DOCSLIB.ORG

Common Pitfalls and Mistakes in Lower Extremity Trauma

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Common Pitfalls and Mistakes in Lower Extremity Trauma Radiology Together Emergency Radiology Conference SOFIA June, 2017 Common pitfalls and mistakes in lower extremity trauma IGOR BORIĆ „St. Catherine” Orthopedic Hospital, Zagreb, CROATIA Croatian Olympic Committee Diagnostic pitfalls • Radiography remains the initial modality to detect or exclude the presence of a fracture. • Failure to recognize lower extremities fractures - are the second most frequently missed diagnosis (after breast cancer) • Radiologist errors - lead to failure or delay in diagnosis Whang JS i sur. Radiology 2012 Diagnostic pitfalls THE RADIOLOGIST NEVER MAKES A MISTAKE !!! Diagnostic pitfalls • In a recent study of 3081 confirmed fractures in ED patients: – 115 - initialy missed – 53% in the lower extremities – foot being the most missed location – 37% - subtle fractures – 33% - radiographically occult fractures Van Rijin i sur. J Trauma Actute Care Surg 2012 Wei CJ i sur. Acta Radiol 2006 Reasons for pitfalls • RADIOLOGICAL - perceptual errors that appear to be avoidable (retrospectivly aproved) • NON-RADIOLOGICAL - out of the interpreting radiologist’s control related to: • anatomic • technical • physiologic factors Radiological pitfalls • insufficient views • improperly positioned or technically imperfect radiographs • nondisplaced fractures • small avulsions portending large injury • sesamoid injuries • commonly missed locations • satisfaction of search • periprosthetic fractures Insufficient views • Fractures visible on only a single view • Additional projections are required – orthogonal views in frontal and lateral projections for the long bones – Weight-bearing view: Lisfranc/Chopart joint injuries – stress view to show injury to the ankle mortise or syndesmotic diastasis – Axial patellar view • Additional methods are required: CT/MRI Fractures were not visible on lateral and anteroposterior radiographs. Middle cuboid fracture was not visible on standard radiographs. Sunrise view shows multiple avulsion fragments along medial margin Weight-bearing view shows fracture of the middle cuboid bone of patella. Improperly positioned or technically imperfect radiographs • the best chance of seeing frx on radiographs is with multiple views that are properly positioned and technically adequate • insufficient tube current (milliamperes) – an underexposed radiograph Digital radiography – properly exposed radiograph - control: gray scale, contrast and britness - image compression - use of substandard or handheld displays Initial oblique radiograph does not show metatarsal fractures because of underpenetration and improper tube angulation. Nondisplaced fractures • Simptomatic - the appropriate clinical findings and mechanism of injury (proximal femur frx in eldery after a groundlevel fall - the inability to bear weight) • The radiographic findings are falsely negative, because the method itself is insufficient to reveal the fracture • Osteoporosis: diffuse loss of bone mineral makes nondisplaced fracture lines less clear – Additional imaging: CT – MR – radionuclide bone scan - US (if the clinical suspicion is high) Small avulsions portending large injury • Small avulsion fractures - easy to overlook • Small avulsion fractures - portend major injuries • Avulsion fractures – need for analysis of the associated soft-tissues • Mechanism of injury analysis Minimally displaced posterior malleolar fracture Acute Segond fracture at lateral tibial plateau is indicative of rupture of ankle syndesmosis. is indicative of ALC rupture. Bipartite sesamoid versus fracture • a unique challenge for the radiologist • Sesamoid bones – Often multipartite – Follow the clinical pictures – Sesamoid injury: stress reaction or fractures in runners • Accessory ossicles – The ankle – „hot spot” – Can be fractured Bipartite medial sesamoid with separation extending diagonally across bone. Transverse avulsion fracture at proximal aspect of the sesamoid. Satisfaction of Search • „Satisfaction of search” - when the detection of one abnormality somehow interferes with the recognition of others • Keep on mined common location for fractured Initial evaluation standard radiographs of foot focused on multiple metatarsal and toe fractures and multiple metatarsophalangeal joint dislocations. Calcaneal fractures were initially overlooked. Fractures after hardware placement • fracture fixation or joint replacement • Hardware implants alter the stresses on the host bone: resulting in chronic bone loss where stress- shielding occurs and bony hypertrophy where stresses are concentrated. • Fractures begin at the interface between implant and bone • Dense overlapping metallic densities can limit visualization of hardware fractures or periprosthetic bone fractures Commonly missed