DOCSLIB.ORG

Scintigraphy of Toddler's Fracture

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Scintigraphy of Toddler's Fracture Case Reports Scintigraphy of Toddler's Fracture John H. Miller and Ronald A. Sanderson Childrens Hospital of Los Angeles and University of Southern California, School of Medicine, Los Angeles, California Under ordinary circumstances a toddler's fracture of the lower extremity is diagnosed by clinical evaluation and history. Often the initial conventional radiograph is unrevealing, but the fracture is diagnosed and treated based on appropriate clinical and laboratory findings. In rare instances, a patient with an unsuspected toddler's fracture may present with an atypical history, unusual physical findings, or laboratory values suggesting the presence of an inflammatory process. Skeletal scintigraphy in this small group of patients has been valuable in defining a spiral fracture of the midshaft of the tibia connected with a toddler's fracture. We report the scintigraphic appearance from the findings in six patients with unsuspected toddler's fracture evaluated by this method. J NucíMed 29:2001-2003,1988 A,. toddler's fracture is an injury to the lower extrem systemic signs secondary to common childhood viral ity, usually seen between 1 and 3 yr of age. It is caused illnesses, such as an acute upper respiratory infection, by a twisting or torsional injury to the lower extremity can add to the difficulty in differentiating an early resulting in a spiral fracture of the midshaft of the tibia. osteomyelitis from a toddler's fracture. The radio- Often the injury is unwitnessed by a parent and is nuclide bone scan will be helpful in establishing the sustained by a fall or by entrapment of the foot as the correct diagnosis in this injury and its appropriate treat patient rolls around. The usual clinical presentation is ment. a child who refuses to walk or to bear weight on the involved limb; there may be pain or irritability related MATERIALS AND METHODS to movement of the involved lower extremity. The Six children, four males and two females, age 15 to 38 mo, clinical signs are a refusal to walk, an antalgic limp, who were subsequently proven to have toddler's fractures were swelling, warmth, local tenderness, or minimal signs initially evaluated clinically and by conventional radiography and/or symptoms. and skeletal scintigraphy. Conventional AP and lateral radiog The conventional radiographie findings vary from a raphy of the involved extremity was performed in all patients fine, spiral microfracture to an obvious, mildly dis at the time of initial presentation. Scintigraphic evaluation placed, long spiral fracture of the midshaft of the tibia. was performed at this time as well, which was between 1 and The most subtle fractures may not be visible on plain 3 days from the initial onset of symptoms. Follow-up radiog films, including oblique views. Treatment of this injury raphy was performed at 7 to 10 days on three patients and at requires the application of a long leg cast to be worn the termination of casting treatment in all patients. Double or for~6wk(7,2). triple phase skeletal scintigraphy was performed in all patients following intravenous administration of 0.280 mCi/kg (mini The diagnostic dilemma caused by this fracture is mum dose 2.0 mCi) of technetium-99m méthylènediphos- that the injury the child sustains is quite often not phonate ([9<)mTc]MDP). Dynamic scintigraphy at 3-sec inter witnessed by the parent, and the child is irritable or vals was performed of both lower extremities. Immediate, refuses to walk relative to the pain experienced in the static, blood-pool scintiphotos were then obtained to assess patient's involved lower extremity. The occurrence of the tissue phase of tracer activity. Delayed static 300,000- an unrevealing initial conventional radiographie ex 500,000 count scintiphotos of the entire lower half of the body amination may add to the diagnostic difficulty. Differ were obtained. Lateral and/or oblique scintiphotos were then ential diagnoses must include osteomyelitis of the prox obtained to best demonstrate abnormalities involving the tibia imal or distal tibia or fibula. A child with fever or in these patients. Received Dec. 22, 1987; revision accepted July 11, 1988. RESULTS For reprints contact: John H. Miller. MD, Div. of Nuclear Radiology, Childrens Hospital of Los Angeles, 4650 Sunset Blvd., In no patient in this series was there history of a fall Los Angeles, CA 90027. or an injury. Moreover, there were signs, such as fever Volume 29 •Number 12 •December 1988 2001 FIGURE 1 Anteroposterior (A) and lateral (B) radiographs of the right tibia are unremarkable. The anterior immediate post injection scintiphoto revealed slightly increased uptake in the mid shaft of the right tibia. Anterior (C) and lateral (D) ["Te] MDP scintiphotos of the lower extremities reveal increased activity in the midshaft of the right tibia. On the lateral scintiphoto (D), the abnormal osteoblastic activity is seen to course from posterior to anterior (arrowheads), indicating the presence of a spiral-type fracture. These scintiphotos were obtained on the same day as the initial radiographs. Anteroposterior (E)and lateral (F)radiographs obtained ~6 wk after the initial radiographs reveal the presence of considerable periosteal bone in the midshaft of the right tibia, confirming the presence of a spiral fracture of the midshaft. 