Factors Affecting Blood Flow in Exercising Muscles

During exercise, several factors affect blood flow in the muscles. One of these factors is the diameter of the arterioles, which can increase due to vasodilation of muscle arterioles. Another factor is the concentration of metabolites, such as adenosine, carbon dioxide, and lactic acid, which accumulate in the tissues due to oxygen deficiency and cause vasodilation.

As a result of these factors, blood flow to the muscles can increase up to 20-fold during exercise, which is the greatest increase in any tissue in the body. This increase in blood flow is mainly due to the actions of local vasodilator substances on the muscle arterioles.

However, the increased demand for oxygen during exercise can also lead to a decrease in oxygen concentration in the tissues. This, in turn, can cause an increase in vascular resistance, which can further affect blood flow to the muscles.

Overall, understanding the factors that affect blood flow in exercising muscles is important for optimizing exercise performance and preventing injuries.

Associations with De Quervain’s Syndrome

De Quervain’s syndrome is a condition that involves the stenosing tenosynovitis of the short extensor or long abductor tendon of the thumb within the first extensor compartment. While it is not associated with malignancy or cirrhosis, it does have a strong association with rheumatoid arthritis. Patients with diabetes and hypothyroidism are more likely to develop carpal tunnel syndrome rather than De Quervain’s syndrome. It is important to consider these associations when diagnosing and treating patients with hand and wrist pain.

Nerve Branches and their Innervations in the Upper Limb

The upper limb is innervated by various nerves that originate from the brachial plexus. Each nerve has specific branches that innervate different muscles and areas of the arm. Here are some important nerve branches and their innervations in the upper limb:

1. Anterior branch of the axillary nerve: This nerve branch winds around the surgical neck of the humerus and innervates the teres minor, deltoid, glenohumeral joint, and skin over the inferior part of the deltoid.

2. Median nerve: This nerve passes through the carpal tunnel and innervates the muscles of the anterior forearm, as well as the skin over the palmar aspect of the hand.

3. Lateral cutaneous nerve: This nerve is a continuation of the posterior branch of the axillary nerve and sweeps around the posterior border of the deltoid, innervating the skin over the lateral aspect of the arm.

4. Posterior interosseous nerve: This nerve is a branch of the radial nerve and does not wind around the surgical neck of the humerus. It innervates the muscles of the posterior forearm.

5. Radial nerve: This nerve winds around the midshaft of the humerus and innervates the muscles of the posterior arm and forearm, as well as the skin over the posterior aspect of the arm and forearm.

Understanding the innervations of these nerve branches is important in diagnosing and treating upper limb injuries and conditions.

Differential Diagnosis for a Postoperative Patient with Severe Pain and Fever

Possible diagnoses for a postoperative patient with sudden onset of severe pain and fever include infection in the overlying tissue or in the bone itself. Cellulitis and necrotising fasciitis are less likely, while osteomyelitis is the most probable diagnosis, as indicated by the urgent request for an MRI and the need for surgical intervention. Osteomyelitis requires prolonged intravenous antibiotics and surgical debridement, and an MRI would typically show bone marrow oedema. A deep vein thrombosis is less likely due to the absence of clinical signs and ultrasound imaging findings. Cellulitis would present with superficial redness and less severe pain, while necrotising fasciitis would show subcutaneous gas on imaging. A surgical wound infection is possible but would typically involve pus discharge and not prompt urgent surgical intervention.

Treatment Options for Distal Radial Fracture in an Elderly Patient

Distal radial fractures, commonly known as Colles’ fractures, are often seen in elderly patients with poor bone quality. There are several treatment options available for this type of fracture, but the choice of treatment depends on various factors, including the patient’s age, overall health, and the severity of the fracture.

Closed Reduction and Below-Elbow Backslab (Half Cast)
This is the most common treatment option for distal radial fractures. The fracture can be reduced with closed manipulation following a haematoma block, and then immobilized with a below-elbow backslab (half cast).

Skeletal Traction
Skeletal traction is not practical for distal radial fractures as it can cause stiffness in the limb.

