Staged Management of Tibial Plateau Fractures
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Kansas Journal of Medicine, Volume 12 Issue 3
KANSAS JOURNAL of MEDICINE wheelbarrow to readjust his grip, he lost control of the wheelbarrow, whose weight pulled him causing him to slide approximately five feet off the trail, where he lost balance and landed on his right knee. The patient landed on a dirt surface. He did not recall hearing a popping sound, but immediately felt pain. There was no loss of consciousness Tibial Plateau Fracture Following Low and no other injuries were sustained. Energy Fall in the Rocky Mountains The patient was unable to bear weight following the fall. Joint sta- Alexandra V. Arvanitakis, B.S.1, Kerry C. Mian, B.S.1, bility was unable to be assessed due to pain. Fellow workers tried to Raymond Kreienkamp, Ph.D.2, Charles E. Rhoades, M.D.1 assist the patient to a vehicle, but the pain was too great to flex his 1University of Kansas Medical Center, Department of knee even 10 degrees while supported by crutches. A medical team Orthopedic Surgery, Kansas City, KS was sent to evaluate the patient in the field. At that time, the patient 2St. Louis University School of Medicine had developed a large right knee effusion. Joint laxity was unable Received Sept. 23, 2018; Accepted for publication Feb. 28, 2019; Published online Aug. 21, 2019 to be assessed due to joint swelling and discomfort. However, given the potential stress on the knee while holding a wheelbarrow and INTRODUCTION falling, a ligamentous injury was suspected. The knee was diffusely Tibial plateau fractures are debilitating injuries. They can occur tender. He was evacuated by stretcher to an emergency vehicle and in younger individuals who sustain a high energy trauma or, with transported, with leg braced, to an emergency department at a local increasing age, lesser degrees of trauma and underlying bone pathol- community hospital. -
A Case of Bilateral Calcaneal Fracture, Following Fall from 35 Feet
rauma & Sastry et al., J Trauma Treat 2015, 4:3 f T T o re l a t a m DOI: 10.4172/2167-1222.1000254 n r e u n o t J Journal of Trauma & Treatment ISSN:ISSN: 2167-1222 2167-1222 CaseResearch Report Article OpenOpen Access Access A Case of Bilateral Calcaneal Fracture, Following Fall from 35 Feet Purushothama Sastry, Sujana Theja JS, Supreeth N and Arjun Markanday* Department of Orthopaedics, JSS Hospital, Mysore, India Abstract Introduction: Called Lover’s Fractures, the calcaneus commonly fractures due to fall from height. The calcaneus is the most frequently fractured tarsal bone. Tarsal bone fractures account for about 2% of all adult fractures. Of these, 60% are calcaneus fractures.The heel bone is often injured in a high-energy collision where other parts of the skeleton are also injured. In up to 10% of cases, the patient can also sustain a fracture of the spine, hip, or the other calcaneus. Injuries to the calcaneus often damage the subtalar joint and cause the joint to become stiff. This makes it difficult to walk on uneven ground or slanted surfaces. Case Report: A 24 year old male, working as a lift operator presented to the casualty of the hospital after the elevator broke down and came down in a free fall from about a height of 4 stories (35 feet). He presented along with the other occupants of the lift who also sustained calcaneal fractures.The case on arrival was subjected to ATLS protocol and through radiologic work up was done. Following a period of 12 days post trauma he was operated for bilateral calcaneal fractures and discharged 10 days post operatively. -
Correlation of Parameters on Preoperative CT Images With
