This is a lecture by Dr. John Burkhardt from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
Ankle sprains are common injuries that can range from mild to severe depending on the ligament damage. The most common type is a lateral ankle sprain caused by foot inversion. Treatment involves RICE (rest, ice, compression, and elevation) followed by rehabilitation exercises and bracing. For severe or recurrent sprains, surgery may be considered to repair ruptured ligaments and reduce instability. Proper rehabilitation is important to aid recovery and prevent chronic issues.
This document provides an overview of common injuries around the hip joint, including dislocation of the hip, fracture of the femoral neck, and intertrochanteric fracture of the femur. It describes the mechanisms, clinical presentations, investigations, complications and treatment approaches for each of these injuries. Key points covered include the posterior dislocation of the hip being the most common type, various classification systems for femoral neck fractures, options for internal or external fixation, arthroplasty or hemiarthroplasty, and complications such as nonunion, avascular necrosis and osteoarthritis.
This document discusses tenosynovitis, including its definition, etiology, prognosis, pathophysiology, history, physical examination findings, workup, treatment, and postoperative care. Tenosynovitis is inflammation of the tendon sheath that can be caused by overuse, infection, or inflammatory conditions like rheumatoid arthritis. Physical exam may reveal tenderness, swelling, or limited range of motion. Treatment depends on the cause but may include rest, splinting, anti-inflammatories, corticosteroid injections, or surgery. Prognosis is generally good if treated early without comorbidities, while complications can include adhesion formation or tendon rupture if left untreated.
This document provides guidance on interpreting knee x-rays and films. It discusses proper positioning for various knee views, including sunrise, tunnel, lateral, and Merchant views. Common findings on knee films are fractures of the patella, tibial plateau, fibular head, and distal femur. Dislocations and occult fractures must also be considered. The document provides tips on evaluating films for specific injuries like patellar fractures and sleeve fractures in children.
Femoral head fractures occur in 5-15% of hip dislocations and often go undiagnosed. The Pipkins classification categorizes femoral head fractures into four types based on location and severity, with implications for surgical management and prognosis. Type I fractures involve the non-weight bearing portion, Type II the weight bearing portion, Type III include an associated neck fracture, and Type IV include an acetabular fracture. Diagnosis is typically via x-ray or CT scan. Treatment depends on fracture type, with smaller Type I fragments sometimes treated non-operatively, Type II fractures requiring open reduction and internal fixation, and arthroplasty considered for more complex or elderly fractures. Complications can include avascular necrosis, arthritis
This document provides information on meniscal tears of the knee. It begins with an introduction stating that meniscal tears are common injuries responsible for many arthroscopies annually. It then covers anatomy of the medial and lateral menisci, blood supply, classification of tears, mechanisms of injury, clinical features, investigations like MRI and arthroscopy, and treatment options including non-operative care, meniscectomy, and meniscal repair. The focus is on providing detailed information on meniscal anatomy, tears, and surgical and non-surgical management.
Osteoarthritis and rheumatoid arthritis are chronic joint disorders. Osteoarthritis involves the progressive breakdown of articular cartilage in a joint. It is associated with aging and risk factors like obesity, joint injury, and genetics. Rheumatoid arthritis is an autoimmune disease where the immune system attacks the joints, causing pain, stiffness, and swelling. It can eventually damage cartilage and bone within joints and may affect other organs. Both diseases are diagnosed based on symptoms, physical exam, x-rays, and blood tests. Treatment focuses on reducing pain and inflammation, maintaining joint mobility, and may include medications, weight loss, or joint replacement surgery.
Ankle sprains are common injuries that can range from mild to severe depending on the ligament damage. The most common type is a lateral ankle sprain caused by foot inversion. Treatment involves RICE (rest, ice, compression, and elevation) followed by rehabilitation exercises and bracing. For severe or recurrent sprains, surgery may be considered to repair ruptured ligaments and reduce instability. Proper rehabilitation is important to aid recovery and prevent chronic issues.
This document provides an overview of common injuries around the hip joint, including dislocation of the hip, fracture of the femoral neck, and intertrochanteric fracture of the femur. It describes the mechanisms, clinical presentations, investigations, complications and treatment approaches for each of these injuries. Key points covered include the posterior dislocation of the hip being the most common type, various classification systems for femoral neck fractures, options for internal or external fixation, arthroplasty or hemiarthroplasty, and complications such as nonunion, avascular necrosis and osteoarthritis.
This document discusses tenosynovitis, including its definition, etiology, prognosis, pathophysiology, history, physical examination findings, workup, treatment, and postoperative care. Tenosynovitis is inflammation of the tendon sheath that can be caused by overuse, infection, or inflammatory conditions like rheumatoid arthritis. Physical exam may reveal tenderness, swelling, or limited range of motion. Treatment depends on the cause but may include rest, splinting, anti-inflammatories, corticosteroid injections, or surgery. Prognosis is generally good if treated early without comorbidities, while complications can include adhesion formation or tendon rupture if left untreated.
This document provides guidance on interpreting knee x-rays and films. It discusses proper positioning for various knee views, including sunrise, tunnel, lateral, and Merchant views. Common findings on knee films are fractures of the patella, tibial plateau, fibular head, and distal femur. Dislocations and occult fractures must also be considered. The document provides tips on evaluating films for specific injuries like patellar fractures and sleeve fractures in children.
Femoral head fractures occur in 5-15% of hip dislocations and often go undiagnosed. The Pipkins classification categorizes femoral head fractures into four types based on location and severity, with implications for surgical management and prognosis. Type I fractures involve the non-weight bearing portion, Type II the weight bearing portion, Type III include an associated neck fracture, and Type IV include an acetabular fracture. Diagnosis is typically via x-ray or CT scan. Treatment depends on fracture type, with smaller Type I fragments sometimes treated non-operatively, Type II fractures requiring open reduction and internal fixation, and arthroplasty considered for more complex or elderly fractures. Complications can include avascular necrosis, arthritis
This document provides information on meniscal tears of the knee. It begins with an introduction stating that meniscal tears are common injuries responsible for many arthroscopies annually. It then covers anatomy of the medial and lateral menisci, blood supply, classification of tears, mechanisms of injury, clinical features, investigations like MRI and arthroscopy, and treatment options including non-operative care, meniscectomy, and meniscal repair. The focus is on providing detailed information on meniscal anatomy, tears, and surgical and non-surgical management.
Osteoarthritis and rheumatoid arthritis are chronic joint disorders. Osteoarthritis involves the progressive breakdown of articular cartilage in a joint. It is associated with aging and risk factors like obesity, joint injury, and genetics. Rheumatoid arthritis is an autoimmune disease where the immune system attacks the joints, causing pain, stiffness, and swelling. It can eventually damage cartilage and bone within joints and may affect other organs. Both diseases are diagnosed based on symptoms, physical exam, x-rays, and blood tests. Treatment focuses on reducing pain and inflammation, maintaining joint mobility, and may include medications, weight loss, or joint replacement surgery.
The document discusses ankle fractures, including their causes, anatomy, types of fractures, and treatment options. Ankle fractures commonly occur from falls or twists and can lead to disability if not treated properly. The ankle is made up of three bones - the tibia, fibula, and talus - held together by ligaments. Fractures are classified using the Weber or Lauge-Hansen systems and are diagnosed via x-rays. Treatment depends on the type of fracture but may involve casting or surgery like plating, screws, or wiring to repair displaced fractures. Complications can include infection, malunion, stiffness, or arthritis.
Flat foot, also known as pes planus, is a condition where the arch of the foot collapses, causing the entire sole of the foot to touch the ground. It can be congenital or acquired later in life. Flexible flat foot can be corrected by dorsiflexing the toes while rigid flat foot cannot. Treatment depends on the type and severity, ranging from exercises and orthotics to reconstructive surgery like triple arthrodesis for rigid flat foot. The goal is to relieve pain by restoring the arch alignment and motion of the foot.
Charcot joint or neuropathic joint are destructed joint occurs in Diabetes, syphilis, syringomyelia , leprosy, AMLS, Peripheral neuropathy and any condition leads to impair sensation of peripheral part of body
Osteochondrosis is a defect in bone growth that causes avascular necrosis. It commonly affects the epiphyses of joints in children and adolescents. Some specific types discussed include Legg-Calve-Perthes disease of the hip, Kohler's disease of the navicular bone, and Freiberg's infraction of the metatarsal heads. The document outlines the causes, presentations, classifications, imaging findings, and treatment options for various forms of osteochondrosis.
The document discusses bone infection or osteomyelitis, including causes such as bacterial infection spreading through the bloodstream or nearby tissue, symptoms like fever and bone pain, diagnosis through tests like blood work, x-rays and biopsies, and treatment involving long-term antibiotic therapy and sometimes surgery to drain infections and remove damaged tissue. Osteomyelitis can affect people of all ages but is more common in infants, children, and older adults.
