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Apophyseal Injury

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161. Osgood-Schlatter Disease (Follow-up)

however both groups reported symptom relief with no adverse outcomes. [ ] Long-term immobilization is typically contraindicated, because it may result in increased knee stiffness in mild cases, thus predisposing the athlete to additional sports-related injuries. However, if a patient is noncompliant, the clinician may recommend immobilization in a knee brace for a minimum of 6 weeks. The brace should be removed daily, but only for stretching and strengthening exercises. Inform the patient to avoid (...) of the extensor mechanism. Open reduction and internal fixation (ORIF) usually is recommended, depending on the size and displacement of the fragment as well as the phase of apophyseal closure. Indications for surgery Occasionally, adults have a large ossicle and an overlying bursa, which may cause pain with kneeling. If so, treatment consists of excision of the bursa, ossicle, and any prominence. [ ] Contraindications for surgery The real question is whether or not surgery is ever indicated in the growing

2014 eMedicine Emergency Medicine

162. Fracture, Pelvic (Diagnosis)

socket when the hip is driven backward in a motor vehicle accident. Occasionally, they occur in a pedestrian struck by a vehicle moving at a significant rate of speed. Pelvic avulsion fractures (see the image below) occur due to indirect trauma from sudden muscular contraction causing injury to the muscular attachment on the pelvis. These most often occur in skeletally immature athletes because of the inherent weakness of the pelvic apophyses. The three most common sites are the anterior superior (...) iliac spine (ASIS), the anterior inferior iliac spine (AIIS), and the ischial tuberosity because of contraction of the sartorius, rectus femoris, and hamstring muscles, respectively. [ ] Pelvic apophyseal avulsion fracture of the ischial tuberosity due to contraction of the hamstring muscles. Courtesy of Wikipedia (https://de.wikipedia.org/wiki/Apophyse). Previous Next: Epidemiology Pelvic fractures make up approximately 3% of all skeletal injuries. Open pelvic fractures are rare and represent only

2014 eMedicine Emergency Medicine

163. Osgood-Schlatter Disease (Diagnosis)

traction (traction apophysitis) on the anterior portion of the developing ossification center leads to multiple subacute microavulsion fractures and/or tendinous inflammation, resulting in a benign, self-limited disturbance manifested as pain, swelling, and tenderness. The most common long-term ramifications of OSD are pain on kneeling as an adult and the cosmesis of a bony prominence on the anterior knee. Less common complications are the persistence of a painful ossicle requiring surgical excision (...) persist for 2-3 years until the tibial growth plate closes. Previous Next: Patient Education Inform patients about activities that aggravate Osgood-Schlatter disease and about the self-limiting nature of the condition. For patient education information, see the , the , and the , as well as . Previous References Pommering TL, Kluchurosky L. Overuse injuries in adolescents. Adolesc Med State Art Rev . 2007 May. 18(1):95-120, ix. . Smith JM, Varacallo M. Osgood Schlatter Disease. StatPearls [Internet

2014 eMedicine Emergency Medicine

164. Anemia, Sickle Cell (Diagnosis)

by a spinal artery branch) results in the characteristic H vertebrae of sickle cell disease. The outer portions of the plates are spared because of the numerous apophyseal arteries. Osteonecrosis of the epiphysis of the femoral head is often bilateral and eventually progresses to collapse of the femoral heads. This same phenomenon is also seen in the humeral head, distal femur, and tibial condyles. Infarction of bone and bone marrow in patients with sickle cell disease can lead to the following changes (...) and an inability to deal with infective encapsulated microorganisms, particularly Streptococcus pneumoniae, ensue, leading to an increased risk of sepsis in the future. Chronic hemolytic anemia SCD is a form of hemolytic anemia, with red cell survival of around 10-20 days. Approximately one third of the hemolysis occurs intravascularly, releasing free hemoglobin (plasma free hemoglobin [PFH]) and arginase into plasma. PFH has been associated with endothelial injury including scavenging nitric oxide

