...Background : Intertrochanteric and subtrochanteric fractures are leading cause of hospital admissions in elderly people. Aim: This study is done to analyze the surgical management of proximal third fractures of femur using Proximal Femoral Nail fixation. Materials and methods: 20 cases there were 15 male and 5 female patients of intertrochanteric and subtrochanteric fractures, who are treated with Proximal Femoral nail. Results: Mean age of 60.4 yrs. 50% of cases were admitted due to slip and fall and with slight predominance of right side. Out of 20 cases, 10 were trochanteric and 10 were subtrochanteric. In Trochanteric class 60% were Boyd and Griffin type 2, in Subtrochanteric class 40% were Seinsheimer type 3a and 20% were 2b. Mean duration...
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...Review of Literature A systematically oriented and driven presentation of relevant literature and research studies concerned with respect to phenomenon underling the present study, such presentation had included almost all issues related to care of fracture that treated with external and internal fixation. Part I: Historical Prospective of Beginning and use External and Internal Fixation. Part II: Traumatic Bone Injury: 2.2.1. Causes of Fracture. 2.2.2 Pathophysiology of Fracture. 2.3. Types of fractures. 2.4. Clinical Manifestations. 2.5. Diagnostic Tests. 2.6. Phase of Bone Healing. 2.7. Complications of Fracture. PartIII: Treatment and Management of Fracture by External and Internal fixation . 2.3.1.External Fixation Method....
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... with 200-300 patients per day. A prospective study was undertaken to analyze the techniques in diagnosis, way of management, medicine preparation, plants used and way of applications by traditional bone setter (TBS) Vaidyas, with special reference to Puttur. We also tried to understand the reasons which make lots of people go to Puttur for getting treatment, means of contact for treatment, pathology of fracture and outcome of some treated cases through this study. 54% of the studied patients came to Puttur TBS on the advice of old patients. It is observed that more educated people are patronizing this therapy and 23% patients of the observed cases took discharge from modern hospital voluntarily to receive Puttur kattu treatment. 80% patients believed that this therapy with home remedy would fasten the healing process. 44% patients opted for this therapy due to fear of pain, heavy plaster of Paris bandage, prolonged period of immobilization, surgery and amputation. 71% patients of the followed cases were satisfied with the treatment of TBS of Puttur with minimum complications. The authors also attempted to put forth the legacy of the tradition, the way of management and the plant used for bone setting by the Puttur bone setting Vaidyas. KEYWORDS: Bone, Puttur, Rachapalem,...
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...FRACTURES: (http://video.about.com/orthopedics/Fractures-1.htm) The Human Skeletal System The skeletal system is made up of 206 bones and provides support, allows for movement, and protects the internal organs of the body. What Is a Fracture? Sometimes, too much pressure is applied to a bone that results in what is known as a fracture. Fractures are commonly caused by a fall; strike from an object, or by twisting or bending of the bone. What Is an Incomplete Fracture? When the bone is only cracked or partially broken, doctors refer to it as an incomplete fracture. What Is a Hairline Fracture? A hairline fracture is an incomplete fracture, like a crack that does not break all the way through the bone. It usually is the result of a relatively minor injury. What Is a Greenstick Fracture? A greenstick fracture is an incomplete fracture that is similar to the break of a young tree branch. Only one side of the bone breaks causing the bone to bend. Both hairline and greenstick fractures are usually treated by immobilization with a cast to allow it to mend. What Is a Complete Fracture? When the bone is broken into pieces, doctors refer to it as a complete fracture. What Is a Simple Fracture? A simple fracture is a complete fracture where the bone is broken into two fragments. This break can be transverse (which means straight across the bone), oblique (which means at an angle)....and spiral (which means an angle that is twisted). What is a Comminuted Fracture? A comminuted...
