Non Complex Fractures Search Strategies Appendix Clinical
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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. -
The Surgical Repair of Transverse Patella Fractures
A vertical patella fracture James Heilman, MD The Surgical Repair of Transverse Patella Fractures Angela Miller, cst Patella fractures constitute about 1% of all fractures, and are mostly caused by direct trauma to the front of the knee.1 There are many types of patella fractures: comminuted, open, nondisplaced and displaced. This article will focus on the about 50% to 80% of patellar fractures that are transverse,3 and requires the surgical treatment using Kirschner wires, also known as K-wires and tension-band wiring. ANATOMY AND PHYSIOLOGY LEARNING OBJECTIVES The patella is the largest sesamoid bone in the human body. Sesamoid ▲ Learn about the use of K-wires for bones are not connected to other bones; instead, they are connected treatment of this fracture by tendons or are embedded in muscle tissue. The patella bone can ▲ Review the anatomy related to this be found in the quadriceps tendons. The function of sesamoid bones is to provide a smooth surface over which the tendon can slide, and procedure increases the ability of the tendons to transmit muscle forces.2 The ▲ Recall the patient preparation patella bone is located anterior to the knee joint, and the posterior sur- specific to this operation face articulates with the femur. It is attached proximally to the femoral ▲ Examine the role of the surgical condyles, and attached distally to the condyles of the tibia and upper technologist during a transverse ends of the fibula.5 patella fracture ▲ Read about studies comparing the POSITIONING use of metallic versus nonmetallic During transverse patella fractures a patient will be placed in the implants supine position, with their arms are placed at each of their sides and A vertical patella fracture James Heilman, MD AUGUST 2016 | The Surgical Technologist | 349 tucked by the draw sheet. -
Vertical Open Patella Fracture, Treatment, Rehabilitation and the Moment to Fixation
Elmer ress Case Report J Clin Med Res. 2015;7(2):129-133 Vertical Open Patella Fracture, Treatment, Rehabilitation and the Moment to Fixation Joao Alberto Larangeiraa, Liliane Bellenziera, Vanessa da Silva Rigoa, Elias Josue Ramos Netoa, Francisco Fritsch Machry Kruma, Tiango Aguiar Ribeiroa, b, c Abstract Introduction Patella fracture is relatively uncommon and the vertical trace frac- Patella fracture is relatively uncommon and represents approx- ture represents almost 12-17%. The open patella fracture expresses imately 0.5-1.5% of all bone injuries [1, 2], and men are more 6-30%. The association of these two uncommon conditions was the affected than women [3, 4]. The classification can be done by aim of this case report even as the treatment and the moment of fixa- characterizing the fracture pattern in osteochondral, multifrag- tion (definitive surgical treatment). A 27-year-old man after a motor- mented, stellate, transversal, vertical and polar fracture (Fig. cycle accident showed an open patella fracture classified as a Gustilo 1). Other classifications may take into account the presence of and Anderson type IIIA lesion. The patient was immediately treated deviation between the fragments, deviated and not deviated, with precocious surgery fixation with a modified tension band which and the mechanism of injury. The transversal type is more fre- consists of two parallel K-wires positioned orthogonal to the fracture quent corresponding to 50-80%, comminuted 30-35% and ver- line and a cerclage wire shaped anteriorly at patella as an eight. The tical fractures 12-17% [2, 3] and these are rarely displaced [5]. -
