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Adiputra PAT. Management of penetrating cervical injury from needlefish impalement: A case report. Int J Surg Case Rep 2024; 119:109717. [PMID: 38696931 DOI: 10.1016/j.ijscr.2024.109717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Revised: 04/23/2024] [Accepted: 04/25/2024] [Indexed: 05/04/2024] Open
Abstract
INTRODUCTION Injuries inflicted by needlefish resemble stab wounds, resulting from the rapid and forceful jumping of needlefish jaws from the water's surface. Needlefish impalement on the neck and face are often fatal compared to body areas or extremities. This case report investigates a rare incident where a 50-year-old male tourist sustained a cervical injury from needlefish impalement during an inter-island cruise. CASE PRESENTATION A 50-year-old male experienced right neck pain due to accidental impalement by a needlefish. The initial extraction attempt at a local health center proved unsuccessful, necessitating subsequent surgical intervention. The procedure involved successful removal of the needlefish jaw, wound cleaning, and primary closure with a penrose drain. The patient was discharged on the third postoperative day, showing no neurological deficits or signs of infection during the four-week follow-up. CLINICAL DISCUSSION Managing needlefish injuries parallels addressing stab wounds, with the treatment approach guided by the specific location of the injury. Zone III injuries in the neck may pose challenges in bleeding control, especially when involving the internal carotid artery. In this case, a diagnostic approach with computed tomography angiography confirmed vessel integrity, allowing for an exploration approach with an L-shaped skin incision. CONCLUSION Penetrating injuries from needlefish can be life threatening. Treatment strategies must target the injured organ, with consideration of further imaging to assess vascular involvement.
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Frati A, Cimatti M, Ileyassoff H, Capobianco M, Santoro A, Armocida D. Combined Anterior Odontoid Screw Fixation and C1-C2 Jefferson Fracture Anterior Fixation: A Step-by-Step Technical Note. World Neurosurg 2024; 184:112-118. [PMID: 38266989 DOI: 10.1016/j.wneu.2024.01.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 01/13/2024] [Accepted: 01/16/2024] [Indexed: 01/26/2024]
Abstract
BACKGROUND Combined triple atlas (C1)-axis (C2) fixation has been described in previous literature as a safe, effective, and minimally invasive procedure for complex atlas and odontoid fractures that allows for a greater range of motion compared with posterior approaches and atlanto-occipital fusion. However, it is rarely performed due to the occipital-cervical diastasis resulting from often-fractured C1 joint masses. No evidence-based consensus has been reached regarding the treatment of complex atlantoaxial fractures, and the choice of surgical strategy is based only on clinical experience. METHODS We report the combined triple C1-C2 fixation technique with manual reduction of the joint masses during patient positioning on the operating table, which allowed for effective stabilization during a single surgical session. We describe our experience in the management of a 75-year-old patient presenting with an acute complex type II fracture of C1, which also involved 1 lateral mass, combined with a type II odontoid fracture and occipital-cervical diastasis. RESULTS We provide a step-by-step guide for combined triple C1-C2 anterior fixation with manual fracture reduction and describe the clinical case of an acute complex type II fracture of C1, which also involved 1 lateral mass, combined with a type II odontoid fracture and occipital-cervical diastasis. CONCLUSIONS Combined triple C1-C2 fixation represents a safe and efficient minimally invasive anterior approach for complex type II fractures of C1 with type II odontoid fractures. Manual reduction of the joint masses during patient positioning allows for effective stabilization in a single surgical session.
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Affiliation(s)
- Alessandro Frati
- Experimental Neurosurgery Unit, IRCCS Ist Neurologico Mediterraneo Neuromed, Pozzilli, Italy
| | - Marco Cimatti
- Neurosurgery Service, Azienda Ospedaliera-Universitaria Sant'Andrea, Sapienza University of Rome, Rome, Italy
| | - Hernán Ileyassoff
- Department of Neurosurgery, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Mattia Capobianco
- Department of Neurosurgery, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Antonio Santoro
- Department of Neurosurgery, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Daniele Armocida
- Experimental Neurosurgery Unit, IRCCS Ist Neurologico Mediterraneo Neuromed, Pozzilli, Italy; Department of Neurosurgery, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy.