2002 Miller and Sanderson The Journal of Nuclear Medicine or increased white blood cell count, or symptoms such 4). We perform scintigraphy of the lower half of the as refusal to bear weight on either limb which precluded body in every patient evaluated for limp, leg pain, the correct clinical diagnosis of toddler's fracture. Initial refusal to walk or bear weight, as referral of pain to the radiographie evaluation of these patients revealed no leg from discitis or sacro-iliac pyarthrosis commonly abnormality of the tibia. occurs (3-5). For this reason, immediate post-injection In three patients, radiographs obtained between 7 blood-pool scintiphotos are obtained of the lumbar and 10 days following initial casting revealed spiral- spine, pelvis, hips, and complete lower extremities, type fractures of the midshaft of the tibia. In all patients which in approximately one-half of patients with a following 6 wk of immobilization, periostea! new bone toddler's fracture will reveal increased tissue phase ac compatible with a healed spiral-type or torsion-type tivity. This represents a local hyperemic response to the fracture was identified. In this group of patients, no subclinical disruption of the periostium (3). Patients other lesion was identified on either radiographie or with a toddler's fracture of the tibia reveal a typical skeletal scintigraphic examination of the lower half of scintigraphic appearance, abnormal osteoblastic activ the body. ity which courses in an oblique manner across the All patients were evaluated by two-phase skeletal midshaft of the involved tibia (Fig. 1). This typical scintigraphy and three patients had three-phase exami distribution allows differentiation from metaphyseal or nations. No abnormality was seen on dynamic scintig juxta-articular increased activity seen in osteomyelitis raphy in these patients. On the blood-pool scintiphotos or inflammatory joint disease. We perform over 450 in three patients there was slightly increased tracer pediatrie isotope skeletal examinations per year, and no activity along the shaft of the involved tibia. In all six other osseous lesion has osteoblastic activity in this patients on the delayed scintiphotos, abnormal uptake spiral or oblique appearance. In patients with a typical of [99mTc]MDPinvolving the tibial shaft at the site of scintigraphic appearance of a toddler's fracture, casting clinical symptomatology was identified. This abnormal can be continued for 6 wk without the need for repeat uptake was seen in the midshaft of the tibia in all radiography and recasting at 7 to 10 days following patients, and an apparent oblique course was seen in initiation of treatment. However, the conventional three. There was no evidence of abnormal uptake of approach of initial casting following the re- tracer in either the metaphyseal regions or the juxta- evaluation at 7 to 10 days should be utilized in those articular or articular regions of any of the involved patients with the clinical symptomatology of toddler's extremities. No positive blood cultures were obtained, fracture and an unremarkable radiographie examina and no patient in this series received any antibiotic tion. therapy. Skeletal scintigraphy provides an excellent means to evaluate the lower half of the body in a child who presents with a limp, an atypical history or clinical DISCUSSION presentation, and signs of systemic illness with a nega Toddler's fracture should be considered when a tive initial radiographie evaluation. Skeletal scintigra phy will reveal an abnormality in those patients with a healthy child presents with refusal to walk and no toddler's fracture of the tibia (3,4). significant physical findings related to the lower extrem ity, particularly when there are no other clinical symp toms. In this instance, following an initial negative radiographie examination, the patient will be placed in REFERENCES a long leg cast for 7 to 10days. The cast will be removed, 1. Silverman FN, ed. In: CafFey's pediatrie x-ray diag and repeat clinical examination and radiography will nosis: an integrated imaging approach, 8th edition, be obtained following this initial period. In patients Chicago: Year Book Medical Publishers, 1985: 763. with a toddler's fracture, either a periostea! reaction or 2. Sharrard WJW. Paediatric orthopaedics and fractures, 2nd edition. Oxford: Blackwell, 1979: 1619-1629. a more obvious fracture, due to reabsorption at the 3. Sty JR. Starshak RJ, Miller JH. Bone scintigraphy. In: fracture site will be seen. The child will then be recasted Current practice in nuclear medicine: pediatrie nuclear and will continue immobilization for a total of 6 wk. medicine. Norwalk: Appleton-Century-Crofts, 1983: Skeletal scintigraphy should be obtained in those 1-25.