2014 eMedicine Emergency Medicine

165. Sickle Cell Anemia (Diagnosis)

by a spinal artery branch) results in the characteristic H vertebrae of sickle cell disease. The outer portions of the plates are spared because of the numerous apophyseal arteries. Osteonecrosis of the epiphysis of the femoral head is often bilateral and eventually progresses to collapse of the femoral heads. This same phenomenon is also seen in the humeral head, distal femur, and tibial condyles. Infarction of bone and bone marrow in patients with sickle cell disease can lead to the following changes (...) and an inability to deal with infective encapsulated microorganisms, particularly Streptococcus pneumoniae, ensue, leading to an increased risk of sepsis in the future. Chronic hemolytic anemia SCD is a form of hemolytic anemia, with red cell survival of around 10-20 days. Approximately one third of the hemolysis occurs intravascularly, releasing free hemoglobin (plasma free hemoglobin [PFH]) and arginase into plasma. PFH has been associated with endothelial injury including scavenging nitric oxide

2014 eMedicine Pediatrics

166. Sever Disease (Treatment)

injuries of the foot and ankle in the child and adolescent athlete. Phys Med Rehabil Clin N Am . 2008 May. 19 (2):347-71, ix. . Weiner DS, Morscher M, Dicintio MS. Calcaneal apophysitis: simple diagnosis, simpler treatment. J Fam Pract . 2007 May. 56 (5):352-5. . Clemow C, Pope B, Woodall HE. Tools to speed your heel pain diagnosis. J Fam Pract . 2008 Nov. 57 (11):714-23. . Irving DB, Cook JL, Young MA, Menz HB. Impact of chronic plantar heel pain on health-related quality of life. J Am Podiatr Med (...) . Is radiographic evaluation necessary in children with a clinical diagnosis of calcaneal apophysitis (sever disease)?. J Pediatr Orthop . 2011 Jul-Aug. 31 (5):548-50. . Brenner JS, American Academy of Pediatrics Council on Sports Medicine and Fitness. Overuse injuries, overtraining, and burnout in child and adolescent athletes. Pediatrics . 2007 Jun. 119 (6):1242-5. . Wu M, Fallon R, Heyworth BE. Overuse Injuries in the Pediatric Population. Sports Med Arthrosc Rev . 2016 Dec. 24 (4):150-158. . Perhamre S

2014 eMedicine Surgery

167. Medial Humeral Condyle Fracture (Overview)

of injury for medial epicondyle fractures [ , ] have been proposed for an acute injury. All of them result in a partial or complete separation of the apophyseal fragment from the rest of the humerus. The first mechanism of injury is a direct blow on the posterior medial aspect of the epicondyle that may be associated with fragmentation of the avulsed bone. The second mechanism is a pure avulsion injury produced by the flexor muscles of the forearm (see the image below). This avulsion may occur (...) fractures appear to do worse if the epicondyle is excised than if they are treated nonsurgically. Previous References Rockwood CA, Wilkins KE, Beaty JH. Apophyseal injuries of the distal humerus. Fractures in Children . 3rd ed. Philadelphia: Lippincott-Raven; 1996. 800-19. Behrman MJ, Shelton ML. Fracture of the medial condyle of the humerus in an elderly patient. J Orthop Trauma . 1990. 4(1):98-101. . Bensahel H, Csukonyi Z, Badelon O. Fractures of the medial condyle of the humerus in children. J

2014 eMedicine Surgery

168. Lumbar Spine Fractures and Dislocations (Overview)

acute fractures are or vertebral endplate fractures caused by sudden axial loading, transverse process avulsion by the origin of the psoas muscle, spinous process avulsions, and acute fracture of the pars interarticularis from hyperextension. Vertebral body compression is more common in patients with decreased bone density. [ , ] In adolescents, it is relatively common to find endplate fractures or apophyseal avulsion fractures. All of these injuries generally are stable and heal with immobilization (...) > Lumbar Spine Fractures and Dislocations Updated: Oct 16, 2018 Author: Federico C Vinas, MD; Chief Editor: Jeffrey A Goldstein, MD Share Email Print Feedback Close Sections Sections Lumbar Spine Fractures and Dislocations Overview Background Each year, more than 150,000 persons in North America sustain fractures of the vertebral column. Injuries to the thoracolumbar and lumbar spine constitute most of these fractures. The immediate neurologic damage that accompanies the bony destruction results

