[Thyroid cartilage fracture following sneezing as a cause of spontaneous pneumomediastinum]

OBJECTIVE

To evaluate the possible etiological factors of spontaneous pneumomediastinum and to describe a case that was unusual in its etiology: a thyroid cartilage fracture as a result of sneezing.

MATERIAL AND METHODS

Six patients (four male, two female, aged 16-82 years) were hospitalized with spontaneous pneumomediastinum diagnosed with a chest X-ray in five patients and 100% with computed tomography. Treatment was symptomatic.

RESULTS

The commonest symptoms (cough, shortness of breath, hoarseness) were in four patients. Spontaneous pneumomediastinum developed in three cases as a result of bronchospasm during an attack of bronchial asthma, in one patient after exercise, in one after fibrogastroscopy, in one after sneezing. We report a 30-year-old man who presenting subcutaneous emphysema on the neck, hoarseness, pain when swallowing, hemoptysis developed after sneezing. His computed tomography revealed a pneumomediastinum due to fistula of the fracture of the thyroid cartilage following sneezing while simultaneously obstructing both nostrils. At laryngoscopy, there was a linear hematoma in the resolution stage on the anterior wall of the larynx. He was treated conservatively and recovered rapidly. There are no previous published reports of spontaneous pneumomediastinum following fracture of the thyroid cartilage.

CONCLUSION

Fracture of the thyroid cartilage as a result of a sharp rapid increase in airway pressure during a sneeze with blocked nasal passages can be one of the rare causes of spontaneous pneumomediastinum. Avoid closing both nostrils at the same time when sneezing.

Vomiting-induced costal cartilage fracture: a case report

The use of ultrasonography as a first line imaging test in cases of possible costal cartilage fracture can be pivotal. In this case report, we present the case of a patient with a suspected atraumatic vomiting-induced costal cartilage fracture. The costal cartilage fracture was non-displaced and incomplete, thus not visible in a Computed Tomography scan. When Ultrasound imaging was employed at the area of tenderness, soft tissue edema and hematoma around the cartilage were visualized. High level of suspicion for a cartilage fracture in this case revealed a subtle osseous injury.

Management of Laryngotracheal trauma: A review of current trends and future Directions

Laryngotracheal trauma is rare but can pose serious threats to one's life. Presenting symptoms vary according to the severity of injury. Immediate Airway control is first step in the management, intubation should be considered by a senior member of the trauma team if the injury is minor while tracheostomy should be reserved for more severe injuries. Evaluation by a fibre-optic laryngoscopy and CT scan should be done whenever possible. Reconstruction is done according to the site involved using suture, titanium miniplates and stents. Tissue engineering has added a new horizon in this management but up till now complete laryngotracheal regeneration is very far-fetched, but tissue regeneration at individual sites have shown some positive results. More work needs to be done in this less explored field including laryngeal transplantation.

Fixation of chondral fracture of the weight-bearing area of the lateral femoral condyle in an adolescent

Purely chondral fractures of the distal femur associated with patellar dislocation are uncommon, and treatment varies from fixation to debridement and marrow stimulation techniques. The unusual case reported here involves an adolescent who underwent fixation of a purely chondral fracture involving a large weight-bearing portion of the lateral femoral condyle. Chondral fracture healing was confirmed on follow-up magnetic resonance imaging and arthroscopic examination. This case suggests that fixation of purely chondral fractures can be successful in weight-bearing areas of the knee. Level of evidence V.

Unusual orientation of talar osteochondral fragment: a case report

The identification of the correct orientation of an osteochondral fragment can be challenging. Orthopaedists have been able to take advantage of advanced imaging techniques to provide guidance to the appropriate surgical intervention. Many advancements have been made in imaging modalities specific to articular cartilage [Fischbach F, Bruhn H, Unterhauser F, Ricke J, Wieners G, Felix R, et al. Magnetic resonance imaging of hyaline cartilage defects at 1.5T and 3.0T: comparison of medium T2-weighted fast spin echo, T1-weighted two-dimensional and three-dimensional gradient echo pulse sequences. Acta Radiol 2005;46(1):67-73 [Erratum in: Acta Radiol 2005;46(April (2)):218]] Furthermore, with the increasing use of bioabsorbable fixation pins, it is imperative that careful attention is paid to the correct orientation of the fragment that is to be fixed. Without awareness of the orientation, it is possible that the 180° displaced fragment could potentially be fixed in this position. At the time of this report, the patient in this case was 6 weeks postoperative and reported 0/10 pain with full painless range of motion without instability. Our goal with this case report is to promote awareness among orthopaedists and radiologists alike regarding the importance of recognizing the orientation of an osteochondral fragment and/or defect of the talus. The patient was informed that data concerning the case would be submitted for publication, and he consented.

Thyroid cartilage fracture: Treatment with biodegradable plates

A 29-year-old man fractured his thyroid cartilage while playing rugby. It was treated successfully with an Inion biodegradable plating system. Biodegradable plates are recommended for laryngeal reconstruction.

