Fractures), Or Cranial Contents (For Skull Fractures) May Cause Other Specific Signs and Symptoms
Total Page:16
File Type:pdf, Size:1020Kb

Load more
Recommended publications
-
Diagnoses to Include in the Problem List Whenever Applicable
Diagnoses to include in the problem list whenever applicable Tips: 1. Always say acute or open when applicable 2. Always relate to the original trauma 3. Always include acid-base abnormalities, AKI due to ATN, sodium/osmolality abnormalities 4. Address in the plan of your note 5. Do NOT say possible, potential, likely… Coders can only use a real diagnosis. Make a real diagnosis. Neurological/Psych: Head: 1. Skull fracture of vault – open vs closed 2. Basilar skull fracture 3. Facial fractures 4. Nerve injury____________ 5. LOC – include duration (max duration needed is >24 hrs) and whether they returned to neurological baseline 6. Concussion with or without return to baseline consciousness 7. DAI/severe concussion with or without return to baseline consciousness 8. Type of traumatic brain injury (hemorrhages and contusions) – include size a. Tiny = <0.6 cm b. Small/moderate = 0.6-1 cm c. Large/extensive = >1 cm 9. Cerebral contusion/hemorrhage 10. Cerebral edema 11. Brainstem compression 12. Anoxic brain injury 13. Seizures 14. Brain death Spine: 1. Cervical spine fracture with (complete or incomplete) or without cord injury 2. Thoracic spine fracture with (complete or incomplete) or without cord injury 3. Lumbar spine fracture with (complete or incomplete) or without cord injury 4. Cord syndromes: central, anterior, or Brown-Sequard 5. Paraplegia or quadriplegia (any deficit in the upper extremity is consistent with quadriplegia) Cardiovascular: 1. Acute systolic heart failure 40 2. Acute diastolic heart failure 3. Chronic systolic heart failure 4. Chronic diastolic heart failure 5. Combined heart failure 6. Cardiac injury or vascular injuries 7. -
Do Fluoroscopic and Radiographic Images Underestimate Pin Protrusion in Paediatric Supracondylar Humerus and Distal Radius Fractures? a Synthetic Bone Model Analysis
Original Clinical Article Do fluoroscopic and radiographic images underestimate pin protrusion in paediatric supracondylar humerus and distal radius fractures? A synthetic bone model analysis S. Kenney Orthopaedic surgeons using fluoroscopy should be aware of J. Schlechter this discrepancy when assessing intraoperative fluoroscopic images to decide on acceptable implant position. Level of Evidence: Level V Abstract Purpose Fluoroscopy is commonly used to confirm accept- Cite this article: Kenney S, Schlechter J. Do fluoroscopic and able position of percutaneously placed pins when treating radiographic images underestimate pin protrusion in pae- paediatric fractures. There is a paucity of literature investigat- diatric supracondylar humerus and distal radius fractures? ing the accuracy of fluoroscopic imaging when determining A synthetic bone model analysis. J Child Orthop 2019;13. DOI: pin position relative to the far cortex of the fixated bone. The 10.1302/1863-2548.13.180173 purpose of this study was to evaluate the accuracy of fluor- oscopic and radiographic imaging in measuring smooth pin Keywords: supracondylar humerus fracture; percutaneous protrusion from the far cortex of a bone model. pinning; fluoroscopic imaging; distal radius fracture; paediatrics Methods Eight bone models were implanted with smooth pins and anteroposterior fluoroscopic and radiographic stud- ies were obtained. All images were evaluated by orthopaedic Introduction attending physicians, residents and medical students. The Paediatric supracondylar humerus and distal radius frac- length of pin protrusion from the model surface was estimat- tures are common injuries making up 17% and 23% of ed on fluoroscopic imaging and measured on radiographs and all paediatric fractures, respectively.1 When these fractures compared with actual lengths measured on the bone models. -
Ultrasound-Assisted Closed Reduction of Distal Radius Fractures
SCIENTIFIC ARTICLE Ultrasound-Assisted Closed Reduction of Distal Radius Fractures Narihito Kodama, MD, PhD, Yoshinori Takemura, MD, PhD, Hiroaki Ueba, MD, Shinji Imai, MD, PhD, Yoshitaka Matsusue, MD, PhD Purpose To assess the accuracy and ability of ultrasound for monitoring closed reduction for distal radius fractures. Methods Consecutive patients undergoing ultrasound-guided closed reduction of acute, dis- placed distal radius fractures between January 2003 and December 2006 at our department were enrolled. The control group was extracted from patients who underwent a closed reduction for similar fractures under fluoroscopy or without any imaging assistance. To confirm the accuracy of the ultrasonography measurements, displacement distance values were compared with those on radiographic imaging before and after reduction. X-ray pa- rameters for pre- and postreduction, reduction time, total cost, and success rate were compared between the ultrasound-guided