Luxofractura compleja del codo con compromiso del húmero distal: reporte de caso clínico / Complex elbow fracture-dislocation with distal humerus involvement: clinical case report

Es conocido que el codo se disloca con frecuencia, y corresponde a la primera causa de luxación en niños y a la segunda causa en adultos. Respecto a las fracturas distales, representan un tercio de todas las fracturas del húmero en población adulta. Por lo general, se presentan en una distribución bimodal que afecta a hombres jóvenes o a mujeres ancianas. En este artículo, reportamos un caso clínico poco frecuente de luxación de codo izquierdo complicada, producto de fractura del húmero distal, en una mujer de 64 años. La lesión comprende una luxación posterolateral de codo izquierdo complicada con fractura articular parcial (compromiso del cóndilo y de la tróclea humeral externa), sagital, multifragmentaria, de húmero distal que requirió tres intervenciones quirúrgicas y terapia de rehabilitación por seis meses que finalizaron en recuperación funcional de la estabilidad de la articulación del codo. El caso reportado es particular debido a la individualidad del paciente con sus comorbilidades, el mecanismo de producción de la luxofractura, el abordaje quirúrgico, y el éxito del tratamiento instaurado. Sin embargo, este éxito terapéutico debe ser confirmado en series de casos

It is known that the elbow is dislocated frequently, representing the first cause of dislocation in children and the second cause in adults. Regarding distal humerus fractures, they represent a third of all humerus fractures in the adult population. They generally occur in a bimodal distribution, affecting young men or elderly women. In the present article, we report a rare clinical case of a complicated left elbow dislocation due to a distal humerus fracture in a 64-year-old woman. The lesion includes a posterolateral dislocation of the left elbow complicated by a sagittal, multifragmentary, partial articular fracture (compromise of the condyle and external humeral trochlea) of the distal humerus which required three surgical interventions and rehabilitation therapy for six months and resulted in functional recovery of the stability of the elbow joint. The case herein reported is particular due to the individuality of the patient, with her comorbidities, the mechanism of production of the fracture-dislocation, the surgical approach, and the success of the established treatment. This therapeutic success must be confirmed in series of cases

Condylar Dislocation for Intracranial Fossa: a Review of the Last 10 Years

The displacement of the mandibular condyle into the cranial fossa is an uncommon event; when it occurs, there is a need for immediate and multidisciplinary surgical intervention. Due to its rare advent, there is still no consolidated service dynamics, as this condition has not yet been described in a sedimented way in the literature databases. In the present article, we performed a literature review of condylar dislocation for the intracranial fossa described in the past 10 years in the PubMed and Lilacs search databases.

Traumatic Atlantoaxial Rotatory Subluxation in Adult: Case Report

Traumatic atlantoaxial rotatory subluxation (AARS) is generally found in pediatric patients, rarely found in adults, being a life-threatening condition especially when early diagnosis is not possible, which can lead to severe late neurological deficits.We describe a 38-year-old patient, victim of physical aggression caused by strangulation attempt who developed AARS, an uncommontraumatic cause. During the hospital care, the early diagnosis allowed us to institute a conservative treatment, which made the case uncommon, since most of the time surgical treatment is imperative. With the patient awake and under analgesia, a closed reduction was performed that promoted immediate pain relief, followed by a prescription of wearing a Philadelphia-type collar for 8 weeks. During the follow-up, cervical spine radiographies demonstrated no subluxation after removing the cervical collar. The patient was asymptomatic after 6months of treatment. This case supports the importance of nonoperative management of AARS in selected cases.

