RESUMO
The diagnosis of a toddler's fracture is frequently difficult at the initial evaluation because of negative radiographs. We propose the presumptive diagnosis of toddler's fracture, despite negative radiographs, when the history and physical examination are consistent with the diagnosis. This retrospective study was designed to evaluate how frequently the diagnosis is correct and to determine if there were any differentiating characteristics with respect to history, gait, or physical examination. Thirty-nine children were presumptively diagnosed with toddler's fracture. A total of 16 (41%) toddler's fractures was confirmed on follow-up radiographs. Comparing the children who demonstrated a toddler's fracture with those who did not, no particular characteristic was found that could predict the outcome. To avoid delay in the treatment of toddler's fracture, we recommend a long-leg cast on those children with a history of an acute injury, inability to walk or limp, no constitutional signs, and negative radiographs.
Assuntos
Fraturas Ósseas/diagnóstico , Pré-Escolar , Serviços Médicos de Emergência , Feminino , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/terapia , Humanos , Lactente , Masculino , Radiografia , Estudos RetrospectivosRESUMO
OBJECTIVE: We describe four cases of osteomyelitis that occurred in and around foci of preexisting osteonecrosis in the medullary cavity. Although sequestration is a well-known complication of osteomyelitis, there is little information known about infection occurring in proximity to large regions of already necrotic bone. CONCLUSION: Osteomyelitis and bone infarction can be seen in the same patient population. Medullary infarcts may function as sequestra, predisposing patients to osteomyelitis and soft-tissue infection.
Assuntos
Osso e Ossos/irrigação sanguínea , Infarto/complicações , Osteomielite/etiologia , Adolescente , Adulto , Osso e Ossos/diagnóstico por imagem , Osso e Ossos/patologia , Criança , Feminino , Humanos , Infarto/diagnóstico por imagem , Infarto/patologia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Osteomielite/diagnóstico por imagem , Osteomielite/patologia , Osteonecrose/complicações , Osteonecrose/diagnóstico por imagem , Osteonecrose/patologia , Tomografia Computadorizada por Raios XAssuntos
Abscesso Peritonsilar/cirurgia , Abscesso , Obstrução das Vias Respiratórias/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Abscesso Peritonsilar/complicações , Abscesso Peritonsilar/diagnóstico por imagem , Abscesso Peritonsilar/patologia , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
Indirect soft tissue repairs of scapholunate dissociation (SLD) address the pathophysiology but have been criticized for significantly limiting wrist flexion and altering wrist kinematics. This study was designed to analyze and compare the kinematics of a normal cadaveric wrist to those of 2 types of soft tissue repairs performed for SLD. Ten uninjured fresh cadaver arms were evaluated by cineradiography and standard x-rays. The average scapholunate (SL) gap was 0.9 mm, with a SL angle of 50 degrees. A model of SLD was produced by sectioning the SL ligaments resulting in an average SL gap of 3.9 mm and SL angle of 66 degrees. The wrists were randomized to a dorsal capsulodesis repair and a distally based split extensor carpi radialis longus (ECRL) repair. The average SL gap after repair was 1.0 mm and the average SL angle was 47 degrees. The split ECRL repair and dorsal capsulodesis reduced scaphoid flexion with only a 10 degree and 18 degree decrease in wrist flexion, respectively. Both repairs reduced the SLD and restored normal wrist kinematics.
