DOCSLIB.ORG

Treatment of Isolated Sternal Fracture with Ultrasound-Guided Paravertebral Nerve Block: a Case Report and Literature Review

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Treatment of Isolated Sternal Fracture with Ultrasound-Guided Paravertebral Nerve Block: a Case Report and Literature Review Kosin Medical Journal 2019;34:152-160. https://doi.org/10.7180/kmj.2019.34.2.152 &D VH 5HSRUWV Treatment of Isolated Sternal Fracture with Ultrasound-Guided Paravertebral Nerve Block: a Case Report and Literature Review Jun-Mo Park 1, Hyunjeong Kim 1 Department of Anesthesiology and Pain Medicine, School of Medicine, Kyungpook National University, Kyungpook Na - tional University Hospital, Daegu, Korea In the case of isolated sternal fractures, conservative treatment with analgesics is common, but pain can persist for more than 10 weeks, which can significantly interfere with daily life. Ultrasound-guided paravertebral nerve block is reported to be a successful means of pain control in patients with chest wall injury or rib fracture. A 70-year-old female patient presented with anterior chest pain that had persisted for 2 weeks despite conservative treat - ment. Sagittal reconstruction chest computed tomography and sternum lateral oblique x-ray revealed an isolated sternal fracture. An ultrasound-guided bilateral paravertebral nerve block was performed for pain control. After performing the procedure twice at a 1-week interval, the patient reported complete pain alleviation, and no other problems were observed over the 3-month follow-up period. Ultrasound-guided bilateral paravertebral nerve block can help patients with isolated sternal fractures to manage pain and return to normal activities sooner than with oral analgesics. Key Words : Fracture, Nerve block, Pain management, Sternum, Ultrasonography Sternal fractures are not uncommon and have to the internal thoracic organs, with isolated ster - been reported to occur in 3.7% of patients hos - nal fractures considered benign lesions in the ab - pitalized after a traffic accident. 1 Before the use sence of accompanying cardio-respiratory of seatbelts became mandatory, a sternal fracture damage. 1,2 More than 95% of sternal fractures was a marker for high-energy trauma. After the are treated conservatively. 2 The most important use of safety belts was legislated, the number of factor in the treatment of isolated sternal frac - patients surviving traffic collisions increased, tures is adequate pain control, usually managed accompanied by an increase in patients present - with oral analgesics. 3 ing with sternal fractures as a result of these ac - Few studies, however, have been published re - cidents. garding the functional effects of isolated sternal The morbidity and mortality rates of sternal fractures on daily activities. According to one fractures are determined by associated injuries study, although chest pain was the most fre - Corresponding Author : Jun-Mo Park, Department of Anesthesiology and Pain Medicine, Kyungpook National Receive d: Aug. 26, 2019 University Chilgok Hospital, 807 Hoguk-ro, Buk-gu, Daegu 41404, Korea Revise d: Oct. 12, 2019 Tel: +82-53-200-2643 Fax: +82-53-200-2027 E-mail: [email protected] Accepted : Oct. 15, 2019 152 Treatment of isolated sternal fracture quently reported and persistent symptom, con - She was examined at a local clinic near her home tinuing for an average of 10.9 weeks, the dura - and was told that her sternum had cracked. That tion of pain was significantly prolonged in doctor recommended rest and prescribed an patients older than 50 years of age presenting NSAID medication. However, her symptoms had with an isolated sternal fracture. 4 This prolonged not improved, and she complained that the chest pain often necessitates the administration NSAID was causing facial swelling and heart - of oral analgesics for a relatively long period, but burn. In addition, the patient was planning an this long-term use can be limited by the side ef - overseas trip with her family in 2 weeks. She vis - fects of non-steroidal anti-inflammatory drugs ited our clinic to address her pain so she could (NSAIDs) and opioids. 5 In particular, older pa - travel unencumbered. tients may have underlying medical conditions A sternal fracture was already suspected at the that contraindicate analgesic use. Other patients other facility, and the pain had persisted even may have to return to their daily lives before the after 2 weeks of adequate treatment. We thereby pain has subsided, which can be difficult to do performed chest computed tomography (CT) in - when undergoing conservative treatment alone. cluding sagittal reconstruction, x-rays of the We report a case of successful management of sternum lateral and lateral oblique aspects, elec - pain in a patient with an isolated sternal fracture trocardiography (ECG), and a cardiac enzyme using an ultrasound-guided bilateral paraverte - test to check for any accompanying injuries. A bral nerve block. thorough physical examination