Urgent diagnostics of musculoskeletal injury: the value of ultrasonography

The article presents a review of literature on the value of ultrasonography in acute musculoskeletal injury diagnostics. The main objectives of emergency ultrasonography are outlined: detection of fractures, large hematomas, injuries of tendons, muscles and nerves, detection of foreign bodies of soft tissues, ultrasonic navigation of surgical manipulations and reposition of fractures. The ultrasound method is highly sensitive цand specific in the detection of long-bone fractures, muscles and tendons rupture, which can make an impact on therapeutic tactic and patient’s routing. Ultrasound diagnostics has become useful for pediatric patients due to its ease of use, mobility and non-ionizing qualities. Ultrasonography of acute musculoskeletal injury will probably be increasingly important for orthopedic surgeons and emergency physicians.

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Tactics of Operative Treatment for Closed Long Bone Fractures in Patients with Polytrauma in Early Period

N.N. Priorov Journal of Traumatology and Orthopedics ◽

10.17816/vto20031033-9 ◽

2003 ◽

Vol 10 (3) ◽

pp. 3-9

Author(s):

V A Sokolov ◽

E I Byalik ◽

V A Sokolov ◽

E I Byalik

Keyword(s):

Soft Tissues ◽

Bone Fractures ◽

Plate Osteosynthesis ◽

Early Period ◽

Functional Results ◽

Fat Embolism ◽

Long Bone ◽

Long Bone Fractures ◽

Embolism Syndrome ◽

Urgent Operation

Results of the treatment of 218 victims with polytrauma were analyzed during the period from 1998 to 2202. There were 127 patients with one and 91 patients with several closed fractures. Authors consider osteosynthesis for closed long bone fractures to be an urgent operation of third term. Osteosynthesis is absolutely indicated to the patients with psychomotor excitation, in cases of the threat for skin perforation by bone fragments and in patients requiring intensive nursing for their life rescue. The choice of operative method depends on polytrauma severity and fracture type. When osteosynthesis is performed by urgent indications in patients with polytrauma the requirements to osteosynthesis stiffness are higher than in isolate injuries, as the rotation displacement, migration and fixator deformity frequently take place in unconscious patients who need constant intensive nursing. In patients with concomitant thorax injury urgent intramedullar osteosynthesis by nail is contraindicated due to the possibility of fat embolism syndrome development. In these patients plate osteosynthesis is preferred. If there are no absolute indications to urgent osteosynthesis this operation could be performed on 3-10 days after trauma using lightly traumatic and invasive methods not waiting for the complete normalization of homeostasis parameters and restoration of soft tissues in the fracture zone. In closed long bone fractures tactics of early osteosynthesis allows to decrease the rate of hypostatic complications and mortality by more than 10% and achieve good functional results.

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Results of Conversion Osteosynthesis in Treatment of Patients with Long Bone Fractures

RUDN Journal of Medicine ◽

10.22363/2313-0245-2019-23-3-257-270 ◽

2019 ◽

Vol 23 (3) ◽

pp. 257-270

Author(s):

Ya. M. Alsmadi ◽

N. V. Zagorodniy ◽

E. I. Solod ◽

A. F. Lazarev ◽

M. A. Abdulkhabirov ◽

...

Keyword(s):