Load more

Recommended publications
  • Part Fracture Dislocation Due to Stress Concentration at Intramedullary Nail End 1Devendra Chouhan, 2Vishal Kumar, 3Manish Kundanmal Kothari, 4Mandeep S Dhillon
    JPMER Devendra Chouhan et al 10.5005/jp-journals-10028-1142 CASE REPORT Dissociation of Shaft of Humerus from Head in Three- part Fracture Dislocation due to Stress Concentration at Intramedullary Nail End 1Devendra Chouhan, 2Vishal Kumar, 3Manish Kundanmal Kothari, 4Mandeep S Dhillon ABSTRACT authors best knowledge. We report the first such case A three-part fracture dislocation of the proximal humerus of three-part fracture dislocation involving the greater usually dissociates from the shaft at the level of the surgical tuberosity and proximal shaft of humerus with a 25 years neck or the anatomical neck. Dissociation from the shaft below old Rush nail in situ. this level has not reported in the literature before. Here we describe the injury of a middle aged patient with a three-part CASE REPORT fracture dislocation of the humerus with dissociation of the head from the shaft at the level of proximal shaft humerus with A 60-year-old male presented in the emergency depart- a 25 years old Rush nail in situ. The dislocated head was found ment with acute pain in right shoulder following road abutting the thoracic wall. This case report highlights the effect traffic accident 8 hours ago. He was travelling on a bike of stress concentration at intramedullary nail ends in the upper limb as well as the need for an extended approach when the when a car hit him from the side. He was violently thrown dislocated head appears close to the thoracic wall. off his motorcycle followed by fall on an outstretched hand. He had no other complaints.
    [Show full text]
  • Metacarpal Fractures
    METACARPAL FRACTURES BY LORYN P. WEINSTEIN, MD, AND DOUGLAS P. HANEL, MD The majority of metacarpal fractures are closed injuries amenable to conservative treatment with external immobilization and subsequent rehabilitation. Internal fixation is favored for unstable fracture patterns and patients who require early motion. Percutaneous pinning usually is successful for metacarpal neck fractures and comminuted head fractures. Shaft and base fractures can be treated with pinning or open reduction and internal fixation; the latter, being more rigid, allows early rehabilitation. External fixation has a limited yet defined role for metacarpal fractures with complex soft-tissue injury and/or segmental bone loss. The recent development of bioabsorbable implants holds promise for skeletal rigidity with minimal soft-tissue morbidity, but long-term in vivo data support- ing the use of these implants is not currently available. Copyright © 2002 by the American Society for Surgery of the Hand arly treatment of metacarpal fractures was lim- Surgical techniques rapidly expanded to include ret- ited to the only tools available: manipulation rograde fracture pinning, intramedullary pinning, and Eand casting. The discovery of percutaneous transfixion pinning. Many of the K-wires in use today fracture fixation near the turn of the century opened have the same diamond-shaped tip and sizing speci- up a new world of possibilities. It was 25 years after fications as the original design. Bennett’s original manuscript that Lambotte de- The first plate and screw set for the hand was scribed the first surgical stabilization of a basilar introduced in the late 1930s. By today’s standards, the thumb fracture by using a thin carpenter’s nail.1 By Hermann Metacarpal Bone Set was quite lean; it 1913, Lambotte had authored a fracture text with included 3 longitudinal plates of 2, 3, and 4 holes, a multiple examples of pinning, wiring, and plating of drill, screwdriver, and 9 screws.1 Improvements in hand fractures.