Luxaciones puras de codo en pacientes pediátricos: tratamiento conservador y complicaciones asociadas a una patología poco prevalente. Serie de 4 casos / Isolated elbow dislocation in pediatric patients: non-operative treatment and complications associated with an infrequent pathology. Series of 4 cases

Si bien el codo es la articulación más frecuentemente luxada en niños, representa el 3-6 % de las lesiones en ese sitio. Las luxaciones sin fracturas asociadas son muy raras y son producto de una caída con el codo en extensión. El paciente consulta por dolor, impotencia funcional y deformidad evidente. La finalidad del tratamiento es restaurar la congruencia articular, lograr estabilidad y minimizar los riesgos de posibles lesiones neurovasculares.Se presentan 4 pacientes tratados con manejo conservador con excelentes resultados funcionales, incluso aquel que presentó una neuropraxia del mediano con restitución ad integrum.Según nuestra experiencia, suelen ser lesiones con buena evolución. Se destaca la importancia de un rápido y preciso examen neurovascular, optando, de ser posible, por una conducta expectante ante las lesiones nerviosas. Se resalta la indicación de una inmovilización acotada con movilización temprana que evite rigidez del codo.

Even though the elbow is the most often dislocated joint in children, this injury accounts for 3-6 % of elbow pathology. Dislocations without associated fractures are extremely rare. They result from a fall onto an outstretched hand. The patient is always referred with a painful joint, movement impairment and even clinical deformity. Acute treatment aims to achieve quick reduction and adequate joint stability, avoiding neurovascular injuries.We sought to analyze the functional outcomes and the complications after non-operative treatment. Our 4 patien had excellent functional results at the latest follow-up, and one of them suffered from a median nerve palsy without further consequences.In our experience, these injuries presented excellent outcomes and we would like to highlight the importance of a quick and precise neurovascular examination with the possibility of non-surgical management of nerve injuries. A short period of immobilization with early rehabilitation should be indicated to avoid joint stiffness

Triple open dislocation in the index finger of the hand without a high-energy trauma / Triple luxación abierta del segundo dedo de la mano tras traumatismo de baja energía

A simultaneous double dislocation (both proximal [PIP] and distal [DIP] interphalangeal joints) of a triphalangeal finger is a rare entity. The most common hand affected is the right hand. In the case of a closed triple dislocation (metacarpophalangeal [MCP], PIP and DIP joints); there are only two cases in the literature revised. In this case, we report an open triple dislocation in the index finger of the left-hand of a 54-year-old man treated by closed reduction and 3 weeks of immobilization followed by active mobilization with satisfactory results.

La luxación simultánea de las articulaciones interfalángicas proximal (IFP) y distal (IFD) de un dedo de tres articulaciones es una rara entidad. La mano que es afectada con más frecuencia es la derecha. Con relación a una triple luxación cerrada (articulación metacarpofalángica [MCF], IFP e IFD), sólo hay descritos dos casos en la literatura revisada. En este caso, describimos una triple luxación abierta del segundo dedo de la mano en un varón de 54 años de edad tratada mediante reducción cerrada,e inmovilización durante 3 semanas seguida de movilización activa supervisada, con resultado final satisfactorio.

A case of elbow dislocation / Un caso de dislocación de codo

Abstract The elbow joint is a stable joint and a significant force is required to disrupt the joint. The elbow joint is the second most commonly dislocated joint. A 29 years old male sustained a fall on outstretched hand and presented with pain, swelling , deformity and inability to move his Right elbow. Closed Reduction was done followed by immobilisation for 3 weeks and thereafter range of movement exercises of the elbow joint. Neurovascular complications , associated fracture around the elbow joint and instability of the joint should be looked for. Associated fractures which are difficult to see on plain X Rays can go for Computerized tomography and unstable fractures where damage to the ligamentous complex is suspected should undergo an Magnetic Resonance imaging study of the involved joint.

Reporte de caso: luxación simultánea carpometacarpiana del pulgar y los cuatro dedos / Case report: simultaneous carpometacarpal dislocation of the thumb and four fingers / Relato de caso: deslocamento carpometacarpal simultâneo do polegar e quatro dedos

