Incidence of early posterior shoulder dislocation in brachial plexus birth palsy

<p>Abstract</p> <p>Background</p> <p>Posterior dislocation of the shoulder in brachial plexus birth palsy during the first year of life is rare but the incidence increases with age. The aim was to calculate the incidence of these lesions in children below one year of age.</p> <p>Methods</p> <p>The incidence of brachial plexus birth lesion and occurrence of posterior shoulder dislocation was calculated based on a prospective follow up of all brachial plexus patients at an age below one in Malmö municipality, Sweden, 2000–2005.</p> <p>Results</p> <p>The incidence of brachial plexus birth palsy was 3.8/1000 living infants and year with a corresponding incidence of posterior shoulder dislocation (history, clinical examination and x-ray) during the first year of 0.28/1000 living infants and year, i.e. 7.3% of all brachial plexus birth palsies.</p> <p>Conclusion</p> <p>All children with a brachial plexus birth lesion (incidence 3.8‰) should be screened, above the assessment of neurological recovery, during the first year of life for posterior dislocation of the shoulder (incidence 0.28‰) since such a condition may occur in 7% of children with a brachial plexus birth lesion.</p

Simulering av experimentell sprickutbredning i keramiskt material

Low-density armour often uses ceramic materials, as their high compressive strength and relatively low weight make the material ideal for moving in the field. The ballistic protection works by redirecting the plastic flow of the projectile radially, which reduces penetration. The main drawback of using ceramics is their brittle behaviour, causing rapid crack propagation. When subjected to ballistic impacts, the ceramic fails catastrophically by spalling and cracking. The fracture behaviour is essential to model correctly to predict the effectiveness of armor systems. In this experiment, a notched specimen was used to investigate mode I fracture. The setup is similar to an open edge on impact experiment where the fracture propagation is initiated by the impact of a projectile fired by an air pressure gun. To avoid spallation, the projectile velocities were kept low to only initiate crack development from bending. For velocities below 15 m/s, a single crack develops across the specimen. For higher velocities between 15-75 m/s, the behaviour is different for short and long projectiles. For short projectiles, a straight crack develops before bifurcating when the projectile and ceramic lose contact. For longer projectiles, the crack bifurcates at the initiation. It forms a pointed ellipse up to the point when the projectile and ceramic lose contact, at which point it behaves the same as for shorter projectiles. Simulations were conducted using LS-Dyna and Impetus AFEA with four different material models. Two different fracture formulations were also used. Erosion was used in LS-Dyna, while erosion and node-splitting were used in Impetus AFEA. Simulations in both LS-Dyna and Impetus AFEA could reproduce experimental results. Simulations show that bifurcation highly depends on the materials' tensile strength. The transition from straight to bifurcating cracks emerges in a small velocity range, allowing for the possibility of calibrating the simulations to experiments. A possibility for comparing the crack development in simulations and the experimental setup besides crack patterns is the crack mouth opening displacement (CMOD). Measurements of CMOD with photon doppler velocimetry (PDV) correlated well with the simulations.Komplexa skydd använder sig ofta av keramiska material då keramer har stark kompressionsstyrka och relativt låg vikt, vilket gör dem idealiska för att röra sig i fält. Ballistiskt skygg verkar genom att omdirigera projektilens plastiska flöde radiellt, vilket reducerar risk för penetration. Största nackdelen med keramiska material är deras spröda beteende. På grund av materialets tidsberoende beteende är materialegenskaperna svåra att bestämma. När materialet utsätts för ballistisk belastning orsakar det ofta katastrofartad sprickbildning. Sprickbeteendet är därför ett viktigt fenomen att bestämma för att förutsäga effektiviteten hos skyddsmaterialet. I detta experiment används en uppställning med ett skårad provkropp för att studera sprickutvecklingen av mod I sprickor. Uppställningen har likheter med kant anslags experiment där sprickutbredningen initieras med hjälp en cylindrisk projektil. För att begränsa brottbeteendet till mod I använder sig uppställningen av låga projektilhastigheter mellan 15 och 75 m/s för att initiera sprickor genom böjning. För hastigheter under 15 m/s utvecklades endast raka sprickor som propagerade över hela provkroppen. För hastigheter mellan 15 och 75 m/s skiljer sig beteendet mellan långa och korta projektiler. För korta projektiler delar sig sprickan när projektilen studsar mot provkroppen. För långa projektiler delar sig sprickan i två redan vid initiering och bildar en spolform upp till den punkt då projektilen tappar kontakt med provkroppen varefter beteendet mellan kort och lång projektil är likartat. Simuleringar utfördes med LS-Dyna och Impetus AFEA med fyra olika materialmodeller. Två olika brottformuleringar användes. Erosion användes i LS-Dyna, medan erosion och node-splitting användes i Impetus AFEA. Simuleringar i både LS-Dyna och Impetus AFEA kunde återskapa de experimentella resultaten. Simuleringarna visar att delningen av sprickan vid avlastning i hög grad beror på materialens draghållfasthet. Övergången från rak spricka till sprickdelningen uppstår i ett snävt hastighetetsfönster vilket ger möjlighet att kalibrera simuleringar mot experimentella resultat. En möjlighet jämföra sprickutvecklingen i simuleringar och experiment förutom sprickmönster är sprick öppnings förskjutning (CMOD). Mätningar av CMOD med fotondopplerhastighetsmätningar (PDV) överensstämmer väl med simuleringarna

Axillary nerve injury in young adults-An overlooked diagnosis? Early results of nerve reconstruction and nerve transfers.

