Resident Comprehensive Fracture Course Wednesday, October 11 Thursday, October 12 Friday, October 13
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Fractures Fractura Pathologica
Fractures Fractura pathologica Myeloma Fractura traumatica Fractura aperta/clausa Fractura simplex/multiplex Fractura comminutiva Fractura transversa/obliqua Fractura spiralis/longitudinalis Fractura compressiva/impressiva Fractura incuneata Infractio = f. partialis = f. incompleta Fractura cum dislocatione ad axim ad latus ad longitudinem cum contractione ad longitudinem cum distractione AO ClassificationAuthentic reports of fractures : 2 S 4220 Fractura colli chirurgici humeri l. dx. comminutiva AO 11-C3 Fracture Healing: 1: REPOSITIO = REDUCTIO fragmentorum CLOSED (short /long term) Fracture Healing: 2: FIXATIO = STABILISATIO fragmentorum PLASTER CAST INTERNAL FIXATION Fracture Healing: 2: FIXATIO = STABILISATIO fragmentorum INTERNAL FIXATION Fracture Healing: 2: FIXATIO = STABILISATIO fragmentorum Name the type of fracture A B C D E F Choose a bone and break it. Try to write as much detailed diagnosis as possible. Authentic reports :1 collement = severe damage of soft tissues Authentic reports :2 Fr. aperta TSCHERNE I - open fracture with small skin injury without its contusion - negligible bacterial contamination Profesor Dr. Harald Tscherne (1933), Traumatology Clinic, Hannover: Classification of fractures published in 1982, T. divides fracture into open and closed. The most important for him is the degree of the soft tissues damage. Authentic reports :3 1 A 45-year-old woman presented with a 3-month history of generalized body pains nonresponsive to analgesic agents. Along with low back pain, she had progressive difficulty in getting up from sitting and supine positions and in walking. There was no history of trauma or any medication intake. She is an orthodox believer who wears a black veil outdoors and is completely covered, with little exposure to the sun. An anteroposterior radio- graph of the pelvis showed an undisplaced transverse fracture of the shaft of both femurs. -
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. -
Biomechanical Comparison of Fixation Stability Using a Lisfranc Plate
Foot and Ankle Surgery 25 (2019) 71–78 Contents lists available at ScienceDirect Foot and Ankle Surgery journa l homepage: www.elsevier.com/locate/fas Biomechanical comparison of fixation stability using a Lisfranc plate $ versus transarticular screws a,b a,c, d d Nathan C. Ho , Sophia N. Sangiorgio *, Spenser Cassinelli , Stephen Shymon , d a,b a,c d John Fleming , Virat Agrawal , Edward Ebramzadeh , Thomas G. Harris a The J. Vernon Luck, Sr., M.D. Orthopaedic Research Center, Orthopaedic Institute for Children, in Alliance with UCLA, 403 W. Adams Blvd., Los Angeles, CA 90007, United States b University of Southern California Department of Biomedical Engineering, Los Angeles, CA, United States c University of California, Los Angeles Department of Orthopaedic Surgery, Los Angeles, CA, United States d Los Angeles County Harbor—UCLA Medical Center, Los Angeles, CA, United States A R T I C L E I N F O A B S T R A C T Article history: Background: To obtain adequate fixation in treating Lisfranc soft tissue injuries, the joint is commonly Received 3 March 2017 stabilized using multiple transarticular screws; however iatrogenic injury is a concern. Alternatively, two Received in revised form 28 July 2017 parallel, longitudinally placed plates, can be used to stabilize the 1st and 2nd tarsometatarsal joints; Accepted 8 August 2017 however this may not provide adequate stability along the Lisfranc ligament. Several biomechanical studies have comparedearliermethodsoffixation using platestothestandardtransarticularscrew fixationmethod, Keywords: highlighting the potential issue of transverse stability using plates. A novel dorsal plate is introduced, Lisfranc injury intended to provide transverse and longitudinal stability, without injury to the articular cartilage. -
