Inhalant abuse of 1,1-difluoroethane (DFE) leading to heterotopic ossification: a case report

<p>Abstract</p> <p>Background</p> <p>Heterotopic ossification (HO) is the formation of mature, lamellar bone within soft tissues other than the periosteum. There are three recognized etiologies of HO: traumatic, neurogenic, and genetic. Presently, there are no definitively documented causal factors of HO. The following factors are presumed to place a patient at higher risk: 60 years of age or older, male, previous HO, hypertrophic osteoarthritis, ankylosing spondylitis, diffuse idiopathic skeletal hyperostosis, prior hip surgery, and surgical risk factors.</p> <p>Case presentation</p> <p>A 33-year-old male, involved in a motor vehicle crash, sustained an irreducible acetabulum fracture/dislocation, displaced proximal humerus fracture, and an impacted pilon fracture. During the time of injury, he was intoxicated from inhaling the aerosol propellant used in "dust spray" cans (1,1-difluoroethane, C₂H₄F₂). Radiographs identified rapid pathologic bone formation about the proximal humeral metaphysis, proximal femur, elbow, and soft tissue several months following the initial injury.</p> <p>Discussion</p> <p>The patient did not have any genetic disorders that could have attributed to the bone formation but had some risk factors (male, fracture with dislocation). Surgically, the recommended precautions were followed to decrease the chance of HO. Although the patient did not have neurogenic injuries, the difluoroethane in dusting spray can cause damage to the central nervous system. Signals may have been mixed causing the patient's body to produce bone instead of tissue to strengthen the injured area.</p> <p>Conclusion</p> <p>What is unusual in this case is the rate at which the pathological bone formation appeared, which was long outside the 4–6 week window in which HO starts to appear. The authors are not certain as to the cause of this rapid formation but suspect that the patient's continued abuse of inhaled aerosol propellants may be the culprit.</p

Repetitive posterior iliac crest autograft harvest resulting in an unstable pelvic fracture and infected non-union: case report and review of the literature

Fractures of the pelvic ring have been well studied, and the biomechanical relationship between the anterior and posterior elements is an important concept to understand these complex injuries. The vast majority of these injuries are due to trauma. However, in rare circumstances, autogenous bone graft harvesting may lead to an unstable pelvic ring. In this case report, we describe a rare complication in a 70-year old female patient who developed an unstable pelvis and an infected non-union secondary to repeated posterior iliac graft harvest. The orthopaedic surgeon should be aware of this detrimental complication associated with extensive or repeated posterior iliac crest graft harvest

Bias towards publishing positive results in orthopedic and general surgery: a patient safety issue?

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United States level I trauma centers are not created equal – a concern for patient safety?

Abstract Background The American College of Surgeons delineates 108 requirements for level I trauma centers. Some of these requirements include: minimum of 1,200 trauma admissions per year; an average of 35 major trauma patients per surgeon; residency training programs; and 10 peer-reviewed journal submissions every three years. This study examines the variation in services provided among U.S. level I trauma centers. Methods 218 facilities identified as level I trauma centers in 2005 were contacted for participation. 136 centers in 37 states completed the questionnaire. Surveys queried variances in trauma, neurosurgery, plastics, and orthopaedic surgery with regard to type of center, type of accreditation, number and training of participating physicians, number of beds, dedicated OR support (staff/rooms), call pay, and research. Results Of the level I centers surveyed, 66% are university-affiliated facilities that employ more surgeons and staffing across trauma and all subspecialties compared to community-based or public centers. However, the community and public centers have more surgeons per capita (44% of the university-affiliated hospitals have six or more trauma surgeons on staff compared to 59% of the community and 70% of the public facilities). University-affiliated centers also provide more in-house subspecialty services (orthopaedic, neurosurgery, and plastics). Thirty-nine percent do not have ACS accreditation and are designated trauma facilities by state or local governments. Only 49% of trauma centers provide on-call pay to trauma surgeons, and these percentages decline for all subspecialties. Dedicated operating rooms and research programs are also lacking among all subspecialties. Conclusion Based on our findings, we conclude that there are no homogeneous criteria for being accredited as a level I trauma center. Reliable resources should be offered at any facility that claims a level I trauma designation. We do not know if such diversity of services truly impacts care or how it can be measured; nevertheless, it would be logical to presume that at some point services that fall below a minimum threshold would potentially adversely affect the quality of care. In order to develop appropriate policy to decrease possible disparities, differentiation in services between trauma centers must be further researched and described.</p

Percentage of all facilities with each operational characteristic for neurosurgery

<p><b>Copyright information:</b></p><p>Taken from "United States level I trauma centers are not created equal – a concern for patient safety?"</p><p>http://www.pssjournal.com/content/2/1/18</p><p>Patient Safety in Surgery 2008;2():18-18.</p><p>Published online 21 Jul 2008</p><p>PMCID:PMC2515286.</p><p></p

Percentage of all facilities with each operational characteristic for plastics

<p><b>Copyright information:</b></p><p>Taken from "United States level I trauma centers are not created equal – a concern for patient safety?"</p><p>http://www.pssjournal.com/content/2/1/18</p><p>Patient Safety in Surgery 2008;2():18-18.</p><p>Published online 21 Jul 2008</p><p>PMCID:PMC2515286.</p><p></p