Open Reduction and Internal Fixation
While open reduction and internal fixation can provide the most anatomical reduction, it comes with risks that may outweigh the benefits, especially in elderly patients with poor bone quality and co-morbidities.

Intramedullary Rod
An intramedullary rod is rarely used for upper limb fractures.

Closed Reduction and Above-Elbow Backslab (Half Cast)
Although an above-elbow backslab can stabilize the joint above and below the fracture, it is not recommended as it can cause stiffness and difficulty in regaining full use after removal.

In conclusion, the treatment of distal radial fractures in elderly patients should be carefully considered, taking into account the patient’s overall health and the severity of the fracture. Closed reduction and below-elbow backslab (half cast) is the most common treatment option, while other options should be considered on a case-by-case basis.

The supraglenoid tubercle of the scapula is where the tendon of the long head of the biceps brachii attaches within the shoulder joint capsule. The lesser tuberosity of the humerus is where the subscapularis muscle inserts, while the crest of the lesser tuberosity is where the latissimus dorsi and teres major muscles attach. The coracoid process of the scapula is where the short head of the biceps brachii, coracobrachialis, and pectoralis minor muscles attach. The greater tuberosity of the humerus is where the supraspinatus, infraspinatus, and teres minor muscles insert. Lastly, the long head of the triceps brachii attaches to the infraglenoid tubercle of the scapula. These attachments and insertions are important for understanding the anatomy and function of the shoulder and arm muscles.

Understanding Salter-Harris Fractures: Types and Characteristics

Salter-Harris fractures are a common type of injury in children that involve the growth plate. These fractures are classified into five different types based on their characteristics. The most common type is a type II fracture, which involves a fracture through the metaphysis sparing the epiphysis. This type of fracture occurs in up to 75% of all Salter-Harris fractures.

Another type of fracture is a transverse fracture through the growth plate, which is relatively rare and occurs in approximately 5% of all cases. A crush fracture, known as a Salter-Harris type V, is an uncommon type of injury that damages the growth plate by direct longitudinal compression. This type of fracture carries a poorer prognosis than the other classes.

It is important to note that Salter-Harris fractures can only occur in children before the fusion of the physis and must involve the growth plate by definition. However, greenstick fractures, which are incomplete fractures that only involve one of the bony cortices, do not affect the growth plate and are not included in the classification.

In summary, understanding the different types and characteristics of Salter-Harris fractures is crucial in diagnosing and treating these injuries in children.

Application of Scaphoid Plaster and Sling for Fracture Treatment

A scaphoid fracture is typically caused by a fall on an outstretched hand, resulting in pain over the base of the thumb. Although special views of the scaphoid are required to confirm the injury, treatment is necessary in the absence of radiographic findings. A scaphoid plaster and sling are commonly used for immobilization, and the plaster should be removed after 14 days for repeat X-rays. If a fracture is detected, a new cast is applied, and a follow-up appointment is scheduled in four weeks. However, if no evidence of a fracture is found, the patient may have suffered a sprain, and no further follow-up is necessary unless symptoms persist. To avoid unnecessary immobilization, a CT or MRI scan may be ordered, with MRI being more sensitive. Slings are not recommended for scaphoid fractures. Repeat X-rays should be taken in 10-14 days, as bone resorption around the fracture allows for better visualization. Discharging the patient without further action is not recommended, as scaphoid fractures may not be immediately apparent and can lead to avascular necrosis.

Nerve Anatomy of the Leg: Common Peroneal, Deep Peroneal, Superficial Peroneal, Saphenous, and Tibial Nerves

The leg is innervated by several nerves, each with its own specific functions. One of these nerves is the common peroneal nerve, which descends through the popliteal fossa and runs parallel to the biceps femoris insertion tendon. It then curves around the fibular head and neck before dividing into the superficial and deep peroneal nerves.

The deep peroneal nerve innervates the dorsiflexors of the foot, including the tibialis anterior, extensor hallucis longus, extensor digitorum longus, peroneus tertius, and extensor digitorum brevis. On the other hand, the superficial peroneal nerve supplies the peroneus longus and brevis before providing cutaneous innervation to the dorsal skin of the foot.

