oalib
Search Results: 1 - 10 of 100 matches for " "
All listed articles are free for downloading (OA Articles)
Page 1 /100
Display every page Item
A Patient with Clavicle Fracture and Recurrent Scapular Winging with Spontaneous Resolutions
Kendra E. Keenan,John G. Skedros
Case Reports in Orthopedics , 2012, DOI: 10.1155/2012/603726
Abstract: Injury to the long thoracic nerve with resulting serratus anterior palsy is a typical cause of medial scapular winging. We report a case of a 70-year-old female with scapular winging in the setting of a mildly comminuted midshaft clavicle fracture. The winging persisted for three months after the fracture, which became a nonunion. The winging spontaneously resolved prior to open reduction and internal fixation of the nonunion. The winging recurred after this surgery. The recurrence was attributed to transient irritation and/or inflammatory neuropathy of the brachial plexus caused by the surgical manipulation. This second episode of winging again spontaneously resolved. There are few reported cases of scapular winging in the setting of a clavicle fracture and only one case of recurrent scapular winging. In that case, which was in the setting of an acromioclavicular joint separation, the second episode of winging required long-term use of a brace. By contrast, our patient did not require bracing because the recurrent winging spontaneously resolved, making this a novel case. This case is important because it illustrates that recurrent scapular winging can occur, and spontaneously resolve, in the setting of a mid-shaft clavicle fracture after subsequent reconstruction of a fracture nonunion.
A Patient with Clavicle Fracture and Recurrent Scapular Winging with Spontaneous Resolutions  [PDF]
Kendra E. Keenan,John G. Skedros
Case Reports in Orthopedics , 2012, DOI: 10.1155/2012/603726
Abstract: Injury to the long thoracic nerve with resulting serratus anterior palsy is a typical cause of medial scapular winging. We report a case of a 70-year-old female with scapular winging in the setting of a mildly comminuted midshaft clavicle fracture. The winging persisted for three months after the fracture, which became a nonunion. The winging spontaneously resolved prior to open reduction and internal fixation of the nonunion. The winging recurred after this surgery. The recurrence was attributed to transient irritation and/or inflammatory neuropathy of the brachial plexus caused by the surgical manipulation. This second episode of winging again spontaneously resolved. There are few reported cases of scapular winging in the setting of a clavicle fracture and only one case of recurrent scapular winging. In that case, which was in the setting of an acromioclavicular joint separation, the second episode of winging required long-term use of a brace. By contrast, our patient did not require bracing because the recurrent winging spontaneously resolved, making this a novel case. This case is important because it illustrates that recurrent scapular winging can occur, and spontaneously resolve, in the setting of a mid-shaft clavicle fracture after subsequent reconstruction of a fracture nonunion. 1. Introduction Damage to the long thoracic nerve is a classic cause of medial scapular winging [1, 2]. This injury, which results in palsy of the serratus anterior muscle, can be caused by a variety of acute trauma events and chronic repetitive activities. In some cases, the winging is not associated with electrodiagnostic evidence of injury to the long thoracic nerve or cervical nerve roots that contribute to it (C-5, C-6, and C-7) [1–3]. With respect to fractures of the shoulder girdle, there are reports of medial scapular winging in association with (1) malunions and nonunions of acromion fractures [2, 4], (2) malunions and nonunions of clavicle fractures [1–3], (3) clavicle fractures with other associated injuries [3, 5], (4) glenoid fractures [1], and (5) malunions of scapular body fractures [2]. Although our review of the English literature revealed a few cases of ipsilateral medial scapular winging in the setting of clavicle fractures prior to being considered nonunions [3, 5], we could only locate one case describing recurrent winging. In that case the patient did not sustain a clavicle fracture, but had an acromioclavicular separation and required a brace to keep working because the winging did not resolve after the recurrence [4]. We report the case of a
Atrophy of the brachialis muscle after a displaced clavicle fracture in an Ironman triathlete: case report
Christoph Rüst, Beat Knechtle, Patrizia Knechtle, Thomas Rosemann
Journal of Brachial Plexus and Peripheral Nerve Injury , 2011, DOI: 10.1186/1749-7221-6-7
