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Yamakawa Y, Masada Y, Ugawa R, Komatsubara T, Numoto K, Mastumoto T. A case of emphysematous cystitis caused by mechanical stimulation of pelvic fracture nonunion. Trauma Case Rep 2024; 51:100987. [PMID: 38515437 PMCID: PMC10950685 DOI: 10.1016/j.tcr.2024.100987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2024] [Indexed: 03/23/2024] Open
Abstract
Emphysematous cystitis is a rare condition that develops due to tissue hyperglycemia and urinary tract infection by gas-producing bacteria. We report a case of emphysematous cystitis caused by mechanical stimulation of a pelvic fracture nonunion. An 80-year-old man was injured in a motorcycle accident and diagnosed with pelvic fracture. Seven days later, he had high fever and computed tomography (CT) revealed gas in the hematoma around the pelvic fracture and the abscess. Therefore, infection following the pelvic fracture was diagnosed. Despite multiple operations and antibiotics treatment, malformation and nonunion of the pelvis occurred. One month after starting weight bearing, emphysema of the bladder wall adjacent to the pubic fracture were found and spread throughout the bladder wall. With stopping of weight bearing, antibiotics treatment and a urinary catheter, emphysema disappeared after 2 months. It was considered that the pubic fracture fragment irritated the bladder wall due to weight bearing and emphysematous cystitis consequently developed.
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Affiliation(s)
- Yasuaki Yamakawa
- Department of Orthopedic Surgery, Kochi Health Sciences Center, Kochi, Japan
| | - Yasutaka Masada
- Department of Orthopedic Surgery, Kochi Health Sciences Center, Kochi, Japan
| | - Ryo Ugawa
- Department of Orthopedic Surgery, Kochi Health Sciences Center, Kochi, Japan
| | - Tadashi Komatsubara
- Department of Orthopedic Surgery, Kochi Health Sciences Center, Kochi, Japan
| | - Kunihiko Numoto
- Department of Orthopedic Surgery, Kochi Health Sciences Center, Kochi, Japan
| | - Toshiyuki Mastumoto
- Department of Orthopedic Surgery, Kochi Health Sciences Center, Kochi, Japan
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Camino-Willhuber G, Schönnagel L, Caffard T, Zhu J, Tani S, Chiapparelli E, Arzani A, Shue J, Duculan R, Bendersky M, Zelenty WD, Sokunbi G, Lebl DR, Cammisa FP, Girardi FP, Mancuso CA, Hughes AP, Sama AA. Severe Intervertebral Vacuum Phenomenon is Associated With Higher Preoperative Low Back Pain, ODI, and Indication for Fusion in Patients With Degenerative Lumbar Spondylolisthesis. Clin Spine Surg 2024; 37:E1-E8. [PMID: 37651562 DOI: 10.1097/bsd.0000000000001510] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 07/19/2023] [Indexed: 09/02/2023]
Abstract
STUDY DESIGN Retrospective study of prospective collected data. OBJECTIVE To analyze the association between intervertebral vacuum phenomenon (IVP) and clinical parameters in patients with degenerative spondylolisthesis. SUMMARY OF BACKGROUND DATA IVP is a sign of advanced disc degeneration. The correlation between IVP severity and low back pain in patients with degenerative spondylolisthesis has not been previously analyzed. METHODS We retrospectively analyzed patients with degenerative spondylolisthesis who underwent surgery. Vacuum phenomenon was measured on computed tomography scan and classified into mild, moderate, and severe. A lumbar vacuum severity (LVS) scale was developed based on vacuum severity. The associations between IVP at L4/5 and the LVS scale, preoperative and postoperative low back pain, as well as the Oswestry Disability Index was assessed. The association of IVP at L4/5 and the LVS scale and surgical decision-making, defined as decompression alone or decompression and fusion, was assessed through univariable logistic regression analysis. RESULTS A total of 167 patients (52.7% female) were included in the study. The median age was 69 years (interquartile range 62-72). Overall, 100 (59.9%) patients underwent decompression and fusion and 67 (40.1%) underwent decompression alone. The univariable regression demonstrated a significantly increased odds ratio (OR) for back pain in patients with more severe IVP at L4/5 [OR=1.69 (95% CI 1.12-2.60), P =0.01]. The univariable regressions demonstrated a significantly increased OR for increased disability with more severe L4/L5 IVP [OR=1.90 (95% CI 1.04-3.76), P =0.04] and with an increased LVS scale [OR=1.17 (95% CI 1.02-1.35), P =0.02]. IVP severity of the L4/L5 were associated with higher indication for fusion surgery. CONCLUSION Our study showed that in patients with degenerative spondylolisthesis undergoing surgery, the severity of vacuum phenomenon at L4/L5 was associated with greater preoperative back pain and worse Oswestry Disability Index. Patients with severe IVP were more likely to undergo fusion.
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Affiliation(s)
- Gaston Camino-Willhuber
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
| | - Lukas Schönnagel
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin
| | - Thomas Caffard
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
- Department of Orthopaedic Surgery, University of Ulm, Ulm, Germany
| | - Jiaqi Zhu
- Biostatistics Core, Hospital for Special Surgery, New York City, NY
| | - Soji Tani
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
- Department of Orthopaedic Surgery, School of Medicine, Showa University Hospital, Tokyo, Japan
| | - Erika Chiapparelli
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
| | - Artine Arzani
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
| | - Jennifer Shue
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
| | | | - Mariana Bendersky
- III Normal Anatomy Department, School of Medicine, University of Buenos Aires
- Intraoperative Monitoring, Department of Pediatric Neurology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - William D Zelenty
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
| | - Gbolabo Sokunbi
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
| | - Darren R Lebl
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
| | - Frank P Cammisa
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
| | - Federico P Girardi
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
| | - Carol A Mancuso
- Hospital for Special Surgery, New York City, NY
- Weill Cornell Medical College, New York, NY
| | - Alexander P Hughes
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
| | - Andrew A Sama
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
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Fang Y, Zhang S, Ye Y, Chen K, Ling G, Wang Q, Chen W, Liu C. Analysis of factors influencing the intravertebral shell phenomenon after posterior reduction internal fixation of thoracolumbar fracture: a retrospective study. BMC Musculoskelet Disord 2024; 25:49. [PMID: 38200488 PMCID: PMC10777656 DOI: 10.1186/s12891-024-07168-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 01/02/2024] [Indexed: 01/12/2024] Open
Abstract
STUDY DESIGN A retrospective study. PURPOSE The study objectives were as follows: 1) to analyze the factors influencing the occurrence of the intravertebral shell phenomenon (ISP) after thoracolumbar spinal fracture surgery and the evolutionary outcome of this phenomenon; and 2) to make recommendations for the clinical prevention and treatment of ISP. METHODS We retrospectively analyzed 331 patients with single-segment fractures of the thoracolumbar spine treated with internal fixation via a pedicle screw-rod system. Univariate and multivariate logistic regression were used to analyze factors influencing ISP. RESULTS A total of 260 patients (78.5%) developed ISP after surgery. Reduced bone mineral density, screw insertion depth, degree of vertebral body injury, and excessive vertebral body spreading were significantly associated with the occurrence of ISP (P < 0.05). A total of 166 of the 260 patients were reviewed via CT at 1 year postoperatively. Among them, 104 patients (62.6%) showed shrinkage or healed vertebral cavities, and 62 patients (37.4%) showed enlarged vertebral cavities or collapsed endplates. CONCLUSION In clinical management, surgeons need to focus on risk factors for ISP, which include decreased bone density, preoperative vertebral overcompression, intraoperative vertebral overextension, screw insertion depth, and the degree of vertebral repositioning. At the 1-year postoperative follow-up, some of the vertebrae with ISP failed to heal or even showed vertebral cleft enlargement, which would affect the stability of the internal fracture fixation device and the quality of the patient's daily life.