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Mayer HF, Palacios Huatuco RM, Pizarro Feijoo BA, Mazzaro EL. Silicone Pectoral Implant to Solve Aesthetic Chest Deformity After Pectoralis Flap Harvesting for Laryngotracheal Reconstruction. Aesthetic Plast Surg 2023:10.1007/s00266-023-03638-y. [PMID: 37700195 DOI: 10.1007/s00266-023-03638-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/07/2023] [Indexed: 09/14/2023]
Abstract
BACKGROUND The pectoralis major musculocutaneous flap has been considered for decades the workhorse in head and neck reconstruction. However, the disadvantages of the pectoralis flap include the morbidity of the donor site in terms of cosmetic and functional results. A silicone pectoral implant can be used to solve such aesthetic chest deformity in male patients. METHODS A 33-years-old man with a history of cervical tracheoesophageal fistula after a blunt trauma due to a motorcycle accident, previously reconstructed with a pectoralis major flap, consulted our Plastic Surgery Department for an aesthetic defect of the donor site . The use of an anatomical pectoral implant was planned with the aim of aesthetic reshaping of the male chest. A pocket was created following the preoperative design to position a 190 cc pectoral implant. Dissection was performed in a subcutaneous plane that included the underneath adipose tissue layer and then over the pectoralis minor and the serratus muscle. Three months later, in a second stage, lipofilling of the depressed areas was performed with 100 ml of adipose tissue obtained from the abdomen. RESULTS After two years of follow-up, the patient obtained a satisfactory aesthetic result, with an improvement in the projection of the thorax and the symmetry of the body contour. As the implant was placed into the subcutaneous pocket, no functional compromise in shoulder flexion or adduction was detected during follow-up. CONCLUSIONS The pectoral implant technique seems safe and provides reshaping of the male chest wall, significantly improving the cosmetic appearance of the patient. In addition, its use with associated procedures such as lipofilling allows optimal results to be obtained. To the best of our knowledge, this is the first case to describe the use of a pectoral implant to solve donor site morbidity after pectoralis flap harvesting for any reconstructive purpose. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Horacio F Mayer
- Plastic Surgery Department, Hospital Italiano de Buenos Aires, University of Buenos Aires Medical School, Hospital Italiano de Buenos Aires University Institute (IUHIBA), 4190 Peron St., 1st. floor, C1991ABB, Buenos Aires, Argentina.
| | - René M Palacios Huatuco
- Plastic Surgery Department, Hospital Italiano de Buenos Aires, University of Buenos Aires Medical School, Hospital Italiano de Buenos Aires University Institute (IUHIBA), 4190 Peron St., 1st. floor, C1991ABB, Buenos Aires, Argentina
| | - Byron A Pizarro Feijoo
- Plastic Surgery Department, Hospital Italiano de Buenos Aires, University of Buenos Aires Medical School, Hospital Italiano de Buenos Aires University Institute (IUHIBA), 4190 Peron St., 1st. floor, C1991ABB, Buenos Aires, Argentina
| | - Eduardo L Mazzaro
- Head and Neck Surgery Section, General Surgery Department, Hospital Italiano de Buenos Aires, University of Buenos Aires Medical School, Hospital Italiano de Buenos Aires University Institute (IUHIBA), 4190 Peron St., C1181ACH, Buenos Aires, Argentina
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Ridia KGM, Astawa P, Deslivia MF, Santosa C, Savio SD. A Systematic Review of Scoring System Based on Magnetic Resonance Imaging Parameters to Predict Outcome in Cervical Spinal Cord Injury. Spine Surg Relat Res 2023; 7:1-12. [PMID: 36819628 PMCID: PMC9931401 DOI: 10.22603/ssrr.2021-0255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 06/06/2022] [Indexed: 11/05/2022] Open
Abstract
Background Magnetic resonance imaging (MRI) is a potential tool for the objective assessment of spinal cord injury (SCI) because it correlates well with the spatial and temporal extension of spinal cord pathology. This study aimed to systematically identify currently available scoring system based on MRI parameters, including measurement of the spinal cord lesion length in sagittal view (intramedullary lesion length (IMLL)) and morphology of the lesion in axial view (Brain and Spinal Injury Center (BASIC) score). Methods A systematic search was conducted using the PubMed/MEDLINE database for English-language studies with the keywords "cervical," "spinal cord injury," "scoring system," "scoring," "classification," and "magnetic resonance imaging" to systematically identify the scoring system based on MRI parameters. The main outcomes of interest are the scoring system's inter- and intraobserver reliabilities and its predictive accuracy of neurological outcome. Results After assessing the full text and applying the inclusion and exclusion criteria, 13 articles were found to be eligible. The inter- and intraobserver reliabilities were rated as good until perfect for increased signal intensity (ISI), maximum canal compromise (MCC), maximum spinal cord compression (MSCC), BASIC score, cord-canal-area ratio, space available for the cord, and the compression ratio. The weighted mean difference of IML between the group with converted ASIA Impairment Scale (AIS) grade and the group without conversion is 31.79 (I2 =93%, P=0.008). The percentage of agreement between the initial BASIC score of 4 with AIS grade of A at follow-up is 100%. Conclusions Certain MRI parameters, including IML and BASIC score, have good reliability and correlate well with neurological outcome, making them candidates for building simple and objective scoring system for cervical SCI. Level of Evidence: 2A.