An Old Mismanaged Lisfranc Injury Treated by Gradual Deformity Correction Followed by the Second-Stage Internal fixation
Strat Traum Limb Recon (2017) 12:59–62 DOI 10.1007/s11751-016-0273-3 CASE REPORT An old mismanaged Lisfranc injury treated by gradual deformity correction followed by the second-stage internal fixation 1 1 1 1 Mehraj D. Tantray • Khurshid Kangoo • Asif Nazir • Muzamil Baba • 1 1 1 Raja Rameez • Syed Tabish • Syed Shahnawaz Received: 29 May 2016 / Accepted: 27 December 2016 / Published online: 5 January 2017 Ó The Author(s) 2017. This article is published with open access at Springerlink.com Abstract The Lisfranc fracture-dislocation of the foot is Keywords Lisfranc injury Á Ilizarov Á Late diagnosis uncommon and diagnosis is often missed. The Lisfranc joint involves the articulation between medial cuneiform and base of the second metatarsal and is considered a Introduction keystone to structural integrity to the midfoot. The articu- lation has a stabilization effect on longitudinal and trans- Injuries to the tarsometatarsal joints are not common and verse arches of the foot. A neglected or untreated injury to represent less than 0.2% of all orthopaedic injuries with the Lisfranc joint can lead to secondary arthritis and sig- a reported incidence of 1 per 55,000 individuals [1]. The nificant morbidity and disability. We present a case of a injury is commonly missed due to gross swelling mask- neglected Lisfranc fracture-dislocation in a 28-year-old ing the deformity and subtle findings on radiological female patient who presented 3 months after injury. A evaluation which requires careful attention. Re-examina- staged treatment of distraction with an Ilizarov ring fixator tion after the decrease in oedema for persistent pain and followed in the second stage by the removal of ring fixator aggravation of pain or instability on stress examination and internal fixation with K wires was performed. -
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. -
Sport Following Lisfranc Injuries: a Systematic Review and Meta-Analysis
Foot and Ankle Surgery 25 (2019) 654–664 Contents lists available at ScienceDirect Foot and Ankle Surgery journal homepage: www.elsevier.com/locate/fas Return to sport following Lisfranc injuries: A systematic review and meta-analysis a, b c a Gregory Aidan James Robertson *, Kok Kiong Ang , Nicola Maffulli , Gary Keenan , d Alexander MacDonald Wood a Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, United Kingdom b Edinburgh Medical School, University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, United Kingdom c Queen Mary University of London, Mile End Road, London E1 4NS, United Kingdom d Leeds General Infirmary, Great George St, Leeds LS1 3EX, United Kingdom A R T I C L E I N F O A B S T R A C T Article history: Background: Information regarding return rates (RR) and mean return times (RT) to sport following Received 25 April 2018 Lisfranc injuries remains limited. Received in revised form 17 July 2018 Methods: A systematic search of nine major databases was performed to identify all studies which Accepted 24 July 2018 recorded RR or RT to sport following lisfranc injuries. Results: Seventeen studies were included (n = 366). Keywords: For undisplaced (Stage 1) injuries managed nonoperatively (n = 35), RR was 100% and RT was 4.0 (0–15) Lisfranc wks. For stable minimally-displaced (Stage 2) injuries managed nonoperatively (n = 16), RR was 100% and Tarso-metarsal RT was 9.1 (4–14) wks. Mid-foot Return For the operatively-managed injuries, Percutaneous Reduction Internal Fixation (PRIF) (n = 42), showed Sport significantly better RR and RT compared to both: Open Reduction Internal Fixation (ORIF) (n = 139) (RR — Rate 98% vs 78%, p < 0.019; RT — 11.6 wks vs 19.6 wks, p < 0.001); and Primary Partial Arthrodesis (PPA) (n = 85) Time (RR — 98% vs 85%, p < 0.047; RT — 11.6 wks vs 22.0 wks, p < 0.002). -