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Affiliation(s)
- Yao Fang
- Department of Clinical Medicine, Faculty of Clinical Medicine, Fujian Medical University, Fuzhou, PR China
- Mindong Hospital Affiliated to Fujian Medical University, Ningde, PR China
| | - Sining Zhang
- Department of Clinical Medicine, Faculty of Clinical Medicine, Fujian Medical University, Fuzhou, PR China
- Mindong Hospital Affiliated to Fujian Medical University, Ningde, PR China
| | - Yuchao Ye
- Department of Clinical Medicine, Faculty of Clinical Medicine, Fujian Medical University, Fuzhou, PR China
- Mindong Hospital Affiliated to Fujian Medical University, Ningde, PR China
| | - Kongning Chen
- Mindong Hospital Affiliated to Fujian Medical University, Ningde, PR China
| | - Guangfeng Ling
- Mindong Hospital Affiliated to Fujian Medical University, Ningde, PR China
| | - Qing Wang
- Department of Clinical Medicine, Faculty of Clinical Medicine, Fujian Medical University, Fuzhou, PR China
- Mindong Hospital Affiliated to Fujian Medical University, Ningde, PR China
| | - Wugui Chen
- Mindong Hospital Affiliated to Fujian Medical University, Ningde, PR China.
| | - Chengzhao Liu
- Mindong Hospital Affiliated to Fujian Medical University, Ningde, PR China.
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Buttiens A, Simko M, Van Goethem J. Vacuum Phenomenon in the Lumbar Spine: Pilot Study for Accuracy of Magnetic Resonance Imaging. J Belg Soc Radiol 2023; 107:83. [PMID: 37928056 PMCID: PMC10624138 DOI: 10.5334/jbsr.3118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 10/12/2023] [Indexed: 11/07/2023] Open
Abstract
Objectives Vacuum phenomenon (VP) is defined as air within a joint. Many pathologies are associated with VP, mainly degenerative disease and trauma. Although patients with intradiscal gas may be asymptomatic, it promotes disc degeneration and can eventually become painful. VP is suspected to be an indicator of segmental mobility, helping in determining the extent of spinal fusion in a preoperative setting. This could make the detection of VP useful on routine magnetic resonance imaging (MRI) of the lower spine. We determined the accuracy of MRI in detecting intradiscal gas through a retrospective observational study. Materials and methods The study population consists of 37 consecutive patients with low back pain who were scheduled for treatment with spinal infiltrations and received a computed tomography and MRI scan within a maximum time interval of 3 months. Spin echo (SE) T1 and T2 and gradient echo (GE) T1 sequences were analyzed. All scans were randomly coded and evaluated by two observers: an experienced neuroradiologist and a radiology resident for the presence of VP. Results GE-imaging revealed a high accuracy with a sensitivity of 89.3%-92% and a specificity of 89.7-95.3% between both observers. In comparison to a sensitivity of 31.5%-76.3% for T1- and 8.5%-86.4% for T2-imaging and a specificity of 95%-100% for T1- and 63.7%-100% for T2-imaging with respective accuracy of 68.1%-85.7% and 54.6%-68.9%. We notice a moderate interobserver variability for the T1 (κ = 0.462) weighted imaging, no agreement for T2 (κ = 0.057) weighted imaging, and almost perfect interobserver variability for the GE sequence (κ = 0.889). Conclusion The presence of VP in degenerative disc disease is a sign of segmental instability which is important for planning spinal fusion surgery. Our study showed that VP can be detected on MRI of the lumbar spine with high accuracy and almost perfect interobserver agreement by adding GE sequences to the scanning protocol.
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Villacres Mori B, Lakra A, Gheewala RA, Carroll JD, Bibicheff D, Smith MP, Mulligan MT. Computed Tomography Scan Versus Saline Load Test for Detection of Traumatic Shoulder Arthrotomy: A Cadaveric Study. J Orthop Trauma 2023; 37:e349-e354. [PMID: 37127902 DOI: 10.1097/bot.0000000000002622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/14/2023] [Indexed: 05/03/2023]
Abstract
OBJECTIVES Traumatic shoulder arthrotomy (TSA) is a rare injury that is commonly detected through saline load test (SLT). There are no studies that have studied the ability of computed tomography (CT) scan to detect a TSA. The purpose of this study is to determine the ability of CT scan to detect a TSA and compare it with the SLT. METHODS Twelve cadaveric shoulders were included in the study. Before intervention, a CT scan was conducted to determine presence of intra-articular air. After confirmation that no air was present, an arthrotomy was made at the anterior or posterior portal site. A CT was obtained postarthrotomy to evaluate for intra-articular air. Each shoulder then underwent an SLT to assess the sensitivity of SLT and the volume needed for extravasation. RESULTS Twelve shoulders were included after a pre-intervention CT scan. Six shoulders received an arthrotomy through the anterior portal and six shoulders received an arthrotomy through the posterior portal. After the arthrotomy, air was visualized on CT scan in 11 of the 12 shoulders (92%). All 12 shoulders demonstrated extravasation during SLT. The mean volume of saline needed for extravasation was 29 mL with an SD of 10 and range of 18-50 mL. CONCLUSIONS CT scan is a sensitive modality (sensitivity of 92%) for detection of TSA. In comparison, SLT is more sensitive (sensitivity of 100%) and outperforms CT scan for the diagnosis of TSA in a cadaveric model. Further research is needed to solidify the role that CT imaging has in the diagnosis of TSAs.