Introducción: Las luxaciones carpo-metacarpianas son lesiones poco frecuentes, que van del 0.5 al 1% de las luxaciones de los huesos de la mano. Siendo extremadamente infrecuente la luxación simultanea de los 5 dedos. Objetivo: El objetivo de nuestro trabajo es documentar una lesión poco frecuente producida en un paciente asistido en nuestro centro. Así como realizar una puesta a punto sobre las medidas diagnósticas y terapéuticas de dicha lesión. Caso clínico: Se presenta el caso de un hombre de 63 años, diestro, artesano en hierro y madera, que sufre un accidente de tránsito de alta energía en moto versus auto, sufriendo traumatismo en mano derecha, sin presentar otros traumatismos. De la exploración física, en el departamento de emergencia, se constata la mano derecha dolorida con gran deformidad en dorso. Se diagnosticó: luxación dorsal carpo-metacarpiano de los 5 metacarpianos, con fractura del sector distal del trapecio, trapezoide, hueso grande y ganchoso. Se realizó reducción cerrada en block quirúrgico con anestesia general, siendo la reducción inestable se colocan agujas de Kirschner para su estabilización. Se confecciona, además, una férula de yeso de protección. Se solicitó una tomografía computada de control donde se objetiva buena reducción de las 5 articulaciones carpo-metacarpianas. Se retiraron las agujas de Kirschner a las 6 semanas. A los 3 meses de la lesión presenta una mano indolora, con buen rango de movilidad, con disminución a la fuerza prensil máxima comparada con la contralateral. El paciente reanuda sus tareas, incorporándose totalmente al trabajo a los 6 meses. Presenta, al año de la cirugía, un score de DASH excelente. Discusión: Las luxaciones de los 5 metacarpianos son lesiones extremadamente raras. Se han reportado en el mundo menos de 20 casos. A pesar de los elementos clínicos sugestivos, el diagnostico de esta lesión es difícil, siendo fundamental contar con un enfoque radiológico de perfil estricto de mano. Los resultados de esta lesión son inciertos, la función de la mano y la muñeca se mantiene pero frecuentemente asociado a una reducción de fuerza prensil. Este tipo de trauma lleva, en mayor o menor grado, al desarrollo de artrosis carpo metacarpiana a largo plazo.

Introduction: Carpometacarpal join dislocations, are really infrequent injuries, with an incidence that goes from 0,5 to 1% of all bone hand dislocations. Being extremely rare the simultaneous luxation of all five fingers. Objectives: Our work objective is to report a very infrequent injury found on a patient treated at our medical center. As well as getting up to date with diagnosis and treatment of such injury. Clinical case: A 63 year old male case is presented, right-handed, wood and iron artisan, who was involved in a high-impact car crush against a motorbike, suffering a trauma on his right hand, without any other injuries. At the emergency room, the physical examination showed a painful right hand deformed on the back. His diagnosis was dorsal carpometacarpal luxation of all 5 metacarpus, with a distal fracture of the trapezium, trapezoid, capitate and hamate bones. A closed reduction at the surgical room was performed, with general anesthesia, being the reduction unstable therefore Kirschner needles were used for stabilization. A plaster cast was used for its protection. A control tomography was performed showing good reduction of all 5 carpometacarpal joints. Kirschner needles were taken out 6 weeks later, at which point the rehabilitation program was started with the physiatrist team. Three months after the injury, the hand was painless, with a good range of movement, a diminished maximum catching strength compared with the other hand. The patient restarted his usual chores, fully reincorporating to his job 6 months later. He presents an excellent DASH score one year after surgery. Discussion: Luxation of all 5 metacarpus is an extremely rare injury. It has been reported less than 20 cases worldwide. In spite of clinical suggestive elements, the diagnosis of this injury is quite difficult, being of great importance to count with x-rays with a straight profile incidence of the hand. The results of this injury are uncertain; the functionality of the hand and wrist is frequently sustained associated with a reduction of the catching strength. This type of trauma will end up developing in greater or lesser degree, long term carpometacarpal arthrosis.

