Xray of Flexion Type Supracondylar Fracture

Supracondylar factures are very common fractures of children. Most of these are extension type injuries where the distal fragment  of the fracture goes into extension as compared to proximal part. This type of injury constitutes about 95% of the injury. Other 5%  is type where the distal fragment goes into flexion.

Following xrays are of  a seven year old male child who suffered flexion type of supracondylar injury to his right humerus

Note that in lateral view the distal fragment has moved volar as compared to proximal fragment. [Read more]

What Is A Neurogenic Shock?

Neurogenic shock is a type of shock caused by the sudden loss of the autonomic nervous system signals to the smooth muscle in vessel walls.

This results in loss of background sympathetic stimulation, which is responsible for maintenence of tone of blood vessels. As a result of loss of vascular tone, the vessels suddenly relax resulting in a sudden decrease in peripheral vascular resistance and decreased blood pressure. [Read more]

Total Knee Replacements In Elderly Increases Mobility and Motor Skills

Duke researches have found that total knee arthroplasty has a positive impact on qualityof life and maintainence of maintenence of independent lifestyles

The surgery was performed for osteoarthritis of the knee. Not only the surgery improved physical functioning but also the motor skills when compared to patients who do not receive TKA.

2272 patients diagnosed with osteoarthritis of the knee were included in the study, , 516 underwent replacement procedures and 1756 did not. The groups were matched on baseline functional status, other health conditions, socioeconomic characteristics, and time before TKA or diagnosis.

Among the patients who underwent TKA, baseline physical functioning measures were taken at an interview before and closest to surgery. For the comparison group, these measures were taken from an interview preceding and closest in time to the year of their first diagnosis with osteoarthritis. [Read more]

Radiograph Fracture of Both Bones of forearm

Fractures of forearm bones are very common in paediatric and young age group. While in children they are amenable to closed reduction and plaster application, in adults they almost always require surgical treatment.

The image belongs to a 40 years old man who sustained trauma to left forearm when his motor bike collided with another vehicle. The man also had fracture of pubic ramus along with this injury.

The patient was operated for his forearm injury and fracture pubic ramus was manged conservatively.

A noteworthy finding in this patient is that both the bones have been injured at the same level.

What Is ASIA Impairment Scale

The ASIA impairment scale describes a person’s functional impairment as a result of their spinal cord injury.

A- Complete

No motor or sensory function in the lowest sacral segment (S4-S5)

B- Incomplete

Sensory function below neurologic level and in S4-S5, no motor function below neurologic level

C- Incomplete

Motor function is preserved below neurologic level and more than half of the key muscle groups below neurologic level have a muscle grade less than 3. [Read more]

What Are Grades Of Muscle Power

muscle power testing is frequent and important part of nweurological examination. Here are the grades of muscle power as examined clinically

Grade 0- complete paralysis

Grade 1 -flicker of contraction present

Grade 2- active movement with gravity eliminated

Grade 3-Active movement against gravity

Grade 4-Active movement against gravity and some resistance described as poor, fair, moderate strength.

Grade 5- Normal power.

Deformities In Colles Fracture

This fracture was first defined by Abraham Colles.

The term Colles’ fracture is classically used to describe a fracture at the distal end of the radius, at its cortico-cancellous junction.

Classical Colles fractures have the following characteristics

• Transverse fracture of the radius
• One  inch (2.5 cm) proximal to the radio-carpal joint
• Dorsally displaced and dorsally angulated

[Read more]

Clinical Photographs of Polydactyly - Extra Thumb

Presence of extra digit is called polydactyly.

The photograph shows an extra thumb.

The image belongs to 16 years old female who had presented with desire of getting extra thumb removed. Though the disorder is mostly congeital, in India it is a common phenomenon to get them removed when children grow up especially females. Social fators are responsible for this delay.

Parents want the deformity or extra digit removed  when the child gets near marriage age.

The extra thumb was successfully removed by surgery and the patient has been followed for six months.

Patient has got absolutely normal function of the hand.

Care of Injured Spine At Site of Accident

It must be kept into the mind that all trauma patients are at risk for spinal injury. The principle of spinal care in all trauma patient is based on the possibility that all trauma patients may have an unstable spine injury definitively excluded.

In any trauma setting the treatment  priorities are preserving life, limb, and function. The spine must be protected as these priorities are addressed.

Extrication

Proper extrication of the patient and immobilization of the cervical spine at the accident scene are critical to avoid further neurologic injury. The neck movements are to be avoided when  taking out the person out of the car or shifting the person. For this, the head and neck need to be aligned with the long axis of the trunk and immobilized in this position.

Immobilization and Transport

The cervical spine needs to be immobilized to prevent further movements that can cause damage to the spinal cord. Immobilization with cervical collar, sandbags, tape, and spine board is superior to immobilization with a collar alone. For field transportation of injured patients, a scoop stretcher is is a very good adjunct.  the spine is usually kept in neutral position irrespective of type of injury.

eutral flexion-extension head and neck alignment is optimal during prehospital transport of cervical spine injury patients . To maintain neutral head-neck alignment. in children, the relatively larger head of should be accommodated by elevating the trunk on padding or using a special pediatric spine board.

Helmet and shoulder gear should be left in position until personnel trained in safe removal techniques are available.

Preliminary Neurological Assessment

Determination of gross neurologic status in the field helps prioritize subsequent treatment interventions.

Following points can help in localising the injur

• Observations of the patient’s spontaneous physical movements and function
• Ask patient about site of pain
• Eliciting symptoms /signs

Communication

Suspicion of neurologic injury should be conveyed to the hospital to prepare for subsequent evaluation and management.

Clinical Photograph of Stage IV Sacral Bed Sore in A Patient Of Cervical Spine Injury

Bed sores or pressure ulcers are a very common complication of spinal injury resulting in sensory loss. Bony prominences like trochanters and sacral area are very prone to developing bed sores in patient who are in lying position. Poor nutrition of the skin and old age further aggravates the problem.

This is a photograph of back of a 32 years old male who suffered cervical spine injury after a fall from moving vehicle. Injured levels were C5 and C6 vertebrae. The injury resulted in transaction of the spinal cord. Patient had quadriplegia and sensory loss below C6 spinal segment distribution.

Patient was managed with fixation of  injured vertebrae and was put on wheel chair mobilisation. He developed a sacral bed sore too that progressed to Stage IV i.e become bone deep.

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