Dr. Haley Dusek is an Emergency Medicine Resident and interested in pediatric emergency medicine and medical education. With the guidance of Dr. Michael Gibbs, a notable Professor of Emergency Medicine, and supervision of Dr. Danielle Sutton, a Pediatric Emergency Medicine specialist, and Dr. Virginia Casey, a Pediatric Orthopedic Surgeon, they aim to help augment our understanding of emergent imaging. Follow along with the EMGuideWire.com team as they post these educational, self-guided radiology slides. This set will cover:
• Tufts fracture
• Mallet fracture
• Seymour fracture
• Volar Plate Injury
• Base fracture
• Phalangeal neck
• Condyle fracture
• Phalanx dislocations
Dr. Kelsey Lena’s CMC Pediatric Orthopedic X-Ray Mastery Project: October CasesSean M. Fox
This document provides a summary of 4 pediatric orthopedic imaging case studies involving femur fractures in patients aged 5 to 17 years old. It then reviews key anatomy, techniques for reading x-rays systematically, and classifications and management of pediatric femur fractures. The cases include femoral head, shaft, spiral and Salter-Harris fractures from injuries like gunshots, motor vehicle collisions and falls. The document emphasizes the importance of anatomy and assessing integrity of soft tissues and neurovascular status. Treatment options like casting or intramedullary nailing are discussed.
Dr. Kelsey Lena’s CMC Pediatric Orthopedic X-Ray Mastery Project: January CasesSean M. Fox
Dr. Kelsey Lena is Emergency Medicine Resident and interested in pediatric emergency medicine and medical education. With the guidance of Dr. Michael Gibbs, a notable Professor of Emergency Medicine, and supervision of Dr. Danielle Sutton, a Pediatric Emergency Medicine specialist, and Dr. Virginia Casey, a Pediatric Orthopedic Surgeon, they aim to help augment our understanding of emergent imaging. Follow along with the EMGuideWire.com team as they post these educational, self-guided radiology slides. This set will cover:
- Clavicle Fractures
Dr. Kelsey Lena’s CMC Pediatric Orthopedic X-Ray Mastery Project: September C...Sean M. Fox
Dr. Kelsey Lena is Emergency Medicine Resident and interested in pediatric emergency medicine and medical education. With the guidance of Dr. Michael Gibbs, a notable Professor of Emergency Medicine, and supervision of Dr. Danielle Sutton, a Pediatric Emergency Medicine specialist, and Dr. Virginia Casey, a Pediatric Orthopedic Surgeon, they aim to help augment our understanding of emergent imaging. Follow along with the EMGuideWire.com team as they post these educational, self-guided radiology slides. This set will cover:
- Buckle Fracture
- Greenstick Fracture
- Displaced Radial and Ulnar Fractures
- Non-Displaced Radial and Ulnar Fractures
- Comminuted Radial Fractures
- Monteggia Fracture
Dr. Kelsey Lena’s CMC Pediatric Orthopedic X-Ray Mastery Project: April CasesSean M. Fox
The document discusses 5 pediatric orthopedic imaging case studies of children presenting with tibia and fibula fractures, including Salter-Harris fractures. It provides imaging and details on each case, discussing factors like fracture classification and treatment approaches. The document also reviews topics like tibia fracture patterns, risks of compartment syndrome, and outcomes of different treatment methods for Salter-Harris II distal tibia fractures.
Dr. Kelsey Lena’s CMC Pediatric Orthopedic X-Ray Mastery Project: August CasesSean M. Fox
Dr. Kelsey Lena is Emergency Medicine Resident and interested in pediatric emergency medicine and medical education. With the guidance of Dr. Michael Gibbs, a notable Professor of Emergency Medicine, and supervision of Dr. Danielle Sutton, a Pediatric Emergency Medicine specialist, and Dr. Virginia Casey, a Pediatric Orthopedic Surgeon, they aim to help augment our understanding of emergent imaging. Follow along with the EMGuideWire.com team as they post these educational, self-guided radiology slides. This set will cover:
- Supracondylar Fracture Type I
- Supracondylar Fracture Type II
- Supracondylar Fracture Type III
- Supracondylar Fracture Type IV
This document discusses common upper extremity injuries in children. It describes injuries such as Monteggia fractures, Galeazzi fractures, greenstick fractures, torus fractures, Salter-Harris fractures, scaphoid fractures, Bennett fractures, Rolando fractures, boxer's fractures, and proximal, middle, and distal phalanx fractures. For each injury, it discusses the mechanism of injury, clinical findings, imaging needed for diagnosis, and treatment options such as splinting, casting, closed reduction, and open reduction with internal fixation. The goal of treatment is to properly immobilize and reduce fractures as needed to promote healing while minimizing long-term functional deficits.
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.
Dr. Kelsey Lena’s CMC Pediatric Orthopedic X-Ray Mastery Project: October CasesSean M. Fox
This document provides a summary of 4 pediatric orthopedic imaging case studies involving femur fractures in patients aged 5 to 17 years old. It then reviews key anatomy, techniques for reading x-rays systematically, and classifications and management of pediatric femur fractures. The cases include femoral head, shaft, spiral and Salter-Harris fractures from injuries like gunshots, motor vehicle collisions and falls. The document emphasizes the importance of anatomy and assessing integrity of soft tissues and neurovascular status. Treatment options like casting or intramedullary nailing are discussed.