fractures D O H Dislocation, Occult fracture, Half of injuries missed D O H – Dislocation, Occult fracture, Half of injuries missed Location „Dislocation” „Occult fracture” „Half of injuries missed” HIP Hip dislocation Femoral neck Another ring fracture Acetabulum sacrum KNEE PF dislocation Tibial platou Proximal fibula with ankle dislocation (Maisonneuve) ANKLE AND Lisfranc injury Kalkaneus Toracolumbar + calcaneus FOOT Talus frx. Hip „Dislocation” „Occult fracture” „Occult fracture” Hip dislocation Femoral neck Acetabulum Most commonly Most commonly Anterior acetabular fracture: posterior missed hip fracture - break in iliopubic line Posterior acetabular fracture: CP: leg is shortened and X-ray: - break in the ilioischial line internally/externally - Can be very subtle rotated - Cortical disruption or Additional Imaging: CT: impacted hyperlucency - X-ray – Judet projection - for associated femoral - Loss of smooth cortical head / transition from femoral - CT acetabular fx’s neck to head. –for intraarticular bone - Trabecular disruption fragments CT - MRI Hip „Dislocation” „Occult fracture” „Half of injuries missed” Hip dislocation Femoral neck Another ring fracture Most commonly Most commonly Because of the inflexible posterior missed hip fracture pelvic bone, injuries are often CP: leg is shortened and X-ray: found in multiples internally/externally - Can be very subtle rotated - Cortical disruption or X-ray : CT: impacted hyperlucency - subtle rami frx - for associated femoral - Loss of smooth cortical - Cortical/trabecular head / transition from femoral break acetabular fx’s neck to head. - Trabecular impaction –for intraarticular bone - Trabecular disruption fragments CT - MR CT - MRI Knee „Dislocation” „Occult fracture” „Occult fracture” Knee dislocation Tibial plateau „SEGOND” fractura 32% of all knee fractures Valgus stress with axial proximal lateral tibial avulsion fx load Not a subtle clinical or radiographic finding Often associated with an ACL X-ray: tear patient with knee pain from Requires angiography: blunt trauma can not walk – 40% have associated oblique views CT – MRI (ligaments) popliteal artery injury CT – to assess for severity Knee „Occult fracture” „Occult fracture” „Occult fracture” Patella fracture Tibial plateau „SEGOND” fracture 32% of all knee fractures 40% of all knee Valgus stress with axial proximal lateral tibial avulsion fx fractures load Often associated with an ACL tear Additional Imaging: X-ray: “Sunrise” view (axial) patient with knee pain from blunt trauma can not walk – oblique views CT – MRI (ligaments) CT – to assess for severity Knee „Occult fracture” „Occult fracture” „Half of injuries missed” Patella fracture Tibial plateau „MAISONNEUVE” fracture 32% of all knee fractures 40% of all knee Valgus stress with axial Proximal fibula fracture fractures load AND medial malleolus (or deltoid ligament) fracture Additional Imaging: X-ray: Mechanism: Abduction “Sunrise” view (axial) patient with knee pain from and external rotation of blunt trauma can not walk – ankle oblique views CT – MRI (ligaments) CT – to assess for severity Ankle and foot „Dislocation” „Occult fracture” „Occult fracture” „Lisfranc” injury Calcaneus fracture Talus fracture Most commonly Tarsal-metatarsal fracture/ fractured tarsal bone Second most commonly dislocation pattern fracture tarsal bone- talar neck Mechanism: 20% are initially missed Often from fall on heels Mechanism: Excessive Xray: Fracture of 2nd from a height dorsiflexion of ankle metatarsal base or Lisfranc ligament and subsequent X- ray: Xray: Can be subtle cortical dislocation of MT #2-5 - Bohler’s angle < 20 break on lateral view from the midfoot Complications: Additional Imaging: AVN, MRI: evaluation of - “calcaneal view” ligaments subchondral collapse, and OA CT/MR - fragments Ankle and foot „Dislocation” „Occult fracture” „Half of injuries missed” „Lisfranc” injury Calcaneus fracture „Jumper’s/lover’s frx” calcaneus fracture Najčešća fraktura Tarzometatarzalna and TH/L spine tarzusa fraktura/dislokacija fracture Obično posljedica 20% su inicijalno 10% associated with pada na petu THORACOLUMBAR previđene FRACTURE Rtg: Rtg: fraktura baze 2. Bohler-ov kut >20° because of load on axial MT ili Lisfrancoog lig.i skeleton when landing on the dislokacija 2-5 MT heels CT - fragmenti MR – rtg. nejasni MR: procjena ligamenata „Take home” • Most undetected fractures - a perceptual errors (in a complex anatomy area) • APROACH – Systematic Approach: ABC’S – Adequacy alignment, bones (fractures), cartilage (joint spaces), soft tissue signs - all views included and properly performed – Targeted Approach – analyze the radiographs for common sites of injury • Corelation with clinical findings: (PACS, teleradiology) • Supplementary or delayed views • Additional methodes: CT/MR • Pseudo‐fractures – Radiographic variants that mimic fractures Thank you! [email protected] .
