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Radiograph Fracture of Both Bones of forearm

June 30, 2009 By Dr Arun Pal Singh Leave a Comment

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.

Fractures of Proximal Thirds Of Radius and Ulna

Fractures of Proximal Thirds Of Radius and Ulna

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

Popularity: 5% [?]

Filed Under: Forearm Fractures, Musculoskeletal Radiology, Orthopaedic Images Tagged With: forearm bones fracture, xray of radius and ulna fracture

What Is ASIA Impairment Scale

June 29, 2009 By Dr Arun Pal Singh Leave a Comment

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...]

Popularity: 1% [?]

Filed Under: Spine Injuries Tagged With: ASIA impairment scale, spinal cord injury

What Are Grades Of Muscle Power

June 28, 2009 By Dr Arun Pal Singh 1 Comment

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.

Popularity: 3% [?]

Filed Under: Spine Tagged With: muscle power grading, newural examination

Deformities In Colles Fracture

June 26, 2009 By Dr Arun Pal Singh Leave a Comment

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...]

Popularity: 12% [?]

Filed Under: Wrist Injuries Tagged With: Colles fracture, fracture of distal end of radius, wrist fractures

Clinical Photographs of Polydactyly – Extra Thumb

June 24, 2009 By Dr Arun Pal Singh 2 Comments

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.

Polydactyly Dorsal view

polydactyly Volar View

polydactyly Volar View

Popularity: 10% [?]

Filed Under: Orthopaedic Images Tagged With: Extra Thumb, Photographs of Polydactyly

Care of Injured Spine At Site of Accident

June 23, 2009 By Dr Arun Pal Singh Leave a Comment

stretcherIt 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.

Popularity: 1% [?]

Filed Under: Spine Injuries Tagged With: accident, field care of spine injury, spinal injury, spine care, spine injury

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

June 20, 2009 By Dr Arun Pal Singh Leave a Comment

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.

A Sacral Bed Sore
A Sacral Bed Sore.

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.

Popularity: 11% [?]

Filed Under: Orthopaedic Images, Spine Injuries Tagged With: bed sore, bed sores, decubitus ulcers, grade IV sacral bed sore, pressure ulcers

What Are Stages of Pressure Ulcers?

June 19, 2009 By Dr Arun Pal Singh Leave a Comment

A pressure ulcer is localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear and/or friction.

Stages of  Pressure Ulcer

Stage I

Intact skin with non-blanchable redness of a localized area usually over a bony prominence. Darkly pigmented skin may not have visible blanching; its color may differ from the surrounding area.

The area may be painful, firm, soft, warmer or cooler as compared to adjacent tissue. Stage I may be difficult to detect in individuals with dark skin tones. It may  indicate a person who is at  risk [Read more...]

Popularity: 2% [?]

Filed Under: Wound Healing Tagged With: bed sore, decubitus ulcer, pressure ulcer, stages of pressure ulcer

Transcutaneous electrical nerve stimulation-TENS

June 18, 2009 By Dr Arun Pal Singh 1 Comment
TENS Unit - Credit Wikipedia

TENS Unit - Credit Wikipedia

Transcutaneous electrical nerve stimulation (TENS) is in essence application of electric current for control of pain. It involves a principle wherein the sensory myelinated fibres are stimulated without discomfort to the patient and without muscle contraction. TENS is a non-invasive, very safe method to reduce pain, both acute and chronic. While ther eare conflicting views on its efficacy, its effectiveness for postoperative pain, osteoarthritis, and chronic musculoskeletal pain has been confirmed by systemic reviews.

How Does TENS Act?

The  stimulation activates local inhibitory circuits within the dorsal horn of spinal cord. These inhibitory circuits reduce the transmission of painful impulse through the spinal cord.

This stimulation is done by a frequency of 70 Hz, patients feel comfortable at this level of stimulation. TENS equipment has a frequency of 1 to 100 Hz. When stimulated at high frequency of 70 Hz, the pain relief is shorter and of fast onset. [Read more...]

Popularity: 3% [?]

Filed Under: Physiotherapy Tagged With: pain, sensory myelinated fibres, spinal cord, tens, transcutaneous electrical nerve stimulation

Few Terms Used In Spinal Injury

June 17, 2009 By Dr Arun Pal Singh Leave a Comment

Impairment

Loss of motor and sensory function

Disability

Loss in daily life functioning

Tetraplegia or Quadriplegia

Loss of motor and/or sensory function in the cervical segments

Paraplegia

Loss of motor and/or sensory function in the thoracic, lumbar, or sacral segments [Read more...]

Popularity: 1% [?]

Filed Under: Spine Injuries Tagged With: Complete injury, Dermatome, Disability, Impairment, Incomplete injury, Motor levelSkeletal level, Motor score, Myotome, Neurologic level Sensory level, paraplegia, Sensory score, Tetraplegia, Zone of partial preservation
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