    [Show full text]
  • Proximal Humerus Fracture After Keyhole Biceps Tenodesis
    A Case Report & Literature Review Proximal Humerus Fracture After Keyhole Biceps Tenodesis Stefanie N. Reiff, BA, Shane J. Nho, MD, MS, and Anthony A. Romeo, MD is the only one published in English. The patient pro- Abstract vided written informed consent for print and electronic A biceps tenodesis is a common surgical procedure that publication of this case report. is often carried out in conjunction with other surgical shoulder repairs to relieve biceps tendonitis. This case CASE REPORT presents a 50-year-old woman who suffered a humerus The patient, a 50-year-old woman, underwent left shoul- fracture following an open keyhole biceps tenodesis. The potential reasons for the fracture as well as a brief der revision arthroscopic subacromial decompression analysis of the technique itself are presented. To our and open biceps tenodesis. Past medical history was sig- knowledge, this is the first case report of a humerus frac- nificant for insulin-dependent diabetes mellitus (onset age, ture following keyhole biceps tenodesis in the English- 15 years) and hypothyroidism. Past surgical history was language literature. notable for left shoulder os acromiale with arthroscopic subacromial decompression performed 7 months before iceps tendonitis, a relatively common condition the revision surgery pertinent to this case. Tenodesis of the that affects the shoulder, causes pain over its biceps tendon was indicated on the basis of past surgical anterior aspect, near the bicipital groove and history, clinical examination in the office, and intraopera-
    [Show full text]
  • Org Tibia (Shinbone) Shaft Fractures
    .org Tibia (Shinbone) Shaf Fractures Page ( 1 ) The tibia, or shinbone, is the most common fractured long bone in your body. The long bones include the femur, humerus, tibia, and fi bula. A tibial shaf fracture occurs along the length of the bone, below the knee and above the ankle. Because it typically takes a major force to break a long bone, other injuries of en occur with these types of fractures. Anatomy The lower leg is made up of two bones: the tibia and fi bula. The tibia is the larger of the two bones. It supports most of your weight and is an important part of both the knee joint and ankle joint. The tibia is the larger bone in your lower leg. Tibial shaf fractures occur Types of Tibial Shaf Fractures along the length of the bone. The tibia can break in several ways. The severity of the fracture usually depends on the amount of force that caused the break. The fi bula is of en broken as well. Common types of tibial fractures include: Stable fracture: This type of fracture is barely out of place. The broken ends of the bones basically line up correctly and are aligned. In a stable fracture, the bones usually stay in place during healing. Displaced fracture: When a bone breaks and is displaced, the broken ends are separated and do not line up. These types of fractures of en require surgery to put the pieces back together. Transverse fracture: This type of fracture has a horizontal fracture line. This fracture can be unstable, especially if the fi bula is also broken.
    [Show full text]
  • Common Fractures and Dislocations of the Hand
    CME Common Fractures and Dislocations of the Hand Neil F. Jones, M.D. Learning Objectives: After reading this article, the participant should be able Jesse B. Jupiter, M.D. to: 1. Describe the concept of early protected movement with Kirschner-wired Donald H. Lalonde, M.D. finger fractures to the hand therapist. 2. Choose the most appropriate method Orange, Calif.; Boston, Mass.; and of fracture fixation to achieve the goal of a full range of motion. 3. Describe the Saint John, New Brunswick, Canada methods of treatment available for the most common fractures and dislocations of the hand. Background: The main goal of treatment of hand and finger fractures and dislocations is to attain a full range of wrist and nonscissoring finger motion after the treatment is accomplished. This CME article consists of literature review, illustrations, movies, and an online CME examination to bring the participant recent available information on the topic. Methods: The authors reviewed literature regarding the most current treat- ment strategies for common hand and finger fractures and dislocations. Films were created to illustrate operative and rehabilitation methods used to treat these problems. A series of multiple-choice questions, answers, discussions, and references were written and are provided online so that the participant can receive the full benefit of this review. Results: Many treatment options are available, from buddy and Coban taping to closed reduction with immobilization; percutaneous pins or screws; and open reduction with pins, screws, or plates. Knowledge of all available options is important because all can be used to achieve the goal of treatment in the shortest time possible.
