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Case Report of the Unusual Presentation of Stridor in an Elderly Patient Following a Cervical Fracture

Benjamin Travers, BS*, Rachel Dearden, MD^, Shanna Jones, MD^, and Michael Opsommer, MD^

DOI: https://doi.org/10.21980/J8V926 Issue 5:1 No ratings yet.
The cervical CT was significant for a transverse fracture through the C4 vertebral body (see red arrow), lateral facet (green arrow), spinous process (blue arrow), and right lamina (purple arrow) as well as surrounding edema and retropharyngeal thickening (yellow line), best appreciated on sagittal view.
OrthopedicsRespiratoryVisual EM

Digital Nerve Block for the Reduction of a Proximal Phalanx Fracture of the Foot – a Case Report

Emerald Raney, MD*, John Costumbrado, MD, MPH*, Barbara Blasko, MD* and Dev Dhillon, BS^

DOI: https://doi.org/10.21980/J8KS8T Issue 5:1 No ratings yet.
Plain film of the right foot showed evidence of an oblique fracture of the body of the proximal 4th phalanx (image 2). No other acute traumatic injuries noted in the rest of the bones and joints of the right foot. After performing a digital block of the toe and reduction, repeat imaging showed evidence of successful reduction with anatomic alignment and redemonstration of the fracture line (image 3).
OrthopedicsVisual EM

Open Subtalar Dislocation

Devan Pandya, MD* and Joseph Fargusson, MD*

DOI: https://doi.org/10.21980/J87P8PIssue 4:4 No ratings yet.
X-ray of the left ankle revealed a complete dislocation of the subtalar joint with medial dislocation of the calcaneus (outlined in orange) relative to the talus (outlined in red) with subcutaneous air noted in the lateral soft tissues (blue arrows in Figure 1). The talonavicular joint has also been disrupted (navicular outlined in blue). There was no evidence of fracture. Post-reduction computed tomography of the left lower extremity confirmed no evidence of associated fracture.
OrthopedicsVisual EM

Ultrasonographic Findings of Acute Achilles Tendon Rupture

Charles Craig Rudy, MD*^, John A Thompson, MD* and Rachel R Bengtzen, MD*^

DOI: https://doi.org/10.21980/J8063S Issue 4:4 No ratings yet.
The ultrasound video clip shows a longitudinal view of the AT during a dynamic exam. While the patient’s foot is gently passively dorsi/plantar flexed, the video demonstrates first a normal Achilles tendon (from the unaffected extremity) without disruption (highlighted by a yellow bracket on screen left).  Then it shows an abnormal tendon (the patient’s affected side) with disruption of the typical linear tendon fibers (red arrow identifies area of rupture). Dynamic testing shows the movement of the distal stump of the AT is evident adjacent to hypoechoic fluid that is reactive edema or blood from the acute rupture. 
OrthopedicsVisual EM

Medial Subtalar Dislocation: A Case Report

Claire Thomas, MD*  and Annasha Vyas, BS*

DOI: https://doi.org/10.21980/J8QP9D Issue 4:4 No ratings yet.
On examination, the patient had a significant deformity to his left foot and ankle. His left foot was pointed medially. His distal left tibia and fibula were visible and palpable upon inspection, with the overlying skin completely intact. There was no neurovascular compromise of the foot. X-ray demonstrated a subtalar dislocation of the left ankle (green arrow) and significant widening of the tibiotalar joint space (yellow arrow). There was associated soft tissue swelling but no acute displaced fractures were identified.
OrthopedicsVisual EM

Classic Slipped Capital Femoral Epiphysis: A Case Report

James Webley, MD*

DOI: https://doi.org/10.21980/J8BD16 Issue 4:4 No ratings yet.
The pelvis X-ray demonstrates a widened right capital femoral epiphysis (more than 2 mm) that is typical of a slipped capital femoral epiphysis (SCFE).1 The yellow highlight outlines this area of widening. The classic Klein’s line (orange lines) is often inaccurate and even difficult to draw with certainty.1 Nevertheless, in this X-ray, one has a sense that the right capital femoral epiphysis does not align with the femoral neck in the same way as it does on the left side, suggesting slippage.
OrthopedicsVisual EM

Point-Of-Care Ultrasound for the Diagnosis of Extensor Tenosynovitis

James A Frank, MD*, Joshua Lupton, MD* and Bryson Hicks, MD*

DOI: https://doi.org/10.21980/J8Q050Issue 4:3 No ratings yet.
Point-of-care ultrasound of the dorsal aspect of the left hand reveals a heterogenous hypoechoic fluid collection surrounding the extensor tendons (axial view) within the retinaculum consistent with edema. Longitudinal view shows anechoic fluid within the tenosynovium which is located between the anisotropic extensor tendon and linear hyperechoic synovial sheath. Longitudinal view also shows some cobblestoning, or tissue edema, superficial to the anisotropic extensor tendon. The patient’s contralateral right dorsal hand was scanned in a longitudinal view and shows no cobblestoning or hypoechoic fluid under the synovial sheath. The patient was diagnosed with tenosynovitis, and started on intravenous antibiotics.
Infectious DiseaseOrthopedicsUltrasoundVisual EM

Asymptomatic CT Iodinated Contrast Extravasation of the Upper Extremity

Eric Liao, MD* and John Costumbrado, MD, MPH*

DOI: https://doi.org/10.21980/J8VK87 Issue 4:3 No ratings yet.
The two radiographs demonstrate extravasation of radiopaque iodinated contrast in the lower left upper extremity with most seen in the left antecubital fossa and left proximal forearm. Extravasation is seen in the subcutaneous and subfascial tissue.
OrthopedicsVisual EM

Open Fracture of the Patella

Zara Khan, BS*, Devan Pandya, MD^ and John Costumbrado, MD, MPH^

DOI: https://doi.org/10.21980/J8BK9Z Issue 4:3 No ratings yet.
X-ray of the right knee showed evidence of an acute comminuted fracture of the patella (red arrows) with a suprapatellar joint effusion with gas (blue arrow). There was no evidence of joint dislocation or other osseous lesions.
OrthopedicsVisual EM

Diagnosis and Treatment of an Anterior Shoulder Dislocation with Bedside Ultrasound

Mary Rometti, MD*, Michael Rohinton Mirza, MD* and Christopher Bryczkowski, MD*

DOI: https://doi.org/10.21980/J8Z924Issue 4:3 No ratings yet.
Bedside ultrasound with the transducer placed on the posterior right shoulder revealed an anterior dislocation of the right humerus. This is evident by displacement of the humeral head further away from the posteriorly placed ultrasound transducer, and appears deep to the glenoid cavity.  In a posterior shoulder dislocation, the humeral head would appear closer to the transducer (and the near field of the ultrasound image) than the glenoid. Note that a hypoechoic, heterogeneous fluid collection is within the joint space, compatible with a hematoma. A right shoulder X-ray confirmed the anterior dislocation with no evidence of fracture.  Under direct ultrasound guidance the glenohumeral joint space was injected with 10 mL of 2% lidocaine as an intraarticular anesthetic block. The right shoulder was reduced using continual traction.  Post-reduction ultrasound demonstrated a successful shoulder reduction, depicted by the humeral head being relocated to its anatomical location, adjacent to the glenoid cavity, as noted on the ultrasound image.  A hematoma remains present within the joint space. Successful shoulder reduction was further confirmed by X-ray. The patient’s arm was placed in a sling and she was discharged home with orthopedics follow-up.
OrthopedicsVisual EM
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