This document provides information about Charcot disease (neuropathic osteoarthropathy). It begins with a brief history, noting early descriptions by Musgrave and Charcot. Charcot disease is defined as a non-infective, destructive process affecting bones and joints caused by neuropathy. Risk factors include diabetes, alcoholism, and other conditions causing neuropathy. Clinical presentation varies from swelling in acute cases to structural deformities in chronic cases. Management involves immobilization, bracing, surgery such as fusion or osteotomy to correct deformities, and sometimes amputation for severe cases. Complications can include fractures, deformities, ulcers, and infection.
Genuvalgum and Genuvarum are conditions where the legs are angled abnormally in relation to the thighs. Genuvarum, also known as bow legs, involves medial angulation where the legs bend outward and the Q angle is small. Genuvalgum, or knock knees, involves lateral angulation where the legs bend inward and the Q angle is large. The document defines these conditions and their characteristics including abnormal femur and tibia positioning and differences in Q angle measurements.
This document discusses hip dislocations, including types, causes, signs, treatments, and complications. It describes three main types of hip dislocation - posterior, anterior, and central. Posterior dislocations are the most common and often result from dashboard injuries, causing the leg to appear short, adducted, internally rotated and flexed. Treatment involves closed or open reduction depending on the severity of the dislocation and any fractures. Complications can be early such as nerve palsies or late such as avascular necrosis and osteoarthritis.
Bursitis and tendinitis are conditions involving inflammation of soft tissues like bursae and tendons around joints. They are commonly caused by overuse or repetitive motions. Symptoms include pain in areas like the shoulder, elbow, wrist, hip, knee or ankle. Diagnosis involves medical history, exams, and sometimes imaging tests. Treatment focuses on rest, anti-inflammatory medications, physical therapy, and corticosteroid injections if needed. Prevention emphasizes warming up, strengthening, taking breaks, and gradually increasing activity levels.
This document discusses flat feet (pes planus), including its anatomy, causes, types, symptoms, physical exam findings, and treatment options. Key points include:
- Pes planus is characterized by a low or absent medial longitudinal arch. It can be flexible or rigid.
- Causes include ligament laxity, obesity, muscle weakness, bony abnormalities, and tarsal coalitions.
- Treatment focuses on orthotics, stretches, braces, and surgery if conservative options fail. Surgical procedures include tendon lengthening, osteotomies, and fusions.
The document discusses internal derangements of the knee, focusing on injuries to ligaments and cartilages. It describes the anatomy of the knee joint and then examines several specific ligament injuries in more detail, including the medial collateral ligament, lateral collateral ligament, and anterior cruciate ligament. For each, it covers anatomy, mechanisms of injury, clinical findings, and treatment approaches. The most common derangements involve injuries to the medial collateral ligament, medial meniscus, and anterior cruciate ligament.
Coccydynia is pain arising from the coccyx or tailbone that is commonly caused by trauma, infection, or idiopathic factors. It presents as pain localized to the coccyx that is exacerbated by sitting, standing from sitting, intercourse, defecation, and menstruation. Diagnosis involves physical exam, x-rays, CT, or MRI. Conservative treatments like anti-inflammatories, cushions, and physical therapy resolve most cases, but injections or coccygectomy may be used if conservative options fail.
This document discusses plantar fasciitis, a common cause of heel pain. It begins by explaining that plantar fasciitis is pain in the heel and arch of the foot, especially upon waking or with the first steps of the day. It then covers the typical symptoms of plantar fasciitis such as heel pain that is worst with the first steps and located inside the arch or central heel. The document discusses that plantar fasciitis is often caused by activities like running that put too much stress on the feet too quickly, hard surfaces, or old shoes without proper support. It concludes by outlining common treatment options for plantar fasciitis that can be done at home or in the doctor's office, such
The document discusses physeal (growth plate) injuries in children. It notes that physeal injuries represent 15-20% of injuries in children and can cause growth arrest and deformities. The most common sites are the distal radius, distal tibia, and phalanges. It describes the anatomy and blood supply of the physis. It discusses the Salter-Harris classification system for physeal fractures and treatment approaches including casting, splinting, and surgery. Complications of physeal injuries like growth arrest, angular deformity, and limb length discrepancy are also summarized. Long term follow up is needed to monitor bone healing and growth.
This document provides an outline and overview of paediatric orthopaedics, focusing on congenital talipes equino varus (clubfoot). It defines clubfoot as an idiopathic condition causing cavus, adductus, varus, and equinus deformities. It discusses the epidemiology, potential causes, anatomical abnormalities, clinical features, imaging, and main treatment approach of serial casting developed by Ponseti. The goal of treatment is to produce a plantigrade, supple foot through gradual correction of the deformities.
This document summarizes the causes, pathogenesis, and grading of Volkmann's ischemic contracture. It begins by describing Volkmann's ischemic contracture as a condition characterized by ischemic necrosis and contractures in the forearm and hand. Prolonged external compression from casts or tight dressings is a main cause, as is internal bleeding or fluid extravasation. The pathogenesis involves prolonged ischemia of muscles and nerves, leading to muscle necrosis, fibrosis, and contracture. Nerve injury can also cause muscle dysfunction or sensory deficits. Rowland's and Seddon's theories are described to explain the development of ischemia and pattern of injury. The contracture is graded as mild, moderate, or severe depending on the extent of flexor
1. The document discusses degenerative disc disease, which describes the natural breakdown of an intervertebral disc in the spine. As discs degenerate, they lose water and proteoglycan content, collagen fibers become distorted, and tears can occur, resulting in decreased disc height, impaired mobility, and pain.
2. Degenerative disc changes include disc bulges, annular tears (concentric, radial, transverse), and herniations (protruded, extruded, intravertebral). Herniations involve the displacement of disc material beyond the disc space.
3. MRI is the best method for diagnosing degenerative disc conditions. Management includes therapeutic exercises and medical treatment.
CPPD deposition disease, also known as pseudogout, most commonly affects the elderly and involves the deposition of calcium pyrophosphate dihydrate crystals in joints. While usually asymptomatic, it can sometimes cause acute arthritis. The deposition is associated with increased pyrophosphate production and decreased glycosaminoglycans in cartilage. Acute attacks are treated with joint aspiration, NSAIDs, or corticosteroids, while chronic cases may require medications like colchicine or DMARDs. The knee is the most frequently involved joint.
This document discusses congenital vertical talus (CVT), a rare foot deformity. It begins by defining CVT and providing background information. It then describes the anatomy and pathoanatomy of CVT. Key points include that CVT results in an almost vertical talus bone and rigid flatfoot deformity. Treatment involves serial casting and manipulation to prepare for surgery, with the goal of restoring normal anatomical relationships in the foot. Surgical techniques described include open reduction and percutaneous fixation of the talonavicular joint with K-wires. Complications of surgery can include wound issues and stiffness.
1) Lumbar spinal stenosis is caused by narrowing of the spinal canal from degenerative changes like disc bulging, thickened ligaments, and bone spurs which compress the spinal nerves and reduce blood flow.
2) It presents with leg and lower back pain that is exacerbated by standing and walking (called neurogenic claudication) and relieved by sitting or leaning forward.
3) Examination may reveal weakness, sensory changes, and reduced reflexes in the legs consistent with nerve root compression.
A physical therapy case study of an individual who presented to the clinic following surgical repair of an open distal tibia fracture. Signs and symptoms consisted of weakness and balance difficulties following prolonged wearing of hard cast, soft cast, and boot. Additional sensation loss over the dorsum and lateral edge of involved foot was also present.
The document discusses ankle fractures, including their causes, anatomy, types of fractures, and treatment options. Ankle fractures commonly occur from falls or twists and can lead to disability if not treated properly. The ankle is made up of three bones - the tibia, fibula, and talus - held together by ligaments. Fractures are classified using the Weber or Lauge-Hansen systems and are diagnosed via x-rays. Treatment depends on the type of fracture but may involve casting or surgery like plating, screws, or wiring to repair displaced fractures. Complications can include infection, malunion, stiffness, or arthritis.
Flat foot, also known as pes planus, is a condition where the arch of the foot collapses, causing the entire sole of the foot to touch the ground. It can be congenital or acquired later in life. Flexible flat foot can be corrected by dorsiflexing the toes while rigid flat foot cannot. Treatment depends on the type and severity, ranging from exercises and orthotics to reconstructive surgery like triple arthrodesis for rigid flat foot. The goal is to relieve pain by restoring the arch alignment and motion of the foot.