An injury to the axillary nerve from a shoulder trauma can easily be overlooked. Spontaneous functional recovery may occur, but occasionally reconstructive surgery is required. The time frame for nerve reconstruction procedures is from a neurobiological view crucial for a good functional outcome. This study presents a group of operatively and non-operatively treated young adults with axillary nerve injuries caused by motorcycle accidents, where the diagnosis was set late. Ten young men (median age at trauma 13 years, range 9-24) with an axillary nerve injury were diagnosed by examination of shoulder function and electromyography (EMG). The patients had either a nerve reconstruction procedure or were treated conservatively and their recovery was monitored. The axillary nerve was explored and reconstructed at a median of 8 months (range 1-22 months) after trauma in 8/10 patients. Two patients were treated non-operatively. In 4/8 cases, a reconstruction with sural nerve graft was performed and in 1/8 case only exploration of the nerve was made (minor neuroma). In 3/8 cases a radial nerve branch transfer to the axillary nerve was chosen as the procedure. The shoulder was mobilised after 3 weeks with physiotherapy and the patients were monitored regularly. Functional recovery was observed in 9/10 cases (median follow up 11 months, range 7-64) with EMG signs of reinnervation in seven patients. Axillary nerve function should not be overlooked in young patients with a minor shoulder trauma. Nerve reconstruction can successfully recreate function

Advanced radiological work-up as an adjunct to decision in early reconstructive surgery in brachial plexus injuries

<p>Abstract</p> <p>Background</p> <p>As neurophysiologic tests may not reveal the extent of brachial plexus injury at the early stage, the role of early radiological work-up has become increasingly important. The aim of the study was to evaluate the concordance between the radiological and clinical findings with the intraoperative findings in adult patients with brachial plexus injuries.</p> <p>Methods</p> <p>Seven consecutive male patients (median age 33; range 15-61) with brachial plexus injuries, caused by motor cycle accidents in 5/7 patients, who underwent extensive radiological work-up with magnetic resonance imaging (MRI), computed tomography myelography (CT-M) or both were included in this retrospective study. A total of 34 spinal nerve roots were evaluated by neuroradiologists at two different occasions. The degree of agreement between the radiological findings of every individual nerve root and the intraoperative findings was estimated by calculation of kappa coefficient (К-value). Using the operative findings as a gold standard, the accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the clinical findings and the radiological findings were estimated.</p> <p>Results</p> <p>The diagnostic accuracy of radiological findings was 88% compared with 65% for the clinical findings. The concordance between the radiological findings and the intraoperative findings was substantial (К = 0.76) compared with only fair (К = 0.34) for the clinical findings. There were two false positive and two false negative radiological findings (sensitivity and PPV of 0.90; specificity and NPV of 0.87).</p> <p>Conclusions</p> <p>The advanced optimized radiological work-up used showed high reliability and substantial agreement with the intraoperative findings in adult patients with brachial plexus injury.</p

Rehabilitation, Using Guided Cerebral plasticity, of a Brachial plexus Injury treated with Intercostal and phrenic Nerve transfers

Recovery after surgical reconstruction of a brachial plexus injury using nerve grafting and nerve transfer procedures is a function of peripheral nerve regeneration and cerebral reorganization. A 15-year-old boy, with traumatic avulsion of nerve roots C5-C7 and a non-rupture of C8-T1, was operated 3 weeks after the injury with nerve transfers: ( a) terminal part of the accessory nerve to the suprascapular nerve, (b) the second and third intercostal nerves to the axillary nerve, and (c) the fourth to sixth intercostal nerves to the musculocutaneous nerve. A second operation-free contralateral gracilis muscle transfer directly innervated by the phrenic nerve-was done after 2 years due to insufficient recovery of the biceps muscle function. One year later, electromyography showed activation of the biceps muscle essentially with coughing through the intercostal nerves, and of the transferred gracilis muscle by deep breathing through the phrenic nerve. Voluntary flexion of the elbow elicited clear activity in the biceps/gracilis muscles with decreasing activity in intercostal muscles distal to the transferred intercostal nerves (i.e., corresponding to eighth intercostal), indicating cerebral plasticity, where neural control of elbow flexion is gradually separated from control of breathing. To restore voluntary elbow function after nerve transfers, the rehabilitation of patients operated with intercostal nerve transfers should concentrate on transferring coughing function, while patients with phrenic nerve transfers should focus on transferring deep breathing function

Compression of the lower trunk of the brachial plexus by a cervical rib in two adolescent girls : case reports and surgical treatment.

Presence of a cervical rib in children is extremely rare, particularly when symptoms of compression of the lower trunk of the brachial plexus occur. We present two cases with such a condition, where two young girls, 11 and 16 years of age were treated by resection of the cervical rib after a supraclavicular exploration of the lower trunk of the brachial plexus. The procedure led to successful results, objectively verified with tests in a work simulator, at one year follow-up