Revia

By C. Hengley. California National University for Advanced Studies.

A special plate was prepared femoral replacement (Mutars system) after resection of the femur with angularly-stable dynamic screws on both ends 640 4 buy generic revia 50mg. The reconstruction involved a combination of a specially pre- b pared hip prosthesis and an allogeneic bone graft that replaced the whole upper section of the femur apart from the hip. The use of the dacron tube, however, has re- discrepancy in relation to the other side will become duced the need for this combination of a joint prosthesis apparent. This problem is very serious particularly if the with allogeneic bone as the dacron tube allows anchorage lower extremities are involved since differences of 10 cm of muscles to the prosthesis. After a single bone as joint cartilage constitutes a very effec- two weeks full weight-bearing on the affected leg can be tive tumor barrier. If a tu- mor prosthesis is implanted, however, both joint-forming Rotationplasty bone surfaces must be replaced, thereby destroying the The technique of rotationplasty was first mentioned by epiphyseal plate of the bone on the other side of the joint. Borggraeve in 1930 in relation to the treatment of a A knee prosthesis was therefore developed whose tibial proximal femoral deficiency. A comprehensive descrip- anchorage was designed so as to allow the proximal tibial tion for the same indication was provided in 1950 by Van epiphyseal plate to continue growing. This problem Nes, hence the more usual term in the English-speak- does not exist if allogeneic bone grafts (allografts) are ing literature of »Van Nes rotationplasty«. The rotation- used since the healthy part of the joint does not need to plasty is a special form of amputation in which the upper be replaced. It was originally used for osteosarcomas of the distal femur Concurrent closure of the epiphyseal plate as a way of improving function after tumor resections. At a Even though the rotationplasty is not a limb-preserv- bone age of 10 years, the distal femur is expected to grow ing method it does provide much better function com- a further 6.

Girls are only ▬ Late onset over 7 years old slightly more frequently affected than boys revia 50mg mastercard. In addition to the thoracic location, lumbar and S-shaped curves also occur. Only 5% of scolioses are The condition known as resolving infantile scoliosis is not non-progressive, while the rest increase annually by 1–3° classed as an idiopathic scoliosis but is a special type of up to aged 10, and by 5–10° a year during the pubertal scoliotic posture. Adolescent (late onset) idiopathic scoliosis Resolving infantile scoliosis Resolving infantile scoliosis occurs at the age of a few This is by far the commonest form of scoliosis and is months, but has become relatively rare in the west as a characterized by the following features: result of the frequent use of the prone position. Resolving It is usually located at the thoracic level and almost infantile scoliosis is characterized by a long, usually left- without exception involves a right-convex curve. It occurs less commonly at the thoracolumbar The rib vertebral angle difference (RVAD) according to and lumbar levels, and such cases show a marked Mehta is measured to distinguish it from progressive tendency to go out of alignment. The prognosis is good scolioses are not truly idiopathic but occur second- and a spontaneous recovery can be expected in over 96% arily to leg length discrepancies or a lumbosacral of cases. In 76% of cases the scoliosis is left convex and often scolioses of the same severity. In the infant, an rib vertebral It is almost always associated with relative lordosis angle difference according to Mehta of more than 20° (for the thoracic level, an overall kyphotic angle of indicates that the condition is not the benign resolving less than 20° is considered to be relative lordosis). In scolioses in the infant, the diminished growth of the posterior sections forces angle between a vertical line passing through the vertebral body and the vertebral bodies to deviate laterally and to ro- the axis of the rib is measured on both the convex and concave sides. Instead of a scoliosis, one might describe this If the difference(γ)between the two angles is 20° or more, the scoliosis is very likely to be the progressive form rather than a spontaneously as a rotational lordosis. In adolescent scoliosis there is a disparity be- tween the growth of the vertebral bodies anteriorly and that of the posterior elements. The vertebral bodies grow faster than the posterior elements, resulting primarily in a lordosis. The diminished dorsal growth impedes the 3 ventrally located vertebral bodies from increasing in height, forcing them to become distorted, i.

