scholarly journals NOVEL PHYSIOTHERAPEUTIC APPROACH TOWARDS A CASE OF COMPLEX MULTIPLE FRACTURE

2021 ◽  
Vol 10 (4) ◽  
pp. 3453-3458
Author(s):  
Manali Bub
Keyword(s):  
Physical Therapy ◽  
Tissue Injury ◽  
Pelvic Ring ◽  
Soft Tissue Injury ◽  
Transverse Process ◽  
High Energy ◽  
Neurological Injury ◽  
Temporary Reduction ◽  
Pelvic Ring Fractures ◽  
Impaired Limb

A straddle fracture of the pelvis is a fracture of the superior and inferior pubic rami which is considered an unstable injury. Injuries most often associated with straddle fracture include sacral fracture, neurological injury, pelvic ring disturbance, lumbar spine fracture, and severe soft tissue injury. A pelvic fracture can happen through the mechanism of either moderate or medium intensity effects. This can range in magnitude from relatively minor mishaps to moderately traumatic fractures that are potentially fatal. L5 transverse process fracture are often associated with pelvic ring fractures, which may indicate high energy trauma. A 35-year-old female with a left-sided straddle fracture, a sacral ala fracture associated with an L5 transverse process fracture L5 was diagnosed by orthopaedic surgeon, on X-ray after a slip and fall sustaining injury to pelvic region, on which open reduction and internal fixation with a 5-hole pre-contoured plate was placed. Temporary reduction was done by K-wire and sacral ala fracture was fixed with 2 CC screws. Post operatively the patient had impaired limb movements and inability to perform daily activities. After operation, patient was managed with physical therapy treatment comprising of static regimens, progressing to dynamic exercises, electrotherapeutic techniques, strengthening exercises, gait exercise for duration of 10 weeks. Patient was given physiotherapy regime for 5 days per week for 10 weeks. This study shows that the operative method and timely recovery in physical therapy contributed to the progress of ROM, strength of muscle, functional activities progressively, which successfully led to further recovery.

Acute Compartment Syndrome of Upper Extremities with Tendon Ruptures

2017 ◽  
Vol 22 (04) ◽  
pp. 411-415
Author(s):  
Taku Suzuki ◽  
Eiko Yamabe ◽  
Takuji Iwamoto ◽  
Katsuji Suzuki ◽  
Harumoto Yamada ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Compartment Syndrome ◽  
Tissue Injury ◽  
Soft Tissue Injury ◽  
Skin Grafting ◽  
High Energy ◽  
Acute Compartment Syndrome ◽  
Mechanism Of Injury ◽  
Sensory Disturbances

Background: It is well known that acute compartment syndrome is associated with fracture of the forearm, while involvement of soft tissue injury including musculotendinous injury remains unclear. The purpose of this study was to evaluate the soft tissue involvement, including musculotendinous ruptures, in acute compartment syndrome of the upper limb. Methods: We retrospectively enrolled 16 patients who underwent surgical treatment for acute compartment syndrome of the upper extremity. The average age of the patients was 47 years (range, 14 to 79) and the mean follow-up period after the surgery was 15 months (range, 12 to 29). Complications included at least one presentation at the final follow up of sensory disturbances or motor disturbances. We examined the presence of musculotendinous injury mechanism of injury, presence of fracture, the performance of skin grafting, and complications. Results: Mechanism of injury of “caught in a machine” was found in six cases. Three of these patients had musculotendinous ruptures and all muscle tears were revealed by intraoperative findings. No patients had muscle ruptures with other injury mechanisms. Seven out of 16 patients (44%) developed complications at final follow-up. Skin grafting was performed in six patients, and five of these patients developed complications. Only one of the nine patients without complications underwent skin grafting. Conclusions: In cases of high-energy injuries, the surgeon should suspect the presence of a musculotendinous injury prior to surgery.