Injury, Int. J. Care Injured 48 (2017) 745–750 Contents lists available at ScienceDirect Injury journal homepage: www.elsevier.com/locate/injury Correlation of parameters on preoperative CT images with intra-articular soft-tissue injuries in acute tibial plateau fractures: A review of 132 patients receiving ARIF a,b,c b,c,d b,c,d b,c,d Hao-Che Tang , I-Jung Chen , Yu-Cheng Yeh , Chun-Jui Weng , b,c,d b,c,d b,c,d, Shih-Sheng Chang , Alvin Chao-Yu Chen , Yi-Sheng Chan * a Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan b College of Medicine, Chang Gung University, Taoyuan 333, Taiwan c Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan d Department of Orthopaedic Surgery, Division of Sports Medicine Section, Chang Gung Memorial Hospital, Linkou, Taiwan A R T I C L E I N F O A B S T R A C T Introduction: Tibial plateau fractures often occur in conjunction with soft-tissue injuries of knees. The Keywords: hypothesis of this study is that parameters of CT imaging can predict intra-articular soft-tissue injuries. Tibial plateau fracture Patients and methods: Patients who underwent arthroscopically assisted reduction and internal fixation CT (ARIF) for acute tibial plateau fractures performed by a single orthopedic surgeon between 2005 and 2015 Arthroscopy were included in this retrospective study. Patients with concomitant ipsilateral femoral fractures, who Meniscus tear ACL avulsion had received revision surgery or who had undergone index surgery more than 30 days from the event were excluded. -
Compartment Syndrome Secondary to Knee Lipohemarthrosis
Open Access Case Report DOI: 10.7759/cureus.16946 Compartment Syndrome Secondary to Knee Lipohemarthrosis Madeleine E. Kim 1 , Thor S. Stead 2 , Latha Ganti 3, 4, 5, 6 1. Emergency Medicine, Baylor School, Chattanooga, USA 2. Epidemiology and Public Health, Alpert Medical School of Brown University, Providence, USA 3. Emergency Medicine, Envision Physician Services, Plantation, USA 4. Emergency Medicine, University of Central Florida College of Medicine, Orlando, USA 5. Emergency Medicine, Ocala Regional Medical Center, Ocala, USA 6. Emergency Medicine, HCA Healthcare Graduate Medical Education Consortium Emergency Medicine Residency Program of Greater Orlando, Orlando, USA Corresponding author: Latha Ganti, [email protected] Abstract When treating patients presenting with knee trauma or intra-articular fracture, clinicians should maintain a high index of suspicion for lipohemarthrosis. Diagnosis of lipohemarthrosis can be accomplished via visualization of a fat-fluid level. Increased fluid and pressure build-up within the joint space may lead to compartment syndrome, which requires emergency compartment fasciotomy. In this paper, we discuss the importance of identifying lipohemarthrosis in patients presenting with intra-articular fracture, as well as the necessity of frequent patient re-evaluations in order to monitor the onset of compartment syndrome. Categories: Emergency Medicine, Orthopedics, Trauma Keywords: lipohemarthrosis, tibial fracture, compartment syndrome, fat-fluid level, fibular fracture, intra-articular fracture, compartment pressure Introduction Knee traumas account for over 500,000 visits to the emergency department (ED) per year in the United States [1-3]. When displaced, intra-articular fractures may result in bone marrow and blood spilling into the surrounding joint capsule [4]. This is defined as lipohemarthrosis. -
Deep Tissue Injury
Deep Tissue Injury Overview Deep tissue injury is a term proposed by NPAUP to describe a unique form of pressure ulcers. These ulcers have been described by clinicians for many years with terms such as purple pressure ulcers, ulcers that are likely to deteriorate and bruises on bony prominences (Ankrom, 2005). NPAUP’s proposed definition, is “A pressure-related injury to subcutaneous tissues under intact skin. Initially, these lesions have the appearance of a deep bruise. These lesions may herald the subsequent development of a Stage III-IV pressure ulcer even with optimal treatment.”(NPAUP, 2002). Why is it important to have another label for pressure ulcers? Aren’t four stages enough? Perhaps not, because deep tissue injury represents a dangerous lesion due to its potential for rapid deterioration. Proper labeling will afford clinicians a more accurate diagnosis, and lay a foundation for the development of efficacious interventions. Background Shea (1975) is often credited with labeling the stages of pressure ulcers, and his descriptions of four depths of ulcers were adapted by IAET, AHCPR, and NPUAP. Missing from that four stage system label is deep tissue injury. However, Shea did not forget them in his review. He described ulcers that appear innocent yet conceal a deep, potentially fatal lesion. In 1873 Paget may have been the first to describe deep tissue injury describing purple areas with sloughing of tissue and large cavities once they open. In 1942, Groth created deep, “malignant pressure sores” in an animal model in a series of experiments that began in deeper tissues and spread to the surface. -