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Affiliation(s)
| | - Akshay Lakra
- Albany Medical Center, Department of Orthopedic Surgery, Albany, NY; and
| | - Rohan A Gheewala
- Albany Medical Center, Department of Orthopedic Surgery, Albany, NY; and
| | - Jeremy D Carroll
- Albany Medical Center, Department of Orthopedic Surgery, Albany, NY; and
| | | | | | - Michael T Mulligan
- Albany Medical Center, Department of Orthopedic Surgery, Albany, NY; and
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Morimoto T, Yamamoto Y, Suzuki S, Yagi M, Kobayashi T, Mawatari M, Matsumoto M, Watanabe K. Analysis of the sacroiliac joint vacuum phenomenon in adolescent thoracic idiopathic scoliosis (Lenke types 1 and 2). Medicine (Baltimore) 2023; 102:e34487. [PMID: 37653771 PMCID: PMC10470709 DOI: 10.1097/md.0000000000034487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 06/19/2023] [Accepted: 06/28/2023] [Indexed: 09/02/2023] Open
Abstract
The sacroiliac joint (SIJ) is the largest axial joint in the human body, and the SIJ vacuum phenomenon (SIJ VP) is a common finding in computed tomography studies of the abdomen, pelvis, and lumbosacral spine in adults, with the incidence increasing with age. Adolescent idiopathic scoliosis (AIS) is an abnormal spinal curvature that appears during adolescence and places abnormal stress on the SIJs. This retrospective observational study aimed to investigate the incidence of the SIJ VP in thoracic AIS (Lenke types 1 and 2). Sixty-seven patients with AIS (age: 12-19 years) and 76 controls (age: 11-19 years) were retrospectively analyzed to investigate SIJ VP, subchondral bone cysts, and SIJ degeneration (Eno classification: type 0, no degenerative change; type 1, mild degenerative changes; type 2, substantial degenerative changes; and type 3, ankylosis). SIJ degeneration was defined as type ≥ 2. The association between SIJ VP, cysts, SIJ degeneration, and sagittal/coronal spinopelvic alignment was assessed. SIJ VP (59% vs. 35.5%, P < .01), cysts (32.8% vs. 1.3%, P < .01), and SIJ degeneration (3.2% vs. 2.6%, P = .823) differed significantly between the 2 groups. There were 0 cases of SIJ ankylosis (Eno classification type 3) in both groups. The VP was not correlated with lumbar lordosis, sacral slope, or Cobb angle. All lumbar modifier type C belonged to the VP present group, whereas none to VP absent group. Our results suggest an association between AIS and SIJ VP and SIJ cysts. SIJ VP and SIJ cysts in AIS may be caused and accelerated by abnormal mechanical stress on SIJ due to spinal deformity.
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Affiliation(s)
- Tadatsugu Morimoto
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Yusuke Yamamoto
- Department of Orthopaedic Surgery, Faculty of Medicine, Nara Medical University, Nara, Japan
| | - Satoshi Suzuki
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Mitsuru Yagi
- Department of Orthopaedic Surgery, Faculty of Medicine, Nara Medical University, Nara, Japan
| | - Takaomi Kobayashi
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Masaaki Mawatari
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kota Watanabe
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
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Yanagawa Y, Hashikasa T, Fujita W, Jitsuiki K. A Clue Supporting a Diagnosis of Atlanto-Occipital Dislocation Based on a Traumatic Vacuum Phenomenon. J Emerg Trauma Shock 2023; 16:136-137. [PMID: 38025503 PMCID: PMC10661566 DOI: 10.4103/jets.jets_4_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 02/01/2023] [Indexed: 12/01/2023] Open
Affiliation(s)
- Youichi Yanagawa
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Shizuoka, Japan
| | - Takeshi Hashikasa
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Shizuoka, Japan
| | - Wataru Fujita
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Shizuoka, Japan
| | - Kei Jitsuiki
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Shizuoka, Japan
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Keshavamurthy C, Bansal P. Pneumarthrosis After Diagnostic Arthrocentesis. Am J Phys Med Rehabil 2023; 102:e73. [PMID: 36228201 DOI: 10.1097/phm.0000000000002118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Chandana Keshavamurthy
- From the Department of Rheumatology, Ochsner Medical Center, New Orleans, Louisiana (CK); and Department of Rheumatology, Mayo Clinic Health System, Eau Claire, Wisconsin (PB)
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9
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Yanagawa Y, Fujita N, Ishikawa K. A Case of Pneumocephalus Induced by Traumatic Vacuum Phenomenon. J Emerg Trauma Shock 2023; 16:73-74. [PMID: 37583373 PMCID: PMC10424742 DOI: 10.4103/jets.jets_135_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 11/16/2022] [Indexed: 08/17/2023] Open
Affiliation(s)
- Youichi Yanagawa
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Tokyo, Japan
| | - Naohide Fujita
- Department of Neurosurgery, Shizuoka Hospital, Juntendo University, Tokyo, Japan
| | - Kouhei Ishikawa
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Tokyo, Japan
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Yang RF, Huang SM, Wu QZ, Ye F, Lan SH. Clinical study of vacuum phenomenon in closed pelvic fracture. J Orthop Surg Res 2023; 18:241. [PMID: 36964627 PMCID: PMC10039573 DOI: 10.1186/s13018-023-03674-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 03/03/2023] [Indexed: 03/26/2023] Open
Abstract
BACKGROUND This study aimed to examine the prevalence and clinical findings of the vacuum phenomenon (VP) in closed pelvic fractures. METHODS We retrospectively reviewed 352 patients with closed pelvic fractures who presented to our institution from January 2017 to December 2020. Pelvic fractures were diagnosed by plain radiography and computed tomography (CT). The default "bone window" was used for inspection in the cross section. Electronic medical records were consulted by two orthopedic physicians to obtain patient information. The VP of pelvic fracture, fracture classification, injury mechanism, and image data were evaluated, and the demographic parameter data were statistically analyzed. The follow-up time was 12-18 months. RESULTS Among them, 169 were males and 183 were females with ages ranging from 3 to 100 years, with an average of 49.6 ± 19.3 years. VP in pelvic fractures was detected by CT in 109 (31%) of the 352 patients with pelvic fractures. Patients were divided into the high-energy trauma group (278 cases) and fragility fractures of the pelvis (FFP) group (74 cases) according to the injury mechanism. In the high-energy trauma group, 227 cases were treated surgically and 201 cases had bony healing. The healing time was 9.8 ± 5.3 weeks. In the FFP group, 54 cases were treated surgically and 49 cases had bone healing. The healing time was 9.3 ± 3.8 weeks. Fractures progressed in nine patients. VP was mostly located in the sacroiliac joint in our study. CONCLUSIONS The incidence of VP in pelvic fractures is statistically high and is affected by many factors, such as examination technique, joint position, population composition, etc. Therefore, the VP is not a reliable sign of pelvic injury. Clinically, we need to determine the nature of VP in conjunction with gas patterns, laboratory tests, history, and physical examination.