Pelvic Ring Fractures: Role of Physical Therapy in the Emergency Department

2019 ◽  
Vol 49 (12) ◽  
pp. 942-942
Author(s):  
Zachary M. Stapleton ◽  
Manasi Bohra ◽  
Nicholas Florence
Keyword(s):  
Emergency Department ◽  
Physical Therapy ◽  
Pelvic Ring ◽  
Pelvic Ring Fractures

Autologous platelets and leukocytes can improve healing of infected high-energy soft tissue injury

2009 ◽  
Vol 41 (1) ◽  
pp. 9-12 ◽  
Author(s):  
Agata Cieslik-Bielecka ◽  
Tomasz Bielecki ◽  
Tadeusz S. Gazdzik ◽  
Jerzy Arendt ◽  
Wojciech Król ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Tissue Injury ◽  
Soft Tissue Injury ◽  
High Energy

scholarly journals EVALUATION OF RESULTS OF INTERNAL FIXATION OF CLOSED, DISPLACED, RECENT FRACTURE SHAFT OF HUMERUS BY MIPPO TECHNIQUE

2019 ◽  
Vol 3 (6) ◽  
Author(s):  
Alok Sobhan Datta ◽  
S. Velagada ◽  
A. Haque
Keyword(s):  
Road Traffic Accident ◽  
Traffic Accident ◽  
Road Traffic ◽  
Tissue Injury ◽  
Soft Tissue Injury ◽  
High Energy ◽  
Time Interval ◽  
Shaft Fractures ◽  
Recent Fracture ◽  
Humerus Shaft

BACKGROUND: The humerus shaft fracture is the second most common fracture of the upper extremity. The predominant causes of humerus shaft fractures include low energy trauma such as fall from a standing height in older population, while in the younger population it is caused by high energy trauma. Aims and Objectives - To investigate the effectiveness of economical MIPPO technique and to determine the radiological and functional significance of MIPPO technique in the patients undergoing treatment for recent fracture shaft of humerus. MATERIALS AND METHODS: A prospective study had been carried out from December 2012 to August 2014 in the Orthopaedics Department of SSKM Hospital, Kolkata, West Bengal, India. Thirty three patients, who presented with fracture shaft of humerus and underwent fixation of humeral shaft fractures by MIPPO technique were included in this study. Complete history was taken and full clinical examination was carried out. RESULTS: The average age group in our study is 35.3 years. Of them 85% are male and 15% are female. In majority cases, mode of injury was road traffic accident. 85% cases had middle 1/3rd fracture shaft of humerus and the average time interval between the injury and surgery was 8.54 days. CONCLUSION: The results obtained in this study have shown that the MIPPO technique is safe, convenient and effective, since there was minimal soft tissue injury with no major complications. KEYWORDS: Minimally Invasive Percutaneous Plate Osteosynthesis (MIPPO); Road Traffic Accident (RTA).

scholarly journals Periarticular Fractures of the Knee in Polytrauma Patients

2015 ◽  
Vol 9 (1) ◽  
pp. 332-346 ◽  
Author(s):  
M.L. Bertrand ◽  
P. Andrés-Cano ◽  
F.J. Pascual-López
Keyword(s):  
General Condition ◽  
Tissue Injury ◽  
Soft Tissue Injury ◽  
High Energy ◽  
Local Characteristics ◽  
Present Complex ◽  
Major Loss ◽  
Polytrauma Patients ◽  
Ideal Method ◽  
The Ideal

Periarticular fractures around the knee are a challenge for the orthopaedic surgeon. When these fractures are presented in the context of a multiple trauma patient, they are even more difficult to manage because the treatment approach depends not only on the fracture itself, but also on the patient’s general condition. These fractures, caused by high-energy trauma, present complex fracture patterns with severe comminution and major loss of articular congruity, and are often associated with vascular and nerve complications, particularly in the proximal tibia, due to its anatomical features with poor myocutaneous coverage. They are almost always accompanied by soft tissue injury. The management of polytrauma patients requires a multidisciplinary team and accurate systemic stabilization of the patient before undertaking orthopaedic treatment. These fractures are usually addressed sequentially, either according to the general condition of the patient or to the local characteristics of the lesions. In recent decades, various fixation methods have been proposed, but there is still no consensus as to the ideal method for stabilizing these fractures. In this paper, we describe the general characteristics of these fractures, the stabilization methods traditionally used and those that have been developed in recent years, and discuss the treatment sequences proposed as most suitable for the management of these injuries.

