DOCSLIB.ORG

Upper Limb Injuries

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Upper Limb Injuries UPPER LIMB INJURIES DR JASON CHOW ORTHOPAEDIC REGISTRAR DESCRIBING A FRACTURE DESCRIBING A FRACTURE • 2 orthogonal views • Age of patient • Mechanism • Open Closed • Which bone • Location on the bone • Intra or extra articular • Fracture Pattern • Displacement • Neurovascular compromise? LOCATION WITHIN BONE FRACTURE PATTERN DISPLACEMENT NEUROVASCULAR EXAMINATION !!! CLAVICLE • Indications for surgery? CLAVICLE • Indications for surgery? • OPEN FRACTURE • SKIN COMPROMISE • NEUROVASCULAR INJURY • FLOATING SHOULDER • RIB FRACTURES / FLAIL CHEST • > 2CM SHORTENING • DISPLACED FRACTURES > 100% CLAVICLE STERNOCLAVICULAR JOINT DISLOCATION • May be ANTERIOR or POSTERIOR, • Anterior dislocations are much more common than posterior dislocations • Posterior dislocations may results in VASCULAR, RESPIRATORY, OESOPHAGEAL & NEUROLOGICAL compromise. STERNOCLAVICULAR JOINT DISLOCATION • XRAYS (AP / SERENDIPITY VIEWS) • Serendipity view = 40° CEPHALIC TILT • CT (gold standard) +/- Angiography STERNOCLAVICULAR JOINT DISLOCATION DISTAL CLAVICLE FRACTURES ACROMIOCLAVICULAR DISLOCATION • ACJ injuries represent nearly half of all sports related shoulder injuries. • Typically TRAUMA related – fall on tip of the shoulder in ADDUCTION. • DISPLACEMENT is measured from the top of coracoid process to bottom of clavicle (CC INTERVAL). • 1-3 non operative • Grade 3-6 operative ACROMIOCLAVICULAR DISLOCATION PROXIMAL HUMERUS FRACTURE PROXIMAL HUMERUS FRACTURE • Third most common fracture in >65 Yrs • 2: 1 Female to male PROXIMAL HUMERUS FRACTURE • Imaging • Xrays – AP/Scapular Y • CT scan – most will require a CT scan PROXIMAL HUMERUS FRACTURE • Pseudosubluxation • Inferior head subluxation secondary to blood in capsule and deltoid atony. PROXIMAL HUMERUS FRACTURE • Management • Most can be treated non operatively in shoulder immobiliser • Minimally displaced surgical and anatomical and GT fracture <5mm • Consider • Age • Fracture type/displacement • Bone quality SHOULDER DISLOCATION • Anterior – most common • Posterior – less common (electrocution, seizure, trauma, alcohol) • History • 1st dislocation? Recurrent? • Mechanism? • Previous management/ operations • Associated conditions • Laxity/ Ehlers Danlos etc? • Imaging • AP/Lateral/ Axillary ANTERIOR DISLOCATION ANTERIOR DISLOCATION • Management • Reduction • Analgesia and muscle relaxation • GA is unsuccessful • Post reduction xray • Rule out fracture (humerus and glenoid) • Prognosis • Age <20 = 90% redislocation rate • Age 20-30 = 60% redislocation rate • Age 30-40 = 30% redislocaiton rate • Age >40 = 10% redislocation rate (higher incidence of acute rotator cuff tear) POSTERIOR DISLOCATION POSTERIOR DISLOCATION • 2% of acute dislocations • Often Missed • Imaging • Light bulb sign • Axillary xrays is diagnostic • CT is unable to get axillary xray HUMERAL SHAFT FRACTURES HUMERAL SHAFT FRACTURES • Union rates are 98% NON-OPERATIVE, 93% ORIF and 87% IMN. • ACCEPTABLE ALIGNMENT for non-operative treatment: • 30° VARUS / VALGUS • 20° ANTERIOR / POSTERIOR • < 15° ROTATION • < 3CM SHORTENING HUMERAL SHAFT FRACTURES HUMERAL SHAFT FRACTURES • INDICATIONS FOR SURGERY • Indications for surgical treatment are: • OPEN FRACTURE • MULTITRAUMA • FLOATING ELBOW (IPSILATERAL FOREARM FRACTURE) • OBESITY (LARGE BREASTS) • IMPENDING PATHOLOGICAL FRACTURE • RADIAL NERVE PALSY AFTER REDUCTION • MALALIGNMENT: • 30° VARUS / VALGUS • 20° ANTERIOR / POSTERIOR • 15° ROTATION • 3CM SHORTENING • Radial nerve palsy after the fracture is not an indication for exploration or internal