Brachial Artery Injury In Distal Humerus Fracture Treated without Vascular Intervention

A 35 year old patient had a RTA and sustained injury to Right Elbow and Arm. He was primararily treated elsewhere and came to us after 8 hrs of injury.

X-rays

But Radial Pulse was not palpable on the right side. Finger movements were full and SPO2 in the fingers showed 94% saturation.

CT Angio showed blockage of Brachial artery at the level of elbow with good distal flow in the ulnar and radial artery in the forearm.

CT ANGIO

Operative Pearls :

- Surgery through Posterior approach

- Bony spike of proximal fragment touching the Brachial artery.

- Spike lifted and Torn Brachialis muscle repaired

- Artery found to be pulsating

- Fracture fixation done

- It is important to visualize the Brachial artery from Posterior approach

INTRA OP PICTURES

POST OP XRAYS

Post operative the distal SPO2 improved to 98% and Patient’s Limb Survived Without VASCULAR INTERVENTION.

After 2 weeks of Surgery, PULSE was WELL PALPABLE and Patient had a full recovery.

Medial Collateral Ligament (MCL) Injury

What are the different types of medial collateral ligament (MCL) injuries?

An injury to a ligament is called a sprain. Like any other sprain, MCL injuries are graded by their severity. When the fibers of the ligament are stretched but not torn, this is referred to as a Grade 1 sprain. Grade 2 sprains are when the ligament fibers are partially torn. When the ligament is completely torn or disrupted, this is a grade 3 sprain.

Because of the anatomy and how the MCL is related to the medial meniscus (cartilage) and the ACL (anterior cruciate ligament), these two structures may also be damaged in association with an MCL injury.

What are causes and risk factors of medial collateral ligament (MCL) injuries?

MCL injuries are the most common ligament sprain of the knee. They are often sports-related and can occur in any age group. Contact sports are the most common risks, including football, hockey, wrestling, and martial arts. Males tend to be more at risk than females.

MCL injuries occur usually from a sudden impact to the outer part of knee. The injury may be either due to contact, being hit on the outside part of the knee, or non contact due to twisting, cutting, or stopping suddenly (deceleration).

What are medial collateral ligament (MCL) injury symptoms and signs?

Pain is the first symptom of an MCL injury. It typically occurs almost immediately and is located along the course of the ligament. Sometimes this is associated with swelling within the knee joint. Occasionally, swelling develops in a matter of minutes. The Pain of an MCL sprain will also cause the person to limp in order to protect the knee joint.

What tests are used to diagnose and assess medial collateral ligament (MCL) injuries?

The diagnosis of an MCL sprain is usually made by history and physical examination. The patient often knows the mechanism of injury, that is precisely what they were doing and what position their body was in when the injury occurred. 

This helps the health-care professional understand the stresses that were put on the knee joint. Other questions might include whether the patient was able to walk, whether the knee began to swell, and how long it took for that to happen after the injury.

The physical examination includes looking at the knee to see whether or not it is swollen and touching the knee in various places to find places of tenderness and pain. With MCL sprains, there is tenderness along the course of the ligament on the inner aspect of the knee.

The ligament can also be stressed on physical examination. By pushing on the outer side of the knee, the examiner can determine if the MCL is stable or unstable. This can be a rough assessment of the grade of sprain, where a grade 1 sprain is stable and a grade 3 sprain is unstable.

Physical examination concentrates on the knee joint and the hip and ankle to identify any other associated injuries.

Plain X-rays of the knee can be used to identify fractures of the femur and tibia bones. An MRI is the best way to actually visualize the MCL and determine the grade of sprain, but it is not always necessary. If there is concern that there is also a tear of the medial meniscus or anterior cruciate ligament, an MRI may be appropriate.

Joint pain...is it osteoarthritis?

Your knee aches from time to time. Or maybe your fingers don't seem as nimble as they used to be. Could it be osteoarthritis?

Osteoarthritis, the most common form of arthritis, develops when cartilage, the flexible tissue lining the joints, deteriorates. As a result, the space between bones gradually narrows and the bone surfaces change shape. Over time, this leads to joint damage and pain.

People with osteoarthritis often have it in more than one joint. It is most common in the knee, hip, lower back, and neck, and in certain finger joints. The symptoms of osteoarthritis usually develop over many years, and many of the early symptoms are the same no matter which joint it starts in. The first sign is often pain in a joint after strenuous activity or overusing the joint. The joint may be stiff in the morning, but loosen up after a few minutes of movement. Or the joint may be mildly tender, and movement may cause a crackling or grating sensation. Some people have continual joint pain that interferes with sleep.

