An 80-year-old man who fell from a 2 m stepladder was transferred to our emergency room. Computed tomography (CT) imaging revealed a thoracolumbar compression fracture and rib fractures. Three hours later, his consciousness level suddenly decreased and breathing state worsened. We diagnosed fat embolism syndrome (FES) as a chest X-ray showed infiltration of both sides, magnetic resonance imaging (MRI) showed high signal scattering on a diffusion weighted image (DWI), and fat droplets were found in his blood. His clinical state improved with the aid of a respirator and steroid treatment, and he was discharged on the 49th day. FES generally occurs following long bone and pelvic bone fractures. However, although it is very rare, FES may also occur following a vertebral bone fracture and non-fracture blunt injury.
We report a case of a 24-year-old male who suffered a fracture-dislocation of the left femoral head (Pipkin type ２) in an automobile traffic accident. Closed reduction was impossible under general anesthesia, so we performed emergency open reduction surgery. The reduction could not be done by only releasing the posterior soft tissue, and trochanteric flip osteotomy was performed for reduction with internal ﬁxation of the fractured femoral head. After considering the risks to the femoral head blood supply, a trochanteric ﬂip osteotomy was used. This approach provided ample and safe exposure. At 12 months follow-up, the Harris Hip Score was 96/100. If closed reduction is impossible on fracture-dislocation of the femoral head, emergency open reduction and internal fixation by trochanteric flip osteotomy is useful to prevent iatrogenic neck fracture and avascular necrosis of the hip.
We report a case of a gastric rupture due to seat-belt injury. A 5-year-old girl, who was involved in a traffic accident, was transferred to our hospital. She was sitting in the seat behind the driver and was wearing a seat belt. Computed tomography revealed intra-abdominal free air and fluid collection. Emergency laparotomy was performed and revealed complete gastric wall tearing and food leakage from the penetration. The injured gastric wall was sutured layer by layer. The patient was discharged on postoperative day 8 without any complications. Traumatic gastric perforation is a rare condition and we suspect that the seat belt was not worn properly. Wearing seat belts properly is essential to protect children in automobiles.