Introdução: As luxações carpo-metacarpianas são lesões raras, variando de 0,5 a 1% das luxações dos ossos da mão. O deslocamento simultâneo dos 5 dedos é extremamente incomum. Objetivo: O objetivo do nosso trabalho é documentar uma lesão rara produzida em um paciente assistido em nosso centro. Bem como realizar um set-up nas medidas diagnósticas e terapêuticas da referida lesão. Caso clínico: O caso de um homem de 63 anos, destro, artesão em ferro e madeira, que sofre um acidente de motocicleta de alta energia em uma motocicleta contra um carro, sofrendo traumatismo em sua mão direita, sem apresentar outras lesões, é apresentado. A partir do exame físico no pronto-socorro, há uma dor na mão direita com grande deformidade nas costas. Foi diagnosticado: luxação metacarpal do dorsal do carpo dos 5 metacarpos, com fratura do setor trapézio distal, trapézio, osso grande e hamato. Uma redução fechada foi realizada em um bloco cirúrgico com anestesia geral, com a redução instável sendo colocada com fios K para estabilização. Uma tala de gesso protetora também é feita. Solicitou-se tomografia computadorizada de controle, onde foi observada boa redução das 5 articulações carpo-metacarpianas. Os fios de Kirschner foram removidos às 6 semanas. Aos 3 meses após a lesão, ele apresenta uma mão indolor, com boa amplitude de mobilidade, com diminuição da força preênsil máxima em comparação com a força contralateral. O paciente retoma suas tarefas, ingressando totalmente no trabalho aos 6 meses. Um excelente escore DASH é apresentado um ano após a cirurgia. Discussão: As luxações dos 5 metacarpos são lesões extremamente raras. Menos de 20 casos foram relatados no mundo. Apesar dos elementos clínicos sugestivos, o diagnóstico dessa lesão é difícil, sendo fundamental a abordagem radiológica do perfil estrito da mão. Os resultados dessa lesão são incertos, a função da mão e do punho é mantida, mas freqüentemente associada a uma redução na força de preensão. Este tipo de trauma leva, em maior ou menor grau, ao desenvolvimento de artrose metacarpal do carpo a longo prazo.

Luxación anterior aislada e irreductible de la cúpula radial en un paciente pediátrico: un raro reporte de caso / Isolated irreducible anterior radial head dislocation in a child: a rare case report

La luxación de la cabeza radial suele asociarse a fractura o deformidad plástica cubital. La luxación aislada es rara. Sin tratamiento, puede evolucionar hacia deformidad cubital en valgo, lesión nerviosa, artrosis precoz y pérdida del rango de movilidad con limitación funcional. Se presenta a un paciente de 9 años que sufrió traumatismo de codo. Acudió a nuestra Institución a los 40 días y se diagnosticó luxación irreductible de la cabeza radial, primero desapercibida. La luxación era irreductible por un ojal en el ligamento anular y requirió ser reducida a cielo abierto. En ausencia de fractura, incluso sin evidencia de deformidad plástica del cúbito, debe sospecharse la luxación de la cabeza radial. La clínica, junto con el par radiográfico bilateral y el conocimiento de esta entidad poco frecuente, son el trípode necesario para alcanzar el diagnóstico y no demorar el tratamiento.

Anterior radial head dislocation in pediatric population is related to Monteggia fracture-dislocations. Isolated radial head dislocation is uncommon. Sometimes, radial head dislocation becomes irreducible. This entity can develop into chronic conditions such as nerve injuries, early osteoarthritis, limited range of motion and cubitus valgus. We describe a case of a 9-year-old patient who suffered elbow trauma. He was admitted to our institution 40 days after, where radial head dislocation was diagnosed. This condition was misdiagnosed at first stage. It was irreducible due to a tear in the annular ligament. He underwent open reduction. Radial head dislocation must be suspected even if there are no fractures or plastic deformity. Pure irreducible radial head dislocation is rare. Physical examination, together with plain bilateral radiographs and full acknowledgement of this rare condition are the basis to reach early diagnosis, which leads to proper non-delayed treatment.