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...MANAGEMENT: * Pain management * Fracture treatment * Realignment (aka reduction) immobilization to maintain alignment casting, splinting * Physical/occupational therapy- regaining/learning achievable mobility, ambulation and ADL capabilities * Treatment of skin integrity, complications * Maintenance/treatment of fluid volume + nutritional status MEDICAL MANAGEMENT: * Pain management * Fracture treatment * Realignment (aka reduction) immobilization to maintain alignment casting, splinting * Physical/occupational therapy- regaining/learning achievable mobility, ambulation and ADL capabilities * Treatment of skin integrity, complications * Maintenance/treatment of fluid volume + nutritional status COMPLLICATIONS * Infection * Shock – hypovolemic/hemorrhage * Pressure ulcers r/t possible decreased mobility/sensation * Compartment syndrome * Fat embolism syndrome * Muscle atrophy * Non-union (fracture doesn’t heal – no new callus formation) * Malunion (fracture heals in incorrect position, can = deformity + malfunction) * Re-fracture COMPLLICATIONS * Infection * Shock – hypovolemic/hemorrhage * Pressure ulcers r/t possible decreased mobility/sensation * Compartment syndrome * Fat embolism syndrome * Muscle atrophy * Non-union (fracture doesn’t heal – no new callus formation) * Malunion (fracture heals in incorrect position, can = deformity...
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...associated with serious complications. It is characterized as a disease in which the rate of bone density decay occurs more rapidly than the occurrence of new bone growth. The first suspicious indicator of one developing osteoporosis is the initial fracture. It is difficult to know if osteoporosis is present otherwise because there is no other physiological way to feel bones losing their strength. Low bone mass is the result of ongoing bone calcium loss which can be caused by a primary, or secondary illness. This disease is more prevalent in Caucasians and Asian as compared to other races...
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...KK DEPARTMENT OF ORTHOPAEDICS, TRAUMATOLOGY & REHABILITATION KULIYYAH OF MEDICINE Case write-up 1: CLOSED FRACTURE OF DISTAL THIRD OF LEFT TIBIA AND FIBULA HISTORY Chief Complain Patient, Sonia a/p Bacik, a 36 years old single mother, orang asli, with a history of fracture at the left leg following industrial accident treated conservatively 1 month prior to admission, was referred from Hospital Pekan 4 days ago with a chief complain of pain at same side of the fracture. History Of Presenting Illness She was apparently well until 1 month and 3 days ago when she was involved with an accident during working at a papaya plantation estate. While she was working, she accidentally slipped and fell prone on a dirt road. Unfortunately, at that time a tractor was moving on that road and she was run over by it. The point at which the tyre of the tractor run over her body were at both her calf and also her back. Full blood count was done and the haemoglobin level was 12.1g/dL and total white cell count was 13.33 x109/L which was increased and may be suggesting infection. Imaging of the left femur was done and showing midshaft left femur fracture. Intravenous drip of four pints of normal saline over 24 hours was secured. Skin traction weighing 3kg was done. Laceration wound of the upper lip was managed by referring to dental. Otherwise, he is able to tolerate orally. He was treated with C. Cloxacillin 500mg QID and intramuscular Voltaren 50mg TDS for pain...
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...procedure used in the clinical setting. Often viewed as a safe bedside procedure, there are risks for numerous complications including tracheobronchial insertion, which could lead to deleterious consequences. We present the first case of bilateral pneumothorax caused by the insertion of mal-positioned nasoenteric tube and discuss common pitfalls for diagnostic positioning as well as risk factors that can predispose a patient to improper placement. Case Report: In this case report, we demonstrate a 74-year-old male patient who presents with multiple orthopedic injuries following an auto-pedestrian collision. During his hospital stay, a routine nasoenteric tube was inserted for the purposes of enteral nutrition. Follow up abdominal X-ray revealed the nasoenteric tube misplaced in the left pleural space. After removal of the nasoenteric tube, a follow up chest X-ray revealed bilateral pneumothorax. The patient fell into respiratory distress and subsequent bilateral chest tubes were placed. Over the course of the next three weeks the patient improved, both chest tubes were removed, and the patient made a full recovery....
