Friday, 16 June 2017
Saturday, 1 April 2017
Elbow Fractures
Elbow Fractures
Elbow fractures are sustained by a fall on the out-stretched hand, or may be part of a Road-traffic accident. One of the worst kind, are the side-swipe injuries that occur due to an on-coming vehicle swiping at the elbow that is sticking out of the window.
While, the simpler ones that are not displaced, are usually treated with immobilisation in a plaster, the displaced ones usually need internal fixation. The open injuries, with a lot of soft-tissue damage will end up needing the plastic surgeon's input, and sometimes the vascular surgeon, if the there is damage to the blood vessels. These injuries may often be stabilised with external fixators, at least in the initially stages.
Stiffness seems to be an inevitable outcome with elbow injuries, sometimes even with the most trivial ones. So it is important to start mobilisation as early as feasible, to minimise stiffness. It is preferable to avoid passive forcible physiotherapy in these patients.
Elbow fractures are sustained by a fall on the out-stretched hand, or may be part of a Road-traffic accident. One of the worst kind, are the side-swipe injuries that occur due to an on-coming vehicle swiping at the elbow that is sticking out of the window.
While, the simpler ones that are not displaced, are usually treated with immobilisation in a plaster, the displaced ones usually need internal fixation. The open injuries, with a lot of soft-tissue damage will end up needing the plastic surgeon's input, and sometimes the vascular surgeon, if the there is damage to the blood vessels. These injuries may often be stabilised with external fixators, at least in the initially stages.
Stiffness seems to be an inevitable outcome with elbow injuries, sometimes even with the most trivial ones. So it is important to start mobilisation as early as feasible, to minimise stiffness. It is preferable to avoid passive forcible physiotherapy in these patients.
Monday, 27 February 2017
Lisfranc's Fracture Dislocation of the foot
Lisfranc's fracture dislocation is one of the worst injuries that can happen in the foot. The findings are subtle, and is easily missed by the in-experienced, and the recovery can be long and sometimes un-predictable.
Though one needs to have a high index of suspicion in crush injuries of the foot, it can occur with simple trauma too. Seemingly normal x-rays with swelling in the foot, that is out of proportion should also raise the index of suspicion.
What actually happens ?
There are several joints in the foot, but this injury occurs at the Tarso-metatarsal joint complex, involving the metatarsals and the cuneiform+cuboid bones. Of importance here is the Lisfranc ligament, which is considered to be the keystone that confers stability to this joint complex.
The disruption this ligament, leads to instability of bones, needing stabilisation of the joints with surgical fixation.
Initial assessment
After a thorough clinical assessment, radiological assessment involves getting x-rays of both feet, and CT scans. The patient is asked to keep their leg elevated, with regular icing to minimise swelling.
Surgery
It first involves an examination under Anaesthesia, where the different components of the joint complex are stressed to check for stability, under the Image Intensifier (X-ray in the operation theatre). After establishing the instability pattern, appropriate incisions are made, with careful dissection to avoid tissue trauma, to expose the joints, and they are reduced carefully and stabilised with screws. Plates, K-wires or memory staples may also be used. Adequacy of fixation is confirmed with x-rays. The incisions are closed, and dressings applied.
Post-operative period
The leg is elevated to keep the swelling down, with regular icing. The patient is mobilised non-weight bearing for atleast a couple of months. Metal work may have to be removed, before normal mobilisation is initiated.
Thursday, 23 February 2017
Forearm Fractures
Forearm fractures in Adults (information for patient education purposes only, not to be used for diagnostic or treatment purposes)
They usually occur with a fall on a out-stretched hand, but can be part of a poly-trauma, in a road-traffic accident. The two bones of the forearm, called the Raduis and the Ulna, usually break, but sometimes, an isolated bone like just the ulna may have a fracture, in a situation when someone tries to block an assault with a stick - called the night stick fracture.
Both bones fractures in the adults, are best treated with an (operation) open reduction and internal fixation, with plates and screws. Treating them non-operatively can risk mal-union, as it will be difficult to maintain reduction with just plaster. Isolated un-displaced fractures, may warrant non-operative management, with careful observation for displacement.
They usually occur with a fall on a out-stretched hand, but can be part of a poly-trauma, in a road-traffic accident. The two bones of the forearm, called the Raduis and the Ulna, usually break, but sometimes, an isolated bone like just the ulna may have a fracture, in a situation when someone tries to block an assault with a stick - called the night stick fracture.