Charcot joint or neuropathic joint are destructed joint occurs in Diabetes, syphilis, syringomyelia , leprosy, AMLS, Peripheral neuropathy and any condition leads to impair sensation of peripheral part of body
Osteochondrosis is a defect in bone growth that causes avascular necrosis. It commonly affects the epiphyses of joints in children and adolescents. Some specific types discussed include Legg-Calve-Perthes disease of the hip, Kohler's disease of the navicular bone, and Freiberg's infraction of the metatarsal heads. The document outlines the causes, presentations, classifications, imaging findings, and treatment options for various forms of osteochondrosis.
The document discusses bone infection or osteomyelitis, including causes such as bacterial infection spreading through the bloodstream or nearby tissue, symptoms like fever and bone pain, diagnosis through tests like blood work, x-rays and biopsies, and treatment involving long-term antibiotic therapy and sometimes surgery to drain infections and remove damaged tissue. Osteomyelitis can affect people of all ages but is more common in infants, children, and older adults.
This document provides information about Charcot disease (neuropathic osteoarthropathy). It begins with a brief history, noting early descriptions by Musgrave and Charcot. Charcot disease is defined as a non-infective, destructive process affecting bones and joints caused by neuropathy. Risk factors include diabetes, alcoholism, and other conditions causing neuropathy. Clinical presentation varies from swelling in acute cases to structural deformities in chronic cases. Management involves immobilization, bracing, surgery such as fusion or osteotomy to correct deformities, and sometimes amputation for severe cases. Complications can include fractures, deformities, ulcers, and infection.
Genuvalgum and Genuvarum are conditions where the legs are angled abnormally in relation to the thighs. Genuvarum, also known as bow legs, involves medial angulation where the legs bend outward and the Q angle is small. Genuvalgum, or knock knees, involves lateral angulation where the legs bend inward and the Q angle is large. The document defines these conditions and their characteristics including abnormal femur and tibia positioning and differences in Q angle measurements.
This document discusses hip dislocations, including types, causes, signs, treatments, and complications. It describes three main types of hip dislocation - posterior, anterior, and central. Posterior dislocations are the most common and often result from dashboard injuries, causing the leg to appear short, adducted, internally rotated and flexed. Treatment involves closed or open reduction depending on the severity of the dislocation and any fractures. Complications can be early such as nerve palsies or late such as avascular necrosis and osteoarthritis.
Bursitis and tendinitis are conditions involving inflammation of soft tissues like bursae and tendons around joints. They are commonly caused by overuse or repetitive motions. Symptoms include pain in areas like the shoulder, elbow, wrist, hip, knee or ankle. Diagnosis involves medical history, exams, and sometimes imaging tests. Treatment focuses on rest, anti-inflammatory medications, physical therapy, and corticosteroid injections if needed. Prevention emphasizes warming up, strengthening, taking breaks, and gradually increasing activity levels.
This document discusses flat feet (pes planus), including its anatomy, causes, types, symptoms, physical exam findings, and treatment options. Key points include:
- Pes planus is characterized by a low or absent medial longitudinal arch. It can be flexible or rigid.
- Causes include ligament laxity, obesity, muscle weakness, bony abnormalities, and tarsal coalitions.
- Treatment focuses on orthotics, stretches, braces, and surgery if conservative options fail. Surgical procedures include tendon lengthening, osteotomies, and fusions.
The document discusses internal derangements of the knee, focusing on injuries to ligaments and cartilages. It describes the anatomy of the knee joint and then examines several specific ligament injuries in more detail, including the medial collateral ligament, lateral collateral ligament, and anterior cruciate ligament. For each, it covers anatomy, mechanisms of injury, clinical findings, and treatment approaches. The most common derangements involve injuries to the medial collateral ligament, medial meniscus, and anterior cruciate ligament.
Coccydynia is pain arising from the coccyx or tailbone that is commonly caused by trauma, infection, or idiopathic factors. It presents as pain localized to the coccyx that is exacerbated by sitting, standing from sitting, intercourse, defecation, and menstruation. Diagnosis involves physical exam, x-rays, CT, or MRI. Conservative treatments like anti-inflammatories, cushions, and physical therapy resolve most cases, but injections or coccygectomy may be used if conservative options fail.
This document discusses plantar fasciitis, a common cause of heel pain. It begins by explaining that plantar fasciitis is pain in the heel and arch of the foot, especially upon waking or with the first steps of the day. It then covers the typical symptoms of plantar fasciitis such as heel pain that is worst with the first steps and located inside the arch or central heel. The document discusses that plantar fasciitis is often caused by activities like running that put too much stress on the feet too quickly, hard surfaces, or old shoes without proper support. It concludes by outlining common treatment options for plantar fasciitis that can be done at home or in the doctor's office, such
The document discusses physeal (growth plate) injuries in children. It notes that physeal injuries represent 15-20% of injuries in children and can cause growth arrest and deformities. The most common sites are the distal radius, distal tibia, and phalanges. It describes the anatomy and blood supply of the physis. It discusses the Salter-Harris classification system for physeal fractures and treatment approaches including casting, splinting, and surgery. Complications of physeal injuries like growth arrest, angular deformity, and limb length discrepancy are also summarized. Long term follow up is needed to monitor bone healing and growth.
This document provides an outline and overview of paediatric orthopaedics, focusing on congenital talipes equino varus (clubfoot). It defines clubfoot as an idiopathic condition causing cavus, adductus, varus, and equinus deformities. It discusses the epidemiology, potential causes, anatomical abnormalities, clinical features, imaging, and main treatment approach of serial casting developed by Ponseti. The goal of treatment is to produce a plantigrade, supple foot through gradual correction of the deformities.
This document summarizes the causes, pathogenesis, and grading of Volkmann's ischemic contracture. It begins by describing Volkmann's ischemic contracture as a condition characterized by ischemic necrosis and contractures in the forearm and hand. Prolonged external compression from casts or tight dressings is a main cause, as is internal bleeding or fluid extravasation. The pathogenesis involves prolonged ischemia of muscles and nerves, leading to muscle necrosis, fibrosis, and contracture. Nerve injury can also cause muscle dysfunction or sensory deficits. Rowland's and Seddon's theories are described to explain the development of ischemia and pattern of injury. The contracture is graded as mild, moderate, or severe depending on the extent of flexor
1. The document discusses degenerative disc disease, which describes the natural breakdown of an intervertebral disc in the spine. As discs degenerate, they lose water and proteoglycan content, collagen fibers become distorted, and tears can occur, resulting in decreased disc height, impaired mobility, and pain.
2. Degenerative disc changes include disc bulges, annular tears (concentric, radial, transverse), and herniations (protruded, extruded, intravertebral). Herniations involve the displacement of disc material beyond the disc space.
3. MRI is the best method for diagnosing degenerative disc conditions. Management includes therapeutic exercises and medical treatment.
CPPD deposition disease, also known as pseudogout, most commonly affects the elderly and involves the deposition of calcium pyrophosphate dihydrate crystals in joints. While usually asymptomatic, it can sometimes cause acute arthritis. The deposition is associated with increased pyrophosphate production and decreased glycosaminoglycans in cartilage. Acute attacks are treated with joint aspiration, NSAIDs, or corticosteroids, while chronic cases may require medications like colchicine or DMARDs. The knee is the most frequently involved joint.
This document discusses congenital vertical talus (CVT), a rare foot deformity. It begins by defining CVT and providing background information. It then describes the anatomy and pathoanatomy of CVT. Key points include that CVT results in an almost vertical talus bone and rigid flatfoot deformity. Treatment involves serial casting and manipulation to prepare for surgery, with the goal of restoring normal anatomical relationships in the foot. Surgical techniques described include open reduction and percutaneous fixation of the talonavicular joint with K-wires. Complications of surgery can include wound issues and stiffness.
1) Lumbar spinal stenosis is caused by narrowing of the spinal canal from degenerative changes like disc bulging, thickened ligaments, and bone spurs which compress the spinal nerves and reduce blood flow.
2) It presents with leg and lower back pain that is exacerbated by standing and walking (called neurogenic claudication) and relieved by sitting or leaning forward.
3) Examination may reveal weakness, sensory changes, and reduced reflexes in the legs consistent with nerve root compression.
A physical therapy case study of an individual who presented to the clinic following surgical repair of an open distal tibia fracture. Signs and symptoms consisted of weakness and balance difficulties following prolonged wearing of hard cast, soft cast, and boot. Additional sensation loss over the dorsum and lateral edge of involved foot was also present.
1) A Lisfranc fracture is a fracture or dislocation of the tarsal bones where they meet the bases of the metatarsal bones in the midfoot.
2) It is usually caused by high-energy twisting injuries or axial loading with the foot fixed. Common mechanisms are falls from heights or motor vehicle accidents.
3) Diagnosis involves x-rays of the foot, and sometimes CT or MRI to further evaluate bone and ligament injuries. Operative treatment is usually needed for displaced fractures to restore the normal alignment of the bones.