and the control groups. Results The ultrasound-guided group consisted of 43 patients (mean age, 68 y) and the control group consisted of 57 patients, which included 35 patients (mean age, 74 y) with fluoroscopic reduction and of 22 patients (mean age, 72 y) with reduction unaided by imaging. There were no significant displacement differences between radiographic and ultrasound measurements. In x-ray parameters for pre- and postreduction, there were no significant differences between the 2 groups. Ultrasound-guided reduction took longer than the other 2 methods. The success rate of the ultrasound and the fluoroscopic groups were similar (95% and 94%, respectively). Conclusions Our data suggest that ultrasound assistance can aid reduction of distal radius fractures as well as fluoroscopy. (J Hand Surg Am. -
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. -
Hangman's Fracture
J Neurosurg Spine 14:198–208, 2011 Hangman’s fracture: a historical and biomechanical perspective Historical vignette MAHMOUD RAYES, M.D., MONIKA MITTAL, M.D., SETTI S. RENGACHARY, M.D., AND SANDEEP MITTAL, M.D., F.R.C.S.C. Department of Neurosurgery, Wayne State University, Detroit, Michigan The execution technique of hanging, introduced by the Angle, Saxon, and Jute Germanic tribes during their invasions of the Roman Empire and Britain in the 5th century, has remained largely unchanged over time. The earli- est form of a gallows was a tree on which prisoners were hanged. Despite the introduction of several modifications such as a trap door, the main mechanism of death remained asphyxiation. This created the opportunity for attempted revival after the execution, and indeed several well-known cases of survival following judicial hanging have been re- ported. It was not until the introduction of the standard drop by Dr. Samuel Haughton in 1866, and the so-called long drop by William Marwood in 1872 that hanging became a standard, humane means to achieve instantaneous death. Hangmen, however, fearing knot slippage, started substituting the subaural knot for the traditional submental knot. Subaural knots were not as effective, and cases of decapitation were recorded. Standardization of the long drop was further propagated by John Berry, an executioner who used mathematical calculations to estimate the correct drop length for each individual to be hanged. A British committee on capital sentences, led by Lord Aberdare, studied the execution method, and advocated for the submental knot. However, it was not until Frederic Wood-Jones published his seminal work in 1913 that cervical fractures were identified as the main mechanism of death following hanging in which the long drop and a submental knot were used. -
2 DMA’S Most Anticipated One Liners 1
Orthopedics 1 Authors: M.Balakrishnana, S.Sakthivel & Roshan Akthar www.dmaedu.com www.dmaedu.com 2 DMA’s Most Anticipated One Liners 1. S.aureus is the Mc organism causing osteomyelitis 2. Quadriceps femoris is the Mc muscle involved in osteoarthritis of knee 3. Mc bone malignancy is metastasis 4. Nasal bone is the Mc bone to get fractured in face and also is the 3rd Mc fracture of the body 5. Housemaid’s knee- prepatellar bursitis 6. Ankle is involved in Cotton’s fracture 7. In children, Ewings sarcoma is the Mc sarcoma of bone 8. Fibrous dysplasia- shepherd crook deformity 9. TB spine causes bony ankyloses 10. Injury to long thoracic nerve affects serratus anterior muscle, causes scapular wing- ing 11. ACL prevents tibia from getting anteriorly dislocated 12. Popliteal artery is the Mc peripheral artery to get damaged in trauma 13. Radial nerve is involved in humerus shaft fracture 14. Ortoloni test is done for Developmental Displasia of Hip 15. Uric acid crystals are deposited in gout 16. In RA, MCP joint is involved and DIP is spared 17. Intranasal calcitonin is given for the treatment of Osteoporosis 18. osteoporosis 19. Wimberger ring sign is seen in scurvy Codfish vertebra is seen in 20. IOC for stress fracture is MRI 21. Garden classification is used for NOF fractures 22. In monteggia fracture, posterior interroseal nerve is involved 23. Strontium 90 isotope is used for treating bone cancer 24. Hanging cast is used for humerus shaft fracture 25. Myositis ossificans is treated by immobilisation and cast application 26. -
MARCH FRACTURE-PIED FORCE Developed Reactions to These Test Products and to Witte Peptone at Least As Severe As Those Shown by Our by Anaphylactic Case