If this is not the case in one of the two x-ray planes (a) order 50mg revia with amex, a radial head dislocation is present and a b must be reduced without delay ▬ lack of a trauma history, ▬ an excessively long radius, ▬ convex instead of concave shape of the proximal radial joint surface, ▬ bilateral occurrence, ▬ lack of deformation of the ulnar shaft. It should be noted that patients are often unable to recall any trauma and a dislocation is missed. In such cases the radius can continue to grow unhindered, the radial head changes its shape as a result of the missing joint partner and the ulnar shaft deformity can also remodel during the course of subsequent growth. Fracture types The classical Monteggia lesion involves the combination of a dislocated radial head and an ulnar shaft fracture. The directions of the ulnar shaft deformation and the radial a b c head dislocation correlate. Types of Monteggia lesion: Apart from the classical proposed by Bado (⊡ Fig. Monteggia fracture (a), olecranon fractures with a radial head disloca- ▬ Type 1: Extension deformity of the ulna, anterior dis- tion fracture (b) and olecranon fractures with radial head dislocation location of the radial head. With increasing age, the ulna may merely suffer plastic deformation, a So-called Monteggia equivalents are ulnar fractures in greenstick fracture or may be completely fractured. A slight bowing of cases the transition from the proximal to middle third the ulna is frequently overlooked, as a result of which the of the ulnar shaft is fractured, less frequently the center radial head dislocation also tends to be missed. This wide variety of injury patterns means that im- already convex or if cartilage damage is present on aging investigations covering the wrist to the elbow the capitulum or radial head, the prospects of success are essential in all forearm fractures. On the other hand, good correction can be achieved for an excessively long radius or a deformity Neurological concomitant lesions are primarily associated of the ulna. A proximal ulnar shaft osteotomy with an with lateral dislocations, but can also occur with the other empirical search for the required degree of correction types. They usually involve cases of neurapraxia and show is a reliable way of achieving the objective. Since, An ulnar external fixator can be helpful in this con- in a case of a plastically deformed ulna or greenstick frac- nection, since it facilitates the search for the correct ture, the elastic recoil force of the ulna usually prevents adjustment of the ulnar osteotomy, the surgeon can a reliable reduction of the radial head, completing the test all movement combinations with the benefit of an fracture is recommended. Full correction of the ulnar deformity in all planes long radius can be compensated for by callus distrac- is essential! In most cases the correct position can be secured with an Periarticular ossification, myositis ossificans and radio- intramedullary flexible nail.

The eye should be An auricular hematoma is a subperichondral accumu- shielded order 50mg revia visa, intraocular pressure measurements avoided, lation of blood following blunt trauma. Treatment involves drainage of the because of a sudden increase in intraocular pressure. Treatment is the same as that of an acute emergency, must be recognized so that proper intraocular foreign body or corneal laceration. Most will be caused by RETROBULBAR HEMORRHAGE either blunt or noise induced trauma and greater than Usually occurs after trauma and presents with acute 90% will heal spontaneously. Antibiotics (either sys- proptosis, pain, swelling, and limitation of extraocu- temic or topical) are typically not necessary for lar muscle (EOM) movement. Those that are caused by “orbital compartment syndrome” and irreversible penetrating trauma should be promptly referred to an vision loss can occur within 1 h. ORBITAL RIM FRACTURE ABDOMINAL/PELVIC INJURY Usually a result of blunt trauma with examination revealing periorbital bony tenderness, crepitus, or Although potentially serious and even life-threaten- paresthesias in the distribution of the infraorbital ing, most abdominal injuries can be managed nonop- nerve, as well as limitation of EOM movement if there eratively with close observation. Athletes should be sent for radi- generally result from either rapid deceleration, direct ographic evaluation, with treatment depending on the blunt trauma to the abdomen, or indirect trauma from extent of injury. The importance of these injuries to the FP lies in erally involves identification of nasal fractures, con- excluding associated intra-abdominal injuries, with trol of epistaxis, or treatment of septal hematomas. Treatment includes ice, analgesics, inadequate in excluding significant intra-abdominal nasal decongestants, and avoidance of further injury. CHAPTER 4 FIELD-SIDE EMERGENCIES 17 SPLENIC/HEPATIC INJURY In terms of fracture care, the FP must always ascertain The spleen and liver comprise the two most common the mechanism of injury and never assume that the organs injured in blunt abdominal trauma. Always check be left or right upper quadrant and/or shoulder pain the neurovascular status of the affected body part respectively, as well as signs of hypotension if bleed- distal to the fracture site. All athletes with significant pain mise, reduction of dislocations and/or fractures should and/or appropriate mechanism of injury should be be attempted in the field with gentle traction. Finally, no athlete should return to play if there Injuries to the renal system seldom require immediate is a question of a fracture, no matter how minor the intervention and suspicion should be based on the injury may seem, as this may transform a nondis- mechanism of injury as well as the presence and placed or a closed fracture into a displaced or open degree of hematuria (Amaral, 1997). In terms of evaluating hematuria, usually only those athletes with gross OPEN FRACTURE hematuria or with persistent microscopic hematuria Previously known as a compound fracture, this is a accompanied by hypotension or associated nonrenal fracture associated with overlying soft tissue injury injuries require radiographic evaluation of the geni- with communication between the fracture site and the tourinary system (Amaral, 1997). These are at high risk for subsequent infection and osteomyelitis and require washout in the operat- ing room.