Supplemental Material: Fracture Codes
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Transolecranon Distal Humerus Fractures: a Mini Review
Patel SS, Gatta J, Lee A, Bafus BT. Transolecranon Distal Humerus Fractures: A Mini Review. J Orthopedics & Orthopedic Surg. 2021;2(1):7-12 Mini Review Open Access Transolecranon Distal Humerus Fractures: A Mini Review Shaan S. Patel*, Julian Gatta, Adrienne Lee, Blaine T. Bafus Department of Orthopaedic Surgery, MetroHealth Medical Center, Cleveland, OH, USA Article Info Abstract Article Notes Background: Transolecranon distal humerus fractures are uncommon Received: March 13, 2021 injuries. The purpose of this study is to review the outcomes and complications Accepted: April 22, 2021 associated with transolecranon distal humerus fractures. *Correspondence: Material and Methods: We performed a systematic search of PubMed *Dr. Shaan S. Patel, Department of Orthopaedic Surgery, for articles published between 1990 and 2021. Included studies reported MetroHealth Medical Center, Cleveland, OH, USA; Telephone No: (205) 495-0460; Email: [email protected]. outcomes and complications of transolecranon distal humerus fractures. Data was extracted from the included studies to describe patient demographics, ©2021 Patel SS. This article is distributed under the terms of the injury characteristics, outcome measurements, and complications. Creative Commons Attribution 4.0 International License. Results: A total of 4 studies met inclusion criteria for data extraction and Keywords analysis. Two studies evaluated an adult cohort of a total of 18 patients. The Transolecranon average Disabilities of the Arm, Shoulder, and Hand (DASH) score was 40 (range Olecranon 4.2 – 76.5). Fifteen patients (83%) had a complication. Elbow stiffness (11/18, Distal humerus 61%) was the most common complication. Eleven patients (61%) underwent Fracture Outcomes more than one procedure. Two studies evaluated a pediatric cohort of a total Complications of 9 patients. -
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. -
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CURRICULUM VITAE Michael J. Prayson, MD Department of Orthopaedic Surgery, Sports Medicine & Rehabilitation Wright State University Boonshoft School of Medicine 30 E. Apple Street, Suite 2200 Dayton, Ohio 45409 937-208-2128 937-208-2920 Fax EDUCATION Institution Concentration Degree/Date Kent State University & Combined 6-Year Program BS/MD 1989 Northeastern Ohio Universities College of Medicine Rootstown, Ohio POST GRADUATE EDUCATION Item Date Orthopaedic Surgery Internship & Residency Training 1989-1994 Akron General Medical Center, Akron, Ohio Orthopaedic Traumatology Fellowship 1994-1995 Department of Orthopaedic Surgery University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania ACADEMIC EXPERIENCE Institution Position Date Northeastern Ohio Universities College of Medicine Clinical Instructor 1993-1994 Rootstown, Ohio University of Missouri Assistant Professor 1995-1998 Department of Orthopaedic Surgery Kansas City, Missouri Akron General Medical Center Assistant Professor 1998-1999 Department of Orthopaedic Surgery Akron, Ohio University of Pittsburgh Medical Center Assistant Professor 1999-2004 Department of Orthopaedic Surgery Pittsburgh, Pennsylvania Wright State University Boonshoft School of Medicine Associate Professor 2004-2009 Department of Orthopaedic Surgery, Director of Orthopaedic Sports Medicine & Rehabilitation Undergraduate Education 2004-2006 Dayton, Ohio Trauma Fellowship Director 2006-Present Director of Orthopaedic Trauma 2004-Present Section Chair of Orthopaedic Trauma 2008-2010 Vice Chairman 2008-Present -
Defining the Morphometrics of the First Metacarpal for the Development of an Osseointegrated Prosthesis
Defining the Morphometrics of the First Metacarpal for the Development of an Osseointegrated Prosthesis Authors: JJ Vaux OMS-IV1, RR Hugate, M.D.2, JW Hills3, RF Grzybowski, D.O.4, CK Funk. Ph.D.1 Affiliations: 1Rocky Vista University College of Osteopathic Medicine, 2Colorado Limb Consultants, 3Dept of Materials and Mechanical Engineering, Denver University, 4Diversified Radiology Objective: Amputation of the thumb presents a serious insult to the hand and can result in up to a 22% loss of functionality in that limb (2,3). To date, several different techniques have been explored for reconstruction of the thumb, however none seem to be incredibly successful (1,4). We