Appendix 2 OSICS Version 10.1 (Continued)
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Femoral Shaft Fractures Andrew Chen, MD University of North Carolina
Femoral Shaft Fractures Andrew Chen, MD University of North Carolina Core Curriculum V5 Disclosure All figures belong to Andrew Chen, MD unless otherwise indicated Core Curriculum V5 Objectives • Review initial management of femoral shaft fractures and possible concomitant injuries • Discuss multiple options with intramedullary nailing • Antegrade/retrograde • Starting point • Reaming • Patient positioning • Understand commonly associated complications Core Curriculum V5 Femoral Shaft Fractures • Bimodal distribution • Young patients after high-energy trauma • Elderly patients after falls from standing secondary to osteopenia/osteoporosis • MVC, MCC, pedestrian struck, fall from height, and gunshot wounds most common mechanisms • Intramedullary nail as “gold standard” treatment, which has continued to evolve since introduction by Gerhard Küntscher around World War II Core Curriculum V5 Anatomy • Largest and strongest bone in body • Anterior bow with radius of curvature ~120 cm1 • Blood supply from primary nutrient vessel through linea aspera and small periosteal vessels • Deformity pattern dependent on attached musculature • Proximal fragment • Flexed (gluteus medius/minimus on greater trochanter) • Abducted (iliopsoas on lesser trochanter) • Distal fragment • Varus (adductors inserting on medial aspect distal femur) • Extension (gastrocnemius attaching on distal aspect of posterior femur) Courtesy of Rockwood and Green’s Fracture in Adults2 Core Curriculum V5 Femur Fracture Classification: AO/OTA • Bone Segment 32 • Type A • Simple • -
Medical Policy Ultrasound Accelerated Fracture Healing Device
Medical Policy Ultrasound Accelerated Fracture Healing Device Table of Contents Policy: Commercial Coding Information Information Pertaining to All Policies Policy: Medicare Description References Authorization Information Policy History Policy Number: 497 BCBSA Reference Number: 1.01.05 Related Policies Electrical Stimulation of the Spine as an Adjunct to Spinal Fusion Procedures, #498 Electrical Bone Growth Stimulation of the Appendicular Skeleton, #499 Bone Morphogenetic Protein, #097 Policy Commercial Members: Managed Care (HMO and POS), PPO, and Indemnity Members Low-intensity ultrasound treatment may be MEDICALLY NECESSARY when used as an adjunct to conventional management (i.e., closed reduction and cast immobilization) for the treatment of fresh, closed fractures in skeletally mature individuals. Candidates for ultrasound treatment are those at high risk for delayed fracture healing or nonunion. These risk factors may include either locations of fractures or patient comorbidities and include the following: Patient comorbidities: Diabetes, Steroid therapy, Osteoporosis, History of alcoholism, History of smoking. Fracture locations: Jones fracture, Fracture of navicular bone in the wrist (also called the scaphoid), Fracture of metatarsal, Fractures associated with extensive soft tissue or vascular damage. Low-intensity ultrasound treatment may be MEDICALLY NECESSARY as a treatment of delayed union of bones, including delayed union** of previously surgically-treated fractures, and excluding the skull and vertebra. 1 Low-intensity ultrasound treatment may be MEDICALLY NECESSARY as a treatment of fracture nonunions of bones, including nonunion*** of previously surgically-treated fractures, and excluding the skull and vertebra. Other applications of low-intensity ultrasound treatment are INVESTIGATIONAL, including, but not limited to, treatment of congenital pseudarthroses, open fractures, fresh* surgically-treated closed fractures, stress fractures, arthrodesis or failed arthrodesis. -
Rare Combination of Ipsilateral Acetabular Fracture-Dislocation and Pertrochanteric Fracture
