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Orthopaedics
Published in Kristen Davies, Shadaba Ahmed, Core Conditions for Medical and Surgical Finals, 2020
Complications of fractures include tissue damage (haemorrhage, shock, infection, rhabdomyolysis), compartment syndrome (increase in pressure within a closed fascial compartment), neurological damage (e.g. neuropraxia, pain), malunion and avascular necrosis. (For specific hip surgery complications see Section 11.1.)
Orthopaedics
Published in Roy Palmer, Diana Wetherill, Medicine for Lawyers, 2020
There are several types of fracture: open or compoundclosed or simplespiralobliquetransversecomminutedgreensticktraction or avulsioncompressionpathological.
Management of a well menopausal 13 woman: the role of menopause clinics
Published in Barry G. Wren, Progress in the Management of the Menopause, 2020
How can osteoporosis be best diagnosed before fracture occurs, rather than after the event? Can osteoporosis be prevented? Can fracture be prevented? Should bone density be measured in all women? Can osteoporosis be predicted on clinical factors only? Ribot and co- workers4concluded that ‘Direct bone densitometry remains indispensable to assess osteoporosis since risk factors alone are not sufficient for accurate delineation of either low or normal bone density’. If bone densitometry is an essential screening tool in all clinics, what is the cost/benefit ratio? This appears not to have been evaluated so far5. This and similar questions may be best answered in a well women’s screening clinic.
Return to physical activity six months after fracture – a prospective cohort study
Published in European Journal of Physiotherapy, 2021
Martin Johansson, Camilla Paludan Nielsen, Anders Falk Brekke, Marianne Lindahl
A population, more or less forced to decrease their level of physical activity, are persons suffering from a fracture due to an accident [6]. Treatment of fractures often consists of immobilisation in a cast or surgical fixation followed by a period with immobilisation of the injured body part. Therefore, it is to be expected, that physically active people consequently reduce their level of physical activity towards a sedentary behaviour in the period with immobilisation [7]. The period with decreased level of physical activity might be prolonged after the immobilisation period due to pain, loss of muscle strength, loss of range of motion and balance. Little is known about how fractures affect leisure time physical activity in the long term, or whether it is at all possible for former physically active individuals to return to their previous level of physical activity. The consequences of an accident leading to fracture and the recovery process should be understood in a biopsychosocial perspective [8] because the impact on patients’ mental health, working life and physical condition are different [9,10].
Comparison of pediatric sports fracture outcomes based on provider type
Published in The Physician and Sportsmedicine, 2021
Emily A. Sweeney, David R. Howell, Morgan N. Potter, Alexia G Gagliardi, Jay C. Albright, Aaron J. Provance
Our study provides innovative insights into fracture management based on the type of physician caring for the patient, paired with follow-up data. Furthermore, we build upon the work done by previous researchers in this area by specifically examining the pediatric athlete population [28–30]. Pertinent to the long-term health of the patient, our results indicate that regardless of provider-type, those with relatively simple fracture presentations have similar rates of healing and functional outcomes approximately 10 months after the injury. This allows primary care sports medicine physicians, who may have seen a young, healthy athlete for other musculoskeletal or sports-related injuries previously, to provide continuity of care when that athlete has a non-surgical fracture. Paired with our finding that patients prefer to continue future care with the same type of physician seen for their fracture, continuity of care may be a high priority for pediatric patients and their parents.
Spinal cord injury providers’ perspectives on managing sublesional osteoporosis
Published in The Journal of Spinal Cord Medicine, 2020
Frances M. Weaver, Bella Etingen, Marylou Guihan, Cara Ray, Michael Priebe, Stephen Burns, Laura Carbone
One provider described the treatment process for fractures: [the fracture] … that’d be evaluated by an orthopedic surgeon and if it were feasible, if it were needed, they might get some hardware. I mean, if they’re not ever, ever, going to walk, anyway … and it's not [as if they use their leg] for transfers … There might be some patients where they say, ‘Well, the risk [of surgery] is kind of high given their medical history and it won't change things functionally very much because this person lays in bed 24 h a day anyway. So, we’re going to treat it non-surgically,’ … . a lot of that decision-making would come from the orthopod.Overall, providers described being limited in their ability to prevent osteoporosis and/or subsequent fractures in their patients with SCI. Most of the patients seen in VA SCI centers and clinics are chronic injuries (>2 years post injury). One provider specifically commented that: So, in terms of treating osteoporosis, I would like to see more medication on the chronic [SCI] side.