believe the answer lies in an osseointegrated prosthesis within the first metacarpal. In order to successfully create an osseointegrated prosthesis, the morphometrics of the first metacarpal are needed. The aim of this study was to define the geometry of the first metacarpal in order to help create a standardized set of stems and prostheses to treat patients who have suffered amputation of the thumb at the level of the first metacarpal phalangeal joint (MCPJ). Methods: A total of eighty first metacarpals from forty-one cadavers were studied. All soft tissues were removed and the first metacarpals were imaged by computed tomography (CT). Three-dimensional models were constructed using cuts from the coronal, sagittal, and axial planes. Using a HyperMesh software, the individual first metacarpals were analyzed and measurements were taken for overall length, radius of curvature, medullary canal diameter, cortical thickness, and distance from the distal end to the center of the isthmus. -
CASE REPORT Injuries Following Segway Personal
UC Irvine Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health Title Injuries Following Segway Personal Transporter Accidents: Case Report and Review of the Literature Permalink https://escholarship.org/uc/item/37r4387d Journal Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health, 16(5) ISSN 1936-900X Authors Ashurst, John Wagner, Benjamin Publication Date 2015 DOI 10.5811/westjem.2015.7.26549 License https://creativecommons.org/licenses/by/4.0/ 4.0 Peer reviewed eScholarship.org Powered by the California Digital Library University of California CASE REPORT Injuries Following Segway Personal Transporter Accidents: Case Report and Review of the Literature John Ashurst DO, MSc Conemaugh Memorial Medical Center, Department of Emergency Medicine, Benjamin Wagner, DO Johnstown, Pennsylvania Section Editor: Rick A. McPheeters, DO Submission history: Submitted April 20, 2015; Accepted July 9, 2015 Electronically published October 20, 2015 Full text available through open access at http://escholarship.org/uc/uciem_westjem DOI: 10.5811/westjem.2015.7.26549 The Segway® self-balancing personal transporter has been used as a means of transport for sightseeing tourists, military, police and emergency medical personnel. Only recently have reports been published about serious injuries that have been sustained while operating this device. This case describes a 67-year-old male who sustained an oblique fracture of the shaft of the femur while using the Segway® for transportation around his community. We also present a review of the literature. [West J Emerg Med. 2015;16(5):693-695.] INTRODUCTION no parasthesia was noted. In 2001, Dean Kamen developed a self-balancing, zero Radiograph of the right femur demonstrated an oblique emissions personal transportation vehicle, known as the fracture of the proximal shaft of the femur with severe Segway® Personal Transporter (PT).1 The Segway’s® top displacement and angulation (Figure). -
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. -
Rib Fracture Management Guideline
Rib Fracture Management Guideline The main goals of treatment for patients with multiple rib fractures, with or without flail segments, are pain control, support of respiratory function, and chest wall stabilization. ICU admission for two or more of the following: Age >65 years History of COPD and/or heart failure, home oxygen use, current smoker, or other significant pulmonary condition 4 or more rib fractures Flail segment (at least 3 consecutive ribs with 2 fractures) IS volumes <50% of predicted volume (see chart) Inadequate pain control Pain Management: Non-ICU patients should receive a multimodal regimen with PRN opioids (also see pain management algorithm for verbal patients) ICU patients should receive a PCA (morphine preferred) in addition to multimodal regimen Multimodal Pain Regimen (include all as appropriate): o Acetaminophen 1000mg PO/IV q8h (po preferred) o Ketoralac 15-30mg IV q6h x 5 days or ibuprofen 600mg po q6 hours PRN (avoid if bleeding or renal dysfunction) o Methocarbamol 500-1000mg PO/IV q8h (po preferred; avoid IV if renal dysfunction) PCA guidelines o PCA should NOT have a continuous rate or be administered with any other opioids o Recommended dose for morphine: 1 mg q6 minutes, max dose 10 mg/hour o Recommended for hydromorphone: 0.1 mg q15 minutes, max dose 0.4 mg/hr o Transition to an oral regimen as soon as possible . Determine the amount of opioid given over the previous 24 hours by PCA . If ≥ 40 mg morphine equivalents, start long-acting oxycodone (can’t be given through a feeding tube) BID with a 50% taper. -