scholarly journals Staged Subtalar Fusion for Severe Calcaneus Fractures with Bone Loss

2013 ◽  
Vol 7 (1) ◽  
pp. 614-618 ◽  
Author(s):  
Chad G. Williams ◽  
Michael J. Coffey ◽  
Peter Shorten ◽  
James D. Lyions ◽  
Richard T. Laughlin
Keyword(s):  
Soft Tissue ◽  
Bone Loss ◽  
Soft Tissues ◽  
Tissue Injury ◽  
Soft Tissue Injury ◽  
High Energy ◽  
Fusion Procedure ◽  
Subtalar Fusion ◽  
Thorough Debridement ◽  
Calcaneus Fractures

Background: With high energy fractures to the calcaneus there is the potential for significant bone loss. The loss of bone can make it difficult to fully regain calcaneal alignment. In addition these fractures are often associated with significant soft tissue injury. These two factors make it difficult to address this injury in a single stage, and can have significant complications. To address these issues our initial goal in treatment has been restoration of calcaneal alignment and stabilization of the surrounding soft tissue, followed by delayed/staged subtalar arthrodesis. Methods: Patients with calcaneus fractures treated by a single surgeon from 2002 to 2012 were reviewed. Injuries which were found to have medial extrusion of the posterior facet and bone loss, and subsequently underwent a staged protocol involving early provisional fixation and late subtalar fusion were included. Results: We treated 6 calcaneus fractures with bone loss. All patients were treated with staged subtalar fusion after initial irrigation and debridement and provisional fixation. No soft-tissue complications were noted after the fusion procedure in any of the six cases. Fusion occurred in all six patients at an average of 20.6 weeks (range, 13-23 weeks). All patients were able to ambulate and wear a regular shoe by one year following the initial injury. Conclusion: It is important in the high energy calcaneus fracture to assess for both soft tissue integrity and bone loss. A thorough debridement of both the soft tissues and any devitalized bone should be performed as well as provisional fixation which attempts to restore near normal calcaneal anatomy. Definitive fusion should not be performed until the soft tissues have fully recovered.

Spinal stability

2019 ◽  
pp. 669-678
Author(s):  
Peter R Loughenbury ◽  
Richard M Hall
Keyword(s):  
Regional Variation ◽  
Vertebral Column ◽  
Tissue Injury ◽  
Soft Tissue Injury ◽  
Lower Limbs ◽  
Neurological Injury ◽  
Spinal Instability ◽  
Clinical Instability ◽  
Decision Making Processes ◽  
Complex Arrangement

The vertebral column is a series of bones that connect the head to the pelvis, supported by a complex arrangement of muscles and ligaments. Regional variation in the anatomy of the column affords protection for the spinal cord, provides stability and mobility, and allows transmittance of movement to the lower limbs. When subjected to forces and displacements the column is uniquely adapted to provide the balance of stability and mobility necessary for upright posture and locomotion. Abnormal loading can cause a failure of the column through a bony or soft tissue injury. This can lead to clinical instability—a failure of the spine to maintain normal physiological loads without undue pain, deformity, or neurological injury. The concepts of spinal biomechanics and spinal instability are central in the decision-making processes following spinal trauma and underpin the understanding of pathological conditions of the spine and their surgical treatment.

scholarly journals Screw migration in a 14-year-old boy with hip osteotomy; a rare cause of upper thigh hematoma

2016 ◽  
Vol 19 (3) ◽  
pp. 324
Author(s):  
Emre Ünal
Keyword(s):  
At Risk ◽  
Physical Therapy ◽  
Soft Tissue ◽  
Vascular Injury ◽  
Tissue Injury ◽  
Soft Tissue Injury ◽  
Therapy Sessions ◽  
Hardware Migration ◽  
Repetitive Trauma ◽  
Uncommon Complication