Calcaneal Fracture and Rehabilitation
1 Calcaneal Fracture and Rehabilitation Surgical Indications and Considerations Anatomic Considerations: The calcaneus articulates with the talus superiorly at the subtalar joint. The three articulating surfaces of the subtalar joint are the: anterior, middle, and posterior facets, with the posterior facet representing the major weight-bearing surface. The subtalar joint is responsible for the majority of foot inversion/eversion (or pronation/supination). The interosseous ligament and medial, lateral, and posterior talocalcaneal ligaments provide additional support for the joint. The tibial artery, nerve, posterior tibial tendon, and flexor hallucis longus tendon are located medially to the calcaneus and are at risk for impingement with a calcaneal fracture, as are the peroneal tendons located on the lateral aspect of the calcaneus. The calcaneus serves three major functions: 1) acts as a foundation and support for the body’s weight, 2) supports the lateral column of the foot and acts as the main articulation for inversion/eversion, and 3) acts as a lever arm for the gastrocnemius muscle complex. Pathogenesis: Fractures of the calcaneal body, anterior process, sustentaculum tali, and superior tuberosity are known as extra-articular fractures and usually occur as a result of blunt force or sudden twisting. Fractures involving any of the three subtalar articulating surfaces are known as intra-articular fractures and are common results of: a fall from a height usually 6 feet or more, a motor vehicle accident (MVA), or an impact on a hard surface while running or jumping. Intra-articular fractures are commonly produced by axial loading; a combination of shearing and compression forces produce both the primary and secondary fracture lines. -
ACR Appropriateness Criteria® Acute Trauma to the Knee
Revised 2019 American College of Radiology ACR Appropriateness Criteria® Acute Trauma to the Knee Variant 1: Adult or child 5 years of age or older. Fall or acute twisting trauma to the knee. No focal tenderness, no effusion, able to walk. Initial imaging. Procedure Appropriateness Category Relative Radiation Level Radiography knee May Be Appropriate ☢ Bone scan with SPECT or SPECT/CT knee Usually Not Appropriate ☢☢☢ CT knee with IV contrast Usually Not Appropriate ☢ CT knee without and with IV contrast Usually Not Appropriate ☢ CT knee without IV contrast Usually Not Appropriate ☢ MR arthrography knee Usually Not Appropriate O MRA knee without and with IV contrast Usually Not Appropriate O MRA knee without IV contrast Usually Not Appropriate O MRI knee without and with IV contrast Usually Not Appropriate O MRI knee without IV contrast Usually Not Appropriate O US knee Usually Not Appropriate O Variant 2: Adult or child 5 years of age or older. Fall or acute twisting trauma to the knee. One or more of the following: focal tenderness, effusion, inability to bear weight. Initial imaging. Procedure Appropriateness Category Relative Radiation Level Radiography knee Usually Appropriate ☢ Bone scan with SPECT or SPECT/CT knee Usually Not Appropriate ☢☢☢ CT knee with IV contrast Usually Not Appropriate ☢ CT knee without and with IV contrast Usually Not Appropriate ☢ CT knee without IV contrast Usually Not Appropriate ☢ MR arthrography knee Usually Not Appropriate O MRA knee without and with IV contrast Usually Not Appropriate O MRA knee without IV contrast Usually Not Appropriate O MRI knee without and with IV contrast Usually Not Appropriate O MRI knee without IV contrast Usually Not Appropriate O US knee Usually Not Appropriate O ACR Appropriateness Criteria® 1 Acute Trauma to the Knee Variant 3: Adult or skeletally mature child. -
Insufficiency Fracture of the Tibial Plateau: a Disease of Rare Diagnosis