Lisfranc Injury and Midfoot Arthritis
Dr Todd Gothelf www.orthosports.com.au 47‐49 Burwood Road, Concord 29‐31 Dora Street, Hurstville 119‐121 Lethbridge Street, Penrith 160 Belmore Road, Randwick Dr Todd Gothelf Shoulder, Foot & Ankle Surgery Midfoot Sprains and Arthritis Todd K Gothelf Foot, Ankle, Shoulder Surgeon Dr Todd Gothelf Shoulder, Foot & Ankle Surgery Midfoot Arthritis • Arthritis of Tarsometatarsal complex • Lisfranc Complex • Major Causes – Lisfranc sprain – Primary Arthritis – Inflammatory Disease Dr Todd Gothelf Shoulder, Foot & Ankle Surgery Lisfranc Injury • One of the most common athletic foot injuries • Difficult Diagnosis • It will see you • Treatable When detected • Arthritis Preventable Dr Todd Gothelf Shoulder, Foot & Ankle Surgery Lisfranc Joints • Tarsometatarsal joint complex • Increased awareness • Fairly common injury in sports • Up to 20% overlooked on initial radiographs • Left untreated, can lead to arthritis, prolonged pain, difficulty returning to sport Dr Todd Gothelf Shoulder, Foot & Ankle Surgery Jacques Lisfranc • French Surgeon • Napolean Era • Described amputations through midfoot Dr Todd Gothelf Shoulder, Foot & Ankle Surgery Mechanism of injury • Direct Injury‐ Crush to Midfoot • Indirect Injury‐ Twisting • With toes planted • Ankle in plantar flexion • Forceful abduction of the midfoot Dr Todd Gothelf Shoulder, Foot & Ankle Surgery Anatomy • Medial cuneiform to the second metatarsal. • Intimately related to one another. • Bones offer primary stability • Held together by ligaments. Dr Todd Gothelf Shoulder, Foot & Ankle Surgery Anatomy‐ -
OUTPATIENT REHABILITATION for a PATIENT FOLLOWING a SURGICALLY STABILIZED TRIMALLEOLAR FRACTURE a Doctoral Project a Comprehensi
OUTPATIENT REHABILITATION FOR A PATIENT FOLLOWING A SURGICALLY STABILIZED TRIMALLEOLAR FRACTURE A Doctoral Project A Comprehensive Case Analysis Presented to the faculty of the Department of Physical Therapy California State University, Sacramento Submitted in partial satisfaction of the requirements for the degree of DOCTOR OF PHYSICAL THERAPY by Julie Hammond FALL 2017 © 2017 Julie Hammond ALL RIGHTS RESERVED ii OUTPATIENT REHABILITATION FOR A PATIENT FOLLOWING A SURGICALLY STABILIZED TRIMALLEOLAR FRACTURE A Doctoral Project by Julie Hammond Approved by: _____________________________________, Committee Chair Edward Barakatt, PT, PhD _____________________________________, First Reader William Garcia, PT, DPT, OCS, FAAOMPT _____________________________________, Second Reader Rafael Escamilla, PhD, PT, CSCS ____________________________ Date iii Student: Julie Hammond I certify that this student has met the requirements for format contained in the University format manual, and that this project is suitable for shelving in the Library and credit is to be awarded for the project. __________________________________, Department Chair ____________ Michael McKeough, PT, EdD Date Department of Physical Therapy iv Abstract of OUTPATIENT REHABILITATION FOR A PATIENT FOLLOWING A SURGICALLY STABILIZED TRIMALLEOLAR FRACTURE by Julie Hammond A 46 year old woman with a right surgically stabilized trimalleolar fracture was seen for physical therapy treatment for 13 sessions from 06/17/2016 to 09/16/2106 at an outpatient pro bono physical therapy clinic. Treatment was provided by a student physical therapist under the supervision of a licensed physical therapist. The patient was evaluated at the initial encounter with manual muscle test, goniometric measurements, single leg balance test, Timed Up and Go test, and a self- report questionnaire (Foot and Ankle Ability Measure). -
Risk Factors for Fracture and Fracture Severity of the Distal Radius and Ankle. What About Osteoporosis, Celiac Disease and Obesity?
