Scapulothoracic dissociation is a rare injury involving separation of scapula from the thorax along with the upper extremity. Majority of the patients have concomitant neurovascular injury and the prognosis is uniformly poor in such cases. We present a case of scapulothoracic dissociation with comminuted fracture of scapula and acromioclavicular joint disruption without neurovascular deficit. There were associated avulsion fractures of the spinous processes of vertebrae (T3-T5). Such presentation is rare in an already rare scapulothoracic dissociation injury. A discussion regarding the probable mechanism of injury, management and prognosis is presented
Vascular System Injuries

No abstract available.
Vascular System Injuries*

No abstract available.
Vascular System Injuries

Tension-free vaginal tape (TVT) has been accepted for a therapeutic modality of stress incontinence and presented as easy, safe, effective, and time-saving procedure with cure rate of more than 86% and another 11% significantly improved with no serious complication. However, there is not always safe without severe complications, because the TVT needle has to pass blindly through the pelvic cavity. Furthermore, it may be very serious once it happened. We, herein, present a case who bled to shock following TVT procedure but was controlled conservatively, and review its complications in the literatures.
Needles ; Shock ; Suburethral Slings* ; Vascular System Injuries*

Conventional surgery for lower lumbar disc herniation is a common practice and its vascular complications have been reported rarely. If the hypotension is severe or prolonged postoperatively, one should suspect vascular injury and perform urgent laparotomy. We experienced two cases of major vascular injuries following hemi-laminectomy and discectomy.
Diskectomy ; Hypotension ; Laparotomy ; Vascular System Injuries*

Surgical correction of a cervicothoracic deformity is difficult with a potential risk of vascular injury. Comprehensive preoperative vascular evaluation is important for safe and successful surgery. The use of multi-detector computed tomography angiography (MDCTA) allows a combined display of vascular and osseous structures of the musculoskeletal system. However, no clinical reports have described the use of MDCTA for surgical planning of anterior cervicothoracic surgery in patients with vascular malformation. The case of a 7-year-old girl with congenital cervicothoracic kyphoscoliosis who underwent preoperative MDCTA evaluation and successful correction is presented in this report.
Angiography ; Child ; Congenital Abnormalities ; Humans ; Kyphosis ; Musculoskeletal System ; Spinal Fusion ; Spine ; Vascular Malformations ; Vascular System Injuries

OBJECTIVE: The use of segmental instrumentation technique using pedicle screw has been increasingly popular in recent years owing to its biomechanical stability. Recently, intralaminar screws have been used as a potentially safer alternative to traditional fusion constructs involving fixation of C2 and the cervicothoracic junction including C7. However, to date, there have been few clinical series of C7 laminar screw fixation in the literature. Thus, the purpose of this study is to report our clinical experiences using C7 laminar screw and the early clinical outcome of this rather new fixation technique. METHODS: Thirteen patients underwent C7 intralaminar fixation to treat lesions from trauma or degenerative disease. Seventeen intralaminar screws were placed at C7. The patients were assessed both clinically and radiographically with postoperative computed tomographic scans. RESULTS: There was no violation of the screw into the spinal canal during the procedure and no neurological worsening or vascular injury from screw placement. The mean clinical and radiographic follow up was about 19 months, at which time there were no cases of screw pull-out, screw fracture or non-union. Complications included two cases of dorsal breech of intralaminar screw and one case of postoperative infection. CONCLUSION: Intralaminar screws can be potentially safe alternative technique for C7 fixation. Even though this technique cannot be used in the cases of C7 laminar fracture, large margin of safety and the ease of screw placement create a niche for this technique in the armamentarium of spine surgeons.
Follow-Up Studies ; Humans ; Spinal Canal ; Spine ; Vascular System Injuries

Platelets play an essential role in hemostasis through aggregation and adhesion to vascular injury sites but their unnecessary activation can often lead to thrombotic diseases. Upon exposure to physical or biochemical stimuli, remarkable platelet shape changes precede aggregation or adhesion. Platelets shape changes facilitate the formation and adhesion of platelet aggregates, but are readily reversible in contrast to the irrevocable characteristics of aggregation and adhesion. In this dynamic phenomenon, complex molecular signaling pathways and a host of diverse cytoskeleton proteins are involved. Platelet shape change is easily primed by diverse pro-thrombotic xenobiotics and stimuli, and its inhibition can modulate thrombosis, which can ultimately contribute to the development or prevention of thrombotic diseases. In this review, we discussed the current knowledge on the mechanisms of platelet shape change and also pathological implications and therapeutic opportunities for regulating the related cytoskeleton dynamics.
Blood Platelets* ; Cytoskeleton* ; Hemostasis ; Thrombosis ; Vascular System Injuries ; Xenobiotics

Symptomatic perforation of the anterior annulus fibrosus/anterior longitudinal ligament during surgery for herniated lumbar disc disease is one of the more solemn and sobering complications experienced by neurosurgeons or orthopedic surgeons. Iatrogenic vascular injuries are unusual complications of lumbar disk surgery. The incidence of such injuries is very low but probably underestimated because clinical manifestations may be extremely variable depending on the extension of trauma. Diagnosis is suspected when early signs or retroperitoneal hemorrhage appear, but may often be delayed. I experienced 5 autopsied cases of acute hemorrhage due to vascular trauma in disk surgery. A review of the literature is present and the medicolegal implications of symptomatic ventral perforations of the annulus fibrosus/anterior longitudinal ligament are discussed.
Autopsy ; Diagnosis ; Hemorrhage ; Incidence ; Longitudinal Ligaments ; Orthopedics ; Vascular System Injuries*

Posterior transarticular screw fixation is effective treatment method in cases of atlanto-axial instabilities. Various surgical procedures have been described for stabilization of unstable C1-C2 complex. The conventional management methods, either a Gallie or Brooks fusion technique, have limitations such as post-operative rigid bracing and relatively high rate of non-union. Since Magerl developed a technique for posterior transarticular screw placement at C1-C2 in 1979, Noel I. Perrin published modified technique for atlanto-axial instability using percutaneous drill guide system in 1995. This instrumentation system improved limitations of conventional fixation technique and reduced complications as well as shortening of operation times. Between May 1997 and February 1998, modification of this surgical approach with Perrin screw system was used in the treatment of 12 cases of atlantoaxial instability. Transarticular screw was placed in conjunction with bone graft wiring through the percutaneous working drill guide. The causes of the instabilities were rheumatoid arthritis(5 cases), traumatic injuries(4 cases), post operative instability(1 case), and non-union with immobilization(2 cases) and other cause. Patient age was ranged from 18 years to 70 years. Mean operation time was 145 min(110 to 225) with mean blood loss was 180 ml. Intraoperative complication was drill tip fracture in 1 case and screw pullout in 1 case postoperatively. Neurological or vascular injury were not observed there was neither radiologic instabilities nor spinal deformities. Neurologic and symptomatic status were improved in all operated cases.
Braces ; Congenital Abnormalities ; Humans ; Intraoperative Complications ; Transplants ; Vascular System Injuries