Correct Trauma Principle in Joint Replacement give Excellent Results.

80year old male presented with pain and inability to bear weight on left Lower Limb since 2 days

Pre Op Xrays

Diagnosis : Severe OA Left knee with Displaced Stress Fracture in Upper Tibia

PLAN : Primary TKR with Extension ROD 

OPERATIVE PEARLS:

• Guarded Knee Flexion for Tibial Cuts
• Use of POLLER SCREW technique to get the alignment of Intramedulary Rod in Proximal tibia.
• Finishing the Femur cuts to Get Space for Entry into Proximal Tibia
• Serial Reaming after putting the Poller Screw and checking reduction under Carm guidance
• Using intramedullary Guide for Proximal Tibial cuts
•  Using large Extension Tibial Rod for Tight fit
• Checking Correct Rotation and Patellar Tracking before final Implantation

 Post Op Xrays

Correct TRAUMA PRINCIPLES in JOINT REPLACEMENT give Excellent Results.

Surgery Performed by Dr Ajay Shah and Dr Kunal Shah

KNEE REPLACEMENT - PRE AND POSTOPERATIVE REHAB

PRE OPERATIVE REHAB

•  Educate patient about knee surgery & procedure to reduce anxiety & stress.
•  Importance of Pre operative exercises :-

1. Ability to build up strength in the knee muscle around your knee prior to surgery will have great impact on speed & quality of recovery. 
2. And it did help in many other ways, pre-operative therapy strengthened his core, hip & quadriceps, the muscles surrounding knee joint.
3. All the muscle that was needed for speedy recovery was prepared for action. 

POST OPERATIVE REHAB

• A regular exercise program is a key part of recovery from operation. 
• Regular exercise to restore your knee mobility & strength & gradually return to everyday activities is important for full recovery.
• When you build up strength in the muscle around your new joint, it will help you get back to your normal activities. 
• It is recommended that exercise approximately 20-30minutes, 2/3 times a day & walk 30minutes.

BENEFITS OF POST OPERATIVE REHAB

1. Restore normal range of motion.

2. Build up strength in the joint & surrounding muscles.

3. Ease pain and swelling.

4. Let you get back to normal activity.

5. Help with circulation, so you don’t have blood clot problem.

POST OPERATIVE CARE

• Post surgical pain usually subsides after a week of rest and strengthening exercises.
• Surgical wound should be kept clean and dry until area heals 
• Patient should avoid soaking for about 2 weeks after total knee replacement.
• Physical therapist involves movements and exercises to help the patient adjust to the new joints and gradually make patient walk.
• Swelling is normal for 2 to 3months after total knee replacement, elevating the leg for 30 to 60 minutes every day can help.
• Patient should be sure to eat a healthy diet and should follow specific dietary instructions.

DO’S

• Walk and exercise daily. 
• Use an ice pack for pain and swelling. 
• Elevate your leg 1hour 2times in a day for swelling 
• Proper use of cane/ stick/ walker 
• Use western toilet 

DONT’S

• Do not twist your knee.
• Avoid putting unwanted load or stress on your knee. 
• Don’t put a pillow or a roll directly under your knee while you are a sleep. 
• Always keep knee out straight while lying down. 
• Avoid a sitting cross leg position 

Dr Purvi Thakkar
B.P.T., STOTT Pilates Trainer
Consultant Physiotherapist
Ashutosh Hospital

Recovery From An MCL Injury?

The medial collateral ligament or the MCL is a large ligament

running along the inner side of the knee. The MCL helps prevent the knee from caving inward. MCL injuries can occur from being hit on the outside of your knee. An MCL injury can also occur if our leg slides to the side and our knee caves inward. Your recovery from an MCL injury can vary from weeks to months depending on the severity of the tear.

The MCL is one of the strongest and largest ligaments in the knee. Anatomically there are two separate parts to the MCL, the deep and superficial portions. The MCL is commonly injured in isolation. Most MCL injuries are usually mild in severity. MCL injuries can also occur in combition with ACL injuries, but that is not a common injury pattern. Unfortunately, MCL injuries are one of the most painful knee injuries.

