Orthopedics - Bone or Joint Injury: By Shalini Ramasunder M.D.
Bone injuries fall into three categories: acute traumatic fractures, pathologic fractures, and stress fractures. Keep in mind these 5 things when seeing a patient with an acute traumatic fracture: Determine mechanism of injury, as high-energy injuries require a complete trauma work-up. Open fractures are usually SURGICAL EMERGENCIES due to the high risk of infection if not cleaned thoroughly. If the angle of the fracture is compressing a nearby nerve or blood vessel, urgent reduction is necessary. Check for Compartment Syndrome, which requires emergent fasciotomy to prevent permanent muscle and nerve damage. A fracture in a child, elderly, or mentally disabled patient with a questionable mechanism of injury must be evaluated for Abuse.
If abuse is suspected, it is your obligation to ensure the safety of that patient. Pathologic fractures occur when a disease process has weakened the integrity of the bone and usually require little or no trauma. Most common causes include metastatic carcinomas, multiple myeloma, or osteoporosis. Radiographs may demonstrate a lytic bone lesion at the fracture site. Definite management involves treatment of the underlying condition.
Stress fractures result from overuse or misuse and often require MRI or bone scans for diagnosis. The foot, anterior tibial shaft, or the femoral neck is most commonly affected. A boot or cast, with limited weight bearing, is usually the cornerstone of management. Patients with frequent stress fractures must be evaluated for nutritional deficiencies or, in females, for the Female Athletic Triad. Joint injuries frequently occur from twisting injuries to the knee or ankle, or a fall causing injury or dislocation of the shoulder or elbow. Work-up of joint injuries involves x-rays to rule out fractures and sometimes MRI to assess for extent of injury and monitor treatment progress.
Lower extremity joint injuries usually require a period of limited weight bearing and immobilization of the joint. Dislocation of the shoulder or elbow requires urgent reduction and immobilization. Tears in the shoulder joint or instability after an elbow dislocation may require surgical repair or fixation.
Bone injuries fall into three categories: acute traumatic fractures, pathologic fractures, and stress fractures. Keep in mind these 5 things when seeing a patient with an acute traumatic…By: Medskl.com
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