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...MANAGEMENT OF FRACTURES CASTS A cast is used to immobilize and hold bone fragments during reduction. It is made up of layers of plaster or fiberglass (water-activated polyurethane resin) bandages molded to the body part that it encases. Indications * To apply uniform compression of soft tissues * To permit early mobilization * To correct and prevent deformities * To support and stabilize weak joints Types of Casts 1 Short and long -arm cast for the upper limbs. : Extends from below the elbow to the proximal palmar crease. 2 Gauntlet Cast (thumb spica): from below the elbow to the proximal palmar crease. 3 Short and Long-leg Cast for the lower limbs. 4 Body Cast: Encircles the trunk stabilizing the spine. 5 Spica Cast: Incorporates the trunk and extremity. 6 Shoulder spica: encloses trunk, shoulder, and elbow. 7 Hip spica: encloses trunk and a lower extremity and can be single or double. Single extends from nipple line to include pelvis and one thigh while double includes both thighs and lower legs. 8 Cast-brace: External support about a fracture that is constructed with hinges to permit early motion of joints, early mobilization, and independence. 9 Cylinder Cast: Can be used for upper or lower extremity e.g. fracture or dislocation of knee or elbow dislocation. Complications of Casts * Pressure of cast may cause necrosis, pressure sores, and nerve palsies. * Compartment syndrome * Cast syndrome associated especially of...
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...treating osteoporotic vertebral compression fractures (OVCF) than Bipedicular vertebroplasty. Zhang L et al. BMC Musculoskeletal Disorders, 2015 Take Home Pearl: Unipedicular and bipedicular PVP are safe and effective treatments for OVCF but when compared to bipedicular PVP, unipedicular PVP entails a shorter surgical time and lower X-ray irradiation. Background: Osteoporosis is one of the most common systemic disorders that is characterized by alter bone micro- architecture, low bone mass and increased risk of fragility fracture. The prevalence of osteoporosis is expected to increase by 25 % in 2025. The fragility fractures associated with osteoporosis are mostly the vertebral compression fractures (OVCFs). It affects 25% of the postmenopausal women. It also causes substantial pain and deformity resulting in disability and poor quality of life. The OVCF usually includes treatments such as analgesics, external braces and physical therapies. Many techniques of the vertebral body augmentation is now available in order to treat refractory cases. The percutaneous vertebroplasty (PVP) has gained much attention in past few decades for treating OVCF. The PVP provides a rapid pain relief to the patients that last for longer period especially in large case series and nonrandomized controlled trials. PVP are relatively safe and effective but are associated with complications that includes cement leakage, soft tissue damage, pedicle fracture, nerve injury and spinal epidural hematoma...
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...o Etiology and Classification o Evaluation and Treatment • Infectious Arthritis o Etiology o Clinical Presentation o Laboratory and Imaging Studies o Treatment and Complications Evaluate arthritic and other disorders of: • The hip o Examination and Imaging o Treatment Nonsurgical Surgical • The Knee o Examination and Imaging o Treatment Nonsurgical Surgical • Foot and Toes (pay particular attention to Diabetic foot problems) o Examination and Imaging o Treatment Surgical Nonsurgical Chapter 45- Fractures o After reading this chapter, the reader should be able to: Classify fractures according to pattern/mechanism Evaluate an extremity using the MEISS (mangled extremity severity score) variables (Table 45-2) Evaluate and Classify Open Fractures (Table 45-1) 1 • Omit (Injuries to the Spine) pp. 541-548 Evaluate Clavicle Fractures • Etiology and Classification • Examination Findings and Imaging • Treatment (Surgical and Surgical) Evaluate Upper Extremity Fracture including • Proximal Humus Fractures • Humeral Shaft Fractures • Fractures about the Elbow o Distal Humerus Fractures o Proximal Radius and Ulna Fractures • Fractures of the Forearm Evaluate Fractures of the Lower Extremity • Fractures of the Pelvis and Acetabulum • Fractures of the Hip, Femur and Tibia • Fractures about the Knee and Lower Leg • Fractures of the Foot and Ankle 2...