FEB. 24, 1940 ANAPHYLAXIS AFTER TETANUS TOXOID MERCALTSORHL 95 erythema than similar dilutions of the extracts, and that within a few minutes of injection many persons MARCH FRACTURE-PIED FORCE developed reactions to these test products and to Witte peptone at least as severe as those shown by our BY anaphylactic case. Further investigations are in progress which it is hoped will be the subject of another paper. F. A. R. STAMMERS, Ch.M., F.R.C.S. Our observations throw considerable doubt on the value Major R.A.M.C., Surgical Specialist of scratch and intradermal tests as usually interpreted on the basis of early readings. Nevertheless, our patient Army medical officers everywhere have been asked to see was the only subject who developed mild anaphylactic all sorts of foot troubles precipitated by military training. symptoms-itching of the nose and tongue, slight swelling More often than not these are due to pre-existing con- of the lower lip, smarting of the eyes, and flushing of the ditions such as hallux rigidus, hallux valgus, hammer-toe, face-soon after 1 in 1,000 dilutions of Witte peptone and or pes planus, which, though formerly symptomless, break two other beef fibrin digests had been injected intra- down under the strain of route-marching, physical train- dermally; and she alone showed areas of redness, 50 to ing, and the general extra footwork the soldier- is called 60 mm. in diameter, swelling, and induration (" like upon to do in heavy army boots. Even a seemingly those occurring after staphylococcus toxoid ") about two normal foot may develop trouble under such circum- hours later at the sites of injection of these products. -
Cervical Spine Injury Risk Factors in Children with Blunt Trauma Julie C
Cervical Spine Injury Risk Factors in Children With Blunt Trauma Julie C. Leonard, MD, MPH,a Lorin R. Browne, DO,b Fahd A. Ahmad, MD, MSCI,c Hamilton Schwartz, MD, MEd,d Michael Wallendorf, PhD,e Jeffrey R. Leonard, MD,f E. Brooke Lerner, PhD,b Nathan Kuppermann, MD, MPHg BACKGROUND: Adult prediction rules for cervical spine injury (CSI) exist; however, pediatric rules abstract do not. Our objectives were to determine test accuracies of retrospectively identified CSI risk factors in a prospective pediatric cohort and compare them to a de novo risk model. METHODS: We conducted a 4-center, prospective observational study of children 0 to 17 years old who experienced blunt trauma and underwent emergency medical services scene response, trauma evaluation, and/or cervical imaging. Emergency department providers recorded CSI risk factors. CSIs were classified by reviewing imaging, consultations, and/or telephone follow-up. We calculated bivariable relative risks, multivariable odds ratios, and test characteristics for the retrospective risk model and a de novo model. RESULTS: Of 4091 enrolled children, 74 (1.8%) had CSIs. Fourteen factors had bivariable associations with CSIs: diving, axial load, clotheslining, loss of consciousness, neck pain, inability to move neck, altered mental status, signs of basilar skull fracture, torso injury, thoracic injury, intubation, respiratory distress, decreased oxygen saturation, and neurologic deficits. The retrospective model (high-risk motor vehicle crash, diving, predisposing condition, neck pain, decreased neck mobility (report or exam), altered mental status, neurologic deficits, or torso injury) was 90.5% (95% confidence interval: 83.9%–97.2%) sensitive and 45.6% (44.0%–47.1%) specific for CSIs. -
Cervical Fracture Complicating Ankylosing Spondylitis a Report of Eight Cases and Review of the Literature
Cervical Fracture Complicating Ankylosing Spondylitis A Report of Eight Cases and Review of the Literature GARVIN C. MURRAY, M.D. Fracture of the cervical spine is a serious and often fatal complication ROBERT H. PERSELLIN. M.D. of ankylosing spondylitis. An evaluation of eight patients and a re- Son Antonio, Texas view of 75 additional cases from the literature are presented. Al- though this complication is relatively uncommon, it is clear that people with advanced disease and complete ankylosis of the cervical spine are at increased risk of sustaining cervical fracture. When fracture occurs it usually stems from minor trauma resulting most commonly in disruption of the lower cervical segments (iIfth through the seventh cervical vertebrae). Fracture is most likely the result of a hyperextension type injury, occurs through what was formerly an intervertebral space, and is unstable. Severe neurologic sequelae occur in 57 percent of the cases and the mortality rate (35 percent) is twice that observed with similar fracture involving normal spines. The majority of patients are best treated with closed reduction with halo traction together with body cast or jacket. Laminectomy is rarely indicated except in the event of an advancing neurologic deficit. With appropriate understanding and execution of management principles, the outcome in these patients can be favorable. Unfortunately, rec- ognition of cervical fracture in patients with ankylosing spondylitis is often needlessly delayed. Distortion of normal anatomy in spon- dylitics, predominant fracture location in lower cervical spine seg- ments and lack of obvious displacement make identification difficult. Thus, management is often inappropriate resulting in exessive neurologic injury and mortality. -
Mandibular Fractures, Diagnostics, Postoperative Complications
