Closed Reduction of Distal Radius Fractures - Discussion: (distal radius fracture menu) - closed reduction & immobilization in plaster cast remains accepted method of treatment for majority of stable distal radius frx; - unstable fractures will often lose reduction in the cast and will slip back to the pre-reduction position; - patients should be examined for carpal tunnel symptoms before and after reduction; - carpal tunnel symptoms that do not resolve following reduction will require carpal tunnel release; - cautions: - The efficacy of closed reduction in displaced distal radius fractures. - Technique: - anesthesia: (see: anesthesia menu) - hematoma block w/ lidocaine; - w/ hematoma block surgeon should look for "flash back" of blood from hematoma, prior to injection; - references: - Regional anesthesia preferable for Colles' fracture. Controlled comparison with local anesthesia. - Neurological complications of dynamic reduction of Colles' fractures without anesthesia compared with traditional manipulation after local infiltration anesthesia. - methods of reduction: - Jones method: involves increasing deformity, applying traction, and immobilizing hand & wrist in reduced position; - placing hand & wrist in too much flexion (Cotton-Loder position) leads to median nerve compression & stiff fingers; - Bohler advocated longitudinal traction followed by extension and realignment; - consider hyper-extending the distal fragment, and then translating it distally (while in extended position) until it can be "hooked over" proximal fragment; - subsequently, the distal fragment can be flexed (or hinged) over the proximal shaft fragment; - closed reduction of distal radius fractures is facilitated by having an assistant provide counter traction (above the elbow) while the surgeon controls the distal fragment w/ both hands (both thumbs over the dorsal surface of the distal fragment); - flouroscopy: - it allows a quick, gentle, and complete reduction; - prepare are by prewrapping the arm w/ sheet cotton and have the plaster or fibroglass ready; - if flouroscopy is not available, then do not pre-wrap the extremity w/ cotton; - it will be necessary to palpate the landmarks (outer shaped of radius, radial styloid, and Lister's tubercle, in order to judge success of reduction; - casting: - generally, the surgeon will use a pre-measured double sugar sugar tong splint, which is 6-8 layers in thickness; - more than 8 layers of plaster can cause full thickness burns: - reference: Setting temperatures of synthetic casts. - position of immobilization - follow up: - radiographs: - repeat radiographs are required weekly for 2-3 weeks to ensure that there is maintenance of the reduction; - a fracture reduction that slips should be considered to be unstable and probably require fixation with (pins, or ex fix ect.) - there is some evidence that remanipulation following fracture displacement in cast is not effective for these fractures; - ultimately, whether or not a patient is satisfied with the results of non operative treatment depends heavily on th

Clinical Examination - Gait, Arms, Legs, Spine

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Ultrasound-guided internal jugular cannulation

Tuberous breast deformity is a congenital breast anomaly that becomes manifest at the time of puberty and breast development. The three components of tubular deformity usually include, pseudoherniation of breast tissue into the nipple areolar complex, poorly defined inframammary fold and flattening of the lower pole of the breast which leads to a conical tubular shape. Stuart Linder M.D. 9675 BRIGHTON WAY, SUITE 420 BEVERLY HILLS CA 90210 (310) 275-4513

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In patients age ;::25, HPV DNA testing is the preferred next step in management if the initial cytology shows ASC-US. In this method, samples are collected for both cytology and reflex HPV DNA. If cytology results are positive, HPV DNA testing is performed. If cytology results are negative, the sample for HPV DNA is discarded. HPV DNA testing along with Pap smear at 3 years is recommended if initial cytology shows ASC-US but HPV DNA testing is negative

-A finding of ASC on cytology requires further investigation to exclude precancerous lesions. Recommendations differ for women age 21 -24 and those age ;::25. For women age 21 -24 with ASCUS or low-grade squamous intraepitheliallesion (LSIL), current guidelines recommend repeating Pap smear in one year. In this younger patient population, HPV infection is transient and malignant transformation is rare. Therefore, colposcopy is not performed unless the patient demonstrates ASC-US or LSIL on 3

Comprehensive physical examination

Perineal rectosigmoidectomy

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ACE Inhibitor Mechanisms. Angiotensin converting enzyme (ACE) inhibitors are agents used to relax blood vessels and lower blood pressure. They prevent an enzyme from producing angiotensin II, which narrows blood vessels and raises blood pressure, meaning the heart has to work harder to pump blood around the body.

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Step by step instruction on placing a subclavian central line. Includes tips on making it "the straightest shot possible

Stapled hemorrhoidectomy for acute hemorrhoidal crisis could be undertaken under local anathesia with early recovery, short hospital stay and minimal postoperative pain

Possible complications could include: Difficulty healing. Infection. Stump pain (severe pain in the remaining tissue) Phantom limb pain (a painful sensation that the foot or toe is still there) Continued spread of gangrene, requiring amputation of more areas of your foot, toes or leg. Bleeding. Nerve damage.

3D animation video of Varicose Veins Sclerotherapy Treatment

Lung cancer starts when cells of the lung become abnormal and begin to grow out of control. As more cancer cells develop, they can form into a tumor and spread to other areas of the body. To learn more about how cancers start and spread

We are looking for 5 patients with knee pain who want to get significantly better in the next 30 days. Click this link to let me know you're interested and learn more.

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One of the most common knee injuries in contact and collision sports is a medial collateral ligament (MCL) injury. This is a ligament on the medial (side closest to the midline) side of your knee that provides stability against side-to-side stress to the knee. You might injure it by cutting maneuvers in sports like soccer or hockey. You can also suffer an MCL injury if another player hits you on the outside of your knee.

Please note: I don't respond to questions and requests for specific medical advice left in the comments to my videos. I receive too many to keep up (several hundred per week), and legally I can't offer specific medical advice to people who aren't my patients (see below). If you want to ask a question about a specific injury you have, leave it in the comments below, and I might answer it in an upcoming Ask Dr. Geier video. If you need more detailed information on your injury, go to my Resources page: https://www.drdavidgeier.com/resources/

The content of this YouTube Channel, https://www.youtube.com/user/drdavidgeier (“Channel”) is for INFORMATIONAL PURPOSES ONLY. The Channel may offer health, fitness, nutritional and other such information, but such information is intended for educational and informational purposes only. This content should not be used to self-diagnose or self-treat any health, medical, or physical condition. The content does not and is not intended to convey medical advice and does not constitute the practice of medicine. YOU SHOULD NOT RELY ON THIS INFORMATION AS A SUBSTITUTE FOR, NOR DOES IT REPLACE, PROFESSIONAL MEDICAL ADVICE, DIAGNOSIS, OR TREATMENT. You should consult with your healthcare professional before doing anything contained on this Channel. You agree that Dr. Geier is not responsible for any actions or inaction on your part based on the information that is presented on the Channel. Dr. David Geier Enterprises, LLC makes no representations about the accuracy or suitability of the content. USE OF THE CONTENT IS AT YOUR OWN RISK.

Unlike tears of the ACL, MCL injuries most often heal without surgery. You might need to wear a hinged knee brace for 2-6 weeks. The length of time you miss from sports or exercise varies depending on the location and severity of the injury.

In this video, I share my thoughts on the nature of an MCL injury, the diagnosis, the treatment options and return to sports.

Please remember, while I appreciate your questions, I cannot and will not offer specific medical advice by email, online, on my show, or in the comments at the end of these posts. My responses are meant to provide general medical information and education. Please consult your physician or health care provider for your specific medical concerns.