Utility of Computed Tomography in Elbow Trauma Patients with Normal X-Ray Study and Positive Elbow Extension Test.

BACKGROUND: Elbow fractures are a common injury seen among emergency department trauma patients. Despite its high frequency, there is no standardized method of diagnosis using conventional x-ray imaging for trauma patients presenting with elbow pain and restricted elbow movement. OBJECTIVE: We aimed to assess trauma patients, using computed tomography (CT), who present with a positive elbow extension test and have no evident fracture on x-ray study. METHODS: Patients presented to our emergency department with elbow trauma and were evaluated between April 2010 and March 2011. A CT scan of the injured elbow was ordered for patients with pain on elbow extension (a positive elbow extension test) and no evidence of fracture on x-ray study. All CT and x-ray images were evaluated by a designated radiologist. RESULTS: One hundred and forty-eight patients presented to our emergency department with elbow trauma. Two patients were excluded from the study, one with former motion disability and another with an open fracture. In the remaining patients, there were 32 fractures in total. Forty-three of 114 patients without fracture signs had a positive elbow extension test and 4 of these patients refused CT imaging. Fractures were found in 5 (12.8%) of the 39 patients assessed with CT. CT imaging found that two of these patients had a radial head fracture, two others had an olecranon fracture, and one patient had a coronoid fracture. CONCLUSIONS: We recommend CT as an additional evaluation imaging study for trauma patients who have a positive elbow extension test and who present with no apparent fracture on x-ray imaging.

Seeking an innocent method for pediatric septoplasty: in vivo comparison of Cottle's method, radiofrequency and laser in rabbits.

OBJECTIVES: In this study, in vivo histopathological and radiological findings in rabbit septum through laser, radiofrequency (RF) and Cottle's method were investigated. MATERIALS AND METHODS: This study was conducted between November 2007 and February 2008 on 36 New Zealand rabbits aged four-to-six months and weighing 1.5 to 2 kg. Subjects were divided into six equal groups. The first group was defined as the control group. Next four groups consisted of subjects where RF or laser was either applied transmucosal or directly to the cartilage. Cottle's method was used in the sixth group. Histopathological and radiological changes were investigated in each group. RESULTS: Histopathological changes in mucosa were not significantly different from those of control group. However, post-intervention changes in cartilage were significantly different, compared to the control group. The highest mucosal and submucosal reaction and damage in cartilage with ossification was found in Cottle group. It was found that radiofrequency was less damaging to mucosa, creating an equal degree of degeneration as laser in cartilage. CONCLUSION: Study results suggest that Cottle method is not so innocent with a considerable reaction rate, whereas RF and laser do not cause irreparable damage in cartilage and surrounding tissues. Radiofrequency seems superior to laser, as it causes more degeneration in cartilage, but no loss in epithelium even transmucosally. The major problem is the unpredictability of the damage.

Physiological periostitis in a 2.5-month-old baby.

Periosteal reaction has different etiologies in early infancy. Physiological periostitis is a well-documented X-ray finding seen in both preterm and term babies aged between 1-6 months and can easily be misdiagnosed as child abuse or pathological periostitis. Here, we present a 2.5-month-old infant admitted with a history of fever, swollen right upper arm after vaccination and X-rays findings revealing periosteal reactions on both sides of the humeri, radii, tibiae and femora. Initial diagnosis was child abuse or congenital syphilis. Due to the normal physical findings and normal serological-biochemical data, physiological periostitis was diagnosed. Physiological periostitis should also be considered in patients with periosteal reactions of the long bones in infants aged between 1-6 months.

Overlooked posterior shoulder dislocation: preoperative and postoperative CT studies (a case report).

Posterior shoulder dislocation is an extremely rare injury. A radiograph of the dislocated shoulder is generally accepted as normal owing to several traps. Therefore if the clinician is not suspicious, this injury can easily be overlooked. Most of the cases described in the literature were overlooked dislocations reported as case reports or series. We aimed to present a case of sustained posterior shoulder dislocation. The injury was initially overlooked, the patient was admitted 1 month later and treated by modified McLaughlin procedure.

Breast abscess mimicking malignant mass due to retained penrose drain: diagnosis by mammography and MRI.

We report a breast mass associated with a foreign body mimicking malignancy on mammography. Although retained penrose drains have been reported in other parts of the body, our case is the first report of a retained penrose drain in breast diagnosed by mammography. Mammography can be used if there is suspicion of a retained penrose drain during the course of breast abscess treatment.