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-Tibial stress fractures are common in athletes and nonathletes who suddenly increase their physical activity. Clinical features include pain, localized tenderness, and swelling. Plain x-ray is <50% sensitive for stress fractures, especially in the first 2-3 weeks after the onset of symptoms. MRI is preferred over bone scan or ultrasound as it can show the fracture line that extends through the cortex into the medullary line. MRI can also identify ligament, muscle, and cartilage injuries. However, MRI findings may be persistently abnormal for up to 1 year after the stress fracture has healed.
If your levels are too low, you have hypothyroidism and may not be ovulating as you should. Taking the right dose of thyroxine, the hormone you lack, can restore your fertility. You may have discovered your underactive thyroid as a result of trying to get pregnant.
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
The cardiac conduction system is a group of specialized cardiac muscle cells in the walls of the heart that send signals to the heart muscle causing it to contract. The main components of the cardiac conduction system are the SA node, AV node, bundle of His, bundle branches, and Purkinje fibers.
Following Dr. Eric Skarsgard on his grueling 19-hour day at BC Children's Hospital, we meet several of his patients -- some of who need surgery that day, and some who have chronic conditions and need regular check-ups with him -- and learn how he works with medical students and on research projects as time allows.
Giant cell tumors of the tendon sheath are common lesions and are the second most frequent tumors in the hand, after synovial cysts. They are diagnosed by means of clinical examination and complementary examinations (simple radiography and magnetic resonance). Erosion and invasion of the phalangeal bone affected may be seen on radiological examination. Magnetic resonance may show a “fluorescent or radiant effect” may be observed, caused by the high quantity of hemosiderin inside the tumor. Surgical treatment is the commonest practice, and complete excision is important for avoiding recurrence of the tumor, especially when bone invasion is observed on imaging examinations, which is generally related to greater tumor recurrence. In this paper, a case of a giant cell tumor of the tendon sheath in the middle phalanx of the third finger of a 45-year-old female patient is presented. This was successfully treated by means of surgery using a double access approach (dorsal and volar)
A Brazilian butt lift (BBL) uses a person's own fat to enhance the size and shape of the buttocks. A plastic surgeon first performs liposuction to remove fat from other areas of the body (often the stomach, hips, and thighs), then injects that fat into the backside. Additional liposuction can be done around the butt to improve the appearance of lift and contour.