was also con - ducted on the patient, and no specific abnormal signs were found other than intense, localized CASE tenderness at the mid portion of the sternal body. A recent fracture was observed at the sternum be - A 70-year-old female patient presented with an - tween the third and fourth ribs on the sagittal re - terior chest pain that had persisted for 2 weeks. construction chest CT and sternum lateral The patient had no pertinent medical history oblique x-ray (Fig. 1A, 1B). There was mild soft other than 10 years of anti-hypertensive drug tissue edema around the fractured area, but no medication. The patient reported a fall 2 weeks hemorrhage, and no soft tissue injury that would before visiting the pain clinic, hitting her chest indicate a pathologic fracture. No abnormalities against a stone, followed by chest pain. The pain were found on the ECG or cardiac enzyme test. was less severe when she remained still but wors - As such, we decided to perform an ultrasound- ened when she coughed or spread her arms, and guided bilateral paravertebral nerve block at the she reported difficulty with bending her chest space between the third and fourth ribs to allow forward or turning over in bed. The patient's vi - the patient to return to normal daily life sooner, sual analog scale (VAS) score was 7 out of 10. particularly, to travel abroad with her family after 153 Kosin Medical Journal 2019;34:152-160. Fig. 1. (A) Sternum lateral oblique x-ray. (B) Sagittal reconstruction chest CT. Arrows indicate fracture site. 2 weeks. The patient was placed in the prone po - direction using an in-plane technique. After it sition, the third and fourth ribs were visualized was confirmed that the needle was placed in the with C-arm guidance (Fig. 2A), and the skin was region under the transverse process and that no marked along the running direction of each rib blood or air was withdrawn during negative as - (Fig. 2B). After sterilization of the skin, a curved piration, a mixture of 10 mL of 0.5% lidocaine transducer (1.5–4.6 MHz) for a GE Logiq7 ul - and 20mg of methylprednisolone acetate was trasound machine (Tokyo, Japan) was placed slowly injected. During the injection, concomi - parallel to the direction indicated on the skin and tant anterior movement of the parietal pleura was moved medially to check the spinous and trans - checked by ultrasound to confirm that the drug verse processes of the third thoracic vertebra. was injected into the correct location (Fig. 3B). The transducer was then moved laterally along After completing this procedure on one side, it the skin markings to locate the thoracic paraver - was repeated on the other side. tebral space for injection (Fig. 2C). The trans - Thirty minutes after the procedure, the patient’s ducer was moved slightly in the cephalad and VAS score of the pain caused by coughing or caudal directions perpendicular to the direction spreading her arms was reduced to 2 out of 10, of the rib indicated on the skin to confirm that without any complications. Since the patient the rib was excluded from the path of the needle complained of side effects from the NSAID, tra - (Fig. 3A). A 10-cm, 22-gauge SonoPlex cannula madol and a skeletal muscle relaxant were pre - with facet grinding (Pajunk GmbH, Geisingen, scribed, and the patient was asked to return for a Germany) was inserted in the lateral to medial follow-up in 1 week. After 1 week, the patient 154 Treatment of isolated sternal fracture Fig. 2. (A) C-arm view showing the direction of the third and fourth ribs. (B) Skin was marked along the running direction of the third and fourth ribs. (C) Curved transducer was placed parallel to the di- rection indicated on the skin and moved medially and laterally along the skin markings and cepha- lad and caudally to locate the thoracic paravertebral space for injection. Fig. 3. (A) Ultrasound view showing the ribs were excluded from the path of the needle. (B) Ultrasound view showing anterior movement of the parietal pleura (small arrow). T: target region, TP: trans- verse process, needle (arrow head), tip of needle (large arrow). 155 Kosin Medical Journal 2019;34:152-160. reported that her VAS score was about 1 or 2 out total of 32,746 cases of injuries including sternal of 10 for most of the day. She also did not com - fracture between 2007 and 2010 using the Na - plain of any particular side effects of the pre - tional Trauma Data Bank, Yeh et al. reported that scribed drugs. Since the patient was concerned 84% of sternal fractures were associated with car that the pain would recur during the planned accidents, with sternal fracture confirmed in overseas trip with her family 1 week later, the 3.7% of all patients hospitalized due to a colli - procedure was repeated, and the same drugs were sion. 1 According to Oyetunji et al., the most com - prescribed. The patient followed up with us 2 mon cause of sternal fracture is car accidents, weeks after the trip and reported that she had not and the second most common cause is falls.
