Axillary artery injury secondary to inferior shoulder dislocation.

BACKGROUND: Dislocation injuries of the glenohumeral joint are common in the general public and generally are corrected without complication. One serious complication with shoulder dislocations, or the subsequent reduction, is a lesion to the axillary artery. This specific complication is most frequently seen in the elderly population, where vascular structures have become less flexible. Also, these injuries are most common in association with anterior dislocations of the shoulder. OBJECTIVES: To bring awareness to the possibility of axillary artery injury with inferior dislocation of the shoulder, the treatment options, and a review. CASE REPORT: We report a 15-year-old male athlete who inferiorly dislocated his shoulder during wrestling practice. The injury was reduced at the scene with manual traction and the patient was transferred to our clinic for evaluation. The patient was determined to have a pseudoaneurysm of the axillary artery, and the history and treatment of the illness are presented. CONCLUSION: Axillary artery injuries secondary to shoulder dislocations are rare, especially in the young athlete, and proper recognition and treatment offer patients a full recovery.

Idiopathic toe-walking.

Idiopathic toe-walking is a diagnosis of exclusion when a child presents with bilateral toe-to-toe gait. Although toe-walking is considered part of the normal gait spectrum in development, it is abnormal when persisting past the age of two. Toe-walking may be caused by cerebral palsy, congenital contracture of the Achilles tendon or paralytic muscular disorders such as Duchenne Muscular Dystrophy. Idiopathic toe-walking may be associated with developmental disorders such as autism or other myopathic or neuropathic disorders. The majority of disorders causing toe-walking can be ruled out through the history and physical examination, resulting in a diagnosis of idiopathic toe-walking. However, it may be difficult to differentiate mild forms of cerebral palsy, specifically mild spastic diplegia, and idiopathic toe-walking. The treatment options for idiopathic toe-walking include observation, conservative methods and surgical methods. Most children can be treated in the primary care setting with either observation or conservative treatment. Patients with severe contracture of the Achilles tendon, or persistent toe-walking, may need surgical intervention. The prognosis of idiopathic toe-walking is favorable with both conservative and surgical treatment allowing children to attain normal function and range of plantarflexion. The following article provides an overview of the background information, differential diagnosis and treatment options for idiopathic toe-walking.

Vertebral compression fractures: treatment and evaluation.

Vertebral compression fractures can occur secondary trauma, malignancies, or most commonly osteoporosis. Osteoporosis causes almost 1.5 million fractures throughout the United States every year and nearly 700,000 of these fractures are vertebral compression fractures. These fractures are frequently seen in elderly women; 40 percent of women older than 80 years old are affected by vertebral compression fractures. These injuries can be treated both conservatively and surgically. The conservative route includes bed rest, pain control, bracing, and strength training. The surgical method includes percutaneous vertebroplasty and kyphoplasty, both minimally invasive procedures. This article provides a general introduction to vertebral compression fractures and osteoporosis, the diagnostic methods used to identify vertebral compression fractures, and the known treatments.

Spinal stenosis.

Spinal stenosis can be generally described as the narrowing of the spinal canal causing compression of the spinal cord. This compression most often occurs in the lumbar portion of the spine and has a clinical presentation of pain and numbness in the low back, legs and buttocks after walking or extension of the lumbar spine. The symptoms associated with lumbar spinal stenosis are usually relieved with flexion of the lower back. In addition, compression at the cervical spine has occasionally been seen in combination with lumbar spinal stenosis, with thoracic spinal stenosis occurring only rarely. Therefore, because spinal stenosis is the most prevalent preoperative diagnosis for spine surgery and affects nearly 5 of every 1000 Americans older than 50 years old, it is imperative to understand the role of spinal stenosis in generating back and leg pain. In this article an overview of the etiology, treatment, and outcomes will be presented to give a better understanding of this condition.

Monteggia fractures: beware!

Monteggia fractures consist of an ulna fracture accompanied by radial dislocation. These fractures are easily overlooked because of the prominence of the ulnar fracture. Furthermore, the leading cause of malpractice cases brought against emergency departments involve missing high-risk orthopedic injuries, such as Monteggia fractures. The purpose of this article is to provide sufficient information to reduce the possibility of underestimating forearm injuries and, consequently, diagnose a Monteggia fracture correctly. This article outlines the classification of Monteggia fractures, the mechanism of injury, a specific case report, and a discussion of consequences when the extent of the injury is underestimated. Finally, specific ways are presented to easily avoid the misjudgment of a Monteggia fracture.