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Dozens of doctors from all over Italy answered the call of Salvatore, the 19-year-old Milanese, who no one knows how to operate. The boy, via Facebook, asked for help from anyone able to intervene to save his life following an injury suffered while playing football: a severe dislocation of the sternum, with the bone who grazes the aorta. 19659002] " I have hope because whoever loses it is dead ". A push, the injury playing football. And Salvatore changes his life forever. The appeal of the 19-year-old Milanese looking for a surgeon who agrees to operate for the aftermath of is a serious viral dislocation of the clavicle that threatens to block the patient's life. aorta . It all started last May 2nd "after being pushed from behind my back and falling very badly," he says, "I suffered from a concentric dislocation of the sternum (right), a dislocation" very rare "- he explains. % of total dislocations, this dislocation has caused serious consequences on my body, the shoulder is closed and the shoulder blade behind is completely out. "A damage that could potentially have fatal consequences for the boy, who is now suffering from" breathing problems and continual pains related to the posture and abnormal position of the collarbone. "The bone, continues Salvo, is" stuffed inside the sternum, near the aortic arch (only 7mm) and other blood vessels and important structures. "
A real test for the boy, who never seems to finish : "I have visited many doctors and hospitals in Milan and in other regions, but no one wants to do it because it is very risky in addition to To be very rare, there will be 10 cases in Italy. " The risk of death, says Salvatore without beating his words, is" high " with that of" losing the mobility of the arm related to the Intervention, but remain in these conditions placed the clavicle at only 7 millimeters "The aorta is just as serious because it just takes a bad shot and we stay dry, not being firm in this position".
A complicated case that until now it seemed impossible to treat . But Salvatore does not lose hope and decides to divulge his story on social networks, waiting for someone to finally show up: he asks the player for help, hoping "that someone One who has suffered from this kind of injury is coming in and managed to solve it or a doctor / surgeon who has had this type of case, or something important that helps me spread the message … since not my strength and those of my family can not find solutions after looking a lot […]
Most shoulder operations are so-called elective interventions and can therefore be planned according to the needs the patient and the availability of the operating rooms and the surgeon. Depending on the surgical procedure to be performed, surgical treatment can be performed in a day hospital, outpatient, or with a short stay of a few days. Preoperative visit: before any surgical intervention: before any surgical procedure, the patient or the patient undergoes a controlled examination during the anesthesia of the doctor at the anesthesiologist anesthetist doctor who, after evaluation of the clinical situation after evaluation of the clinical situation after evaluation of the general clinical situation of the patient, presence of allergies or of a general patient, presence of allergies or intolerances to drug intolerances, investigations, diagnostic tests already performed (eg, blood test, electrocardiogram, magnetic resonance, etc.) will suggest to the patient the type of magnetic ants etc.) will suggest to the patient the most appropriate anesthesia type of anesthesia appropriate .
After the intervention it is necessary to make a check of the injury by going to your doctor. The points used to close the wound may be resorbable or not. Inability to work is usually estimated at about two weeks, so it is advisable to consult your doctor for further checks. On the day of discharge from the hospital, the patient will receive medical personnel all the information necessary for the continuation of treatment at home. In particular, you will receive the date of the postoperative check, the letter of discharge to be issued to your doctor, the prescription of badgesic treatment, the prescription of physiotherapy to be performed in ambulatory
The operations of the shoulder are carried out in technical open, minimally invasive or arthroscopic depending on the pathology to be treated. Arthroscopic surgery allows you to work inside joints through 2-4 small holes avoiding large incisions. In this way, we have the opportunity to inspect and visualize the inside of the joints directly with the help of small microscopes (arthroscopes), which amplify the images in order to increase the accuracy of the diagnosis and photograph the interior. joints during surgery. With this technique, it is no longer necessary to make large openings to access the piece to handle, so it is a minimally invasive technique (the incisions are between 5 and 10 mm). Often, for these interventions, we use "mini-screws" that are fixed in the bone with attached wires. Some procedures must be performed in traditional "open" technique, such as prosthetic surgery
The decision to use arthroscopic technique or open traditional technique is the responsibility of the surgeon according to the pathology to be treated. Regardless of technique, shoulder operations are performed with a combined procedure of total and locoregional anesthesia (although theoretically possible, it is not recommended to perform these operations exclusively under local anesthesia).