Another nerve that supplies cutaneous innervation to the leg is the saphenous nerve. It passes superficial to the femoral triangle and is not likely to be damaged in injuries involving the fibula.

Finally, the tibial nerve arises in the distal third of the thigh and passes deep through the popliteal fossa. It does not pass close to the fibula but instead leaves the fossa, passing through the two heads of the gastrocnemius.

Bursae of the Knee: Locations and Causes of Inflammation

The knee joint is surrounded by several small fluid-filled sacs called bursae, which act as cushions between bones, tendons, and muscles. However, these bursae can become inflamed due to repetitive stress or injury, causing pain and discomfort. Here are some of the bursae located around the knee joint and their associated conditions:

1. Prepatellar bursa: This bursa is located between the skin and the kneecap and can become inflamed due to repeated friction, such as in professions that require prolonged kneeling.

2. Popliteus bursa: This bursa lies between the popliteus tendon and the lateral condyle of the tibia and can become inflamed due to overuse or injury.

3. Suprapatellar bursa: This bursa can be felt during a knee exam and may become inflamed due to trauma or infection.

4. Infrapatellar bursa: This bursa is located below the kneecap and can become inflamed due to repetitive kneeling, hence the name clergyman’s knee.

5. Semimembranous bursa: This bursa is located at the back of the knee and can become inflamed due to injury or underlying conditions such as arthritis.

In conclusion, understanding the locations and causes of knee bursitis can help individuals take preventive measures and seek appropriate treatment when necessary.

Identifying Vertebral Levels: Landmarks and Importance in Clinical Scenarios

Being able to identify the vertebral level is crucial in clinical scenarios, especially following trauma. It allows for effective communication with clinicians who may not be on site or at a distant tertiary center. To identify the level of the vertebral spine, certain landmarks can be used. The spine of the scapula is at T3, the most inferior aspect of the scapula is at T7, the most superior aspect of the iliac crest is at L4, and the posterior superior iliac spine is at S2. C7 is the level of the vertebra prominens, making it a useful landmark for orientation. The spine of the scapula is not found at T1, but it is found at T2. Knowing these landmarks and their corresponding vertebral levels is essential for effective communication and diagnosis in clinical scenarios.

Muscles and Bony Features of the Foot

The foot is a complex structure that contains numerous muscles and bony features. Here are some important details about the muscles and their attachments:

Flexor Hallucis Longus: This muscle originates on the fibula and inserts onto the plantar surface of the distal phalanx of the great toe. It passes underneath the sustentaculum tali, which has a groove for the tendon of this muscle.

Flexor Hallucis Brevis: This intrinsic muscle of the foot originates from the plantar surface of the cuboid and lateral cuneiform bones and tendon of the tibialis posterior muscle. It inserts on the lateral and medial sides of the base of the proximal phalanx of the great toe. It does not pass underneath the sustentaculum tali.

Extensor Digitorum Longus: This muscle originates from the proximal one-half of the medial surface of the fibula and related surface of the lateral tibial condyle. It inserts via dorsal digital expansions into the bases of the distal and middle phalanges of the lateral four toes. It does not pass underneath the sustentaculum tali.

Extensor Hallucis Longus: This muscle originates from the middle one-half of the medial surface of the fibula and adjacent surface of the interosseous membrane. It inserts on the dorsal surface of the base of the distal phalanx of the great toe. It does not pass underneath the sustentaculum tali.

Flexor Digitorum Longus: This muscle originates from the medial side of the posterior surface of the tibia and inserts onto the plantar surfaces of the bases of the distal phalanges of the lateral four toes. It does not pass underneath the sustentaculum tali.

Understanding the muscles and bony features of the foot is important for diagnosing and treating foot injuries and conditions.

