Images of Human Bone.
Bone fracture : is structural break in normal continuity of a bone. It is usually caused by trauma, example; car accident, fall from height, fall on ground etc.
Types of fracture:
1. Transverse, due to direct trauma
2. Oblique, due to indirect violence
3. Spiral, due to indirect trauma
4. Comminuted, and due to severe compression
5. Green -stick fractures, and
6. Avulsion. In the end of page, there are some images...
Site of the fracture:
1. Intra-articular,
2. Epiphyseal,
3. Metaphyseal, And
4. Diaphyseal.
Fracture may be complete or incomplete.
Displacement:
Deformity of a bone fractured, it describes the position of the distal component in the relation the proximal one.
There are six displacement possible below.....
1. Lateral displacement; distal fragment deviates to one side with loss of opposition.
3. Over-riding; distal fragment overlaps the proximal fragment with shortening of the limb.
2. Angulation; loss of normal longitudinal axis of the shaft.
5. Distraction; the fragments are separated by vigorous traction during treatment.
4. Distal fragment is rotated along its long axis, and
7. Depression ; a fragment of bone is displaced.
6. IMPACTION.
Skin damage: According to the condition of the overlying skin fractures are classified into
1. Simple fracture and, in which the skin surface is intact,
2. Compound fracture, in which a laceration in the skin or mucous membrane communicates with fracture hematoma.
Classification of compound fractures shown in the below.
Type of fracture
Skin wound
Soft tissues drainage
Infection risk
Type one
<7 centimeters soft tissue drainage
Minimal Skin wound
<2 % Infection risk
Type two
>7 cm
Moderate Skin Wound
10% Infection risk
Type three
Any size
Severe, example; war wounds or RTA
More than 10%
Case 1.
Over 50 years old female having postmenopausal osteoporosis falls on her right palm of the outstretched hand in the ground. Patient complaining of pain at wrist, swelling, radial deviation of hand and tenderness in the deformity site.
X-ray is done, shown fracture of distal end of radius of the right hand. And also Dinner-fork deformity of hand.
X-ray is diagnostic for the colles fracture.
Treatment :
Reduction is done by manipulation under anaesthesia and fixation of fracture by below elbow plaster cast through holding wrist in palmar flexion and ulnar deviation.
Complications:
1. Malunion of bone,
2. Stiffness of the wrist,
3. Carpal tunnel syndrome, treated by division of flexor retinaculum.
4. Rupture of the extensor pollicis longus tendon and,
5. Sudeck's atrophy.
Case 2:
5 years old boy fallen onto outstretched hand with slightly flexion of the right elbow during playing football.
The boy complaining of pain and swelling in the elbow region, inability to move his right elbow, and palpable medial and lateral epicondyle.
Patient's radial pulse is felt.
X-ray shows supracondylar fracture of humerus.
Treatment : Depends on type of fracture.
-In the undisplaced fractures and greenstick fractures with angulation less than 20° require no manipulation. Only fixation is done by using a posterior plaster slab and collar and cuff with the elbow flexed for 3 weeks.
- Greenstick fractures with angulation more than 20° reduction by flexion only then fixation as above.
While
-Displaced fractures are treated by either..........
1. Closed reduction and fixation by posterior slab under anaesthesia
2. Closed reduction and percutaneous pinning, and
3. Open reduction and internal fixation if failed closed reduction.
The boy should be admitted to the hospital for observation of the circulation to the hand. If impaired, immediately manage the circulation by removing................ .
Complications of the fracture of the supracondylar of humerus:
1. Nerve injury ;
2. Brachial artery injure ; Volkmann's ischemic contracture.
3. Elbow stiffness and
4. Myositis ossificans.
Case 3:
25 Years old male complaining of inability to raise his left shoulder, and pain due to trauma by car accident since 2012. X- ray is done shown the Anterior Shoulder Dislocation. The patient has epilepsy since 2009.
After management of the shoulder dislocation, patient falls on the ground several times due to epileptic cause as a result several times shoulder dislocation happened as recurrence of shoulder dislocation.
Recurrence should be managed by surgical operations, example;
1. Putti-platt operation ; capsulorrhaphy and shortening of suprascapular muscle.
2. Bankart operation ; reattaching glenoidal labrum to the bony part as shortening the space between... .
Bankart operation was done for that patient. Some X-ray are shown in the right corner.
Complications of anterior shoulder dislocation are
1. Axillary nerve injury,
2. Bone fracture,
3. Joint stiffness,
4. Avulsion of supraspinatus tendon and
5. Recurrence.
Some Images below...
Information will be updated later..
Ulnar Claw Hand;
24 Years old M complaining of gradually progressive deformity of left hand after 1.5 years of surgical operation of left hand due to trauma by rulling machine. Trauma is healed by secondary intention. Operation was done 4 years ago.
Today, patient presents left hand deformity with loss of sensation of the medial part of the palm and fingers (ring and little ) is marked by black ink in the picture.
- On cardboard test: fingers of left hand can not grasp a paper sheet due to paralysis of interossei as a result lost of adduction and abduction of fingers.
- Ulnar claw hand due to paralysis of medial two lumbricals due to ulnar nerve injured due to trauma
- Paralysis of adductor pollicis longus; if pinched a paper Between thumb and ring finger , thumb is flexed as froment sign.
- marked atrophy of theinner muscle; muscle wasting. Picture of Claw hand...
Investigation: X-ray is done.
Treatment: conservative treatment and nerve suture as usual.
This patient also have recurrent umbilical hernia.
In this ulnar claw hand case, you need to know the innervation of hand muscles by ulnar nerve and its root.
Muscles are innervated by ulner nerve below.
1. flexor carpi ulnaris**
2. flexor digitorum profundis***
3. lumbrical muscles***
4. opponens digiti minimi
5. flexor digiti minimi
6. abductor digiti minimi
6. interossei** and
7. adductor pollicis**
Root of ulnar nerve: C8 and T1. Shown below
Information will be updated with time.
Today, patient presents left hand deformity with loss of sensation of the medial part of the palm and fingers (ring and little ) is marked by black ink in the picture.
- On cardboard test: fingers of left hand can not grasp a paper sheet due to paralysis of interossei as a result lost of adduction and abduction of fingers.
- Ulnar claw hand due to paralysis of medial two lumbricals due to ulnar nerve injured due to trauma
- Paralysis of adductor pollicis longus; if pinched a paper Between thumb and ring finger , thumb is flexed as froment sign.
- marked atrophy of theinner muscle; muscle wasting. Picture of Claw hand...
Investigation: X-ray is done.
Treatment: conservative treatment and nerve suture as usual.
This patient also have recurrent umbilical hernia.
In this ulnar claw hand case, you need to know the innervation of hand muscles by ulnar nerve and its root.
Muscles are innervated by ulner nerve below.
1. flexor carpi ulnaris**
2. flexor digitorum profundis***
3. lumbrical muscles***
4. opponens digiti minimi
5. flexor digiti minimi
6. abductor digiti minimi
6. interossei** and
7. adductor pollicis**
Root of ulnar nerve: C8 and T1. Shown below
Information will be updated with time.
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| Ulnar Nerve |