Risk factors for fracture and fracture severity of the distal radius and ankle. What about osteoporosis, celiac disease and obesity? Anja Myhre Hjelle Thesis for the degree of Philosophiae Doctor (PhD) University of Bergen, Norway 2021 Risk factors for fracture and fracture severity of the distal radius and ankle. What about osteoporosis, celiac disease and obesity? Anja Myhre Hjelle ThesisAvhandling for the for degree graden of philosophiaePhilosophiae doctorDoctor (ph.d (PhD). ) atved the Universitetet University of i BergenBergen Date of defense:2017 17.06.2021 Dato for disputas: 1111 © Copyright Anja Myhre Hjelle The material in this publication is covered by the provisions of the Copyright Act. Year: 2021 Title: Risk factors for fracture and fracture severity of the distal radius and ankle. Name: Anja Myhre Hjelle Print: Skipnes Kommunikasjon / University of Bergen 1 CONTRIBUTORS This work is the result of a collaboration between and funding from The Department of Global Public Health and Primary Care at the University of Bergen, The Department of Rheumatology at the District Hospital of Førde, and The Centre for Health Research in Sogn og Fjordane (a collaborative effort between Førde Health Trust and the health studies department of the Western Norway University College of Applied Sciences). We have also collaborated with The Department of Orthopedic surgery and the Department of Radiology at the District Hospital of Førde, The Departement of Rheumatology at Haukeland University Hospital, Bergen, and The KB Jebsen Coeliac Disease Research Centre, University of Oslo. We are grateful for additional funding received from The Norwegian association for Celiac Disease (Norsk Cøliakiforening) in 2012 and 2015. -
Complex Cases
Repair and Fix the Lisfranc Joint Don’t Fuse It Gil R. Ortega, MD, MPH Sonoran Orthopaedic Trauma Surgeons Orthopaedic Trauma Director, Mayo Clinic Arizona Residency Program Vice Chair, Department of Surgery, Scottsdale Osborn Level 1 Trauma Center, Scottsdale, AZ, USA Disclosures • Founding Member, Orthopaedic Board of Advisors: Carbofix • Founding Member, Orthopaedic Board of Advisors: Artross Nanobone • Consultant: Smith and Nephew Why Fuse a joint that suffers a ligament injury without a fracture? • Do we fuse shoulder or elbow joints after dislocations without fractures? • Do we fuse hips after dislocations without fractures? • Do we fuse knees after knee dislocations with ligament injuries only? • Do we fuse ankles after ankle dislocations without fractures? • NO OF COURSE NOT…So why fuse the Lisfranc? Fusing a Lisfranc joint after a dislocation makes no physiologic sense • A Lisfranc injury is a ligamentous injury with or without associated fractures The Weak Argument to Fuse a Lisfranc is based on one study • Forty-one patients in prospective, randomized clinical trial comparing primary arthrodesis with ORIF • Patients followed for average of 42.5 months Evaluation was performed with clinical examination, radiography, American Orthopaedic Foot and Ankle Society (AOFAS) Midfoot Scale, a visual analog pain scale, and a clinical questionnaire The Weak Argument to Fuse a Lisfranc is based on one study • Twenty patients-ORIF and 21-Fusion • Two years postop, mean AOFAS Midfoot score was 68.6 points in ORIF and 88 points in the arthrodesis -
A Study of Functional Outcome of Lisfranc Fracture Dislocations
National Journal of Clinical Orthopaedics 2018; 2(4): 85-89 ISSN (P): 2521-3466 ISSN (E): 2521-3474 © Clinical Orthopaedics A study of functional outcome of lisfranc fracture www.orthoresearchjournal.com 2018; 2(4): 85-89 dislocations managed by various operative methods in Received: 12-08-2018 Accepted: 13-09-2018 rural south Indian population Dr. J Kumaran Postgraduate, Department of Dr. J Kumaran, Dr. R Neelakrishnan, Dr. V Bharathiselvan and Orthopaedics, Rajah Muthiah Dr. Anush Rao Medical College & Hospital, Annamalai University, Tamil Nadu, India Abstract This study is an attempt to analyse the midterm results of “functional outcome of lisfranc fracture Dr. R Neelakrishnan dislocations managed by various operative methods” in rural south Indian population. Lisfranc Fracture Professor & HOD, Department dislocations have low incidence as they are commonly missed. Painful malunion or impaired functions of Orthopaedics, Rajah Muthiah may result if not treated adequately. Anatomic reduction and internal fixation is recommended. The study Medical College & Hospital, involves 15 patients, aged 18 to 65 admitted to our hospital, Rajah Muthiah Medical College, Annamalai University, Chidambaram for period of 24 months from May 2016 to April 2018.Myerson’s Classification of lisfranc Tamil Nadu, India fracture disloaction was used to classify and manage the injuries accordingly. Patients were managed with surgical reduction (Open or closed) using Kwires/Screws. Post operatively immobilisation was done Dr. V Bharathiselvan using BK cast/slab for a period varying from 4 - 12 weeks and later Gradual weight bearing allowed after Lecturer, Department of 6 -8 weeks. AOFAS Midfoot score was used to document the prognosis. The study involves 15 patients, Orthopaedics, Rajah Muthiah Medical College & Hospital, 11 men and 4 women aged 18 to 65 years (mean = 31) admitted to our hospital, for period of 24 months Annamalai University, from May 2016 to April 2018 (mean follow up period - 9 months).