Load more

Recommended publications
  • The Surgical Repair of Transverse Patella Fractures
    A vertical patella fracture James Heilman, MD The Surgical Repair of Transverse Patella Fractures Angela Miller, cst Patella fractures constitute about 1% of all fractures, and are mostly caused by direct trauma to the front of the knee.1 There are many types of patella fractures: comminuted, open, nondisplaced and displaced. This article will focus on the about 50% to 80% of patellar fractures that are transverse,3 and requires the surgical treatment using Kirschner wires, also known as K-wires and tension-band wiring. ANATOMY AND PHYSIOLOGY LEARNING OBJECTIVES The patella is the largest sesamoid bone in the human body. Sesamoid ▲ Learn about the use of K-wires for bones are not connected to other bones; instead, they are connected treatment of this fracture by tendons or are embedded in muscle tissue. The patella bone can ▲ Review the anatomy related to this be found in the quadriceps tendons. The function of sesamoid bones is to provide a smooth surface over which the tendon can slide, and procedure increases the ability of the tendons to transmit muscle forces.2 The ▲ Recall the patient preparation patella bone is located anterior to the knee joint, and the posterior sur- specific to this operation face articulates with the femur. It is attached proximally to the femoral ▲ Examine the role of the surgical condyles, and attached distally to the condyles of the tibia and upper technologist during a transverse ends of the fibula.5 patella fracture ▲ Read about studies comparing the POSITIONING use of metallic versus nonmetallic During transverse patella fractures a patient will be placed in the implants supine position, with their arms are placed at each of their sides and A vertical patella fracture James Heilman, MD AUGUST 2016 | The Surgical Technologist | 349 tucked by the draw sheet.
    [Show full text]
  • Vertical Open Patella Fracture, Treatment, Rehabilitation and the Moment to Fixation
    Elmer ress Case Report J Clin Med Res. 2015;7(2):129-133 Vertical Open Patella Fracture, Treatment, Rehabilitation and the Moment to Fixation Joao Alberto Larangeiraa, Liliane Bellenziera, Vanessa da Silva Rigoa, Elias Josue Ramos Netoa, Francisco Fritsch Machry Kruma, Tiango Aguiar Ribeiroa, b, c Abstract Introduction Patella fracture is relatively uncommon and the vertical trace frac- Patella fracture is relatively uncommon and represents approx- ture represents almost 12-17%. The open patella fracture expresses imately 0.5-1.5% of all bone injuries [1, 2], and men are more 6-30%. The association of these two uncommon conditions was the affected than women [3, 4]. The classification can be done by aim of this case report even as the treatment and the moment of fixa- characterizing the fracture pattern in osteochondral, multifrag- tion (definitive surgical treatment). A 27-year-old man after a motor- mented, stellate, transversal, vertical and polar fracture (Fig. cycle accident showed an open patella fracture classified as a Gustilo 1). Other classifications may take into account the presence of and Anderson type IIIA lesion. The patient was immediately treated deviation between the fragments, deviated and not deviated, with precocious surgery fixation with a modified tension band which and the mechanism of injury. The transversal type is more fre- consists of two parallel K-wires positioned orthogonal to the fracture quent corresponding to 50-80%, comminuted 30-35% and ver- line and a cerclage wire shaped anteriorly at patella as an eight. The tical fractures 12-17% [2, 3] and these are rarely displaced [5].