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Affiliation(s)
- Rui-Feng Yang
- Department of Orthopedics, Lishui Municipal Central Hospital, Lishui, 323000, Zhejiang, People's Republic of China
| | - Shu-Ming Huang
- Department of Orthopedics, Lishui Municipal Central Hospital, Lishui, 323000, Zhejiang, People's Republic of China
| | - Quan-Zhou Wu
- Department of Orthopedics, Lishui Municipal Central Hospital, Lishui, 323000, Zhejiang, People's Republic of China
| | - Fang Ye
- Department of Orthopedics, Lishui Municipal Central Hospital, Lishui, 323000, Zhejiang, People's Republic of China
| | - Shu-Hua Lan
- Department of Orthopedics, Lishui Municipal Central Hospital, Lishui, 323000, Zhejiang, People's Republic of China.
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Jessen M, Schnetzke M, Studier-Fischer S, Grützner PA, Gühring T, Porschke F. Morphologic Alterations of the Sternoclavicular Joint following Ipsilateral Clavicle Fractures. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15011. [PMID: 36429729 PMCID: PMC9690708 DOI: 10.3390/ijerph192215011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 11/07/2022] [Accepted: 11/08/2022] [Indexed: 06/16/2023]
Abstract
RATIONALE To our knowledge, no study has investigated concomitant injuries of the sternoclavicular joint (SCJ) in acute clavicle fractures. The purpose of this study was to determine the effect of an ipsilateral clavicle fracture on the SCJ in a systematic computer tomography (CT) morphologic evaluation. METHODS CT scans in the axial and coronal plane of 45 consecutive patients with clavicle fractures were retrospectively analyzed. The scans were assessed regarding anatomic congruence of bilateral SCJs-joint space width (JSW); the position of bilateral medial clavicles (PC); and the non-fusion of epiphyses, arthritis, calcifications, and intra-articular gas. RESULTS The mean SCJ JSW was significantly different in the coronal (cJSW; 8.70 mm ± 2.61 mm in affected vs. 7.63 mm ± 2.58 mm in non-affected side; p = 0.001) and axial plane (aJSW; 9.40 mm ± 2.76 mm in affected vs. 9.02 ± 2.99 in non-affected SCJs; p = 0.044). The position of the medial clavicle showed a significant difference in the coronal plane (cPC; 14.31 mm ± 3.66 mm in the affected vs. 13.49 ± 3.34 in the non-affected side; p = 0.011), indicating a superior shift. CONCLUSION Acute clavicle fractures may be associated with an enlargement of the ipsilateral SCJ space width and a superior shift of the proximal clavicle. Both morphologic alterations could indicate concomitant injuries of the SCJ as well as a potential increase in the risk of SCJ instability.
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Affiliation(s)
- Malik Jessen
- Department of Trauma Surgery, Clinic Rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Marc Schnetzke
- German Joint Center Heidelberg, ATOS Clinic Heidelberg, Bismarckstr. 9-15, 69115 Heidelberg, Germany
| | - Stefan Studier-Fischer
- BG Trauma Center Ludwigshafen, Heidelberg University, Ludwig-Guttmann-Straße 13, 67071 Ludwigshafen, Germany
| | - Paul Alfred Grützner
- BG Trauma Center Ludwigshafen, Heidelberg University, Ludwig-Guttmann-Straße 13, 67071 Ludwigshafen, Germany
| | - Thorsten Gühring
- Orthopedic Clinic Paulinenhilfe, Diakonieklinikum Stuttgart, Rosenbergstr. 38, 70176 Stuttgart, Germany
| | - Felix Porschke
- BG Trauma Center Ludwigshafen, Heidelberg University, Ludwig-Guttmann-Straße 13, 67071 Ludwigshafen, Germany
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Kanna RM, Hajare S, Thippeswamy PB, Shetty AP, Rajasekaran S. Advanced disc degeneration, bi-planar instability and pathways of peri-discal gas suffusion contribute to pathogenesis of intradiscal vacuum phenomenon. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:755-763. [PMID: 35089418 DOI: 10.1007/s00586-022-07122-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 10/14/2021] [Accepted: 01/10/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Intradiscal vacuum phenomenon (IDVP), despite being ubiquitous, is poorly understood. The dynamic passage of peri-discal gases into the degenerated disc is a commonly accepted theory. But the reasons behind its selective appearance in some discs are unevaluated. METHODS 721 patients with chronic low back pain ± radiculopathy, were evaluated with AP and flexion-extension lateral radiographs and MRI. IDVP was classified based on its morphology and location. Radiographic parameters including sagittal translation, sagittal angulation, lateral listhesis, eccentric disc collapse, Pfirrmann's grade, disc height, Modic changes, anterior longitudinal ligament status, and primary spinal disease at the level of IDVP was analyzed. RESULTS IDVP was present in 342 patients, and they had a higher mean age (57.2 ± 12.5 years) than controls (p < 0.001). Eccentric disc space narrowing (26.5% vs 1.3%, p < 0.01), coronal listhesis (7.83% vs 1.1%, p < 0.001), sagittal angular motion difference (11.3 ± 4.6°, p < 0.001), higher mean disc degeneration (4.36 ± 0.69, p < 0.001), ALL disruption (30.3% vs 2.2%, p < 0.001) and Modic changes (88.6% vs 17.5%, p < 0.001) were significantly higher in IDVP discs (vs. non-IDVP). Binary logistic regression analysis indicated sagittal angular motion difference was the most predictive factor. IDVP was classified into three types-dense type (47.5%), linear (29.5%), dot type (23%). Dense type matched radiological correlations of IDVP while dot types behaved like non-IDVP discs. CONCLUSION Modic disc-endplate contacts, ALL disruption and coronal translation could be pathways for the passage of peri-discal gases into the degenerated disc. In the pathogenesis of IDVP, advanced disc degeneration, the presence of pathways of gas transfer and angular/coronal instability seem to play complementary roles.
