Cineradiograms of cervical spine in diagnosis of soft-tissue injuries.
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In a material consisting of approximately 6,000 injections of Adriamycin during a 2-year period, eleven moderate and five severe extravasation injuries have been observed. Even a small leakage of the drug may cause a permanent lesion. The most serious injuries were caused by large doses and on the dorsum of the hand. Plastic surgical operations were successfully performed in the severe cases. An active surgical intervention after primary neutralization of the extravasated Adriamycin is recommended.
In contrast to rare occurrence of blood vessel and nerve injuries the frequency of tendinous lesions of the shoulder is high. The clinical diagnosis of the ruptured tendon of the M. biceps brachii is obvious. On the other hand only arthrography or arthroscopy can verify the diagnosis of a ruptured supraspinatus tendon. The best access for tenosuture and tenoplasty of the latter is the transacromeal method.
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Three pediatric hand injury subtypes and their management have been presented. Finger tip injuries, while often minor and self-healing in children, may require surgical repair if the nailbed is disrupted or if there has been significant skin or pad loss from the tip. The decision between local repair and skin graft or pedicle reconstruction depends on the nature and extent of the injury. Multiple digit injuries should be carefully evaluated and manged with a view toward retention of digit length and restoration of function. Immediate closure of all wounds, while desirable, is not necessary. Minor hand burns are quite easily managed but burn injuries more severe in extent and/or depth must be treated with careful attention to detail. Splinting and elevation of the hand, early incisional decompression, the institution of early and diligent active motion and expeditious wound closure with skin grafts where full thickness loss has occurred will hasten the time of healing, minimize deformity and assist in the recovery of normal hand function.
Fifteen upper extremities, in 14 patients in whom incipient or actual Volkmann's ischemic contracture was present, were seen in a 5 year period. Nine patients were stuporous due to drug overdose and had laid on the extremity; two had received a recent injury of main arterial trunks; two had sudden severe compression; one with chronic myelogenous leukemia had each arm involved at different times in a bizarre autoimmune response causing massive swelling. No patient had a fracture or dislocation. Pain and tenderness, loss of sensibility, resistant muscle contracture, and rock-hard muscle compartments were warning signs. Immediate fasciotomy was done. Useful function was restored when treatment was carried out in the early stages of the ischemia.
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A histological study of transverse sections of lumbar facet joints from 36 lumbar spines of subjects dying from serious trauma revealed injuries not visible on standard radiography, and in a high percentage of joints. They include fractures of the superior articular process, central infractions of the subchondral bone plate, and tears of the articular capsule, including the ligamentum flavum. The facet joint injuries in young subjects were almost entirely absent from the facet joints of a comparable group of young subjects with no recent history of major trauma. The injuries resemble some of the 'age changes' seen in older subjects dying non-violent deaths. It is suggested that such injuries may lead to early onset facetal arthritis in survivors of major trauma.
The main force which muscles, tendons and ligaments resist is tension. A single maximal tensile force will cause disruption of the tissue and an acute injury. Cyclic submaximal forces will cause adaptation if sufficient time is given for healing, and breakdown in the forces are applied over too short a period of time. The adaptive response is rate-limited. It is affected by the magnitude of the force and other factors.
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