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Affiliation(s)
- K G Mulyadi Ridia
- Consultant of Orthopaedics and Traumatology Department, Faculty of Medicine Udayana University, Sanglah General Hospital, Denpasar, Bali, Indonesia
| | - Putu Astawa
- Consultant of Orthopaedics and Traumatology Department, Faculty of Medicine Udayana University, Sanglah General Hospital, Denpasar, Bali, Indonesia
| | - Maria Florencia Deslivia
- Resident of Orthopaedics and Traumatology Department, Faculty of Medicine Udayana University, Sanglah General Hospital, Denpasar, Bali, Indonesia
| | - Claudia Santosa
- Resident of Orthopaedics and Traumatology Department, Faculty of Medicine Udayana University, Sanglah General Hospital, Denpasar, Bali, Indonesia
| | - Sherly Desnita Savio
- Resident of Orthopaedics and Traumatology Department, Faculty of Medicine Udayana University, Sanglah General Hospital, Denpasar, Bali, Indonesia
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Russo S, Mobasheri R, de Negreiros Nanni F, Lam K. Does fracture-extension into the pars interarticularis alter outcomes in odontoid failure? a technical note on pars interarticularis osteotomy and atlantoaxial distraction arthrodesis. Eur Spine J 2021; 30:1556-65. [PMID: 33738557 DOI: 10.1007/s00586-021-06806-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 02/02/2021] [Accepted: 03/03/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Odontoid process fractures can extend rostral into the C2 arch. We investigated the clinical impact of a concurrent fracture of the pars interarticularis on odontoid failure. To overcome the surgical challenges related to the morphology of these fractures, we describe a novel surgical strategy using atlantoaxial joint distraction arthrodesis. METHODS We conducted a single centre cohort study of 13 consecutive patients with odontoid fractures extending into the pars treated between June 2016 and June 2018. Criteria for a stable fibrous non-union were: Atlanto-Dens Interval (ADI) < 3 mm, Posterior Atlanto-Dens Interval (PADI) > 14 mm and lack of symptomatic motion at the fracture site. Atlantoaxial instability was defined as greater than 50% subluxation across the C1-C2 joint. Return to pre-injury performance status was considered a satisfactory clinical outcome. RESULTS The mean age of the patient population was 77.2 years (SD 11.9). The mean follow-up time was 15 months (SD 5.2). 69% had an associated atlantoaxial instability (P-value 0.0005). Cervical orthosis treatment was associated with a high non-union rate (70%) (P-value 0.04) although it did not affect the overall clinical outcome. 2 cases presented with cord compression were treated surgically with pars interarticularis osteotomy and atlantoaxial distraction arthrodesis. CONCLUSIONS Odontoid fracture with extension into the pars interarticularis often present with atlantoaxial instability and may result in stable fibrous non-union if treated non-operatively. The C1-C2 segment can be stabilised with atlantoaxial distraction arthrodesis achieved through an osteotomy of the pars interarticularis.
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Kasturi S, Muthirevula A, Gadennavar AS, Lingaraju VC. Bilateral pneumothoraces secondary to an isolated midline zone 1 cervical stab injury. Indian J Thorac Cardiovasc Surg 2021; 37:338-340. [PMID: 33967427 DOI: 10.1007/s12055-020-01094-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/03/2020] [Accepted: 11/05/2020] [Indexed: 11/26/2022] Open
Abstract
Penetrating neck trauma, though rare, carries a high morbidity and mortality risk if not recognized promptly, due to the presence of vital neurovascular and airway elements within a closed compartment. We describe the unique presentation of a high zone 1 anterior midline cervical stab injury with bilateral large pneumothoraces and extensive pneumomediastinum. Understanding the respiratory mechanics and a high clinical suspicion will help to recognize such complications of tracheobronchial injuries and their timely management is key to salvage of these patients.
