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Vascular Trauma
Published in James Michael Forsyth, How to Be a Safe Consultant Vascular Surgeon from Day One, 2023
Circulation → Heart rate 100, blood pressure 100/80 mmHg. Abdomen is soft and non-tender, not distended. Patient has an obviously deformed right thigh. There is a 2-cm wound in the medial right thigh, and beneath this you can feel/see a bone spike. There is a large swelling in the medial right thigh that looks like a big underlying haematoma. The patient has a femoral pulse but nil distally. The right calcaneum is deformed, but there is no open wound. The right foot is cool with a capillary refill time of 4 seconds. The sensation and power in the right foot are reduced.
Evaluation of the Spine in a Child
Published in Nirmal Raj Gopinathan, Clinical Orthopedic Examination of a Child, 2021
Ashish Dagar, Sarvdeep Singh Dhatt, Deepak Neradi, Vijay G Goni
Palpation of the supraclavicular fossa, axilla, triangles of the neck, chest, abdomen, iliac fossa, groin, hip, and thigh should be part of the lumbosacral spine examination. Any swelling should be looked for in the loin, iliac fossae, pettit’s triangle, groin, and medial aspect of the thigh and, if present, should raise the suspicion of a cold abscess.
Musculoskeletal trauma
Published in Ian Greaves, Keith Porter, Chris Wright, Trauma Care Pre-Hospital Manual, 2018
Ian Greaves, Keith Porter, Chris Wright
The powerful muscles of the thigh act to prevent manual reduction of the fracture. Opiate intravenous analgesia is essential and the affected limb should be placed in a traction splint after manual correction of the deformity during which the leg should be pulled out to near its normal length. Once the splint is in place, the patient’s analgesic requirements normally drop dramatically.
Disseminated Nocardia farcinica infection associated with bacteraemia and osteomyelitis pubis in an elderly patient
Published in Infectious Diseases, 2023
Domingo Fernández Vecilla, Mary Paz Roche Matheus, Mikel Joseba Urrutikoetxea Gutiérrez, Felicitas Elena Calvo Muro, Cristina Aspichueta Vivanco, Iñigo López Azkarreta, Mikel Grau García, José Luis Díaz de Tuesta del Arco
Antibiotic treatment was changed to 320 mg/1600 mg/12 h of IV trimethoprim/sulfamethoxazole and magnetic resonance imaging (MRI) was conducted. The MRI revealed findings that were indicative of osteomyelitis in the right iliopubic branch. Additionally, multiple abscessed collections were observed in the abductor, glutaeal, and right iliac musculature, as well as in the left glutaeal and posterior aspects of both thighs, with a larger abscess formation on the right side. Abscesses were also present in both gastrocnemius muscles (Figure 2). Almost 1000 ml were drained from the right thigh and calf muscle collections. A whole-body computed tomography scan showed dissemination of the infection affecting the thorax and lower extremities (Figure 3) with a suspicious lytic lesion in the right iliopubic branch. N. farcinica was also isolated from all samples obtained from the multiple abscesses.
Fatal bone marrow embolism
Published in Baylor University Medical Center Proceedings, 2022
Rasmey Thach, Alexandra Cina, Lorenzo Gitto
Due to the history of drug abuse and the lack of information regarding the traumatic fracture, a medicolegal autopsy was ordered. External examination revealed multiple stage III and IV pressure ulcers localized to the sacrum, left gluteal fold, and right gluteus. The right lower extremity was in an externally rotated position and shorter in length than the left. There was no evidence of rib fractures. Dissection of the right thigh revealed a displaced femoral fracture, surrounded by dark brown to black-colored necrotic soft tissues, consistent with a fracture that occurred several days before the examination. Microscopic examination of lung tissue revealed focal areas of hyaline membranes and alveolar hemorrhage, suggestive of early stage acute respiratory distress syndrome. Fragments of mature bone marrow particles showing myeloid and lymphoid precursors surrounded by adipose tissue were present in the lumen of multiple pulmonary vessels, consistent with widespread pulmonary BME. Adipose cells with admixed scattered immature myeloid and lymphoid elements were also present in small vessels of the heart and liver (Figure 1). Blood cultures drawn at admission returned negative.
Posterior and anterior epidural and intradural migration of the sequestered intervertebral disc: Three cases and review of the literature
Published in The Journal of Spinal Cord Medicine, 2022
Daphne J. Theodorou, Stavroula J. Theodorou, Yousuke Kakitsubata, Evangelos I. Papanastasiou, Ioannis D. Gelalis
A 72-year-old man presented at an outpatient clinic with progressive pain in the lower extremities for several days. Gradually worsening pain radiated in the anterolateral aspect of the thigh on both sides. He experienced no low back pain, or abnormal bowel or bladder function. Previous history was unremarkable for trauma, lumbar surgery, fever, weight loss, or other constitutional symptoms. On examination, the upper lumbar spine was tender to palpation. The straight leg raising test was negative and there was diminished patellar reflex, which was worse on the left leg than on the right. Motor strength was 3/5 proximally on the left leg and 4/5 on the right leg, and 4/5 distally in both legs. Ill-defined loss of sensation to light touch and pinprick was appreciated on the left thigh. Laboratory values were within normal limits. MR imaging of the lumbar spine revealed a posterior epidural mass lesion at the L2–L3 level, compressing the spinal cord. The lesion was of T1-weighted intermediate and T2-weighted increased signal intensity, relative to the intervertebral disc (Fig. 1A,B). Within the spinal canal at the L2–L3, axial T2-weighted MR images displayed a tract-like structure extending from the intervertebral disc to the posterior epidural mass (Fig. 1C). After administration of gadolinium-containing contrast material, peripheral enhancement of the epidural mass was seen (Fig. 1D). There was linear enhancement of the structure connecting the mass with the disc (Fig. 1E). An extruded disc herniation that enhanced in its periphery also was seen at this interspace.