External Fixation ◽

Soft Tissues ◽

Bone Fractures ◽

Damage Control ◽

Traumatic Shock ◽

Long Bone ◽

Optimal Time ◽

Long Bones ◽

Results Of Treatment ◽

Post Traumatic

Аbctract. Treatment of long bones fractures of the extremities has a particular relevance in modern traumatology due to their high frequency, as well as a large number of deaths in patients with polytrauma. It is dangerous to perform an urgent final osteosynthesis in severe patients because of the possibility of shock and the deterioration of the condition of the injured. Therefore, the principle of Damage control with urgent fixation of damaged segments by external fixation and their subsequent replacement (converse) to intramedullary osteosynthesis had a particular relevance in the treatment of patients with long bones fractures. Purpose: Improving treatment outcomes for patients with long bones fractures. Materials and methods. In the present study, a retrospective analysis of using conversion osteosynthesis in the treatment of 120 patients with long bones extremities fractures in a multidisciplinary hospital was carried out. For a better analysis of the results of treatment, we divided the patients into two groups: The first group 44 patients with fractures of the long bones with polytrauma according to the ISS severity scale> 17. The second group consists of 76 patients with closed isolated unstable comminuted fractures of the long bones with severe post-traumatic edema, who have a high risk of significant trauma of soft tissues. Results. The most optimal time for conversion osteosynthesis to patients with polytrauma was 7-12 days, which prevented the occurrence of traumatic shock; and for patients with closed isolated unstable fractures of long bones with significant of post-traumatic edema for conversion osteosynthesis, the optimal time was 3-7 days after injury, which prevented the occurrence of inflammatory complications in the postoperative period. Conclusion. The study confirmed the feasibility of conversion osteosynthesis in the treatment of patients with diaphyseal fractures. The use of the technique of transferring the fixation of fragments by the external fixation device to the internal osteosynthesis (conversion) contributed to a reduction in the duration of inpatient treatment of patients with fractures of the long bones.

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(A130) Advantages of Apparatus of External Fixation in Severe Injuries of Extremities in Children

Prehospital and Disaster Medicine ◽

10.1017/s1049023x11001312 ◽

2011 ◽

Vol 26 (S1) ◽

pp. s36-s37

Author(s):

A. Karabenyuk ◽

A. Levitskiy

Keyword(s):

External Fixation ◽

Soft Tissues ◽

Bone Fractures ◽

Shock Therapy ◽

Long Bone ◽

Late Period ◽

Severe Injuries ◽

Acute Period ◽

Restorative Treatment ◽

Treatment Indications

PurposeTo study advantages of external fixation in severe injuries of extremities in children.Material and Method305 children at the age from 3 to 17 years with polytrauma (ISS > 18) were studied. From them skeletal injuries took place in 198 patients, cranioskeletal trauma - 125, multiple bone fractures - 56, bone fractures + visceral trauma - 24. 44 children had open bone fractures or fractures accompained with vast defects of soft tissues. Operative interventions in polytrauma are divided into urgent, elective and delayded. Urgent intervention (according to vital indications) are conducted together with anti-shock therapy in massive blood losses (injury of spleen, liver), crushing of lungs, cardiac tamponade, intracranial compression. Elective interventions are prformed after stabilization of patient's state and after bringing him out of shock.ResultsSets for external fixation were used in acute period of trauma, in early and late posttraumatic period. Tipe of sets depended on character of injury and followed steps of treatment. Indications for external fixation in acute period and catabolic phase of traumatic disease were: 1. multiple fragmental fractures, 2. defects of bones, 3. vast defects of soft tissues, 4. long bone fractures accompained with severe brain trauma. Indications for external fixation in late period were mulunion, in postpond – ununion, deformations and shortening of extremities.ConclusionThe usage of external fixation was an effective approach in treatment of children with severe complicated injuries of extremities. Advantages of external fixation in conditions of polytrauma were undiscutable: management in force effects, absence of secondary dislocations, good conditions for debridment and follow restorative treatment, mobility of patients.

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Comparison of Screw Quantity and Placement of Metacarpal Fracture Fixation: A Biomechanical Study

Hand ◽

10.1177/1558944720974116 ◽

2020 ◽

pp. 155894472097411

Author(s):

Stephen P. Canton ◽

Srujan Dadi ◽

Austin Anthony ◽

Michael Clancy ◽

John R. Fowler

Keyword(s):

