Comminuted Fracture Case Study

She said, she fell last night while playing volley ball. She landed on her right shoulder and heard a pop sound, too. She did not take any pain medicines. She applied icepack and felt burning pain. This was an interesting musculoskeletal assessment case. We assessed her right shoulder and compared with the left one. We found slight dislocation of the shoulder joint. She had good circulation in her right arm, no swelling noted in the right hand and the capillary refill was < 2 secs. Mary said, since she had burning pain, it could be a nerve injury, too. We also noted a slight swelling of her trapezius muscle on the right side. She complained of pain on palpation. Mary applied a sling to her right arm to keep it elevated. She may need an MRI to see the damage. Mary sent her to the urgent care. She told her that, since she heard the popped sound, the ER or Urgent care doctor can replace it. It will be a painful procedure, and she will need a strong pain medicine. She gave her the note for her teacher and asked her friend to drive her to the urgent

Bone bruises often accompany ACLu tears, and their locations may indicate the mechanismu of injury. ( 49 )

Keep all follow-up visits as directed by your health care provider. This is important. Failure to follow-up as recommended could result in permanent injury, disability, and long-lasting (chronic) pain.

PHYSICAL EXAM: Examination shows comparing the right hand to the left, including the hand and wrist region, that there are skin scratches, very superficial, from activity. There is no tenderness. There is no soft tissue swelling. There is normal alignment. No deep tenderness to palpation over the fractures. No crepitus. No instability. Active range of motion is about 85% of the contralateral left side.

Based on the progress report dated 06/27/16 by Dr. Mcclurg, the patient complains of sharp right shoulder pain, post-operative shoulder arthroscopy. Symptoms are moderate with significant limitations. PT is to be started on the next visit.

The parties again utilized Dr. Previte as the AME. In his report dated May 23, 2015, Dr. Previte found impairment to both wrists. Interestingly, he apportioned 50% of the right arm impairment to the cumulative trauma injury ending on January 14, 2006. He then apportioned another 50% of the right arm impairment as well as 100% of the left arm impairment to the other cumulative trauma injury ending on March 2,

A more severe fracture will require surgery. This includes some type II fractures and all type III fractures. Surgical treatment requires opening the knee (open reduction) or using a small surgical instrument equipped with a scope (arthroscopy) to operate inside the

“The decision to observe a fracture or proceed with surgery is based on the clinical exam findings, orbital imaging, and assessment of the risk and benefit of either option may also make a decision to do surgery” (Boyette et al., 2015, p. 230). One of their options is to prescribe the patient with prophylactic antibiotics. These antibiotics will reduce the likelihood of infection, which is caused by the interaction between the orbital floor and maxillary sinus (Prentice, 2016). If symptoms persist, physicians will then decide whether or not surgery is necessary. One of the most common indications that physicians need to move forward in the treatment process, is the symptom of diplopia. If diplopia occurs, it is highly suggested that the patient moves forward and undergoes surgical treatment. During a surgical repair, doctors will reconstruct the orbit of the eye. The surgeon has different choices when it comes to the size of the implant they decide to use. They may either use a large, single implant or multiple, tiny implants (Hur et al., 2015). Following any type of a blowout fracture, the patient is not required to go through any type of rehabilitation. Everyday activities, including chewing and facial expressions, serve as a natural form of

Posterior malleolar fractures (PMF) are relatively common injuries with an incidence of 7%-44% among rotational ankle fractures (1-3). It can occur in settings of tri malleolar fractures or in association with pilon fractures as a distinguished posterior column fracture ( 4…….). It can also be presented as an isolated posterior malleolar farcture (5 ). Less satisfactory clinical outcomes and a high risk of degenerative osteoarthritis are reported in literature with posterior malleolus involvement (6-10). Biomechanically, the displaced posterior malleolar fragment causes a decrease in the joint contact area and predisposing the ankle to degenerative changes (11-13). Fixation of the posterior malleolar fractures remains an area of controversy in orthopaedic surgery.

While you may be able to get a good idea if a break occurred from eyeballing the injury, the only way to be sure if a break occurred is through an x-ray. If you are not sure about a fracture, follow this one simple rule: When in doubt, check it out.

• Do not use the injured limb to support your body weight until your health care provider says that you can. Use crutches, a scooter, a walker, or a wheelchair as told by your health care provider.

Therefore, numerous spectrums of instability types and associated lesions affecting capsuloabral, ligamentous, and osseous structures can be identified (Stayner et al., 2000). The pathophysiology of an anterior shoulder dislocation involves violent external rotation in abduction levers causing the humerus to be dislodged from the glenoid socket, tearing the shoulder capsule and detaching the labrum from the glenoid (the Bankart lesion) (Farber et al., 2006). Additionally, the posterior part of the humeral head exits the joint, colliding with the anterior rim of the glenoid, producing a bony depression at the back of the humeral head (the Hill Sachs lesion) (Farber et al., 2006). Furthermore, anterior dislocation can occur when people fall with a combination of abduction, extension, and a force directed posteriorly on the arm; this is a common mechanism in the elderly (Stayner et al. 2000). A fracture of the humeral head, neck or greater tuberosity can occur with a dislocation (Stayner et al., 2000). In contrast, a posteriorly dislocated shoulder is less common. It is commonly caused by external forces acting on the shoulder when the shoulder is held in internal rotation and adduction caused by direct trauma experienced during sporting activities (Hegedus et al., 2008). Additionally, it may be result from an epileptic fit,

• The fractured tibia may be fixed in place using one or more of the following

The primary cause of a fracture is trauma from car accidents, sports injuries and falls. The trauma may be a direct blow to the bone or an indirect force from muscle contractions or pulling on the bone. Other factors that may contribute to fractures include: vigorous exercise, malnutrition, genetic factors, and osteoporosis. The most common cause of a distal radius fracture is falling onto an outstretched arm (Ignatavicius & Workman, 2013). “Wrist fractures of the distal radius are common and may present special problems for the surgeon and therapist. There are several categories of distal radius fractures, but the Colles fracture of the distal radius is the most common injury to the wrist and may result in limitations in wrist flexion and extension, as well as forearm pronation and supination, resulting from the involvement of the distal radioulnar joint” (Early, p.613).

Nine Type-I and six Type-IV fractures were identified in this series. All patients were right-hand dominant. The dominant side was injured in three cases only. The mechanism of injury was a low-energy fall in all cases. All fractures were closed. There were no associated neurovascular injuries. There were two ipsilateral radial head fractures and one lateral epicondyle fracture. No other concomitant upper limb musculoskeletal injuries were seen. Intraoperatively, trochlear involvement was identified in association with all Type-IV fractures. The lateral collateral ligament was intact in all fractured elbows, except in one where the lateral collateral ligament was found to be avulsed along with an attached lateral epicondyle fracture fragment.