The Tenth Rib and the Costal Margin

The tenth rib plays an important role in forming the costal margin. This margin is the lower edge of the ribcage, and it helps to protect the organs in the abdomen. Specifically, the tenth rib forms the costal margin at the mid-axillary line. It is important to note that the eighth, seventh, and ninth ribs do not form the costal margin. Additionally, the eleventh and twelfth ribs are shorter than the tenth rib and do not reach as far as the mid-axillary line. Understanding the anatomy of the ribcage and the costal margin can be helpful in diagnosing and treating injuries or conditions in this area.

The Importance of Repeat Scaphoid Views in Suspected Fractures

When a scaphoid fracture is suspected but not visible on initial X-rays, it is recommended to repeat the radiographs in 10-14 days. During this time, bone resorption around the fracture occurs, making the diagnosis easier. However, proceeding without treatment is not advised due to the risk of avascular necrosis. Requesting another lateral view or a bone scan would not be appropriate. Instead, a cast is usually applied after the acute injury and remains in place until the fracture is diagnosed. MRI wrist imaging after only 3 days is not necessary in this setting. Repeat scaphoid views are crucial in ensuring proper diagnosis and treatment.

The Carpal Bones: An Overview of the Bones in the Wrist

The wrist is composed of eight small bones known as the carpal bones. These bones are arranged in two rows, with each row containing four carpal bones. The proximal row includes the scaphoid, lunate, triquetrum, and pisiform, while the distal row includes the trapezium, trapezoid, capitate, and hamate.

The capitate bone is located in the center of the wrist and articulates with the base of the third metacarpal bone. The trapezium bone is the most lateral bone in the distal row and articulates with the base of the first metacarpal bone. The hamate bone is the most medial bone in the distal row and articulates with the fourth and fifth metacarpal bones.

The pisiform bone is a small, seed-shaped bone located on the medial side of the proximal row and does not articulate with any of the metacarpal bones. The triquetrum bone is also located in the proximal row and does not articulate with any of the metacarpal bones.

Understanding the anatomy of the carpal bones is important for diagnosing and treating wrist injuries and conditions.

Understanding Osteoporosis: Definition, Diagnosis, and Management

Osteoporosis is a common bone disease characterized by a loss of bone mineral density, micro-architectural deterioration of bone tissue, and increased risk of fracture. This article provides an overview of osteoporosis, including its definition, diagnosis, and management.

Peak bone mass is achieved between the ages of 20 and 40 and falls afterwards. Women experience an acceleration of decline after menopause due to estrogen deficiency, resulting in uncoupling of bone resorption and bone formation. Osteoporosis in men is less common and often has an associated secondary cause or genetic risk factors.

Osteoporosis is diagnosed when the T score falls to below −2.5, whereas T scores between −1.0 and −2.5 are indicative of osteopenia. Values of BMD above −1.0 are regarded as normal. Management includes lifestyle advice and drug treatments such as bisphosphonates, hormone replacement therapy, calcium and vitamin D replacement supplements, calcitonin, raloxifene, parathyroid hormone, strontium ranelate, and anabolic steroids.

It is important to understand osteoporosis, as it is the most common reason for fractures among the elderly. Lifestyle factors such as lack of exercise and smoking are common risk factors for developing osteoporosis. Regular bone density screenings and appropriate management can help prevent fractures and improve quality of life.

Common Fractures of the Wrist: Colles’, Smith’s, Barton’s, and Chauffeur’s Fractures

Fractures of the wrist are common injuries, with the most frequent being the Colles’ fracture. This type of fracture occurs within 2.5 cm of the wrist and is often seen in elderly women who suffer a fall onto an outstretched hand. The Colles’ fracture is characterized by dorsal displacement of the distal fragment, radial displacement of the hand, radial shortening due to impaction, and avulsion of the ulnar styloid. Treatment involves assessing the patient’s neurovascular status, followed by reduction and fixation of the fracture with a Colles’ plaster.

Another type of wrist fracture is the Smith’s fracture, which is a reverse Colles’ fracture with ventral displacement of the distal fragment. This injury often results from a fall onto the back of the hand. A Barton’s fracture is an intra-articular fracture of the distal radius with associated dorsal or volar subluxation of the distal fragment, similar to a Colles’ or reverse Colles’ fracture. Finally, a Chauffeur’s fracture is an intra-articular fracture of the radial styloid process.