The Carpometacarpal Joint of the Thumb: MR Appearance in Asymptomatic Volunteers
Skeletal Radiol (2013) 42:1105–1112 DOI 10.1007/s00256-013-1633-4 SCIENTIFIC ARTICLE The carpometacarpal joint of the thumb: MR appearance in asymptomatic volunteers Anna Hirschmann & Reto Sutter & Andreas Schweizer & Christian W. A. Pfirrmann Received: 23 January 2013 /Revised: 1 April 2013 /Accepted: 21 April 2013 /Published online: 15 May 2013 # ISS 2013 Abstract subjects. The AOL showed a variable SI (36 %/42 % low, Purpose To prospectively characterize the MR appearance 27 %/27 % increased, 36 %/30 % striated). The IML was the of the carpometacarpal (CMC) joint of the thumb in asymp- thickest ligament with a mean of 2.9 mm/3.1 mm and the tomatic volunteers. DRL the thinnest (1.2 mm/1.4 mm). There was a mean Materials and methods Thirty-four asymptomatic volun- dorsal subluxation of 1.8 mm/2.0 mm and radial subluxation teers (17 women, 17 men, mean age, 33.9±9.2 years) of 2.8 mm/3.4 mm of the metacarpal base. The AOL was underwent MR imaging of the thumb after approval by the significantly thicker in men (1.7 mm) than in women local ethical committee. Two musculoskeletal radiologists (1.2 mm; p=0.02). Radial subluxation was significantly independently classified visibility and signal intensity (SI) larger in men (3.4 mm) than in women (2.2 mm; p=0.02). characteristics of the anterior oblique (AOL/beak ligament), No subluxation in palmar or ulnar direction was seen. the posterior oblique (POL), the intermetacarpal (IML), and Conclusions Radial and dorsal subluxation of the CMC the dorsoradial ligaments (DRL) on a three-point Likert joint can be a normal finding in a resting position at MR scale. -
Rib Cartilage Injuries
PHYSIO4ALL revitalise – bounce – be healthy Rib Cartilage Injuries Structure of the ribcage The ribcage supports the upper body, protects internal organs including the heart and lungs, and assists with breathing. It consists of 24 curved ribs arranged in 12 pairs. Each pair is attached to a vertebra in the spine. At the front of the body, the first seven pairs of ribs are attached directly to the sternum (breastbone) by cartilage known as costal cartilage. These ribs are often called ‘true ribs’. The next three pairs aren’t connected to the sternum. Instead, costal cartilage attaches these ‘false ribs’ to the last pair of true ribs. The remaining two pairs aren’t attached at the front of the body at all and are known as ‘floating ribs’. The ribcage is supported by ligaments and muscles, including the muscles between the ribs (intercostal muscles). These muscles allow the ribcage to expand when you breathe in, and drop when you breathe out. Rib injuries include bruises, torn cartilage and bone fractures. Shop No. P16, NorthPoint, 100 Miller St. North Sydney. NSW – 2060 T – (02) 99222212 F – (02) 99225577 W: www.physio4all.com.au E: [email protected] ABN: 77 548 297 578 PHYSIO4ALL revitalise – bounce – be healthy Symptoms of rib cartilage injury Symptoms of rib injuries depend on the type and severity of the injury, but can include: • Pain at the injury site • Pain when the ribcage flexes – for example when you breathe, cough, sneeze or laugh • Pain when rotating or side flexing your spine • Crunching or grinding sounds (crepitus) when the injury site is touched or moved • Muscle spasms of the ribcage • Deformed appearance of the ribcage • Breathing difficulties. -
Rib Fracture Management in the Older Adult; an Opportunity for Multidisciplinary Working
Subspecialty Section Rib fracture management in the older adult; an opportunity for multidisciplinary working Lauren Richardson and Shvaita Ralhan The elderly will soon make up the largest number of patients sustaining major trauma; a fall from standing height is their most common mechanism of injury1. Rib fractures are a common consequence of blunt chest trauma and are important to recognise and diagnose as complications can be fatal. They can be considered a surrogate for major trauma as up to 90% of patients will Lauren Richardson is an ST7 Registrar go on to have additional injuries identified2. The older in Geriatric and General Medicine working in the Thames Valley. Whilst adult presents a unique challenge. Their injuries are often undertaking