RehabEdge homepageHost a course at your facilityCEU by topic and providerSearch for CEU by state, topic, format, etc.Comprehensive therapy products and supplies catalogRehabEdge Forum main pageReach thousands of therapists to show off your products and CEUAsk us. We're here to help.

case of the week august week 3

  		Logged in as: Guest
Users viewing this topic: none
  Printable Version
All Forums >> [RehabEdge Forum] >> Medical Complexity >> case of the week august week 3 Page: [1]
Login
Message << Older Topic   Newer Topic >>
case of the week august week 3 - August 23, 2007 6:49:47 PM   
Dr.Wagner


Posts: 1239
Joined: January 24, 2003
From: Indianapolis
Status: offline 		20 year old male involved in a MVA
Restrained, car vs tree

Describe this fracture (as if giving a report), give the name of this fracture, and describe the mechanism.







Attachment (1)

_____________________________

Dr. Wagner DO
Moderator of Medical Complexity Forum
Post #: 1
RE: case of the week august week 3 - August 23, 2007 6:50:24 PM   
Dr.Wagner


Posts: 1239
Joined: January 24, 2003
From: Indianapolis
Status: offline 		picture 2





Attachment (1)

_____________________________

Dr. Wagner DO
Moderator of Medical Complexity Forum

(in reply to Dr.Wagner)
Post #: 2
RE: case of the week august week 3 - August 23, 2007 7:10:41 PM   
Chocco

 

Posts: 58
Joined: September 5, 2006
Status: offline 		Radiology is not my strong point, but is it  closed comminuted fracture of the distal tibia. The distal fibula doesn't look to be fractured but seems to be too lateral from the mortise ( ? Trimaleolar fx). Either way it looks like a crush type injury like his foot was braced against something ( pedal or dashboard. etc) when he hit the tree. Like i said radiology isn't my strong suit, but i think these are fun so i thought i would give it a try.

(in reply to Dr.Wagner)
Post #: 3
RE: case of the week august week 3 - August 23, 2007 9:05:17 PM   
jma

 

Posts: 2356
Joined: August 24, 2000
From: NY
Status: offline 		The first one looks like an oblique displaced comminuted closed fracture of the left distal tibia.
The second is a lateral displaced comminuted closed fracture of the left distal tibia. Hope they are right.

(in reply to Chocco)
Post #: 4
RE: case of the week august week 3 - August 23, 2007 10:01:45 PM   
USAPT

 

Posts: 277
Joined: January 14, 2004
Status: offline 		closed, displaced comminuted spiral fx of distal tibia. Pt may have tried to brace himself with his L foot next to the pedals. The force of the collision may have forcefully internally rotated his L LE. Just a thought. Thanks Doc.

(in reply to jma)
Post #: 5
RE: case of the week august week 3 - August 23, 2007 10:08:20 PM   
Dr.Wagner


Posts: 1239
Joined: January 24, 2003
From: Indianapolis
Status: offline 		Should've added this...one hand on the foot, other on the camera...it really isn't as gross as the picture seems...remember this fracture has a NAME





Attachment (1)

< Message edited by Dr.Wagner -- August 23, 2007 10:12:51 PM >

_____________________________

Dr. Wagner DO
Moderator of Medical Complexity Forum

(in reply to USAPT)
Post #: 6
RE: case of the week august week 3 - August 24, 2007 7:15:45 AM   
JCOY

 

Posts: 34
Joined: April 13, 2006
Status: offline 		Spiral fracture of distal left tibia with posterior displacement.

(in reply to Dr.Wagner)
Post #: 7
RE: case of the week august week 3 - August 24, 2007 10:09:34 AM   
FLAOrthoPT

 

Posts: 1011
Joined: May 8, 2004
From: West Palm Beach
Status: offline 		Fracture name:
ugonnalimpawhile
or
mayajustalosedefoot

(in reply to JCOY)
Post #: 8
RE: case of the week august week 3 - August 24, 2007 11:35:33 AM   
Shill

 

Posts: 1078
Joined: February 13, 2003
From: Madison WI USA
Status: offline 		How about a MESS, group 2 sprial oblique comminuted open distal tibial fx?  Am I getting close? (Mangled Extremity Severity Score)  Finally, an acronym that makes sense.

Or maybe a Tscherne grade C II sprial oblique comminuted open distal tibial fx?   Shouldnt be a Weber, as the fibula is OK(?)