Abstract: Lesions of the brachial plexus are known to occur after displaced clavicle fractures. The most common way to get a lesion of the brachial plexus is a high-energy trauma leading to traction injuries[1,2], whereas lesions of the medial and the posterior cord have been reported most frequently[3,4]. A bone fragment from a displaced clavicle fracture is described in only 1% of the cases as the causative factor[4]. In this report we describe the case of a lesion of both, the musculocutaneous and axillar nerve with subsequent atrophy of the brachialis muscle. Regarding the anatomy, the axillar nerve originates from the posterior cord, whereas the musculocutaneous nerve originates from the lateral cord, which is not known to be affected by such injuries very often. The additional fact that a lesion of the brachial plexus occurred a certain time after a displaced midshaft fracture of the clavicle makes the case even more interesting and remarkable.In the last two kilometres of the cycling split in an Ironman triathlon a highly trained athlete hit a duck in the street and fell on his right side. He felt a sharp pain in his right shoulder and had to stop the race. Due to a previous clavicular fracture on his left side, the rider was highly suspicious of having sustained a similar injury. He returned back home and put on his old figure-of-eight dressing from the last fracture, without consulting a physician. He continued his training of indoor cycling and running and had no problems. Two weeks later before starting his swim training he continued to feel pain in his right shoulder, radiating into the radial side of the forearm and into the fingers. The clavicular head of the deltoid muscle showed a decreased sensation to light touch. An X-ray revealed a displaced fracture of the right clavicle (see Figure 1Panel A) and the athlete was advised to get this fracture treated surgically. A pre-operative CT scan was performed to help determine surgical fixation choices (see Figure 1P
A variant of a type V lateral clavicle fracture involving a posteriorly displaced medial segment. A case report
Goss Thomas P,Li Xinning
Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology , 2012, DOI: 10.1186/1758-2555-4-47
Abstract: The clavicle connects the shoulder girdle to the axial skeleton, providing support and mobility for optimal upper extremity function. Fractures of the clavicle account for up to 4% of all fractures and comprise up to 44% of all injuries to the shoulder girdle. We present a 63-year-old female patient who suffered what appeared to be a minimally displaced Type V lateral clavicle fracture after a fall as evidenced by an anteroposterior shoulder radiograph. However, an axillary projection demonstrated the proximal segment to be posteriorly displaced and buttonholed through the trapezius musculature with tenting of the skin. The patient underwent an open reduction and Kirschner wire fixation of the fracture with complete healing, subsequent removal of the hardware and return to her previous level of function six months following surgery. After an extensive literature search, we believe this is the first case report documenting a variant of a Type V lateral clavicle fracture, specifically with significant posterior displacement of the proximal segment, mimicking a Type IV AC separation. This fracture pattern is unstable and represents a double disruption of the superior shoulder suspensory complex. Surgical management was successful in returning our patient back to her previous activity of daily living.
Scapular fracture: lower severity and mortality
Salimi, Javad;Khaji, Ali;Karbakhsh, Mojgan;Saadat, Soheil;Eftekhar, Behzad;
Sao Paulo Medical Journal , 2008, DOI: 10.1590/S1516-31802008000300009
Abstract: context and objective: the presence of scapular fracture is believed to be associated with high rates of other injuries and accompanying morbidities. the aim was to study injury patterns and their overall outcomes in patients with scapula fractures. design and setting: cross-sectional study of trauma patients treated at six general hospitals in tehran. methods: one-year trauma records were obtained from six general hospitals among these, forty-one had sustained a scapular fracture and were included in this study. results: scapular fracture occurred predominantly among 20 to 50-year-old patients (78%). road traffic accidents (rtas) were the main cause of injury (73.2%; 30/41). pedestrians accounted for 46.7% (14/30) of the injuries due to rtas. falls were the next most common cause, accounting for seven cases (17.1%). body fractures were the most common type of scapular fractures (80%). eighteen patients (43.9%) had isolated scapular fractures. limb fracture was the most common associated injury, detected in 18 cases (43.9%). three patients (7.3%) had severe injuries (injury severity score, iss > 16) which resulted in one death (2.4%). the majority of the patients were treated conservatively (87.8%). conclusions: patients with scapula fractures have more severe underlying chest injuries and clavicle fractures. however, this did not correlate with higher rates of injury severity score, intensive care unit admission or mortality.