Repair of nasal complex fractures and the need for secondary septo-rhinoplasty

PURPOSE

This study was undertaken to evaluate the efficacy of closed reduction of nasal fractures and determine the incidence of the need for post-traumatic septo-rhinoplasty in the management of residual nasal deformities.

PATIENTS AND METHODS

Medical records of all patients with nasal fractures evaluated and treated by the Division of Oral and Maxillofacial Surgery at the University of Florida Health Science Center, Jacksonville, FL between January 2001 and October 2004 were retrospectively evaluated. Out of a total of 344 patients, 50 patients met the inclusion criteria. Forty-four patients (group A) underwent closed reduction of nasal bones and septum along with a septoplasty if needed within 2 weeks of initial injury. Six patients (group B) could not tolerate any surgical intervention because of multisystem injury or comorbidities. All 50 patients were then followed up in the Division of Oral and Maxillofacial Surgery to determine overall efficacy of the initial treatment modality, as well as the need for secondary post-traumatic septo-rhinoplasty. Group A was then further subdivided into groups A1 and A2. Group A1 consisted of patients who underwent a closed reduction of their nasal complex fracture without a residual deformity or the need for a secondary post-traumatic septo-rhinoplasty. Group A2 consisted of patients who underwent a closed reduction of their nasal complex fracture and developed a secondary nasal deformity significant enough to require a septo-rhinoplasty.

RESULTS

The follow-up period ranged from 1 week to 12 months. Nine patients in group A were lost to follow-up. Patients in group A1 (31 patients) were pleased with their results and did not require a secondary surgery. Four patients developed a post-traumatic nasal deformity requiring a post-traumatic septo-rhinoplasty (group A2). All patients in group B required post-traumatic septo-rhinoplasty.

CONCLUSION

Closed reduction of nasal fractures appears to be an effective method of treatment as long as careful attention is paid to the key regions in the nasal complex, including the septum at the initial time of treatment. Ideal results are obtained when surgery is performed within 2 weeks of initial injury. Factors such as timing of surgery, the status of the nasal septum, delay in treatment, and other associated injuries may influence the overall result.

[Use of intranasal splints in acute septoplasty in the treatment of composite nasoseptal fractures]

Etiology and pathogenesis of nasoseptal fractures are reviewed. The results of examination and treatment of 103 patients with acute nasal traumas are analysed. Efficacy of intranasal splints in acute septoplasty for creation of nasal septum base in the treatment of composite nasoseptal fractures compared to conventional methods are shown.

An unusual meniscal ganglion cyst that triggered recurrent hemarthrosis of the knee

A 58-year-old woman suffered spontaneous recurrent hemarthrosis of the knee. In the clinical course, pigmented villonodular synovitis was mostly suspected, but in arthroscopic surgery the lateral meniscus appeared to be upturned and stuck into the lateral pouch with the meniscal ganglion cyst. It was suggested that meniscal tear with meniscal ganglion cyst was related with recurrent hemarthrosis. Generally, both the meniscal ganglion cysts and spontaneous recurrent hemarthrosis are highly rare conditions. In this case, we speculated that a negligible power could induce the meniscal tear with recurrent hemarthrosis in the particular situation in which the meniscal ganglion cyst existed. In other words, the meniscal ganglion cyst might basically and physically relate with hemorrhagic condition. Arthroscopically, the meniscal ganglion cyst was removed together with the anterior segment of the lateral meniscus. Recurrent hemarthrosis was treated successfully by resection of the meniscus.

Medial meniscal tears and spontaneous osteonecrosis of the knee

We report on a series of 5 patients over 60 years of age who had a symptomatic medial meniscus degenerative tear followed-up with magnetic resonance imaging (MRI) sequence without arthroscopic surgery who developed spontaneous osteonecrosis of the knee. The average patients age was 68 years. Clinically, all 5 patients had tenderness at the medial joint line. At initial evaluation, MRI studies showed degenerative tears of the posterior horn of the medial meniscus with no evidence of osteonecrosis. After a mean time of 2.7 months, all patients had increased pain and were re-evaluated with a second MRI study that showed images compatible with osteonecrosis. The size of the osteonecrotic image shown on the MRI was measured, and values obtained averaged 21% of the femoral condyle with a range from 17% to 26%. Development of osteonecrosis after arthroscopic partial meniscectomy has been previously reported as a rare and unexpected complication. We report an MRI sequence between medial meniscus degenerative tears and the development of spontaneous osteonecrosis without any arthroscopic procedure. Elderly patients with medial meniscal tears should be alerted of this potential sequence of events and the impossibility for the surgeon to predict or prevent this situation at this stage, especially before performing an arthroscopic meniscectomy.