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Affiliation(s)
- Rishi M Kanna
- Department of Orthopaedics and Spine Surgery, Ganga Hospital, Coimbatore, Tamil Nadu, India.
| | - Swapnil Hajare
- Department of Orthopaedics and Spine Surgery, Ganga Hospital, Coimbatore, Tamil Nadu, India
| | | | - Ajoy Prasad Shetty
- Department of Orthopaedics and Spine Surgery, Ganga Hospital, Coimbatore, Tamil Nadu, India
| | - S Rajasekaran
- Department of Orthopaedics and Spine Surgery, Ganga Hospital, Coimbatore, Tamil Nadu, India
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Doğan E, Aydoğmuş H, Aydoğmuş S. An Omitted Radiological finding in the Pediatric Age Group: Physiological Sacroiliac Joint Vacuum Normal Variant. Spartan Med Res J 2021; 6:27361. [PMID: 34532626 PMCID: PMC8405278 DOI: 10.51894/001c.27361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 08/05/2021] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Gas accumulation in human joint spaces has been generally described as the vacuum phenomenon (VP). To date, the sacroiliac joint VP has been associated mostly with pathological, particularly degenerative conditions (e.g., arthritis, obesity, discal degenerations, fractures, dislocations, avascular necrosis). OBJECTIVE The study aimed to examine the characteristics of the physiological form of VP and its radiological patterns in a sample of pediatric patients. METHODS A sample of seventy patients between 0 and 17 years old (mean age, 11.4 ± 5.54) were included in the study. Sample VP cases was evaluated according to types, age group, anatomic localization, gender, and sides. RESULTS: Two (2.9%) of sample children had degenerative VP, with 24 (34.2%) of patients demonstrating physiological VP in the sacroiliac joints. VP rates significantly increased after nine years of age (p < 0.01) and 83% of physiological VP cases were determined to be bilateral. CONCLUSIONS Although degenerative VP is a rare entity in children, non-pathological VP can be a more common aspect of sacroiliac anatomy. Although sacroiliac VP is frequently an underreported or omitted finding in imaging studies, this condition may be clinically important as a clue for other degenerative diagnoses. Normal variants of VP may be clinically important in children since they may mimic inflammatory and infectious pathologies during magnetic resonance imaging and computed tomography images.
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Ravago MA, Maldjian PD. Pneumomediastinum From Vacuum Disc and Vertebral Trauma. Cureus 2021; 13:e16942. [PMID: 34513510 PMCID: PMC8412849 DOI: 10.7759/cureus.16942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2021] [Indexed: 12/03/2022] Open
Abstract
We present a case of pneumomediastinum associated with an endplate fracture adjacent to a vacuum disc. Pneumomediastinum from trauma can be due to damage to the lungs, airway, or esophagus. In this case, we present a unique complication of the vacuum disc phenomenon in which vertebral injury at the site of a vacuum disc releases gas bubbles into the mediastinum. We believe that compressive forces from the trauma produced a disruption of the annulus fibrosis and forced gas previously sequestered in the intervertebral disc space to escape into the mediastinum.
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Affiliation(s)
- Mark A Ravago
- Department of Radiology, Rutgers University, Newark, USA
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15
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Uygur E, Türkmen İ, Ayaz T, Duman E. Osteochondral Lesions of the Talus May Cause the Vacuum Phenomenon in the Ankle Joint. J Am Podiatr Med Assoc 2021; 111:470033. [PMID: 34478527 DOI: 10.7547/19-135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The few reports available on the vacuum phenomenon in the ankle joint refer to osteoarthritic and traumatic lesions. We present the first case concomitant with an osteochondral lesion of the talus. This case report presents computed tomographic images of the ankle. We speculate that the osteochondral lesion of the talus was the most likely cause of the vacuum phenomenon.
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16
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Camino Willhuber G, Bendersky M, De Cicco FL, Kido G, Duarte MP, Estefan M, Petracchi M, Gruenberg M, Sola C. Development of a New Therapy-Oriented Classification of Intervertebral Vacuum Phenomenon With Evaluation of Intra- and Interobserver Reliabilities. Global Spine J 2021; 11:480-487. [PMID: 32875883 PMCID: PMC8119922 DOI: 10.1177/2192568220913006] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Diagnostic study, level of evidence III. OBJECTIVES Low back pain is a common cause of disability among elderly patients. Percutaneous discoplasty has been developed as a tool to treat degenerative disease when conservative management is not successful. Indications for this procedure include low back pain and the presence of vacuum phenomenon. The objective of this study was to describe a new classification of vacuum phenomenon based on computed tomography scan in order to improve the indications for percutaneous discoplasty. METHODS We developed a classification of vacuum phenomenon based on computed tomography scan images. We describe 3 types of vacuum based on the relationship between vacuum and the superior/inferior endplates and 2 subtypes based on the presence of significant subchondral sclerosis. A validation study was conducted selecting 10 orthopedic residents with spine surgery training to analyze 25 vacuum scenarios. Inter- and intraobserver reliabilities were assessed through the Fleiss's and Cohen's kappa statistics, respectively. RESULTS The overall Fleiss's κ value for interobserver reliability was 0.85 (95% CI 0.82-0.86) in the first reading and 0.93 (95% CI 0.92-0.95) in the second reading. Cohen's κ for intraobserver reliability was 0.88 (95% CI 0.77-0.99). CONCLUSION The new classification has shown almost perfect inter- and intraobserver reliabilities for grading the vacuum phenomenon and could be an important tool to improve the indications for percutaneous cement discoplasty.
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Affiliation(s)
- Gaston Camino Willhuber
- Institute of Orthopedics “Carlos E. Ottolenghi” Hospital Italiano de Buenos
Aires, Buenos Aires, Argentina,Gaston Camino Willhuber, Orthopaedic and
Traumatology Department. Institute of Orthopedics “Carlos E. Ottolenghi”
Hospital Italiano de Buenos Aires, Potosi 4215, Buenos Aires, Argentina.