a fellowship in Perioperative under-estimated and therefore under-triaged. Delays to Medicine she helped to develop the diagnosis are not uncommon3. Major Trauma Geriatric service at the John Radcliffe Hospital in Oxford. he mortality and thoracic deal with. Decisions regarding which team morbidity in the elderly as these patients should be admitted under can a result of rib fractures is therefore be contentious. Nationally, there is double that of their younger significant variation, and even in institutions counterparts. In elderly patients, such as ours where pathways do exist, Tfor each additional rib fracture, mortality conflicts often arise as to where the patient increases by 19% and the risk of pneumonia should be managed and by whom. increases by 27%4. It is therefore not surprising that older adults who sustain rib This article aims to address the key issues fractures have increased lengths of stay and that arise when managing older adults with more prolonged intensive care admissions5–7. -
Pediatric Orthopedic Injuries… … from an ED State of Mind
Traumatic Orthopedics Peds RC Exam Review February 28, 2019 Dr. Naminder Sandhu, FRCPC Pediatric Emergency Medicine Objectives to cover today • Normal bone growth and function • Common radiographic abnormalities in MSK diseases • Part 1: Atraumatic – Congenital abnormalities – Joint and limb pain – Joint deformities – MSK infections – Bone tumors – Common gait disorders • Part 2: Traumatic – Common pediatric fractures and soft tissue injuries by site Overview of traumatic MSK pain Acute injuries • Fractures • Joint dislocations – Most common in ED: patella, digits, shoulder, elbow • Muscle strains – Eg. groin/adductors • Ligament sprains – Eg. Ankle, ACL/MCL, acromioclavicular joint separation Chronic/ overuse injuries • Stress fractures • Tendonitis • Bursitis • Fasciitis • Apophysitis Overuse injuries in the athlete WHY do they happen?? Extrinsic factors: • Errors in training • Inappropriate footwear Overuse injuries Intrinsic: • Poor conditioning – increased injuries early in season • Muscle imbalances – Weak muscle near strong (vastus medialus vs lateralus patellofemoral pain) – Excessive tightness: IT band, gastroc/soleus Sever disease • Anatomic misalignments – eg. pes planus, genu valgum or varum • Growth – strength and flexibility imbalances • Nutrition – eg. female athlete triad Misalignment – an intrinsic factor Apophysitis • *Apophysis = natural protruberance from a bone (2ndary ossification centres, often where tendons attach) • Examples – Sever disease (Calcaneal) – Osgood Schlatter disease (Tibial tubercle) – Sinding-Larsen-Johansson -
University of Washington Orthopaedics & Sports Medicine
Discoveries 2018 University of Washington Orthopaedics & Sports Medicine University of Washington Department of Orthopaedics and Sports Medicine Discoveries 2018 Department of Orthopaedics and Sports Medicine University of Washington Seattle, WA 98195 EDITOR-IN-CHIEF: Howard A. Chansky, MD [email protected] ASSISTANT EDITORS: Christopher H. Allan, MD [email protected] Stephen A. Kennedy, MD, FRCSC [email protected] Adam A. Sassoon, MD, MS [email protected] MANAGING EDITOR: Fred Westerberg [email protected] Front Cover Illustration: Angie Kennedy, MSc, is a Seattle-based mixed media artist. She specializes in custom collage pieces that use mementos and artifacts to celebrate people and special life events. She drew on her experience as a former scientific researcher to create this collage of images from the pages of the current publication. The ‘W’ in the background is a nod to the University of Washington with an overlay of the current imagery arranged in an abstract assemblage. For more information www.americanheavyweight.com A pdf of this publication is available at our website: www.orthop.washington.edu. Permission Requests: All inquiries should be directed to the Managing Editor, University of Washington, Department of Orthopaedics and Sports Medicine, 1959 NE Pacific Street, Box 356500, Seattle, WA 98195-6500, or at the email address above. Contents 1 Foreword 2 From The Assistant Editors: The Modern Art of Musculoskeletal Research, Education, and Clinical Care 3 2018 Distinguished Alumnus, David J. Belfie, MD 4 New Faculty 6 Department of Orthopaedics and Sports Medicine Faculty 12 Visiting Lecturers Validation of a Rabbit Model of Trauma-Induced 14 Brandon J. Ausk, PhD, Philippe Huber, BS, Heterotopic Ossification Ted S.