Acute brachialis muscle tear in a pediatric patient.

Acute tears or ruptures of the brachialis muscle are rare events, with only 10 cases reported to date and all of which have been in adults. We report a case of an acute, complete tear of brachialis in an 8-year-old female that occurred while the patient was practicing a gymnastic move. Although rare, this case underscores the need to include brachialis tears in the differential diagnosis for musculoskeletal injuries at the elbow in all age groups.

Incidental detection of previously undiagnosed primary breast carcinoma with a gallium-67 scan performed for evaluation of occult infection.

A 63-year-old female patient with a recent left posterior cerebral artery infarction and pyelonephritis presented with persistent fevers despite adequate intravenous antibiotic therapy. Whole-body gallium-67 scintigraphy was performed to evaluate for occult infection. Tracer accumulated bilaterally in the kidneys consistent with the previously diagnosed pyelonephritis. Relatively intense uptake was also noted in the area of a known occipitoparietal infarct. Incidentally noted was an abnormal focus of increased tracer uptake in the retroareolar region of the right breast. Subsequent guided core biopsy of the right breast mass demonstrated a previously undiagnosed invasive ductal carcinoma.

Scaphoid fracture detection in a military population: a standardized approach for medical referral.

OBJECTIVE: The objective was to test, refine, and implement an algorithm for early detection and referral of clinical scaphoid fractures by U.S. Army medical personnel. Our goal was to reduce complications resulting from delayed diagnosis and to improve outcomes affecting soldier health and unit readiness. METHODS: Data on scaphoid fractures treated in the orthopedic department at Tripler Army Medical Center were collected from January 1, 2001, through December 31, 2003. Demographic variables included gender, age, and military rank. RESULTS: The incidence of scaphoid fractures in our population was 43 cases per 100,000 personnel per year. An algorithm to guide nonorthopedic providers was developed after review of the medical literature. CONCLUSION: We present an algorithm-based approach to soldiers presenting with post-traumatic wrist pain. The algorithm was fashioned with the aim of reducing complications and poor outcomes associated with delayed diagnosis of scaphoid fractures, affecting soldier health and unit readiness. A prospective study of the algorithm is underway.