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Affiliation(s)
- Srikanth Kasturi
- Department of Thoracic Surgery, Mazumdar Shaw Medical Center, 258/A, Hosur Road, Bommasandra Industrial Area, Bengaluru, Karnataka 560099 India
| | - Arvind Muthirevula
- Department of Thoracic Surgery, Mazumdar Shaw Medical Center, 258/A, Hosur Road, Bommasandra Industrial Area, Bengaluru, Karnataka 560099 India
| | - Amulya Siddarameshwar Gadennavar
- Department of Thoracic Surgery, Mazumdar Shaw Medical Center, 258/A, Hosur Road, Bommasandra Industrial Area, Bengaluru, Karnataka 560099 India
| | - Vijay Cholenahalli Lingaraju
- Department of Thoracic Surgery, Mazumdar Shaw Medical Center, 258/A, Hosur Road, Bommasandra Industrial Area, Bengaluru, Karnataka 560099 India
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Mathew M, Mezue WC, Chikani MC, Jimoh AO, Uche EO, Mathew MB. Correlation of Quantitative MRI Parameters with Neurological Outcome in Acute Cervical Spinal Cord Injury. J West Afr Coll Surg 2021; 11:5-10. [PMID: 35873875 PMCID: PMC9302387 DOI: 10.4103/jwas.jwas_52_22] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 04/12/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The unbearable morbidity and significant mortality associated with traumatic cervical spine injuries (T-CSIs) have been complicated by difficulties in outcome prediction. OBJECTIVES This study aims to determine the correlation between quantitative magnetic resonance imaging (MRI) parameters and neurological outcome among patients with acute T-CSI. MATERIALS AND METHODS This is a prospective study in which patients with T-CSI were recruited over a 12-month period. ASIA Impairment Scale (AIS) at admission, 6 weeks, and 3 months was assessed. Mean spinal cord compression (MSCC), mean canal compromise (MCC), and length of lesion (LOL) were calculated from MRI at admission, and correlation with neurological severity and outcome was determined. The data were analysed using SPSS version 21. A P-value of less than 0.05 was considered significant for associations. RESULTS Sixty-nine patients were enrolled comprising 55 males and 14 females giving a male-female ratio of 4.9:1. Their ages ranged from 18 to 74 years with a mean age of 40.2 ± 15.1 years. Injuries were ASIA A in 55.1% and ASIA E in 7.2% on admission. The mean MSCC, MCC, and LOL were higher for ASIA A and B and lowest in ASIA E injuries. Patients with good AIS (D and E) had significantly lower MSCC on admission (P = 0.032) and at 6 weeks (P = 0.000), and the LOL was also lower on admission (P = 0.000), at 6 weeks (P = 0.006), and at 3 months (P = 0.007). None of MRI parameters predicted outcome. CONCLUSION The MSCC, MCC, and LOL correlate with T-CSI severity but were not sufficient to predict outcome.
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Affiliation(s)
- Mesi Mathew
- Surgery Department, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | - Wilfred C. Mezue
- Surgery Department, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Mark C. Chikani
- Surgery Department, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Abdullahi O. Jimoh
- Surgery Department, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | - Enoch O. Uche
- Surgery Department, University of Nigeria Teaching Hospital, Enugu, Nigeria
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Purvis TE, De la Garza-Ramos R, Abu-Bonsrah N, Goodwin CR, Groves ML, Ain MC, Sciubba DM. External fixation and surgical fusion for pediatric cervical spine injuries: Short-term outcomes. Clin Neurol Neurosurg 2018; 168:18-23. [PMID: 29505977 DOI: 10.1016/j.clineuro.2018.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 02/03/2018] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To compare in-hospital complication rates in pediatric patients with atlantoaxial and subaxial injuries undergoing either external fixation or surgical fusion. PATIENTS AND METHODS Baseline and outcome data were obtained from the 2002-2011 Nationwide Inpatient Sample (NIS) for patients under the age of 18 with a diagnosis of cervical spine fracture without spinal cord injury or cervical spine subluxation. Patients who underwent external immobilization or internal fixation were included for analysis. Variables analyzed included length of stay, in-hospital mortality, discharge disposition, total hospital charges, and development of at least one in-hospital complication. RESULTS A total of 2878 pediatric patients with cervical spine injury were identified; 1462 patients (50.8%) with atlantoaxial (C1-2) injury and 1416 (49.2%) with subaxial (C3-7) injury. Among atlantoaxial injury patients, external fixation was associated with lower total charges ($73,786 vs. $98,158, p = .040) and a lower likelihood of developing at least one complication (1.9% vs. 6.8%, p = .029) compared to surgical fusion, and was a more common treatment for subluxation alone (16.4% vs. 2.6%, p < .001). Among subaxial injury patients, there were no significant differences in age (p = .262), length of stay (p = .196), occurrence of at least one complication (p = .334), or total charges (p = .142). Subaxial subluxation injuries alone were treated more often with surgical fusion (2.2% vs. 1.2%, p < .001). CONCLUSION Optimal treatment of patients with cervical injury may vary by location of injury. Our findings warrant further investigation into the difference in clinical outcomes between surgical and non-surgical management of atlantoaxial and subaxial injury.
