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Thoracic Trauma
Published in Ian Greaves, Keith Porter, Jeff Garner, Trauma Care Manual, 2021
Ian Greaves, Keith Porter, Jeff Garner
The diagnosis of a flail segment is usually clinical, by observation of abnormal chest wall movement and the palpation of crepitus. Flail segments are often more easily seen from low down near the patient’s feet looking tangentially across their chest. Splinting from chest wall muscular spasm may mask the paradoxical movement, and the diagnosis is not uncommonly delayed until these muscles relax from exhaustion. The chest radiograph will not always reveal rib fractures or costochondral separation. An anterior flail chest can be particularly difficult to diagnose, as paradoxical movement (although present) is hard to detect when movement appears symmetrical. The possibility of a central flail, although rare, should always be considered.
Kawasaki disease
Published in Samar Razaq, Difficult Cases in Primary Care, 2021
Ten-year-old Joshua presents with mum who tells you that he has been complaining of left-sided chest pain for 2 weeks. On examination you find an isolated, tender and mildly swollen second costochondral junction. What is the most likely diagnosis? CostochondritisTietze’s syndromeSlipping rib syndromeTexidor’s twingePericarditis
Examination of Pediatric Shoulder
Published in Nirmal Raj Gopinathan, Clinical Orthopedic Examination of a Child, 2021
Use a systematic approach and always follow the same sequence during examination. We usually start the palpation from the midline, i.e., the sternoclavicular joint. An increase in temperature, tenderness, or step deformities can be identified. This is followed by palpation of the suprasternal notch, sternocleidomastoid muscle, and the first rib. Palpate the costochondral junctions if suspecting costochondritis or Teitze syndrome. Next, both clavicles are palpated. At the concavity of the clavicle, palpate the coracoid a finger’s breadth below the clavicle. Be gentle in doing this because even the normal coracoid may be a bit tender on palpation. Always compare with the opposite side.
Immediate reconstruction of segmental mandibular defects via tissue engineering
Published in Baylor University Medical Center Proceedings, 2022
Robert O. Weiss, Patrick E. Wong, Likith V. Reddy
Reconstruction was performed based on a tissue engineering protocol. Both patients were taken to the operative room for surgical resection and immediate reconstruction. A combined intraoral and extraoral approach was used to allow access in both cases. For Patient 1, the zygomatic arch was osteotomized to allow for unfettered access to the expansive lesion. Following anterior osteotomy in the parasymphysis region, disarticulation of the condyle easily aided in completing the hemimandibulectomy. A costochondral autograft was obtained from the patient’s right sixth rib to reconstruct the temporomandibular joint aspect. For Patient 2, the resection did not require disarticulation of the joint, and an osteotomy was performed at the anterior parasymphysis region and mid-ramus. A cadaveric rib allograft was secured to the inferior aspect of the reconstruction plate to provide for an inferior stop for bone grafting material. Nerve allografts were secured to the inferior alveolar nerve stumps and a multilayered water-tight closure concluded the procedure.
The Morphology and Bending Behavior of Regenerated Costal Cartilage with Kawanabe-Nagata Method in Rabbits – the Short Term Result of an Experimental Study
Published in Journal of Investigative Surgery, 2021
Jingjian Han, Roberto Cuomo, Yanyong Zhao, Bo Pan, Qinghua Yang
The rabbit was fixed in a supine position and a mid-sternal incision was made. The pectoral muscles were dissected and the costal cartilages exposed. A section of costal cartilage about 1.5 cm lengths was excised from the fifth costal cartilage on both sides of each animal. The perichondrium was left completely intact and closed with a 7-0 nylon suture to form a perichondrial pocket. The costochondral junction was preserved intact. The excised costal cartilage was cut into about 0.5 mm cartilage pieces using a scalpel, and put back to the perichondrial pocket of left side. On the right side, we close the pocket without reimplantation. The amount of cartilage returned was about 1/5 to 1/4 of its original volume to simulate the clinical practice in ear framework fabrication. The pectoral muscle and skin was closed in sequence.
Cluster subgroups based on overall pressure pain sensitivity and psychosocial factors in chronic musculoskeletal pain: Differences in clinical outcomes
Published in Physiotherapy Theory and Practice, 2019
Suzana C Almeida, Steven Z George, Raquel D. V Leite, Anamaria S Oliveira, Thais C Chaves
The points evaluated by algometry were the thenar region of the nondominant hand and the nine sites described by the American College of Rheumatology (Wolfe et al., 1990), including the following: 1) sternal border of the sternocleidomastoid muscle above the head of the clavicle; 2) midpoint of the upper trapezius muscle; 3) second rib, lateral to the costochondral junction, on the upper surface (request contraction of the pectoralis major); 4) 2–4 cm distal to the lateral epicondyle (m. brachioradialis); 5) medial knee fat, proximal to the joint interline; 6) insertion of the suboccipital muscle; 7) supraspinatus insertion above the spine of the scapula, near the upper edge; 8) superolateral quadrant of the buttock, anterior to the muscle (contraction of the gluteus maximus); and 9) posterior to the greater trochanter.