    [Show full text]
  • Is There Any Difference Between the Biomechanical Strengths of The
    550 Acta Orthop. Belg.O. KOCADAL, 2017, ,83 M,. 550-557PEPE, Z. GUNES, E. AKSAHIN, S. DURAN, C. N. AKTEKIN ORIGINAL STUDY Is there any difference between the biomechanical strengths of the current fixation techniques for comminuted distal patellar fractures? (Comparison of distal patella fracture fixation techniques) Onur KOCADAL, Murad PEPE, Zafer GUNES, Ertugrul AKSAHIN, Semra DURAN, Cem Nuri AKTEKIN From the Ankara Training and Research Hospital, Ulucanlar, Ankara, Turkey In this biomechanical study, the strength of five surgical treatment for the patella inferior pole different fixation techniques -anterior tension band fractures (15). Internal fixation of the distal part, if wiring with K-wires, separate vertical wiring, headless possible, or excision of the small bone fragments compression screws with anterior tension band with repair of the patellar tendon by transosseous wiring, cannulated screws with tension band wiring pull-out sutures, in the extremely comminuted and memory shape patellar fixator- for distal patellar cases, should be performed (17). However in the fractures were compared. Forty calf knees were used for the biomechanical testing. Each specimen latter, non-absorbable synthetic sutures and partial was pre-loaded with 10 N at 1 N/s. The distraction patellectomy necessitate immobilization of the forces were applied consistently with the velocity of 5 knee, which causes weakness in the quadriceps mm/s. The ultimate load (N) and displacement (mm) muscle (7,14,17,30). Therefore, fixation of the distal values were recorded. The headless compression patellar fractures has gained popularity over partial screw with anterior tension band wiring (656.9±167.9 patellectomy. N) and the cannulated screws with anterior tension There are various previously defined surgical band wiring (642.6±166.0 N) obtained significantly fixation options for patella inferior pole fractures: higher ultimate loading values compared to the other anterior tension band wiring, combining screw fixation methods (p<0.05).
    [Show full text]
  • Pseudogout at the Knee Joint Will Frequently Occur After Hip Fracture
    Harato and Yoshida Journal of Orthopaedic Surgery and Research (2015) 10:4 DOI 10.1186/s13018-014-0145-9 RESEARCH ARTICLE Open Access Pseudogout at the knee joint will frequently occur after hip fracture and lead to the knee pain in the early postoperative period Kengo Harato1,3*† and Hiroki Yoshida2† Abstract Background: Symptomatic knee joint effusion is frequently observed after hip fracture, which may lead to postoperative knee pain during rehabilitation after hip fracture surgery. However, unfortunately, very little has been reported on this phenomenon in the literature. The purpose of the current study was to investigate the relationship between symptomatic knee effusion and postoperative knee pain and to clarify the reason of the effusion accompanied by hip fracture. Methods: A total of 100 patients over 65 years of age with an acute hip fracture after fall were prospectively followed up. Knee effusion was assessed on admission and at the operating room before the surgery. If knee effusion was observed at thetimeofthesurgery,synovialfluidwascollectedintosyringes to investigate the cause of the effusion using a compensated polarized light microscope. Furthermore, for each patient, we evaluated age, sex, radiographic knee osteoarthritis (OA), type of the fracture, laterality, severity of the fracture, and postoperative knee pain during rehabilitation. These factors were compared between patients with and without knee effusion at the time of the surgery. As a statistical analysis, we used Mann–Whitney U-test for patients’ age and categorical variables were analyzed by chi-square test or Fisher’sexacttest. Results: A total of 30 patients presented symptomatic knee effusion at the time of the surgery.
    [Show full text]
  • 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.