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Affiliation(s)
- Taylor E Purvis
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Rafael De la Garza-Ramos
- Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY, USA
| | - Nancy Abu-Bonsrah
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - C Rory Goodwin
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA.
| | - Mari L Groves
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael C Ain
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Daniel M Sciubba
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Lobo JPFM, Moutinho VV, Serdoura AFM, Oliveira CF, Pinho AR. Anterior fixation of odontoid fractures: results. Rev Bras Ortop 2017; 53:532-536. [PMID: 30245990 PMCID: PMC6147805 DOI: 10.1016/j.rboe.2017.07.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 07/10/2017] [Indexed: 11/30/2022] Open
Abstract
Objective To evaluate the clinical and radiological outcomes of the surgical treatment in patients diagnosed with odontoid fracture who underwent open reduction and internal fixation (ORIF) with screws. Methods This was a retrospective study with nine patients. Pain (visual analog scale [VAS]) and neurological status (Frankel scale) were assessed. The neck disability index (NDI) and the post-operative cervical range of motion were calculated. The cervical spine was radiologically evaluated (X-ray and CT) pre- and postoperatively. Results The mean age of patients was 70 years. All patients presented type IIb (Grauer classification) fractures, with a mean deviation of 2.95 mm. Two patients had subaxial lesions. The mean follow-up was 30 months. The mean time from trauma to surgery was seven days. The pre-operative Frankel score was E in all except one patient (B), in whom a post-operative improvement from B to D was observed. Post-operative pain was 2/10 (VAS). A total of 77% of patients presented a mild or moderate disability (NDI). Six patients regained full range of cervical movement, and bone union required approximately 14 weeks. Pseudarthrosis complications were observed in two patients (77% union rate), one patient presented screw repositioning and one case, dysphonia. Conclusion Delayed diagnosis is still an issue in the treatment of odontoid fractures, especially in elderly patients. Concomitant lesions, especially in younger patients, are not uncommon. The literature presents high fusion rates with ORIF (≥80%), which was also observed in the present study. However, surgical success depends on proper patient selection and strict knowledge of the technique. This pathology presents a reserved functional prognosis in the medium-term, especially in the elderly.
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Agrawal D, Sinha TP, Bhoi S. Assessment of ultrasound as a diagnostic modality for detecting potentially unstable cervical spine fractures in pediatric severe traumatic brain injury: A feasibility study. J Pediatr Neurosci 2015; 10:119-22. [PMID: 26167212 PMCID: PMC4489052 DOI: 10.4103/1817-1745.159196] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background: Early cervical spine clearance is extremely important in unconscious trauma patients and may be difficult to achieve in emergency setting. Objectives: The aim of this study was to assess the feasibility of standard portable ultrasound in detecting potentially unstable cervical spine injuries in severe traumatic brain injured (TBI) patients during initial resuscitation. Materials and Methods: This retro-prospective pilot study carried out over 1-month period (June–July 2013) after approval from the institutional ethics committee. Initially, the technique of cervical ultrasound was standardized by the authors and tested on ten admitted patients of cervical spine injury. To assess feasibility in the emergency setting, three hemodynamically stable pediatric patients (≦18 years) with isolated severe head injury (Glasgow coma scale ≤8) coming to emergency department underwent an ultrasound examination. Results: The best window for the cervical spine was through the anterior triangle using the linear array probe (6–13 MHz). In the ten patients with documented cervical spine injury, bilateral facet dislocation at C5–C6 was seen in 4 patients and at C6–C7 was seen in 3 patients. C5 burst fracture was present in one and cervical vertebra (C2) anterolisthesis was seen in one patient. Cervical ultrasound could easily detect fracture lines, canal compromise and ligamental injury in all cases. Ultrasound examination of the cervical spine was possible in the emergency setting, even in unstable patients and could be done without moving the neck. Conclusions: Cervical ultrasound may be a useful tool for detecting potentially unstable cervical spine injury in TBI patients, especially those who are hemodynamically unstable.