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. -
Is There Any Difference Between the Biomechanical Strengths of The
550 Acta Orthop. Belg.O. KOCADAL, 2017, ,83 M,. 550-557PEPE, Z. GUNES, E. AKSAHIN, S. DURAN, C. N. AKTEKIN ORIGINAL STUDY Is there any difference between the biomechanical strengths of the current fixation techniques for comminuted distal patellar fractures? (Comparison of distal patella fracture fixation techniques) Onur KOCADAL, Murad PEPE, Zafer GUNES, Ertugrul AKSAHIN, Semra DURAN, Cem Nuri AKTEKIN From the Ankara Training and Research Hospital, Ulucanlar, Ankara, Turkey In this biomechanical study, the strength of five surgical treatment for the patella inferior pole different fixation techniques -anterior tension band fractures (15). Internal fixation of the distal part, if wiring with K-wires, separate vertical wiring, headless possible, or excision of the small bone fragments compression screws with anterior tension band with repair of the patellar tendon by transosseous wiring, cannulated screws with tension band wiring pull-out sutures, in the extremely comminuted and memory shape patellar fixator- for distal patellar cases, should be performed (17). However in the fractures were compared. Forty calf knees were used for the biomechanical testing. Each specimen latter, non-absorbable synthetic sutures and partial was pre-loaded with 10 N at 1 N/s. The distraction patellectomy necessitate immobilization of the forces were applied consistently with the velocity of 5 knee, which causes weakness in the quadriceps mm/s. The ultimate load (N) and displacement (mm) muscle (7,14,17,30). Therefore, fixation of the distal values were recorded. The headless compression patellar fractures has gained popularity over partial screw with anterior tension band wiring (656.9±167.9 patellectomy. N) and the cannulated screws with anterior tension There are various previously defined surgical band wiring (642.6±166.0 N) obtained significantly fixation options for patella inferior pole fractures: higher ultimate loading values compared to the other anterior tension band wiring, combining screw fixation methods (p<0.05). -
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. -
Management of Knee Injuries Protocol in Mius and Wics
Management of Knee Injuries Protocol FINAL 04.12.15 Document Control Title Management of Knee Injuries Protocol in MIUs and WICs Author Author’s job title Professional Lead, Minor Injuries Unit Directorate Department Emergency Services, Logistics and Resilience Emergency Department Date Version Status Comment / Changes / Approval Issued 0.1 Dec Draft Initial Version for Consultation 2015 1.0 Jun Final Approved by (Clinician) and (Clinical Director) June 2015 and 2015 published on Bob. 1.1 Jun Final Reviewed and amended Karen Watts / Fionn Bellis 2015 1.2 Feb 2017 Revision Amendment to protocol, age reference under section 1 Main Contact Emergency Department Tel: Direct Dial – 01271 322480 North Devon District Hospital Raleigh Park Barnstaple, EX31 4JB Lead Director Medical Director Document Class Target Audience Protocol MIU Distribution List Distribution Method Senior Management Trust’s internal website Superseded Documents Knee Injuries (over 2 years of age) Protocol Issue Date Review Date Review Cycle December 2015 December 2018 Three years Consulted with the following stakeholders Contact responsible for implementation and ED Consultant monitoring compliance: MIU Leads Professional Lead, Minor Injuries Unit Education/ training will be provided by: Professional Lead, Minor Injuries Unit Approval and Review Process Lead Clinician for Emergency Department Emergency Department Management of Knee Injuries Protocol V1.2 Feb2017 Page 1 of 12 Management of Knee Injuries Protocol FINAL 04.12.15 Local Archive Reference G:\Policies and Protocols Local Path MIU Filename Knee Injuries (over 2 years of age) Protocol V1.2 Policy categories for Trust’s internal website Tags for Trust’s internal website (Bob) (Bob) MIU MIU Emergency Department Management of Knee Injuries Protocol V1.2 Feb2017 Page 2 of 12 Management of Knee Injuries Protocol FINAL 04.12.15 2. -