| | - Mariana Bendersky
- Institute of Orthopedics “Carlos E. Ottolenghi” Hospital Italiano de Buenos
Aires, Buenos Aires, Argentina,III Normal Anatomy Department, School of Medicine, University of
Buenos Aires, Argentina
| | - Franco L. De Cicco
- Institute of Orthopedics “Carlos E. Ottolenghi” Hospital Italiano de Buenos
Aires, Buenos Aires, Argentina
| | - Gonzalo Kido
- Institute of Orthopedics “Carlos E. Ottolenghi” Hospital Italiano de Buenos
Aires, Buenos Aires, Argentina
| | - Matias Pereira Duarte
- Institute of Orthopedics “Carlos E. Ottolenghi” Hospital Italiano de Buenos
Aires, Buenos Aires, Argentina
| | - Martin Estefan
- Institute of Orthopedics “Carlos E. Ottolenghi” Hospital Italiano de Buenos
Aires, Buenos Aires, Argentina
| | - Matias Petracchi
- Institute of Orthopedics “Carlos E. Ottolenghi” Hospital Italiano de Buenos
Aires, Buenos Aires, Argentina
| | - Marcelo Gruenberg
- Institute of Orthopedics “Carlos E. Ottolenghi” Hospital Italiano de Buenos
Aires, Buenos Aires, Argentina
| | - Carlos Sola
- Institute of Orthopedics “Carlos E. Ottolenghi” Hospital Italiano de Buenos
Aires, Buenos Aires, Argentina
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17
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Yanagawa Y, Nagasawa H, Jitsuiki K, Omori K. Successful Observational Management of a Patient with Blunt Abdominal Trauma with the Traumatic Vacuum Phenomenon. J Emerg Trauma Shock 2021; 14:58-60. [PMID: 33911443 PMCID: PMC8054805 DOI: 10.4103/jets.jets_27_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 02/24/2021] [Indexed: 11/17/2022] Open
Affiliation(s)
- Youichi Yanagawa
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Izunokuni, Japan
| | - Hiroki Nagasawa
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Izunokuni, Japan
| | - Kei Jitsuiki
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Izunokuni, Japan
| | - Kazuhiko Omori
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Izunokuni, Japan
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Dapena JC, Lansdorp CA, Mitchell SJ. Persistent extravascular bubbles on radiologic imaging after recompression treatment for decompression sickness: A case report. Diving Hyperb Med 2020; 50:424-430. [PMID: 33325027 DOI: 10.28920/dhm50.4.424-430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 06/25/2020] [Indexed: 11/05/2022]
Abstract
Decompression sickness (DCS) is a condition arising when dissolved inert gas in tissue forms extravascular and/or intravascular bubbles during or after depressurisation. Patients are primarily treated with 100% oxygen and recompression, which is often assumed to lead to resolution of bubbles. After this, repeated hyperbaric exposures can be provided in case of persistent symptoms, with oxygen delivery to ischaemic tissues, anti-inflammatory properties and reduction of oedema considered the main mechanisms of action. In this case report we present the history and imaging of a diver diagnosed with DCS that was treated with two US Navy Treatment Table 6 recompressions, but who still had multiple extravascular bubbles apparent on CT-imaging after these hyperbaric treatments. Based on these findings we hypothesise that, contrary to general belief, it is possible that large extravascular bubbles can persist after definitive treatment for DCS.
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Affiliation(s)
- Juan C Dapena
- Navy Medicine Operational Training Center, Hyperbaric Medicine Department, Pensacola (FL), USA.,Corresponding author: Dr Juan C Dapena, Navy Medicine Operational Training Center, Hyperbaric Medicine Department, 220 Hovey Rd, Pensacola, Florida, 32508, USA,
| | - Corine A Lansdorp
- Amsterdam University Medical Centre, location AMC, Department of Anaesthesiology/Hyperbaric Medicine, Amsterdam, The Netherlands
| | - Simon J Mitchell
- Department of Anaesthesiology, School of Medicine, University of Auckland, New Zealand.,Department of Anaesthesia, Auckland City Hospital, Auckland, New Zealand
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19
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Jitsuiki K, Kushida Y, Nishio R, Yanagawa Y. Gas in Joints After Diving: Computed Tomography May Be Useful for Diagnosing Decompression Sickness. Wilderness Environ Med 2020; 32:70-73. [PMID: 33309396 DOI: 10.1016/j.wem.2020.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/07/2020] [Accepted: 09/09/2020] [Indexed: 10/22/2022]
Abstract
A 26-y-old experienced scotoma scintillans after 59 min of scuba diving at a maximum depth of 26 m. After the patient smoked a cigarette, the scotoma scintillans ceased. However, he then developed a headache, general fatigue, and shoulder and elbow pain. He therefore called an ambulance. Based on the rules of the medical cooperative system for decompression sickness in Izu Peninsula, the fire department called a physician-staffed helicopter. After a physician checked the patient, his complaints remained aside from a low-grade fever. A portable ultrasound revealed bubbles in his inferior vena cava. Because of the risk of his being infected with COVID-19, he was transported to our hospital not by air evacuation but via ground ambulance staff while receiving a drip infusion of fluid and oxygen. After arriving at the hospital, his symptoms had almost subsided. Whole-body computed tomography revealed gas around the bladder, left hip, right knee, bilateral shoulder, joints, and right intramedullary humerus. The patient received high-concentration oxygen, infusion therapy, and observational admission. On the second day of admission, his symptoms had completely disappeared, and he was discharged. To our knowledge, this is the first report that computed tomography might be useful for detecting gas in multiple joints, suggesting the onset of decompression sickness after diving. This might be the first report of gas in an intramedullary space after diving as a potential cause of dysbaric osteonecrosis.
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Affiliation(s)
- Kei Jitsuiki
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Shizuoka, Japan
| | - Yoshihiro Kushida
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Shizuoka, Japan
| | - Ryota Nishio
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Shizuoka, Japan
| | - Youichi Yanagawa
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Shizuoka, Japan.
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20
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Smith TJ, Judice A, Forte S, Boniello M, Kleiner M, Fuller D. The Vacuum Phenomenon in the Elbow: A Case Report. JBJS Case Connect 2020; 10:e2000203. [PMID: 32910591 DOI: 10.2106/jbjs.cc.20.00203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 33-year-old man presented with a closed distal humerus fracture after a fall from scaffolding. Computed tomography demonstrated intra-articular gas, despite the lack of arthrotomy, open fracture, or skin defects. The "vacuum phenomenon" (VP), or the presence of intra-articular gas in closed injuries, has primarily been described in the axial skeleton. To our knowledge, there are no reports in fractures of the elbow. CONCLUSION The incidence of the VP is under-reported and represents a lack of physician awareness. The VP should remain a diagnosis of exclusion; however, physicians should be aware of this phenomenon to prevent unnecessary patient harm.
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Affiliation(s)
- Tyler J Smith
- 1Department of Orthopedic Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania 2Department of Orthopedic Surgery, Cooper University Hospital, Camden, New Jersey
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21
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Cianci F, Ferraccioli G, Ferraccioli ES, Gremese E. Comprehensive review on intravertebral intraspinal, intrajoint, and intradiscal vacuum phenomenon: From anatomy and physiology to pathology. Mod Rheumatol 2020; 31:303-311. [PMID: 32374204 DOI: 10.1080/14397595.2020.1764744] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The term 'vacuum phenomenon' (VP), is characterized by gas-like density areas due to a rapid increase in the joint space volume ('acute VP') or represent a chronic gas collection. It can occur within a collapsed vertebral body, the spinal canal, joints but mainly the intervertebral disc. Studies support that VP is originated by a dynamic process involving the balance between tissues' liquid and gaseous components, influenced by the duration and the depth of mechanical and metabolic alterations, by the nature of neighboring tissues and the variability in both pressure and permeability of disc or vertebral or joint structures. Prevalence of VP in the general population is about 2%, reaching 20% in the elderly with disc degeneration. Although it's often a random finding in asymptomatic patients, VP is an eventually painful expression of disc degeneration, or disc or vertebral fracture, or bone lesions. In sporadic cases, intradiscal gas can be expelled (all-in-one or gradually), resulting in a gaseous cyst, causing pain and neurological symptoms. Considering that spontaneous resolution and recurrence after surgery are both possible, most of the authors recommend conservative treatment in patients with intradiscal and intravertebral VP; occasionally percutaneous CT(computed tomography) -guided aspiration or vertebral stabilization.