fixation DISTAL HUMERUS FRACTURES • 2 groups • Young patient with high velocity • Older patient (OP) • Most need operative intervention • NV exam is important. • Always needs a CT scan ELBOW DISLOCATION • Mechanism is FOOSH • Obtain and Maintain and concentric reduction • Pre and post xrays • Look for associated fractures • Radial head • Coranoid process • Neurovascular exam (Ulnar nerve or AIN) ELBOW DISLOCATION • Management • Pop at 90 degrees for 2/52 • 1 and 2 week check x- ray • ROM at 2/52 and check stability OLECRANON FRACTURE • Most need operative intervention unless undisplaced • Elderly can manage with functional ROM and fibrous union RADIAL HEAD FRACTURES RADIAL HEAD FRACTURES • Type 1 – Undisplaced < 2mm no mechanical block to rotation • Type 2 – Displaced >2mm but block to motion • Type 3 – Comminuted FOREARM FRACTURES • Mechanism is important? • Direct blow • Look for associated dislocations • Monteggia • Galleazzi • Associated Injuries • Ulna can be open • Compartment Syndrome ULNA – NIGHT STICK FRACTURE • Direct blow ulna fracture MONTEGGIA • Proximal 1/3 ulna with radial head dislocation GALLEAZZI • Distal 1/3 radial fracture with DRUJ disruption COMPARTMENTS SYNDROME • Circulation of tissues within a closed osteo-fascial space are compromised by increased pressure within that space • Prerequisite is volume restricting envelope • fascia & skin • POP • dressings COMPARTMENTS SYNDROME • Aetiology • 1. Increased contents • Bleeding / edema • fracture • osteotomies • crush injuries • post - ischaemic swelling • 2. Decreased size • Tight casts & dressings • Tight closure of fascial defects • Fracture reduction COMPARTMENTS SYNDROME • Increased local tissue pressure increases pressure within intracompartmental veins • local AV gradient is reduced • causes decreased local perfusion secondary to Starling Forces • Metabolic tissues demands not met • loss of tissue function & viability • distal pulses remain as ICP < SBP • digit capillary refill remains as venous return extracompartmenta COMPARTMENTS SYNDROME • P’s • Pain (most important) • Paraesthesia (often early) • Palpation (swollen and tense) • Passive stretch • Paresis (proximal nerve injury or guarding) • Pulseless (late sign) COMPARTMENTS SYNDROME • Clinical Diagnosis • Tense compartment and pain +++ • Pressure measurement • Patient is unresponsive • Uncoperative • Underlying peripheral nerve defect. COMPARTMENTS SYNDROME • Management • Prevention • Remove tight dressings • Split plasters • Early fasciotomy < 8 hours • Complications • Ischemic muscles fibrosis and contractions • Deformity and stiffness • Nerve damage and variable numbness DISTAL RADIUS FRACTURE DISTAL RADIUS FRACTURE • Normal radius angles • Volar tilt 10 degrees • Radial inclination 22 degrees • Radius is 10mm longer than ulna • Ulnar variance 2mm positive DISTAL RADIUS FRACTURE • Colles fracture • Distal radius fracture with dorsal displacement • Smiths fracture • Distal radius fracture with volar displacement DISTAL RADIUS FRACTURE • Management • Immediate reduction if displaced • NV exam pre and post reduction • ?haematoma block with elderly • Molded volar and dorsal slab DISTAL RADIUS FRACTURE • Indications for surgery • Absolute • Open fracture • CTS • Relative • Instablity • Inability to maintain adequate reduction • >2mm or radial step • Radial shortening >5mm • Sagital tilt > 15 degrees dorsal and 20 degrees volar +/- dorsal communation DISTAL RADIUS FRACTURE .
Load more

Recommended publications
  • 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.
    [Show full text]
  • 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.