2014 eMedicine Surgery

169. Kyphosis (Overview)

of Scheuermann disease is still imprecisely defined. Scheuermann postulated that the condition resulted from avascular necrosis of the apophyseal ring. Other theories include histologic abnormalities at the endplate, osteoporosis, [ ] and mechanical factors that affect spinal growth. [ ] A Danish study demonstrated an important genetic component to the entity. [ ] Postural kyphosis is present when accentuated kyphosis is observed without the characteristic 5° of wedging over three consecutive vertebral (...) , and one had a wound infection. No permanent neurologic injuries occurred. Video-assisted thoracoscopic release followed by posterior arthrodesis has been successful. In one study, deformity correction was 84.8° to 45.3° in patients with thoracic kyphosis associated with Scheuermann disease. [ ] Mean loss of correction was 1.6°, and one hook pulled out. No cases of junctional kyphosis were observed. In a retrospective study, anterior-posterior correction was compared with posterior-only instrumentation

2014 eMedicine Surgery

170. K&ouml (Overview)hler Disease (Overview)

or secondary centers of ossification; almost all of the epiphyses, apophyses, and small bones can be implicated. [ ] In Köhler disease, AVN of the navicular bone occurs. The etiology of these conditions is not well known, but vascular accidents, coagulation anomalies, and heredity have been implicated. [ ] The most common osteochondroses are Kienbock, and Panner diseases. Surgery is not indicated for Köhler disease; treatment is nonoperative (see ). Next: Pathophysiology Vascularization of the navicular (...) ; this clinical entity has been rarely reported in the years since. Dharamsi and Carl reported a case of isolated bilateral Köhler disease of the patella in a male athlete aged approximately 7 years. [ ] Previous Next: Etiology The etiology of Köhler disease, like those of the other osteochondroses, is unknown, but the condition is thought to result from compressive stress-related injury at a critical time of growth. [ ] Vascular insults, retarded bone age, and genetic predilection have also been implicated

2014 eMedicine Surgery

171. Sever Disease (Follow-up)

injuries of the foot and ankle in the child and adolescent athlete. Phys Med Rehabil Clin N Am . 2008 May. 19 (2):347-71, ix. . Weiner DS, Morscher M, Dicintio MS. Calcaneal apophysitis: simple diagnosis, simpler treatment. J Fam Pract . 2007 May. 56 (5):352-5. . Clemow C, Pope B, Woodall HE. Tools to speed your heel pain diagnosis. J Fam Pract . 2008 Nov. 57 (11):714-23. . Irving DB, Cook JL, Young MA, Menz HB. Impact of chronic plantar heel pain on health-related quality of life. J Am Podiatr Med (...) . Is radiographic evaluation necessary in children with a clinical diagnosis of calcaneal apophysitis (sever disease)?. J Pediatr Orthop . 2011 Jul-Aug. 31 (5):548-50. . Brenner JS, American Academy of Pediatrics Council on Sports Medicine and Fitness. Overuse injuries, overtraining, and burnout in child and adolescent athletes. Pediatrics . 2007 Jun. 119 (6):1242-5. . Wu M, Fallon R, Heyworth BE. Overuse Injuries in the Pediatric Population. Sports Med Arthrosc Rev . 2016 Dec. 24 (4):150-158. . Perhamre S

2014 eMedicine Surgery

172. Diaphyseal Femur Fractures (Follow-up)

polytrauma patients) with these fractures. Surgery for diaphyseal femur fracture should be reserved for those able to tolerate the appropriate procedure for their circumstance. Young children can often be treated successfully with noninvasive measures; thus, surgery can be avoided. Definite indications include polytrauma patients, especially those with head and chest injuries, and those with injuries to multiple limbs or those otherwise unable to care for themselves to maximize postoperative independence (...) . Most others are surgical candidates because of the lower incidence of complication and the higher union rates with surgery. Those who should not be treated surgically include patients too unstable to tolerate the procedure and children weighing less than 80 lb. No one can argue with the high success rate of reamed locked antegrade nailing. However, patients with femoral-shaft fractures often present with a multitude of injuries including head and chest trauma. Laboratory studies have shown