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Affiliation(s)
- Francesco Cianci
- Istitute of Rheumatology, Università Cattolica del Sacro Cuore, Roma, Italy
| | | | | | - Elisa Gremese
- Istitute of Rheumatology, Università Cattolica del Sacro Cuore, Roma, Italy
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22
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Laux CJ, Weigelt L, Osterhoff G, Slankamenac K, Werner CML. Feasibility of iliosacral screw placement in patients with upper sacral dysplasia. J Orthop Surg Res 2019; 14:418. [PMID: 31818320 PMCID: PMC6902468 DOI: 10.1186/s13018-019-1472-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 11/13/2019] [Indexed: 11/10/2022] Open
Abstract
Background Exact knowledge of the sacral anatomy is crucial for the percutaneous insertion of iliosacral screws. However, dysplastic anatomical patterns are common. In addition to a preoperative computed tomography (CT) analysis, conventional radiographic measures may help to identify upper sacral dysplasia and to avoid damage to surrounding structures. Aiming to further increase safety in percutaneous iliosacral screw placement in the presence of sacral dysmorphism, this study examined the prevalence of previously established radiographic signs and, in addition, defined the “critical SI angle” as a new radiographic criterion. Methods Pelvic CT scans of 98 consecutive trauma patients were analysed. Next to assessment of established signs indicating upper sacral dysplasia, the critical sacroiliac (SI) angle was defined in standardized pelvic outlet views. Results The critical SI angle significantly correlates with the presence of mammillary bodies and an intraarticular vacuum phenomenon. With a cut-off value of − 14.2°, the critical SI angle detects the feasibility of a safe iliosacral screw insertion in pelvic outlet views with a sensitivity of 85.9% and a specificity of 85.7%. Conclusions The critical SI angle can support the decision-making when planning iliosacral screw fixation. The clinical value of the established signs of upper sacral dysplasia remains uncertain.
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Affiliation(s)
- Christoph J Laux
- Department of Trauma Surgery, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.
| | - Lizzy Weigelt
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Georg Osterhoff
- Department of Trauma Surgery, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.,Department of Orthopaedic, Trauma and Plastic Surgery, University Hospital Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany
| | - Ksenija Slankamenac
- Institute of Emergency Medicine, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Clément M L Werner
- Department of Trauma Surgery, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
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23
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Uluc ME, Cilengir AH, Karasu S, Mete BD, Tosun O. Vacuum phenomenon in multiple joints; prevalence and association with age and gender. J ANAT SOC INDIA 2018. [DOI: 10.1016/j.jasi.2018.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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24
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Schulze K, Ebert LC, Ruder TD, Fliss B, Poschmann SA, Gascho D, Thali MJ, Flach PM. The gas bubble sign-a reliable indicator of laryngeal fractures in hanging on post-mortem CT. Br J Radiol 2018; 91:20170479. [PMID: 29327945 DOI: 10.1259/bjr.20170479] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE The purpose was to evaluate the presence of gas in the tissue adjacent to the laryngeal structures, "the gas bubble sign", in cases of hanging as a diagnostic indicator of neck trauma. METHODS In this study, post-mortem CT (PMCT) scans and autopsies of 35 victims of hanging were examined to reveal age-dependent changes, laryngeal fracture, fracture location and the presence of gas. A matched group with cardiac arrest or intoxication was used as controls (n = 35). An autopsy was performed in each case. RESULTS Incomplete suspension was the most common method in hanging. The thyroid horns (90.5%) were identified as the most vulnerable location for fractures. Laryngeal deformity and dislocation, which was only detected on PMCT, was observed in 57.1% and was concomitant with fractures in 83.3%. Laryngeal fractures are more common with advanced age (>40 years, 88.9%) and less common in younger subjects (<40 years, 29.4%). The gas bubble sign with regard to laryngeal fractures yielded a sensitivity of 79.2%, a positive predictive value of 95%, a specificity of 90.9%, a negative predictive value of 34.5% and an accuracy of 83%. CONCLUSION The complex evaluation of the larynx is profoundly supported by PMCT and the detection of the gas bubble sign as a diagnostic indicator of neck trauma. This relevant diagnostic finding might aid in not only post-mortem cases but also clinical cases, for patients who survive an assault to the neck. Advances in knowledge: (1) The gas bubble sign is a diagnostic indicator of neck trauma in not putrefied bodies. (2) PMCT supports evaluation of trauma to the neck in hanging tremendously. (3) The diagnostic finding of gas located at the laryngeal structures may not only aid in post-mortem cases but also clinical cases of people who survive an assault to the neck.
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Affiliation(s)
- Katja Schulze
- 1 Institute of Forensic Medicine and Imaging, University of Zurich , Zurich , Switzerland
| | - Lars Christian Ebert
- 1 Institute of Forensic Medicine and Imaging, University of Zurich , Zurich , Switzerland
| | - Thomas Daniel Ruder
- 1 Institute of Forensic Medicine and Imaging, University of Zurich , Zurich , Switzerland.,2 Institute of Diagnostic, Interventional and Pediatric Radiology, University Hospital Bern , Bern , Switzerland
| | - Barbara Fliss
- 1 Institute of Forensic Medicine and Imaging, University of Zurich , Zurich , Switzerland
| | | | - Dominic Gascho
- 1 Institute of Forensic Medicine and Imaging, University of Zurich , Zurich , Switzerland
| | - Michael Josef Thali
- 1 Institute of Forensic Medicine and Imaging, University of Zurich , Zurich , Switzerland
| | - Patricia Mildred Flach
- 1 Institute of Forensic Medicine and Imaging, University of Zurich , Zurich , Switzerland.,3 Clinic for Radiology and Nuclear Medicine, Kantonal Hospital St. Gallen , St. Gallen , Switzerland
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Abstract
OBJECTIVE The objective of our study was to retrospectively determine the anatomic distribution of chest wall ectopic gas resembling pneumoperitoneum (i.e., pseudopneumoperitoneum) and its relationship with trauma mechanisms and clinical outcomes using CT. MATERIALS AND METHODS Investigators from two separate trauma referral centers screened 492 chest, abdomen, and pelvis CT examinations of patients who had sustained any form of trauma between 2010 and 2015. After excluding 186 patients with recognized causes of ectopic gas, 306 patients (211 men and 95 women; mean age, 44.5 years; range, 6-95 years) remained for analysis by two radiology residents in center 1 and a radiology resident in center 2. Positive cases were reviewed by all investigators, including an experienced fellowship-trained abdominal radiologist. The anatomic location of the pseudopneumoperitoneum, injury severity score, trauma velocity (high speed vs low or unknown speed), trauma mechanism, clinical findings on follow-up, and exploratory laparotomy data were collected for patients with pseudopneumoperitoneum. Two hundred consecutive nontrauma CT examinations from 2015 were selected as control cases by a resident in center 1. The t test and chi-square test were used for determining associations. RESULTS Pseudopneumoperitoneum was identified in 5.2% of patients, occurring bilaterally adjacent to the lower six costochondral junctions, and was significantly more common with high-velocity trauma than with low-velocity trauma (p = 0.010). None of the patients with pseudopneumoperitoneum had evidence of perforated hollow viscus at surgery (n = 2) or on clinical follow-up (n = 14). No patients had unnecessary surgery due to pseudopneumoperitoneum. CONCLUSION Pseudopneumoperitoneum is a posttraumatic phenomenon centered near the lower six costochondral junctions. Recognizing these findings may help prevent unnecessary laparotomy in the trauma setting.