    [Show full text]
  • Pronation-External Rotation Fractures
    CHAPTER 24 PRONATION-EXTERNAL ROTATION FRACTURES George S. Gumann, DPM INTRODUCTION needs to be addressed, or reduction of the fibular fracture fails to reduce the ankle mortise. Pronation-external rotation injuries represent the second If the medial malleolus is fractured, it is exposed and the most common pattern associated with ankle fractures. They medial joint space inspected for osteochondral fractures. It is are consistent with the Danis-Weber Type C fracture. 1,2 then anatomically reduced, and can be fixated employing The stages 2,3 of pronation-external rotation fractures are: several techniques. 6-8 If the fracture is large, then two 4.0 Stage I (rupture of the deltoid ligament or fracture of the mm partially-threaded cancellous screws are placed. They medial malleolus); stage II (rupture of the anterior inferior can be either cannulated or non-cannulated. Another tibiofibular [anterior syndesmotic] ligament and the fixation technique if the fracture is osteoporotic, smaller in interosseous membrane); stage III (spiral fracture of the size, comminuted, or if the screws fail to purchase is tension fibula above the level of the syndesmosis); and stage IV band wire. The wire may be placed through a drill hole in (rupture of the posterior inferior tibiofibular [posterior the tibial metaphysis but is more commonly placed over a syndesmotic] ligament or fracture of the posterior malleolus). unicortical hanging screw. If the tibia is osteoporotic, then make sure the hanging screw engages both the medial and STAGE I lateral cortex for increased stability. Two other options for fixation of a smaller sized medial malleolus fracture are Stage I represents injury to the medial structures of the utilizing 1 cancellous screw with adjacent Kirschner-wire or ankle.
    [Show full text]
  • Child Protection Evidence Systematic Review on Fractures
    Child Protection Evidence Systematic review on Fractures Published: September 2020 The Royal College of Paediatrics and Child Health (RCPCH) is a registered charity in England and Wales (1057744) and in Scotland (SC038299) Original reviews and content © Cardiff University, funded by NSPCC Updates and new material by RCPCH September 2020 While the format of each review has been revised to fit the style of the College and amalgamated into a comprehensive document, the content remains unchanged until reviewed and new evidence is identified and added to the evidence-base. Updated content will be indicated on individual review 1 pages. Child Protection Evidence – Systematic review on Fractures RCPCH Table of contents Summary ................................................................................................................................................. 4 Evidence summary ................................................................................................................................ 4 Background ............................................................................................................................................. 5 Methodology .......................................................................................................................................... 5 Findings of clinical question 1 .............................................................................................................. 6 Which fractures are indicative of abuse? ..........................................................................................
    [Show full text]
  • 9 Fractures of the Radius and Ulna 137 9 Fractures of the Radius and Ulna
    9 Fractures of the Radius and Ulna 137 9 Fractures of the Radius and Ulna M. Tile (1957), reporting 92% unsatisfactory functional 9.1 results in the treatment of 41 isolated, displaced Introduction radial shaft fractures (Galeazzi type). Therefore, even Charnley (1961), in his classic treatise Closed Treat- Fractures of the forearm present unique manage- ment of Common Fractures, strongly recommended ment problems. In these particular diaphyseal frac- operative treatment of forearm fractures. tures, perhaps more than any others, the combination of anatomical reduction and skeletal stability with mobility of the extremity is necessary to produce excellent functional results. Of all diaphysial frac- 9.2.2 tures, only the forearm requires anatomical reduc- Open Treatment tion and stable internal fixation, in order to main- tain full function of the hand. The ASIF system of Early attempts at enhancing the functional results stable internal fixation is admirably suited to this by open reduction and internal fixation did little to end; therefore, it is not surprising that the use of this improve the situation, but they represented pioneer- system in diaphyseal fractures of the radius and ulna ing efforts. Unstable fixation with inadequate and has revolutionized their management and improved poorly applied plates required long-term plaster the end results. immobilization, again compromising the final results. Despite the necessary cast immobilization, which resulted in some stiffness of the injured extremity, the nonunion rate remained significantly high. This was particularly evident in the report of Knight and 9.2 Purvis (1949). Natural History Smith and Sage (1957) attempted to change this outlook by the development of specialized intramed- ullary devices, with improved results, but their non- 9.2.1 union rate was unacceptably high.