A Case Report & Literature Review Rare Combination of Ipsilateral Acetabular Fracture-Dislocation and Pertrochanteric Fracture Kevin M. Kuhn, CDR, MC, USN, John A. Boudreau, MD, and J. Tracy Watson, MD oral fractures. Other case reports have described acetabular Abstract fracture-dislocations associated with femoral neck fractures.1-3 Acetabular fracture-dislocations are severe This case report describes an acetabular fracture-dislocation injuries that require urgent closed reduction associated with an ipsilateral pertrochanteric fracture and sub- of the hip and often require surgery to restore trochanteric extension. hip stability. Other authors have described We propose a staged treatment strategy consisting of early acetabular fracture-dislocations associated minimally invasive reduction of the hip and delayed reduction with femoral neck fractures, but to our knowl- and fixation of the fractures. This strategy may be useful in edge, this case report is the first to describe an managing a polytraumatized patient who may not be stable acetabular fracture-dislocation in association enough to undergo early definitive management, or a patient with an ipsilateral pertrochanteric fracture and who requires prolonged transfer to receive definitive care. subtrochanteric extension. The patient provided written informed consent for print The polytraumatized patient initially was not and electronic publication of this case report. stable enough for prolonged surgery. Through a 3-cm anterolateral hip incision, a 5-mmAJO Schanz Case Report screw was introduced percutaneously into the A 44-year-old man was involved in a head-on motor vehicle femoral head through the primary fracture site collision at highway speed. He was taken to a local hospital, under fluoroscopic guidance. -
Mandibular Fractures, Diagnostics, Postoperative Complications
Journal of Medical Sciences. March 23, 2020 - Volume 8 | Issue 13. Electronic-ISSN: 2345-0592 Medical Sciences 2020 Vol. 8 (13), p. 45-52 e-ISSN: 2345-0592 Medical Sciences Online issue Indexed in Index Copernicus Official website: www.medicsciences.com Mandibular fractures, diagnostics, postoperative complications Shahaf Givony1 1 Lithuanian University of Health Sciences. Academy of Medicine. Faculty of Odonthology. ABSTRACT Mandibular fractures usually happen among young males at the age of 16-30 years old. The mandible which has been rated as the second facial bone with the highest rate of injuries, tends to break much more often compared to any other bone of the cranium and represent up to 70% of the cases. This tendency to fracture may be explained by the protruded position, mobility and particular shape of it. The tendency for a mandibular fracture may also be explained by the common risk factors such as vehicle accidents and physical violence that are part of our daily life. There are many other risk factors according to the literature which differ between individuals due to the different socio-economic status, culture, technology and environment. Before the clinical examination of the fracture, it is obligatory to make sure that a clear airway path presents with no other fatal injuries. The examination may be supported by imaging methods which together will approve the diagnosis and method of treatment. Patients with a fracture of the mandible may suffer from post-operative complications which may occur after a short or long duration of the treatment. Those complications may be malocclusion, infections, trismus, damaged teeth and soft tissue, esthetic disfiguration, functional problems, pain and many more. -
CASE REPORT Injuries Following Segway Personal
UC Irvine Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health Title Injuries Following Segway Personal Transporter Accidents: Case Report and Review of the Literature Permalink https://escholarship.org/uc/item/37r4387d Journal Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health, 16(5) ISSN 1936-900X Authors Ashurst, John Wagner, Benjamin Publication Date 2015 DOI 10.5811/westjem.2015.7.26549 License https://creativecommons.org/licenses/by/4.0/ 4.0 Peer reviewed eScholarship.org Powered by the California Digital Library University of California CASE REPORT Injuries Following Segway Personal Transporter Accidents: Case Report and Review of the Literature John Ashurst DO, MSc Conemaugh Memorial Medical Center, Department of Emergency Medicine, Benjamin Wagner, DO Johnstown, Pennsylvania Section Editor: Rick A. McPheeters, DO Submission history: Submitted April 20, 2015; Accepted July 9, 2015 Electronically published October 20, 2015 Full text available through open access at http://escholarship.org/uc/uciem_westjem DOI: 10.5811/westjem.2015.7.26549 