Metrical analysis of disc-condyle relation with different splint treatment positions in patients with TMJ disc displacement

Abstract Objective: To evaluate the effect of bite positions characterizing different splint treatments (anterior repositioning and stabilization splints) on the disc-condyle relation in patients with TMJ disc displacement with reduction (DDwR), using magnetic resonance imaging (MRI). Material and Methods: 37 patients, with a mean age of 18.8±4.3 years (7 male and 30 females) and diagnosed with DDwR based on the RDC/TMD, were recruited. MRI metrical analysis of the spatial changes of the disc/condyle, as well as their relationships, was done in three positions: maximum intercuspation (Position 1), anterior repositioning splint position (Position 2), and stabilization splint position (Position 3). Disc/condyle coordinate measurements and disc condyle angles were determined and compared. Results: In Position 1, the average disc-condyle angle was 53.4° in the 60 joints with DDwR, while it was −13.3° with Position 2 and 30.1° with Position 3. The frequency of successful "disc recapture" with Position 2 was significantly higher (58/60, 96.7%) than Position 3 (20/60, 33.3%). In Positions 2 and 3, the condyle moved forward and downward while the disc moved backward. The movements were, however, more remarkable with Position 2. Conclusions: Anterior repositioning of the mandible improves the spatial relationship between the disc and condyle in patients with DDwR. In addition to anterior and inferior movement of the condyle, transitory posterior movement of the disc also occurred.

Transtriquetral perihamate fracture-dislocation: case report / Fratura-luxação transtriquetral peri-hamato: relato de caso

ABSTRACT The wrist is a region that is very vulnerable to injuries of the extremities. Among these injuries, fractures of the pyramidal bone (or triquetrum) in association with dislocation of the hamate and carpal instability are uncommon. They are generally correlated with high-energy trauma and may be associated with neurovascular deficits, muscle-tendon disorders, skin lesions or injuries to other carpal bones. Thus, in this report, one of these rare cases of transtriquetral perihamate fracture-dislocation with carpal instability is presented, diagnosed by means of radiography on the right wrist of the patient who presented pain, edema and limitation of flexion-extension of the carpus after trauma to the region. The stages of attending to the case are described, from the initial consultation to the surgical treatment and physiotherapy, which culminated in restoration of the strength and range of motion of the wrist.

RESUMO O punho é uma região muito vulnerável a traumas de extremidade. Entre tais lesões, as fraturas do piramidal (ou triquetrum), associadas à luxação do hamato e à instabilidade carpal, são pouco frequentes. Geralmente relacionadas a traumatismos de alta energia, podem estar associadas a déficit neurovascular, miotendíneo, lesões de pele ou em outros ossos do carpo. Assim, neste relato, apresenta-se um desses casos raros de fratura-luxação transtriquetral peri-hamato com instabilidade carpal, diagnosticadas por radiografias do punho direito de um paciente que apresentava dor, edema e limitação da flexoextensão do carpo após trauma na região. As etapas do atendimento foram descritas desde a consulta inicial até o tratamento cirúrgico e a fisioterapia, que culminaram com a restauração da força e da amplitude de movimento do punho.

Luxación aislada del escafoides / Luxation isolée du scaphoïde / Isolated dislocation of the scaphoid

El funcionamiento armónico de la mano desempeña un papel fundamental para el desarrollo de la vida del hombre. En la sociedad moderna las lesiones a este nivel, a pesar de su baja incidencia, son causa frecuente de discapacidad funcional. Se presenta un paciente blanco, masculino, de 38 años, atendido por el Servicio de Urgencias tras un trauma de alta energía con hiperflexión forzada de la muñeca. Se diagnostica una luxación aislada del escafoides que se reduce bajo anestesia con ayuda del intensificador de imágenes. Se inmoviliza por 6 semanas con férula braquial, tomando primer dedo, y posteriormente comienza el proceso de rehabilitación. El tratamiento oportuno y adecuado de la afección mencionada es indispensable para obtener los mejores resultados en la recuperación funcional(AU)

The orderly functioning of the hand plays a key role for the development of human life. In modern society injuries at this level are a frequent cause of functional disability, despite its low incidence. A case of a white, male patient, 38, attended by the emergency department after a high-energy trauma with forced hyperflexion of the wrist is presented here. An isolated dislocation of the scaphoid is diagnosed and it is reduced under anesthesia using the image intensifier. It is immobilized for 6 weeks with brachial splint, taking first finger, and then the rehabilitation process begins. The timely and proper treatment of this condition is essential to obtain the best results in functional recovery(AU)