Types of MCL Injury

MCL injuries are graded 1-3. Grade 3 injuries are the most

severe and represent a complete rupture. The ligament has completely torn into 2 parts. Grade 1 injuries are the least severe and only a small portion of the MCL has torn. Grade 2 injuries are somewhere in between. In grade 2 MCL injuries, nearly half of the ligament is usually injured, stretched or torn.

Treatment of MCL Injury

Most MCL injuries do not require surgery. Most MCL injuries are grade 1 or grade 2 tears. Because of the pain that occurs when the MCL is stretched we will typically put you in a brace for a few weeks to support the ligament and ease your pain. Most of you can be started in physical therapy to rehab your knee soon after the injury. Grade 3 injuries might require a longer period of bracing and in some instances a grade 3 complete MCL tear might require surgery to repair the tear.

Recovery From An MCL Injury

Recovery from an MCL injury is very dependent on the grade of your MCL tear. Recovery from a grade 1 MCL injury can be as short as a few weeks. Once your range of motion and strength have recovered most grade 1 MCL injuries can anticipate a full return to sports. MCL injuries do tend to be painful so the pain from the injury might linger on for a month or two.

The recovery from a grade 2 MCL injury will take a while longer. A grade 2 injury might take between 2-3 months until you are comfortable, the knee is stable and your motion and strength have returned to normal. Once you have sustained a grade 2 or 3 injury it is also very important to focus on sports specific rehabilitation and neuromuscular rehabilitation to make sure that your knee is ready to compete.

The recovery from a grade 3 injury can take up to 6 months to recover from. Especially if surgery is necessary to repair the ligament. If surgery was not necessary then you may recover between 3-5 months after your injury. Once again, sports specific and neuromuscular rehabilitation is critical to your recovery and minimizing the risk of reinjury when you return to play.

Know the Warning Signs: Early Symptoms of Osteoarthritis of the Knee

Osteoarthritis is a disease where the cartilage of the joints wears away, and the bones start to rub together. The knee is the biggest joint in the body, and it carries a lot of weight.

As people get older, the task of carrying this weight can wear down the cartilage that covers the ends of the bones in a joint.

Cartilage is the tissue that makes sure the bones pass over each other smoothly. It also acts as a kind of cushion or shock absorber.

If the cartilage wears away, the bones will rub together. This can lead to osteoarthritis (OA), the most common type of arthritis.

OA causes pain, swelling, and stiffness. People with OA of the knee may find it hard to exercise, climb stairs, or even walk.

Symptoms that can appear at the early stages of knee OA are:

• Early symptoms of knee OA include pain, swelling, and stiffness.
• Pain, especially on bending and straightening the knee
• Swelling, caused by a buildup of fluid in the joint, or by bony growths called osteophytes that form as the cartilage breaks down
• Warmth in the skin over the knee, especially at the end of the day
• Tenderness when pressing down on the knee
• Stiffness when moving the joint, especially first thing in the morning, or after a period of inactivity
• Creaking or cracking on bending, known as crepitus

Activity can make symptoms worse, leading to pain at the end of the day, especially after a long time of standing.

If the knee is red, the person has a fever, or both symptoms occur, the problem is likely to be a different condition to osteoarthritis.

Treatment of OA depends on how serious the condition is.

There are some home remedies and over-the-counter treatments for OA of the knee that can be used at home and are readily available from the pharmacy. 

These treatments include:

• Applying heat or cold. Heat relieves stiffness and cold can ease pain. The heating pad or ice pack should be covered with a towel so as not to burn the skin.
• An assistive device, such as a cane or walker, can help take some of the weight off of the knees. Holding the cane in the opposite hand to the painful knee is most effective.
• Pain relief medications are available over the counter. These should always be used with caution as they can cause side effects.

For some people, pain and other symptoms are severe enough to interfere with daily life, and over-the-counter medications do not help.

People should see a doctor if their knee pain and other symptoms begin to interfere with daily life.

The next step is to consult a general physician, who may refer the patient to a rheumatologist or orthopedic surgeon.