Load more

Recommended publications
  • Managing a Rib Fracture: a Patient Guide
    Managing a Rib Fracture A Patient Guide What is a rib fracture? How is a fractured rib diagnosed? A rib fracture is a break of any of the bones that form the Your doctor will ask questions about your injury and do a rib cage. There may be a single fracture of one or more ribs, physical exam. or a rib may be broken into several pieces. Rib fractures are The doctor may: usually quite painful as the ribs have to move to allow for normal breathing. • Push on your chest to find out where you are hurt. • Watch you breathe and listen to your lungs to make What is a flail chest? sure air is moving in and out normally. When three or more neighboring ribs are fractured in • Listen to your heart. two or more places, a “flail chest” results. This creates an • Check your head, neck, spine, and belly to make sure unstable section of chest wall that moves in the opposite there are no other injuries. direction to the rest of rib cage when you take a breath. • You may need to have an X-ray or other imaging test; For example, when you breathe in your rib cage rises out however, rib fractures do not always show up on X-rays. but the flail chest portion of the rib cage will actually fall in. So you may be treated as though you have a fractured This limits your ability to take effective deep breaths. rib even if an X-ray doesn’t show any broken bones.
    [Show full text]
  • Delayed Traumatic Hemothorax in Older Adults
    Open access Brief report Trauma Surg Acute Care Open: first published as 10.1136/tsaco-2020-000626 on 8 March 2021. Downloaded from Complication to consider: delayed traumatic hemothorax in older adults Jeff Choi ,1 Ananya Anand ,1 Katherine D Sborov,2 William Walton,3 Lawrence Chow,4 Oscar Guillamondegui,5 Bradley M Dennis,5 David Spain,1 Kristan Staudenmayer1 ► Additional material is ABSTRACT very small hemothoraces rarely require interven- published online only. To view, Background Emerging evidence suggests older adults tion whereas larger hemothoraces often undergo please visit the journal online immediate drainage. However, emerging evidence (http:// dx. doi. org/ 10. 1136/ may experience subtle hemothoraces that progress tsaco- 2020- 000626). over several days. Delayed progression and delayed suggests HTX in older adults with rib fractures may development of traumatic hemothorax (dHTX) have not experience subtle hemothoraces that progress in a 1Surgery, Stanford University, been well characterized. We hypothesized dHTX would delayed fashion over several days.1 2 If true, older Stanford, California, USA be infrequent but associated with factors that may aid adults may be at risk of developing empyema or 2Vanderbilt University School of Medicine, Nashville, Tennessee, prediction. other complications without close monitoring. USA Methods We retrospectively reviewed adults aged ≥50 Delayed progression and delayed development of 3Radiology, Vanderbilt University years diagnosed with dHTX after rib fractures at two traumatic hemothorax (dHTX) have not been well Medical Center, Nashville, level 1 trauma centers (March 2018 to September 2019). characterized in literature. The ageing US popula- Tennessee, USA tion and increasing incidence of rib fractures among 4Radiology, Stanford University, dHTX was defined as HTX discovered ≥48 hours after Stanford, California, USA admission chest CT showed either no or ’minimal/trace’ older adults underscore a pressing need for better 5Department of Surgery, HTX.