The Lisfranc joint was named after a field surgeon who described an amputation through the joint due to gangrene from an injury sustained after a soldier fell from a horse. Lisfranc injuries account for less than 1% of fractures and can result from high-energy trauma or less stressful twisting injuries. Diagnosis can be difficult as swelling and pain in the midfoot region are often the only findings. Treatment involves immobilization for mild sprains but surgery within 1-2 days for fractures or dislocations to ensure proper healing and prevent long-term disability. Surgical techniques include open reduction and internal fixation to anatomically realign the bones which allows for better functional outcomes compared to fusion or casting.
Kin191 A. Ch.5. Ankle. Lower Leg. Evaluation. Fall 2007JLS10
The document provides an overview of procedures for evaluating lower extremity injuries of the ankle and lower leg. It details assessing history, inspecting for signs of injury, performing palpation of anatomical structures, range of motion and ligament stability testing, and evaluating neurologic and vascular function. The evaluation covers the anterior, lateral, medial, and posterior structures of the ankle and lower leg.
This document discusses Jones fractures, which are fractures of the metaphyseal-diaphyseal junction of the fifth metatarsal bone. It describes the anatomy and vascular supply of the region. Treatment options include non-operative management with casting for non-athletic patients or operative fixation with screws for athletes or active patients to expedite healing. The technique of percutaneous screw fixation is discussed, emphasizing the importance of starting the guidewire "high and inside" the bone. Postoperative management and potential complications are also reviewed.
Hip, pelvis, femur and knee lower extremity trauma 2012matthewjimenezMD
This document provides an overview of lower extremity trauma, with a focus on injuries to the hip, pelvis, femur, and knee. It discusses the relevant anatomy, mechanisms of injury, classifications of fractures, indications for surgery, and surgical approaches. Key points covered include the importance of pelvic stability, classifications of pelvic fractures, indications for surgical stabilization such as rotationally unstable or multiplanar unstable fractures, and approaches like external fixation. Acetabular fractures, femoral head fractures, and femoral neck fractures are also summarized in terms of anatomy, classifications, and treatment considerations.
This document discusses the physical examination of the shoulder, including assessment of range of motion and specific tests to evaluate for common shoulder pathologies. It begins by reviewing the anatomy of the shoulder joint and surrounding structures. Range of motion is assessed in all planes, including active and passive motion. Specific tests are described to evaluate the rotator cuff muscles, biceps tendon, and impingement. Conditions like tendonitis, bursitis, tears, and impingement can be identified by pain or weakness during particular range of motion activities against resistance. The physical examination provides insight into shoulder function and the source of any pain or limitations.
This document discusses common pediatric disorders of the lower extremity, including developmental dysplasia of the hip (DDH), Legg-Calve-Perthes disease, slipped capital femoral epiphysis, knee deformities like bowing and knock-knees, clubfoot, and flat feet. For DDH, it describes methods for detection in newborns, including the Ortolani and Barlow tests, and treatments like Pavlik harnesses or surgery. For knee issues, it provides guidance on when bowing or valgus deformities require intervention versus allowing for natural resolution. Treatment methods for clubfoot including serial casting are also outlined.
The ankle is a three bone joint composed of the tibia, fibula, and talus. The talus articulates superiorly with the tibial plafond and posteriorly and medially with the posterior and medial malleoli. Laterally, it articulates with the fibular malleolus. The ankle joint is saddle-shaped and wider anteriorly than posteriorly. During dorsiflexion, the fibula rotates externally through the tibiofibular syndesmosis to accommodate the widened anterior surface of the talar dome. Displacement of the talus within the ankle mortise by only 1 mm decreases the contact area by 42%.
The document discusses Jones fractures, which are fractures of the fifth metatarsal bone. It defines Jones fractures, explains their anatomy and blood supply, mechanisms of injury, classification, treatment options including casting, surgery, and post-operative care. Jones fractures have a high rate of non-union due to the area's poor blood supply and are challenging to treat, especially in active patients. Surgical fixation may allow for shorter recovery times compared to casting alone.
Plantar fasciitis is an inflammation of the plantar fascia in the foot that causes heel pain. It is caused by overuse from activities like long-distance running or tight calf muscles limiting the foot's range of motion. Symptoms include pain, swelling, and warmth in the heel area. Conservative treatments include stretching exercises, orthotics, night splints, taping, and manual therapies to increase flexibility and support the arch. Treatment may last several months to two years and surgery is an option for severe cases that do not improve.
Dr. Manoj Das' document provides an overview of examining the foot and ankle. It discusses the anatomy of the foot and ankle including bones, joints, ligaments and muscles. The examination involves taking a history, observing gait, posture and deformities, palpating for tenderness, and assessing range of motion, neurovascular status, and performing special tests. The goal is to assess, diagnose and treat conditions of the foot and ankle.
The document discusses various types of lower extremity trauma including fractures of the hip, femur, knee, tibia, and ankle. For each injury, the document describes the mechanism of injury, classification systems, treatment options, and important clinical considerations. Management involves restoring anatomy, protecting soft tissues, preventing complications, and allowing for early mobilization depending on the specific fracture pattern and patient factors.
An ankle sprain is a common injury caused by trauma to the ankle ligaments from excessive inversion or eversion. It can range from mild stretching to complete tears. Incidence is highest among athletes. Symptoms include pain, swelling, bruising and difficulty walking. Assessment involves examining range of motion, stability tests like the anterior drawer test, and imaging to rule out fractures. Treatment depends on severity but may include RICE, bracing and physical therapy.
The document discusses various radiographic exposure factors and how they influence the quantity and quality of x-radiation exposure to patients. It describes how factors like kVp, mA, and exposure time determine the radiation dose and beam quality. It also discusses how the design of the x-ray machine like focal spot size, filtration, and high voltage generation impact technical settings. Film factors like sensitometry, contrast, and processing also influence radiographic image quality.
Fractures of the lower limb can result from high-energy trauma or osteoporosis in the elderly. Common fractures include the femur, patella, tibia, fibula, ankle, and bones of the foot. Treatment depends on the type and location of the fracture, ranging from closed reduction and casting to open reduction with internal fixation using plates, screws, or intramedullary nails. Pelvic fractures may also require surgical fixation depending on the forces involved and stability of the injury.
The shoulder joint is a ball and socket joint formed between the humerus, scapula, and clavicle. It allows for a great range of motion but lacks stability. Stability is provided by bony structures like the acromion and ligaments like the glenohumeral and coracohumeral ligaments. The joint is surrounded by muscles like the deltoid and rotator cuff which both move the arm and provide dynamic stability. Blood supply comes from branches of the axillary artery and it is innervated by nerves like the axillary nerve.
GEMC- Lower Extremity Injuries- Resident Training Open.Michigan
This is a lecture by Dr, John Burkhardt from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
The document provides an overview of common lower extremity injuries involving the knee, ankle, and foot that present in emergency departments. It reviews the epidemiology, history, physical exam, diagnostic workup, and initial management of injuries to structures like the ligaments, bones, meniscus, and articular cartilage in the knee. Key points covered include evaluating for effusions, assessing range of motion and joint stability, and implementing decision rules like the Ottawa Knee Rules to determine if imaging is needed. Initial treatment focuses on splinting, immobilization, referral to orthopedics, and considering surgical intervention for unstable or displaced fractures.
GEMC - Musculoskeletal Emergencies - for NursesOpen.Michigan
This is a lecture by Katherine A Perry from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC - Plain Films of the Foot and Ankle - Resident TrainingOpen.Michigan
1) The document provides an overview of plain films of the ankle and foot, reviewing normal anatomy, common injuries, and radiographic findings.
2) Key points covered include the Ottawa Ankle Rules for determining need for ankle and foot x-rays, targeting analysis of malleoli and mortise joint for ankle films, and common fractures of the ankle, calcaneus, fifth metatarsal, and Lisfranc joint.
3) Radiographs are recommended based on pain location and tenderness findings rather than just swelling, and isolated injuries of distal phalanges may not require films.
11.30.09(a): Introduction to the M2 Musculoskeletal SequenceOpen.Michigan
This document provides an overview of the M2 Musculoskeletal Sequence curriculum at the University of Michigan Medical School in Fall 2009. The goals are to learn the musculoskeletal exam, common musculoskeletal disorders and treatments, forms of arthritis, autoimmune disorders, and metabolic bone diseases. The curriculum includes lectures, pathology labs, physical exam sessions, case discussions and is graded based on exams, participation and practice sessions. The overall aim is to improve musculoskeletal education and prepare students for managing related conditions.