    [Show full text]
  • Management of Knee Injuries Protocol in Mius and Wics
    Management of Knee Injuries Protocol FINAL 04.12.15 Document Control Title Management of Knee Injuries Protocol in MIUs and WICs Author Author’s job title Professional Lead, Minor Injuries Unit Directorate Department Emergency Services, Logistics and Resilience Emergency Department Date Version Status Comment / Changes / Approval Issued 0.1 Dec Draft Initial Version for Consultation 2015 1.0 Jun Final Approved by (Clinician) and (Clinical Director) June 2015 and 2015 published on Bob. 1.1 Jun Final Reviewed and amended Karen Watts / Fionn Bellis 2015 1.2 Feb 2017 Revision Amendment to protocol, age reference under section 1 Main Contact Emergency Department Tel: Direct Dial – 01271 322480 North Devon District Hospital Raleigh Park Barnstaple, EX31 4JB Lead Director Medical Director Document Class Target Audience Protocol MIU Distribution List Distribution Method Senior Management Trust’s internal website Superseded Documents Knee Injuries (over 2 years of age) Protocol Issue Date Review Date Review Cycle December 2015 December 2018 Three years Consulted with the following stakeholders Contact responsible for implementation and ED Consultant monitoring compliance: MIU Leads Professional Lead, Minor Injuries Unit Education/ training will be provided by: Professional Lead, Minor Injuries Unit Approval and Review Process Lead Clinician for Emergency Department Emergency Department Management of Knee Injuries Protocol V1.2 Feb2017 Page 1 of 12 Management of Knee Injuries Protocol FINAL 04.12.15 Local Archive Reference G:\Policies and Protocols Local Path MIU Filename Knee Injuries (over 2 years of age) Protocol V1.2 Policy categories for Trust’s internal website Tags for Trust’s internal website (Bob) (Bob) MIU MIU Emergency Department Management of Knee Injuries Protocol V1.2 Feb2017 Page 2 of 12 Management of Knee Injuries Protocol FINAL 04.12.15 2.
    [Show full text]
  • Fracture Lower Extremity Part II
    CONTENTS FEMUR SHAFT BOTH BONE SUBTROCHANTERIC TIBIAL PLAFON FRACTURE LOWER FRACTURE ANKLE EXTREMITIES: PART 2 FRACTURE FEMUR FOOT SUPRACONDYLAR FRACTURE FEMUR CALCANEUS PATELLA TALUS WORAWAT LIMTHONGKUL, M.D. 14 JAN 2013 TIBIA LISFRANC’S TIBIAL PLATEAU METATARSAL 1 2 SUBTROCHANTERIC FRACTURE FEMUR A PART OF FRACTURE OCCUR BETWEEN TIP OF LESSER TROCHANTER AND A POINT 5 SUBTROCHANTERIC CM DISTALLY CALCAR FEMORALE FRACTURE LARGE FORCES ARE NEEDED TO CAUSE FRACTURES IN 5 CM YOUNG & ADULT INJURY IS RELATIVELY TRIVIAL IN ELDERLY 2° CAUSE: OSTEOPOROSIS, OSTEOMALACIA, PAGET’S 3 4 SUBTROCHANTERIC FRACTURE FEMUR TREATMENT INITIAL FEMUR SHAFT TRACTION DEFINITE FRACTURE ORIF WITH INTRAMEDULLARY NAIL OR 95 DEGREE HIP- SCREW-PLATE 5 6 FEMUR FRACTURE FILM HIPS SEVERE PAIN, UNABLE TO BEAR WEIGHT 10% ASSOCIATE FEMORAL SUPRACONDYLAR NECK FRACTURE FEMUR FRACTURE TREATMENT: ORIF WITH IM NAIL OR P&S COMPLICATION: HEMORRHAGE, NEUROVASCULAR INJURY, FAT EMBOLI 7 8 SUPRACONDYLAR FEMUR FRACTURE SUPRACONDYLAR ZONE DIRECT VIOLENCE IS THE USUAL CAUSE PATELLA FRACTURE LOOK FOR INTRA- ARTICULAR INVOLVEMENT CHECK TIBIAL PULSE TREATMENT: ORIF WITH P&S 9 10 PATELLA FRACTURE PATELLA FRACTURE FUNCTION: LENGTHENING THE ANTERIOR LEVER ARM DDX: BIPATITE PATELLA AND INCREASING THE (SUPEROLATERAL) EFFICIENCY OF THE QUADRICEPS. TREATMENT: DIRECT VS INDIRECT NON-DISPLACE, INJURY INTACT EXTENSOR : CYLINDRICAL CAST TEST EXTENSOR MECHANISM DISPLACE, DISRUPT EXTENSOR: ORIF WITH VERTICAL FRACTURE: TBW MERCHANT VIEW 11 12 PATELLAR DISLOCATION ADOLESCENT FEMALE DISLOCATION AROUND USUALLY