    [Show full text]
  • Rib Fracture Management Guideline
    Rib Fracture Management Guideline The main goals of treatment for patients with multiple rib fractures, with or without flail segments, are pain control, support of respiratory function, and chest wall stabilization. ICU admission for two or more of the following: Age >65 years History of COPD and/or heart failure, home oxygen use, current smoker, or other significant pulmonary condition 4 or more rib fractures Flail segment (at least 3 consecutive ribs with 2 fractures) IS volumes <50% of predicted volume (see chart) Inadequate pain control Pain Management: Non-ICU patients should receive a multimodal regimen with PRN opioids (also see pain management algorithm for verbal patients) ICU patients should receive a PCA (morphine preferred) in addition to multimodal regimen Multimodal Pain Regimen (include all as appropriate): o Acetaminophen 1000mg PO/IV q8h (po preferred) o Ketoralac 15-30mg IV q6h x 5 days or ibuprofen 600mg po q6 hours PRN (avoid if bleeding or renal dysfunction) o Methocarbamol 500-1000mg PO/IV q8h (po preferred; avoid IV if renal dysfunction) PCA guidelines o PCA should NOT have a continuous rate or be administered with any other opioids o Recommended dose for morphine: 1 mg q6 minutes, max dose 10 mg/hour o Recommended for hydromorphone: 0.1 mg q15 minutes, max dose 0.4 mg/hr o Transition to an oral regimen as soon as possible . Determine the amount of opioid given over the previous 24 hours by PCA . If ≥ 40 mg morphine equivalents, start long-acting oxycodone (can’t be given through a feeding tube) BID with a 50% taper.
    [Show full text]
  • Rib Cartilage Injuries
    PHYSIO4ALL revitalise – bounce – be healthy Rib Cartilage Injuries Structure of the ribcage The ribcage supports the upper body, protects internal organs including the heart and lungs, and assists with breathing. It consists of 24 curved ribs arranged in 12 pairs. Each pair is attached to a vertebra in the spine. At the front of the body, the first seven pairs of ribs are attached directly to the sternum (breastbone) by cartilage known as costal cartilage. These ribs are often called ‘true ribs’. The next three pairs aren’t connected to the sternum. Instead, costal cartilage attaches these ‘false ribs’ to the last pair of true ribs. The remaining two pairs aren’t attached at the front of the body at all and are known as ‘floating ribs’. The ribcage is supported by ligaments and muscles, including the muscles between the ribs (intercostal muscles). These muscles allow the ribcage to expand when you breathe in, and drop when you breathe out. Rib injuries include bruises, torn cartilage and bone fractures. Shop No. P16, NorthPoint, 100 Miller St. North Sydney. NSW – 2060 T – (02) 99222212 F – (02) 99225577 W: www.physio4all.com.au E: [email protected] ABN: 77 548 297 578 PHYSIO4ALL revitalise – bounce – be healthy Symptoms of rib cartilage injury Symptoms of rib injuries depend on the type and severity of the injury, but can include: • Pain at the injury site • Pain when the ribcage flexes – for example when you breathe, cough, sneeze or laugh • Pain when rotating or side flexing your spine • Crunching or grinding sounds (crepitus) when the injury site is touched or moved • Muscle spasms of the ribcage • Deformed appearance of the ribcage • Breathing difficulties.
    [Show full text]
  • Rib Fracture Management in the Older Adult; an Opportunity for Multidisciplinary Working
    Subspecialty Section Rib fracture management in the older adult; an opportunity for multidisciplinary working Lauren Richardson and Shvaita Ralhan The elderly will soon make up the largest number of patients sustaining major trauma; a fall from standing height is their most common mechanism of injury1. Rib fractures are a common consequence of blunt chest trauma and are important to recognise and diagnose as complications can be fatal. They can be considered a surrogate for major trauma as up to 90% of patients will Lauren Richardson is an ST7 Registrar go on to have additional injuries identified2. The older in Geriatric and General Medicine working in the Thames Valley. Whilst adult presents a unique challenge. Their injuries are often undertaking a fellowship in Perioperative under-estimated and therefore under-triaged. Delays to Medicine she helped to develop the diagnosis are not uncommon3. Major Trauma Geriatric service at the John Radcliffe Hospital in Oxford. he mortality and thoracic deal with. Decisions regarding which team morbidity in the elderly as these patients should be admitted under can a result of rib fractures is therefore be contentious. Nationally, there is double that of their younger significant variation, and even in institutions counterparts. In elderly patients, such as ours where pathways do exist, Tfor each additional rib fracture, mortality conflicts often arise as to where the patient increases by 19% and the risk of pneumonia should be managed and by whom. increases by 27%4. It is therefore not surprising that older adults who sustain rib This article aims to address the key issues fractures have increased lengths of stay and that arise when managing older adults with more prolonged intensive care admissions5–7.