That all Ive got.

< Message edited by Shill -- August 24, 2007 11:44:27 AM >

(in reply to FLAOrthoPT)
Post #: 9
RE: case of the week august week 3 - August 24, 2007 7:09:57 PM   
Dr.Wagner


Posts: 1239
Joined: January 24, 2003
From: Indianapolis
Status: offline 		Open communuted oblique fracture of the distal tibia with minimal anterior displacement...


This type of fracture (open or closed) is called a PILON fracture (pronounced peelon).  Happens via axial load as the talus is forcefully directed into the tibia...like in a car accident.

Wicked cool.

Thanks for playing, I will try to get them posted on monday with answers on Friday.


_____________________________

Dr. Wagner DO
Moderator of Medical Complexity Forum

(in reply to Shill)
Post #: 10
RE: case of the week august week 3 - August 26, 2007 3:49:27 PM   
JCOY

 

Posts: 34
Joined: April 13, 2006
Status: offline 		I am curious as to "anterior displacement..."  per above.

Paul and Juhl state:
"When describing displacement of fracture fragments, it is usual to refer to the displacement of the distal fragment in relation to the proximal, the latter being considered as the stationary part.  Thus one speaks of a posterior displacement of the distal fragment of the tibia on the proximal fragment, rather than an anterior displacement of the proximal on the distal."
 
On the lateral film above, the distal tibial fragment appears posterior to the proximal.  

Thoughts?

(in reply to Dr.Wagner)
Post #: 11
RE: case of the week august week 3 - August 27, 2007 7:34:01 AM   
Dr.Wagner


Posts: 1239
Joined: January 24, 2003
From: Indianapolis
Status: offline
To be honest with you, displacement probably is the least important part of this.  As this is a communuted fracture, you could probably say anything and it matters little...specifically because this is an open fracture...fun.


_____________________________

Dr. Wagner DO
Moderator of Medical Complexity Forum

(in reply to JCOY)
Post #: 12
RE: case of the week august week 3 - August 27, 2007 8:41:52 AM   
JCOY

 

Posts: 34
Joined: April 13, 2006
Status: offline 		>>>To be honest with you, displacement probably is the least important part of this.<<<<
That is probably true if one has the films to look at, which would be the case, for the attending doc pinning this back together.

However- you posted:
>>>"Describe this fracture (as if giving a report),...."<<<.

I've seen/read,  good and HORRIBLE rad reports.  AND-  universal frame of reference in a report is absolutely essential in a quality report.   Reports are read by many that do not neccessarily have the films in front of them.  Communicating the information in a report is paramount.  Non-adherence to a univeral reference can create many problems. 

Do you think the  "anterior displacement" discriptor on this image study fits with the standard of image/radiology reports/ing? 

(in reply to Dr.Wagner)
Post #: 13
RE: case of the week august week 3 - August 27, 2007 9:24:56 AM   
Dr.Wagner


Posts: 1239
Joined: January 24, 2003
From: Indianapolis
Status: offline 		I understand your point, but this description, when given to a orthopedist taking call, the description of the displacement of the communuted fragment is most helpful.  In a closed fracture of the wrist, giving displacement is great because it helps with discussion of immediate vs delayed reduction.
In the case of an OPEN communuted fracture in trauma, the surgeon wants to have an idea of the complexity of the surgery he is entering.  If I would say to him, "Hey Joe, I have an open communuted pilon fracture of the left ankle with neurovascular involvement" he knows to call the OR pretty quickly...I reduce and splint the fracture, then he operates.

Thanks for all the imput guys, enjoy the next case already posted!


_____________________________

Dr. Wagner DO
Moderator of Medical Complexity Forum

(in reply to JCOY)
Post #: 14
Page:   [1]
All Forums >> [RehabEdge Forum] >> Medical Complexity >> case of the week august week 3 Page: [1]
Jump to:





New Messages No New Messages
Hot Topic w/ New Messages Hot Topic w/o New Messages
Locked w/ New Messages Locked w/o New Messages
 Post New Thread
 Reply to Message
 Post New Poll
 Submit Vote
 Delete My Own Post
 Delete My Own Thread
 Rate Posts



Google Custom Search
Forum Software © ASPPlayground.NET Advanced Edition 2.5.5 Unicode

0.172