The doctor will examine the knees, moving them forward and back to note the range of motion, and to find out which movements cause pain.

There are a number of tests to diagnose osteoarthritis:

• Joint aspiration involves using a needle to draw a sample of fluid from the joint. That fluid is then checked in a laboratory for signs of other joint problems such as gout or infection.
• Magnetic resonance imaging (MRI) can provide detailed images of the person’s knees, which may show fluid buildup in the thigh or knee bones.
• X-rays can reveal whether the knee joints have been damaged in the later stages, but may not reveal damage in the early stages.

There are some lifestyle changes that can relieve the pain and stiffness caused by knee arthritis:

• Losing weight can relieve pain and prevent further joint damage
• Exercise is one of the best ways to relieve arthritis pain, especially low-impact exercises such as walking, riding a stationary bicycle, or swimming
• Swimming is ideal because the buoyancy of the water takes pressure off the joints, while the warmth soothes them.

OA is a common but painful condition that affects many people as they age. Pain, stiffness, swelling, warmth, or cracking in the joints may be signs that it is time to seek medical help.

Brachial Artery Injury In Distal Humerus Fracture Treated without Vascular Intervention

A 35 year old patient had a RTA and sustained injury to Right Elbow and Arm. He was primararily treated elsewhere and came to us after 8 hrs of injury.

X-rays

But Radial Pulse was not palpable on the right side. Finger movements were full and SPO2 in the fingers showed 94% saturation.

CT Angio showed blockage of Brachial artery at the level of elbow with good distal flow in the ulnar and radial artery in the forearm.

CT ANGIO

Operative Pearls :

- Surgery through Posterior approach

- Bony spike of proximal fragment touching the Brachial artery.

- Spike lifted and Torn Brachialis muscle repaired

- Artery found to be pulsating

- Fracture fixation done

- It is important to visualize the Brachial artery from Posterior approach

INTRA OP PICTURES

POST OP XRAYS

Post operative the distal SPO2 improved to 98% and Patient’s Limb Survived Without VASCULAR INTERVENTION.

After 2 weeks of Surgery, PULSE was WELL PALPABLE and Patient had a full recovery.

Medial Collateral Ligament (MCL) Injury

What are the different types of medial collateral ligament (MCL) injuries?

An injury to a ligament is called a sprain. Like any other sprain, MCL injuries are graded by their severity. When the fibers of the ligament are stretched but not torn, this is referred to as a Grade 1 sprain. Grade 2 sprains are when the ligament fibers are partially torn. When the ligament is completely torn or disrupted, this is a grade 3 sprain.

Because of the anatomy and how the MCL is related to the medial meniscus (cartilage) and the ACL (anterior cruciate ligament), these two structures may also be damaged in association with an MCL injury.

What are causes and risk factors of medial collateral ligament (MCL) injuries?

MCL injuries are the most common ligament sprain of the knee. They are often sports-related and can occur in any age group. Contact sports are the most common risks, including football, hockey, wrestling, and martial arts. Males tend to be more at risk than females.

MCL injuries occur usually from a sudden impact to the outer part of knee. The injury may be either due to contact, being hit on the outside part of the knee, or non contact due to twisting, cutting, or stopping suddenly (deceleration).

What are medial collateral ligament (MCL) injury symptoms and signs?

Pain is the first symptom of an MCL injury. It typically occurs almost immediately and is located along the course of the ligament. Sometimes this is associated with swelling within the knee joint. Occasionally, swelling develops in a matter of minutes. The Pain of an MCL sprain will also cause the person to limp in order to protect the knee joint.

What tests are used to diagnose and assess medial collateral ligament (MCL) injuries?

The diagnosis of an MCL sprain is usually made by history and physical examination. The patient often knows the mechanism of injury, that is precisely what they were doing and what position their body was in when the injury occurred. 

This helps the health-care professional understand the stresses that were put on the knee joint. Other questions might include whether the patient was able to walk, whether the knee began to swell, and how long it took for that to happen after the injury.