    [Show full text]
  • Fragility Fractures and Imminent Fracture Risk in Hong Kong: One of the Cities with Longest Life Expectancies
    Archives of Osteoporosis (2019) 14:104 https://doi.org/10.1007/s11657-019-0648-4 ORIGINAL ARTICLE Fragility fractures and imminent fracture risk in Hong Kong: one of the cities with longest life expectancies Ronald Man Yeung Wong1 & Wing Tung Ho1 & Law Sheung Wai1 & Wilson Li2 & Wai Wang Chau1 & Kwoon-Ho Simon Chow1 & Wing-Hoi Cheung1 Received: 6 May 2019 /Accepted: 27 August 2019 # International Osteoporosis Foundation and National Osteoporosis Foundation 2019 Abstract Introduction Imminent fracture risk, or fractures within 2 years of an initial fracture, is a pressing issue worldwide. Hong Kong is a city with one of the longest life expectancies. The concern of fragility fractures and the imminent risk of a subsequent fracture is becoming a top priority. The objective of this study was to present the epidemiology of incident fragility fractures of all public acute hospitals and the imminent risk of a subsequent fracture in Hong Kong. Methodology This was a retrospective population-based analysis. Patient records from all acute hospitals in Hong Kong from 1 January 2004 to 31 December 2018 were retrieved for patients ≥ 50 years of age with hip, distal radius, or proximal humerus fractures. Secondary fractures and falls were identified in the subsequent 5 years. Post hoc analysis in recent 2013–2018 period was performed. Overall survival (re-fracture incidence) on age subgroups using Kaplan survival analysis and variables was compared using the log-rank test. Cox proportional hazard regressions, obtaining the hazard ratios (HR) and their respective 95% confidence intervals (CI), were used. Results There is an overall increasing trend of fragility fractures (hip, distal radius, proximal humerus) from 5596 in 2004 to 8465 in 2018.
    [Show full text]
  • Distal Humerus Nonunion After Failed Internal Fixation: Reconstruction with Total Elbow Arthroplasty Dawn M
    (aspects of trauma • an original study) Distal Humerus Nonunion After Failed Internal Fixation: Reconstruction With Total Elbow Arthroplasty Dawn M. LaPorte, MD, Michael S. Murphy, MD, and J. Russell Moore, MD ABSTRACT onunion occurs in 2% ing treatment option. In the 1980s, In nonunion after distal humerus to 5% of distal humerus TEA for nonunion with tightly con- fracture, osteoporosis, devas- fractures.1 The condition strained or custom prostheses had cularized fracture fragments, is difficult to treat, and fair to moderately good results but and periarticular fibrosis limit Nno single treatment modality has a high complication rates (4/7, 57%6; potential reconstructive options. high success rate with few compli- 5/14, 36%10). According to a recent We assessed pain relief, func- 2-6 11 tional gains, and complications cations. Without intervention, the review, however, 31 (86%) of 36 in 12 patients whose long-stand- patient is left with a painful, unstable, patients had a satisfactory result with ing, painful nonunions after previ- and often flail extremity and with a semiconstrained prosthesis, and ous treatment with rigid internal limitations in activities of daily liv- only 7 (19%) of the 36 patients had fixation were reconstructed with ing. Frequently, there is an associ- complications. a semiconstrained total elbow ated ulnar neuropathy. Osteoporosis, In the current study, we assessed arthroplasty, frequently with a devascularized fracture fragments, outcomes (complications, symptoms, triceps-sparing approach and and periarticular fibrosis limit poten- function) after semiconstrained anterior ulnar nerve transposition. tial reconstructive options for long- TEA for long-standing distal humer- At mean follow-up of 63 months, 11 patients had good pain relief and standing distal humerus nonunions.
    [Show full text]
  • Managing a Rib Fracture: a Patient Guide
    Managing a Rib Fracture A Patient Guide What is a rib fracture? How is a fractured rib diagnosed? A rib fracture is a break of any of the bones that form the Your doctor will ask questions about your injury and do a rib cage. There may be a single fracture of one or more ribs, physical exam. or a rib may be broken into several pieces. Rib fractures are The doctor may: usually quite painful as the ribs have to move to allow for normal breathing. • Push on your chest to find out where you are hurt. • Watch you breathe and listen to your lungs to make What is a flail chest? sure air is moving in and out normally. When three or more neighboring ribs are fractured in • Listen to your heart. two or more places, a “flail chest” results. This creates an • Check your head, neck, spine, and belly to make sure unstable section of chest wall that moves in the opposite there are no other injuries. direction to the rest of rib cage when you take a breath. • You may need to have an X-ray or other imaging test; For example, when you breathe in your rib cage rises out however, rib fractures do not always show up on X-rays. but the flail chest portion of the rib cage will actually fall in. So you may be treated as though you have a fractured This limits your ability to take effective deep breaths. rib even if an X-ray doesn’t show any broken bones.