Soft tissue injury due to orthopedic hardware migration is an uncommon complication. However particularly patients who have routine physical therapy sessions for extremity contractures are at risk for vascular injury in the setting of migrated screws. Ultrasound is an efficient modality to evaluate migrated screws and adjacent soft tissue structures. As a consequence of repetitive trauma a migrated screw would eventually result in injury. Herein a case of upper thigh hematoma due to screw migration in a patient with hip osteotomy is reported.

scholarly journals Bilateral Gastrocnemius Flap For Harlequin Defects Around The Knee

2020 ◽  
Vol 6 (1) ◽  
pp. 248-253
Author(s):  
Tarun Chabra ◽  
Venkatramani Hari ◽  
Sabapathy SR
Keyword(s):  
Soft Tissue ◽  
Proximal Tibia ◽  
Tissue Injury ◽  
Soft Tissue Injury ◽  
High Energy ◽  
Tissue Loss ◽  
Lateral Side ◽  
Gastrocnemius Flap ◽  
Schatzker Type ◽  
The Mean

Background : Tibial plateau fractures (especially bicondylar Schatzker type 5 and type 6) are a result of high energy trauma. Along with bony component, soft tissue injury is a major determinant in the treatment and final outcome. Bicondylar fractures needs bicolumnar fixation and as such require separate approaches: postero-medial and lateral incisions. The soft tissue of the proximal tibia swells significantly after the injury, coupled with extensive soft tissue dissection during fixation this can lead to subsequent wound breakdown and infection along either side of the proximal tibia which resembles “harlequin eyes”. This study describes outcome of management of post operative soft tissue complications following bicolumnar fixation of proximal tibia with medial and lateral gastrocnemius flap. Method : Three patients who had bilateral soft tissue necrosis at surgical incision sites treated with debridement and bilateral gastrocnemius flaps between January 2016 and December 2017 were included in this study. The mean age was 38 years (range 18–50 years) and the mean duration of follow-up was 10 months. Outcome assessments included the condition of the flap and fracture healing time. Result : All fractures united after surgery. There were no soft tissue complications and all flaps healed well. The mean bony union time was 6 months. Conclusion: Our technique of covering soft tissue loss at surgical site on medial and lateral side of proximal tibia with bilateral gastrocnemius flap in the same setting is a reliable and safe surgical method for these conditions.

scholarly journals ‘Within Ring’ Concept Treatment for Displaced H-Shaped Type IVb Fragility Fractures of the Pelvis

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Yohei Yanagisawa ◽  
Yusuke Eda ◽  
Shotaro Teruya ◽  
Hisanori Gamada ◽  
Masashi Yamazaki
Keyword(s):  
Pelvic Ring ◽  
Pedicle Screws ◽  
Fragility Fractures ◽  
Clinical Results ◽  
High Energy ◽  
Fixation Method ◽  
Case Presentation ◽  
Pelvic Fixation ◽  
Pelvic Ring Fractures ◽  
Sacroiliac Rod Fixation

Introduction. Sacroiliac rod fixation (SIRF) preserves the mobility of L5/S1 (lumber in the pelvis), as a surgical procedure for high-energy pelvic ring fractures. The concept of SIRF method without pedicle screws into L4 and L5 is called ‘within ring’ concept. Case Presentation. We report here the clinical results of ‘within ring’ concept treatment with sacroiliac rod fixation for a case of displaced H-shaped Rommens and Hofmann classification type IVb fragility fractures of the pelvis (FFP), which A 79-year-old woman had been difficult to walk due to pain that had been prolonged for more than one month since her injury. The patient was successfully treated with SIRF, no pain waking with a walking stick and returned to most social activities including living independently within 6 months of the operation. Conclusion. SIRF is useful because it can preserve the mobility in the lumbar pelvis; not including the lumbar spine in the fixation range like spino pelvic fixation is a simple, safe, and low-invasive internal fixation method for displaced H-shaped type IVb fragility fractures of the pelvis.

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