The physical examination includes looking at the knee to see whether or not it is swollen and touching the knee in various places to find places of tenderness and pain. With MCL sprains, there is tenderness along the course of the ligament on the inner aspect of the knee.

The ligament can also be stressed on physical examination. By pushing on the outer side of the knee, the examiner can determine if the MCL is stable or unstable. This can be a rough assessment of the grade of sprain, where a grade 1 sprain is stable and a grade 3 sprain is unstable.

Physical examination concentrates on the knee joint and the hip and ankle to identify any other associated injuries.

Plain X-rays of the knee can be used to identify fractures of the femur and tibia bones. An MRI is the best way to actually visualize the MCL and determine the grade of sprain, but it is not always necessary. If there is concern that there is also a tear of the medial meniscus or anterior cruciate ligament, an MRI may be appropriate.

Joint pain...is it osteoarthritis?

Your knee aches from time to time. Or maybe your fingers don't seem as nimble as they used to be. Could it be osteoarthritis?

Osteoarthritis, the most common form of arthritis, develops when cartilage, the flexible tissue lining the joints, deteriorates. As a result, the space between bones gradually narrows and the bone surfaces change shape. Over time, this leads to joint damage and pain.

People with osteoarthritis often have it in more than one joint. It is most common in the knee, hip, lower back, and neck, and in certain finger joints. The symptoms of osteoarthritis usually develop over many years, and many of the early symptoms are the same no matter which joint it starts in. The first sign is often pain in a joint after strenuous activity or overusing the joint. The joint may be stiff in the morning, but loosen up after a few minutes of movement. Or the joint may be mildly tender, and movement may cause a crackling or grating sensation. Some people have continual joint pain that interferes with sleep.

But some telltale signs of osteoarthritis are specific to certain joints. If you're experiencing any of the types of joint pain listed below, ask your doctor to check you for osteoarthritis.

• Knees. When osteoarthritis affects the knee, the result is pain, swelling, and stiffness of that joint. What starts out as some discomfort after a period of disuse can progress to difficulty walking, climbing, bathing, and getting in and out of bed.

• Hands. Osteoarthritis of the hand often starts with stiffness and soreness of the fingers and in the base of the thumb, particularly in the morning. You may find that it becomes harder to pinch, and that your joints crackle when moved. People with hand osteoarthritis may have difficulty doing routine movements, like opening a jar, turning a key, or typing.

• Hips and spine. When osteoarthritis affects the hip, pain may be felt in the groin, down the inside thigh, or even as far away as the knee. Osteoarthritis of the cervical spine (in the neck) can cause pain in the shoulders and arms. When it affects the lower spine, pain can spread to the buttocks or legs.

What You Should Know About Middle Back Pain

Chances are good that if you don't suffer from back pain you know someone who does. Most back pain sufferers complain of lower or upper back pain but there is that seldom talked about and elusive middle back pain that gets very little lip service.


The truth is that though we don't hear about it very often, middle back pain is a common source of back pain among manual laborers. While the population as a whole doesn't suffer from mid back pain as much as manual laborers, there are a variety of reasons for your current bout of middle back pain.

Should you be concerned about mid back pain? Quite simply: yes. Because the portion of the back sandwiched between the upper and lower back gets less use, an injury to this portion of the back is incredibly painful and severely limits upper body mobility.

Where Exactly Is Your Mid Back?

Although some upper and lower back pain radiates up and down, the middle back goes from your shoulders and ends at the base of the rib cage. The pain will be more concentrated in this area than it is when you suffer from other forms of pain in the back.

What Causes Mid Back Pain?

Unlike the other forms of back pain, middle back pain doesn't have quite as many causes. While injury can cause just about any type of back pain, there are a few common causes, including:

• Poor posture Thanks to too many hours spent in front of computer screens, tablets and e-readers, middle back pain is due to that weird hunch associated with technology hounds.
• Trauma is a common cause of back pain whether due to a fall, a football hit, auto accident or improper lifting.
• Bad sleep posture isn't something we often think of as a source for back pain, but the truth is how we sleep for hours at a time can have a serious impact on the middle back area. Sleeping (or standing) hunched over has the same impact as sitting hunched over a computer screen.
• Excess weight causes many types of back pain because it strains the muscles in the back, causing pain. Specifically an excessively large stomach can pull at the lower and middle back, causing muscle strain.

