Archive | August, 2013

Answer to Trivia Question…

August 28, 2013

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This is an inferior dislocation at the glenohumeral joint, otherwise known as Luxatio Erecta Humeri

Luxatio Erectae

Inferior dislocation accounts for less than 0.5% of shoulder dislocations.  The characteristic clinical finding is that the patient holds their arm up as if wanting to ask a question in class.

Author:  Russell Jones, MD

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Trivia question…

August 24, 2013

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Trivia time:  What is the latin name for this type of shoulder dislocation?

Luxatio Erectae

Image Contributors:  Rupinder Chima, MD and Mary Bing, MD.

Author:  Russell Jones, MD

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Distal fibula fracture…

August 20, 2013

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Distal fibula fractures are very common.  Here is a mid-50s female who twisted her ankle:

Distal Fib fx 1 Distal fib fx 2 Gravity stress mortis 1

The first two images show a minimally displaced spiral-type fracture of the distal fibula without mortis widening.  However, when the patient is placed in “gravity stress” view (third image) you can see the medial part of the mortis (red arrow) widens quite significantly (5.4mm).  Orthopedic literature has classified this type of fracture as a Danis-Weber B fracture (1).  With stress on the ankle joint, medial widening of the mortis beyond 5mm is highly suggestive of deltoid ligament disruption (1).   Essentially this is similar to a bimalleolar fracture.  Operative stabilization and ligamentous repair may help this patient in the long-term.

Consider gravity stress views in all of your distal fibular fractures, especially those above the level of the mortis (Weber B).  For a comprehensive review article on these types of fractures please read reference #1 below.

Author:  Russell Jones, MD

References

1.  van den Bekerom MPJ, Mutsaerts ELAR, Niek van Dijk C.  Evaluation of the integrity of the deltoid ligament in supination external rotation ankle fractures: a systematic review of the literature.  Arch Ortho Traum Surg 129 (2); 227-235.

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Lung Mets…

August 16, 2013

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This patient has a history of recently diagnosed uterine cancer and came in with dyspnea:

Mets

Just a simple CXR showing multiple lesions highly suspect of secondary lung neoplasms (metastasized uterine cancer).

The most common type of uterine malignancy is endometrial carcinoma.  It commonly metastasizes to lung, liver, brain, vagina, bone, and abdominal and pelvic lymph nodes (1).  Almost any malignancy can metastasize to the lung due to its rich blood flow, however here is a list of some of the more common primary sites that metastasize to the lungs:

  • Bladder
  • Colon
  • Breast
  • Prostate
  • Wilm’s Tumor
  • Neuroblastoma

Author:  Russell Jones, MD

References

1.  Endometrial Cancer Treatment.  National Cancer Institute. http://www.cancer.gov/cancertopics/pdq/treatment/endometrial/HealthProfessional/page1.  Accessed 8/2013.

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Biker hit by car…

August 12, 2013

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This is a humerus radiograph of a biker who was “clipped” by a car and fell on their side:

Humerus fx 2Humerus fx 1

The image shows a comminuted fracture of the proximal humerus.  It is important, as discussed on past posts, to ensure the axillary nerve is intact as well as the axillary artery.  The other important consideration in this case is obtaining a “Y” or “Axillary” view of the shoulder to make sure you aren’t missing a dislocation either anterior or posterior to the glenoid fossa.

Author:  Russell Jones, MD

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Answer to WWWTP #9

August 9, 2013

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This patient came in after a fall and had an obvious elbow dislocation.  What else is visible?

Elbow dislocation 1elbow-dislocation-2 edited

The patient also has a radial head fracture, minimally displaced.  Radial head fracture as well as olecranon fracture (coronoid process) are common injuries associated with elbow dislocation.  Most elbow dislocations are posterior and can be associated with medial collateral ligament injury (MCL).

Author:  Russell Jones, MD

References:

1.  Dislocation of the Elbow.  Wheeless’ Textbook of Orthopedics.  http://www.wheelessonline.com/ortho/dislocations_of_the_elbow.  Accessed 7/2013.

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What’s Wrong With This Picture (WWWTP) #9

August 5, 2013

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This patient came in with elbow pain after falling on an outstreched hand.  There is an obvious posterior dislocation of the elbow.  What else is wrong with this picture (WWWTP)?

Elbow dislocation 1Elbow dislocation 2

Answer to follow

Author:  Russell Jones, MD

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Answer to Humerus fracture…

August 2, 2013

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Humerus fracture

Classically the radial nerve can be damaged by a mid-shaft humerus fracture.  The radial nerve courses in the radial groove on the lateral aspect of the shaft of the humerus.  Other associated nerve injuries with humerus fractures include:

  1. Proximal humerus fracture = axillary nerve
  2. Supracondylar humerus fracture = median nerve
  3. Medial epicondylar humerus fracture = ulnar nerve

It is very important to understand that these are not uniform and other nerves could be damaged with any humerus fracture.  Always test median, ulnar, radial, and axillary nerve function in any upper arm fracture!

Author:  Russell Jones, MD

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