Introduction Perilunate dislocation (PLD) and perilunate fracture dislocations are complex types of wrist instabilities, resulting from high energy injuries such as motor vehicle accidents, falls from height, and extreme athletic activities that constitute about 10% of all carpal injuries (1), while scaphoid fractures, associated with dislocation of capitate from the lunate, referred to as transscaphoid perilunate dislocations (TSPDs) are observed in 61% to 65% of these types of injuries (2). Perilunate injuries can result in poor functional results, if left untreated, and patients may have mild to moderate dysfunction even after treatment (3). Although closed treatment was historically advocated for these injuries, early treatment with open …show more content…
The arm was prepped and draped on the hand table with the patient in supine position; pneumatic brachial tourniquet was fastened. A volar approach was used with internal fixation of scaphoid fracture with Herbert screw. The incision was centered over the scaphoid’s tubercle and curved distally in to the base of thenar eminence, the flexor carpi radialis was exposed and retracted ulnarly, the radial artery was protected, the dorsal sheath of flexor carpi radialis was incised longitudinally, and pericapsular fat was divided; the anterior capsule of wrist was incised longitudinally to display the anterior surface of scaphoid. Fibrin and clots were removed from the fracture surface and after exposing the distal fragment of the scaphoid and the capitate head by traction on the hand, the proximal fragment was pushed dorsally and distal fragment pulled volarly. The fracture was then reduced and the scaphoid fracture was fixed with a screw (Herbert: Zimmer, Inc). Three k-wires were inserted from radial side of the wrist, distal to the radial styloid; two were used to stabilize the scaphoid to the lunate and the other to secure the scaphoid distal to the capitate. There were no ligamentous repair or reconstruction required. Then the wires were placed inside out, remaining one end of each wire percutaneous. Anterior part of the wire was carefully repaired and the skin was closed as routine. Then the wrist was immobilized with long arm cast for about eight weeks. The k-wires and splint were removed after eight weeks, then, physiotherapy of wrist with gentle movements started, and heavy manual activities were avoided for at least three
Many factors like patients age, symptoms, size of the tear, and nature of onset (traumatic or degenerative) are responsible for determining the prognosis of the physical therapy treatment 9. Since it’s a partial thickness tear of the rotator cuff, the non-operative treatment is reasonable unlike, a full thickness tear where surgery will be required to treat the patient 9. The patient shows symptoms of moderate irritability without significant functional deficit which makes him a good candidate for conservative treatment 10. The pain reported by the patient is 6/10 so the patient participates well in physical therapy exercise to increase shoulder strength, and flexibility. There was a study done from Finland which asserted that physical therapy alone can produce results which are equal to those produced by arthroscopic surgery and open surgical repair in cases of rotator cuff tears 11. In this case, with three weeks of physical therapy the patient has showed a decrease in pain and reported it as 4/10 on pain rating scale and showed improvements in abduction (140̊) and external rotation (65̊). The MMT for shoulder abduction was 4-/5 and external rotation is still same as
The ability to flex the finger consists of a serial of flexor muscles in the forearm and their tendons are inserted to the bones of finger. The injury of flexor tendon might cause the loss of bending of the fingers or thumb. The flexor digitorum profundus tendon (FDP) attaching to the distal phalanx and the flexor digitorum superficialis tendon banding to middle phalanx well demonstrated the specific type of tendon-to-bone insertion site characterized by the four-zone enthesis.[1] The retinacula (sheath) structures serve as strong fibrous bands wrap around the flexor tendons in order to keep the flexor tendons in place while flexion.
In spite of this the rate of ACL injury is almost equal through all levels of sports, from beginner, to recreational, to professional athletes. The most widely publicized incident of ACL damage has come from Theresa Edwards who was a top female athlete. She was a basketball player who went to the limit with sports. She went beyond her capability and her ligament couldn’t withstand the pressure and snapped. She is not the only but just one example of many who have suffered this same problem. As female athletes continue to become more competitive and aggressive, ACL damage continues to rise.
When comparing rotator cuff tears from the common people and athletes, they are much more common when a person is physically active in sports. An injury in the rotator ...
All injuries are a serious matter, but upper body injuries are more delicate. “Although the majority of contusions to the most parts of the body result injuries that are self-correcting and without serious consequence, even relatively
"Chapter 37." Operative Techniques in Orthopaedic Surgery. Ed. Sam Wiesel. 4th ed. Vol. 2. Lippincott Williams & Wilkins, 2011. eBook.
These types of injuries could take upwards to eighteen months to return to playing condition, and in this time an athlete will often fall behind in the sport that they love. This often causes the athlete to quit the sport they once loved because they can no longer truly compete amongst their peers. I know that there has to be a way to accelerate this process of recovery and get those athletes back on the field. This is where my passion for orthopaedics
People have created a hectic and busy world, that includes careers and daily activities that require physical activity. While attempting to attain the required physical conditioning, people often take chances with their personal health as they try to stretch their physical limits. Sometimes, people can surpass their current limits and form new boundaries; however, other times people are not so fortunate. These unfortunate times often lead to injury, including workplace accidents, sporting incidents, disease afflictions, as well as others; any or all of which could bring about the need of rehabilitation services. Many of these require physical therapy, which includes assisting injured or otherwise impaired patients as they recover to their pre-injury status or to recover as much as is physically possible. The field of physical therapy is a choice career for those who enjoy helping people recover from injury, and the following text will provide reason for choosing this profession.
The possibility of having a mild TBI is much more common than to have a severe injury. This does not mean that the injury will not be long lasting. Doctors are able to determine how severe an inj...
In conclusion, the case study performed at Chatham Orthopaedic clinic is consistent with the research shown in the article by the Archives of Emergency Medicine. The Boxer’s fracture is a fairly common fracture in being at least 20 percent of hand fractures and is fairly easy to recover from. The patient at the Chatham Orthopaedic Clinic showed statistical signs of a Boxer’s fracture and the recovery process to date.
The mechanism how she landed on the ground with the out stretched hand, and the sign and symptoms such as a swelling, and a sharp pain while palpating indicate that the cheerleader might be suffering from the scaphoid fracture, unlike many other hand and wrist injury, scaphoid injury doesn’t show any dislocation or deformity as well,
Balta, D. M. D. (2009). The TMJ: How can Such a Small Joint Cause so Much Trouble?, [Online]. Available: http://www.drbalta.com/tmj.htm [11/12/14].
The current patient may be experiencing a range of traumatic injuries after his accident, the injuries that the paramedic will focus on are those that are most life threatening. These injuries include: a possible tension pneumothroax or a haemothorax, hypovolemic shock, a mild or stable pelvic fracture and tibia fibula fracture. A pneumothorax is defined as “the presence of air or gas in the plural cavity which can impair oxygenation and/or ventilation” (Daley, 2014). The development of a pneumothorax to a tension pneumothorax can be caused from positive pressure ventilation.
Staff, Mayo Clinic. "Self Injury." Mayo Clinic. Mayo Foundation for Medical Education and Research, 03 Aug. 2010. Web. 10 Apr. 2012. .
Schmidt, M. S. (2014, January 19). Reviving a Life Saver, the Tourniquet. The New York Times [New York], p. D3.