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26
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Rutkauskas S, Paleckis V, Skurvydas A, Satkunskiene D, Brazaitis M, Snieckus A, Baranauskiene N, Rancevas R, Kamandulis S. Intratendinous Air Phenomenon: A New Ultrasound Marker of Tendon Damage? Front Physiol 2017; 8:570. [PMID: 28824461 PMCID: PMC5541021 DOI: 10.3389/fphys.2017.00570] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 07/21/2017] [Indexed: 11/13/2022] Open
Abstract
Purpose: To explore the presence of intratendinous air in physically active males after different types of strenuous physical exercise. Materials and Methods: To detect foci (air bubbles) in the quadriceps femoris tendon (QFT) and the proximal and distal parts of the patellar tendon, ultrasound examination was performed under two conditions: (1) after high-intensity cycling on a cycle ergometer (metabolic); (2) after 200 drop jumps (exercise-induced muscle damage). Based on the results of these two interventions, the presence of air in the tendons after 100 drop jumps was examined further with frequently repeated ultrasound measurements. Results: Foci were detected in exercise-induced muscle damage. Twenty-three of Sixty investigated tendons (38.3%) were observed to contain hyperechoic foci after 100 drop jumps. QFT foci were present in 13/23 cases (56.5%). The location of foci in the QFT was mostly lateral and centro-lateral (76.9%). The foci disappeared completely between 40 and 180 min after completing 100 drop jumps. Conclusions: The presence of intratendinous air seems related to high-magnitude, high-force, high-strain exercise of the particular tendon areas. It might represent the stress response of tendons to overload condition.
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Affiliation(s)
- Saulius Rutkauskas
- Institute of Sports Science and Innovation, Lithuanian Sports UniversityKaunas, Lithuania
| | - Vidas Paleckis
- Institute of Sports Science and Innovation, Lithuanian Sports UniversityKaunas, Lithuania
| | - Albertas Skurvydas
- Institute of Sports Science and Innovation, Lithuanian Sports UniversityKaunas, Lithuania
| | - Danguole Satkunskiene
- Institute of Sports Science and Innovation, Lithuanian Sports UniversityKaunas, Lithuania
| | - Marius Brazaitis
- Institute of Sports Science and Innovation, Lithuanian Sports UniversityKaunas, Lithuania
| | - Audrius Snieckus
- Institute of Sports Science and Innovation, Lithuanian Sports UniversityKaunas, Lithuania
| | - Neringa Baranauskiene
- Institute of Sports Science and Innovation, Lithuanian Sports UniversityKaunas, Lithuania
| | - Ruslanas Rancevas
- Department of Radiology, Lithuanian University of Health SciencesKaunas, Lithuania
| | - Sigitas Kamandulis
- Institute of Sports Science and Innovation, Lithuanian Sports UniversityKaunas, Lithuania
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Lee RKL, Griffith JF, Tang WK, Ng AWH, Yeung DKW. Effect of traction on wrist joint space and cartilage visibility with and without MR arthrography. Br J Radiol 2017; 90:20160932. [PMID: 28181830 DOI: 10.1259/bjr.20160932] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE To compare the effect of traction during non-arthrographic and arthrographic MR examination of the wrist with regard to joint space width, joint fluid dispersion and cartilage surface visibility. METHODS Prospective 3-T MRI study of 100 wrists in 96 patients. The first 50 wrists underwent MR arthrography first without traction and then with traction. The following 50 wrists underwent standard MR first without traction and then with traction. On these examinations, two radiologists independently measured (i) joint space width, semi-quantitatively graded (ii) joint fluid dispersion between opposing cartilage surfaces and (iii) articular cartilage surface visibility. The three parameters were compared between the two groups. RESULTS Traction led to an increase in joint space width at nearly all joints in all patients (p < 0.05), although more so in the arthrography (∆ = 0.08-0.79 mm, all p < 0.05) than in the non-arthrography (∆ = 0.001-0.61 mm, all p < 0.05) group. Joint fluid dispersion and cartilage surface visibility improved after traction in nearly all joints (p < 0.05) in all patients and more so in the arthographic than in the non-arthrography group. CONCLUSION Traction did significantly improve cartilage surface visibility for standard MRI of the wrist although the effect was not as great as that seen with MR arthography or MR arthrography with traction. Advances in knowledge: This is the first study to show the beneficial effect of traction during standard non-arthrography MRI of the wrist and compare the effect of traction between non-arthrographic and arthrographic MRI of the wrist.
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Affiliation(s)
- Ryan K L Lee
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong
| | - James F Griffith
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong
| | - W K Tang
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong
| | - Alex W H Ng
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong
| | - David K W Yeung
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong
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Ohsaka H, Hayashi C, Omori K, Yanagawa Y. A Case of Traumatic Vacuum Phenomenon in the Sleeve of a Nerve Root Due to Nerve Root Avulsions. J Emerg Trauma Shock 2017; 10:216-217. [PMID: 29097863 PMCID: PMC5663143 DOI: 10.4103/jets.jets_133_16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Hiromichi Ohsaka
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Tokyo, Japan. E-mail:
| | - Chikato Hayashi
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Tokyo, Japan. E-mail:
| | - Kazuhiko Omori
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Tokyo, Japan. E-mail:
| | - Youichi Yanagawa
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Tokyo, Japan. E-mail:
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