Occipito-atlanto-axial dissociation in a child with preservation of life: a case report and review of the literature.

We report a case of a survivor of occipito-atlantal dislocation with atlantoaxial subluxation, an injury which is frequently fatal. Children less than 11 years of age appear to be especially vulnerable to these injuries due to their anatomy. The mechanism is alluded to but poorly understood.

Shoehorn technique for reduction of distal radius fracture: a technical note.

We describe a minimally invasive technique for reducing a fracture of the distal radius after closed reduction has failed. Being able to disimpact, distract, and translate the distal fracture fragment--using a small, intrafocally placed periosteal elevator as a lever--can make formal open reduction unnecessary for such fractures. Soft-tissue dissection and bone devascularization can be minimized with use of this technique.

Symptomatic cervical disc herniation following a motor vehicle collision: return to work comparative study of workers' compensation versus personal injury insurance status.

Background Context: Patients with approved workers' compensation injuries receive guaranteed compensation for the duration of their injury, whereas patients with personal injury claims are only compensated, if at all, at the time of a successful settlement or trial verdict at a time point distant from their injury.

Purpose: This study compares the financial impact and loss of work patterns due to a workers' compensation (WC) claim or personal injury in patients with a symptomatic cervical disc herniation resulting from a motor vehicle collision.

Study Design: A prospective study of patients who were seen by a single spine specialist between 1/2/96 and 9/1/01.

Is wound drainage necessary after lumbar spinal fusion surgery?

Background: Despite a lack of any evidence to support the utilization of closed-suction drainage after spinal surgery, it is a frequently utilized procedure.

Material/methods: A retrospective evaluation of eighty-five consecutive posterior lumbar fusions at a single level for degenerative disease was performed during the six-year period between March of 1996 and February 2002 by a single surgeon. No patient had a drain placed at the conclusion of the surgical procedure.

Norwegian scabies in the immunocompromised patient.

Norwegian, or crusted, scabies can be defined as a generalized severe scabies (Sarcoptes scabiei var. hominis) infestation usually affecting the immunocompromised patient that is most commonly seen with the leukemia-lymphoma group of neoplasms. The diagnosis is commonly missed, which can lead to mismanagement.

Long-term clinical manifestations of retained bullet fragments within the intervertebral disk space.

A retrospective review of 12 patients who were victims of penetrating trauma with a bullet or bullet fragments lodged within the intervertebral disk space was conducted. The objective of the review was to evaluate the potential systemic effects of lead resorption at long-term follow-up. Literature regarding the potential for lead toxicity due to retained bullet fragments within the intervertebral disk space is lacking.

Conjoined lumbar nerve roots: a frequently underappreciated congenital abnormality.

Nerve root anomalies are frequently underrecognized on advanced imaging studies and may account for some percentage of failed spinal surgical procedures. The conjoined nerve root represents the most common nerve root anomaly. It is a well-known cause of false-positive readings for bulging and herniated disks in patients with purely axial neuroimaging studies.

Total ankle arthroplasty: a review of 11 current ankle implants.

Introduced in the early 1970s, total ankle arthroplasty offered patients with debilitating ankle arthritis reduction in pain and almost normal mobility at the ankle joint. The idea of replacing an arthritic ankle joint with a mobile ankle prosthesis was originally welcomed to replace ankle arthrodesis. Unfortunately, high failure rates of first-generation implants led many surgeons in the United States to recommend ankle arthrodesis as the best alternative.

Hyperbaric oxygen therapy for lower-extremity soft-tissue sports injuries.

Lower-extremity injuries have become increasingly common as sports performance demands have risen. Hyperbaric oxygen therapy is one method used to return athletes to competition as quickly as possible, but it has received criticism and lacks support. This review examines the literature on hyperbaric oxygen therapy and soft-tissue sports injuries.

Onychomycosis: an analysis of 50 cases and a comparison of diagnostic techniques.

Onychomycosis is an extremely common condition that is increasing in prevalence. Although often innocuous, it may be complicated by discomfort and secondary bacterial infections. Recently introduced oral medications may be highly effective in the eradication of this condition; however, they may carry with them significant expense and potentially serious side effects.

Shift Change.

[Parkhurst DC: Shift change. Ann Emerg Med June 1998;31:785-788.].

Graves' disease in a patient with thyroid hemiagenesis.

A case is presented of Graves' disease occurring in a patient with hemiagenesis of the thyroid gland. The diagnosis was suspected clinically and was confirmed by laboratory tests and imaging studies, as well as by the presence of thyroid-stimulating antibody.