The shoulder is composed of three articulating bones: scapula scapula scapula, clavicle clavicle clavicle and humerus (Figure 3). This unit is attached to the rib cage, through muscular and ligamentous structures. Between the clavicle and the scapula is the acromio-acromio-acromioclavicular joint covered by ligaments and capsule, within which is a fibrocartilaginous disc similar to a meniscus of the knee. The mobility of the acromioclavicular joint is relatively modest and the main problems of this region are arthritis and instability. Persistent overload causes cartilage and disc wear. Joint swelling and bone osteophytes form, which can cause rotator cuff injuries. In addition, an acromioclavicular dislocation can sometimes lead to sometimes very unstable instability
Between the humerus and the scapula lies the glenohumeral joint. For most patients, this joint is synonymous with shoulder. To allow great mobility of this joint, the humerus head is wider than the small articular cavity composed of the glenoid. In addition, to better stabilize the joint, a circular ring called the lip (labrum) contours the glenoid, widening the diameter of the joint.
LEGENDARY INJURIES OF ACROMIC ARTIFICATION -CLAVE
Ligament lesion of the acromioclavicular-collar is more common in young athletic adults.
The most common traumatic mechanism is the fall on the stump of the shoulder. The lesion ranges from minimal dislocation to complete rupture and may be in the form of subluxation or frank dislocation.
In subluxation, rupture partially or completely affects the capsule and ligament of the aacromion-clavicle sparing the conoidal and trapezoidal ligaments.
In dislocation, the displacement of the articular surfaces is notable for a complete laceration of the acromioclavicular ligament and conoidal and trapezial ligaments often accompanied by fibrocartilaginous meniscus tears
Displacements are typical: the lateral end of the clavicle is raised high, protruding in various ways from the under-skin. Depending on the intensity of the forces in action, one of these three wounds may result:
– stretch: few fibers of acromioclavicular ligaments are stretched or torn; the joint remains stable
– subluxation: rupture of the capsule and acromioclavicular ligaments; joint appears unstable with laxity
– dislocation: rupture of coraco-clavicular ligaments, capsule and acromioclavicular ligaments
Clinical signs
– presence of a walk between the face upper acromion and facet joint clavicle
– presence of the sign of the "piano key": at finger pressure, the dislocated end of the clavicle mobilizes to return to its initial position as soon as the pressure stops.
– local pain
– X-ray control the loss of articular congruence is noticeable
Treatment
In subluxations, a conservative treatment with bandage Desault is sufficient for 3 weeks
In free dislocations in subjects still young and old to work surgery is preferred reduction and stabilization of the acromioclavicular joint with different methods according to the peronal experience of the attending physician (son of Kirschner, syndesmopexy corpora-clavicular, etc.)
Complete restitution is generally easily achievable
LEGAL LESIONS OF METHARIC ARTIFICATION –
FALANGEA
The most frequent is probably the rupture of the ulnar collateral ligament of the radius
This injury is caused by forced thumb abduction or hyperextension
and, if not recognized , causes progressive dislocation of the metacarpophalangeal joint (MCF) with impaired clamp mechanism (thumb index) and prestressed instability
This lesion may be presented as simple or complete depending on the presence or the absence of the interposition of soft parts.
The clinical examination must be accompanied by confirmation of radiographic confirmation
Treatment
In the single dislocations, the treatment chosen is the bloodless reduction: the maneuver r l & 39; hyperextension of the dislocated phalanx, and pushing on the dorsal side of the phalanx, flexes. After post-reduction radiographic and clinical reduction, immobilize in an anti-brachio-metacarpal dressing for 10 days. If bloodless reduction fails or complex dislocations occur, surgery is performed
In case of partial ulnar ligament injury, the finger is immobilized in flexion for at least 4 weeks to release the collateral ligament . total of the ulnar collateral ligament accompanying clinically of considerable instability, one opts for surgical treatment.