    [Show full text]
  • Practice Management Guidelines for Screening of Blunt Cardiac Injury
    PRACTICE MANAGEMENT GUIDELINES FOR SCREENING OF BLUNT CARDIAC INJURY EAST Practice Parameter Workgroup for Screening of Blunt Cardiac Injury Michael D. Pasquale, MD Kimberly Nagy, MD John Clarke, MD © Copyright 1998 Eastern Association for the Surgery of Trauma 1 Practice Management Guidelines for Screening of Blunt Cardiac Injury I. Statement of the problem The reported incidence of blunt cardiac injury (BCI), formerly called myocardial contusion, depends on the modality and criteria used for diagnosis and ranges from 8% to 71% in those patients sustaining blunt chest trauma. The true incidence remains unknown as there is no diagnostic gold standard, i.e. the available data is conflicting with respect to how the diagnosis should be made (EKG, enzyme analysis, echocardiogram, etc.) The lack of such a standard leads to confusion with respect to making a diagnosis and makes the literature difficult to interpret. Key issues involve identifying a patient population at risk for adverse events from BCI and then appropriately monitoring and treating them. Conversely, patients not at risk could potentially be discharged from the hospital with appropriate follow-up. II. Process A Medline search from January 1986 through February 1997 was performed. All English language citations during this time period with the subject words “myocardial contusion”, “blunt cardiac injury”, and “cardiac trauma” were retrieved. Letters to the editor, isolated case reports, series of patients presenting in cardiac arrest, and articles focusing on emergency room thoracotomy were deleted from the review. This left 56 articles which were primarily well-conducted studies or reviews involving the identification of BCI. III. Recommendations A.
    [Show full text]
  • Theappearanceof Bonescansfollowingfractures,Inciudingimmediateand Long@-Termstudies
    CLINICAL SCIENCES DIAGNOS11C NUCLEAR MEDICINE TheAppearanceof BoneScansFollowingFractures,InciudingImmediateand Long@-TermStudies Philip Matin RosevilleCommunityHospital,Roseville,andUniversityof California,Davis,California Bone scans were performed on 204 patients at Intervals ranging from 6 hr to several years after traumatic fractures. The minimum time for a bone scan to be come abnormal following fracture was age-dependent; however, 80% of all frac tures were abnormal by 24 hr, and 95 % by 72 1w,after Injury. Three distinct tempo rally related phases were noted on bone scans as sequential studies showed a gradual return to normal. The minimum tIme for a fracture to return to normal on a bone scan was 5 mo. Approximately 90% of the fractures returned to normal by 2 yr after injury. J NuciMed 20:1227—1231,1979 Bone scans performed with technetium-99m phos were performed within 2 wk after fracture, including 60 phate compounds have proven to be among the most patients who had bone scans within the first week of in useful nuclear medicine procedures. The bone scan jury. The studies on these patients were performed until provides a sensitive method of detecting primary and their fractures became abnormal or until 7 days after metastatic skeletal neoplasms, and it has been useful in injury. In this group, nine patients were studied within evaluating metabolic bone disease and various joint 6 hr of their injury, and 20 within 24 hr. abnormalities (1—8).Although the procedure is helpful The subacute studies were performed during the in in evaluating skeletal trauma (9—12,14)little informa terval from 4 wk to 4 mo after injury; and the long-term tion is available about how bone scans change in ap or healing-stage studies were performed at periods pearance following fracture, and there have been es varying from 6 to 36 mo after fracture.
