This is a powerpoint developed by the consultants from the mater children's hospital brisbane emergency department (which has now amalgamated with the royal children's hospital to create the brand new Lady Cilento Children's Hospital LCCH)
This is ideal for medical students/ residents to use to learn paediatrics orthopaedics.
Easy and fun to go through.
painful hip in adults active person either male or female. limitation in hip movement, In FAI, bone overgrowth — called bone spurs — develop around the femoral head and/or along the acetabulum.
painful hip in adults active person either male or female. limitation in hip movement, In FAI, bone overgrowth — called bone spurs — develop around the femoral head and/or along the acetabulum.
Fractures in Children: Is conservative treatment still alive?ROBERT ELBAUM
Pediatric traumatology represent the first cause of death in chidren.
It is also the first cause of inability
And also the first reason of hospital stay
Paediatric trauma and osteotomy symposium and workshoporthopaedicdoctors
FOCUS is a specialized educational endeavor for experienced orthopedic surgeons whichaddresses complexities of Paediatric Trauma & Osteotomy. With an objective of delivering 'solution oriented learning',FOCUS entails detailed indication based
discussions led by expert panel of faculty.
FOCUS further elaborates and provides a dynamic platform to evaluate multiple treatment options applicable for trauma
fractures. Built around a selection of cases by eminent surgeon faculty as well as the participants, FOCUS provides an
opportunity for one-on-one discussion of common and complex clinical issues related to the focused anatomical region. By addressing key domains like post operative issues and care along with prognosis management, FOCUS finally aims to offer an end-to-end learning opportunity to the participants.desired objectives through expert lectures, dynamic case discussions and hands on workshops on bone models. This unique focused approach to learning is aimed to enlighten the participants with a detailed understanding and comfort in providing best solutions to complex advanced patient care.
Designed through a distinctively structured educational methodology, FOCUS achieves the desired objectives through expert lectures, dynamic case discussions and hands on workshops on bone models. This unique focused approach to learning is aimed to enlighten the participants with a detailed understanding and comfort in providing best solutions to complex advanced patient care.
Management of compound fracture tibia in children with titanium elastic nailsApollo Hospitals
Tibia fractures in the skeletally immature patient can usually be treated without surgery. The purpose of this study was to assess the use of flexible titanium nails in the open fracture tibia that requires operative stabilization.
paediatric injuries around the elbow
supracondylar elbow injuries
pulled elbow in paediatric age r
radiological signs around elbow in supracondylar fracture humerus
this ppt is based on clinical anatomy related with upper limb which will help all medical students to understand the upper limb related clinical situations for the diagnostic purposes.
Appendicular trauma refers to injuries or damage sustained to the appendicular skeleton, which includes the bones of the upper and lower extremities (arms and legs) as well as the pelvis. These injuries can result from various causes such as accidents, falls, sports-related incidents, or direct blows.
elbow and wrist and hand fracture with managementkajalgoel8
describing anatomy of the wrist and hand ..
what is fracture
mechanism of injury of all the fracture
classification of fracture
clinical features
radiologicals exminations
management of the fracture
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
2. Fractures in Children
• Children’s fractures are unique due to their immature
skeleton.
• This module will take you through some common and
important fractures, helping you to recognise and
describe them.
• You will also learn about fractures and conditions that
are less common, but very important not to miss.
3. Common Fractures
The sites of the most common fractures
vary with each age group.
[Pictures from Thornton, Gill
“Children’s Fractures”
Saunders 1999]
4. Parts of a Long Bone
You will need to know these for describing fractures in children.
Epiphysis
Epiphyseal plate (Physis)
Metaphysis
Diaphysis
6. Describing Fractures
When describing a fracture, follow the following formula:
1. open or closed
2. bone/s involved
3 .part of bone involved – midshaft/distal third/metaphysis/epiphysis
4. type of fracture –bowing
-buckle
-greenstick (with or w/o cortical or periosteal breach)
-transverse
-oblique
-spiral
-comminuted
5. displacement – direction of displacement of distal fragment relative
to proximal fragment eg palmar or volar/dorsal, anterior/posterior
6. angulation – the angle the distal fragment makes with the main axis
of the bone eg ‘distal fragment angulated 20 degrees posteriorly’
7. Presence or absence of associated dislocation
8. Presence or absence of associated neurovascular injury
7. For example…
This is a closed greenstick-type fracture of the distal radius with minimal
displacement and 10 degrees of dorsal angulation of the distal fragment.