Dr. Kelsey Lena’s CMC Pediatric Orthopedic X-Ray Mastery Project: January CasesSean M. Fox
Dr. Kelsey Lena is Emergency Medicine Resident and interested in pediatric emergency medicine and medical education. With the guidance of Dr. Michael Gibbs, a notable Professor of Emergency Medicine, and supervision of Dr. Danielle Sutton, a Pediatric Emergency Medicine specialist, and Dr. Virginia Casey, a Pediatric Orthopedic Surgeon, they aim to help augment our understanding of emergent imaging. Follow along with the EMGuideWire.com team as they post these educational, self-guided radiology slides. This set will cover:
- Clavicle Fractures
Dr. Kelsey Lena’s CMC Pediatric Orthopedic X-Ray Mastery Project: September C...Sean M. Fox
Dr. Kelsey Lena is Emergency Medicine Resident and interested in pediatric emergency medicine and medical education. With the guidance of Dr. Michael Gibbs, a notable Professor of Emergency Medicine, and supervision of Dr. Danielle Sutton, a Pediatric Emergency Medicine specialist, and Dr. Virginia Casey, a Pediatric Orthopedic Surgeon, they aim to help augment our understanding of emergent imaging. Follow along with the EMGuideWire.com team as they post these educational, self-guided radiology slides. This set will cover:
- Buckle Fracture
- Greenstick Fracture
- Displaced Radial and Ulnar Fractures
- Non-Displaced Radial and Ulnar Fractures
- Comminuted Radial Fractures
- Monteggia Fracture
Dr. Kelsey Lena’s CMC Pediatric Orthopedic X-Ray Mastery Project: April CasesSean M. Fox
The document discusses 5 pediatric orthopedic imaging case studies of children presenting with tibia and fibula fractures, including Salter-Harris fractures. It provides imaging and details on each case, discussing factors like fracture classification and treatment approaches. The document also reviews topics like tibia fracture patterns, risks of compartment syndrome, and outcomes of different treatment methods for Salter-Harris II distal tibia fractures.
Dr. Kelsey Lena’s CMC Pediatric Orthopedic X-Ray Mastery Project: August CasesSean M. Fox
Dr. Kelsey Lena is Emergency Medicine Resident and interested in pediatric emergency medicine and medical education. With the guidance of Dr. Michael Gibbs, a notable Professor of Emergency Medicine, and supervision of Dr. Danielle Sutton, a Pediatric Emergency Medicine specialist, and Dr. Virginia Casey, a Pediatric Orthopedic Surgeon, they aim to help augment our understanding of emergent imaging. Follow along with the EMGuideWire.com team as they post these educational, self-guided radiology slides. This set will cover:
- Supracondylar Fracture Type I
- Supracondylar Fracture Type II
- Supracondylar Fracture Type III
- Supracondylar Fracture Type IV
This document discusses common upper extremity injuries in children. It describes injuries such as Monteggia fractures, Galeazzi fractures, greenstick fractures, torus fractures, Salter-Harris fractures, scaphoid fractures, Bennett fractures, Rolando fractures, boxer's fractures, and proximal, middle, and distal phalanx fractures. For each injury, it discusses the mechanism of injury, clinical findings, imaging needed for diagnosis, and treatment options such as splinting, casting, closed reduction, and open reduction with internal fixation. The goal of treatment is to properly immobilize and reduce fractures as needed to promote healing while minimizing long-term functional deficits.
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.
This document discusses paediatric fractures, including physeal injuries, supracondylar fractures of the humerus, and paediatric abuse. Key points include:
- Children's bones have a physis/growth plate not present in adults, making physeal injuries common fracture patterns like buckle fractures and greenstick fractures.
- Supracondylar fractures frequently occur in the distal humerus and can be posteriorly or anteriorly displaced. Nerve injuries and compartment syndrome are complications.
- Paediatric abuse is difficult to diagnose but risk factors include inconsistent history, delay in care, and fractures in non-mobile children. A skeletal survey aids investigation.
This document discusses mallet finger injuries, which involve disruption of the extensor tendon mechanism at the distal interphalangeal joint. It covers the anatomy of the finger extensor mechanism, classification of mallet finger injuries, clinical evaluation, treatment options including nonsurgical management with splinting and surgical repair or fixation, and management approaches for different types of acute mallet finger injuries.
1) The document discusses different types of scissor bites (malocclusions where the maxillary teeth are positioned buccal to the mandibular teeth), including definitions, classifications, causes, and treatment options.
2) Scissor bites can be caused by factors like microglossia, abnormal tooth germ position, and skeletal Class II issues. Treatment depends on a patient's age and severity of the scissor bite, ranging from removable appliances to orthodontic devices to orthognathic surgery.
3) The document presents several case studies as examples. One case discusses using a bonded constriction quad-helix appliance to reduce the maxillary arch width in a growing patient with a bilateral scissor
Paediatric Forearm Diaphysial Fractures are very common in children, accounting for 40% of childhood fractures. The document discusses the mechanisms, assessment, classification, treatment strategies and complications of these fractures. Treatment involves closed reduction and casting for most fractures, with surgical fixation reserved for open fractures, fractures that cannot maintain reduction, or refractures. The goals of treatment are satisfactory healing and remodeling while achieving acceptable alignment parameters.
This document discusses mandibular fractures, including:
- The uniqueness of the mandible as the only mobile bone in the facial region with bilateral joint articulations.
- The biomechanical aspects of fractures, which tend to occur in areas of tension due to irregularities in the mandibular arch.
- Treatment options including closed reduction with fixation, open reduction with rigid fixation using plates, screws or external pin fixation.
- Factors determining the appropriate treatment and length of intermaxillary fixation.
Paediatric femur fracture in preschool children.pptxhariramhalder
This document discusses treatment options for pediatric femur fractures, including conservative treatment with a Pavlik harness or casting, and surgical treatment with elastic stable intramedullary nailing (ESIN). ESIN allows early mobilization and weight bearing but has risks of pin-related problems like perforation and need for implant removal surgery. Studies have found ESIN and casting to have similar outcomes with fewer complications from casting, though casting delays mobilization. Prerequisites for ESIN include proper equipment and technique considerations like adequate nail sizing and symmetrical bilateral insertion crossing the fracture site twice.