    [Show full text]
  • Sternal Insufficiency Fracture Related to Steroid-Induced Osteoporosis: a Case Report Jessica J
    0008-3194/2013/48–54/$2.00/©JCCA 2013 Sternal insufficiency fracture related to steroid-induced osteoporosis: A case report Jessica J. Wong, BSc, DC, FCCS(C)1 Brian Drew, MD, FRCPS2 Paula Stern, BSc, DC, FCCS(C)1 Osteoporosis often results in fractures, deformity L’ostéoporose cause souvent des fractures, des and disability. A rare but potentially challenging difformités et l’invalidité. Une complication rare, mais complication of osteoporosis is a sternal insufficiency potentiellement grave, de l’ostéoporose est la fracture fracture. This case report details a steroid-induced par insuffisance osseuse du sternum. Ce rapport osteoporotic male who suffered a sternal insufficiency décrit en détail le cas d’un mâle atteint d’ostéoporose fracture after minimal trauma. Prompt diagnosis causée par les stéroïdes et qui a subi une fracture par and appropriate management resulted in favourable insuffisance osseuse du sternum après un traumatisme outcome for the fracture, though a sequalae involving a minime. Grâce à un diagnostic rapide et une gestion myocardial infarction ensued with his osteoporosis and appropriée, on a obtenu de bons résultats pour la complex health history. The purpose of this case report fracture, mais des séquelles ont été laissées sous forme is to heighten awareness around distinct characteristics d’un infarctus du myocarde en raison de ses antécédents of sternal fractures in osteoporotic patients. Discussion médicaux complexes. Le but de cette étude de cas est focuses on the incidence, mechanism, associated de sensibiliser sur les caractéristiques distinctes des factors and diagnostic challenge of sternal insufficiency fractures du sternum chez les patients ostéoporotiques. fractures. This case report highlights the role primary La discussion porte sur l’incidence, le mécanisme, contact practitioners can play in recognition and les facteurs associés et la difficulté de diagnostic des management of sternal insufficiency fractures related to fractures par insuffisance osseuse du sternum.
    [Show full text]
  • Vertebroplasty
    Association for Radiologic & Imaging Nursing Clinical Practice Guideline Vertebroplasty Overview Vertebroplasty is a percutaneous procedure performed to treat painful vertebral compression fractures. The procedure uses Polymethlymethacrylate (PMMA) through a needle percutaneously inserted into the body of the vertebrae to stabilize the compression fracture. This procedure is commonly performed as an outpatient procedure for treatment of osteoporotic, metastatic, and benign lytic lesions such as hemangiomas of the spine. It is not typically used to treat the non- osteoporotic acute traumatic compression fracture. Target Audience RNs working in the Interventional Radiology Division Content/Strategies Osteoporosis is present in one out of every four women and one out of every eight men, over the age of 50. Along with the aging baby boomer generation, it is being identified by the public in greater numbers as a health risk. Neoplastic disease can metastasize to the vertebrae causing compression fractures. Treating these painful lesions in a palliative manner can improve end-of-life quality. Hemangiomas destabilize the body of the vertebrae leading to compression fracture. Eighty to 90 percent of patients obtain significant pain relief. Nursing Considerations: Pre procedure- Adequate intravenous access Proper positioning—often these patients are frail elders who must be positioned prone for the procedure. Bony prominences must be protected. Care must be taken when moving these patients to prevent causing fragility fractures to legs and ribs. Adequate airway maintenance in the prone position must be assured. Most procedures can be done under conscious sedation with some local anesthetic, although some might require general anesthesia depending on their acuity level. Intra procedure- Absolute sterility of this procedure is imperative—full surgical scrub of site, cap/mask for all in room.
    [Show full text]
  • Ribloc U Plus Muscle-Sparing and Subscapular Rib Fracture