Symptoms

How do you know if that nagging pain in the middle of your back is a simple run-of-the-mill backache or actual middle back pain? It can be difficult to tell the difference since you won't feel that unbearable pain associated with lower back pain and because the mid-back muscles get used far less.

The most obvious symptom of middle back pain is a limited range of motion particularly when bending. If you bend beyond what the pain allows, it may be dull or sharp pain radiating throughout the midsection of the back. Sometimes the pain can be accompanied by numbness or tingling, especially after long periods of inactivity.

It will be very hard to know if your pain is more than a simple ache, but that is why it is important to seek out a back specialist. You need to make sure that a few days of pain don't turn into several weeks or months, allowing the pain and your range of motion to worsen.

An Ounce of Prevention...

If you've ever suffered from any type of back pain in the past and wished you could have done something to prevent it, the good news is that you can. In fact, simple acts such as regular exercise and a healthy diet can go a long way to help prevent muscle strain in the middle back. Exercise keeps the muscles strong and when combined with a healthy diet, is conducive to weight loss, which will reduce muscle strain.

Do you spend time staring in the mirror at the gym while you pump iron? If so you may want to take it easy and reduce the weight on your bar. Often the problem is simply that we're trying to push our bodies further than its ready to go. This happens often with those who are returning to exercise after a long period of inactivity or those trying to expedite their weight lifting goals.

The moment you begin to notice pain in the middle back you should reduce the weight you're lifting. In general, however, if you feel that you are having difficulty with a heavier weight, reduce it.

One of the best prevention tools for mid back pain is ergonomic equipment. Use ergonomic keyboards, desks and office chairs to keep your back properly aligned. If you need a sleep pillow to keep your posture proper in sleep, there are many places to purchase one to stop mid back pain before it starts.

Rest your body properly after any amount of physical exertion. Muscle strain can turn into a long-term problem if you continue to push your body too far and the best way to prevent it is to let your body rest. Whether it is after a workout, a long day of manual labor or sitting at a desk, take a few minutes to stretch and relax your muscles.

Slow Burn

Middle back pain is a problem that takes time before you truly begin to experience painful or uncomfortable symptoms. This is why you should take note of your symptoms as they pop up and if the pain persists for longer than a couple of weeks, get in to see your doctor immediately.

The sooner you take care of the pain in the early stages, the less likely it is to make it to the more painful stages.

Spinal Fractures and Vertebroplasty

As you age, the bones in your spine become weaker and more brittle, which often develops into a disease called osteoporosis. Although osteoporosis affects all the bones in your body, the most vulnerable area is your spine. In fact, spinal fractures – also known as vertebral compression fractures – are experienced by up to 700,000 elderly individuals each year.

To combat this disease, it is important to first understand the specifics of spinal compression fractures and the risks involved:

Your spine consists of 24 vertebrae, which are separated by inter-vertebral disks for cushioning and shock absorption and held together by the spinal cord. This flexible system remains straight while you are young but gradually bends as the vertebrae weaken and flatten with age. In this weakened state, your spine is at a significantly higher risk of fracture in the case of a fall as well as everyday activities such as reaching, bending or even sneezing and coughing.

If you experience severe back pain or have been previously diagnosed with osteoporosis, there are a number of solutions that your orthopedic physician may recommend. A common surgical solution for a spinal fracture is vertebroplasty. Through a relatively simple outpatient surgery, a specialized bone cement is injected into the weakened vertebrae as a preventative measure against fractures and/or for the purpose of stabilizing existing fractures.

Vertebroplasty is an effective solution with high rates of successful results. Most patients experience immediate pain relief and improved mobility, allowing them to return to their regular daily activities soon after completion of the procedure.

Why let your age dictate what you can or cannot do when solutions for your back pain could be achieved by speaking with a pain management doctor? If you are ready to discuss your concerns and learn whether you require vertebroplasty or another treatment, please do not hesitate to contact your pain management specialist at Ashutosh Hospital, Vadodara, Gujarat.

