Mid-third forearm fractures in children: an unorthodox treatment.

Twenty children with fractures of both bones in the middle third of the forearm were immobilized in extension after closed reduction. Unlike distal-third fractures, these fractures are prone to develop rotary and angular deformities that may lead to permanent functional impairment and visible deformity. Mid-third forearm fractures with the radius fracture proximal to the ulnar fracture are even more troublesome. Nineteen patients had no clinical deformity at cast removal, and by 1 year, there was no difference in forearm rotation. Extension casting can be used initially for proximal fractures or to salvage forearms that lost reduction in flexed elbow casts. Extension cast application is easy while the reduction is maintained, whereas the problems are often encountered while applying a flexed elbow cast. This unorthodox treatment is safe and effective and may alleviate the need for surgical intervention.

An unusual cause of low back pain? A case report.

STUDY DESIGN: Case report. OBJECTIVE: To highlight the evaluation of a patient with low back pain after an incidental radiographic finding clouded routine management. SUMMARY OF BACKGROUND DATA: Greenfield filters have been used for 20 years with good results. Complications have been seen and documented, but the natural history of filter placement in young patients is not fully appreciated. A prong from a Greenfield filter embedded within a vertebral body has been reported once as an incidental finding in a patient undergoing prophylactic monitoring for recurrence of tumor. METHODS: A 31-year-old woman had a pulmonary embolus after surgery for a benign adnexal mass. A bleeding complication occurred after systemic anticoagulation, and a vena caval filter was placed to limit the possibility of further emboli. The patient was referred to the orthopedic clinic 5 years later with low back pain and an unusual finding on computer tomographic scan: One prong of the filter was embedded within a vertebral body. RESULTS: A bone scan was obtained to evaluate the status of bone activity around the prong. Bone reaction was not evident. Conservative management of her low back pain was instituted, and after 2 years, the patient remains asymptomatic. CONCLUSION: The overall use of vena caval filters has produced favorable results, although numerous complications have been reported. All long-term sequelae have not been completely identified.

Congenital synchondrosis of the scaphotrapezio-trapezoidal joint.

Incomplete cavitation of the cartilaginous precursor of the carpus during the fourth to eighth weeks of intrauterine life results in carpal synostosis or synchondrosis, which becomes radiographically apparent as the carpus ossifies. Such anomalies occur rarely, are generally believed to be asymptomatic, and are usually discovered as incidental radiographic findings. We present two cases of symptomatic, nonsyndromic congenital synchondrosis of the scaphotrapezio-trapezoidal joint, a type of carpal coalition not previously reported.

Bilateral tubal pregnancy in the presence of an IUD: a case report.

Bilateral tubal pregnancy was confirmed by histologic examination in a 32-year-old multipara with an intrauterine contraceptive device (IUD) in situ. The patient had developed intraperitoneal bleeding and hypovolemic shock. Bilateral salpingectomy was performed and was followed by a rapid recovery.