Journal of Medical Sciences. March 23, 2020 - Volume 8 | Issue 13. Electronic-ISSN: 2345-0592 Medical Sciences 2020 Vol. 8 (13), p. 45-52 e-ISSN: 2345-0592 Medical Sciences Online issue Indexed in Index Copernicus Official website: www.medicsciences.com Mandibular fractures, diagnostics, postoperative complications Shahaf Givony1 1 Lithuanian University of Health Sciences. Academy of Medicine. Faculty of Odonthology. ABSTRACT Mandibular fractures usually happen among young males at the age of 16-30 years old. The mandible which has been rated as the second facial bone with the highest rate of injuries, tends to break much more often compared to any other bone of the cranium and represent up to 70% of the cases. This tendency to fracture may be explained by the protruded position, mobility and particular shape of it. The tendency for a mandibular fracture may also be explained by the common risk factors such as vehicle accidents and physical violence that are part of our daily life. There are many other risk factors according to the literature which differ between individuals due to the different socio-economic status, culture, technology and environment. Before the clinical examination of the fracture, it is obligatory to make sure that a clear airway path presents with no other fatal injuries. The examination may be supported by imaging methods which together will approve the diagnosis and method of treatment. Patients with a fracture of the mandible may suffer from post-operative complications which may occur after a short or long duration of the treatment. Those complications may be malocclusion, infections, trismus, damaged teeth and soft tissue, esthetic disfiguration, functional problems, pain and many more. -
5Th Metatarsal Fracture
FIFTH METATARSAL FRACTURES Todd Gothelf MD (USA), FRACS, FAAOS, Dip. ABOS Foot, Ankle, Shoulder Surgeon Orthopaedic You have been diagnosed with a fracture of the fifth metatarsal bone. Surgeons This tyPe of fracture usually occurs when the ankle suddenly rolls inward. When the ankle rolls, a tendon that is attached to the fifth metatarsal bone is J. Goldberg stretched. Because the bone is weaker than the tendon, the bone cracks first. A. Turnbull R. Pattinson A. Loefler All bones heal in a different way when they break. This is esPecially true J. Negrine of the fifth metatarsal bone. In addition, the blood suPPly varies to different I. PoPoff areas, making it a lot harder for some fractures to heal without helP. Below are D. Sher descriPtions of the main Patterns of fractures of the fifth metatarsal fractures T. Gothelf and treatments for each. Sports Physicians FIFTH METATARSAL AVULSION FRACTURE J. Best This fracture Pattern occurs at the tiP of the bone (figure 1). These M. Cusi fractures have a very high rate of healing and require little Protection. Weight P. Annett on the foot is allowed as soon as the Patient is comfortable. While crutches may helP initially, walking without them is allowed. I Prefer to Place Patients in a walking boot, as it allows for more comfortable walking and Protects the foot from further injury. RICE treatment is initiated. Pain should be exPected to diminish over the first four weeks, but may not comPletely go away for several months. Follow-uP radiographs are not necessary if the Pain resolves as exPected. -
Pattern of Skeletal Injuries in Child Physical Abuse
1 Bahrain Medical Bulletin, Vol. 33, No. 2, June 2011 Pattern of Skeletal Injuries in Physically Abused Children Fadheela Al-Mahroos, MD, MHPE* Eshraq A Al-Amer, MD, ABMS (Ped)** Nabar J Umesh, MD, DMRE*** Ali I Alekri, FRCSI, CABS (Ortho)**** Objective: The aim of this study is to identify the frequency and patterns of skeletal injuries among victims of child abuse in Bahrain. Design: Retrospective. Setting: Child Protection Unit at Salmaniya Medical Complex. Method: Child’s characteristics, type of skeletal injuries, location, pattern, radiological findings, and associated other injuries of 36 children were reviewed. Data management and analysis was done using SPSS for Windows, version 18. Result: Thirty-six children with skeletal injuries resulting from child physical abuse were seen from 1991 to 2009. Twenty-three (64%) were males and 13 (36%) were females; the mean age was 3.8 years. Twenty-three (64%) were ≤ 3 years old. Multiple fractures were documented in 19 (53%) children. Bone fracture types and frequency were as follow: 10 (28%) affecting the femur, 9 (25%) skull, 8 (22%) humerus, 6 (17%) rib, 4 (11%) radius, 4 (11%) ulna and 2 (6%) tibia. Other bones less frequently affected were mandible, nasal bone, vertebral, metatarsals, and calcaneus fractures. In addition, other injuries included slipped femoral epiphysis, large bilateral hematoma in vastus lateralis, and full thickness tendon Achilles tear. Hundred percent of rib, ulnar, radial and tibial fractures were in children under one year old. In addition, 7 (78%) of skull fractures, 5 (62%) of humerus fractures, and 5 (50) of femur fractures were under one year old.