Physical Medicine Rehabilitation

Field Guide to Fracture Management (Field Guide Series) by Richard Birrer MD FAAFP FACSM, Robert L. Kalb MD

By Richard Birrer MD FAAFP FACSM, Robert L. Kalb MD

Equipped via physique zone and fracture style, this sensible source covers the complete spectrum of subject matters on the topic of powerful fracture management—from crucial scientific counsel on casting and splinting innovations and dealing with issues to chapters on education, case choice, and coverage matters. transparent a route to potent fracture administration! Standardized bankruptcy layout contains a "how-to" define that will help you find key evidence simply. worthy illustrations, tables, and figures supply important visible assistance within the potent therapy of straightforward and complicated fractures. useful, how-to process indicates you what works, what does not, and why. Pediatric content material assists the relations practitioner in treating adolescence fractures. pointers on fending off pitfalls assist you optimize effects.

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Example text

This is done by checking the tension of the skin, eliciting pain with passive extension of the big toe, and noting decreased light touch sensation in the first web space. If compartment syndrome is suspected, an orthopedic consultation is mandatory. Radiology Anteroposterior (AP)/lateral and a 20-degree caudal tilt AP x-ray are helpful. Fractures are classified according to where the fracture line extends (Fig. 1). In the past, treatment guidelines were based solely on x-ray; now, computed tomography scans are also used to assess articular depression and comminution.

Prevent blood clots by placing calf pumps and start enoxaparin (Lovenox) low-molecular-weight heparin. Make sure to discontinue Lovenox 12 hours preoperatively. A medical consultation is needed for surgical clearance. Draw preoperative laboratory tests: prothrombin time/partial thromboplastin time, complete blood cell count, chemistry profile, electrocardiogram, chest x-ray, and urinalysis. Do all in emergency room on admission to avoid delay in medical clearance. Definitive Treatment For all fractures, orthopedic evaluation is warranted.

Patients with ischial tuberosity avulsions are more comfortable with leg extension and external rotation. Figure 3 Lateral projection of the left innominate bone. Note the muscular attachments to the ilium, ischium, and pubis. cgi Figure 4 Inlet view of the pelvis. cgi Figure 5 Outlet view of the pelvis. 30 Figure 6 Obturator oblique x-ray of the left hemipelvis. This view is taken by elevating the affected hip 45 degrees to the horizontal by means of a wedge and directing the beam through the hip joint with a 15-degree upward tilt.

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