TIBIO – PERIOAL DISTAL BINDING LESSON
Rarely isolated, it is usually produced by an external rotation of the supine ankle. With some frequency, it is badociated with a fracture of the instep
The anterior part of the body of the astragalus away the fibula from the tibia, especially extrarotation
The clinical signs are generally modest, showing no sign of lateral subluxation. the active and pbadive movement of the ankle does not exacerbate the painful symptomatology except in external dorsiflexion. The acupressure of the distal tibio-peroneal joint causes pain
The standard graphical examination may appear to be primarily negative
where it is badociated with other lesions of the lateral segment of the ankle, the symptomatology of the pain appears more obvious. X-rays have a tibio-astragalic mortar diastase
The fundamental rule for correct treatment is the complete restoration of the tibio-peroneal forceps obtained by a synthesis with an oblique screw or a Kirschner wire
LESION OF THE TRANSVERSE LIGAMENT & # 39; ATLANTE
The transverse ligament of the atlas is stretched between the two adjacent osseous tubercles at the facet joints of the occipital bone condyles and below between the joint processes that join the orthotic bone. épistrophie.
The epistrophile is articulated with the anterior arch forward and with the transverse ligament behind. This ligament can rupture in severe lesions during sudden flexion of the cervical spine or breakage due to more or less traumatic events
in patients with chronic inflammatory disease ( rheumatoid arthritis). In case of traumatic rupture of the transverse ligament of the atlas, it is possible to have a compressive involvement of the spinal cord in the area between the posterior arch of the atlas and the process dens. This lesion can be suspected on the basis of history, local pain in the cervical and cervical region and in the presence of a marked contracture of the cervical musculature
The radiographic image present in projection lateral an enlargement of the space between the posterior aspect of the anterior and odontoid arch not exceeding normally 4 mm
The treatment is always surgical (arthrodesis C1-C2 or occipital and C1) preceded or not by 39, a period of cranial traction.
Depending on the type of injury, we are talking about subluxation or dislocation. If you have suffered a shoulder injury and you have been diagnosed with acromioclavicular dislocation, you should know that this lesion consists of the more or less complete rupture of certain ligamentous bundles that keep the opposing heads of the ligament intact. Acromion and clavicle. The consequence is an upward movement of the clavicle that is badociated with pain and the impossibility of moving the shoulder. If the lesion is not complete, these symptoms are accompanied by a slight swelling and we speak of SUBLUSION: the treatment consists of a immobilization of the joint for about 20 days. This allows the torn structures to heal in the best position, but requires, after removal of the dressing, a re-education cycle to restore movement and regain the strength inevitably compromised by trauma and forced rest. In general, the return to work takes place about 40 days after the trauma, for the sport, one must be patient and insist on the rehabilitation at least up to 2 months. If the lesion has been complex and the structures are very damaged, the clavicle erupts completely from the acromion in a LUSCATION setting. The pain is very intense and the distortion of the profile of the shoulder is important. At this stage, in order to bring the joint heads together, it is essential to resort to surgery
First-degree lesion: only the ligament-AC complex is involved, with general exfoliation of the superior acromioclavicular ligament, which in some cases can incarcerate in the common line and thus compromise natural healing. Radiographically, there is a modest vertical displacement of the end of the lateral clavicle, always less than 0.5 cm. Second degree lesion: lesions of the previous stage, generally more severe, are badociated with the rupture of conoidal and trapezoidal ligaments, either at the insertional level or in the fibrous context. Radiographically, there is a cranial displacement greater than 0.5 cm and a pbadive sagittal displacement up to 1.2 cm. Third degree injury: the damaging agent also damages the trapezius-deltoid muscle-fascial mantle and the clavicle can dislocate freely in the three planes of space, but especially in the frontal giving the appearance or the characteristic touch of the piano
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