    [Show full text]
  • Anesthesia for Trauma
    Anesthesia for Trauma Maribeth Massie, CRNA, MS Staff Nurse Anesthetist, The Johns Hopkins Hospital Assistant Professor/Assistant Program Director Columbia University School of Nursing Program in Nurse Anesthesia OVERVIEW • “It’s not the speed which kills, it’s the sudden stop” Epidemiology of Trauma • ~8% worldwide death rate • Leading cause of death in Americans from 1- 45 years of age • MVC’s leading cause of death • Blunt > penetrating • Often drug abusers, acutely intoxicated, HIV and Hepatitis carriers Epidemiology of Trauma • “Golden Hour” – First hour after injury – 50% of patients die within the first seconds to minutesÆ extent of injuries – 30% of patients die in next few hoursÆ major hemorrhage – Rest may die in weeks Æ sepsis, MOSF Pre-hospital Care • ABC’S – Initial assessment and BLS in trauma – GO TEAM: role of CRNA’s at Maryland Shock Trauma Center • Resuscitation • Reduction of fractures • Extrication of trapped victims • Amputation • Uncooperative patients Initial Management Plan • Airway maintenance with cervical spine protection • Breathing: ventilation and oxygenation • Circulation with hemorrhage control • Disability • Exposure Initial Assessment • Primary Survey: – AIRWAY • ALWAYS ASSUME A CERVICAL SPINE INJURY EXISTS UNTIL PROVEN OTHERWISE • Provide MANUAL IN-LINE NECK STABILIZATION • Jaw-thrust maneuver Initial Assessment • Airway cont’d: – Cervical spine evaluation • Cross table lateral and swimmer’s view Xray • Need to see all seven cervical vertebrae • Only negative CT scan R/O injury Initial Assessment • Cervical
    [Show full text]
  • Bone Mineral Density and Prevalence of Osteoporosis in Postmenopausal Korean Women with Low-Energy Distal Radius Fractures
    ORIGINAL ARTICLE Musculoskeletal Disorders http://dx.doi.org/10.3346/jkms.2016.31.6.972 • J Korean Med Sci 2016; 31: 972-975 Bone Mineral Density and Prevalence of Osteoporosis in Postmenopausal Korean Women with Low-Energy Distal Radius Fractures Hong Jun Jung,1 Ho Youn Park,2 The aim of this study was to evaluate the bone mineral density and the prevalence of Jin Sam Kim,1 Jun-O Yoon,1 osteoporosis in postmenopausal Korean women with low-energy distal radius fractures and and In-Ho Jeon1 compared with those of aged-matched normal Korean women. Two hundred and six patients with distal radius fractures between March 2006 and March 2010 were included in 1Department of Orthopaedic Surgery, Asan Medical Center, School of Medicine, University of Ulsan, this study. Patients were divided into three groups by age; group 1 (50-59 years), group 2 Seoul, Korea; 2Department of Orthopedic Surgery, (60-69 years), and group 3 (70-79 years). Controls were age-matched normal Korean Uijeongbu St. Mary’s Hospital, The Catholic women. The bone mineral density values at all measured sites, except for the spine, were University of Korea, Uijeongbu, Korea significantly lower in group 1 than those of control. While the bone mineral density values Received: 3 July 2015 in groups 2 and 3 were lower than those of controls, these differences were not statistically Accepted: 16 March 2016 significant. All groups had significantly higher prevalence of osteoporosis at the Ward’s triangle; however, at the spine, femoral neck and trochanteric area it was not significantly Address for Correspondence: different from those of age-matched controls.