Soft Tissues ◽

Bone Fractures ◽

Plate Fixation ◽

Study Groups ◽

Bending Stiffness ◽

Biomechanical Study ◽

Long Bone ◽

Metacarpal Fractures ◽

Loading Mode ◽

Bending Load

Background It is recommended to have 6 bicortical screws for plate fixation of long bone fractures; however, many metacarpal fractures do not allow 6 screws due to size limitations and proximity of crucial anatomical structures. The purpose of this biomechanical study was to determine whether the mechanical properties of a 4-screw nonlocking construct are noninferior to those of a 6-screw nonlocking construct. Methods Metacarpal sawbones were used to simulate a midshaft, transverse fracture. Nonlocking bicortical screws were placed in the 6-hole plate, and the metacarpals were randomly assigned to 2 equal study groups: (1) 4 screws, 2 on either side of the fracture (4S); and (2) 6 screws, 3 on either side of the fracture (6S). The metacarpals were tested in a cyclic loading mode and load to failure in a cantilever bending mode. Results Maximum deflection was significantly higher for 4S compared with 6S. Cyclic root mean square (RMS) was also significantly greater for 4S at 70 and 100 N. There were no statistically significant differences observed between the 2 constructs for maximum bending load, bending stiffness, and cyclic RMS at 40 N. The maximum bending load in 4S and 6S was 245.6 ± 37.9 N and 230.8 ± 41.9 N, respectively; 4S was noninferior and not superior to 6S. Noninferiority testing was inconclusive for bending stiffness. Conclusions A 4-screw bicortical nonlocking construct is noninferior to a 6-screw bicortical nonlocking construct for fixation of metacarpal fractures, which may be advantageous to minimize disruption of soft tissues while maintaining sufficient construct stability.

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Results of the Treatment of Infected Nonunions of the Lower Limbs Using the Ilizarov Method

Ortopedia Traumatologia Rehabilitacja ◽

10.5604/15093492.1237999 ◽

2017 ◽

Vol 19 (2) ◽

pp. 111-125 ◽

Cited By ~ 3

Author(s):

Marek Dróżdż ◽

Stanisław Rak ◽

Paweł Bartosz ◽

Jerzy Białecki ◽

Wojciech Marczyński

Keyword(s):

Soft Tissues ◽

Bone Fractures ◽

Good Condition ◽

High Energy ◽

Bone Transport ◽

Lower Limbs ◽

Bone Union ◽

Long Bone ◽

Ilizarov Method ◽

Infected Nonunion

Background. Infected nonunion is a complex complication of the treatment of long bone fractures. An in creased incidence of injuries, including high energy injuries (often open ones), contributes to a higher incidence of nonunion. These primarily infected injuries cause osteomyelitis, which prevents bone union, resulting in an infected nonunion. The Ilizarov method meets the biological and biomechanical treatment requirements, opti mising the process of inflammation healing and producing bone union. Material and methods. A total of 54 patients were treated in 2000–2014 for nonunion in the lower limbs with the Ilizarov method, which was used after previous treatment had failed. The subjects underwent intra operative resection of the locus of infection, sequestrectomy and a Judet procedure, followed by the use of the Ilizarov apparatus and bone transport, depending on the defect. Results. Inflammation healed in 52 patients (96%) and bone union was achieved in 46 patients (86%). Good outcomes with healed inflammation and bone union were reported in 76% of the cases, fair outcomes with tem porary elimination of the inflammation and without bone union in 16%, and poor outcomes without inflam ma tion healing and without bone union in 7%. Conclusions. Treatment of infected nonunion can only be effective after eliminating endogenous inflamma tory foci, covering skin defects, ensuring a good condition of the skin and soft tissues, restoring normal blood supply to the bone fragments, and good biomechanical fixation of the fragments with dynamisation or compression. The Ilizarov method is a method of choice in the treatment of cases of infected nonunion where other treatments have failed.

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Sports-Related Injuries of the Pediatric Musculoskeleton

IDKD Springer Series - Musculoskeletal Diseases 2021-2024 ◽

10.1007/978-3-030-71281-5_19 ◽

2021 ◽

pp. 269-281

Author(s):

Kirsten Ecklund

Keyword(s):

Bone Fractures ◽

Critical Role ◽

Well Being ◽

Musculoskeletal Injury ◽

Long Bone ◽

Athletic Programs ◽

Imaging Features ◽

Medical Visits ◽

Optimal Evaluation ◽

Health And Well Being

AbstractWorldwide, more than 50 million children and adolescents participate in organized athletic programs annually. Despite the numerous health and well-being benefits, this widespread involvement also leads to acute and overuse injuries that account for millions of medical visits each year. Musculoskeletal injury in childhood may lead to growth disturbance and lifelong disability. Imaging plays a critical role in the diagnosis and management of these injuries. While radiography is sufficient for most long bone fractures, MRI is often necessary for optimal evaluation of injuries involving the radiolucent growth mechanism and articular structures. The following review will discuss the imaging features associated with many sports-related injuries unique to the pediatric musculoskeleton, specifically the lower extremity.

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