Fractures and fracture dislocations of the tarsometatarsal jointMurugesh M Kurani
Here I have discussed an article from Journal of Bone and Joint Surgery. The presentation includes classification, treatment, results and complications. Lets share and learn.
This document provides an introduction to posterior hip dislocation, including definitions, causes, symptoms, and treatment. It then presents a case study of an 8-year-old male patient from Masbate, Philippines who suffered a posterior dislocation of the right hip after falling from a tree two weeks prior. He was unable to walk since the incident. Upon examination at the hospital, he displayed limited range of motion and tenderness in the right hip. He was diagnosed with posterior hip dislocation of the right hip and prescribed balance skeletal traction to aid in reduction.
its a presentation done in AIIMS rishikesh on pediatric fracture around elbow
includes supracondylar humerus fracture, lateral and medial condyle fracture monteggia fracture, neglected monteggia fracture pulled elbow, TRASH lesions around elbow
1. Pediatric fractures are different than adult fractures due to children's bones being metabolically more active with better resilience and remodeling potential. This makes failure of union rare and few fractures require operative treatment.
2. Injuries to the growth plate are more common in boys and the upper limb. They can cause deformity if not properly treated. The Salter-Harris classification is used to describe physeal injuries.
3. Treatment depends on the fracture type but generally involves closed reduction and immobilization for Types I-II and anatomic open reduction for Types III-IV. Fixation methods include casting, K-wires, elastic nails and plating which aim to achieve stabilization while avoiding further injury to
This document summarizes a study of fractures of the distal clavicle in pediatric patients. It describes 10 patients ages 5-11 who presented with these fractures. Nine were treated conservatively with plaster casting, while one patient with a more severe fracture was treated surgically with K-wire fixation. All fractures healed without complications. The document concludes that fractures of the distal clavicle in children are rare but can generally be treated conservatively with good results and that surgery is only needed in rare cases involving more severe fractures.
This document summarizes a study of fractures of the distal clavicle in pediatric patients. It describes 10 patients ages 5-11 who presented with these fractures. Nine were treated conservatively with plaster casting, while one patient with a more severe fracture was treated surgically with K-wire fixation. All fractures healed without complications. The document concludes that fractures of the distal clavicle in children are rare but can generally be treated conservatively with good results and that surgery is only occasionally needed for more severe fractures.
This document summarizes a study of fractures of the distal clavicle in pediatric patients. It describes 10 patients ages 5-11 who presented with these fractures. Nine were treated conservatively with plaster casting, while one patient with a more severe fracture was treated surgically with K-wire fixation. All fractures healed without complications. The document concludes that fractures of the distal clavicle in children are rare but can generally be treated conservatively with good results and that surgery is only occasionally needed for more severe fractures.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
00919248678078
This document discusses distraction osteogenesis, a technique used to lengthen bones by gradual separation of surgically cut bone segments. It originated for treating leg length discrepancies and was later used for craniofacial bones. The key steps are cutting the bone, applying distraction forces slowly over 1-2mm per day in two sessions, allowing new bone formation in the gap. This immature bone then remodels into mature bone over 4-6 weeks of consolidation. Distraction osteogenesis is now commonly used as an alternative to orthognathic surgery for treating craniofacial abnormalities.
Background: Distal femur fractures make up 6 to 7% of all femur fractures. Various plating options for distal femur fracture are conventional buttress plates, fixed-angle devices, and locking plates. This study was planned to evaluate and explore locking compression plate fixation in distal end femur fractures which is expected to provide a stable fixation with minimum exposure, early mobilization, less complications and a better quality of life.
Methods: The study was conducted as prospective clinical study in 20 skeletally mature patients with x-ray evidence of distal femur fracture fulfilling inclusion and exclusion criteria, operated with distal femur LCP plating. Patients were assessed radiologically and classified according to distal femur fracture classification and outcome graded as excellent, good, fair and poor based on Lysholm Knee Score.
Results: Out of 15 excellent outcome cases, 3 cases were type A1 fracture, 1 case had type A3, 2 cases had type B1 and B2 each, 5 cases had type C2 and 2 cases had type C3 fracture. 1 case with good outcome was type C3. 1 case with fair outcome was type B2. While 3 cases with poor outcome were type A1, A2 and C3.
Conclusions: The DF-LCP is an ideal implant to use for fractures of the distal femur. However, accurate positioning and fixation are required to produce satisfactory results. We recommend use of this implant in Type A and C, osteoporotic and periprosthetic fractures.