    [Show full text]
  • Suture Repair of Patellar Inferior Pole Fracture: Transosseous Tunnel Suture Compared with Anchor Suture
    EXPERIMENTAL AND THERAPEUTIC MEDICINE 22: 998, 2021 Suture repair of patellar inferior pole fracture: Transosseous tunnel suture compared with anchor suture WENZHOU HUANG1‑3, TIANLONG WU1‑3, QIANGQIANG WEI1‑3, LONGHAI PENG1‑3, XIGAO CHENG1‑3 and GUICHENG GAO1‑3 1Department of Orthopaedic Surgery, The Second Affiliated Hospital of Nanchang University; 2Institute of Orthopedics of Jiangxi Province; 3Institute of Minimally Invasive Orthopedics of Nanchang University, Nanchang, Jiangxi 330006, P.R. China Received May 18, 2020; Accepted March 10, 2021 DOI: 10.3892/etm.2021.10430 Abstract. Patellar inferior pole fracture is difficult to treat due Introduction to the inherent weakness of small comminuted distal fragments. However, suture fixation was recently introduced and reported. Inferior pole fracture of the patella is an extra‑articular injury The aim of the present study was to evaluate and compare that accounts for 5% of all patellar fractures and usually requires the clinical outcomes of two suture techniques, transosseous operative treatment if displaced or associated with complete tunnel suture (TTS) and anchor suture (AS), for the fixation disruption of the extensor mechanism (1). However, displaced of patellar inferior pole fracture. A total of 35 patients with fracture fragments are typically small and comminuted and it patellar inferior pole fracture treated at the Second Affiliated is difficult to fix and maintain anatomical reduction (2). The Hospital of Nanchang University (Nanchang, China) between inferior patellar pole is continuous with the patellar tendon and June 2014 and April 2018 were retrospectively reviewed. Of the key to reconstructing the fracture fragment surgically is these, 14 were treated with the TTS technique and 21 using AS to reestablish the extensor mechanism while simultaneously fixation.
    [Show full text]
  • Patella Fracture
    Patella Fracture A fracture is a broken bone. A patellar fracture is a break in the patella, or kneecap, the small bone that sits at the front of your knee. Because the patella acts as a shield for your knee joint, it is vulnerable to fracture if you fall directly onto your knee or hit it against the dashboard in a vehicle collision. Some patellar fractures can be treated by wearing a cast or splint until the bone heals. In some patellar fractures, however, the pieces of bone move out of place when the injury occurs. For these more complicated fractures, surgery is needed to restore and stabilize the kneecap and allow for the return of function. Depending upon your specific fracture, you may be allowed to bear weight on your leg while wearing a cast or brace. With some fractures, however, weight bearing is not allowed for 6 to 8 weeks. Your Consultant will talk with you about restrictions on weight bearing. Physiotherapy Exercises- Stage 1 These exercises can be carried out to maintain lower limb strength even if you are non-weight bearing or wearing a brace. Use ice and elevate your leg to control swelling. Ensure you have adequate pain relief. 1. Quads set QUAD SET - TOWEL UNDER KNEE Tighten your top thigh muscle as you attempt to press the back of your knee downward towards the table. 2. Short arc Place two rolled towels under the quads knee to lift it about 5 inches off the mat. Bring your toes towards your head (dorsiflexion) then straighten the knee for a hold of 3-5 seconds.
