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Pelvic Fractures In Elderly Persons

May 6, 2008 By

Increasing number of aged people is having a profound impact on pelvic fracture management. As the number of elderly people increases, so would be old patients with increasing number of injuries.

Pelvic trauma in young individuals occur due to severe trauma in young individuals. However, the elderly people can get fractures with minor trauma due to weakened skeletal framework as a result of osteoporosis.The elderly experience higher mortality and late morbidity than younger patients with comparable injuries. [Read more...]

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Urethral and OtherVisceral Injuries With Pelvic Trauma

May 6, 2008 By Leave a Comment

Visceral injuries are a potential source of life-threatening complications in a pelvic fracture. Injury to the lower urinary tract is a common consequence of a disruption of the anterior pelvic ring, and it can involve the ureter or, more commonly, the bladder and urethra.

Urogenital system injury (injury to urethra, bladder, kidney) occurs in as many as 25% of all cases involving disruption of the pelvic ring.

It is more common with bilateral pubic arch injury. Potential sites of visceral injury with a pelvic fracture. other potential sites of injury are

  • Large and small Intenstines
  • Bladder and urethra
  • Vagina
  • Rectum
  • Other intraabdominal structures

[Read more...]

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Open Pelvic Fractures

May 5, 2008 By 2 Comments

Open pelvic trauma has been associated with high mortality in the past. Recent studies have suggested that mortality is similar to to the closed injuries. Pelvis fracture is an emergency situation itself. If associated with open wounds, there is considerable danger of bleeding to death if immediate medical services are not available.

Open fracture can result from the wound due to external force or the broken bone cutting the skin from inside out.

The principal sites for the open fracture and associated wounds are:

Rami: Perineal laceration, Urethra or bladder injury
Sarcum: Presacral laceration, rectal laceration
Ilium: Blunt trauma, missile, small bowel laceration [Read more...]

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Pelvic Fractures-Associated Blood Loss and Therapeutic Intervention

May 5, 2008 By Leave a Comment

At the time of a traumatically induced pelvic fracture, some degree of hemorrhage is inevitable. The principal sites of bleeding are outlined. The anticipated sites of major hemorrhage correlate with the region of the pelvis fracture, the vector of the provocative blow, and the magnitude of pelvic displacement.

For example, a displaced fracture of the posterior ilium that exists through the roof of the greater sciatic notch is likely to be associated with an injury to the superior gluteal vessels. [Read more...]

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Fracture Pelvis-Mechanisms of Injury

May 4, 2008 By Leave a Comment

Patterns of fractures and dislocations of the pelvis are characterized by the force of blow, magnitude, and nature of adjacent soft-tissue disruption and the quality of the involved tissue. Depending on the intensity of the trauma there are different types of fracture pattern that might result.

Major Trauma

Depending on the vector and magnitude of the provocative blow, specific injury patterns are likely to ensue that involve diverse supportive elements of the pelvic ring. The injury patterns are may be

  • The external rotation injuries or lateral compression injury
  • Crushing injury.

Fall of a log over pelvis results in compression fractures.

Source of Violent or Major Trauma to the Pelvis are [Read more...]

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Displaced Fractures of the Pelvic Ring-An Overview

May 3, 2008 By Leave a Comment

Displaced fractures of the pelvic ring constitute a diverse group of skeletal injuries that usually result from motor-vehicle accidents, industrial trauma, sporting events, or falls from great heights.

The typical pelvic ring disruption is notable for the immense amount of force needed to provoke a displacement of the pelvic ring.

A patient who sustains such an injury is likely to present with other serious or life-threatening injuries involving the musculoskeletal, respiratory, central nervous, gastrointestinal, urologic, and cardiovascular systems.

The management of a pelvic ring fracture, requires concomitant diagnosis and treatment of the other systemic and musculoskeletal injuries. [Read more...]

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Posture and Postural Defects In Children

May 3, 2008 By 1 Comment

Posture can be defined as the relationship of the parts of the body to the line of the center of gravity. The posture is a gauge of mechanical efficiency of the neuromusculoskeletal system in the erect position.

Development of Posture

In the uterus the fetus is almost invariably in a position of flexion, with the convex curve of the spine lying against the curve of the uterine wall. The head, arms, and legs of the fetus are flexed on the torso.

The entire fetus lies suspended in the amniotic fluid, which has a specific gravity similar to that of the fetus. Following birth the development of posture is affected by constant forces exerted by gravity.

The newborn holds his shoulders, elbows, hips, and knees in flexion, with his limbs slightly bowed and rotated inward. Fifteen to thirty degrees of flexion contracture of the knee is a normal physical finding. [Read more...]

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General Principles of Tendon Transfer

May 2, 2008 By Leave a Comment

Tendon transfers are used  to replace deficient motor units and to restore function. Functional loss may occur secondary to tendon rupture, peripheral nerve injury, brachial plexopathy, stroke, or other problems.

Tendon ruptures secondary to inflammatory arthritis have been discussed in an earlier section. This section will focus on tendon transfers used in restoring hand and wrist function or balancing deformity.

The functional tendon to be transferred is transected then transferred to another tendon or bone to restore function. The neurovascular supply of the donor unit is preserved, in contrast to a free tendon graft which functions primarily as a spacer or connection. [Read more...]

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Bursae At The Knee

May 2, 2008 By 2 Comments

Numerous bursae occur in the vicinity of the knee joint, in relation to the attachments of the various muscles and ligaments. Anteriorly there are the suprapatellar and the pre-patellar bursae, a small subcutaneous bursa sometimes present in front of the tibial tuberosity, the infrapatellar bursa, and the deep infrapatellar bursa between the proximal extremity of the tibia and the deep surface of the ligamentum patellae. [Read more...]

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Trigger Thumb

May 1, 2008 By Leave a Comment

Trigger thumb or stenosing tendovaginitis of the flexor pollicis longus, is a relatively rare deformity in which the fibrous tendon sheath is thickened and constricted.

There is a palpable nodule on the volar aspect of the thumb in the region of the metacarpo-phalangeal joint.

The incongruity of the tendon’s surface interferes with its normal gliding within its sheath. Snapping or triggering results from the blockage of the tendon prominence against the constricted sheath and the sudden release following application of passive force and passage past the obstruction.

In most cases the thumb is locked in flexion, but occasionally it may be locked in extension. The nodule is not painful. The infant or child has no complaints. It is the infant or child has no complaints. It is the concern of the parents that brings the patient to the surgeon. [Read more...]

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