Keywords: Distal femur, DF-LCP, Lysholm score, Periprosthetic fracture
Implanted Devices - VP Shunts: EMGuidewire's Radiology Reading RoomSean M. Fox
The Department of Emergency Medicine at Carolinas Medical Center is passionate about education! Dr. Michael Gibbs is a world-renowned clinician and educator and has helped guide numerous young clinicians on the long path of Mastery of Emergency Medical Care. With his oversight, the EMGuideWire team aim to help augment our understanding of emergent imaging. You can follow along with the EMGuideWire.com team as they post these educational, self-guided radiology slides or you can also use this section to learn more in-depth about specific conditions and diseases. This Radiology Reading Room pertains to Ventriculoperitoneal Shunts and their Complications and is brought to you by Brandon Friedman, MD, Kelsey Patterson, and L. Erin Miller MD. It is has special guest editor: Scott Wait, MD
Sternal Fractures & Dislocations - EMGuidewire Radiology Reading RoomSean M. Fox
The Department of Emergency Medicine at Carolinas Medical Center is passionate about education! Dr. Michael Gibbs is a world-renowned clinician and educator and has helped guide numerous young clinicians on the long path of Mastery of Emergency Medical Care. With his oversight, the EMGuideWire team aim to help augment our understanding of emergent imaging. You can follow along with the EMGuideWire.com team as they post these educational, self-guided radiology slides or you can also use this section to learn more in-depth about specific conditions and diseases. This Radiology Reading Room pertains to Sternal Fractures and Dislocations and is brought to you by Carrie Bissell, MD, Aaron Fox, MD, Kendrick Lim, MD, Stephanie Jensen, MD, and Olivia Rice, MD. It is has special guest editor: Sean Dieffenbaugher, MD and Laurence Kempton, MD
Diaphragmatic Injuries - Radiology Reading RoomSean M. Fox
The Department of Emergency Medicine at Carolinas Medical Center is passionate about education! Dr. Michael Gibbs is a world-renowned clinician and educator and has helped guide numerous young clinicians on the long path of Mastery of Emergency Medical Care. With his oversight, the EMGuideWire team aim to help augment our understanding of emergent imaging. You can follow along with the EMGuideWire.com team as they post these educational, self-guided radiology slides or you can also use this section to learn more in-depth about specific conditions and diseases. This Radiology Reading Room pertains to Diaphragm Injury and is brought to you by Kylee Brooks, MD, Parker Hambright, MD, Alexis Holland, MD, and William Lorenz, MD. It is has special guest editor: Kyle Cunningham, MD
More Related Content
Similar to Dr. Haley Dusek’s CMC Pediatric Orthopedic X-Ray Mastery Project: #6 Presentation
This document discusses paediatric fractures, including physeal injuries, supracondylar fractures of the humerus, and paediatric abuse. Key points include:
- Children's bones have a physis/growth plate not present in adults, making physeal injuries common fracture patterns like buckle fractures and greenstick fractures.
- Supracondylar fractures frequently occur in the distal humerus and can be posteriorly or anteriorly displaced. Nerve injuries and compartment syndrome are complications.
- Paediatric abuse is difficult to diagnose but risk factors include inconsistent history, delay in care, and fractures in non-mobile children. A skeletal survey aids investigation.
This document discusses mallet finger injuries, which involve disruption of the extensor tendon mechanism at the distal interphalangeal joint. It covers the anatomy of the finger extensor mechanism, classification of mallet finger injuries, clinical evaluation, treatment options including nonsurgical management with splinting and surgical repair or fixation, and management approaches for different types of acute mallet finger injuries.
1) The document discusses different types of scissor bites (malocclusions where the maxillary teeth are positioned buccal to the mandibular teeth), including definitions, classifications, causes, and treatment options.
2) Scissor bites can be caused by factors like microglossia, abnormal tooth germ position, and skeletal Class II issues. Treatment depends on a patient's age and severity of the scissor bite, ranging from removable appliances to orthodontic devices to orthognathic surgery.
3) The document presents several case studies as examples. One case discusses using a bonded constriction quad-helix appliance to reduce the maxillary arch width in a growing patient with a bilateral scissor
Paediatric Forearm Diaphysial Fractures are very common in children, accounting for 40% of childhood fractures. The document discusses the mechanisms, assessment, classification, treatment strategies and complications of these fractures. Treatment involves closed reduction and casting for most fractures, with surgical fixation reserved for open fractures, fractures that cannot maintain reduction, or refractures. The goals of treatment are satisfactory healing and remodeling while achieving acceptable alignment parameters.
This document discusses mandibular fractures, including:
- The uniqueness of the mandible as the only mobile bone in the facial region with bilateral joint articulations.
- The biomechanical aspects of fractures, which tend to occur in areas of tension due to irregularities in the mandibular arch.
- Treatment options including closed reduction with fixation, open reduction with rigid fixation using plates, screws or external pin fixation.
- Factors determining the appropriate treatment and length of intermaxillary fixation.
Paediatric femur fracture in preschool children.pptxhariramhalder
This document discusses treatment options for pediatric femur fractures, including conservative treatment with a Pavlik harness or casting, and surgical treatment with elastic stable intramedullary nailing (ESIN). ESIN allows early mobilization and weight bearing but has risks of pin-related problems like perforation and need for implant removal surgery. Studies have found ESIN and casting to have similar outcomes with fewer complications from casting, though casting delays mobilization. Prerequisites for ESIN include proper equipment and technique considerations like adequate nail sizing and symmetrical bilateral insertion crossing the fracture site twice.
Fractures and fracture dislocations of the tarsometatarsal jointMurugesh M Kurani
Here I have discussed an article from Journal of Bone and Joint Surgery. The presentation includes classification, treatment, results and complications. Lets share and learn.
This document provides an introduction to posterior hip dislocation, including definitions, causes, symptoms, and treatment. It then presents a case study of an 8-year-old male patient from Masbate, Philippines who suffered a posterior dislocation of the right hip after falling from a tree two weeks prior. He was unable to walk since the incident. Upon examination at the hospital, he displayed limited range of motion and tenderness in the right hip. He was diagnosed with posterior hip dislocation of the right hip and prescribed balance skeletal traction to aid in reduction.
its a presentation done in AIIMS rishikesh on pediatric fracture around elbow
includes supracondylar humerus fracture, lateral and medial condyle fracture monteggia fracture, neglected monteggia fracture pulled elbow, TRASH lesions around elbow
1. Pediatric fractures are different than adult fractures due to children's bones being metabolically more active with better resilience and remodeling potential. This makes failure of union rare and few fractures require operative treatment.
2. Injuries to the growth plate are more common in boys and the upper limb. They can cause deformity if not properly treated. The Salter-Harris classification is used to describe physeal injuries.