10
8. Example 2
30 This is a closed transverse fracture of
the distal third of the radius and ulna.
The distal fragment of the ulnar fracture
is displaced dorsally and both distal
fragments are angulated to
approximately 30 degrees.
Remember that displacement and
angulation are different – displacement
means that there is lateral translation or
distraction or shortening of the two
fracture fragments relative to one
another, angulation means they are bent!
9. Example 3
Dislocations without fractures are
described in a similar way, but instead
of the bone, it is the involved joint that
is described.
This is a closed dislocation of the
metacarpophalangeal joint of the
thumb with dorsal displacement of the
distal fragment/proximal phalanx.
10. Upper Limb Fractures
We will now work through the most important
upper limb fractures:
• Supracondylar fracture
• Dislocated elbow
• Medial epicondyle fracture
• Fractured radius and ulna
• Distal radial fracture
• Fractured metacarpals
• Fractured scaphoid
• Monteggia fracture-dislocation
11. Supracondylar Fracture
• Unique to children under 10, rare in adults
• Most common elbow fracture in children
• Caused by a fall on the outstretched hand, with
hyperextension of the elbow
• The fracture is at the lower end of the humerus,
above the medial and lateral epicondyles
• May be radiologically subtle
• Missed fractures may result in permanent
neurovascular injuries or elbow deformity
12. Supracondylar fractures
• Supracondylar fractures are important because of the
associated high incidence of nerve and vessel injury
• The brachial artery and the median, radial and ulnar
nerves can all be kinked or torn by the fracture fragment
as they run in front of and behind the elbow joint
• All must be clinically evaluated and documented in every
patient
• Brachial artery injury may manifest as delayed capillary
refill, a cold pale hand or absent pulses at the wrist
• Median nerve injury (most common) may manifest as
inability to flex the interphalangeal joint of the thumb or
sensory loss
• To diagnose a supracondylar fracture it is important to
know the Elbow Rules
13. Cubital fossa nerves and artery
Radial N S: dorsal forearm
M: Finger gun gesture
Median N S: radial palm
M: OK gesture
Ulnar N S: ulnar forearm
M: Cross fingers
Brachial A: radial and ulnar
pulses and hand
perfusion
14. Elbow Rule #1
A line drawn through the radial head always intersects the
capitellum in both AP and lateral views
Radial head
capitellum
15. Every time you see an elbow xray, just think to yourself:
radial headcapitellum, radial headcapitellum.
capitellum
Radial head
16. Elbow Rule #2
A line drawn along the anterior aspect of the humerus (the
Anterior Humeral Line) should intersect the middle third of the
capitellum.
Capitellum
17. Elbow Rule #3
A posterior fat pad (a black lucency posterior to the distal
humerus), if visible in a true lateral film, indicates a fracture.
No fat pad Posterior fat pad
Normal elbow Supracondylar fracture
18. Radiographic Findings
In most supracondylar fractures, the
anterior humeral line does not pass
through the middle third of the
capitellum, but anterior to it.
In addition, there is a visible
posterior fat pad
The radial head and the capitellum
are usually still aligned, because the
fracture is above this level
In this fracture there is posterior
angulation and displacement of the
distal fragment
19. Supracondylar Fracture
This xray shows a suprandylar fracture with posterior displacement, angulation
and rotation of the distal fragment.
Anterior humeral line
20. Dislocated Elbow
Generally, this is not a tricky diagnosis clinically or radiologically. The xray
shows a dislocation of the right elbow joint with posterior displacement of the
radius and ulna.
21. Medial Epicondyle Injuries
•The medial epicondyle is the third ossification centre in the
elbow, becoming visible at around 6 years of age.
•Injuries usually occur when the elbow is forcibly abducted, and
the medial epicondyle is pulled away from the lower end of the
humerus by the ulnar collateral ligament.
•On AP view, the medial epicondyle should lie within 3mm of the
distal humerus. If it is further away than this, it is likely to have
been avulsed.
•On lateral view the medial epicondyle should not be visible, as it
is obscured by the capitellum. If you can see it in a true lateral,
it’s not in the right place.
