Undiagnosed fractures in severely injured children and young adults. Identification with technetium imaging.

A whole-body bone scan was performed to search for undetected fractures in forty-eight patients who had multiple injuries or a head injury, or both, and who were less than twenty-two years old. The study took place from January 1991 to July 1992. Radiographs had been made of all areas of suspected skeletal trauma at the time of admission. Follow-up plain radiographs were made of all areas where unexpected abnormal tracer activity was noted. Forty-two of these areas were noted in eighteen skeletally immature patients and fifty-two, in twelve skeletally mature patients. Nineteen previously unrecognized fractures were identified in the subsequent radiographic analysis. Four skeletally immature and two skeletally mature patients had an alteration in treatment on the basis of the identification of a previously undiagnosed injury. Each of these six patients had a cast applied. A fracture was identified three weeks or more after the injury in two skeletally mature patients. These fractures would have been treated (one with a cast and the other with open reduction and internal fixation) if they had been diagnosed earlier. We believe that this analysis demonstrates the usefulness of technetium radionucleotide bone-imaging, as an adjuvant to the orthopaedic examination, in the identification of undiagnosed musculoskeletal injuries in a patient who is less that twenty-two years old and who has sustained a head injury or multiple injuries, or both.

Ventilator-assisted youth: appraisal and nursing care.

An interdisciplinary review of 16 ventilator-assisted, cervical-cord injured youth, aged 3-19 years, was completed to explore long-term outcomes and develop recommendations for care. Ten youths were younger than 12 years; 6 were adolescents. The mean initial hospital length of stay was 192 days. Discharged youths were followed for 1-73 months after hospitalization. Nursing implications were developed using a systems approach with North American Nursing Diagnosis Association (NANDA) approved diagnoses. Nursing case management was used to coordinate discharge planning and continuity of care. At the time of data collection 13 youths had been successfully reintegrated to home, school and community, the least restrictive environments for all.

Projection geometry and stress-reduction techniques in craniofacial surgery.

Since 1981, we have been able to modify the mathematical patterns of projection geometry to reshape the skull in craniofacial surgery. Unlike burring, morcellization, rotation, and plate switching, this technique actually changes the shape of individual sections of the skull by changing their radius of curvature. The technique is an adaptation of the principles used by engineers to build complex structures such as ships' hulls, airfoils, and domes. The result is a rigid form of the desired shape that becomes permanent with healing. This has several advantages: 1. An increase in the level of safety of craniofacial procedures for remodeling the skull. This is so because there is no need to dissect normal areas as in the standard plate-switching techniques. 2. Decreased operating room time. 3. An increased range of surgical manipulations. No longer is the surgeon limited to the shape of the material present. 4. Relief of edge pressure on the frontal lobes during scalp closure. 5. Creation of a solid bony form over which the pericranial scalp flap can be draped to form new layers of bone.

Eosinophilic granuloma of the cervical spine without vertebrae plana.

A case of eosinophilic granuloma of the cervical spine is described. Cervical radiography and computed tomography demonstrated destruction of pedicles and posterior portions of the neural arch. Vertebral body heights were essentially preserved and the importance of this finding is underscored. Computed tomography played an important role in evaluating the extent of this disease.

Cerebral venous angioma and a varix: a rare combination.

A patient with a rare combination of cerebral venous angioma and a varix is reported. Only two such cases have been previously reported in the literature. The importance of being aware of the association of two such vascular malformations in the same patient is underscored.

Multiple cerebral aneurysms associated with left-sided inferior vena cava and hemiazygos continuation: a case report.

A case of multiple saccular cerebral aneurysms in association with a left-sided inferior vena cava and hemiazygos continuation is presented. To our knowledge, this association has not previously been recorded in the literature.