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Affiliation(s)
- Deepak Agrawal
- Department of Neurosurgery, JPNA Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Tej Prakash Sinha
- Department of Emergency Medicine, JPNA Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjeev Bhoi
- Department of Emergency Medicine, JPNA Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
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Cohen J, Bornes M, Darai E. [The four-valve vaginal speculum: a new device to manage post-partum hemorrhage]. Gynecol Obstet Fertil 2015; 43:169-171. [PMID: 25618537 DOI: 10.1016/j.gyobfe.2014.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Accepted: 11/19/2014] [Indexed: 06/04/2023]
Affiliation(s)
- J Cohen
- Service de gynécologie-obstétrique, GRC 6-UPMC centre expert en endométriose (C3E), hôpital Tenon, AP-HP, université Pierre-et-Marie-Curie Paris 6, 4 rue de La-Chine, 75020 Paris, France.
| | - M Bornes
- Service de gynécologie-obstétrique, GRC 6-UPMC centre expert en endométriose (C3E), hôpital Tenon, AP-HP, université Pierre-et-Marie-Curie Paris 6, 4 rue de La-Chine, 75020 Paris, France
| | - E Darai
- Service de gynécologie-obstétrique, GRC 6-UPMC centre expert en endométriose (C3E), hôpital Tenon, AP-HP, université Pierre-et-Marie-Curie Paris 6, 4 rue de La-Chine, 75020 Paris, France
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D’Oliveira GLC, Figueiredo FA, Passos MCF, Chain A, Bezerra FF, Koury JC. Physical exercise is associated with better fat mass distribution and lower insulin resistance in spinal cord injured individuals. J Spinal Cord Med 2014; 37:79-84. [PMID: 24090139 PMCID: PMC4066554 DOI: 10.1179/2045772313y.0000000147] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVES The aim of the study was to compare total and regional body composition and their relationship with glucose homeostasis in physically active and non-active individuals with cervical spinal cord injury (c-SCI). METHODS Individuals with lesion level between C5-C7 were divided into two groups: physically active (PA; n = 14; who practiced physical exercise for at least 3 months, three times per week or more, minimum of 150 minutes/week): and non-physically active (N-PA n = 8). Total fat mass (t-FM) and regional fat mass (r-FM) were assessed by dual energy X-ray absorptiometry. Fasting plasma insulin (FPI) was determined by enzyme-linked immunosorbent assay. RESULTS PA group present lower (P < 0.01) total fat mass (t-FM), % and kg, regional fat mass (r-FM), % and kg, FPI levels and HOMA index, while they had higher (P < 0.001) total free fat mass (t-FFM), %, and regional free fat mass (r-FFM), %, compared to the N-PA group. In the N-PA group, FPI and HOMA index were negatively (P < 0.05) correlated with FFM% (r = -0.71, -0.69, respectively) and positively correlated to trunk-FM (r = 0.71, 0.69, respectively) and trunk-FM:t-FM (kg) ratio (r = 0.83, 0.79, respectively). CONCLUSION Physical exercise is associated with lower t-FM, r-FM, and insulin resistance, which could contribute to the decrease of the risk of cardiovascular and metabolic conditions in individuals with c-SCI.
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Affiliation(s)
- Giselle Louise C. D’Oliveira
- Department of Basic and Experimental Nutrition, Institute of Nutrition, State University of Rio de Janeiro, RJ, Brazil
| | - Flávia A. Figueiredo
- Department of Basic and Experimental Nutrition, Institute of Nutrition, State University of Rio de Janeiro, RJ, Brazil
| | - Magna Cottini Fonseca Passos
- Department of Applied Nutrition, Institute of Nutrition, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil,Correspondence to: Magna Cottini Fonseca Passos, Department of Applied Nutrition, Institute of Nutrition, State University of Rio de Janeiro, Rua São Francisco Xavier 524, Rio de Janeiro, RJ 20550-900, Brazil.
| | - Amina Chain
- Department of Basic and Experimental Nutrition, Institute of Nutrition, State University of Rio de Janeiro, RJ, Brazil
| | - Flávia F. Bezerra
- Department of Basic and Experimental Nutrition, Institute of Nutrition, State University of Rio de Janeiro, RJ, Brazil
| | - Josely Correa Koury
- Department of Basic and Experimental Nutrition, Institute of Nutrition, State University of Rio de Janeiro, RJ, Brazil
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