•If in doubt, xray the opposite side to compare
23. Medial Epicondyle Fracture
Extensive soft tissue
swelling Gap >3mm
Avulsed medial epicondyle
Normal elbow
Gap less than 3mm
24. Fractured Radius and Ulna
These fractures may be very obvious clinically and radiologically. This
xray shows fractures of the mid-shaft of the radius and ulna with
dorsal angulation of 80 degrees with minimal displacement of the
distal fragments because the dorsal cortex and periosteum of the
bones are still intact.
80
25. These fractures can also be very subtle – shown here is a greenstick fracture
of the distal radius with ulnar bowing – a fracture type unique to children.
Radial greenstick fracture
Ulnar bowing
Radial greenstick fracture
26. Distal Radial Fracture
Again, these fractures may be very obvious, as shown at left, or
just a subtle buckle (torus) fracture
28. Fractured Scaphoid
Scaphoid fractures are uncommon in
children
When they do occur, it is in the more
skeletally mature child (usually greater
than 10 years)
Fracture across waist of scaphoid
29. Monteggia Fracture-dislocation
In its most common variant, this is a fracture of the distal ulna associated with a
dislocation of the radial head at the elbow. This is an uncommon injury, but the
radial head dislocation is often missed, making it important to know what to
look for.
Generally, the ulnar fracture is obvious. Due to the close relationship between
radius and ulna, the resultant shortening should prompt a search for a balancing
radial defect.
The radial head dislocation becomes apparent if you follow the ‘radial
headcapitellum’ rule.
This particular fracture-dislocation is usually treated with closed reduction
under general anaesthesia. Other variations of disruption/dislocation occur.
32. Fractured Femur
This is usually an unequivocal diagnosis. This xray shows a transverse fracture
of the midshaft of the left femur with lateral displacement of the distal fragment,
but with minimal angulation. That is, the distal fragment has moved sideways
from the fracture site but has not angled away from the long axis of the bone.
33. Fractured Tibial Spine
This fracture is the paediatric equivalent of the anterior cruciate ligament tears seen in
adults. Because ligaments have maximal tensile strength in childhood, the bone at the
site of insertion fractures (or avulses) first. Because these fractures are subtle on AP
view, they can be missed. However, as with all joints, an effusion after trauma in the
paediatric population usually indicates significant, often bony disruption and should
always be referred to the orthopaedic team.
Fracture line just
visible on AP view
Fracture line more
apparent on lateral
34. Fractured Tibia
Spiral fractures of the tibia are relatively
common in toddlers as they are learning to
walk. As the child gets older, however,
considerably more force is required to
fracture the tibia.
Note that the fracture is quite difficult to
see on the lateral film. Remember all
fractures require a minimum of two views,
and the joints above and below need to be
visualised.
35. Ankle Fractures
With all ankle fractures, remember
that the tibia and fibula often fracture
together (like the radius and ulna) and
a fracture in one should prompt a
thorough search for a fracture in the
other.
The fibula in particular may fracture at
a site distant from the site of the tibial
fracture. The entire length of the fibula
needs to be xrayed so as not to miss
this.
This fracture is described on the next
slide.
36. Ankle Fractures
This fracture looks difficult to
describe, but if you follow the formula
it makes it easier.
This is a closed fracture of the distal
Tibial fracture
line
left tibia and fibula. The tibial fracture
extends through the epiphyseal plate
Fibular fracture and into the metaphysis of the tibia
sites
(Salter Harris type II fracture). The
distal fragment is displaced laterally
and is angulated to 30 degrees.
30
30 The fibula shows two greenstick
fractures of the distal shaft. The
fractures are not displaced but are
angulated to 30 degrees.
37. Ankle Fractures
This is a Tillaux fracture of the
ankle –the adolescent
equivalent of an avulsion
fracture of the medial malleolus
in a child (again, as the
ligaments are so strong the bone
fractures first).
Fracture Without knowing the
line eponymous name for it though,
you could describe it as a closed
fracture of the medial distal left
tibial epiphysis with minimal
displacement and no angulation.
The fracture line extends from
the epiphyseal plate to the tibio-
epiphysis talar joint space.
38. Slipped Upper Femoral
Epiphysis = SUFE
Slipped upper femoral epiphysis is a condition where the there is
displacement of the femoral head relative to the femoral neck
through the epiphyseal plate. The underlying multi-factorial
vulnerability to shear stress may cause gradual cumulative
slippage, or the epiphysis may slip acutely. It is the most common
hip problem of adolescence.
