Orbital apex syndrome after trauma in a 6-year-old - a rare occurrence.

Orbital apex syndrome is rare, but can occur as a consequence of trauma from fracture of the medial orbit. This case report highlights the fact that a high index of suspicion is needed when a patient presents with a facial injury, especially in children who cannot give an account of the actual events that transpired. Radiological investigation should be done early when an underlying injury is suspected in a trauma patient. A low threshold for computed tomography should be maintained when proptosis and vision loss are present.

Comparing Hypertropia in Upgaze and Downgaze Distinguishes Congenital From Acquired Fourth Nerve Palsies.

BACKGROUND: Isolated fourth nerve palsies are commonly caused by decompensation of a congenitally dysfunctional superior oblique muscle ("decompensated congenital palsies"). Distinguishing such palsies at initial presentation from palsies caused by presumed microvascular ischemia ("ischemic palsies") has value for patient reassurance and in forestalling ancillary testing. Abnormally large vertical fusional amplitudes traditionally have been used to identify decompensated congenital palsies, but that may not be a reliable distinguishing feature. This study was undertaken to determine if the amount of hypertropia in upgaze and downgaze might be a more efficient separator. We also studied traumatic and tumorous fourth nerve palsies to see if they could be distinguished from decompensated congenital palsies by using this hypertropia comparison. METHODS: Retrospective review of case records of patients diagnosed with isolated fourth nerve palsies at the University of Michigan Neuro-Ophthalmology Clinics over the past 15 years. We recorded the age, gender, vascular risk factors, duration of follow-up, cause, side of palsy, and alignment measurements in all patients. RESULTS: Inclusion criteria were met by 118 patients. Hypertropia was equal or greater in upgaze than downgaze in 50 of the 58 decompensated congenital palsies (86%) in whom those data were recorded. Hypertropia was never greatest in upgaze in the 15 patients with traumatic palsies. Vertical fusional amplitudes were increased in only 15 of 27 patients (56%) with decompensated palsies in whom those data were recorded. Torsional misalignment on double Maddox rod testing was present in 16 (94%), 13 (87%), and 3 (100%) patients with ischemic, traumatic, and tumorous palsies, but also in 19 patients (54%) with decompensated congenital palsies in whom those data were recorded. CONCLUSIONS: Hypertropia greater in upgaze than downgaze or equal in upgaze and downgaze was an efficient separator of congenital from ischemic and tumorous fourth nerve palsies, being characteristic of patients with decompensated congenital palsies and never present in patients with ischemic, traumatic, or tumorous palsies. Vertical fusional amplitudes and torsional misalignment did not effectively differentiate between the patient groups. Comparing the hypertropia in upgaze and downgaze improved differential diagnosis and reduces the potential for unnecessary ancillary tests.

Neuropatía cubital secundaria a artropatía neuropática del codo por siringomielia cervicotorácica / Ulnar neuropathy due to neuropathic arthropathy of the elbow caused by cervicothoracic syringomyelia

La artropatía neuropática o articulación de Charcot es una artritis degenerativa progresiva asociada a un déficit neurosensorial con múltiples etiologías, siendo la siringomielia la segunda causa más frecuente después de la diabetes mellitus. El hombro es la articulación que con más frecuencia se afecta en miembros superiores, siendo la artropatía neuropática del codo una entidad muy poco prevalente. La neuropatía cubital es una complicación rara, que puede aparecer en los pacientes con artropatía neuropática del codo debido al atrapamiento nervioso que ocasiona la desestructuración articular. Existen muy pocos casos descritos en la literatura de neuropatía cubital secundaria a una artropatía neuropática del codo por siringomielia. El objetivo de este trabajo es presentar el caso de una paciente de 61 años con neuropatía cubital secundaria a artropatía neuropática del codo por siringomielia cervicotorácica (AU)

Neuropathic arthropathy, or Charcot joint, is a progressive degenerative arthritis with multiple causes, syringomyelia being the second most common cause after diabetes mellitus. The shoulder is the most frequently affected joint in the upper limbs, and neuropathic arthropathy of the elbow is very infrequent. Ulnar neuropathy is a complication that can occur in patients with neuropathic arthropathy of elbow due to nerve entrapment causing by joint disintegration. There are very few previous case reports of ulnar neuropathy secondary to neuropathic arthropathy of the elbow due to syringomyelia. This report describes the case of a 61-year-old woman with ulnar neuropathy due to neuropathic arthropathy of the elbow caused by cervicothoracic syringomyelia (AU)

Reconstrucción de defecto troclear lateral traumático con autoinjerto de cabeza radial / Reconstruction of a traumatic lateral trochlear defect with a radial head autograft

Objetivo. Presentar el resultado de la reparación de un defecto troclear severo en el codo mediante un autoinjerto óseo con la cabeza radial ipsilateral, como una alternativa a la artroplastia total. Caso clínico. Presentamos el caso de un paciente, que sufrió una fractura abierta de codo con pérdida ósea importante en la región humeral distal, y que precisó tras la estabilización inicial una cirugía de reconstrucción mediante autoinjerto ipsilateral de cabeza radial. Discusión. Las fracturas abiertas de codo son infrecuentes. Cuando existe un defecto troclear severo, las alternativas quirúrgicas son la artroplastia total de codo, con unos resultados a corto y medio plazo que parecen ser insuficientes, o la artrodesis. Creemos que la reconstrucción del defecto empleando un autoinjerto de cabeza radial homolateral es una alternativa más funcional que los otros procedimientos descritos. Conclusión. La reconstrucción con cabeza radial ipsilateral de los defectos trocleares laterales es una técnica, que al contrario que la artrodesis, conserva la funcionalidad sin los inconvenientes de la artroplastia total de codo (AU)

Objective. To report the result of a severe articular defect secondary to a complex open fracture of the distal humerus, using the ipsilateral radial head as a bone autograft for the trochclear region as an alternative to total arthroplasty. Case report. We describe a patient who suffered an open fracture of the elbow with bone loss in the distal humeral region and, after the initial stabilisation surgery, needed a reconstruction with an ipsilateral radial head autograft. Discussion. Open fractures of elbow are rare. When there is a severe trochlear defect, surgical options are total elbow arthroplasty, where the short and medium term results appear to be insufficient, or elbow arthrodesis. We believe that reconstruction of the defect using an ipsilateral radial head autograft is a more functional alternative than the other procedures described. Conclusion. Radial head reconstruction with ipsilateral lateral trochlear defects is a technique that, unlike fusion, preserves functionality without the problems of total elbow arthroplasty (AU)