Treatment of Displaced Mid-Clavicle Fractures by Closed Titanium Elastic Nail  [PDF]
Hrushikesh Saraf, Sarang Kasture
Surgical Science (SS) , 2016, DOI: 10.4236/ss.2016.72006
Abstract: Introduction: Recently, intramedullary nailing for displaced middle third fractures of clavicle has received wide attention. Though open nailing has been widely described, closed nailing finds less mention. This paper therefore aims to study the outcome of closed titanium elastic nailing for displaced mid-clavicular fractures. Material and Methods: This was a prospective study of 34 patients with displaced middle third clavicle fracture who underwent closed intramedullary nailing with titanium elastic nail at a tertiary care centre. The operative time, length of incision, time for radiological union, pain and functional outcome after union were noted. Results: The mean operative time was 34.33 mins. The mean time of discharge was 2.25 days. The average time of radiological union was 10.23 weeks. All the patients achieved full, painless range of motion of the ipsilateral shoulder. The average Constant-Murley score at 12 months was 94.28 indicating excellent result. Conclusion: Closed titanium elastic nailing offers a safe and minimally invasive method of fixation for fractures of middle-third clavicle with excellent functional outcome.
Delayed presentation of Subclavian venous thrombosis following undisplaced clavicle fracture
Tony Kochhar, Chethan Jayadev, Jay Smith, Emmet Griffiths, Kamaljit Seehra
World Journal of Emergency Surgery , 2008, DOI: 10.1186/1749-7922-3-25
Abstract: Injuries to the clavicle are very common and account for up to 10% of all fractures[2]. Midshaft and lateral third clavicle fractures are common sporting injuries; the vast majority present without neurovascular injury and proceed to uncomplicated union [1-3]. Fractures to the medial clavicle are uncommon, accounting for only 2–5% of all clavicle fractures [2-5] and are often due to high energy injuries. The medial clavicle protects the brachial plexus, subclavian and axillary vessels and the superior lung. Fractures can therefore be complicated by damage to these structures.Much of the literature and research has concentrated on midshaft and distal clavicle fractures and acromioclavicular joint injuries. We aim to highlight the difference in mechanism of injury and complications associated with medial third clavicle fractures.In general, vascular injuries following clavicle fractures are uncommon but are recognised as either an immediate complication due to transection of the vessel by the displaced fracture [6,7], or as a late complication, secondary to compression from abundant callus formation. There have been several reported cases of venous insufficiency associated with clavicle fractures [8-11] and of acute compression of the subclavian vessels following displaced midshaft fractures[12]. There have also been reported cases of neural injury associated with these common injuries [13].Isolated injuries of the medial end of the clavicle are uncommon and are usually part of multisystem injuries[14]. Throckmorton and Kuhn presented a review of all clavicle fractures treated at their institution over a five year period. Out of 614 clavicle fractures, only 57 were identified as medial third fractures. 80% of these occurred in middle aged men. Just over 80% of these injuries were associated with motor vehicle accidents (53% were passengers/driver of a vehicle; 16% were pedestrians hit by a vehicle; 11% motorcycle accidents). Ninety percent of cases were defined as hav
Hook plate fixation of acute displaced lateral clavicle fractures: mid-term results and a brief literature overview
Davut Tiren, Alexander JM van Bemmel, Dingeman J Swank, Frits M van der Linden
Journal of Orthopaedic Surgery and Research , 2012, DOI: 10.1186/1749-799x-7-2
Abstract: To evaluate the results and long term effects in use of this plate we performed a retrospective analysis with a mean follow up of 65 months (5.4 years) of 28 consecutive patients with acute displaced lateral clavicle fractures, treated with the clavicle hook plate.Short term functional results in all patients were good to excellent. All but one patient had a united fracture (96%). Nine patients (32%) developed impingement symptoms and in 7 patients (25%) subacromial osteolysis was found. These findings resolved after plate removal. Twenty-four patients were re-evaluated at a mean follow-up period of 5.4 years. The Constant-Murley score was 97 and the DASH score was 3.5. Four patients (14%) developed acromioclavicular joint arthrosis of which one was symptomatic. Three patients (11%) had extra articular ossifications of which one was symptomatic. There was no relation between the impingement symptoms, subacromial osteolysis and development of acromioclavicular joint arthrosis or extra articular ossifications.The clavicle hook plate is a good primary treatment option for the acute displaced lateral clavicle fracture with few complications. At mid term the results are excellent and no long term complications can be addressed to the use of the plate.In the last decade, the clavicle hook plate has been used extensively [1-10]. Although this plate achieves, like most other operative techniques, a high percentage of union and a low percentage of complications, concerns about long term complications still exist, particularly the involvement of the acromioclavicular joint (ACJ) [11].To evaluate the results and long term effects in use of this plate we performed a retrospective analysis with a mean follow up of 65 months (5.4 years) of 28 consecutive patients with acute displaced lateral clavicle fractures, treated with the clavicle hook plate.All patients diagnosed with a displaced lateral clavicle fracture in our hospital from 2001 to 2008 were retrospectively assessed.Two