But some telltale signs of osteoarthritis are specific to certain joints. If you're experiencing any of the types of joint pain listed below, ask your doctor to check you for osteoarthritis.

• Knees. When osteoarthritis affects the knee, the result is pain, swelling, and stiffness of that joint. What starts out as some discomfort after a period of disuse can progress to difficulty walking, climbing, bathing, and getting in and out of bed.

• Hands. Osteoarthritis of the hand often starts with stiffness and soreness of the fingers and in the base of the thumb, particularly in the morning. You may find that it becomes harder to pinch, and that your joints crackle when moved. People with hand osteoarthritis may have difficulty doing routine movements, like opening a jar, turning a key, or typing.

• Hips and spine. When osteoarthritis affects the hip, pain may be felt in the groin, down the inside thigh, or even as far away as the knee. Osteoarthritis of the cervical spine (in the neck) can cause pain in the shoulders and arms. When it affects the lower spine, pain can spread to the buttocks or legs.

What You Should Know About Middle Back Pain

Chances are good that if you don't suffer from back pain you know someone who does. Most back pain sufferers complain of lower or upper back pain but there is that seldom talked about and elusive middle back pain that gets very little lip service.


The truth is that though we don't hear about it very often, middle back pain is a common source of back pain among manual laborers. While the population as a whole doesn't suffer from mid back pain as much as manual laborers, there are a variety of reasons for your current bout of middle back pain.

Should you be concerned about mid back pain? Quite simply: yes. Because the portion of the back sandwiched between the upper and lower back gets less use, an injury to this portion of the back is incredibly painful and severely limits upper body mobility.

Where Exactly Is Your Mid Back?

Although some upper and lower back pain radiates up and down, the middle back goes from your shoulders and ends at the base of the rib cage. The pain will be more concentrated in this area than it is when you suffer from other forms of pain in the back.

What Causes Mid Back Pain?

Unlike the other forms of back pain, middle back pain doesn't have quite as many causes. While injury can cause just about any type of back pain, there are a few common causes, including:

• Poor posture Thanks to too many hours spent in front of computer screens, tablets and e-readers, middle back pain is due to that weird hunch associated with technology hounds.
• Trauma is a common cause of back pain whether due to a fall, a football hit, auto accident or improper lifting.
• Bad sleep posture isn't something we often think of as a source for back pain, but the truth is how we sleep for hours at a time can have a serious impact on the middle back area. Sleeping (or standing) hunched over has the same impact as sitting hunched over a computer screen.
• Excess weight causes many types of back pain because it strains the muscles in the back, causing pain. Specifically an excessively large stomach can pull at the lower and middle back, causing muscle strain.

Symptoms

How do you know if that nagging pain in the middle of your back is a simple run-of-the-mill backache or actual middle back pain? It can be difficult to tell the difference since you won't feel that unbearable pain associated with lower back pain and because the mid-back muscles get used far less.

The most obvious symptom of middle back pain is a limited range of motion particularly when bending. If you bend beyond what the pain allows, it may be dull or sharp pain radiating throughout the midsection of the back. Sometimes the pain can be accompanied by numbness or tingling, especially after long periods of inactivity.

It will be very hard to know if your pain is more than a simple ache, but that is why it is important to seek out a back specialist. You need to make sure that a few days of pain don't turn into several weeks or months, allowing the pain and your range of motion to worsen.

An Ounce of Prevention...

If you've ever suffered from any type of back pain in the past and wished you could have done something to prevent it, the good news is that you can. In fact, simple acts such as regular exercise and a healthy diet can go a long way to help prevent muscle strain in the middle back. Exercise keeps the muscles strong and when combined with a healthy diet, is conducive to weight loss, which will reduce muscle strain.

Do you spend time staring in the mirror at the gym while you pump iron? If so you may want to take it easy and reduce the weight on your bar. Often the problem is simply that we're trying to push our bodies further than its ready to go. This happens often with those who are returning to exercise after a long period of inactivity or those trying to expedite their weight lifting goals.

The moment you begin to notice pain in the middle back you should reduce the weight you're lifting. In general, however, if you feel that you are having difficulty with a heavier weight, reduce it.

One of the best prevention tools for mid back pain is ergonomic equipment. Use ergonomic keyboards, desks and office chairs to keep your back properly aligned. If you need a sleep pillow to keep your posture proper in sleep, there are many places to purchase one to stop mid back pain before it starts.