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Sports Medicine Treatment

It’s a Good move!

Many of us play sports everyday. Some go for a run before work in the morning. Others enjoy a round of golf or a competitive game of basketball on the weekends. Over eight million young men and women play high school and college sports. It’s natural for injuries to happen with physical activity—whether it’s stopping and changing direction too quickly on the cricket field or stretching improperly before a run. No matter the injury, immediate treatment is always the best solution.

At Ashutosh Hospital, we deliver world-class orthopedic care for athletes of all ages. Our sports medicine specialists are skilled and experienced in treating all types of sports-related injuries, from fractures and sprains to tears and concussions. We use state-of-the-art equipment and procedures that enable fast and precise diagnosis, treatment, and recovery.

Personalized Treatment

We understand that each sports-related injury requires a different and exact treatment plan. In addition to developing different approaches to injuries in ​youths versus adults, we also understand that women and men are prone different athletic injuries. For example, young women are 2-8 times more likely to tear their anterior cruciate ligament (ACL) than men. We provide advice and care based on the widest range of knowledge, so you receive the most personalized treatment plan.

Physical Therapy

Physical therapy is also a top priority at Ashutosh Hospital. Our orthopedic doctors work closely with physical therapists to prevent future injuries and to ensure you stay physically active. The medical professionals at Ashutosh Hospital are dedicated to facilitating a healthy, active lifestyle before, during, and after an injury.

When it comes to sports medicine, the orthopedic care at Ashutosh Hospital is a natural choice for injured athletes who want to get back in the game as quickly as possible.

ShoulderHemiarthroplasty

A 58 year old female presented with history of fall at home. She sustained injury to her right shoulder. She had a Previous history of IHD.

X ray of Right shoulder showed Four Part Right Proximal Humerus Fracture.

FACTORS IN CONSIDERATION :

·         - Age of the patient

·        -  Low Demand

·         - Comminution

·         - Osteoporosis

In view of the above factors HEMIARTHROPLASTY was offered to the patient.

OPERATIVE PEARLS:

·         - Separation and preservation of Greater and Lesser Tuberosity

·        -  Modular Prosthesis for achieving perfect fit and tension

·        -  After the prosthesis was fit the tuberosity were fixed with each other and to the prosthesis

·         - Bone graft from the head was packed at the Shaft Tuberosity junction

ShoulderHemiarthroplasty

A 58 year old female presented with history of fall at home. She sustained injury to her right shoulder. She had a Previous history of IHD.

X ray of Right shoulder showed Four Part Right Proximal Humerus Fracture.

FACTORS IN CONSIDERATION :

·         - Age of the patient

·        -  Low Demand

·         - Comminution

·         - Osteoporosis

In view of the above factors HEMIARTHROPLASTY was offered to the patient.

OPERATIVE PEARLS:

·         - Separation and preservation of Greater and Lesser Tuberosity

·        -  Modular Prosthesis for achieving perfect fit and tension

·        -  After the prosthesis was fit the tuberosity were fixed with each other and to the prosthesis

·         - Bone graft from the head was packed at the Shaft Tuberosity junction

MIO Tibial Plating

A 24 year old male had a RTA and sustained a Femur fracture with a Comminuted Tibia Fracture and Compound Foot injury.

Tibia Fracture was Comminuted in the Mid shaft for about 2/3 rd of the tibial length. There was segmental fracture of the fibula

Pre Op Xray :

Considering the Comminution MIO/MIPPO plating was planned.

The length of the Plate could have been a problem and hence X rays were taken with the longest plate available.

PLATE XRAY

OPERATIVE PEARLS :

·         MIO Plating was performed spanning the Comminuted Shaft fragment.

·         Segmental Fibula fracture was fixed with One proximal and one distal Rush nail.

 10 WEEKS                                                                            10 WEEKS 

 Fianl 10 WEEKS                                                                   Final 10 WEEKS 

   

After 24 Weeks                                                                       After 24 Weeks                                                                 

Fracture united at 5 months and patient has excellent Functional Range of movements.