Fracture Lower Extremity Part II
CONTENTS FEMUR SHAFT BOTH BONE SUBTROCHANTERIC TIBIAL PLAFON FRACTURE LOWER FRACTURE ANKLE EXTREMITIES: PART 2 FRACTURE FEMUR FOOT SUPRACONDYLAR FRACTURE FEMUR CALCANEUS PATELLA TALUS WORAWAT LIMTHONGKUL, M.D. 14 JAN 2013 TIBIA LISFRANC’S TIBIAL PLATEAU METATARSAL 1 2 SUBTROCHANTERIC FRACTURE FEMUR A PART OF FRACTURE OCCUR BETWEEN TIP OF LESSER TROCHANTER AND A POINT 5 SUBTROCHANTERIC CM DISTALLY CALCAR FEMORALE FRACTURE LARGE FORCES ARE NEEDED TO CAUSE FRACTURES IN 5 CM YOUNG & ADULT INJURY IS RELATIVELY TRIVIAL IN ELDERLY 2° CAUSE: OSTEOPOROSIS, OSTEOMALACIA, PAGET’S 3 4 SUBTROCHANTERIC FRACTURE FEMUR TREATMENT INITIAL FEMUR SHAFT TRACTION DEFINITE FRACTURE ORIF WITH INTRAMEDULLARY NAIL OR 95 DEGREE HIP- SCREW-PLATE 5 6 FEMUR FRACTURE FILM HIPS SEVERE PAIN, UNABLE TO BEAR WEIGHT 10% ASSOCIATE FEMORAL SUPRACONDYLAR NECK FRACTURE FEMUR FRACTURE TREATMENT: ORIF WITH IM NAIL OR P&S COMPLICATION: HEMORRHAGE, NEUROVASCULAR INJURY, FAT EMBOLI 7 8 SUPRACONDYLAR FEMUR FRACTURE SUPRACONDYLAR ZONE DIRECT VIOLENCE IS THE USUAL CAUSE PATELLA FRACTURE LOOK FOR INTRA- ARTICULAR INVOLVEMENT CHECK TIBIAL PULSE TREATMENT: ORIF WITH P&S 9 10 PATELLA FRACTURE PATELLA FRACTURE FUNCTION: LENGTHENING THE ANTERIOR LEVER ARM DDX: BIPATITE PATELLA AND INCREASING THE (SUPEROLATERAL) EFFICIENCY OF THE QUADRICEPS. TREATMENT: DIRECT VS INDIRECT NON-DISPLACE, INJURY INTACT EXTENSOR : CYLINDRICAL CAST TEST EXTENSOR MECHANISM DISPLACE, DISRUPT EXTENSOR: ORIF WITH VERTICAL FRACTURE: TBW MERCHANT VIEW 11 12 PATELLAR DISLOCATION ADOLESCENT FEMALE DISLOCATION AROUND USUALLY -
Upper Extremity Fractures
Department of Rehabilitation Services Physical Therapy Standard of Care: Distal Upper Extremity Fractures Case Type / Diagnosis: This standard applies to patients who have sustained upper extremity fractures that require stabilization either surgically or non-surgically. This includes, but is not limited to: Distal Humeral Fracture 812.4 Supracondylar Humeral Fracture 812.41 Elbow Fracture 813.83 Proximal Radius/Ulna Fracture 813.0 Radial Head Fractures 813.05 Olecranon Fracture 813.01 Radial/Ulnar shaft fractures 813.1 Distal Radius Fracture 813.42 Distal Ulna Fracture 813.82 Carpal Fracture 814.01 Metacarpal Fracture 815.0 Phalanx Fractures 816.0 Forearm/Wrist Fractures Radius fractures: • Radial head (may require a prosthesis) • Midshaft radius • Distal radius (most common) Residual deformities following radius fractures include: • Loss of radial tilt (Normal non fracture average is 22-23 degrees of radial tilt.) • Dorsal angulation (normal non fracture average palmar tilt 11-12 degrees.) • Radial shortening • Distal radioulnar (DRUJ) joint involvement • Intra-articular involvement with step-offs. Step-off of as little as 1-2 mm may increase the risk of post-traumatic arthritis. 1 Standard of Care: Distal Upper Extremity Fractures Copyright © 2007 The Brigham and Women's Hospital, Inc. Department of Rehabilitation Services. All rights reserved. Types of distal radius fracture include: • Colle’s (Dinner Fork Deformity) -- Mechanism: fall on an outstretched hand (FOOSH) with radial shortening, dorsal tilt of the distal fragment. The ulnar styloid may or may not be fractured. • Smith’s (Garden Spade Deformity) -- Mechanism: fall backward on a supinated, dorsiflexed wrist, the distal fragment displaces volarly. • Barton’s -- Mechanism: direct blow to the carpus or wrist. -