3. Treatment depends on the fracture type but generally involves closed reduction and immobilization for Types I-II and anatomic open reduction for Types III-IV. Fixation methods include casting, K-wires, elastic nails and plating which aim to achieve stabilization while avoiding further injury to
This document summarizes a study of fractures of the distal clavicle in pediatric patients. It describes 10 patients ages 5-11 who presented with these fractures. Nine were treated conservatively with plaster casting, while one patient with a more severe fracture was treated surgically with K-wire fixation. All fractures healed without complications. The document concludes that fractures of the distal clavicle in children are rare but can generally be treated conservatively with good results and that surgery is only needed in rare cases involving more severe fractures.
This document summarizes a study of fractures of the distal clavicle in pediatric patients. It describes 10 patients ages 5-11 who presented with these fractures. Nine were treated conservatively with plaster casting, while one patient with a more severe fracture was treated surgically with K-wire fixation. All fractures healed without complications. The document concludes that fractures of the distal clavicle in children are rare but can generally be treated conservatively with good results and that surgery is only occasionally needed for more severe fractures.
This document summarizes a study of fractures of the distal clavicle in pediatric patients. It describes 10 patients ages 5-11 who presented with these fractures. Nine were treated conservatively with plaster casting, while one patient with a more severe fracture was treated surgically with K-wire fixation. All fractures healed without complications. The document concludes that fractures of the distal clavicle in children are rare but can generally be treated conservatively with good results and that surgery is only occasionally needed for more severe fractures.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
00919248678078
This document discusses distraction osteogenesis, a technique used to lengthen bones by gradual separation of surgically cut bone segments. It originated for treating leg length discrepancies and was later used for craniofacial bones. The key steps are cutting the bone, applying distraction forces slowly over 1-2mm per day in two sessions, allowing new bone formation in the gap. This immature bone then remodels into mature bone over 4-6 weeks of consolidation. Distraction osteogenesis is now commonly used as an alternative to orthognathic surgery for treating craniofacial abnormalities.
Background: Distal femur fractures make up 6 to 7% of all femur fractures. Various plating options for distal femur fracture are conventional buttress plates, fixed-angle devices, and locking plates. This study was planned to evaluate and explore locking compression plate fixation in distal end femur fractures which is expected to provide a stable fixation with minimum exposure, early mobilization, less complications and a better quality of life.
Methods: The study was conducted as prospective clinical study in 20 skeletally mature patients with x-ray evidence of distal femur fracture fulfilling inclusion and exclusion criteria, operated with distal femur LCP plating. Patients were assessed radiologically and classified according to distal femur fracture classification and outcome graded as excellent, good, fair and poor based on Lysholm Knee Score.
Results: Out of 15 excellent outcome cases, 3 cases were type A1 fracture, 1 case had type A3, 2 cases had type B1 and B2 each, 5 cases had type C2 and 2 cases had type C3 fracture. 1 case with good outcome was type C3. 1 case with fair outcome was type B2. While 3 cases with poor outcome were type A1, A2 and C3.
Conclusions: The DF-LCP is an ideal implant to use for fractures of the distal femur. However, accurate positioning and fixation are required to produce satisfactory results. We recommend use of this implant in Type A and C, osteoporotic and periprosthetic fractures.
Keywords: Distal femur, DF-LCP, Lysholm score, Periprosthetic fracture
Similar to Dr. Haley Dusek’s CMC Pediatric Orthopedic X-Ray Mastery Project: #6 Presentation (19)
Implanted Devices - VP Shunts: EMGuidewire's Radiology Reading RoomSean M. Fox
The Department of Emergency Medicine at Carolinas Medical Center is passionate about education! Dr. Michael Gibbs is a world-renowned clinician and educator and has helped guide numerous young clinicians on the long path of Mastery of Emergency Medical Care. With his oversight, the EMGuideWire team aim to help augment our understanding of emergent imaging. You can follow along with the EMGuideWire.com team as they post these educational, self-guided radiology slides or you can also use this section to learn more in-depth about specific conditions and diseases. This Radiology Reading Room pertains to Ventriculoperitoneal Shunts and their Complications and is brought to you by Brandon Friedman, MD, Kelsey Patterson, and L. Erin Miller MD. It is has special guest editor: Scott Wait, MD
Sternal Fractures & Dislocations - EMGuidewire Radiology Reading RoomSean M. Fox
The Department of Emergency Medicine at Carolinas Medical Center is passionate about education! Dr. Michael Gibbs is a world-renowned clinician and educator and has helped guide numerous young clinicians on the long path of Mastery of Emergency Medical Care. With his oversight, the EMGuideWire team aim to help augment our understanding of emergent imaging. You can follow along with the EMGuideWire.com team as they post these educational, self-guided radiology slides or you can also use this section to learn more in-depth about specific conditions and diseases. This Radiology Reading Room pertains to Sternal Fractures and Dislocations and is brought to you by Carrie Bissell, MD, Aaron Fox, MD, Kendrick Lim, MD, Stephanie Jensen, MD, and Olivia Rice, MD. It is has special guest editor: Sean Dieffenbaugher, MD and Laurence Kempton, MD
Diaphragmatic Injuries - Radiology Reading RoomSean M. Fox
The Department of Emergency Medicine at Carolinas Medical Center is passionate about education! Dr. Michael Gibbs is a world-renowned clinician and educator and has helped guide numerous young clinicians on the long path of Mastery of Emergency Medical Care. With his oversight, the EMGuideWire team aim to help augment our understanding of emergent imaging. You can follow along with the EMGuideWire.com team as they post these educational, self-guided radiology slides or you can also use this section to learn more in-depth about specific conditions and diseases. This Radiology Reading Room pertains to Diaphragm Injury and is brought to you by Kylee Brooks, MD, Parker Hambright, MD, Alexis Holland, MD, and William Lorenz, MD. It is has special guest editor: Kyle Cunningham, MD
Acute Chest Syndrome - EMGuidewire's Radiology Reading RoomSean M. Fox
The Department of Emergency Medicine at Carolinas Medical Center is passionate about education! Dr. Michael Gibbs is a world-renowned clinician and educator and has helped guide numerous young clinicians on the long path of Mastery of Emergency Medical Care. With his oversight, the EMGuideWire team aim to help augment our understanding of emergent imaging. You can follow along with the EMGuideWire.com team as they post these educational, self-guided radiology slides or you can also use this section to learn more in-depth about specific conditions and diseases. This Radiology Reading Room pertains to Acute Chest Syndrome and is brought to you by Angela Pikus, MD, Mark Baumgarten, MD, Andres Gil Bustamante, and Ahmed Mashal, MD. As always, Michael Gibbs, MD serves as the projects editor.