In conclusion, wrist fractures are common injuries that can be classified into different types based on their location and displacement. Proper assessment and treatment are essential for optimal recovery and function of the affected wrist.

The radial nerve originates from the posterior cord of the brachial plexus and runs alongside the deep brachial artery in the spiral groove of the humeral shaft. It is susceptible to damage during midshaft humeral fractures, resulting in loss of sensation on the dorsal aspect of the hand and weakness in wrist extension. The ulnar nerve is located medially to the radial nerve and is not typically affected by midshaft humeral fractures. However, it can be injured by a fracture of the medial epicondyle, resulting in weakness in wrist flexion and loss of adduction and sensation in the medial aspect of the hand. The axillary nerve branches closer to the shoulder and is prone to injury with shoulder dislocation, causing weakness in the deltoid muscle. The median nerve is not located near the midshaft of the humerus but can be injured in various ways, resulting in sensory and motor deficits. The musculocutaneous nerve passes over the brachialis muscle and can be affected by entrapment or upper brachial plexus injury, causing weakness in elbow flexion and forearm supination and sensory loss on the radial aspect of the forearm.

Imaging Modalities for Hip Fractures and Bone Density Assessment

Hip fractures can be difficult to diagnose, especially if they are occult fractures that do not appear on initial X-rays. It is important to identify these fractures early to prevent long-term disability. The National Institute for Health and Care Excellence recommends using MRI as the imaging modality of choice if a hip fracture is suspected despite negative X-rays. If MRI is not available within 24 hours, a CT scan may be considered.

Ultrasound scans of the hip are commonly used to investigate developmental dysplasia of the hip, but they are not useful in diagnosing occult fractures. Dual-energy X-ray absorptiometry (DEXA) scans are used to assess bone density after a suspected fragility fracture, but they are not used in diagnosing occult fractures.

Positron-emission tomography (PET) scans use radioactive isotopes to detect areas of increased metabolic activity, such as rapidly growing tumors. They are not used in diagnosing hip fractures or assessing bone density.

The initial X-ray for a suspected hip fracture will include lateral views, as a fracture may be difficult to identify on one view but obvious on another.

Differential Diagnosis for Bone and Joint Pain: Paget’s Disease

Paget’s disease is a musculoskeletal pathology that can cause bone and joint pain. This disease is often asymptomatic for many years before being diagnosed through abnormal blood tests or X-ray images. Symptoms of Paget’s disease include constant, dull bone pain, joint pain, stiffness, and swelling. Shooting pain, numbness, tingling, or loss of movement may also occur.

Other potential causes of bone and joint pain were considered and ruled out. Primary hyperparathyroidism, osteoporosis, and osteoarthritis were all unlikely due to normal calcium, phosphate, and ALP levels. Osteomalacia, a condition caused by vitamin D deficiency, can also cause bone and joint pain, but it is accompanied by low calcium and phosphate levels and a raised ALP.

In conclusion, based on the patient’s symptoms and blood test results, Paget’s disease is the most likely diagnosis for their bone and joint pain.

Common Hand Deformities and Their Causes

Heberden’s nodes and Bouchard nodes are bony growths that indicate osteoarthritis in the distal and proximal interphalangeal joints, respectively. Arachnodactyly is characterized by long, thin fingers and is often seen in patients with Marfan syndrome. Claw hand is caused by hyperextension of the metacarpophalangeal joints and flexion at the proximal and distal interphalangeal joints, usually due to an ulnar nerve lesion. Dupuytren’s contracture results in a flexion deformity of the fingers due to thickening of the palmar fascia, often affecting the little and ring fingers. Trigger finger occurs when nodules form on the tendons, causing them to get caught and leading to difficulty in extending and flexing the finger. All of these conditions can cause pain and discomfort in the hand, and may require medical attention.