    [Show full text]
  • Tennessee X-Ray Jul-Dec 2021
    Volume 27 Issue 3 Tennessee X-Ray Jul-Dec 2021 Radiology Events to Remember • October—National Breast Cancer Awareness Month Visit http:// www.nationalbreastcancer.org/breast-cancer-awareness-month • TSRT Annual Meeting: Fall 2021 Visit http://www.tsrt.org/ • National Mammography Day: October 15, 2021 • World Osteoporosis Day: October 20, 2021 • Remembering Wilhelm Conrad Roentgen 126th Anniversary of the discovery of x-rays November 8, 1895 • National Radiologic Technology Week: November 7-13, 2021 Theme: Essential Together https://www.asrt.org/events-and- conferences/nrtw • Radiological Society of North America: November 28–December 2, 2021 RSNA Scientific Assembly and Annual meeting to be held in Chicago Visit www.rsna.org Limited Scope Exam Fee Increase Limited Scope Testing (LST) provides application processing services for eligible students wishing to sit for the American Registry of Radiologic Technologists (ARRT) Limited Scope of Practice in Radiology examination and the Bone Densitometry Equipment Operator examination for the state of Tennessee. The cost of both these exams will increase to $275 on January 1, 2022 due to an ARRT exam fee increase. Renewing in 2022? If you renew your license next year in 2022, you need to complete your 20 CE credits by December 31, 2021 to be compliant with current state rules. Even though you must complete your CE credits within the 2 preceding calendar years, the due date for proof of that completion is not until your biennium renewal due date. INSIDE THIS ISSUE Puzzle Challenge 3 X-Ray Quiz 3 Amazing Facts 3 Online Access Instructions 4 Answer Sheet Instructions 4 Direct Reading DR-105 Article 5 DR-105 DR-105 Post-Test 32 Extremity Fractures Link to XRN Order Form 35 Link to RES Enrollment 35 Link to CE Enrollment 35 Change of Address Form 36 Important Facts to Remember About Your TN Medical X-Ray License 1.
    [Show full text]
  • Postoperative Instructions Following Open Repair of Patella Fracture-- Dr
    Postoperative Instructions Following Open Repair of Patella Fracture-- Dr. Kerns You are going home after surgical repair of your broken knee-cap. This does not mean that you are on your own. Please read the instructions below carefully and if you have any other questions or concerns, there is always someone available to talk you through your troubles. If it is between the hours of 8AM and 4PM, please call Covenant Medical Group Orthopedic Surgery mainnumber (989) 583-7450. After office hours, you can reach the orthopedic surgeon on-call through our answering service at (989) 583-7450. Protecting Your Repair • Wear your knee immobilizer. Do not take it off…ever. • You may walk on the injured leg only so long as you are wearing your knee immobilizer. • Keep your dressing clean and dry. Stay in cool, temperature controlled spaces to avoid excessive sweating and moisture around your incision. This will also help to prevent itching skin within your splint. Sponge bathing is the safest technique for personal hygiene, but a trash bag that has been secured over the splint or cast with Saran-wrap and tape can allow careful use of a shower. Be sure to meticulously dry the bag before attempting to remove it. Water may collect in pockets and creases, then drain down the top of your splint before you have a chance to prevent it, otherwise. Minimize Pain and Swelling Even though your incisions are quite small, you have had a significant surgical procedure at your knee. It is normal to have pain throughout your wrist and forearm but rest assured that this will pass.
    [Show full text]
  • Medical Consultation for the Elderly Patient with Hip Fracture
    J Am Board Fam Pract: first published as 10.3122/15572625-11-5-366 on 1 September 1998. Downloaded from CLINICAL REVIEW Medical Consultation for the Elderly Patient With Hip Fracture RichardJ Ackermann, MD Background: This article describes a family physician geriatrician's perspective on the comprehensive management of hip fracture in frail elderly patients. Primary care physicians might be called upon to pro­ vide medical consultation for these patients. Methods: Guidelines were developed by a combination of personal experience in consulting for several hun­ dred elderly patients with hip fracture at a large community hospital, literature review using the key words "hip fractures," "aged," and "aged, 80 and over," and educational presentations for family practice residents. Results and Conclusions: Elderly patients with hip fracture offer a prime opportunity for comprehensive geriatric assessment. Intertrochanteric fractures are almost always treated with internal fixation, whereas femoral neck fractures can be treated by either fixation or by hemiarthroplasty. Hip fracture should be re­ garded as a surgical urgency, and generally operation should not be delayed, even if patients have serious comorbidity. The family physician can be instrumental in preparing the patient for surgery, preventing and treating complications, and assisting in the placement and rehabilitation of patients after hospital dis­ charge. 0 Am Board Fam Pract 1998; 11:366-77.) As the result of an aging population, family physi­ Some hip fractures and the falls that precede cians are increasingly likely to participate in the them are probably preventable. Strategies to de­ care of elderly patients suffering hip fracture. This tect and treat osteoporosis, especially in high-risk copyright.
    [Show full text]