GEMC- Arthritis and Arthrocentesis- Resident TrainingOpen.Michigan
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC: Musculoskeletal Jeopardy: Resident Training Open.Michigan
This is a lecture by Dr. Jeff Holmes from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
12.02.09(a): Other Inflammatory ArthritidesOpen.Michigan
Slideshow is from the University of Michigan Medical School's M2 Musculoskeletal sequence
View additional course materials on Open.Michigan:
openmi.ch/med-M2Muscu
This is a lecture by Dr. Joseph Hartmann from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
A lecture on uncertainty by Dr. Rajesh Mangrulkar, M.D. This lecture was taught as a part of the University of Michigan Medical School's M1 - Patients and Populations Sequence.
View the course materials:
http://open.umich.edu/education/med/m1/patientspop-decisionmaking/2010/materials
Creative Commons Attribution-Non Commercial-Share Alike 3.0 License
http://creativecommons.org/licenses/by-nc-sa/3.0/
This is a lecture by Dr. Jeff Holmes from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC - Bone and Joint Infections - Resident TrainingOpen.Michigan
This is a lecture by Dr. Keith Kocher from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Dr. Keith Kocher from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
HOT COFFEE” MOVIE WORKSHEET BUS 347 PROF. CHIZEVER TERMPazSilviapm
“HOT COFFEE” MOVIE WORKSHEET BUS 347 PROF. CHIZEVER TERM:____
Student Names/Group #:_________________________________________
1. The McDonald’s hot coffee case was the “bumper sticker” case and the subject of jokes as an example of frivolous lawsuits. What is your definition of a frivolous lawsuit?
2. Had you heard of this case before? What were your impressions of the case before you saw this movie?
3. When the plaintiff spilled the coffee, was she driving the car? How did she spill the coffee? Have you ever spilled coffee or any other hot drink?
4. How extensive were the burns? What effect do you think would there have been if the coffee spilled on a baby?
5. The jury was asked to allocate a percentage of fault to the plaintiff. What percentage did they give to her?______ What would you have given?_____
6. Name three reasons why the jury found McDonalds liable for her injuries:
7. What are compensatory damages?
8. How much did they award in punitive damages?_____________
9. What is the purpose of punitive damages?
10. How did the jury come up with that amount?
11. Do you believe their evaluation was fair? Explain.
12. McDonalds’ coffee is now 10 degrees lower. On balance, are you pleased they lowered it to avoid more injuries, or is this an unfair restriction on the freedom of the company to do business as they wish?
13. What is a tort?
14. What is tort reform? Were you aware of this before seeing the movie?
15. ATRA (American Tort Reform Association). Who formed it and whose interests do they primarily represent?
16. George W Bush mounted a campaign in Texas for medical liability reform, claiming there were “too many lawsuits in America” and that excessive jury awards were a major cause of increased costs in the health care system.
Texas instituted limits and caps on jury awards. What has happened to health care costs in Texas since then?
17. Caps on damages in Nebraska required that the jury award of $5.6 million for Colin, a permanently disabled child whose disability was caused by medical malpractice, was dramatically reduced. Who is now responsible for paying for the money needed for his care?
18. Who benefitted from the reduction?
9. Some lawyers claim it is unconstitutional to take away the power of the jury to determine the amount of damages and give it to the legislature. What constitutional right may be violated?
20. Caps on damages may be applied to punitive, non-economic and the entire amount. What are non-economic damages?
21. Where caps have been instituted, have medical malpractice rates decreased?
22. Who are the founders and major supporters of the U.S. Chamber of Commerce?
23. What is the Chamber’s main function and who is on the Board of Directors?
24. What are the limits on individuals’ contributions to elections?
25. Why would businesses want to influence the election of judges in a state?
26. In Mississippi, what per ...
Slideshow is from the University of Michigan Medical School's M1 Patients and Populations: Medical Decision-Making Sequence
View additional course materials on Open.Michigan:
openmi.ch/med-M1PatientsPopulations
GEMC - Trauma Patient Care in the Emergency Department : Pitfalls to AvoidOpen.Michigan
This is a lecture from the Ghana Emergency Medicine Collaborative (GEMC). To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This document provides guidelines for the initial assessment and management of trauma patients, outlining the primary survey using the ABCDE approach to identify and treat life-threatening injuries, ensure adequate breathing and ventilation, establish intravenous access for fluid resuscitation, and conduct a full secondary survey to identify all injuries. It describes mechanisms of blunt and penetrating trauma, preparation of the trauma team, and interventions for airway management and spinal immobilization during the primary survey.
GEMC: Upper Extremity Injuries: Shoulder, Elbow and Wrist: Resident TrainingOpen.Michigan
This is a lecture by Dr. Patrick Carter from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/
Knee injuries are very common, especially in athletes and workers. The knee is a complex joint made of bones, ligaments, tendons and cartilage that allow flexion and extension. Common work-related knee injuries include strains, ligament tears, cartilage injuries, tendon injuries and fractures. Injuries to the ACL, meniscus and articular cartilage are most frequent. Treatment depends on the injury but may include RICE, rehabilitation, bracing, surgery and activity modification. Surgical reconstruction is often needed for severe ligament and tendon injuries.
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Jim Holliman, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC- Alterations in Body Temperature: The Adult Patient with a Fever- Reside...Open.Michigan
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC- Rapid Sequence Intubation & Emergency Airway Support in the Pediatric E...Open.Michigan
This is a lecture by Michele Nypaver, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This document provides an overview of ocular emergencies. It begins with an introduction to the Project: Ghana Emergency Medicine Collaborative and author information. The bulk of the document consists of slides reviewing various eye conditions and emergencies, including styes, chalazions, conjunctivitis, iritis, orbital cellulitis, subconjunctival hemorrhages, and scleritis. Treatment approaches are provided for many of the conditions. The document concludes with a discussion of the eye examination approach and areas to be reviewed.
GEMC- Disorders of the Pleura, Mediastinum, and Chest Wall- Resident TrainingOpen.Michigan
This document provides an overview of disorders of the pleura, mediastinum, and chest wall. It discusses several topics in 1-3 sentences each, including costochondritis (inflammation of the costal cartilages), mediastinitis (infection of the mediastinum), mediastinal masses, pneumothorax (air in the pleural space), and catamenial pneumothorax (recurrent pneumothorax associated with menstruation). The document aims to enhance understanding of the major clinical disorders commonly encountered in emergency medicine involving the pleura, mediastinum, and chest wall.
GEMC- Dental Emergencies and Common Dental Blocks- Resident TrainingOpen.Michigan
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC- Bursitis, Tendonitis, Fibromyalgia, and RSD- Resident TrainingOpen.Michigan
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC- Right Upper Quadrant Ultrasound- Resident TrainingOpen.Michigan
This is a lecture by Jeff Holmes from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
The document summarizes cardiovascular topics including pericardial tamponade, pericarditis, infective endocarditis, hypertension, tumors, and valvular disorders. It provides details on the causes, signs and symptoms, diagnostic studies, and management of these conditions. The document also includes bonus sections on cardiac transplant patients, pacemakers and ICDs, and EKG morphology.
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC: Nursing Process and Linkage between Theory and PracticeOpen.Michigan
This is a lecture by Jeremy Lapham from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
2014 gemc-nursing-lapham-general survey and patient care managementOpen.Michigan
This is a lecture by Dr. Jeremy Lapham from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This document discusses the evaluation and management of patients with kidney failure presenting to the emergency department. It covers causes of acute kidney injury including pre-renal, intra-renal and post-renal failure. It also discusses evaluation of kidney function, risks of intravenous contrast, dialysis indications and complications in chronic kidney disease patients including infection, cardiovascular issues and electrolyte abnormalities. Special considerations are outlined for resuscitating, evaluating and treating kidney failure patients in the emergency setting.
GEMC: The Role of Radiography in the Initial Evaluation of C-Spine TraumaOpen.Michigan
This is a lecture by Dr. Stephen Hartsell from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Dr. Jim Holliman from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC- Sickle Cell Disease: Special Considerations in Pediatrics- Resident Tra...Open.Michigan
This is a lecture by Hannah Smith, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
Main Java[All of the Base Concepts}.docxadhitya5119
This is part 1 of my Java Learning Journey. This Contains Custom methods, classes, constructors, packages, multithreading , try- catch block, finally block and more.
How to Build a Module in Odoo 17 Using the Scaffold MethodCeline George
Odoo provides an option for creating a module by using a single line command. By using this command the user can make a whole structure of a module. It is very easy for a beginner to make a module. There is no need to make each file manually. This slide will show how to create a module using the scaffold method.
How to Add Chatter in the odoo 17 ERP ModuleCeline George
In Odoo, the chatter is like a chat tool that helps you work together on records. You can leave notes and track things, making it easier to talk with your team and partners. Inside chatter, all communication history, activity, and changes will be displayed.