2014 eMedicine Surgery

173. Growth Plate (Physeal) Fractures (Follow-up)

cause significant genu recurvatum. The image below illustrates a procurvatum deformity of the proximal tibia after repair of a proximal tibia apophyseal avulsion. Growth plate (physeal) fractures. Procurvatum of proximal tibia after open reduction and internal fixation of proximal tibia apophysis injury. If the fracture is nondisplaced or an anatomic stable reduction can be obtained with closed manipulation, treatment consists of an above-knee cast for 4 weeks. Generally, displaced apophyseal (...) =aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMTI2MDY2My10cmVhdG1lbnQ= processing > Growth Plate (Physeal) Fractures Treatment & Management Updated: Jul 13, 2017 Author: Steven I Rabin, MD; Chief Editor: Jeffrey D Thomson, MD Share Email Print Feedback Close Sections Sections Growth Plate (Physeal) Fractures Treatment Approach Considerations Salter-Harris (SH) I and SH II growth plate (physeal) injuries usually can be managed adequately with closed manipulative reduction. Upon reduction, these injuries are typically stable, and casting suffices. At times

2014 eMedicine Surgery

174. Tibial Tubercle Fracture (Diagnosis)

. [ , , ] This condition should be distinguished from , a chronic apophysitis of the tibial tuberosity due to recurrent traction injury. Nondisplaced type I injuries can be managed conservatively by cast immobilization in a long leg cast in full-knee extension. All other injuries are best treated by open reduction and internal fixation (ORIF) with cast immobilization for 6-8 weeks. (See .) Next: Anatomy The extensor complex of the thigh exerts its force through the ligamentum patellae on the tibial tuberosity. During (...) its histogenesis, the tibial tuberosity is an anterior extension of the proximal tibial epiphysis separated from the rest of the tibia by the growth plate. As the growth plate closes in late puberty, it is transiently replaced by fibrocartilaginous elements, which predispose it to traction injury as a result of its weaker tensile strength. Previous Next: Pathophysiology The proximal tibia has two ossification centers, the proximal tibial epiphysis and the tibial tuberosity, which are separated

2014 eMedicine Surgery

175. Osgood-Schlatter Disease (Follow-up)

however both groups reported symptom relief with no adverse outcomes. [ ] Long-term immobilization is typically contraindicated, because it may result in increased knee stiffness in mild cases, thus predisposing the athlete to additional sports-related injuries. However, if a patient is noncompliant, the clinician may recommend immobilization in a knee brace for a minimum of 6 weeks. The brace should be removed daily, but only for stretching and strengthening exercises. Inform the patient to avoid (...) of the extensor mechanism. Open reduction and internal fixation (ORIF) usually is recommended, depending on the size and displacement of the fragment as well as the phase of apophyseal closure. Indications for surgery Occasionally, adults have a large ossicle and an overlying bursa, which may cause pain with kneeling. If so, treatment consists of excision of the bursa, ossicle, and any prominence. [ ] Contraindications for surgery The real question is whether or not surgery is ever indicated in the growing

2014 eMedicine Surgery

176. Medial Humeral Condyle Fracture (Follow-up)

-term studies and does not appear to be a major issue with these fractures. Previous References Rockwood CA, Wilkins KE, Beaty JH. Apophyseal injuries of the distal humerus. Fractures in Children . 3rd ed. Philadelphia: Lippincott-Raven; 1996. 800-19. Behrman MJ, Shelton ML. Fracture of the medial condyle of the humerus in an elderly patient. J Orthop Trauma . 1990. 4(1):98-101. . Bensahel H, Csukonyi Z, Badelon O. Fractures of the medial condyle of the humerus in children. J Pediatr Orthop . 1986 (...) . . Karlsson MK, Herbertsson P, Nordqvist A, Besjakov J, Josefsson PO, Hasserius R. Comminuted fractures of the radial head. Acta Orthop . 2010 Apr. 81 (2):224-7. . Haxhija EQ, Mayr JM, Grechenig W. [Treatment of medial epicondylar apophyseal avulsion injury in children]. Oper Orthop Traumatol . 2006 Jun. 18(2):120-34. . Hoppenfeld S, Murthy VL. Treatment and Rehabilitation of Fractures . Philadelphia: Lippincott Williams & Wilkins; 2000. Media Gallery Schematic of two types of medial condyle fractures