    [Show full text]
  • Open Reduction and Internal Fixation of a Neglected Posterior Pilon Variant Fracture in an Uncontrolled Diabetic with Peripheral
    Open reduction and Internal Fixation of a Neglected Posterior Pilon Variant Fracture in an Uncontrolled Diabetic with Peripheral Neuropathy: A Case Report and Literature Review Nathaniel LP Preston, DPM a , Chandana Halaharvi, DPM a , Randall C Thomas, DPM, AACFAS b,c a Resident, Grant Medical Center Foot and Ankle Surgery Residency Program, Columbus, Ohio b Assistant Director, Grant Medical Center Foot and Ankle Surgery Residency Program, Columbus, Ohio c Private Practice, Clintonville Foot and Ankle, Columbus Ohio Introduction Case Report Discussion It is estimated that 4 % of all fractures are ankle fractures, and pilon fractures as A 66 year old female with past medical history uncontrolled IDDM, HTN, TIA, Peripheral Neuropathy, Depression, and disc herniation who presented to the ER with complaint Fractures of the medial and lateral malleoli are often times accompanied by a whole represent less than 1% of all lower extremity fractures (7). Amongst of acute pain and disfigurement to her left ankle. She related an event 6 weeks prior to presenting to the ER in which she fell at home and heard something distinctly “pop in fracture of the posterior malleolus thus constituting a trimalleolar ankle fracture. those, 7% to 44% of all ankle fractures involve the posterior malleolus (6). In a her left ankle”. She had significant swelling to her ankle since the described inciting event but did not pursue treatment and continued to ambulate normally with full weight The posterior pilon variant fracture pattern is an increasingly recognized fracture retrospective case series of 270 patients suffering from unstable ankle fractures, bearing to the affected extremity.
    [Show full text]
  • Spiral Fracture of the Humerus During Arm Wrestling
    Kocatepe Tıp Dergisi The Medical Journal of Kocatepe 6: 75-77 / Ocak 2006 Afyon Kocatepe Üniversitesi Spiral Fracture Of The Humerus During Arm Wrestling Bilek Güreşi Sırasında Humerusun Spiral Kırığı Yucel YAVUZ1, Yusuf YURUMEZ1, Levent ALTINEL2, Kamil Çağrı KÖSE2 1 Afyon Kocatepe University, Faculty of Medicine, Department of Emergency Medicine, Afyonkarahisar-Turkey 2 Afyon Kocatepe University, Faculty of Medicine, Department of Orthopaedic Surgery and Traumatology, Afyonkarahisar-Turkey ABSTRACT: Arm wrestling contests have become a ÖZET: Bilek güreşi müsabakaları halk arasında ve hatta pro- common pub and even professional sport. Although arm- fesyonel sporcular arasında yaygın bir şekilde yapılmaktadır. wrestling injuries are not common, several have been Bilek güreşi yaralanmaları çok sık olmamasına rağmen, tıbbi reported in the medical literature. In this case, spiral literatürde bir kaç yayın rapor edilmiştir. Bu vakada bilek gü- fracture of the humerus with large free fragments which reşi sırasında meydana gelen, serbest kemik parçası olan had occurred during arm wrestling and occurring humerusun spiral cisim kırığına ve travmanın oluş mekaniz- mechanism of injury was attracted attention. It is masına dikkat çekildi. Bilek güreşinin tamamiyle zarasız bir concluded that arm wrestling should not be considered a spor olarak düşünülmemesi gerektiği ve bilek güreşine karşı completely harmless sport and it appears appropriate to bu sporla uğraşan profesyonel sporcuların ve halkın uyarılma- warn public and arm wrestler against arm wrestling. sının uygun olduğu sonucuna varıldı. Key Words: arm wrestling, humerus, spiral fracture, sport Anahtar Kelimeler: bilek güreşi, humerus, spiral kırık, spor INTRODUCTION CASE PRESENTATION Arm wrestling contests have become a common A 19-year-old right-hand-dominant man pre- pub and even professional sport (1).