Common Hand Conditions: Trigger Finger, Dupuytren’s Contracture, and Osteoarthritis

Trigger Finger: A common cause of hand pain and disability, trigger finger occurs when the tendon to the finger cannot easily slide back into the tendon sheath due to swelling. This results in a fixed flexion of the finger, which pops back suddenly when released. It may be due to trauma or have no obvious cause. Treatment may include corticosteroid injection or tendon release surgery.

Dupuytren’s Contracture: This condition causes a fixed flexion contracture of the hand, making it difficult to straighten the affected fingers.

Osteoarthritis: A degenerative joint disease, osteoarthritis may cause deformity and pain in the affected joint, but not the symptoms of trigger finger.

Other possible hand conditions include cramp and tetany, which may cause muscle spasms and tingling sensations. It is important to seek medical attention for any persistent hand pain or discomfort.

Diagnostic Imaging for Shoulder Injuries: MRI, Bone Scans, CT Scans, X-rays, and EMG

Shoulder injuries in patients over 40 years old are often associated with acute avulsion injuries and rotator cuff tears. These tears can be degenerative and not related to trauma. The incidence of rotator cuff tears after acute dislocation in patients over 40 years old is high. Ultrasound and MRI are the preferred diagnostic tools for rotator cuff disease.

Bone scans are not useful in this scenario, and CT scans with iv contrast may reveal bony pathology but are not necessary. Repeat shoulder X-rays are also not beneficial if the post-reduction X-rays are normal.

Axillary nerve and brachial plexus injuries can occur after acute shoulder dislocation, but EMG is not necessary if there is no sensory deficit or distal weakness. Overall, MRI is the most effective diagnostic tool for shoulder injuries in this patient population.

Management of Sciatica: Analgesia and Referral for Physiotherapy

Sciatica, also known as lumbar radiculopathy, is a common condition caused by a herniated disc, spondylolisthesis, or spinal stenosis. It is characterized by pain, tingling, and numbness that typically extends from the buttocks down to the foot. Diagnosis is made through a positive straight leg raise test. Management involves analgesia and early referral to physiotherapy. Bed rest is not recommended, and patients should continue to stay active. Symptoms usually resolve within 6-8 weeks, but if they persist, referral to a specialist may be necessary for further investigation and management with corticosteroid injections or surgery. Red flag symptoms, such as major motor weakness, urinary/faecal incontinence, saddle anaesthesia, night pain, fever, systemic symptoms, weight loss, past history of cancer, or immunosuppression, require urgent medical attention.

Nerves of the Upper Arm: Course and Vulnerability to Injury

The upper arm is innervated by several nerves, each with a distinct course and function. The radial nerve, formed from the posterior cord of the brachial plexus, runs deep with the brachial artery and is at risk for injury during midshaft humeral fractures. It has both sensory and motor components, which can be tested separately. The axillary nerve, intimately related to the surgical neck of the humerus, is at risk in fractures of this area but not in midshaft humeral fractures. The ulnar nerve passes medially to the radial nerve and is not at risk in midshaft humeral fractures. The median nerve, more superficial than the radial nerve, has a distinct course and is less likely to be injured in midshaft humeral fractures. The musculocutaneous nerve, also more superficial than the radial nerve, has a distinct course and is less likely to be injured in midshaft humeral fractures. Understanding the course and vulnerability of these nerves is important in diagnosing and treating upper arm injuries.

Understanding Carpal Tunnel Syndrome: Causes and Symptoms

Carpal tunnel syndrome is a condition caused by the compression of the contents of the carpal tunnel, which is the space between the flexor retinaculum and the carpal bones. This compression leads to the compression of the median nerve, which supplies the muscles of the thenar eminence. As a result, any compression or space-occupying lesion in the carpal tunnel causes wasting of the thenar eminence.

It is important to note that the recurrent thenar nerve, which actually supplies the thenar eminence, does not pass through the carpal tunnel. Instead, it branches off the median nerve beyond the carpal tunnel. Therefore, compression of the median nerve within the carpal tunnel will cause the symptoms associated with carpal tunnel syndrome.

While the exact cause of carpal tunnel syndrome is often unknown, it has been associated with pregnancy, acromegaly, diabetes, and other diseases. Trauma to the forearm may also lead to this condition.

