Pressure epiphyses c

Metaphyseal side of the plate is nourished by vessels from the shaft (M). In the tibia (I) the epiphysis is supplied by extra-articular vessels. Vessels to the femoral head (2) lie close to the joint space and epiphyseal plate (P). There is a variable (up to 25 ) contribution from the ligamentum teres. Epiphyseal displacements may lead to avascular necrosis or growth arrest. The head of radius is similarly at risk. C capsule. A articular cartilage. 74. Pressure epiphyses (a) Pressure epiphyses...

Info

The coma score E+M+V. with a value of 3 being the worst possible response and IS the best. A value of less than 7 indicates severe coma. 8-12 moderate and 13-14 mild. Severe injuries are infrequent, and most patients who develop haemalomas requiring surgery arc classified as moderate or minor on admission. inflatable splint in such a position that the distal circulation is maintained, or the use of light temporary plaster splintage. 2. Where there is a head injury in which the immediate...

The Treatment Of Fractures Primary Aims

The primary aims of fracture treatment are 1. The attainment of sound bony union without deformity. 2. The restoration of function, so that the patient is able to resume their former occupation and pursue any athletic or social activity they wish. To this might be added 'as quickly as possible' and 'without risk of any complications, whether early or late'. These aims cannot always be achieved, and in some situations are mutually exclusive. For example, internal fixation of some fractures may...

Compression or crush fractures

Crush fractures occur in cancellous bone which is compressed beyond the limits of tolerance. Common sites are (I) the vertebral bodies (as a result of llexion injuries) and (2) the heels (following falls from a height). If the deformity is accepted, union is invariably rapid. In the spine, if correction is attempted, recurrence is almost inevitable. 30. Avulsion fractures (a) An avulsion fracture may be produced by a sudden muscle contraction, the muscle pulling off the portion of bone to which...

Fractures open from without in

(a) This lype of injury is causcd by direct violence, the causal force breaks the skin and fractures the underlying bone. Causes include injuries from falling objects (e.g. in the construction industry, mining, rock falls in mountaineering, etc.) and motor vehicle impacts. 56. Open from without in (b) The risks of infection are greater in this type of open fracture as (I) dirt and fragments of clothing, etc. may be driven into the wound. (2) the skin is often badly damaged skin may even be...

I

Localised views Where there is marked local tenderness but routine films are normal, coned-down localised views may give sufficient gain in detail to reveal a hairline fracture. If such films are also negative, the radiographs should be repeated after an interval of 10-14 days if the symptoms are persisting (see also Hairline Fractures p. 6). 18. Stress films (a) Stress films can he ol value in certain situations, e.g. when a complete tear of a major ligament is suspected. Where the lateral...

Classification of open fractures

The AO Group use separate classifications for closed and open skin injuries and for injuries to muscle they employ a separate fourth classification for nerve and vascular injuries. The classification is more complex and is given here for completeness Skin lesions in closed fractures (Integuments. Closed) IC4 Extensive (but closed degloving IC5 Skin necrosis resulting from contusion Skin lesions in open fractures (Integuments. Open) IOI Skin broken from within out l()2 Skin broken from without...

Suspected Child Abuse

The possibility of child abuse should always be kept in mind, especially in dealing with injuries sustained by children under (he age of 3 years (80 of cases lie within this age group). The other factors which might alert you include the following 1. The presence of a fracture with no history of injury, or a vague history which is not in keeping with the nature or the extent of the injury. 2. The presence of multiple fractures or other injuries, especially when these are at different stages of...

Treatment Of The Fracture

Undue movement at the fracture site should he prevented by the use of temporary splintage until radiographic and any other examination is complete. This will reduce pain and haemorrhage and minimise the chances of a closed fracture becoming open. In the case of the lower limb, support with pillows and sandbags may be adequate. In both the upper and the lower limbs inflatable splints arc invaluable. 2. If the deformity is so great that the fracture or dislocation is seriously endangering the...

Persisting Circulatory Impairment

Where rapid, appropriate transfusion fails to control the situation, the commonest cause is continued bleeding. In most cases the site is obvious. 1. External haemorrhage accompanying limb injuries should be readily controlled if this has not already been done. 2. Continuing blood loss from intrathoracic injuries should be obvious. Assuming that a haemothorax has been diagnosed and treated by the insertion of a chest drain, the quantity and rate of loss may be evaluated by monitoring the...

Multifragmental fractures are

Generally the result of greater violence than is the case with most simple fractures, and consequently there is an increased risk of damage to neighbouring muscle, blood vessels and skin (I). The fractures tend to he unstable, and delayed union and joint stiffness are common. Segmental fractures are often difficult to reduce by closed methods, anil direct exposure may threaten the precarious blixid supply to the central segment. Non-union at one level is not uncommon in these fractures (2). 31....

Green Stick Fracture Treatment

Elastic Fracture

Fracture patterns and their significance Hairline fractures (a) Hairline fractures result from minimal trauma, i.e. trauma which is just great enough lo produce a fracture but not severe enough to produce any significant displacement or (he fragments. Such fractures may he (I) incomplete or (2) complete. 14. Hairline fractures (b) These fractures may be difficult to detect on the radiographs, and where there arc reasonable clinical grounds for suspecting a fracture, the rides are quite...

Diagnostic Pitfalls

A number of fractures are missed with great regularity - sometimes with serious consequences. You should always be on the look-out for the following 1. An elderly patient who is unable to weight bear after a fall must be examined most carefully. The commonest cause by far is a fracture of the femoral neck, and this must be eliminated in every case. If the femoral neck is intact, look for a fracture of the pubic rami. Note that, on the rare occasion, a patient with an impacted fracture of the...

