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by Brian Alverson, MD, Kevin Pei, MD, Hetal Verma, MD
Fractures have accompanied humanity throughout its history, being encountered in aspect of human life that involve exertion or hard labor, from battlefields to construction sites. Today, fractures are still a common sight in the ER and outpatient settings, and are considered a staple of orthopedics. In this course, the student will be given a tour of commonly encountered fractures. For optimal understanding, the student is required to be familiar with the anatomy and physiology of the musculoskeletal, or locomotor, system.
Bone, while seemingly inert, is an active, growing, and changing part of the human body, in addition to being the body's primary calcium reservoir. In the correct homeostatic conditions, bone can remodel in response to damage, stress, or hormonal signaling (parathyroid hormone and calcitonin). Osteocytes located deep in the bone sense damage and signal bone-lining cells that will begin the process of remodeling. This process is vital not only for damage repair but also to adapt to a new environment and conditions.
The apophysis is a secondary ossification center found on non-weight-bearing segments of bones. The apophysis is also the site of ligament or tendon insertion and is involved in the peripheral growth of the bone. These secondary growth centers are generally open in late childhood and may not close until early adulthood. With overuse, the apophysis may become inflamed and painful, becoming vulnerable to tearing and avulsion. An acute apophyseal avulsion fracture occurs when a portion of the apophysis is pulled off by the ligament, usually secondary to explosive movements and eccentric muscular contractions. Apophyseal avulsion fractures are primarily treated conservatively, but may require surgical repair if the avulsed fragment is large or significantly displaced.
The bones of growing children exhibit unique characteristics, which, combined with the unique mechanisms of injury seen in children, result in fracture patterns differing significantly from those common in adults. The greenstick fracture is an incomplete fracture usually seen in long bones. The bone is typically bent, and the fracture extends only partway through the bone. Greenstick fractures are at high risk for refracture and should be completely immobilized. Greenstick fractures rarely require reduction but should be managed cautiously to prevent malunion or angulation deformities. A patient with a greenstick fracture should be referred for orthopedic follow-up.
A “toddler’s fracture” is a spiral or oblique fracture of the distal tibia in toddlers resulting from a low-energy trauma with a rotational/twisting component. These fractures are often seen in children who are learning to walk and who do not have a specific history of trauma. The child can sometimes present with a painful limp or refusal to bear weight on the affected limb. Management comprises analgesia and immobilizing the injured leg for several weeks.
The bones of growing children exhibit unique characteristics. These characteristics, combined with the unique mechanisms of injury seen in children, result in fracture patterns that differ significantly from those that are common in adults. When axial loads are applied, particularly to long bones in children, compressive forces may result in buckling of the bone without disruption of the periosteum. These fractures are called buckle or torus fractures and are considered generally stable, requiring only immobilization.
A fracture is a disruption of the cortex of any bone and periosteum and is commonly due to mechanical stress after an injury or accident. Open fractures due to trauma can be a medical emergency. Fractures are frequently associated with automobile accidents, workplace injuries, and trauma. Clinical presentation varies depending on the cause and location of the injury, but generally includes deformity, pain, edema, and inflammation. Diagnosis is made clinically and confirmed with imaging, and management may be with splinting or may require surgery.
The knee joint is made up of the articulations between the femur, tibia, and patella bones, and is one of the largest and most complex joints of the human body. The knee is classified as a synovial hinge joint, which primarily allows for flexion and extension with a more limited degree of translation and rotation. The supporting structures of the knee joint include a joint capsule, the lateral and medial menisci, and multiple ligaments that help ensure mobility and stability of the knee.
A dislocation of the knee (tibiofemoral joint) is a rare injury but is important to recognize because of limb-threatening trauma. Knee dislocations (KDs) are emergent cases that require immediate reduction and evaluation of the neurovascular system. Clinical presentation includes precedent trauma, obvious deformity, effusion, ecchymosis, and possible signs of vascular injury to the popliteal artery. Management includes reduction of the dislocation, serial examinations for arterial perfusion, imaging of the vascular system, and orthopedic and vascular consultations.
Your Educators of course Common Fractures and Dislocations (MBBS India)
Brian Alverson, MD
Dr. Brian Alverson is a Professor of Pediatrics and Professor of Medical Science at Brown University, as well as the Director for the Division of Pediatric Hospital Medicine at Hasbro Children's Hospital, Rhode Island, USA.
He obtained his MD at the University of Pennsylvania School of Medicine in 1999 and is currently also the Director of Undergraduate Pediatric Education at the Alpert School of Medicine at Brown University.
Due to his achievements in pediatric education, he has won over 25 teaching awards at two Ivy League Medical Schools.
Within Lecturio, Dr. Alverson teaches courses on Pediatrics.
Kevin Pei, MD
Dr. Kevin Pei is the Associate Chief Academic Research Officer and the Program Director of the General Surgery Residency at Parkview Health, in Indiana, USA.
After his residency at George Washington University, he was the Assistant Professor of Surgery at Yale School of Medicine for several years and obtained an additional Master's Degree in Education from Yale University.
He is an experienced educator and has received various teaching awards. In 2018, the Association for Surgical Education granted him the prestigious Philip J. Wolfson Outstanding Educator Award.
Within Lecturio, Dr. Pei teaches courses on Surgery.
Hetal Verma, MD
Dr. Hetal Verma is a Clinical Instructor of Radiology and the Co-Director of the Radiology Cambridge Integrated Clerkship at Harvard Medical School, MA, USA.
She is a graduate of the University of Massachusetts Medical School and completed her Breast Imaging fellowship at the Massachusetts General Hospital. Since 2012, she is the Director of Breast Imaging at Cambridge Health Alliance Radiology, a teaching affiliate of Harvard Medical School.
She is passionate about women's health and has vast experience in teaching medical students and residents at Harvard Medical School.
Within Lecturio, Dr. Verma teaches courses on Radiology.
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