Suture Repair of Patellar Inferior Pole Fracture: Transosseous Tunnel Suture Compared with Anchor Suture
EXPERIMENTAL AND THERAPEUTIC MEDICINE 22: 998, 2021 Suture repair of patellar inferior pole fracture: Transosseous tunnel suture compared with anchor suture WENZHOU HUANG1‑3, TIANLONG WU1‑3, QIANGQIANG WEI1‑3, LONGHAI PENG1‑3, XIGAO CHENG1‑3 and GUICHENG GAO1‑3 1Department of Orthopaedic Surgery, The Second Affiliated Hospital of Nanchang University; 2Institute of Orthopedics of Jiangxi Province; 3Institute of Minimally Invasive Orthopedics of Nanchang University, Nanchang, Jiangxi 330006, P.R. China Received May 18, 2020; Accepted March 10, 2021 DOI: 10.3892/etm.2021.10430 Abstract. Patellar inferior pole fracture is difficult to treat due Introduction to the inherent weakness of small comminuted distal fragments. However, suture fixation was recently introduced and reported. Inferior pole fracture of the patella is an extra‑articular injury The aim of the present study was to evaluate and compare that accounts for 5% of all patellar fractures and usually requires the clinical outcomes of two suture techniques, transosseous operative treatment if displaced or associated with complete tunnel suture (TTS) and anchor suture (AS), for the fixation disruption of the extensor mechanism (1). However, displaced of patellar inferior pole fracture. A total of 35 patients with fracture fragments are typically small and comminuted and it patellar inferior pole fracture treated at the Second Affiliated is difficult to fix and maintain anatomical reduction (2). The Hospital of Nanchang University (Nanchang, China) between inferior patellar pole is continuous with the patellar tendon and June 2014 and April 2018 were retrospectively reviewed. Of the key to reconstructing the fracture fragment surgically is these, 14 were treated with the TTS technique and 21 using AS to reestablish the extensor mechanism while simultaneously fixation. -
Distal Radius Fracture
Distal Radius Fracture Osteoporosis, a common condition where bones become brittle, increases the risk of a wrist fracture if you fall. How are distal radius fractures diagnosed? Your provider will take a detailed health history and perform a physical evaluation. X-rays will be taken to confirm a fracture and help determine a treatment plan. Sometimes an MRI or CT scan is needed to get better detail of the fracture or to look for associated What is a distal radius fracture? injuries to soft tissues such as ligaments or Distal radius fracture is the medical term for tendons. a “broken wrist.” To fracture a bone means it is broken. A distal radius fracture occurs What is the treatment for distal when a sudden force causes the radius bone, radius fracture? located on the thumb side of the wrist, to break. The wrist joint includes many bones Treatment depends on the severity of your and joints. The most commonly broken bone fracture. Many factors influence treatment in the wrist is the radius bone. – whether the fracture is displaced or non-displaced, stable or unstable. Other Fractures may be closed or open considerations include age, overall health, (compound). An open fracture means a bone hand dominance, work and leisure activities, fragment has broken through the skin. There prior injuries, arthritis, and any other injuries is a risk of infection with an open fracture. associated with the fracture. Your provider will help determine the best treatment plan What causes a distal radius for your specific injury. fracture? Signs and Symptoms The most common cause of distal radius fracture is a fall onto an outstretched hand, • Swelling and/or bruising at the wrist from either slipping or tripping.