The Segway® self-balancing personal transporter has been used as a means of transport for sightseeing tourists, military, police and emergency medical personnel. Only recently have reports been published about serious injuries that have been sustained while operating this device. This case describes a 67-year-old male who sustained an oblique fracture of the shaft of the femur while using the Segway® for transportation around his community. We also present a review of the literature. [West J Emerg Med. 2015;16(5):693-695.] INTRODUCTION no parasthesia was noted. In 2001, Dean Kamen developed a self-balancing, zero Radiograph of the right femur demonstrated an oblique emissions personal transportation vehicle, known as the fracture of the proximal shaft of the femur with severe Segway® Personal Transporter (PT).1 The Segway’s® top displacement and angulation (Figure). -
Clinical Efficacy of Extended Modified Posteromedial Approach Versus
Clinical ecacy of extended modied posteromedial approach versus posterolateral approach for surgical treatment of posterior pilon fracture: a retrospective analysis Qin-Ming Zhang Aliated Hospital of Jining Medical University Hai-Bin Wang Aliated Hospital of Jining Medical University Xiao-Yan Li Aliated Hospital of Jining Medical University Feng-Long Chu Aliated Hospital of Jining Medical University Liang Han Aliated Hospital of Jining Medical University Dong-Mei Li Aliated Hospital of Jining Medical University Bin Wu ( [email protected] ) Alited Hospital of Jining Medical University https://orcid.org/0000-0003-3707-0056 Research article Keywords: posterior pilon fracture, approach, fracture xation, buttress plate Posted Date: March 30th, 2020 DOI: https://doi.org/10.21203/rs.3.rs-19392/v1 License: This work is licensed under a Creative Commons Attribution 4.0 International License. Read Full License Page 1/12 Abstract Background: Posterior pilon fracture is a type of ankle fracture associated with poorer treatment results compared to the conventional ankle fracture. This is partly related to the lack of consensus on the classication, approach selection, and internal xation method for this type of fracture. This study aimed to investigate the clinical ecacy of posterolateral approach versus extended modied posteromedial approach for surgical treatment of posterior pilon fracture. Methods: Data of 67 patients with posterior pilon fracture who received xation with a buttress plate between January 2015 and December 2018 were retrospectively reviewed. Patients received steel plate xation through either the posterolateral approach (n = 35, group A) or the extended modied posteromedial approach (n = 32, group B). Operation time, intraoperative blood loss, excellent and good rate of reduction, fracture healing time, American Orthopaedic Foot & Ankle Society (AOFAS) Ankle- Hindfoot Scale score, and Visual Analogue Scale score were compared between groups A and B. -
Pattern of Skeletal Injuries in Child Physical Abuse
1 Bahrain Medical Bulletin, Vol. 33, No. 2, June 2011 Pattern of Skeletal Injuries in Physically Abused Children Fadheela Al-Mahroos, MD, MHPE* Eshraq A Al-Amer, MD, ABMS (Ped)** Nabar J Umesh, MD, DMRE*** Ali I Alekri, FRCSI, CABS (Ortho)**** Objective: The aim of this study is to identify the frequency and patterns of skeletal injuries among victims of child abuse in Bahrain. Design: Retrospective. Setting: Child Protection Unit at Salmaniya Medical Complex. Method: Child’s characteristics, type of skeletal injuries, location, pattern, radiological findings, and associated other injuries of 36 children were reviewed. Data management and analysis was done using SPSS for Windows, version 18. Result: Thirty-six children with skeletal injuries resulting from child physical abuse were seen from 1991 to 2009. Twenty-three (64%) were males and 13 (36%) were females; the mean age was 3.8 years. Twenty-three (64%) were ≤ 3 years old. Multiple fractures were documented in 19 (53%) children. Bone fracture types and frequency were as follow: 10 (28%) affecting the femur, 9 (25%) skull, 8 (22%) humerus, 6 (17%) rib, 4 (11%) radius, 4 (11%) ulna and 2 (6%) tibia. Other bones less frequently affected were mandible, nasal bone, vertebral, metatarsals, and calcaneus fractures. In addition, other injuries included slipped femoral epiphysis, large bilateral hematoma in vastus lateralis, and full thickness tendon Achilles tear. Hundred percent of rib, ulnar, radial and tibial fractures were in children under one year old. In addition, 7 (78%) of skull fractures, 5 (62%) of humerus fractures, and 5 (50) of femur fractures were under one year old. -
