Ocular Manifestation of a Cervical Spine Injury: An Adult Case of Traumatic Atlantoaxial Rotatory Subluxation Manifesting with Nystagmus.

BACKGROUND: Atlantoaxial rotatory subluxation (AARS) is a rare type of traumatic cervical spine injury in adults, commonly manifesting with painful torticollis and suboccipital headache. Early diagnosis is mandatory to avoid catastrophic consequences. We report a rare case of a patient with AARS who presented with nystagmus due to rotational vertebral artery occlusion. CASE DESCRIPTION: A 35-year-old man was evaluated in the emergency department after falling from 9-m height. In the intensive care unit, left-sided torticollis and nystagmus were noted in the patient. Reassessment of the patient with cervical computed tomography scans revealed AARS type 1. After applying cervical traction and confirmation of partial reduction, the nystagmus resolved, and treatment was continued with posterior C1-2 fusion. CONCLUSIONS: Careful neurologic examination is of paramount importance in diagnosis and management of cervical spine injuries. Nystagmus, as a well-known manifestation of rotational vertebral artery syndrome, can be the presenting symptom of AARS.

Synoviorthesis induced by rifampicin in hemophilic arthropathy: a report of 24 treated joints.

Intra-articular hemorrhage is the clinical hallmark of hemophilia. Synoviorthesis, the intra-articular injection of chemical or radioactive substances in order to produce fibrosis of the hypertrophied synovium, has proved effective in the treatment of chronic hemophilic synovitis. Between December 2006 and July 2007, we treated 21 patients with hemophilic arthropathy by synoviorthesis with rifampicin once a week. The procedures were performed on 14 knees, five elbows, four ankles, and one shoulder (24 joints and 113 injections). The mean age was 16.7 years (range, 7-49 years). According to the Fernandez-Palazzi classification, synoviorthesis was considered satisfactory (excellent or good) in 21 (87.5%) joints and unsatisfactory (fair or poor) in three (12.5%). A mean reduction of 6.3 bleeding episodes per month was obtained (P < 0.0001). The mean pain score was reduced from 2.62 (range, 2-3; SD, 0.49) before treatment to 0.79 (range, 0-2; SD, 0.65) after treatment. The mean World Federation of Hemophilia (WFH) score was 5.45 (range, 2-8) before synoviorthesis and 3.5 (range, 1-7) after treatment. This method effectively reduced hemarthrosis and pain and also improved the range of motion in patients with hemophilic arthropathy. Chemical synoviorthesis with rifampicin appears to be efficient, inexpensive, and simple and also especially practical in developing countries where radioactive agents are not easily available.

Arthroscopic anterior cruciate ligament reconstruction with modified "wireless" cross-screw transfix femoral fixation.

Among several graft fixation options in arthroscopic ACL reconstruction for hamstring tendons, transcondylar fixation has been suggested to offer mechanical advantages compared to other femoral fixation systems. Blind nature of the procedure may result in several complications including iliotibial band irritation syndrome, breakage of the bio absorbable cross-pin, stress fracture of the femoral cortex, and more commonly intraoperative wire loop twisting, resulting in fixation failure, wire breakage or graft laceration. We used "wireless" transfixation technique to avoid complications associated with wire loop.