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Spinal Injuries – Initial Evaluation

July 27, 2009 By 2 Comments

Spine and spinal cord are vital and complex organs. therefore there initial evaluation is also complex and involves a multitude of signs and tests. Spinal examination cannot be straightforward examination. Rather it needs to be modified as more information about the patient becomes available.

Each subsequent event in the patient’s evaluation is influenced by the findings of the initial evaluation, both for diagnosis and management of the spinal injury and for management of other potential injuries.

Severe injuries require continuous or serial examinations to monitor and diagnose conditions because some conditions may not readily apparent early. [Read more...]

Filed Under: Spine Injuries, Trauma Tagged With: , , , ,

Cast Syndrome or Superior Mesenteric Artery Syndrome

June 15, 2009 By Leave a Comment

scoliosis-jacketsCast syndrome is an uncommon complication in the treatment of orthopaedic conditions. It results from obstruction of third portion of the duodenum by superior mesenteric artery leading to high intestinal obstruction. It should be kept in mind that this obstruction can occur in absence of plaster also because there are many causes to mesentric artery obstruction.

Most cases involve young adults with more than half of these cases have patients with scoliosis or kyphosis or treatment of hip condtions.  It has been seen after casting with body jackets, shoulder spicas, and hip spicas where the common denominator is exten¬sive coverage of the abdomen and chest.

The problem usually is located at the junction of the third and fourth parts of the duodenum, where the duodenum is bound by the ligament of Treitz. The duodenum passes across the anterior aspect of the lumbar spine from right to left at the level of the first and second lumbar vertebrae. Just above this point, the superior mesenteric artery arises from the abdominal aorta and passes downward with its ac¬companying veins in the mesentery. [Read more...]

Filed Under: Plaster Techniques, Spine, Trauma Tagged With: , , ,

Soft Tissue Bleeding In Hemophilia

August 5, 2008 By Leave a Comment

Soft tissue bleeding is common in hemophila. Following a direct injury, a large hematoma may accumulate in the subcutaneous tissues. This generally is resorbed spontaneously occasionally ulceration occurs, commonly on the forehead, the olecranon process, or the prepatellar area.

Superficial soft-tissue hemorrhage in the form of ecchymosis is common in the severe hemophiliac. It is of no clinical significance.

Intramuscular and Intermuscular Hemorrhage

Quadriceps is most common site of bleeding in lower limb. Other comon sites are triceps surae,adductors of the thigh, hamstrings , and sartorius.

In the upper limb the most common site of bleeding is deltoid, followed by wrist and finger flexors in the forearm, brachio-radialis, biceps, wrist and finger extensors in the forearm, and triceps.

The presenting complaint is pain on movement or at rest. [Read more...]

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Common Complications Associated With Trauma

April 9, 2008 By Leave a Comment

From the orthopedist’s viewpoint, the major complications associated with trauma are acute respiratory distress syndrome (Fat embolism syndrome), multisystem organ failure, thromboembolic disease, atelectasis, compartment syndrome, sepsis, and ectopic bone formation.

The first four disorders involve pulmonary complications and must constantly be kept in mind in managing the polytrauma patient. The institution of early fixation of fractures with concomitant mobilization of patient has helped to reduce the incidence of these four conditions significantly. They continue to be problems, however, and constant vigilance is necessary to prevent serious consequences.

A. Acute Respiratory Distress Syndrome

Acute respiratory distress syndrome (ARDS) can be a sequelae of trauma with subsequent shock. Massive tissue injury releases inflammatory mediators, with subsequent disruption of the microvasculature of the pulmonary system.

Pulmonary edema results, with decreased partial pressures of oxygen and arterial oxygen saturation and increased carbon dioxide levels. The onset is frequently within 24 h after trauma and is revealed by hypoxemia, inflammatory reaction, and progressive decrease in arterial oxygen saturation if appropriate treatment is not instituted. [Read more...]

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Seat Belt Use by Pregnant Women Could Save 200 Fetuses a Year

April 4, 2008 By Leave a Comment

Pregnant women should wear seat belts, not only to save themselves in the event of a car accident but also to save their fetus.

According to a new study published in the April issue of the American Journal of Obstetrics & Gynecology, almost 200 fetuses each year or half of all fetal losses in motor-vehicle crashes could be saved if pregnant women buckled up properly.

Dr. Richard Jones, assistant professor of obstetrics/gynecology at Texas A&M Health Science Center College of Medicine, said, “Pregnant women need to be properly wearing seat belts,” with the best type of seat belt the three-point restraint. [Read more...]

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Whiplash Injury of Cervical Spine

April 4, 2008 By 3 Comments

The anatomic characteristics of the cervical spine predispose it to injury by direct as well as indirect forces. According to published reports, as many as 85 percent of neck disorders result from acute or repetitive injuries.

Whiplash describes the injury caused by an abrupt hyperextension of the neck from an indirect force, as in a rear-end motor vehicle collision. The body is propelled forward in a linear and horizontal manner. The head is then thrown backward, which causes acute hyperextension of the cervical spine. Recoil of the head with marked cervical neck flexion occurs, and then, the head and neck return to the neutral position. [Read more...]

Filed Under: Cervical Spine, Trauma Tagged With: , , , , , ,

Transfusion of Blood and Blood Products In Patients of Trauma

January 25, 2008 By Leave a Comment

Transfusion of blood and its components has an important role in management of the trauma patient. As transfusion is not without risks, decisions must weigh the benefits of potential improvement in outcome versus the associated risks.

Blood and blood products have ability to replace red blood cells and improve oxygen transport capacity, and to correct coagulation defects. [Read more...]

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Role of Fluids in Management of Shock

January 24, 2008 By Leave a Comment

Shock in trauma occurs due to loss of blood from the body. To counter this loss and replenish the lost fluid, blood needs to be transfused in ideal conditions. But blood may not be always available immediately.

Fluids are used to expand the decreased blood volume so that tissue perfusion is maintained. Fluids do not have any capacity to carry oxygen. Only blood has.

There are two types of fluids used for resuscitation-crystalloids and colloids. [Read more...]

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How To Take Care of the Plaster Cast

January 23, 2008 By Leave a Comment

Plaster of Paris casts become supportive in three to five minutes, depending on the water temperature and the thickness of the cast. The cast does not fully dry out until 36 to 72 hours after application. [Read more...]

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Management of Shock In Trauma

January 23, 2008 By Leave a Comment

Shock is defined as an abnormality of the circulatory system that results in inadequate organ perfusion and tissue oxygenation. In simple terms it means that tissues are not getting adequate blood perfusion and oxygenation.

Persistent shock leads to cellular metabolic dysfunction and organ failure. In trauma patient the cause of shock is loss of blood following injury. This kind of shock is called hypovolemic shock . Acute hemorrhage is the primary cause of the intravascular volume depletion associated with hypovolemic shock. [Read more...]

Filed Under: Trauma Tagged With: , , , ,
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