Treatment of Common Hip Fractures: Evidence Report/Technology
This report is based on research conducted by the Minnesota Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. HHSA 290 2007 10064 1). The findings and conclusions in this document are those of the authors, who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services. The information in this report is intended to help clinicians, employers, policymakers, and others make informed decisions about the provision of health care services. This report is intended as a reference and not as a substitute for clinical judgment. This report may be used, in whole or in part, as the basis for the development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied. Evidence Report/Technology Assessment Number 184 Treatment of Common Hip Fractures Prepared for: Agency for Healthcare Research and Quality U.S. Department of Health and Human Services 540 Gaither Road Rockville, MD 20850 www.ahrq.gov Contract No. HHSA 290 2007 10064 1 Prepared by: Minnesota Evidence-based Practice Center, Minneapolis, Minnesota Investigators Mary Butler, Ph.D., M.B.A. Mary Forte, D.C. Robert L. Kane, M.D. Siddharth Joglekar, M.D. Susan J. Duval, Ph.D. Marc Swiontkowski, M.D. -
Anatomy Review Upper Extremity WARNING: the Content in This Slideshow Contains Some Sports Footage That May Be Gross
BONES Anatomy Review Upper Extremity WARNING: The content in this slideshow contains some sports footage that may be gross. If you don’t like bodily injuries be warned! SKULL/ FACE Four major bones fuse together to create our cranium . → parietal,temporal,occipital and frontal bones Two major bones of the jaw . → Mandible and Maxilla INJURIES TO THE SKULL & FACE This is raccoon eyes, and battle sign which indicate a skull fracture. Common cause is blunt force trauma to the head, for example, getting hit in the head with a baseball. Often seen in individuals who are beaten or abused. INJURIES TO THE SKULL & FACE This is a picture of Victor Hedman a top defenseman in the NHL. INJURY: laceration to the face. CAUSE: helmet visor was pushed into his face. Lacerations are common during sports and either treated with stitches or glue INJURIES TO THE SKULL & FACE Mandibular Fracture Video Link above is for a Fracture to the mandible Sidney Crosby was hit in the face by a 90 mph slapshot! INJURY: Mandibular Fracture TREATMENT: Surgery ( Jaw was wired shut) He was also provided with a Jaw shield ANTERIOR TORSO Ribs- Remember ribs are discussed in pairs True ribs vs. False ribs- true ribs connect directly to the sternum false ribs do not. Sternum- Broken down into three parts: 1. Manubrium 2. Body 3. Xiphoid process INJURIES TO THE ANTERIOR TORSO INJURY: Fractured Ribs CAUSE: A direct blow or trauma to the ribs Usually detected on x-ray POSTERIOR TORSO Vertebrae → 7 cervical 12 thoracic 5 lumbar BONES OF THE ARM 3 Major bones make up the shoulder: 1. -
Femoral Shaft Fracture Fixation and Chest Injury After Polytrauma
This is an enhanced PDF from The Journal of Bone and Joint Surgery The PDF of the article you requested follows this cover page. Femoral Shaft Fracture Fixation and Chest Injury After Polytrauma Lawrence B. Bone and Peter Giannoudis J Bone Joint Surg Am. 2011;93:311-317. doi:10.2106/JBJS.J.00334 This information is current as of January 25, 2011 Reprints and Permissions Click here to order reprints or request permission to use material from this article, or locate the article citation on jbjs.org and click on the [Reprints and Permissions] link. Publisher Information The Journal of Bone and Joint Surgery 20 Pickering Street, Needham, MA 02492-3157 www.jbjs.org 311 COPYRIGHT Ó 2011 BY THE JOURNAL OF BONE AND JOINT SURGERY,INCORPORATED Current Concepts Review Femoral Shaft Fracture Fixation and Chest Injury After Polytrauma By Lawrence B. Bone, MD, and Peter Giannoudis, MD, FRCS Thirty years ago, the standard of care for the multiply injured tients with multiple