Both bones fractures in the adults, are best treated with an (operation) open reduction and internal fixation, with plates and screws. Treating them non-operatively can risk mal-union, as it will be difficult to maintain reduction with just plaster. Isolated un-displaced fractures, may warrant non-operative management, with careful observation for displacement.
Monday, 6 February 2017
Wrist Fractures
Wrist Fractures - For general patient education only. Not intended for diagnostic or treatment purposes.
The commonest cause for wrist fractures, is a fall on the out-stretched hand. Of-course, they may also be part of several fractures, in a poly-trauma, as that may occur following a Road Traffic Accident. Commonly the bone involved at the wrist is that of the Radius, with sometimes the Ulna too. The tiny bones called the carpal bones, may be involved too, but un-common.
The Distal end fractures of the radius may be displaced (seperated fractured fragments), or un-displaced. Clinically, the patient will have pain swelling, and sometimes deformity. The treating doctor will assess for other injuries like that of the soft-tissues, blood-vessels and nerves. X-rays will be needed, sometimes ct-scans will add value.
The un-displaced fractures are usually treated with immobilisation of the wrist with plaster application, and careful observation for a couple of weeks to check for displacement. If they remain un-displaced, plaster treatment may continue till upto 6 weeks. After which physiotherapy maybe instituted to treat the ensuing stiffness of the wrist.
The displaced fractures, usually need Manipulation, under some kind of anaesthesia and plaster application, or fixation if they require, for stability. The fixation maybe by K-wires, driven across fracture fragments, by an External-fixator or by open reduction and internal fixation by plates and screws.
Example of Specialised Locking Plates used for wrist fractures.
X-ray of a Volar Plate, for a wrist fracture.
The commonest cause for wrist fractures, is a fall on the out-stretched hand. Of-course, they may also be part of several fractures, in a poly-trauma, as that may occur following a Road Traffic Accident. Commonly the bone involved at the wrist is that of the Radius, with sometimes the Ulna too. The tiny bones called the carpal bones, may be involved too, but un-common.
The Distal end fractures of the radius may be displaced (seperated fractured fragments), or un-displaced. Clinically, the patient will have pain swelling, and sometimes deformity. The treating doctor will assess for other injuries like that of the soft-tissues, blood-vessels and nerves. X-rays will be needed, sometimes ct-scans will add value.
The un-displaced fractures are usually treated with immobilisation of the wrist with plaster application, and careful observation for a couple of weeks to check for displacement. If they remain un-displaced, plaster treatment may continue till upto 6 weeks. After which physiotherapy maybe instituted to treat the ensuing stiffness of the wrist.
The displaced fractures, usually need Manipulation, under some kind of anaesthesia and plaster application, or fixation if they require, for stability. The fixation maybe by K-wires, driven across fracture fragments, by an External-fixator or by open reduction and internal fixation by plates and screws.
Example of Specialised Locking Plates used for wrist fractures. X-ray of a Volar Plate, for a wrist fracture.Saturday, 12 March 2016
Why do Knee Replacements Fail ?
Why do Knee Replacements Fail ? (Revision Knee Replacements)
The commonest reasons why a Replacement might fail are, Polyethylene wear (Plastic), Osteolysis (loss of bone around the implant), aseptic loosening of the implant, loosening due to infection, loss of stability of the implant, Fractures (peri-prosthetic) around the implant and extensor mechanism ( inability to straighten the knee). Often more than one reason may be a cause for the failure.
Ligament laxity, Inappropriate balancing of the knee, are some of the reasons for instability. inattention to sterile techniques. wound problems after the Knee Replacement, poor nutrition of the patient, conditions like Diabetes, Rheumatoid Arthritis and Obesity are some of the risk factors. As for aseptic loosening, cementless implants may fail early due to aseptic loosening than cemented implants, where they fail late. Patellofemoral problems and Arthrofibrosis (stiffness) are some of the reasons, needing revision.
The commonest reasons why a Replacement might fail are, Polyethylene wear (Plastic), Osteolysis (loss of bone around the implant), aseptic loosening of the implant, loosening due to infection, loss of stability of the implant, Fractures (peri-prosthetic) around the implant and extensor mechanism ( inability to straighten the knee). Often more than one reason may be a cause for the failure.
Ligament laxity, Inappropriate balancing of the knee, are some of the reasons for instability. inattention to sterile techniques. wound problems after the Knee Replacement, poor nutrition of the patient, conditions like Diabetes, Rheumatoid Arthritis and Obesity are some of the risk factors. As for aseptic loosening, cementless implants may fail early due to aseptic loosening than cemented implants, where they fail late. Patellofemoral problems and Arthrofibrosis (stiffness) are some of the reasons, needing revision.
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