Femur Posterior Angulation

Delay Union Fracture

Describing the deformity If there is no deformity, i.e. il'lhe violence which has produced the fracture has been insufficient to cause any movement of the bone ends relative to one another, then the fracture is said to be in anatomical position. Similarly, if a perfect position has been achieved after manipulation of a fracture, it may be described as being in anatomical position. 41. Displacement (a) Displacement (or translation) is present if the bone ends have shifted relative to one...

L History

In taking the history of a patient who may have a fracture, the following points may prove to be helpful, especially when there has been a traumatic incident. 1. What activity was being pursued at the time of the incident (e.g. taking part in a sport, driving a car, working at a height, etc.) 2. What was the nature of the incident (e.g. a kick, a fall, a twisting injury, etc.) 3. What was the magnitude of the applied forces For example, if a patient was injured in a fall, it is helpful to know...

Further Assessment

Screening films At an early stage in the assessment of a patient with multiple injuries, screening films of the cervical spine, chest and pelvis should be obtained. Where there is the possibility of an abdominal injury with intra-abdominal haemorrhage an ultrasound examination should be carried out. If the circumstances dictate and allow, the opportunity may be taken at this stage to arrange an X-ray examination of any limb injury, or any injury to the skull or facial bones. Fluid replacement...

Open fractures internal fixation

Tetanus Treatment Image

When Ihe case first presents, ensure that the following procedures are carried out in every case (I) Take a bacteriology swab from the wound. (2) Commence a short course of appropriate antibiotics (see p. SO). (.1) Cover ihe wound with care, using sterile dressings (to reduce the risks of secondary (hospital) infection). (4) Apply temporary splintage (e.g. a plaster back shell or, if appropriate, an inflatable splint). 4. Type I cntd Carry out a thorough (preferably pulsatile) wound lavage. Up...

Fixation Devices And Systems

Internal External Fixation Device

Fractures vary enormously in pattern bones vary in their size, texture and strength. To cope with even the most common situations and be a match for every subtle variation of circumstance requires an impressive range of devices and instruments for their insertion. The design of fixation devices has in the past been somewhat haphazard, and aimed at the treatment either of one fracture or the solution of a single fixation problem. There have been attempts to produce integrated systems of fracture...

Closed reduction and casting techniques in fracture management

Fracture Plaster Techniques

Closed reduction of fractures Basic techniques a The direction and magnitude of the causal force I and the deformity 2 are related, and may be worked out from the history, the appearance of the limb and the radiographs. Any force required to correct the displacement of a fracture is applied in the opposite direction 3 . 4. Basic techniques d In some fractures there may be difficulty in reduction due to prominent bony spikes or soft tissue interposition. Reduction may sometimes be achieved by...

Factors Affecting The Rate Of Healing Of A Fracture

Fracture Remodeling Images

Cancellous bone spongy bone Healing in cancellous bone is generally well advanced 6 weeks from he time of the injury, and protection of the fracture can almost invariably be abandoned by that time. This applies to fractures of bones which are composed principally of cancellous issue, and also to fractures involving the cancellous bone to be found at the ends of long bones. This rule is illustrated in the following examples 1. Weight bearing after a fracture of the calcaneus may be permitted...

Protection of the skin Stockinet A

Treatment Undisplaced Metacarpal

Layer of stockinet is usually applied next to the skin 11 . This has several functions it helps prevent the limb hairs becoming caught in the plaster it facilitates the conduction of perspiration from the limb it removes any roughness caused by the ends of the plaster and it may aid in the subsequent removal of the plaster. After the plaster has been applied, the stockinet is turned back 2 . 8. Stockinet cntd Alter the stockinet has been reflected, excess is removed, leaving 3-4 cm only at each...

Plaster bandage application d

Applying Roller Bandages Hand And Arm

Where possible, the assistant should hold the limb in such a way hat the surgeon has a clear run while applying the plaster I . Where support must be given to a part included in the plaster, the fiats of the hands should be used, and the hands eased proximally and distally to avoid local indentation. Where slabs are used, try to let gravity assist rather than hinder 2 . 37. Removal of rings a Wherever possible rings should be removed in ease linger swelling leads to distal gangrene. A tight...

Instructions for Patients in Plaster of Paiis Splints

Backslab Colles Fracture

A. 1 II linger or toes become swollen 21 If no improvement in half an hour call in Doctor or return to hospital immediately. B. ii lixercisc all joints not included in plaster especially fingers and toes 2 If you hnve been fitted with a 3 If plaster becomes loose or cracked report to hospital as soon as possible. 46. The patient who is being allowed home must be given clear warnings to return should the circulation appear in any way to be impaired. Inform the patient or. where appropriate, a...

Epiphyseal plate injuries

Lateral Malleolus Fracture Treatment

Type I The whole epiphysis is separated Type 2 The epiphysis is displaced, carrying with it a small, triangular metaphyseal fragment the commonest injury . Type 3 Separation of part of the epiphysis. Type 4 Separation of part of the epiphysis, with a metaphyseal fragment. Type 5 Crashing of part or all of the epiphysis. 78. Type 1 injuries a The epiphysis is separated from the shall without any accompanying fracture. I'llis may follow trauma in childhood illustrated is a traumatic displacement...

Complications Of Prolonged Recumbency

Deep venous thrombosis and pulmonary embolism. 4. Muscle wasting and stiffening of joints, making subsequent mobilisation more difficult and prolonged. 5. Skeletal decalcification and the formation of urinary tract calculi. 7. Neurological complications such as i Common peroneal nerve palsy. This sometimes results from a less than ideal posture of the leg when external rotation leads to pressure in the region of the fibular neck, or it sometimes occurs from pressure against a splint, ii...