Adult Orthopedic Imaging Series: Presentation #2 Native Hip DislocationsSean M. Fox
Drs. Carrie Bissell, Aaron Fox, and Kendrick Lim are Emergency Medicine Residents at Carolinas Medical Center and are interested in emergency medicine and medical education. With the guidance of Dr. Michael Gibbs, a notable Professor of Emergency Medicine and Dr. Laurence Kempton, an Orthopedic Surgeon, they aim to help augment our understanding of emergent imaging. Follow along with the EMGuideWire.com team as they post these educational, self-guided radiology slides that focus on Adult Orthopedic cases. This set will cover:
- Hip Dislocations
Neuroimaging Mastery Project: Presentation #5 Subdural HematomasSean M. Fox
Drs. Faith Meyers, Madison Watts and Steven Perry are Emergency Medicine Residents at Carolinas Medical Center who are interested in medical education. Dr. Rebecca DeCarlo, MD is a Neurosurgical resident at Carolinas Medical Center. Along with the guidance of Dr. Michael Gibbs (Chair of Emergency Medicine), Dr. Jonathan Clemente (Chief of the Department of Radiology and Neuroradiology specialist), Dr. Christa Swisher (Neurocritcal Care Intensivist), and Dr. Scott Wait (Chief of Pediatric Neurosurgery) they aim to help educate us on Neuroimaging. In this presentation they will address Subdural Hematomas. Follow along with the EMGuideWire.com team as they post the CMC Neuroimaging Case Studies.
- Subdural Hematomas
Neuroimaging Mastery Project Presentation #4: Acute Epidural HematomasSean M. Fox
Drs. Faith Meyers, Madison Watts and Steven Perry are Emergency Medicine Residents at Carolinas Medical Center who are interested in medical education. Along with the guidance of Dr. Michael Gibbs (Chair of Emergency Medicine), Dr. Jonathan Clemente (Chief of the Department of Radiology and Neuroradiology specialist), Dr. Christa Swisher (Neurocritcal Care Intensivist), and Dr. Scott Wait (Chief of Pediatric Neurosurgery) they aim to help educate us on Neuroimaging. In this presentation they will address Atraumatic Neurosurgical Intracranial Infections. Follow along with the EMGuideWire.com team as they post the CMC Neuroimaging Case Studies.
- Acute Epidural Hematomas
Pediatric Orthopedic Imaging Case Studies #7 Pediatric Elbow FracturesSean M. Fox
The document provides an overview of commonly encountered pediatric elbow injuries seen in the emergency department setting. It reviews the anatomy and imaging evaluation of pediatric elbow fractures including the supracondylar humerus, radial neck, lateral condyle, and medial epicondyle fractures. Specific radiographic findings that help identify subtle fractures are discussed. Challenges in pediatric elbow imaging related to ossification centers are also covered. The goal is to help emergency physicians accurately diagnose pediatric elbow fractures on radiographs.
Adult Orthopedic Imaging Mastery Project - Pelvic Ring FracturesSean M. Fox
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1. Pediatric Orthopedic Imaging Case Studies
Haley Dusek, MD1, Danielle Sutton, MD1, Virginia Casey, MD2
Departments of Emergency Medicine1 & Orthopedic Surgery2
Carolinas Medical Center & Levine Children’s Hospital
Presentation #6
CMC Imaging Mastery Project
Michael Gibbs, MD – Lead Editor
2. Disclosures
▪ This ongoing pediatric orthopedic imaging interpretation series is proudly
sponsored by the Emergency Medicine Residency Program at Carolinas
Medical Center.
▪ The goal is to promote widespread imaging interpretation mastery.
▪ There is no personal health information [PHI] within, and ages have been
changed to protect patient confidentiality.
5. The Physics of X-Rays
• How far an X-ray projects depends on the density of tissue that the X-
ray beam is attempting to penetrate.
• For reference, X-ray beams travelling through air will be black.
• Versus X-ray beams travelling through bone, which is high density, will
subsequently appear bright white.
6. 1. Confirm patient identity (name, date of birth)
2. Confirm the date of imaging
3. Confirm laterality (right vs. left)
4. Trace the bony cortex and look for irregularities
5. Review images in 2 planes at right angles to each other (AP + lateral)
to characterize fracture patterns, displacement, and angulation
6. Identify which bone and what part of the bone is injured
7. Review X-rays of both the joint above and the joint below the injury
The System: Bony Imaging
7. Example
4-year-old girl with finger
pain after slamming her
hand in a door.
With her fingers overlying
each other on this single
image, it is challenging to
accurately assess for a
fracture.
1. Dedicated finger views
are needed
2. Always be sure to check
two views at right angles
to each other.
12. Phalanx Fractures
• The phalanx is the most commonly injured bone
• Distal > proximal
• Bimodal age distribution
• Toddler – household crush / lacerations
• Adolescent– contact sports
• 2/3 of fractures occur in boys
• Bone growth through the physis
• Located at proximal aspect of the phalanx
• Remain open until approx. 16.5 in males, 14.5 in females
• Associated tendon injuries common
November 2016; 24:11.