    [Show full text]
  • 6.3.3 Distal Radius and Wrist
    6 Specific fractures 6.3 Forearm and hand 6.3.3 Distal radius and wrist 1 Assessment 657 1.1 Biomechanics 657 1.2 Pathomechanics and classification 657 1.3 Imaging 658 1.4 Associated lesions 659 1.5 Decision making 659 2 Surgical anatomy 660 2.1 Anatomy 660 2.2 Radiographic anatomy 660 2.3 Preoperative planning 661 2.4 Surgical approaches 662 2.4.1 Dorsal approach 2.4.2 Palmar approach 3 Management and surgical treatment 665 3.1 Type A—extraarticular fractures 665 3.2 Type B—partial articular fractures 667 3.3 Type C—complete articular fractures 668 3.4 Ulnar column lesions 672 3.4.1 Ulnar styloid fractures 3.4.2 Ulnar head, neck, and distal shaft fractures 3.5 Postoperative care 674 3.6 Complications 676 3.7 Results 676 4 Bibliography 677 5 Acknowledgment 677 656 PFxM2_Section_6_I.indb 656 9/19/11 2:45:49 PM Authors Daniel A Rikli, Doug A Campbell 6.3.3 Distal radius and wrist of this stable pivot. The TFCC allows independent flexion/ 1 Assessment extension, radial/ulnar deviation, and pronation/supination of the wrist. It therefore plays a crucial role in the stability of 1.1 Biomechanics the carpus and forearm. Significant forces are transmitted across the ulnar column, especially while making a tight fist. The three-column concept (Fig 6.3.3-1) [1] is a helpful bio- mechanical model for understanding the pathomechanics of 1.2 Pathomechanics and classification wrist fractures. The radial column includes the radial styloid and scaphoid fossa, the intermediate column consists of the Virtually all types of distal radial fractures, with the exception lunate fossa and sigmoid notch (distal radioulnar joint, DRUJ), of dorsal rim avulsion fractures, can be produced by hyper- and the ulnar column comprises the distal ulna (DRUJ) with extension forces [2].
    [Show full text]
  • Pearls and Pitfalls of Forearm Nailing
    Current Concept Review Pearls and Pitfalls of Forearm Nailing Sreeharsha V. Nandyala, MD; Benjamin J. Shore, MD, MPH, FRCSC; Grant D. Hogue, MD Boston Children’s Hospital, Boston, MA Abstract: Pediatric forearm fractures are one of the most common injuries that pediatric orthopaedic surgeons manage. Unstable fractures that have failed closed reduction and casting require surgical intervention in order to correct length, alignment, and rotation to optimize forearm range of motion and function. Flexible intramedullary nailing (FIN) is a powerful technique that has garnered widespread popularity and adaptation for this purpose. Surgeons must become familiar with the technical pearls and pitfalls associated with this technique in an effort to prevent complications. Key Concepts: • Flexible intramedullary nailing is a useful technique that is widely utilized for most unstable both-bone forearm fractures except in the setting of highly comminuted fracture patterns or in refractures with abundant intrame- dullary callus formation. • Proper contouring of the rod prior to insertion and bending of the tip will help decrease the risk of malunion and facilitate rod passage across the fracture site. • The surgeon must be aware of the numerous pitfalls that are associated with flexible intramedullary nailing and the methods to mitigate each complication. Introduction Flexible intramedullary nailing (FIN) offers several key As enthusiasm grows for FIN as a treatment for pediatric advantages for the management of those pediatric fore- forearm fractures, surgeons must also clearly understand arm fractures that are not amenable to closed treatment. the technical nuances, controversies, and strategies to These advantages include cosmetic incisions for nail in- mitigate complications associated with this technique.