It is important to recognize the symptoms of carpal tunnel syndrome, which include weakness and wasting of the thenar eminence. Seeking medical attention and treatment can help alleviate these symptoms and prevent further complications.

Management of Acutely Hot and Swollen Knee Joint: Aspiration, Antibiotics, and Arthroscopy

Any patient presenting with an acutely hot and swollen joint should be treated as septic arthritis until proven otherwise. To diagnose and treat this condition early, the knee joint should be aspirated and the aspirate should be analyzed for white cells and microorganisms. IV antibiotics are necessary after the knee joint has been aspirated to increase the yield of the knee aspiration. Blood cultures have already been taken and further cultures are not required at this stage. An ultrasound scan of the knee may reveal increased joint fluid and swelling suggestive of infection or inflammation, but it will not confirm any infection. After the knee aspiration, if there was any pus, an arthroscopy and washout of the joint should be done to clear the joint of the infective fluid and protect the articular junction.

Treatment Options for Smith’s Fracture

Smith’s fracture, also known as a reverse Colles’ fracture, is a type of wrist fracture where the distal radius fragment is displaced anteriorly/volarly. The following are treatment options for this type of fracture:

Reduction under local anaesthesia: This method is not recommended for best cosmetic and functional results.

Reduction under anaesthetic: This method involves either a manipulation under anaesthetic (MUA) or an open reduction and fixation (ORIF) for best cosmetic and functional results.

Application of a scaphoid cast and referral to Fracture clinic: This method is not indicated for prompt reduction and possibly fixation.

Application of a backslab plaster of Paris cast and referral to Fracture clinic the next day: This method is not appropriate for prompt reduction and possibly fixation.

Application of a backslab plaster of Paris cast and referral to Fracture clinic in 2-6 weeks: This method is not appropriate for prompt reduction and possibly fixation.

Treatment Options for Smith’s Fracture

Femoral Fractures: Myths and Facts

Femoral fractures are common and can have serious consequences. However, there are many myths and misconceptions surrounding these injuries. Here are some facts to help dispel these myths:

Myth: Unimpacted fractures of the femoral shaft do not cause limb shortening.
Fact: Unimpacted fractures of the femoral shaft are typically associated with shortening of the limb due to muscle contractions.

Myth: Subcapital fractures of the femoral neck do not cause avascular necrosis of the femoral head.
Fact: Intracapsular fractures of the femoral neck can disrupt the blood supply to the femoral head and cause avascular necrosis.

Myth: Pertrochanteric fractures of the femur are always associated with avascular necrosis of the femoral head.
Fact: Pertrochanteric fractures lie outside of the line of attachment of the hip joint capsule and are not typically associated with avascular necrosis of the femoral head.

Myth: Closed fractures of the femoral shaft do not cause significant blood loss.
Fact: Fractures of the femoral shaft can cause significant blood loss into the soft tissue of the thigh.

Myth: Traction splints should always be applied to distal supracondylar fractures of the femur.
Fact: Application of a traction splint to a supracondylar fracture of the distal femur may cause disimpaction of the fracture and damage to the popliteal artery.

By understanding the facts about femoral fractures, healthcare professionals can provide better care for their patients and avoid potential complications.

Avascular necrosis (AVN) of the femoral head can be caused by chronic corticosteroid use or excessive alcohol consumption, with systemic lupus erythematosus (SLE) also being a risk factor. X-rays may not show changes until weeks later, so magnetic resonance imaging (MRI) is the preferred diagnostic tool. Slipped capital femoral epiphysis (SCFE) is a disorder of the adolescent hip that occurs when the femoral head slips off in a backward direction due to a weakness in the growth plate. Septic arthritis of the hip due to immunosuppression will present with severe pain, joint tenderness, and swelling, and is unlikely to present bilaterally. Osteomalacia, which is characterized by decreased bone mineralization, can cause pathological fractures and diffuse bone pain. Steroid-induced osteoporosis, on the other hand, is characterized by osteopenia and an increased risk of fractures, and can be treated with bisphosphonates.