Chapter wise All Notes of First year Basic Civil Engineering.pptxDenish Jangid
Chapter wise All Notes of First year Basic Civil Engineering
Syllabus
Chapter-1
Introduction to objective, scope and outcome the subject
Chapter 2
Introduction: Scope and Specialization of Civil Engineering, Role of civil Engineer in Society, Impact of infrastructural development on economy of country.
Chapter 3
Surveying: Object Principles & Types of Surveying; Site Plans, Plans & Maps; Scales & Unit of different Measurements.
Linear Measurements: Instruments used. Linear Measurement by Tape, Ranging out Survey Lines and overcoming Obstructions; Measurements on sloping ground; Tape corrections, conventional symbols. Angular Measurements: Instruments used; Introduction to Compass Surveying, Bearings and Longitude & Latitude of a Line, Introduction to total station.
Levelling: Instrument used Object of levelling, Methods of levelling in brief, and Contour maps.
Chapter 4
Buildings: Selection of site for Buildings, Layout of Building Plan, Types of buildings, Plinth area, carpet area, floor space index, Introduction to building byelaws, concept of sun light & ventilation. Components of Buildings & their functions, Basic concept of R.C.C., Introduction to types of foundation
Chapter 5
Transportation: Introduction to Transportation Engineering; Traffic and Road Safety: Types and Characteristics of Various Modes of Transportation; Various Road Traffic Signs, Causes of Accidents and Road Safety Measures.
Chapter 6
Environmental Engineering: Environmental Pollution, Environmental Acts and Regulations, Functional Concepts of Ecology, Basics of Species, Biodiversity, Ecosystem, Hydrological Cycle; Chemical Cycles: Carbon, Nitrogen & Phosphorus; Energy Flow in Ecosystems.
Water Pollution: Water Quality standards, Introduction to Treatment & Disposal of Waste Water. Reuse and Saving of Water, Rain Water Harvesting. Solid Waste Management: Classification of Solid Waste, Collection, Transportation and Disposal of Solid. Recycling of Solid Waste: Energy Recovery, Sanitary Landfill, On-Site Sanitation. Air & Noise Pollution: Primary and Secondary air pollutants, Harmful effects of Air Pollution, Control of Air Pollution. . Noise Pollution Harmful Effects of noise pollution, control of noise pollution, Global warming & Climate Change, Ozone depletion, Greenhouse effect
Text Books:
1. Palancharmy, Basic Civil Engineering, McGraw Hill publishers.
2. Satheesh Gopi, Basic Civil Engineering, Pearson Publishers.
3. Ketki Rangwala Dalal, Essentials of Civil Engineering, Charotar Publishing House.
4. BCP, Surveying volume 1
This slide is special for master students (MIBS & MIFB) in UUM. Also useful for readers who are interested in the topic of contemporary Islamic banking.
it describes the bony anatomy including the femoral head , acetabulum, labrum . also discusses the capsule , ligaments . muscle that act on the hip joint and the range of motion are outlined. factors affecting hip joint stability and weight transmission through the joint are summarized.
A workshop hosted by the South African Journal of Science aimed at postgraduate students and early career researchers with little or no experience in writing and publishing journal articles.
How to Fix the Import Error in the Odoo 17Celine George
An import error occurs when a program fails to import a module or library, disrupting its execution. In languages like Python, this issue arises when the specified module cannot be found or accessed, hindering the program's functionality. Resolving import errors is crucial for maintaining smooth software operation and uninterrupted development processes.
বাংলাদেশের অর্থনৈতিক সমীক্ষা ২০২৪ [Bangladesh Economic Review 2024 Bangla.pdf] কম্পিউটার , ট্যাব ও স্মার্ট ফোন ভার্সন সহ সম্পূর্ণ বাংলা ই-বুক বা pdf বই " সুচিপত্র ...বুকমার্ক মেনু 🔖 ও হাইপার লিংক মেনু 📝👆 যুক্ত ..
আমাদের সবার জন্য খুব খুব গুরুত্বপূর্ণ একটি বই ..বিসিএস, ব্যাংক, ইউনিভার্সিটি ভর্তি ও যে কোন প্রতিযোগিতা মূলক পরীক্ষার জন্য এর খুব ইম্পরট্যান্ট একটি বিষয় ...তাছাড়া বাংলাদেশের সাম্প্রতিক যে কোন ডাটা বা তথ্য এই বইতে পাবেন ...
তাই একজন নাগরিক হিসাবে এই তথ্য গুলো আপনার জানা প্রয়োজন ...।
বিসিএস ও ব্যাংক এর লিখিত পরীক্ষা ...+এছাড়া মাধ্যমিক ও উচ্চমাধ্যমিকের স্টুডেন্টদের জন্য অনেক কাজে আসবে ...
Strategies for Effective Upskilling is a presentation by Chinwendu Peace in a Your Skill Boost Masterclass organisation by the Excellence Foundation for South Sudan on 08th and 09th June 2024 from 1 PM to 3 PM on each day.
Your Skill Boost Masterclass: Strategies for Effective Upskilling
GEMC- Injuries of the Lower Extremity: Knee, Ankle and Foot- Resident Training
1. Project: Ghana Emergency Medicine Collaborative
Document Title: Injuries of the Lower Extremity: Knee, Ankle and Foot
Author(s): John Burkhardt (University of Michigan), MD 2012
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2
3. 3
Injuries of the Lower Extremity:
Knee, Ankle and Foot
John Burkhardt, MD
Clinical Lecturer
University of Michigan
Departments of Emergency Medicine and
Medical Education
4. 4
First Steps
• I need a volunteer or two who is willing to move
up to the front of the room and help me a
demonstration
• The rest of you come closer and arrange
yourselves so you can talk amongst yourselves
(No not because my lecture is going to be that
boring)
5. 5
Objectives
• To provide a review of common lower extremity
injuries that present in an Emergency
Department setting, focusing on those involving
in the knee, ankle and foot
• To describe the epidemiology of these injuries
• To review the appropriate history and physical
exam maneuvers in order to quickly evaluate
and distinguish the different emergent injuries
• To review the diagnostic examinations available
for further evaluation
• To describe the preliminary management of the
in the emergent setting
6. 6
Basic Anatomy of the Knee
•
•
•
•
•
Large Hinge Joint
Femur
Tibia
Fibula
Patella
Kari Stemmen,
Wikimedia Commons
9. 9
Types of Knee Injuries
• Injuries to one or more of the ligaments of the
knee (ACL, PCL, MCL, and LCL)
• Injuries to the bony structures (Patellar
fractures, femur fractures, tibial fractures)
• Injuries to the meniscus and articulating surface
10. 10
Key Pieces of History
• Fracture
▫ High-velocity collision
Inability to immediately bear
weight
"Pop" occurred with injury
• Meniscal tear
• ACL tear
▫ Cut or pivot mechanism of
injury
Knee "gave way"
Inability to continue
participation
"Pop" felt or heard with injury
• Overuse syndrome
• PCL tear
▫ Blow to proximal tibia
Less instability than ACL tear
▫ Squat/kneel associated with a twist
Clicking
Locking
Pain with rotational movement
▫ Occupational or recreational
repetitive movement
11. Epidemiology of Knee Injuries
• Subset of
Ligamentous injuries
• All Knee injuries
Source undetermined
11
12. 12
Stepwise evaluation of the
injured knee
• Palpate the knee and determine the areas of
maximal tenderness
• Examine and note the presence and location of
any effusion
• Evaluate the Range of Motion at the Knee
• Evaluate the movement and stability of the
patella
• Perform specific ligamentous stability testing
• Perform Meniscal examination
• Examine for neurovascular compromise
13. 13
Palpation
• Superior Patella Pole
(Quadriceps Tendonitis)
• Inferior Patella Pole
(Prepatellar Tendonitis)
• Anterior Patella (Prepatellar
Bursitis)
bernblue, flickr
17. 17
tronixstuff, flickr
Range of Motion
• The knee should be able to range from
hyperextension to 135 degrees of flexion
• Loss of active extension and inability to maintain
passive extension are indicative of quadriceps
and patellar tendon
18. Patellar Testing
• Examine the patella,
with ROM testing,
feeling for catches
and grinding
• Next test the
movement of the
patella testing for
lateral laxity (Patellar
Dislocation
openmichigan, YouTube
18
19. ACL testing
• Anterior Drawer sign
▫ Performed at 90 degrees
flexion
▫ Make sure the quadriceps
muscles are relaxed
▫ Compare the amount of
laxity of movement
compared to unaffected side
• Lachman’s Test
▫ Perfromed at 20 to 30
degrees flexion
Mak-Ham Lam et al.,
19
Wikimedia Commons
20. 20
PCL Testing
• Posterior Drawer sign
▫ Gold Standard
▫ Performed similarly to
Anterior drawer sign
openmichigan, YouTube
Posterior Sag Sign
-Observe the lag at maximum
muscle relaxation
-Compare to unaffected leg
openmichigan, YouTube
21. 21
MCL Testing
• Valgus stressing of the
MCL at both 0 and 30
degrees
• Testing at 30 degrees
removes the stabilization
provided by the cruciate
ligaments
openmichigan, YouTube
openmichigan, YouTube
22. 22
LCL Testing
• LCL testing similar to
MCL testing
• Varus stress testing
• Performed at 0 and 30
degrees
openmichigan, YouTube
23. Meniscal Testing
openmichigan, YouTube
• McMurray’s Test to
evaluate for Meniscal
injury
• Positive test is
“clicking” along joint
line along with pain
during internal and
external rotation
23
24. Ottawa Knee Rules
• OK break into groups
and lets take 1 minute
and list the criteria
• Hint: There are 5
24
25. Ottawa Knee Rules
• Age 55 years or older
• Tenderness at head of
fibula
• Isolated tenderness of
patella
• Inability to flex to 90°
• Inability to bear weight
both immediately and in
ED
25
26. Ottawa Knee Rules: The Numbers
• In one meta-analysis the decision
rule had a sensitivity of 1.0 (95%
confidence interval 0.96 to 1.0) in
identifying clinically important
fractures.