    [Show full text]
  • Delayed Traumatic Hemothorax in Older Adults
    Open access Brief report Trauma Surg Acute Care Open: first published as 10.1136/tsaco-2020-000626 on 8 March 2021. Downloaded from Complication to consider: delayed traumatic hemothorax in older adults Jeff Choi ,1 Ananya Anand ,1 Katherine D Sborov,2 William Walton,3 Lawrence Chow,4 Oscar Guillamondegui,5 Bradley M Dennis,5 David Spain,1 Kristan Staudenmayer1 ► Additional material is ABSTRACT very small hemothoraces rarely require interven- published online only. To view, Background Emerging evidence suggests older adults tion whereas larger hemothoraces often undergo please visit the journal online immediate drainage. However, emerging evidence (http:// dx. doi. org/ 10. 1136/ may experience subtle hemothoraces that progress tsaco- 2020- 000626). over several days. Delayed progression and delayed suggests HTX in older adults with rib fractures may development of traumatic hemothorax (dHTX) have not experience subtle hemothoraces that progress in a 1Surgery, Stanford University, been well characterized. We hypothesized dHTX would delayed fashion over several days.1 2 If true, older Stanford, California, USA be infrequent but associated with factors that may aid adults may be at risk of developing empyema or 2Vanderbilt University School of Medicine, Nashville, Tennessee, prediction. other complications without close monitoring. USA Methods We retrospectively reviewed adults aged ≥50 Delayed progression and delayed development of 3Radiology, Vanderbilt University years diagnosed with dHTX after rib fractures at two traumatic hemothorax (dHTX) have not been well Medical Center, Nashville, level 1 trauma centers (March 2018 to September 2019). characterized in literature. The ageing US popula- Tennessee, USA tion and increasing incidence of rib fractures among 4Radiology, Stanford University, dHTX was defined as HTX discovered ≥48 hours after Stanford, California, USA admission chest CT showed either no or ’minimal/trace’ older adults underscore a pressing need for better 5Department of Surgery, HTX.
    [Show full text]
  • Distal Radius Fractures (Broken Wrist)
    DISEASES & CONDITIONS Distal Radius Fractures (Broken Wrist) The radius is the larger of the two bones of the forearm. The end toward the wrist is called the distal end. A fracture of the distal radius occurs when the area of the radius near the wrist breaks. Distal radius fractures are very common. In fact, the radius is the most commonly broken bone in the arm. Description A distal radius fracture almost always occurs about 1 inch from the end of the bone. The break can occur in many different ways, however. One of the most common distal radius fractures is a Colles fracture, in which the broken fragment of the radius tilts upward. This fracture was first described in 1814 by an Irish surgeon and anatomist, Abraham Colles -- hence the name A Colles fracture occurs when the "Colles" fracture. broken end of the radius tilts upward. Other ways the distal radius can break include: Intra-articular fracture. A fracture that extends into the wrist joint. ("Articular" means "joint.") Extra-articular fracture. A fracture that does not extend into the joint is called an extra-articular fracture. Open fracture. When a fractured bone breaks the skin, it is called an open fracture. These types of fractures require immediate medical attention because of the risk for infection. Comminuted fracture. When a bone is broken into more than two pieces, it is called a comminuted fracture. It is important to classify the type of fracture, because some fractures are more difficult to treat than others. Intra-articular fractures, open fractures, comminuted fractures, and displaced fractures (when the broken pieces of bone do not line up straight).are more difficult to treat, for example.
    [Show full text]
  • Fractures of the Proximal Humerus
    Fractures of the Proximal Humerus David Rothberg, MDa,*, Thomas Higgins, MDb KEYWORDS Proximal humerus fracture Neer classification Fibular strut Shoulder arthroplasty KEY POINTS Proximal humeral fractures are common. Classification systems have evolved to develop treatment guidelines. Bone quality must be considered for treatment. Surgical stabilization may require augmentation. Arthroplasty must be considered especially in the elderly. INTRODUCTION common osteoporotic extremity fracture after hip fractures and distal radius fractures.1 Greater Proximal humeral fractures are common, with low- than 70% of these fractures occur in patients older energy injuries occurring in the elderly population than 60 years, with a 4:1 female/male ratio and an and less frequent higher-energy fractures striking incidence steadily increasing after the age of 40 young people. The decision to pursue operative years. or nonoperative treatment is driven by the func- Independent risk factors for proximal humeral tional goals and the degree of displacement of fractures include a recent decline in health status, the proximal humeral anatomic parts. Operative insulin-dependent diabetes mellitus, infrequent management is based on the ability to obtain walking, indicators of neuromuscular weakness, and maintain reduction, vascularity of the articular diminished femoral neck bone density, height/ segment, quality of soft-tissue attachments, and weight loss, previous falls, impaired balance, and bone porosity. Despite much study, the optimal maternal history of hip fractures.2 In a 3-decade treatment of significantly displaced fracture population-based study of osteoporotic proximal patterns remains controversial. humeral fractures, Palvanen and colleagues3 found that the incidence in patients older than 60 EPIDEMIOLOGY years increased by 13.7% per year of age.
    [Show full text]