rosis and o P op h e y t s s i c O a f l o A Journal of Osteoporosis & Physical l c a t i n v r i u t y o Chu ECP, et al., J Osteopor Phys Act 2015, 3:2 J Activity ISSN: 2329-9509 DOI: 10.4172/2329-9509.1000138 Case Report Open Access Insufficiency Fracture of the Tibial Plateau: A Disease of Rare Diagnosis Eric Chun-Pu Chu1,2 and David Bellin1,2* 1Tsinghua University-Life University Chiropractic Research Center, Beijing, China 2New York Medical Group, Hong Kong, China *Corresponding author: David Bellin, Director, Tsinghua University-Life University Chiropractic Research Center, 1 Qinghuayuan, Haidai District, Beijing 100084, China, Tel: +852- 3594 7844; E-mail: [email protected] Received date: April 26, 2015; Accepted date: May 21, 2015; Published date: May 26, 2015 Copyright: ©2015 Chu ECP. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract A 52-year-old woman with diabetes and a known cancer complained of non-traumatic knee pain for two weeks duration. Her initial radiographs and clinical findings were inconclusive. However, subsequent work-up including bone scan and MRI suggests an insufficiency fracture of the left tibial plateau. Tibial plateau fractures may directly extend to the articular surfaces of the weight-bearing joint. Insufficiency fracture of the tibial plateau is a rare diagnosis. Delayed diagnosis can cause persistent knee pain and can lead to deformity of the joint. -
AM17 International Poster 008: Investigating the “Weekend Effect
9400 West Higgins Road, Suite 305 Rosemont, IL 60018-4975 Phone: (847) 698-1631 FAX: (847) 430-5140 E-mail: [email protected] It is my pleasure to provide the OTA Annual Meeting welcome for the sec- ond consecutive year. This anomaly is related to an organizational shift in the timing for transition of OTA held offices and positions from the Spring AAOS to the Fall OTA meeting. When the OTA was established, some 30 years ago, there was no OTA Annual Meeting. There was no OTA specific venue or opportunity for gathering, sharing, learning, educating, partner- ing, or doing OTA business. Since 1985, our Annual Meeting has grown from nonexistent to the premier orthopaedic trauma related meeting in the world. The timing shift for transition affected all committees. The Program William M. Ricci, MD Committee was no exception. Last year Mike McKee did double duty as the Program Committee Chair and Second President- Elect positions and Mike Gardner entered as Co-Chair of the Program Committee. Rather than following the normal two-year cycle in their Pro- gram Committee leadership duties, Mike McKee rotated off after one year to assume Presidential Line responsibilities, and Mike Gardner assumed the helm of the Program Committee a year early. Stephen Kottmeier joined the Program Committee as co-Chair. Despite the disturbance in normal cadence, the 2018 OTA Annual Meeting in Orlando, FL, as you will see, represents an evolution toward a more robust, more comprehensive, and more modern Annual Meeting sure to be our best yet. A testament to the commitment and dedication of all our member volunteers and the hard work of our OTA staff. -
Ankle and Foot Disorders Guideline
Ankle and Foot Disorders Effective Date: July 16, 2018 Contributors to Ankle and Foot Disorders Guideline Editor-in-Chief: Kurt T. Hegmann, MD, MPH, FACOEM, FACP Assistant Editor: Matthew A. Hughes, MD, MPH Evidence-based Practice Ankle and Foot Panel Chair: Nelson S. Haas, MD, MPH, FACOEM Evidence-based Practice Ankle and Foot Panel Members: Patrick J. Beecher, MD, MPH, MBA, FACOEM Mark Easley, MD Hannah Edwards, MD, MPH Harold Hoffman, MD, FRCPC Steven Mandel, MD, FACOEM RobRoy L. Martin, PhD, PT, CSCS Pete Thomas, DPM, QME The Evidence-based Practice Ankle/Foot Panel represents expertise in occupational medicine, neurology, podiatric surgery, foot and ankle surgery, physical therapy, and rehabilitation science. Guidelines Methodology Consultant: Kurt T. Hegmann, MD, MPH, FACOEM, FACP Research Conducted By: Kurt T. Hegmann, MD, MPH, FACOEM, FACP Matthew A. Hughes, MD, MPH Jeremy J. Biggs, MD, MSPH Matthew S. Thiese, PhD, MSPH Ulrike Ott, PhD, MSPH Kristine Hegmann, MSPH, CIC Atim Effiong, MPH Holly Diane