14. General Approach
• Visual inspection
• Nail bed / matrix laceration
• Evaluate digital cascade
• Specifically rotational deformity
• Active and passive range of motion
• Flex fingers with passive wrist extension or by squeezing the forearm
• Sensation
• Wrinkle test: place hands in warm water x 10 min, wrinkles on
fingertip indicate intact autonomic sensory function
• X-Ray orders
• AP, lateral and oblique view of individual finger
• Hand X-rays if > 3 fingers involved
15. General Approach
Avoid tight woven gauze wraps
after the evaluation as these
may cause compression injury
of the digit(s)!
Image At Follow-Up After A
Compressive Gauze Was Applied
16. Case #1:
10-year-old girl with
finger pain and
bleeding after her
little brother closed a
cabinet door on her
hand.
What do you see?
17. Case #1:
10-year-old girl with
finger pain and
bleeding after her
little brother closed a
cabinet door on her
hand.
Distal tuft fracture
with associated soft
tissue swelling and a
suspected laceration.
18. Tuft Fracture
• Usually crush injury, toddlers
• Does not involve the physis
• X-rays of individual the fingers
Management:
• Open - treat soft tissue / nail bed injury,
distal amputation if avulsion injury
• Closed – clam shell / mitten cast
• Neutral hand splint 2-3 weeks, active
range of motion of the DIP joint
• Oral antibiotics for open fractures
Ancef -> Keflex x5 days
• Hand Surgery follow up if desired,
around 2-3 weeks
19. What they studied:
Functional and clinical outcomes of fixation of open and
unstable tuft fractures in toddlers using hypodermic needle.
How:
Retrospective chart review study. Exclusion criteria: fractures that
were reduced closed, fractures stable after reduction, closed
fractures, additional upper extremity fractures, distal phalanx
fractures other than tuft fractures.
1. Pediatric anesthesia managed sedation with oral midazolam,
followed by digital block.
2. Hypodermic needle inserted antegrade, passing fracture line
and touching surface of distal phalangeal joint, AP and lateral
images obtained with C arm
3. Nail bed laceration repair and trepanation was performed
with 4 holes using 23-g hypodermic needle to prevent
subungual hematoma
4. Placed in aluminum splint.
5. Discharge with 40 mg/kg/day of amox –clav, BID x 3 days.
What they found:
5/72 patients with superficial tissue infection within 1 week of
discharge. Pin loosening without fracture displacement in 2/72.
No significant difference in age, and time to union between
cosmetic and functional results. Cosmetic outcomes were better
in girls than boys (P = 0.042).
What conclusions can we make?
Fixation of open and unstable tuft fractures in children < 6 yo is
feasible in the ED, which may lead to faster time to union and less
resources than OR treatment, with functionally and cosmetically
satisfactory results.
20. Mallet Deformity /
Fracture
• ANATOMY: Extensor tendon inserts on epiphysis
• Can also have soft tissue injury with mallet
deformity, not associated with fracture (image)
• MECHANISM: Injury usually from forced flexion
• Avulsion fracture at attachment site -> damage
to extensor mechanism -> mallet deformity
• EXAM: distal phalanx flexed without active
extension of DIP, tenderness to palpation over
DIP joint
• EVAL: AP and lateral of isolated finger
• MANAGEMENT:
• Ortho consult: cortical bony misalignment that
persists after reduction attempt, persistent volar
subluxation of distal phalanx, involving more than
1/3 of articular surface
• Bony mallet fractures: immobilize x4 wks min
• Tendinous mallet fracture: immobilize x6 wks min
21. Wehbe & Schneider Management
Type I • No DIP joint subluxation
• Less than 1/3 of articular
surface involvement
• Splint / cast immobilization of
DIP in full extension for 6—8
weeks
• Hand surgery follow up
Type II • DIP joint subluxation
• 1/3 – 2/3 of articular surface
involvement
• Ortho consult
• Surgical management
Type III • Injury to epiphysis and physis
• > 2/3 of articular surface
involvement
• Ortho consult
• Surgical management
Mallet Fracture
23. Case #2:
10-year-old boy
stepped on while
playing with friends
on the school
playground.
Widened physis and
flexion deformity of
distal third phalanx.
Bone almost at the
soft tissue surface
suggesting an
associated nailbed
injury. Findings more
pronounced on the
lateral view.
24. Seymour Fracture
• Juxta-epiphyseal to distal phalanx + concomitant
nail bed laceration.
• Typically from volar force and angulation of
diaphysis compared to epiphysis
• Include physis (as opposed to tuft fractures)
• Usually secondary to hyperextension injury
• EVAL – AP and lateral of isolated finger
• Nail plate must be removed to eval for nail
matrix laceration if suspected
• ATTN: middle finger injury, can arrest growth
and alter normal arcade of finger length
MANAGEMENT:
• Closed – closed reduction, splint, Hand
Surgery follow up 1 week for repeat XR
• Open – repair nail bed laceration, (6-0 or
7-0 absorbable suture), splint, parenteral -
> PO abx x5-7 d, Hand Surgery follow up
• If not repaired, need Hand follow up in 24-
48 hours
25. Mallet v. Seymour Fracture
Tendon injuries are uncommon with Seymour
fractures because the physis is
biomechanically weaker than other
structures and displacement is at the
physis/fracture, and not at the DIP joint.
26. Case #3:
16-year-old boy, with
right 4th finger pain
after baseball
tryouts. The finger is
hyperextended on
exam
What do you see?
27. Case #3:
16-year-old boy, with
right 4th finger pain
after baseball
tryouts. The finger is
hyperextended on
exam
Avulsion fracture of
the base of the 4th
proximal phalanx
with hyperextension
concerning for a
volar plate injury.