The role of ankle arthroscopy on the surgical management of ankle fractures

Nineteen patients were prospectively randomized for operative treatment of their ankle fracture to be supplemented with or without ankle arthroscopy. All patients had an SER or PER fracture with an intact medial malleolus requiring operative treatment without evidence of intra-articular debris preoperatively. All patients underwent plate fixation of their fibula fracture and had a similar postoperative protocol. Ten patients were randomized to the control group with plate fixation only and nine patients randomized to the plate fixation plus operative arthroscopy. The average follow-up was 21 months. The arthroscopic examination of the study group revealed eight of the nine patients to have articular damage to the dome of the talus. Minimal arthroscopic treatment of these joints was required. All patients healed their fractures. No difference was noted between SF-36 scores or lower extremity scores between the two groups. At short-term follow-up, it does not appear that the arthroscopic procedure will impact upon the patient's eventual outcome in this small group of patients.

Sequelae after nasal septum injuries in children

OBJECTIVE

To study the results of surgical treatment and sequelae in nasal septum injuries in children.

METHODS

Between January 1990 and December 1997, 16 pediatric patients with septal haematoma and/or abscess were treated. Mean age was 5 years (range: 2-14 years). Thirteen were male (81.2%), and three were female (18.8%). In nine cases (56.2%) the disease was a consequence of a minor trauma. Only two children had nasal fracture associated (12.5%). Minimum follow-up after the first visit was 10 months (mean, 3 years).

RESULTS

All cases were surgically treated. Minor sequelae were observed in six cases (37.5%), and major ones in ten patients (62.5%). In this latter group, multiple reconstructive procedures were needed.

CONCLUSIONS

It is necessary to be aware of the possibility of haematoma and abscess of the nasal septum. Major sequelae can be also expected after cases following minor traumas.

Acquired conditions that lead to osteoarthritis in the dog

There are many acquired arthopathies that will result in some degree of osteoarthritis, even after proper management. Once the articular cartilage is damaged, it is unlikely that the architecture of the original cartilage surface will return to the normal conditions that existed prior to injury. The purpose of timely and meticulous management of traumatic joint events is to stop the progression of osteoarthritic development. When dealing with articular fractures or other forms of trauma to articular cartilage, three important principles to remember are anatomic reduction of the articular surfaces, stable fixation, and limited weight bearing on the affected limb as soon as possible after surgery. Even after strict adherence to these principles, the pet owner should always be warned that the animal will develop some degree of osteoarthritis in the affected joint at some future time; at that time, chronic medical management may be indicated.

Bilateral vocal cord paralysis following blunt trauma to the neck

Blunt trauma to the anterior neck has been known to cause upper-airway obstruction requiring emergency tracheostomy. We report the case of a 26-year-old man who sustained blunt trauma to the anterior neck in whom upper-airway obstruction developed. Although computed tomography of the neck revealed a thyroid cartilage fracture and a retropharyngeal hematoma, fiberoptic examination of the larynx identified vocal cord paralysis as the primary cause of his upper-airway obstruction. Emergency tracheostomy was performed, and the patient recovered uneventfully. A Medline search of the literature for the past 3 years failed to identify any individual case reports of bilateral vocal cord paralysis secondary to blunt anterior neck trauma.

Acute laryngeal trauma: a review of 77 patients

Acute laryngeal trauma is a rare injury. In the past 18 years, 77 patients with acute laryngeal trauma have been evaluated at our institution. Each patient's care was overseen by the senior author (E.S.P.). The 61 patients who were seen within 48 hours of their accident are compared with those treated after 48 hours. All patients are classified by both injury (groups 1 through 5) and treatment (types I through III). Results are reported for voice, airway, and swallowing. Our methods of evaluation and treatment are outlined, and controversial aspects of patient management are addressed. We conclude that conservative treatment of group 1 and 2 injuries is 100% effective, expeditious repair of laryngeal injuries greatly reduces poor outcome, and the type of injury can be used to roughly predict patient outcome. Further, with use of current methods of diagnosis and management, almost all patients will be decannulated (98%) with functional speech (100%) and normal deglutition (100%).

Long-Term Outcome of Articular Fractures of the Phalanges: An Eleven Year Follow Up

Fifty-four patients with fifty-nine intra-articular fractures of the phalanges have been followed prospectively for eleven years, at the end of which time only four had significant pain and sixteen others discomfort in cold weather. Improvement in the symptoms and in the range of motion often continued for more than a year after injury. Although 17% of joints developed minor osteophytes or cysts, only one had both radiological evidence of arthritis and persistent pain.

Transverse volar skin laceration of the finger: Sign of volar plate injury

Transverse tears of the volar skin of a finger with a hyper-extension injury is associated with frequent volar plate tears or avulsions. Recognition is essential for surgical exploration of the volar plate and supporting joint structures and, if injured, surgical repair should be carried out at the time of skin suturing.

Traumatic avulsion of the trachea associated with cricoid fracture

A 15-year-old girl sustained a cricoid fracture, avulsion of the trachea, and bilateral cord paralysis in a automobile injury. An airway was established by intubation, and primary repair was performed on the day of injury. A postoperative stricture was successfully managed by endoscopic dilatation and injection of triamcinolone into the stricture. Function of one vocal cord appears to be returning 6 months after the injury, and the patient is leading an active life.