    [Show full text]
  • Traumatic Injuries of the Foot and Ankle
    Henry Ford Health System Henry Ford Health System Scholarly Commons Orthopaedics Articles Orthopaedics / Bone and Joint Center 1-1-2021 Traumatic Injuries of the Foot and Ankle Alexander D. Grushky Sharon J. Im Scott D. Steenburg Suzanne Chong Follow this and additional works at: https://scholarlycommons.henryford.com/orthopaedics_articles Traumatic Injuries of the Foot and Ankle Alexander D. Grushky, MD,*, Sharon J. Im, MD,†, Scott D. Steenburg, MD, FASER,z and Suzanne Chong, MD, MS, FASERx Introduction operative subset averaged 69 weeks until return to work, with an average cost of injury of $65,384.8 he pathologies involving the foot and ankle in the emer- Timely recognition of these injuries allows for early treat- T gency setting are widely ranging and vary from traumatic ment and minimizes the risk of complications related to fractures to soft tissue/joint infection. The ankle is the most delayed or missed diagnosis. Knowledge of mechanism and frequently injured major weight-bearing joint in the body, patterns of injury can aid in the detection of subtle or unsus- with lateral ankle sprains representing the most common pected injuries that impact management. injury in the musculoskeletal system.1,2 Fractures of the ankle and foot account for 9% and 10% of all fractures, respectively1,3; a review of the National Trauma Data Bank between 2007 and 2011 revealed 280,933 fracture-disloca- Imaging Technique tions of the foot and/or ankle4 and a population-based study found an incidence of 168.7/100,000/year, with lateral mal- The recommended initial imaging evaluation of patients with leolus fractures representing 55% of fractures.5 Common suspected acute traumatic injuries to the foot and ankle con- causes of injury range from trauma, eg, motor vehicle acci- sists of standard 3 view radiographs (Reference 2 ACR- dents and sports injury, to osteoporosis.6 Appropriateness Criteria: Acute Trauma to Ankle, and Foot).
    [Show full text]
  • Accurate Reporting of Pediatric Fractures a Guide for Orthopedic Consultation
    Accurate Reporting of Pediatric Fractures A Guide for Orthopedic Consultation Kapi’olani Medical Center For Women And Children’s Emergency Department Children's Orthopaedics of Hawaii, LLC Displaced lateral condyle fracture Avoid giving predictions to the family about Accurate description of the fracture (radial side; capitellum) are intra-articular injuries is the most important factor in determining the need for since they involve the joint surface. These what the orthopedic management will be once immediate orthopedic care. In describing the fracture to commonly require surgery if displaced, but the the orthopedist is involved. Delayed surgical the orthopedic surgeon, please include the following: urgency of the orthopedic referral is based on the intervention or delayed casting is sometimes patient’s neurovascular status. Site of injury : Which bone(s) are affected? the preferred management option. Parents What part is broken? Proximal / Midshaft / Distal may be unhappy with this if they are initially Fracture pattern: Transverse (broken straight across) led to expect immediate intervention. Oblique (slanted or diagonal break) Spiral (“twisted” break) Splinting an extremity is an easy office skill Comminuted (shattered) Non-displaced Early casting may have a higher complication rate Angulation present? (i.e. Is the fracture bent?) lateral condyle compared to later casting. Splinting provides excellent initial fracture Degrees and direction of angulation. care until orthopedic surgery can see the patient. Displacement present? (i.e. Has the fracture shifted?) 1. Obtain splinting material such as Approximate percentage of displacement. plaster, Ortho-glass, Scotchcast, Sam Medial epicondyle fracture: Partially displaced medial (ulnar side) epicondyle Is any shortening present? How much? splint, or even an IV board.
    [Show full text]