injuries, defined as an ISS of ‡18, and patient with fractures was placement of the fractured limb in a patients with essentially an isolated femoral fracture and an splint or skeletal traction, until the patient was considered stable ISS of <18. Pulmonary complications consisting of ARDS, enough to undergo surgery for fracture fixation1. This led to a pulmonary dysfunction, fat emboli, pulmonary emboli, and number of complications2, such as adult respiratory distress pneumonia were present in 38% (fourteen) of thirty-seven syndrome (ARDS), infection, pneumonia, malunion, non- patients in the late fixation/multiple injuries group and 4% union, and death, particularly when the patient had a high (two) of forty-six in the early fixation/multiple injuries group; Injury Severity Score (ISS)3. -
Coleman Sign: a Hallmark for Mandibular Fracture? a Rare Case Exception
European Journal of Molecular & Clinical Medicine ISSN 2515-8260 Volume 07, Issue 10, 2020 Coleman Sign: A Hallmark For Mandibular Fracture? A Rare Case Exception Dr Premalatha Shetty(MDS)1, Dr Aditya Nandan, 2, Dr Mahabalesh Shetty3, Dr Suraj Shetty4 1Associate Dean, Professor, Oral and Maxillofacial department, Manipal College of Dental sciences, Mangalore, Manipal Academy of Higher Education, Manipal 2 Postgraduate(BDS), Oral and Maxillofacial department, Manipal College of dental sciences, Mangalore, Manipal Academy of Higher Education, Manipal 3Professor& Head of Department, Department of Forensic Medicine & Toxicology K S Hegde Medical Academy, NIITE (Deemed to be University) 4Associate Professor, Department of Forensic Medicine & Toxicology, K S Hegde Medical Academy, NIITE (Deemed to be University) Email ID:[email protected], [email protected], [email protected], [email protected] Abstract: Mandibular fracture involving the parasymphysis region is one of the most common fractures of mandible. Majority of parasymphysis fractures are due to direct blow or injury to the chin region. Specific signs and symptoms for parasymphysis fracture are pain, swelling, tenderness in the chin region, deranged occlusion, soft tissue injury to chin and the lower lip and sublingual hematoma. Frank Coleman considered a sublingual hematoma as “almost pathognomonic of fracture of the mandible”. We present a case that fails to replicate this hallmark sign associated with a mandibular fracture, as the patient had all the signs and symptoms of parasymphysis fracture except sublingual hematoma which is very rare and unusual to observe. The final diagnosis was made on the basis of radiographic examination using CBCT scan. On surgical exposure the mandibular parasymphysis fracture in the region of right lateral incisor and canine was confirmed. -
Code Description
Code Description 0061 Chronic intestinal amebiasis without mention of abscess 0062 Amebic nondysenteric colitis 0063 Amebic liver abscess 0064 Amebic lung abscess 00642 West Nile fever with other neurologic manifestation 00649 West Nile fever with other complications 0065 Amebic brain abscess 0066 Amebic skin ulceration 0068 Amebic infection of other sites 0069 Amebiasis, unspecified 0070 Other protozoal intestinal diseases, balantidiasis (Infection by Balantidium coli) 0071 Other protozoal intestinal diseases, giardiasis 0072 Other protozoal intestinal diseases, coccidiosis 0073 Other protozoal intestinal diseases, trichomoniasis 0074 Other protozoal intestinal diseases, cryptosporidiosis 0075 Other protozoal intestional disease cyclosporiasis 0078 Other specified protozoal intestinal diseases 0079 Unspecified protozoal intestinal disease 01000 Primary tuberculous infection, unspecified 01001 Primary tuberculous infection bacteriological or histological examination not done 01002 Primary tuberculous infection, bacteriological or histological examination results unknown 01003 Primary tuberculous infection, tubercle bacilli found by microscopy 01004 Primary tuberculous infection, tubercle bacilli found by bacterial culture 01005 Primary tuberculous infection, tubercle bacilli confirmed histolgically 01006 Primary tuberculous infection, tubercle bacilli found by other methods 01010 Tuberculous pleurisy in primary progressive tuberculosis unspecified 01011 Tuberculous pleurisy bacteriological or histological examination not done 01012 Tuberculous