28. Middle / Proximal
Phalanx Fracture
Fracture Patterns Management
Volar Plate • Hyperextension injury with localized
bruising over volar aspect of PIP
• Eval XR for avulsion fragment
• Dorsal splint to prevent hyperextension
30. Case #4:
14-year-old girl stuck
out her hand to
brace herself during
a car crash.
There is an articular
surface fracture of
base and shaft of
middle phalanx, with
avulsion of the volar
surface.
31. Case #4:
14-year-old girl stuck
out her hand to
brace herself during
a car crash.
This is an unstable
injury pattern!
Image on the right
following surgical
fixation (→).
33. Case #5:
6-year-old girl fell
running on the
playground.
There is a basal
metaphysis fracture
of the proximal
phalanx, which can
be seen >25 degrees
of valgus angulation
of the distal
fragment measured.
Indications for operative fixation: extra-articular fractures with >10° of angulation or
>2 mm shortening, rotational deformities, and any displaced intra-articular fractures.
34. Middle / proximal
phalanx fracture
Fracture Patterns Management
Shaft / Base • Minimally displaced • Buddy taping / splint for 3-4 weeks
• Routine Orthopedic follow-up
• Vertical oblique and spiral fractures • Plaster / fiberglass rigid splint
• Hand Surgery follow-up 3-4 weeks
• Salter Harris II at the base • ED reduction, neutral hand splint
• Follow-up with Hand Surgery
• Salter Harris III / IV • Neutral hand splint, operative
intervention in > 30% joint involvement
• Hand Surgery follow up
36. Case #6:
13-year-old boy
following a gunshot
wound to the hand.
4th finger proximal
phalanx diaphysis
fracture with
extensive
comminution.
This is an unstable
injury pattern!
37. Middle / proximal
phalanx fracture
Fracture Patterns Management
Neck • Type I - nondisplaced • Immobilization 3-4 wks
Considered
extra-articular
transverse
fracture
• Type II – displaced, unstable • Surgical management
• Neutral hand splint under surgical repair
/ eval by Hand within few days of injury
• Buddy taping / short arm splint with PIP
joint in 40-50 degree and DIP in 10 to 20
degree flexion similar outcomes1
• Type III - displaced with rotational
deformity
• Surgical management
39. Case #7:
Similar initial injury
pattern to Case 5
following reduction
and K-wire fixation of
the proximal
phalanx.
There is also a
longitudinal hairline
fracture of the base
and shaft of the
middle phalanx (→).
40. Phalanx dislocation
• Typically result from hyperextension injury
• Proximal phalanx dorsal > volar dislocation
• Simple dislocation: reduced by placing wrist
and proximal interphalangeal joint in flexion,
apply translational force at the base of the
proximal phalanx
Sumarriva G, Cook B, Godoy G, Waldron S. Pediatric Complex Metacarpophalangeal Joint Dislocation of the Index Finger. Ochsner J. 2018;18(4):398-401.
• Complex dislocation: irreducible to closed
maneuvers -> surgical fixation
• Increased odds of complex dislocation with
MCP dislocation, specifically volar plate
interposition into MCP joint, and presence
of sesamoid bones
41. What they studied:
Characterization of pediatric hand fractures that were reduced
in the ED and subsequently required repeat reduction.
How:
Retrospective chart review.
Exclusion criteria: > 18 yo, open injury, delayed presentation > 2
wks after initial injury, no follow up in hand surgery clinic or
ultimately requiring surgical fixation.
Need for repeat reduction was based on judgement of treated
physician / surgeon based on clinical exam and XR.
What they found:
2/36 proximal phalanx base fractures, 1/6 proximal
phalanx neck fractures required repeat reduction.
1/21 PIP dislocation and 2/9 MCP dislocations required
repeat reduction.
No injuries that required repeat reduction involved the
physes.
> 90% first attempt success by ED physicians.
What can we take away?
ED physicians will likely be successful with closed
reductions for pediatric hand injuries. MCP dislocations
and proximal phalanx neck fractures may be more
likely to require repeat reduction regardless.
43. Additional References
• Park KB, Lee KJ, Kwak YH. Comparison Between Buddy Taping With a Short-Arm Splint and Operative
Treatment for Phalangeal Neck Fractures in Children. J Pediatr Orthop. 2016;36(7):736-742.
doi:10.1097/BPO.0000000000000521
• Sumarriva G, Cook B, Godoy G, Waldron S. Pediatric Complex Metacarpophalangeal Joint Dislocation
of the Index Finger. Ochsner J. 2018;18(4):398-401. doi:10.31486/toj.18.0032
• Market M, Bhatt M, Agarwal A, Cheung K. Pediatric Hand Injuries Requiring Closed Reduction at a
Tertiary Pediatric Care Center. HAND. 2021;16(2):235-240. doi:10.1177/1558944719850635
• Cornwall R. Pediatric Finger Fractures: Which Ones Turn Ugly? J Pediatr Orthop.
2012;32(Supplement 1):S25-S31. doi:10.1097/BPO.0b013e31824b2582
• Lankachandra M, Wells CR, Cheng CJ, Hutchison RL. Complications of Distal Phalanx Fractures in
Children. J Hand Surg. 2017;42(7):574.e1-574.e6. doi:10.1016/j.jhsa.2017.03.042
• Dinh P, Franklin A, Hutchinson B, Schnall SB, Fassola I. Metacarpophalangeal Joint Dislocation. J Am
Acad Orthop Surg. 2009;17(5):7.
• https://www.rch.org.au/clinicalguide/guideline_index/fractures/Phalangeal_Finger_Fractures/
• https://www.orthobullets.com/hand/6038/phalanx-dislocations