Le fonctionnement harmonieux de la main joue en rôle essentiel dans le développement de la vie de l'homme. Dans la société moderne, les lésions au niveau de la main, malgré leur faible incidence, sont la cause la plus fréquente d'invalidité fonctionnelle. Un patient, blanc, âgé de 38 ans, traité au service d'urgence dû à un traumatisme à haute énergie qui a été provoqué par une hyperflexion forcée du poignet, est présenté. Une luxation isolée du scaphoïde, corrigée sous anesthésie à l'aide d'un intensificateur d'images, est diagnostiquée. Tout d'abord, le poignet a été immobilisé pendant 6 semaines par une attelle ante-brachiale de poignet avec trou pour le pouce, et puis la rééducation a commencé. Le traitement précoce et approprié de cette affection est indispensable pour obtenir les meilleurs résultats dans la récupération de la fonction(AU)

Comparison of Results between Hook Plate Fixation and Ligament Reconstruction for Acute Unstable Acromioclavicular Joint Dislocation

BACKGROUND: In the present study, we aimed to compare clinical and radiographic outcomes between hook plate fixation and coracoclavicular (CC) ligament reconstruction for the treatment of acute unstable acromioclavicular (AC) joint dislocation. METHODS: Forty-two patients who underwent surgery for an unstable acute dislocation of the AC joint were included. We divided them into two groups according to the treatment modality: internal fixation with a hook plate (group I, 24 cases) or CC ligament reconstruction (group II, 18 cases). We evaluated the clinical outcomes using a visual analog scale (VAS) for pain and Constant-Murley score, and assessed the radiographic outcomes based on the reduction and loss of CC distance on preoperative, postoperative, and final follow-up plain radiographs. RESULTS: The mean VAS scores at the final follow-up were 1.6 +/- 1.5 and 1.3 +/- 1.3 in groups I and II, respectively, which were not significantly different. The mean Constant-Murley scores were 90.2 +/- 9.9 and 89.2 +/- 3.5 in groups I and II, respectively, which were also not significantly different. The AC joints were well reduced in both groups, whereas CC distance improved from a mean of 215.7% +/- 50.9% preoperatively to 106.1% +/- 10.2% at the final follow-up in group I, and from 239.9% +/- 59.2% preoperatively to 133.6% +/- 36.7% at the final follow-up in group II. The improvement in group I was significantly superior to that in group II (p < 0.001). Furthermore, subluxation was not observed in any case in group I, but was noted in six cases (33%) in group II. Erosions of the acromion undersurface were observed in 9 cases in group I. CONCLUSIONS: In cases of acute unstable AC joint dislocation, hook plate fixation and CC ligament reconstruction yield comparable satisfactory clinical outcomes. However, radiographic outcomes based on the maintenance of reduction indicate that hook plate fixation is a better treatment option.

Carpometacarpal Joint Fracture Dislocation of Second to Fifth Finger

BACKGROUND: Carpometacarpal joint fracture dislocation of the second to fifth finger is a rare hand injury associated with high energy trauma. Due to severe swelling and overlapping of bones on the radiograph of wrist-hand, dislocations are missed. We reported a series of six patients with rare carpometacarpal joint fracture dislocation treated with open reduction. METHODS: We retrospectively studied six cases of carpometacarpal joint fracture dislocation. All patients were treated with open reduction and internal fixation with Kirschner wire. Functional assessment was done with Quick Disabilities of the Arm, Shoulder and Hand score (Quick DASH score) at regular intervals. RESULTS: Average Quick DASH score was improved from 75.76 to 1.9 from 6 weeks to 18 months of duration. Of the six patients, three patients had a Quick DASH score of 0 at the end of 18 months. CONCLUSIONS: Careful hand examination and radiographic assessment is necessary to avoid missed diagnosis of carpometacarpal joint fracture dislocation. Early open reduction and internal fixation lead to excellent recovery of hand function.