• In the same study the potential
reduction in use of radiography
was estimated to be 49%
• The probability of fracture, if the
decision rules were negative, was
estimated to be 0% (95% CI 0% to
0.5%)
• Not worth a patient complaint
trekkyandy, flickr
26
28. Plain Films
• Traditional Standard
of Care when concern
for fracture
• Generally A/P and
Lateral performed in
ER
• Additional Useful
images include a
“Sunrise” view
Source Undetermined
28
29. 29
Computer Tomography
• Useful in detecting tibial plateau fracture
• Usually performed when diagnosis is unclear
Source Undetermined
30. 30
Ultrasound
Source Undetermined
• Often used to examine the musculature of a joint
while in use
• Provides dynamic imaging for examining muscle
tears, tendon ruptures, and other soft tissue
injuries.
31. Magnetic Resonance Imaging
• Most useful for
examination of meniscal
injuries
• Can be used for
evaluating for
ligamentous injury
▫ ACL has high sensitivity but
poor sensitivity in
determining complete
versus partial tear
▫ Very sensitive in PCL
Source Undetermined
31
33. Patellar Fractures
• If extension is possible
without displacement
▫ non operative management
▫ Initially treated in knee
immobilizer
▫ Treated long leg cast 4-6
weeks
▫ Operative management
consists of ORIF
Source Undetermined
33
34. Patellar Dislocation
• Closed reduction may be
attempted
▫ Gentle extension of the leg
with anteriomedial pressure
on the lateral aspect of the
patella
▫ Following reduction patient
should be placed in a knee
immobilizer for 3-6 weeks
▫ 30-50% recurrence rate in
properly treated primary
dislocations
Nadja.robot, flickr
34
35. Distal Femur Fracture
Source Undetermined
• Usually secondary to
MVC or significant
fall
• After examination,
the leg should be
splinted
• If joint incongruity,
Othro consult and
ORIF
• Patients are at risk for
fat embolus
35
36. Tibial Plateau Fracture
•
•
•
•
More common in the elderly
Usually strong varus force as cause
By definition are intrarticular
Often with associated ACL or MCL
injury (20-25%)
• Patient should be made non-weight
bearing and placed in immobilization
either with a long leg cast or
immobilizer
• Patient may require ORIF in more
serious or displaced fractures
Source Undetermined
36
37. 37
Epiphyseal Fracture
• Constitute a fracture through an open growth
plate
• Anatomic reduction
• Ice, elevation, immobilization with a long leg
splint
• Early orthopedic consultation
SalterHarris,
Wikimedia Commons
38. 38
Osteochondritis Dissecans (OCD)
• Unknown etiology, thought to be related to
chronic or acute trauma
• Occurs mostly in adolescent males
• Usually seen on plain films
• In patients with open growth plates, treat with
protected weight bearing
• Poor prognosis if closed
• If loose piece, may require OR
Kristin M Houghton,
Wikimedia Commons
39. Meniscal Injuries
Arthroscopist,
Wikimedia Commons
• Crescent shaped semilunar
fibrocartilaginous structures
• Diagnosis via MRI after
clinical suspicion
• Unless locking, initial
management is NSAIDs, ice,
knee immobilization, non
weight bearing, and
orthopedic referral
• Ultimate management is
determined often secondary
to associate ligamentous
injury
39
41. ACL injuries
• 50% of ACL injuries are associated with meniscal injuries
• Often associated with bleeding and thus immediate
swelling
• Grade I and II should be managed conservatively with
pain meds and range of motion exercises
• Patient should be made non weight bearing
• If possible, patient should not be placed in a knee
immobilizer if an isolated injury
41
42. 42
PCL injuries
John Collins,
Wikimedia Commons
• Hyperflexion and Dashboard injuries when
isolated injury
• Generally managed non-operatively
• Treated long term with quadriceps
strengthening
43. 43
MCL injuries
• Often due to a direct blow to the lateral aspect of
the knee
• Should be placed in knee immobilizer and
allowed to “scar” down
• Long term management is generally non
operative in isolated injury
44. 44
LCL injury
• Less common than others, due to protection
provided by other leg
• Management the same as with MCL
▫ Non-operative management
▫ Knee immobilization
46. 46
Tibial Femoral Knee Dislocation
• Longitudinal Reduction should be
attempted immediately after
documentation of neurovascular status
• Recheck of neurovascular status post
reduction
• Arteriogram should be performed in any
patient not immediately going to the OR
if there is any concern of vascular injury
• Prompt vascular surgery involvement in
a must
49. 49
Ankle Anatomy
Subtalar Function
• Subtalar joint consists of the
talus and the calcaneus
• Allows for inversion and
eversion
eversion
inversion
Grook Da Oger,
Wikimedia Commons
51. 51
Ankle Medial ligament (Deltoid)
Anterior tibiootalar part
Tibiocalcaneal part
Tibionavicular part
Posterior tibiootalar part
Pngbot, Wikimedia Commons
52. 52
Ankle Ring
• Integrity of the ring necessary
for stability of the ankle
• Consists of the following:
אנדר-ויק
Wikimedia
Commons
▫
▫
▫
▫
▫
▫
▫
Tibial plafond,
Medial malleolus,
Deltoid ligaments,
Calcaneus,
Lateral collateral ligaments
Lateral malleolus
Syndesmotic ligaments
54. 54
Ankle Injury Pathophysiology
• Excessive inversion stress
(85%) is the most common
cause of ankle injuries for two
reasons:
▫ Medial malleolus is shorter
than the lateral malleolus,
allowing the talus to invert
more than evert.
▫ Deltoid ligament stabilizing
the medial aspect is stronger
• However, given the above
when eversion injuries occur
there is often substantial
damage
55. 55
Ankle examination
• Look at the ankle for signs of deformity,
redness, or swelling
• Feel for tender areas, systematically
checking:
• 1. the anterior joint line
• 2. the lateral gutter and lateral ligaments
• 3. the syndesmosis
• 4. the posterior joint line
• 5. the medial ligament complex
• 6. the medial gutter
• Feel for an effusion, synovitis, deformity,
bony prominence and loose bodies.
• Examine for neurovascular compromise
56. 56
Ankle Joint Testing
• Drawer and Talar tilt
examination techniques are
used to assess ankle instability
• Anterior talofibular ligament
▫ Anterior drawer test
• Calcaneofibular ligament
▫ (Talar Tilt) Inversion stress
test
• Deltoid ligament
▫ (Talar Tilt) Eversion stress
test
Grook Da Oger,
Wikimedia Commons
• Use of these techniques in
acute injuries an be limited by
pain, edema, and muscle
spasm
58. Ottawa Ankle/Foot Rules
• OK break into groups one more time and
lets take 1 minute and list the criteria
58
59. 59
Ottawa Ankle Rules
• X-rays are only required if:
• There is any pain in the
malleolar zone and:
• Bone tenderness along the
distal 6 cm of the posterior
edge of the tibia or tip of the
medial malleolus
• Bone tenderness along the
distal 6 cm of the posterior
edge of the fibula or tip of the
lateral malleolus
• An inability to bear weight
both immediately and in the
ED
http://www.bmj.com/content/
326/7386/417.full
60. 60
Ottawa Ankle Rules: The Numbers
• In a meta-analysis the pooled negative likelihood ratios for the
ankle and midfoot were 0.08 (95% confidence interval 0.03 to
0.18) and 0.08 (0.03 to 0.20)
• Applying these ratios to a 15% prevalence of fracture gave a less
than 1.4% probability of actual fracture
• Sensitivity of almost 100%
• Reduce the number of unnecessary radiographs by 3040%
61. 61
Ankle Sprain Classification
• Grade 1: Ligament stretching
with microscopic tearing but
not macroscopic tearing.