This disorder is important because early diagnosis improves outcome.
Initial missed diagnosis is the rule, with the average time to
diagnosis of 6 to 10 months.
SUFE eventually occurs in the opposite hip in 60% of patients.
Obese adolescent boys are most at risk, but SUFE can occur in any
adolescent (8-15 years).
Clinically there will be hip, knee or groin pain with or without a history
of trauma. In some 50% of patients, hip pain never develops and
the primary symptom is isolated knee pain referred from the hip.
39. SUFE
The radiologic findings can be subtle but become more obvious when the correct views
are obtained. While the AP can appear normal, the head should “mushroom” out over
the neck. As you can see in this case the frog-leg lateral clearly shows the slippage of
the femoral head t the level of the epiphyseal plate.
AP view Frog-leg lateral view
40. Cervical Spine Injuries
You will learn about:
• How to assess xrays of the cervical spine
• Teardrop fracture
• Jefferson fracture
41. Cervical Spine - 7 bones
and 3 views
A minimum of three views showing all seven cervical vertebra is the minimum
requirement for an adequate assessment of the cervical spine. The three views are
AP, lateral down to C7/T1 junction, and an open mouth peg view.
1
2
3
4
5
6
7
42. Cervical Spine Imaging
Note that for optimal neutral positioning in the supine
position, children under 10 with suspected spinal
injury must have a foam thoracic elevation device
(TED) inserted as part of routine spinal
immobilisation [to counter-balance their large heads].
Without this, hyperflexion and false positive
radiological findings, such as increased prevertebral
soft tissue thickening and pseudo-subluxation, are
more common.
Pandie et al 2010 BMJ
43. Cervical Spine- the 4 lines
Start with the lateral. Trace the 4 lines below, looking for any part of the vertebrae
that are out of alignment. The lines become more curved as you go from anterior to
posterior.
Spino-laminar line Anterior vertebral line
Spinous process line
Posterior vertebral line
44. Cervical spine – the soft
tissues
Next look at the soft tissues.
The maximal allowable width of the pre-
vertebral soft tissue space is:
- one half the vertebral body width from C1
to C4
- one whole vertebral body width from C4
to C7
Increased width of the pre-vertebral space
of a properly positioned cervical spine
suggests swelling, eg from a fracture or
ligamentous injury.
45. Cervical Spine – vertebral
bodies
The next step is to trace around individual
vertebral bodies in turn, looking for
irregularities in the usual rectangular shape.
Look particularly for wedge or
compression fractures, with irregular loss
of height, or teardrop fractures of the
anterior inferior corner of the vertebral
body. These are important because
although small, they indicate significant
ligamentous injury and hence potential
instability.
47. The next thing to assess on a lateral film is the pre-dental space – that is, the space
between the anterior border of the peg, and the anterior arch of C1. Anything greater
than 5mm (child or adult) is abnormal and suggests instability of the transverse
ligament
48. Cervical spine - AP
Next assess the AP view.
The main things to look for in this
view are:
-that the spinous processes line up
-that the vertebral bodies are
symmetrical and have no obvious
fracture
-that the vertebrae are evenly spaced
49. Cervical Spine - peg
Lastly assess the peg view. Look for a well-centred film with the peg lining up
with the gap between the front incisors. This film is slightly rotated.
Next look at the space either side of the peg – this should be symmetrical.
Then look at the outside edge of the lateral masses of C1 – this should line up
with the outside edge of C2.
Lateral masses of C1
Body of C2 Odontoid
process
50. C1/C2 Fracture
Note that the anterior and posterior vertebral lines are abnormal, and
the soft tissue spaces very widened. The peg has fractured and has
tilted forward, as has the anterior arch of C1. This will cause
angulation and compression of the spinal cord at the level of C2.
51. Jefferson Fracture
A Jefferson fracture is a burst
fracture of C1. Think of C1 as
peppermint lifesaver – it is
impossible to break it in only one
place. The ring will always break
in at least 2 places. This fracture
occurs due to compression – a
fall from a height, or hitting the
head on the roof of the car in a
motor vehicle accident. This film
shows a widened pre-dental space
from an associated ligamentous
instability.
52. Jefferson Fracture
On the peg view, it is apparent that the space either side of the peg is
widened and asymmetrical. In addition, the lateral masses do not
align with the lateral borders of C2 – they have been laterally
displaced.