Uphold Emilee Eden, MPH Jenna K. Lindsey, BS Copyright © 2008-2018 by Reed Group, Ltd. All rights reserved. Commercial use prohibited. Licenses may be purchased from Reed Group, Ltd. at https://www.mdguidelines.com/. Specialty Society and Society Representative Listing: ACOEM acknowledges the following organizations and their representatives who served as reviewers of the “Ankle and Foot Disorders” guideline. Their contributions are greatly appreciated. By listing the following individuals or organizations, it does not infer that these individuals or organizations support or endorse the ankle and foot treatment guidelines developed by ACOEM. Copyright ©2020 Reed Group, Ltd. Page | 1 2011 EXTERNAL REVIEWERS American Physical Therapy Association Stephanie Albin, DPT, FAAOMPT, OCS Thomas G. -
Fracture Blisters
CONTINUING MEDICAL EDUCATION Objectives After completion of this CME, the reader will: 1) Understand the etiology of fracture blisters. 2) Understand the difference Fracture Blisters between serous and hemor- rhagic fracture blisters. Here’s how to recognize and treat 3) Gain information on the various treatment options for this complication. the blisters. 4) Understand ways to pre- BY GEORGE F. WALLACE, DPM, MBA vent fracture blisters. 141 Welcome to Podiatry Management’s CME Instructional program. Our journal has been approved as a sponsor of Con- tinuing Medical Education by the Council on Podiatric Medical Education. You may enroll: 1) on a per issue basis (at $26.00 per topic) or 2) per year, for the special rate of $210 (you save $50). You may submit the answer sheet, along with the other information requested, via mail, fax, or phone. You can also take this and other exams on the Internet at www.podiatrym.com/cme. If you correctly answer seventy (70%) of the questions correctly, you will receive a certificate attesting to your earned credits. You will also receive a record of any incorrectly answered questions. If you score less than 70%, you can retake the test at no additional cost. A list of states currently honoring CPME approved credits is listed on pg. 146. Other than those entities currently accepting CPME-approved credit, Podiatry Management cannot guarantee that these CME credits will be acceptable by any state licensing agency, hospital, managed care organization or other entity. PM will, however, use its best efforts to ensure the widest acceptance of this program possible. -
Fracture Blisters
Case RepoRt Fracture Blisters Claire M. Uebbing, MD* *Henry Ford Hospital, Detroit, MI Mark Walsh, MD† †Indiana University School of Medicine, South Bend Campus Joseph B. Miller, MD* ‡Memorial Hospital of South Bend Mathew Abraham, MD‡ Clifford Arnold‡ Supervising Section Editor: Jeffrey Druck, MD Submission history: Submitted May 18, 2010; Revision received August 9, 2010; Accepted October 11, 2010 Reprints available through open access at http://escholarship.org/uc/uciem_westjem Fracture blisters are a relatively uncommon complication of fractures in locations of the body, such as the ankle, wrist elbow and foot, where skin adheres tightly to bone with little subcutaneous fat cushioning. The blister that results resembles that of a second degree burn. These blisters significantly alter treatment, making it difficult to splint or cast and often overlying ideal surgical incision sites. Review of the literature reveals no consensus on management; however, most authors agree on early treatment prior to blister formation or delay until blister resolution before attempting surgical correction or stabilization. [West J Emerg Med. 2011;12(1):131-133.] INTRODUCTION The patient presented two days later complaining of Fracture blisters are relatively uncommon, occurring in blisters bulging from his splint. He did admit to walking on 1 about 2.9% of all acute fractures requiring hospitalization. his splint to get back and forth to the bathroom, but said that These blisters alter the management and definitive repair he thought it was only a sprain. significantly; however, there is still no consensus on the Physical exam revealed interval formation of large, timing of surgery nor the treatment of the blisters themselves.