Rest your body properly after any amount of physical exertion. Muscle strain can turn into a long-term problem if you continue to push your body too far and the best way to prevent it is to let your body rest. Whether it is after a workout, a long day of manual labor or sitting at a desk, take a few minutes to stretch and relax your muscles.

Slow Burn

Middle back pain is a problem that takes time before you truly begin to experience painful or uncomfortable symptoms. This is why you should take note of your symptoms as they pop up and if the pain persists for longer than a couple of weeks, get in to see your doctor immediately.

The sooner you take care of the pain in the early stages, the less likely it is to make it to the more painful stages.

Spinal Fractures and Vertebroplasty

As you age, the bones in your spine become weaker and more brittle, which often develops into a disease called osteoporosis. Although osteoporosis affects all the bones in your body, the most vulnerable area is your spine. In fact, spinal fractures – also known as vertebral compression fractures – are experienced by up to 700,000 elderly individuals each year.

To combat this disease, it is important to first understand the specifics of spinal compression fractures and the risks involved:

Your spine consists of 24 vertebrae, which are separated by inter-vertebral disks for cushioning and shock absorption and held together by the spinal cord. This flexible system remains straight while you are young but gradually bends as the vertebrae weaken and flatten with age. In this weakened state, your spine is at a significantly higher risk of fracture in the case of a fall as well as everyday activities such as reaching, bending or even sneezing and coughing.

If you experience severe back pain or have been previously diagnosed with osteoporosis, there are a number of solutions that your orthopedic physician may recommend. A common surgical solution for a spinal fracture is vertebroplasty. Through a relatively simple outpatient surgery, a specialized bone cement is injected into the weakened vertebrae as a preventative measure against fractures and/or for the purpose of stabilizing existing fractures.

Vertebroplasty is an effective solution with high rates of successful results. Most patients experience immediate pain relief and improved mobility, allowing them to return to their regular daily activities soon after completion of the procedure.

Why let your age dictate what you can or cannot do when solutions for your back pain could be achieved by speaking with a pain management doctor? If you are ready to discuss your concerns and learn whether you require vertebroplasty or another treatment, please do not hesitate to contact your pain management specialist at Ashutosh Hospital, Vadodara, Gujarat.

.

Sports Medicine Treatment

It’s a Good move!

Many of us play sports everyday. Some go for a run before work in the morning. Others enjoy a round of golf or a competitive game of basketball on the weekends. Over eight million young men and women play high school and college sports. It’s natural for injuries to happen with physical activity—whether it’s stopping and changing direction too quickly on the cricket field or stretching improperly before a run. No matter the injury, immediate treatment is always the best solution.

At Ashutosh Hospital, we deliver world-class orthopedic care for athletes of all ages. Our sports medicine specialists are skilled and experienced in treating all types of sports-related injuries, from fractures and sprains to tears and concussions. We use state-of-the-art equipment and procedures that enable fast and precise diagnosis, treatment, and recovery.

Personalized Treatment

We understand that each sports-related injury requires a different and exact treatment plan. In addition to developing different approaches to injuries in ​youths versus adults, we also understand that women and men are prone different athletic injuries. For example, young women are 2-8 times more likely to tear their anterior cruciate ligament (ACL) than men. We provide advice and care based on the widest range of knowledge, so you receive the most personalized treatment plan.

Physical Therapy

Physical therapy is also a top priority at Ashutosh Hospital. Our orthopedic doctors work closely with physical therapists to prevent future injuries and to ensure you stay physically active. The medical professionals at Ashutosh Hospital are dedicated to facilitating a healthy, active lifestyle before, during, and after an injury.

When it comes to sports medicine, the orthopedic care at Ashutosh Hospital is a natural choice for injured athletes who want to get back in the game as quickly as possible.

ShoulderHemiarthroplasty

A 58 year old female presented with history of fall at home. She sustained injury to her right shoulder. She had a Previous history of IHD.

X ray of Right shoulder showed Four Part Right Proximal Humerus Fracture.

FACTORS IN CONSIDERATION :

·         - Age of the patient

·        -  Low Demand

·         - Comminution

·         - Osteoporosis

In view of the above factors HEMIARTHROPLASTY was offered to the patient.

OPERATIVE PEARLS:

·         - Separation and preservation of Greater and Lesser Tuberosity

·        -  Modular Prosthesis for achieving perfect fit and tension

·        -  After the prosthesis was fit the tuberosity were fixed with each other and to the prosthesis

·         - Bone graft from the head was packed at the Shaft Tuberosity junction