Lower limb fractures

A laxative should be prescribed as Mrs TY is prescribed codeine which can cause constipation. As Mrs TY is immobile and has a fracture of the lower limb, she should have some form of thromboprophylaxis. 

Osteomyelitis may be acute or chronic and the causative bacteria arrive in the bloodstream or are implanted directly (through a compound fracture, chronic local infection of local tissue, or surgical operation). Staphylococcus aureus is the commonest isolate in all patient groups but Haemophilus influenzae is frequently seen in children (much reduced now by the Hib vaccine), and Salmonella species in the tropics. Chronic osteomyelitis of the lower limbs (especially when underlying chronic skin infection in the elderly) frequently involves obligate anaerobes (such as Bacteroides species) and coliforms. 

Orcel P, de Vernejoul MC, Prier A, Miravet L, Kuntz D, Kaplan G. Stress fractures of the lower limbs in osteoporotic patients treated with fluoride. J Bone Miner Res 1990 5(Suppl l) S191-94. 

This is usually the result of forces transmitted through the axial skeleton from an impact into the head and shoulders through to the lower limbs. There may be symphyseal diastasis, anterior arch fractures or posterior disruption of the sacroiliac joints with cephalic displacement. Vertical injuries are often severe with disruption of all the ligaments plus associated pelvic instability. Radiographs demonstrate ipsilateral or contralateral pubic rami fractures, with disruption of the sacroiliac joint. The major differentiating feature from compression injuries is the cephalic displacement of the pelvis on the side of the impact (Fig. 12.14). 

Approximately 25% of fractures in children occur in the lower limb. The injury and fracture pattern vary with age and skeletal maturity. The peak incidence is bimodal, with high energy trauma (falls from height or motor vehicle accidents) peaking in preadolescents and sporting injuries peaking in adolescents. 

The spectrum of metabolic bone diseases will result in a generalized weakness of bone thereby predisposing to pathological fracture formation. In rickets, due to a dietary deficiency of vitamin D, this can manifest as insufficiency fractures in the pelvis and long bones of the lower limb (Fig. 21.14). Advances in the management of chronic renal failure... 

Fig. 9.3. Patient who fell from a 6-m height, admitted with a Glasgow Coma Scale score of 9. Neurological examination in the emergency room revealed an asymmetry of tone and deep tendon reflex involving both right upper and lower limbs. Admission contrast-enhanced cerebral CT demonstrated a displaced left parietal skull fracture, associated with a large cephalhematoma. A small left parieto-occipital epidural hematoma (white arrowhead) and a small contusion area (white...

Musculoskeletal Clinical studies have shown an increased risk of fractures, especially in females with the use of thiazelidiones. In the PERISCOPE study, fractures occurred in 3% of patients treated with pioglitazone, compared with none in the glimepiride group. The majority of fractures observed in females were in the distal upper limb (forearm, hand, and wrist) or distal lower limb (foot, ankle, fibula, and tibia). [59 ]... 

The measured values (specified in Figure 3) show, at a glance, that there is a variation in the values of bioimpedance in the different situations that can be present in a long bone structure innate integrity, fracture, integrity after the recuperation and no union after a long recuperation period. These values were measured in the upper limb (humerus) as well as in the lower limb (tibias and fibula). 

Numerous clinical studies and published case reports confirm the efficacy of aescin-containing topical products, especially in the treatment of sport injuries, including blunt trauma of the lower limbs, joint sprains, tendonitis, hematomas, muscle strain, traumatic edema, Achilles tendonitis surgical outpatient trauma, including fractures, sprains, crush injuries, and contusions postoperative or postpartum edema in obstetrics and gynecology and others. 

Bodner G, StOckl, Fierhnger A et al (2005) Sonographic findings in stress fractures of the lower limb preliminary findings. Bur Radiol 15 356-359... 

Blitz NM, Ford LA, Christensen JC (2004) Plantar plate repair of the second metatarsophalangeal joint technique and tips. J Foot Ankle Surg 43 266-270 Bodner G, Stockl B, Fierlinger A et al (2005) Sonographic findings in stress fractures of the lower limb preliminary findings. Eur Radiol 15 356-359... 

All fractures should be immobilised as soon as possible. This increases patient comfort and reduces post-injury damage to the soft tissues. Initially a simple plaster backslab or conventional splint is appropriate. The Thomas splint still has a valuable role to play in lower-limb injuries. When plaster of Paris is used, it should be split to prevent unnecessary pressure resulting from tissue swelling. 

The interpretation of the results is difficult because a number of the children had received other drugs, but in one child on methotrexate, hepato-splcnomegaly, osteoporosis, severe seoliosis and cirrhosis on percutaneous liver biopsy were noted. On discontinuing the methotrexate, many of these abnormal features returned to normal. The onset of osseous changes was insidious fractures, bone pain and osteoporosis were noted in 26 children, 15 had fractures of which 10 were in the lower extremity, osteoporosis was generalized in 2 and confined to the lower limbs in a further 2. 

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