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... Our view is supported by a retrospective study Jones et al19. They compared the results of 31 fractures managed operatively with 31 fractures conservatively matching age, occupation and gender. They concluded that operative treatment of displaced scapula fractures results in similar healing rates, return to work, pain, and complications as non- operative treatment. There was clear advantage of operative management in displaced glenoid fractures and displaced scapular neck fractures. Only 25% of displaced glenoid fractures managed without surgery had satisfactory results, but the results of operative management were satisfactory in 90.2% of patients. Furthermore, scapular neck fractures which were displaced more than >10mm had satisfactory...
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...What clinical manifestations would you expect to see when assessing this patient? The major risk factors for hip fracture are osteoporosis, cardiovascular and fall in the elderly. The client usually reports a sudden onset of hip pain in the groin, after a fall, and pain radiating to the lateral hip, buttock, or knee. Many clients lose the ability walk, but in some instances the client with a minimally impacted facture may continue to bear weight. If a displaced fracture is present, the client will not be able to bear weight and the leg may be externally rotated and shortened, and because the facture is intracapsular, there will be some bruising (Foster, 2017, p. 1) What would be three nursing management considerations for this patient pre-operatively? Patient should be evaluated prior to surgery A comprehensive history, a detailed physical examination, and a laboratory workup (chemistry, blood count coagulation, and electrocardiogram) are some of the interventions that the nurse has to obtain prior to the patient going to surgery. A general history of the client will help to meet the client's health care needs. The nurse...
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...“Stump the Teacher”: Non-Ossifying Fibromas Shamaya Moore Kaiser Permanente School of ALlied Health Science March 14, 2013 The patient arrived to radiology on August 5, 2012. The patient was a 10 year old hispanic male whom presented to the hospital with pain in his right ankle. Prior to coming into the radiology department he had fallen on a play structure at his school. Immediately after his fall he was brought to the hospital by his parents. As a result the patient was x-rayed on August 5, 2012. An ankle complete series was performed which consisted of an AP, Oblique, and Lateral view. However, due to his age comparison films were also taken of his left ankle which consisted of only an ap and lateral. According to the radiology report from the images obtained the patient was said to have a non-ossifying fibroma in his right distal tibia metaphysis region. The recommendation following his visit from the radiologists was for the patient to be seen again for a followup in six months. On March 1, 2013 the patient returned to the department for his 6 month followup. Since the patient was being seen for a followup on this visit instead of for trauma like his initial visit, only three images were obtained. An AP, Oblique, and Lateral view of only his right ankle. According to the radiology reports from this visit the patient still was said to have a non ossifying fibroma on his right lower leg/ankle. A non-ossifying fibroma is a benign, non-aggressive...
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...would bleed for a few minutes and then stop. The problem is that clots can usually dislodge and cause further bleeding if the patient chews on something hard. Physical trauma that dislodged teeth may also cause severe bleeding. A dentist specializing in emergency cases would attempt to control the bleeding through the application of pressure on the affected area for about fifteen to thirty minutes. They may use a hemostatic agent if the compress is not effective. Suturing the area is the last resort. Another reason to seek an emergency dentist is fractured teeth. Fractures in permanent teeth, especially those that reach all the way into the teeth's inner layers, require immediate treatment to prevent pulpal infection. What the emergency dentist would do is to place dentine padding on the affected part. You need to see a dentist within 24 hours to make sure there are no complications. Post dental surgery complications are also situations that may require urgent care. One such situation is post extraction pain. Some discomfort is normal after an extraction, and it usually fades after a few hours. However, if the condition persists and painkillers do not work, you may need a dentist to check for other problems such as dry socket or a jaw...
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