Application of spiral CT reconstruction in the forensic identification of atlantoaxial injuries / 法医学杂志

OBJECTIVE@#To evaluate diagnostic value of spiral CT reconstruction in atlantoaxial injuries.@*METHODS@#The images of 25 cases of spiral CT reconstruction were analyzed and compared with images of CT scan and X-ray.@*RESULTS@#In 7 cases of odontoid process fracture, X-ray demonstrated 4 cases and CT demonstrated 5 cases, whereas the spiral CT reconstruction diagnosed 7 cases, which could display the displacement of fracture clearly. The X-ray and CT showed asymmetric space between left and right gaps of atlantoaxial joint in 6 cases, while spiral CT reconstruction showed normal and excluded the possibility of atlantoaxial dislocation. There was one case of lateral atlantoaxial joint dislocation, which was demonstrated by the spiral CT reconstruction clearly but not by the X-ray and CT scan. There were 3 cases of atlantoaxial congenital deformity (1 case of absence of both posterior arch of atlas and odontoid process and 2 cases of maldevelopment of the odontoid process), which were displayed clearly by spiral CT reconstruction, but misdiagnosed as odontoid process fracture and atlantoaxial subluxation by X-ray and CT scan.@*CONCLUSION@#Spiral CT reconstruction can provide the most accurate and integrity imaging information and is very useful in the diagnosis of atlantoaxial injuries and deformity.

Spontaneous reduction of a traumatic L2-L3 subluxation without fracture in a 14-year-old boy

To report a rare case of lumbar vertebral subluxation associated with spontaneous reduction in an adolescent treated conservatively. A 14-year-old male victim of a snowboard accident, which caused a lumbar spinal injury, was referred to the emergency room with significant lumbar pain. Neurologic examination was normal. Radiographic assessment at admission showed a unilateral left lateral subluxation of the L2-L3 vertebrae without associated fractures. These findings were confirmed by CT scan and a surgical management was decided. The preoperative MRI performed 24 h after the accident, however, revealed the spontaneous reduction of the subluxation, and an associated tear of the quadratus lumborum and the psoas muscles on the right side at the level of L2, L3 and L4. Following these findings conservative treatment with a plaster brace for 2 months was carried out. The brace was removed after 2 months. The patient had no pain and the range of motion of his lumbar spine was normal. Three months after injury, sports activities were resumed. At follow-up of 24 months, the patient was free of pain and radiographs showed a right positional bending without rotational or translation anomaly. To date, this is the first case of subluxation without fracture in a child, presenting without neurological deficit and where spontaneous reduction occurred. In this case, conservative treatment was effective and the outcome at 2-year follow-up was excellent

Scapulothoracic dissociation--A case report.

Scapulothoracic dissociation (SCTD) is a rare clinical entity with fewer than 70 cases reported in English literature. The mechanism of injury is severe rotational force, which causes disruption of the shoulder girdle from the rest of chest wall. Frequently, SCTD produces massive blood loss as it involves major fractures of the upper extremity, disruption of muscle, brachial plexus, and vascular damage. This case report demonstrates classical radiological findings of SCTD with brachial plexus injury but with no associated vascular damage.

Clinical and Radiological Manifestations of Osteogenesis Imperfecta Type V

We reviewed clinical manifestation of 12 patients from three Korean families. They showed mild to moderate bone fragility, and suggested an autosomal dominant inheritance pattern. Significant intrafamilial phenotype variability was obvious. Clinical, radiological, and histopathologic characteristics that distinguished this subtype from others include ossification of interosseous membrane of the forearm with radial head dislocation, hyperplastic callus formation, no evidence of type I collagenopathy and an abnormal histopathologic pattern. Severity of the interosseous membrane ossification was correlated with increasing age (p<0.01) and the radial head dislocation was thought to be a developmental problem rather than a congenital problem. Four children who had bisphosphonate treatment showed improved bone mineral density, radiological changes, and biochemical responses. Osteogenesis imperfecta type V was a distinctive subtype of osteogenesis imperfecta, which caused mild to moderate disability clinically.