DOCSLIB.ORG

Pediatric Orthopedics Alexander Rogers, MD Associate Professor Emergency Medicine and Pediatrics Michigan Medicine/University of Michigan

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Pediatric Orthopedics Alexander Rogers, MD Associate Professor Emergency Medicine and Pediatrics Michigan Medicine/University of Michigan 1/16/2018 Pediatric Orthopedics Alexander Rogers, MD Associate Professor Emergency Medicine and Pediatrics Michigan Medicine/University of Michigan Disclosures I have no conflicts of interest to disclose I will not be talking about off label use of medications 1 1/16/2018 Scope of the problem • In 2010, analysis of National data showed more than 7.5 million pediatric ED visits for injuries and poisoning – the top visit category – (Wier LM, Yu H, Owens PL, Washington R. Healthcare Cost and Utilization Project (HCUP) Statistical Briefs [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2006-2013 Jun) • Immaturity of pediatric skeletal structures leads to different fracture patterns than adults, with different short and long term risks Learning goals • Review common pediatric specific injuries • Recognize when we need to intervene • Cover some non-traumatic presentations 2 1/16/2018 Pediatric Musculoskeletal System • Pediatric skeleton less densely calcified than adult • Bones are lighter and more porous • More porous= more pliableless strength increase fractures • Actively growing structure: – long bones contain growth plates/physes – end of bones contain epiphysis Pediatric Musculoskeletal System • Bones of child surrounded by thick and active periosteum • Ligaments and periosteum stronger than bone itself – physis is weak link – fractures more common than sprains in younger children • Response to trauma age dependent 3 1/16/2018 Salter-Harris Classification • SH I – fracture through physis – may be displaced • SH II- through physis and metaphysis • SH III – through physis and epiphysis • SH IV – through metaphysis, physis and epiphysis • SH V – crush to physis In general – higher grade Associated with higher risk of growth abnormality 5 yo upper extremity injury (or ‘why I work in Pediatrics’) • Doctor: What brings you in today? • Patient: I jumped off a chair and hurt my arm • Doctor: oh, why did you jump off the chair? • Patient: I was trying to fly • Doctor: Did you? • Patient: A little bit! 4 1/16/2018 Distal Forearm fractures • Common fracture type • 2 view radiographs key • Acute reduction can avoid the OR • Reduce if > 15-20 degrees angulated • If not reduced acutely – end up needing OR for pinning Distal Radius and Forearm fractures Orthop Rev (Pavia). 2014 Apr 22; 6(2): 5325. • Multiple recommendations regarding acceptable alignment parameters • Younger age have more remodeling potential • Age > 9 higher risk • after skeletal maturity tx as adult • Distal fractures remodel better • If initial reduction is not adequate – these are difficult to manage in the office* *A friendly plug from my orthopedic colleagues 5 1/16/2018 Forearm fracture variants • 6 yo with fall from the monkey bars • Pain in mid-forearm • Subtle swelling/deformity Bowing fracture • Plastic deformity of long bone (in this case the ulna) • If > 20 degrees of deformity can prevent remodeling of the other bone • Increased need to reduce if > 10 yo • Reduce with either weights or slow, constant traction 6 1/16/2018 Forearm fracture variants • 5 yo FOOSH • Still using affected arm, but decreased • Pain with supination • No swelling or deformity Buckle/Taurus fracture • Distal Radius most common but can be any bone • Can usually treat with prefabricated splints – and your patients will thank you for it!* *Williams KG et al. A randomized controlled trial of cast versus splint for distal radial buckle fracture: an evaluation of satisfaction, convenience, and preference. Pediatr Emerg Care. 2013 May;29(5):555-9. 7 1/16/2018 Forearm Fracture variants • 9 yo fall from a giant yoga ball that was next to a tree at family camp Monteggia Fracture • Monteggia fracture- dislocations consist of a fracture of the ulnar shaft with associated dislocation of the radial head. The ulnar fracture is usually obvious, whereas the radial head dislocation can be overlooked 8 1/16/2018 Monteggia Fracture Monteggia Fracture • Ulnar fracture + radial head dislocation • Uncommon (2% all elbow fx’s)– but peak age 4-10 • Can be easily missed- must have films of both elbow and forearm • Isolated ulna fractures rare • If unrecognized and not reduced, can lead to permanent disability • Closed reduction possible in children, less likely with increased age Galleazzi Fracture • Classic: - Fx distal 1/3 radius - dislocation of distal ulna • Disruption of radioulnar joint • Peak age 9-12 years • Suspect in angulated distal radius fractures • Difficult to recognize MUGR fractures… Monteggia has fractured Ulna • Requires ortho consult in ED and reduction Galeazzi has fractured Radius 9 1/16/2018 Pediatric Elbow • 6 ossification centers around the elbow joint • C= Capitellum ( 1 yr) • R = Radial head ( 3-5 yrs) • I = Internal/ medial epicondyle- (4-6 yrs) on ulnar side of elbow • T = Trochlea (6-8 yrs) • O = Olecranon (8- 10 yrs) • E= External/ lateral epicondyle ( 10-12 yrs) – due to anatomical position lateral epicondyle on radial side of elbow Elbow Fractures and Anatomic Landmarks • Anterior Fat Pad – May be normal • Posterior far pad – Always abnormal if visible – Treat a posterior fat pad as an occult fracture even if the rest of the structures are normal 10 1/16/2018 Radiography and Anatomic Landmarks • Anterior humeral line – Follow anterior humeral cortex – Should pass through the middle 1/3 of the capitellum – Note the visible posterior fat pad! Radiography and Anatomic Landmarks • Radiocapitellar line (need a good lateral film!) – Should intersect the middle 1/3 of the capitellum – If not – think radial head dislocation/Monteggia fracture Case courtesy of Dr Benoudina Samir, Radiopaedia.org, rID: 41196 11 1/16/2018 Supracondylar fractures • Fall on outstretched arm with hyperextension • Neuropraxia • Absent pulse in 7-12% • Volkmann contraction with brachial artery compression after repair Supracondylar types Type 1 Type 2 Type 3 • Abnormal fat pad • Posterior cortex • Both cortices • Posterior splint intact disrupted • Pain control • Posterior splint • Check pulse and • Outpatient ortho • Pain control nerve function! for casting • Operative repair – • Posterior splint in vs outpatient • Pain control • Urgent/emergent OR 12 1/16/2018 Supracondylar Reduction • If pulseless extremity and delay in transport to definite care, consider closed reduction • Traction • ‘Milking’ of displaced portion • Hyperflexion of elbow • Follow by documentation of pulses and splinting • Do not delay transport for reduction if pulses are thready but capillary refill is adequate – closed reduction is a last resort as often slips! Heading down… 13 1/16/2018 Lower Extremity Injuries/Kids who won’t walk Limping Teenager • 14 yo male with 1 month hx of limp and progressive knee pain • No known trauma • 100 kg male • Pain with internal rotation of hip 14 1/16/2018 Slipped Capital Femoral Epiphesis • 14 yo male with 1 month hx of limp and progressive knee pain • No known trauma • 100 kg male • Pain with internal • Slipped Capital Femoral Epiphysis rotation of hip (SCFE) • Male>Female, African American, obese • Often present as knee pain • AP, Frog leg view of both hips • Urgent operative repair • Worsening slip can lead to AVN Family Case Study • 18 month old male being swung in circle by father (me) and swings free • Fall approximately 8 inches with rotational torque • Won’t bear weight • No deformity noted • Mother of child (my wife) not happy 15 1/16/2018 Toddler’s Fracture • Nondisplaced spiral fracture of tibial shaft • Ambulatory children < 3 yo • Can occur with low energy mechanism • Up to 40% of initial films are negative (? US dx) • Pain control and casting – sometimes empiric – for 3 weeks • Casting preferable to splinting (kids escape splints) Hip pain and fever • 3 year old male with recent fall off bike • URI one week ago • Now with fever, unwilling to bear weight • Complains of pain with movement of the right hip 16 1/16/2018 Hip Septic Arthritis vs. Transient Synovitis • Both can cause patients to be unwilling to bear weight and have pain with hip movement • Risk factors in order of importance – Fever (38.5) > CRP (>2.0) > ESR(>40) > refusal to bear weight > WBC (>12) Caird et al. The Journal of Bone & Joint Surgery. 88(6):1251–1257, JUN 2006 Non-accidental trauma • Close to 1% all children victims of abuse • 1/3 of these kids will be reinjured • 1-5% of these kids will die if returned to original environment • Abuse is 2nd leading cause of death infants and children • Risk factors*: – child < 4 years of age (majority are < 2) – parental substance abuse – young parents, single parents, large # children – Nonbiological, transient caregivers in the home – disability *https://www.cdc.gov/violenceprevention/childmaltreatment/riskprotectivefactors.html 17 1/16/2018 Orthopedic injuries and abuse Fractures associated with NAT • Bucket handle and corner fractures are considered Classic Metaphyseal Lesions • Torsional force applied to immature bone • Highly suspicious and should prompt a skeletal survey if < 2 (NOT a babygram), 3200 and NAT workup or transfer to appropriate facility 18 1/16/2018 Fractures associated with NAT • Posterior rib fractures – often found in contiguous ribs and different stages of healing if repetitive trauma • Compressive force applied to sternum and costovertebral junction during violent shaking • Highly suspicious and should prompt a skeletal survey if < 2 (NOT a babygram), 3200 and NAT workup or transfer to appropriate facility Acknowledgements • Thanks to… • Stuart Bradin, MD – Pediatric Emergency • Ramon Sanchez, MD – Pediatric Radiology • Matthew Abbott, MD – Pediatric Orthopedics • Michelle Caird, MD – Pediatric Orthopedics • Marco Rogers – my son who had the Toddler’s fracture 19 1/16/2018 Thank you to MCEP!!!! Questions? Fractures that only need a sling… • Humerus fractures with < 50 degree angulation in younger kids • Clavicle fractures – even with significant displacement in kids < 10 years old • Kids approaching skeletal maturity can consider outpatient surgery 20.
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]