Base of coracoid process fracture with acromioclavicular dislocation in a child
Prithee Jettoo, Gavin de Kiewiet, Simon England
Journal of Orthopaedic Surgery and Research , 2010, DOI: 10.1186/1749-799x-5-77
Abstract: Coracoid fracture is an uncommon injury, accounting for only 2% to 13% of all scapular fractures and approximately 1% of all fractures [1-3]. Acromioclavicular joint dislocation is a very rare injury in a child below the age of thirteen [4]. We report an interesting case of fracture of the coracoid process associated with acromioclavicular joint dislocation in a child. He underwent open reduction internal fixation of the acromioclavicular joint and coracoid process. He subsequently made a good progress with pain free full range of shoulder movement.A twelve year old boy came off a rope swing from four metres, landed on his right shoulder and sustained an isolated injury to his right shoulder girdle. He complained of pain and swelling. Clinically, he had a prominent lateral clavicle associated with swelling, marked bruising and tenderness over his right shoulder and scapular area. His range of motion was restricted. He had no evidence of a brachial plexus injury, and had no vascular compromise.His initial radiographs showed a widely displaced acromioclavicular joint with possible coracoid process fracture (Figure 1). He had a computed tomography (CT) scan, which confirmed the associated fracture at the base of his coracoid process (Figures 2, 3). A three dimensional CT scan reconstruction showed a spatial view of the coracoid process fragment (Figures 4, 5)He underwent surgical intervention with reduction and fixation of the acromioclavicular joint with two threaded half pins and screw fixation of the base of coracoid fracture (Figure 6). Intraoperatively, his coracoclavicular and coracoacromial ligaments were intact and attached to the fracture fragment; but he had a disrupted acromioclavicular capsule. Post-operatively, a shoulder immobiliser was applied; and he started intermittent graded right shoulder movement. The threaded pins were removed four weeks later (Figure 7). At 3 months follow-up, the patient had a good range of movement of his right shoulder, with o
Analysis of Contoured Anatomic Plate Fixation versus Intramedullary Rod Fixation for Acute Midshaft Clavicle Fractures  [PDF]
Juliann Kwak-Lee,Elke R. Ahlmann,Lingjun Wang,John M. Itamura
Advances in Orthopedic Surgery , 2014, DOI: 10.1155/2014/518310
Abstract: The recent trend has been toward surgical fixation of displaced clavicle fractures. Several fixation techniques have been reported yet it is unclear which is preferable. We retrospectively reviewed one hundred one consecutive patients with acute midshaft clavicle fractures treated operatively at a level-1 trauma center. Thirty-four patients underwent intramedullary pin fixation and 67 had anatomic plate fixation. The outcomes we assessed were operative time, complications, infection, implant failure, fracture union, range of motion, and reoperation rate. There were 92 males and 9 females with an average age of 30 years (range: 14–68 years). All patients were followed to healing with an average followup of 20 months (range: 15–32 months). While fracture union by six months and range of motion at three months were similar, the overall healing time for pin fixation was shorter . The pin group had more infections and implant failures than the plate group. Intramedullary pin fixation may have improved early results, but there was no long term difference in overall rate of union and achievement of full shoulder motion. The higher rate of implant failure with pin fixation may indicate that not all fracture patterns are amenable to fixation using this device. 1. Introduction Clavicle fractures are common injuries accounting for 5–10% of all fractures [1–3]. The majority of fractures (70–80%) are located within the middle third of the shaft [1, 2, 4]. Traditionally, acute midclavicular fractures have been treated nonoperatively with either sling or figure-of-eight bandage, with a reported less than 1% rate of fracture nonunion [5–8]. Until recently, operative indications typically included open fractures, tenting of the skin, neurovascular injuries, and concomitant shoulder girdle injuries [9, 10]. However, more recent studies have reported nonunion rates of 4–29% [11–16] and malunion rates of 14–36% [9, 14, 17–19] with displaced clavicle fractures. One study demonstrated that shoulder biomechanics were significantly altered by malunion of the clavicle [19]. Patients complained of weakness, rapid fatiguability, loss of endurance, numbness, and paraesthesias with overhead activities and deficits in functional cosmesis. Studies that have used patient-based outcome measures have described unsatisfactory outcome rates of 25–30%, with complications including neurologic symptoms and functional deficits [2, 9, 12, 15, 19]. Improved patient outcomes, earlier return to function, decreased nonunion and malunion rates, and better cosmesis have all been reported with
Page 1 /100
Display every page Item


Home
Copyright © 2008-2017 Open Access Library. All rights reserved.