2014 eMedicine Surgery

177. Idiopathic Scoliosis (Follow-up)

of the nerve injury risks of sublaminar wires. Pedicle screws have also become a popular anchor for the rods used in posterior scoliosis fusion procedures. [ ] They offer the potential advantage of increased strength (and possibly power of correction) while at the same time introducing added insertion-technique complexity and different neurologic complication risks. A very real and major increase in the overall cost of instrumentation constructs that include many pedicle screws is the case when (...) are not often directly visualized during posterior surgical approaches for scoliosis, but they must not be forgotten. These muscles include the trapezius, the rhomboid major, the rhomboid minor, and the latissimus dorsi. Using an animal model, Kawaguchi et al showed that significant posterior muscle injury can be induced by the pressure exerted by surgical retractors. [ ] This certainly makes a case for intermittent removal and replacement of such retractors during the course of posterior spinal surgery

2014 eMedicine Surgery

178. Pediatrics, Sickle Cell Disease (Overview)

by a spinal artery branch) results in the characteristic H vertebrae of sickle cell disease. The outer portions of the plates are spared because of the numerous apophyseal arteries. Osteonecrosis of the epiphysis of the femoral head is often bilateral and eventually progresses to collapse of the femoral heads. This same phenomenon is also seen in the humeral head, distal femur, and tibial condyles. Infarction of bone and bone marrow in patients with sickle cell disease can lead to the following changes (...) and an inability to deal with infective encapsulated microorganisms, particularly Streptococcus pneumoniae, ensue, leading to an increased risk of sepsis in the future. Chronic hemolytic anemia SCD is a form of hemolytic anemia, with red cell survival of around 10-20 days. Approximately one third of the hemolysis occurs intravascularly, releasing free hemoglobin (plasma free hemoglobin [PFH]) and arginase into plasma. PFH has been associated with endothelial injury including scavenging nitric oxide

2014 eMedicine Emergency Medicine

179. Fracture, Pelvic (Overview)

socket when the hip is driven backward in a motor vehicle accident. Occasionally, they occur in a pedestrian struck by a vehicle moving at a significant rate of speed. Pelvic avulsion fractures (see the image below) occur due to indirect trauma from sudden muscular contraction causing injury to the muscular attachment on the pelvis. These most often occur in skeletally immature athletes because of the inherent weakness of the pelvic apophyses. The three most common sites are the anterior superior (...) iliac spine (ASIS), the anterior inferior iliac spine (AIIS), and the ischial tuberosity because of contraction of the sartorius, rectus femoris, and hamstring muscles, respectively. [ ] Pelvic apophyseal avulsion fracture of the ischial tuberosity due to contraction of the hamstring muscles. Courtesy of Wikipedia (https://de.wikipedia.org/wiki/Apophyse). Previous Next: Epidemiology Pelvic fractures make up approximately 3% of all skeletal injuries. Open pelvic fractures are rare and represent only

2014 eMedicine Emergency Medicine

180. Anemia, Sickle Cell (Overview)

by a spinal artery branch) results in the characteristic H vertebrae of sickle cell disease. The outer portions of the plates are spared because of the numerous apophyseal arteries. Osteonecrosis of the epiphysis of the femoral head is often bilateral and eventually progresses to collapse of the femoral heads. This same phenomenon is also seen in the humeral head, distal femur, and tibial condyles. Infarction of bone and bone marrow in patients with sickle cell disease can lead to the following changes (...) and an inability to deal with infective encapsulated microorganisms, particularly Streptococcus pneumoniae, ensue, leading to an increased risk of sepsis in the future. Chronic hemolytic anemia SCD is a form of hemolytic anemia, with red cell survival of around 10-20 days. Approximately one third of the hemolysis occurs intravascularly, releasing free hemoglobin (plasma free hemoglobin [PFH]) and arginase into plasma. PFH has been associated with endothelial injury including scavenging nitric oxide

2014 eMedicine Emergency Medicine

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