    Surgical Technique Muscle-Sparing and Subscapular Rib Fracture Repair Acute Innovative Solutions for Challenging A Innovations® Thoracic Procedures an company Acute Innovations® RibLoc® U Plus Chest Wall Plating System: Muscle-Sparing and Subscapular Rib Fracture Repair Muscle-Sparing and Subscapular Rib Fracture Repair Planning, Positioning, and Surgical Approach Timothy Pohlman, MD R. Lawrence Reed, MD John Seccombe, MD IU Health Methodist Hospital, IN IU Health Methodist Hospital, IN St. Vincent Hospital, WI John C. Mayberry, MD Bruce Ham, MD St. Alphonsus Health Systems, ID Oregon Health & Science University Operative repair of rib fractures is beneficial and cost effective, reducing pain and disability and restoring pulmonary function.1, 2, 3 Muscle-sparing exposure is advocated in any rib fracture repair. Addressing subscapular fractures may not be necessary in all cases,4 but when deemed beneficial, it can be technically challenging and requires a planned approach. Keys for Success Preoperative Planning ⊲ 3D CT imaging to identify fracture locations and to plan approach ⊲ Patient-specific risk-benefit analysis to determine if fractures should be addressed and which to target ⊲ Optimal patient positioning to access fractures: lateral or prone ⊲ Arm prepped into sterile field to aid in scapula manipulation ⊲ Table-mounted retraction system (worth the set-up time) Surgical Exposure ⊲ Muscle-sparing primary incision to address majority of displaced fractures PRE-OP: 3D CT reconstruction showing ⊲ Identification of muscles to preserve,
    [Show full text]
  • First Rib Fracture Nonunion Treated with Bone Marrow Aspirate Concentrate in a Division 1 Collegiate Baseball Player Kanjiya S1*, Gambardella RA1 and Moon CN2
    ISSN: 2469-5718 Kanjiya et al. Int J Sports Exerc Med 2021, 7:187 DOI: 10.23937/2469-5718/1510187 Volume 7 | Issue 2 International Journal of Open Access Sports and Exercise Medicine CASE REPORT First Rib Fracture Nonunion Treated With Bone Marrow Aspirate Concentrate in a Division 1 Collegiate Baseball Player Kanjiya S1*, Gambardella RA1 and Moon CN2 1Cedars-Sinai Kerlan-Jobe Institute, USA 2Director of Orthopaedic Trauma, Department of Orthopedics, USA Check for updates *Corresponding author: Shrey M. Kanjiya, MD, Cedars-Sinai Kerlan-Jobe Institute, USA Introduction boids. He had normal neurologic and vascular evalua- tion. The remainder of his shoulder exam has normal. Fractures of the first rib have historically been de- Conventional shoulder radiographs were obtained in scribed in major trauma with a high prevalence for car- the office which demonstrated an acute non displaced diothoracic and musculoskeletal fractures. However, posterior first rib fracture (Figure 1). The patient was there have been several case reports describing first rib treated conservatively and discontinued playing base- fractures in athletes. The vast majority of these patients ball. Evaluation 6 weeks later demonstrated normal return to play with conservative management. Unfortu- physical exam findings and radiographs showed early nately, some patients may develop fracture nonunion. callus formation. At 12 weeks (7 months from injury) Patients that develop a nonunion may remain asymp- from presentation the patient was allowed to resume tomatic. In the rare case that a patient is symptomatic baseball related activities. However, the patient began or develops thoracic outlet from a fracture nonunion to have dull posterior shoulder pain with batting.
    [Show full text]
  • Fracture of the Scapula with Intrathoracic Penetration in a Skeletally Mature Patient
    Wright State University CORE Scholar Department of Surgery Faculty Publications Surgery 12-2006 Fracture of the Scapula with Intrathoracic Penetration in a Skeletally Mature Patient Cary C. Schwartzbach Hani Seoudi Amy E. Ross Kimberly M. Hendershot Wright State University, [email protected] Linda Robinson See next page for additional authors Follow this and additional works at: https://corescholar.libraries.wright.edu/surg Part of the Surgery Commons Repository Citation Schwartzbach, C. C., Seoudi, H., Ross, A. E., Hendershot, K. M., Robinson, L., & Maekzadeh, A. (2006). Fracture of the Scapula with Intrathoracic Penetration in a Skeletally Mature Patient. The Journal of Bone and Joint Surgery, 88 (12), 2735-2738. https://corescholar.libraries.wright.edu/surg/198 This Report is brought to you for free and open access by the Surgery at CORE Scholar. It has been accepted for inclusion in Department of Surgery Faculty Publications by an authorized administrator of CORE Scholar. For more information, please contact [email protected]. Authors Cary C. Schwartzbach, Hani Seoudi, Amy E. Ross, Kimberly M. Hendershot, Linda Robinson, and Alireza Maekzadeh This report is available at CORE Scholar: https://corescholar.libraries.wright.edu/surg/198 Schwartzbach.fm Page 2735 Monday, November 6, 2006 2:27 PM 2735 COPYRIGHT © 2006 BY THE JOURNAL OF BONE AND JOINT SURGERY, INCORPORATED Fracture of the Scapula with Intrathoracic Penetration in a Skeletally Mature Patient A CASE REPORT BY CARY C. SCHWARTZBACH, MD, HANI SEOUDI, MD, AMY E. ROSS, MD, KIMBERLY HENDERSHOT, MD, LINDA ROBINSON, MA, MS, AND ALIREZA MALEKZADEH, MD Investigation performed at Inova Fairfax Hospital, Falls Church, Virginia o our knowledge, intrathoracic displacement of a frac- late reconstruction should nonoperative management fail.
    [Show full text]