal solid viscus injuries with an AIS score > or = 6, were predictive of hollow viscus injury. Identification of these injury patterns should prompt consideration for early operative intervention.
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Case Reports
Aortoventricular fistula secondary to blunt trauma: a case report and review of the literature.
An aorto-right ventricular fistula secondary to nonpenetrating trauma is described. Review of the literature is reported. ⋯ Blunt cardiac injury is a frequent concomitant injury and contributes to the high mortality of this lesion. Prompt surgical intervention is required for survival.