Professional Documents
Culture Documents
By Eman A. Salem
History
Usually includes a history of injury; Followed by inability to use the joint Fracture is not always at the sight of injury. ptn age and mech. Of injury are important Trivial truma path. Fracture Pain, bruising, and swelling are common symptoms.
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Fracture VS. Soft tissue injury Deformity more suggestive of a FX. Green stick FX. and elderly with impacted FX. of femoral neck may experience little or no pain, or loss of function. Enquire about sympt. of associated injury: numbness, loss of movement, skin pallor, cyanosis, blood in urine, abdominal pain, difficulty with breathing and transient loss of consciousness.
History cont.
Ask about previous or other musculoskeletal abnormality Finally take general medical history.
Examination
Unless purely local injury priority must be given to deal with the general effects of truma In any case X-ray diagnosis is more reliable 1. Examine the most obviously injured part 2. Check for arterial damage 3. Test for nerve injury 4. Look for injury in distant parts
Look for
Swelling Bruising Deformity If skin is intact or not (open VS simple) Posture of distal extremities and color of the skin signs of nerve or vessel damage
Feel
Palpate for localized tenderness In high energy injuries, always examine spin and pelvis Vascular and peripheral nerve abnormalities should be tested for both before and after treatment
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Move
Crepitus and abnormal movement tested only in unconscious patients Ask if patient can move the joint distal to the injury
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Imaging
X-ray is mandatory
Rule of twos:
1.
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4. Two occasions
some fractures are difficult to detect soon after injury, another X-ray a week or two latter may show the lesion. example Undisplaced frx. of distal end of clavicle
CT and MRI
display Frx. patterns in difficult sites such as vertebral column and acetabulum, and calcaneum
Secondary injuries should always be assumed to have occurred unless proven other wise
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1.Thoracic injury:
lung or heart.
neurological ex. Is essential to check for spinal cord or nerve root injury and to obtain a base line for latter comparison
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Signs of healing
1. Absences of pain during daily activities 2. Absences of tenderness at Frx. site 3. Absences of pain on stressing the Frx. 4. Absences of mobility at Frx. Site 5. X-ray signs of callus formation, bone bridging, and finally trabeculation
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Fractures in children
1.
2.
Children bones are less brittle and more liable to plastic deformation. Higher incidence of incomplete fx.
Buckling of the cortex and the green stick frx. are rare in adults.
3.
4. 5. 6.
Periosteum is thicker than adult bones thats why frx. displacement is more controlled. Cellular
activity is increased (frx. heals faster).
Injury to the physis damage to growth plate can have serious consequences.
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Type 3: frx. partly along the physis and then veering off through the epiphysis into the joint space. It damages the reproductive zone and results in growth disturbance. Type 4: frx. splits the epiphysis but continues through the physis into metaphysis. Partly liable to displacement and consequent misfit between separated parts of the physis and results in asymmetrical growth. Type 5: a longitudinal compression injury of the physis. No visible fx., growth plate is crushed causing growth arrest.
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Physeal frx. falls and traction injury. Mostly in RTA and during sports or playground activities. Boys > Girls Any injury in child followed by pain and tenderness near the joint should arouse suspicion. X-ray is essential.
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X-ray: physeal frx. are difficult to diagnose in younger children. Compare X-ray with the normal side. A 2nd X-ray after 4-5 days is essential.
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Thank You
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