[Isolated Fractures Of The Mandible In Children: Epidemiological, Clinical And Therapeutic Aspects]

INTRODUCTION

Facial fractures are rare in the pediatric population compared to adults. They represent 1 to 15% of maxilla-facial trauma. The objective of this study was to describe the epidemiological, clinical and therapeutic characteristics of mandible fractures in children in a developing country.

MATERIAL AND METHODS

This was a retrospective descriptive cross-sectional study - from January 1, 2016 to June 31, 2020 involving 17 cases. It took place in the Department of Odonto-Stomatology and Maxillofacial Surgery of the Hospital and University Center (CHU) of Bouaké.

RESULTS

There were 14 boys (82.35%) and 3 girls (17.65%) i.e. a sex ratio of 4.66. Road traffic accidents were the main cause with 64.72% (n=11). Unifocal fractures were found in 14 patients (82.35%). The seat was parasymphyseal in 29.41% (n=5). Bifocal fractures were found in 3 patients (17.65%). The site was condylar and symphyseal in 2 patients (75%). It involved the symphysis and the horizontal branch in 1 patient (25%). Orthopedic treatment was performed in all patients (100%). The evolution was favorable in all patients, i.e. 100% of cases.

CONCLUSION

The fracture of the mandible in children is a traumatological entity which is an epidemiological and therapeutic particularity.

If there is smoke, there must be fire - Isolated distal, non-displaced, intraarticular ulna fracture: A case report

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Isolated distal ulna styloid fractures are a rarity.

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Timely diagnosis and appropriate therapy reduce posttraumatic morbidity.

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High level of suspicion should be maintained in the presence of nonspecific pain, even if the initial X-ray is inconspicuous.

Introduction

Falling on the outstretched arm is a frequent trauma. The consequences can be isolated fractures of the distal radius, combined fractures of the distal radius and distal ulna - whereas the isolated fracture of the distal ulna is an uncommon trauma.

Presentation of case

We report on a 20- year- old male who presented at the emergency department after a motorcycle accident, suffering pain at his left forearm and left wrist. After an unremarkable x-ray in two planes, a CT- scan of the left wrist was performed and detected an isolated distal ulna fracture. The patient was treated with a forearm cast which led to a satisfying long term outcome.

Discussion

Based on the presented case the anatomical peculiarities of the distal radioulnar joint and the different trauma mechanisms as well as the resulting lesions, the diagnostic modalities and the treatment options are discussed.

Conclusion

We recommend performing an additional CT scan of the wrist in case of credible complaints after trauma to avoid baulking this very rare type of fracture.

Occult isolated fracture of the trapezoid diagnosed by ultrasonography

PURPOSE

To describe a patient with an occult isolated trapezoid fracture of the wrist. Isolated trapezoid fractures are very difficult to detect without advanced radiological imaging, since the fragment displacement does not occur in the sagittal plane. A discussion regarding the investigation of trapezoid fractures utilizing multiple imaging modalities includes the first demonstration of its detection via ultrasonography (US).

METHODS

A 26-year-old male presented to a chiropractic teaching clinic with pain involving the left wrist, after vaulting over the handlebars of his bicycle 2 days prior. The mechanism of injury was hyperflexion of the left wrist. Left wrist pain, reduced range of motion, and dorsal soft tissue edematous changes were identified at examination. Although the initial radiographic examination was negative, elevated clinical suspicion triggered an US examination 4 days later. The US exam demonstrated an isolated 1.8 mm dorsal trapezoid fracture, which was minimally displaced by 0.7 mm.

RESULTS

Following the US diagnosis of an isolated trapezoid fracture, the wrist was immobilized. The patient elected to not pursue an orthopedic consultation. Conservative care included ice and Class IV therapeutic laser therapy. The patient reported complete alleviation of clinical symptoms after approximately 2 weeks of splinting and treatment.

CONCLUSION

We emphasize the limitations of radiography in the diagnosis of this fracture. To our knowledge, this is the first case to describe the use of US in the diagnosis of an isolated trapezoid fracture.

Isolated greater tuberosity fractures of the proximal humerus: anatomy, injury patterns, multimodality imaging, and approach to management

The greater tuberosity is an important anatomic structure and its integrity is important for shoulder abduction and external rotation. Isolated fractures of the greater tuberosity are often subtle and may not be detected on initial radiographs. Clinically, these patients display symptoms which mimic a full thickness rotator cuff tear. It is important to differentiate these two entities, as their treatment is different (typically nonsurgical management for minimally displaced fractures versus rotator cuff repair for acute full thickness rotator cuff tears). When greater tuberosity fractures are significantly displaced and allowed to heal without anatomic reduction, they can lead to impingement. This article will review greater tuberosity anatomy and function, as well as the clinical presentation and multimodality imaging findings of greater tuberosity fractures. Imaging optimization, pitfalls, and clinical management of these fractures will also be discussed.