Post OP Xray

Post OP Xray

Hip Replacement in Acetabular Fracture

A 78 year old Patient had an RTA and sustained a Hip injury. He was diagnosed as having a Central fracture dislocation (Bicolumnar Fracture). He was not operated by the treating Orthopedic Surgeon considering the Risks involved at the Age. He presented to us after 7 months with ProtrusioAcetabuli with AVN of Femoral head.

His major Complaints were:

•             Severe restriction of daily activities
•       Night pain and Rest Pain
•        Difficulty in Sitting and Getting up

Pre Op Xray

Discussing the risks involved, the Patient was asked to undergo a hip replacement to alleviate his symptoms.

CT Pelvis was done to get a better understanding of the defects.

CT 1

CT 2

CT 3

CT findings :

·         Defect in anterosuperior wall

·         Posterior wall was intact

·         Defect in anterosuperior part of head

Challenges of Surgery :

·         Defect Reconstitution

·         To get the Perfect Rim fit

·         Early mobilization considering the advanced age

·         Restoring near normal Hip Centre

Operative Pearls:

·     It was decided to use a Trabecular Metal cup and Uncemented Stem on the Femoral side Head and neck

·       The graft was Fixed with the Screws through the cup

·       Rim fit Gription Cup was placed and sufficient lateralization was achieved

Post Op Xray

Colle’s Fracture / Broken Wrist

Colle’s fracture is a wrist fracture which occurs within an inch of the wrist joint involving the forearm bone’s distal end of the radius.

The fracture runs transversely just above the wrist joint and displays this distal end of the bone more dorsally giving the wrist the classical “dinner fork” deformity look.

Colle’s fracture is named after Abraham Colles, an Irish surgeon, who first described the condition. Another name for this fracture is the “Pouteau” fracture. It mostly results from a “slip and fall” on an outstretched hand.

Usually the incidence goes up after the rains or after the first snow fall in winter when the roads are icy and slippery or. Typically, when people fall they try and prevent injury to their head or other parts of the body by putting their hands out to hit the ground first. A bad fall results in fracture of the wrist with bruise of the skin over it. As the bone is a living hard tissue it is supplied by blood vessels and nerves. This causes the fracture to be very painful.

Although this fracture occurs in all age groups it tends to be more common in two age groups – the elderly people and in children. In Children the bones are soft and supple and hence tend to bend easily. Here the fracture is usually incomplete while in adults it is a complete fracture. These fractures are also seen in menopausal women with osteoporosis, in whom it is second only to vertebral fractures.

Wrist arthritis can occur as a Colles fracture complication, either from cartilage injury, or from wear and tear in the joints after the fracture is healed. Carpel tunnel syndrome, characterized by numbness and tingling, may also set in after the fracture.

Knee Cap Fracture

A Patella Fracture is a fracture of the knee cap and is one of the most common knee injuries.

The knee cap (patella) acts like a shield for the knee joint and so it can easily be injured. About 15% percent of sport injuries involve the knee. The knee is the weakest if a person is involved in high-velocity, cutting, twisting, and jumping activities. Patella fractures are more common in males than in females.

Falling directly onto the knee is a common cause of Patellar fractures.

Pain and swelling of the knee are the common symptoms of Patellar fracture.

Diagnostic techniques like x-ray and MRI can be used to determine the type and extent of fracture.

Patellar fracture is a serious injury and often requires surgery to heal. In the long run, it may cause arthritis in the knee, weakness of the quadriceps muscles and chronic pain.

What are the Causes of Fracture of Knee Cap?

The knee cap can be fractured due to -

- A direct blow, such as a collision with dashboard in a motor vehicle accident.

- A fall on a flexed knee or forceful quadriceps contraction, such as with stumbling or falling.

- Chronic stress to the knee.

- Pathologic conditions or chronic infections can lead to fractures.

- Swelling and pain in the knee are the main symptoms of knee cap fracture.\

Other symptoms include

- Bruises over the knee in case of direct violence.

- Inability to straighten the knee.

- Inability to walk.