▫ Little swelling is present
▫ Little or no functional loss
and no joint instability
▫ Able to fully or partially bear
weight.
• Grade 2: Partial tear
▫ Moderate-to-severe swelling,
ecchymosis
▫ Moderate functional loss, and
mild-to-moderate joint
instability
▫ Difficulty bearing weight
• Grade 3: Complete rupture of
the ligament
▫ Immediate and severe
swelling and ecchymosis
▫ Moderate-to-severe
instability of the joint
▫ Cannot bear weight without
experiencing severe pain.
62. 62
ATFL
Ankle Ligamentous Injury Types
CFL
PTFL
Pngbot, Wikimedia Commons
• ATFL is the most likely
ATFL component of the lateral ankle
complex to be injured in a
lateral ankle sprain
• In forced dorsiflexion, the
PTFL can rupture
• External rotation can disrupt
the deep deltoid ligament on
the medial side
• Forced adduction in neutral
and dorsiflexed positions can
disrupt the Calcaneofibular
(CFL)
63. Syndesmosis Sprains
Ankle syndesmosis injury
• Account 10% of all ankle
sprains and as high as 18% of
football players
• Excessive external rotation of
the talus or forced dorsiflexion
causes the talus to place
pressure on the fibula
• Results in spreading of the
distal syndesmosis as well as
damage to anterior or
posterior tibiofibular ligament
Quibik, Wikimedia Commons
65. 65
Ankle Sprain Prognosis
• Most report full recovery at 2 weeks to 36 months (36-85%)
▫ Independent of the initial grade of sprain
▫ Most recovery occurs within the first 6 months
• After 12 months, the risk of recurrent ankle sprain returns to
pre-injury levels
• Re-sprains occur in up to 36% of patients, athletes are at
increased risk
66. 66
Isolated Malleolar Fracture
(Unimalleolar)
• ED Docs describe based off
number fractures
▫ unimalleolar, bimalleolar,
trimalleolar
• Distal fibula or less common
tibial fracture
• Fractures below the Tibiotalar
line (T-t, distal to the tibial
plafond) are usually stable
http://www.wheelessonline.com/image7/ank120.jpg
67. 67
Bimalleolar fracture
• Involves the lateral and medial
malleolus
• ED Treatment involves
fracture reduction and
realignment
• Initial ED management is
usually followed by surgical
fixation
• Ortho consult in ED
Source Undetermined
http://www.georgelianmd.com/cms/ConditionsITreat/
AnkleFractures/tabid/117/Default.aspx
68. 68
Trimalleolar Fracture
• Involves the lateral malleolus,
medial malleolus, and the
distal posterior aspect of the
tibia
• Unstable, loss of lateral control
• Surgical repair is required
• Ortho consult in ED
http://www.georgelianmd.com/cms/ConditionsITreat/
AnkleFractures/tabid/117/Default.aspx
69. 69
Ankle Fracture Classifications
• Danis-Weber classification
often used by Ortho
▫ Some correlation with need
for operative stabilization
▫ Lauge-Hansen alternative
classification system
• Type A: Transverse fibular
avulsion fracture, occasionally
with an oblique fracture of the
medial malleolus
▫ From internal rotation and
adduction
▫ Usually stable fractures
• Type B: Oblique fracture of the
lateral malleolus with or
without rupture of the
tibiofibular syndesmosis and
medial injury
▫ From external rotation
▫ May be unstable
• Type C High fibular fracture
with rupture of the tibiofibular
ligament and transverse
avulsion fracture of the medial
malleolus
▫ From adduction or abduction
with external rotation
▫ Usually unstable and require
operative repair
70. 70
Pilon Fracture
• Fracture of the distal tibial
metaphysis combined with
disruption of the talar dome.
• Result of an axial loading
mechanism drives the talus
into the tibial plafond
▫ Foot braced against a
floorboard in an auto
collision.
▫ Skiers coming to an
unexpected sudden stop
▫ Free fall from heights
• Fractures often open and can
be associated with lumbar
spine injuries
http://www.georgelianmd.com/cms/ConditionsITreat/
AnkleFractures/tabid/117/Default.aspx
71. 71
Maisonneuve fracture
• Proximal fibular fracture
coexisting with a medial
malleolar fracture or
disruption of the deltoid
ligament
• Associated with partial or
complete disruption of the
syndesmosis
• Important to perform a
physical exam or xrays to
assess for this in ankle injuries
http://www.wheelessonline.com/
image7/mason1.jpg
72. 72
Tillaux fracture
• Salter-Harris (SH) type III
injury of the anterolateral
tibial epiphysis
• Caused by extreme eversion
and lateral rotation
• Incidence is highest in
adolescents because the
fracture occurs after the
medial aspect of the epiphyseal
plate closes but before the
lateral
http://emedicine.medscape.com/article/
824224-clinical#showall
73. 73
Ankle Dislocation
• Associated fractures are the
rule rather than the exception
with ankle dislocations
• Neurovascular injury is the
principal concern
• Tented skin may be subject to
ischemic necrosis
• Immediate reduction in the ED
is often required
OakleyOriginals, flickr
76. 76
Ottawa Foot Rules
• X-ray series is indicated if
there is any pain in the
midfoot zone and any one of
the following:
• Bone tenderness at the base of
the fifth metatarsal (for foot
injuries)
• Bone tenderness at the
navicular bone (for foot
injuries)
• An inability to bear weight
both immediately and in the
emergency department for
four steps.
http://www.bmj.com/content/
326/7386/417.full
78. 78
Padding
Toe fractures
• Buddy tape the broken toe to
an adjacent, uninjured toe
• Apply a rigid flat-bottom
orthopedic shoe
• Union of fracture segments
occurs in 3-8 weeks
• Symptoms usually improve
much earlier
• Irreducible fractures
sometimes require open
reduction and internal fixation
spaceninja,flickr
Buddy-taped toes
79. 79
First metatarsal fracture
• Least commonly fractured
metatarsal
• Bears twice the weight of other
metatarsal heads.
• Treat minimally displaced or
nondisplaced fractures with
immobilization without weight
bearing
• Displaced fractures usually
require open reduction and
internal fixation
http://www.mdmercy.com/footandankle/
conditions/trauma/fractures_metatarsals.html
80. 80
Internal metatarsal fracture
• Nondisplaced and displaced fractures usually heal well, with
weight bearing as tolerated, in a cast or rigid flat-bottom
orthopedic shoe.
• Elastic support bandages may be equivalent or superior to casts
• Must look for Lisfranc Injury as this is a game changer
• March fracture is a stress fracture of the second or third
metatarsal that occurs in joggers.
81. 81
Jones’ fracture
• Transverse fracture of the 5th
metatarsal
• Must be at least 15 mm distal
to proximal end
• High rate of malunion
• As above contact Ortho
• Pseudo-Jones: avulsion
fracture of tuberosity at 5th
metatarsal
Stress
Frx
Jones
Frx
Avulsion
Frx
Lucien Monfils ,
Wikimedia Commons
82. 82
Lisfranc fracture
• Site of articulation between the
midfoot and forefoot
• Dislocation at the TMT joint
• Result of direct blow to the
joint or by axial loading along
the metatarsal, either with
medially or laterally directed
rotational forces
• Fracture at the base of second
metatarsal should raise
concern for this type on injury
• Often need weight bearring
films to see displacement
James Heilman, MD, Wikimedia Commons
84. 84
Navicular Fracture
• Avuslsion fracture most common • All navicular body fractures
with 1 mm or more of
displacement require open
• Type 1: coronal fracture with no
reduction and internal
dislocation
fixation.
• Type 2: dorsolateral to
plantomedial fracture with
medial forefoot displacement
• Type 3: comminuted fracture
with lateral forefoot displacement
• Most patients are placed in a
non–weight-bearing cast for 6
weeks
http://www.aafp.org/afp/2003/0101/p85.html
85. 85
Calcaneal fracture-Bohler’s angle
• Calcaneus fractures most often
occur in males 5:1
• Peak age: between 30 and 50
years.
• Associated injuries (Lumbar
spine vertebral compression
fractures)
• Treatment: Operative vs
Casting
• Ortho Consult
Thomas Steiner,
Wikimedia Commons
86. 86
When to call Ortho for foot injuries
• Talus fractures
• Calcaneusfractures
• Navicular fractures, especially
if intraarticular
• Cuboid fractures
• Lisfranc injuries
• Metatarsal shaft fractures with
> 3 mm displacement or 10
degrees angulation
• Metatarsal head and neck
fractures
• Jones fractures
greggoconnell, flickr
88. 88
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