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An X-ray is essential for the proper diagnosis of a malunion. The doctor will look into the patient’s history and the treatment process for the bone fracture. Oftentimes a CT scan and probably a MRI are also used in diagnosis. MRI are used to check of cartilage and ligament issues that developed due to the malunion and misalignment. CT scans are used to locate normal or abnormal structures within the body and to help during procedures to guide the placement of instruments and/or treatments.
Computed tomography is the most sensitive and specific of the imaging techniques. The facial bones can be visualized as slices through the skeletal in either the axial, coronal or sagittal planes. Images can be reconstructed into a 3-dimensional view, to give a better sense of the displacement of various fragments. 3D reconstruction, however, can mask smaller fractures owing to volume averaging, scatter artifact and surrounding structures simply blocking the view of underlying areas.
Research has shown that panoramic radiography is similar to computed tomography in its diagnostic accuracy for mandible fractures and both are more accurate than plain film radiograph. The indications to use CT for mandible fracture vary by region, but it does not seem to add to diagnosis or treatment planning except for comminuted or avulsive type fractures, although, there is better clinician agreement on the location and absence of fractures with CT compared to panoramic radiography.
A diagnosis can be made using clinical examination, laryngoscope examination, and/or radiographic studies.
There are various classification systems of mandibular fractures in use.
A bone fracture may be diagnosed based on the history given and the physical examination performed. Radiographic imaging often is performed to confirm the diagnosis. Under certain circumstances, radiographic examination of the nearby joints is indicated in order to exclude dislocations and fracture-dislocations. In situations where projectional radiography alone is insufficient, Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) may be indicated.
This abnormally wide gap can be diagnosed by radiologic studies such as x-ray, MRI, CT scan or bone scan. Manual testing by a healthcare professional can also be used. The patient is placed in various positions and pressure is applied in such a way that it provokes pain and maybe movement in the pubis.
Anteroposterior (AP) and lateral radiographs the include the entire length of the lower leg (knee to ankle) are highly sensitive and specific for tibial shaft fractures.
When a child experiences a fracture, he or she will have pain and will not be able to easily move the fractured area. A doctor or emergency care should be contacted immediately. In some cases even though the child will not have pain and will still be able to move, medical help must be sought out immediately. To decrease the pain, bleeding, and movement a physician will put a splint on the fractured area. Treatment for a fracture follows a simple rule: the bones have to be aligned correctly and prevented from moving out of place until the bones are healed. The specific treatment applied depends on how severe the fracture is, if it’s an open or closed fracture, and the specific bone involved in the fracture (a hip fracture is treated differently from a forearm fracture for example)
Different treatments for different fractures:
The general treatments for common fractures are as follows:
Two systems of fracture classification are commonly used to aid diagnosis and management of tibia shaft fractures:
- Oestern and Tscherne Classification
- Gustilo-Anderson Classification
Management is dependent on the determination of whether the fracture is open or closed.
The diagnosis of nonunion is generally done when there is no progress between to occasions of medical imaging such as X-ray. This is generally the case after 6-8 months.
The basic method to check for a clavicle fracture is by an X-ray of the clavicle to determine the fracture type and extent of injury. In former times, X-rays were taken of both clavicle bones for comparison purposes. Due to the curved shape in a tilted plane X-rays are typically oriented with ~15° upwards facing tilt from the front. In more severe cases, a computerized tomography (CT) or magnetic resonance imaging (MRI) scan is taken.
However, the standard method of diagnosis through ultrasound imaging performed in the emergency room may be equally accurate in children.
By definition, a nonunion will not heal if left alone. Therefore the patient's symptoms will not be improved and the function of the limb will remain impaired. It will be painful to bear weight on it and it may be deformed or unstable. The prognosis of nonunion if treated depends on many factors including the age and general health of the patient, the time since the original injury, the number of previous surgeries, smoking history, the patient's ability to cooperate with the treatment. In the region of 80% of nonunions heal after the first operation. The success rate with subsequent surgeries is less.
Nasal fractures are usually identified visually and through physical examination. Medical imaging is generally not recommended. A priority is to distinguish simple fractures limited to the nasal bones (Type 1) from fractures that also involve other facial bones and/or the nasal septum (Types 2 and 3). In simple Type 1 fractures X-Rays supply surprisingly little information beyond clinical examination. However, diagnosis may be confirmed with X-rays or CT scans, and these are required if other facial injuries are suspected.
A fracture that runs horizontally across the septum is sometimes called a "Jarjavay fracture", and a vertical one, a "Chevallet fracture".
Although treatment of an uncomplicated fracture of nasal bones is not urgent—a referral for specific treatment in five to seven days usually suffices—an associated injury, nasal septal hematoma, occurs in about 5% of cases and does require urgent treatment and should be looked for during the assessment of nasal injuries.
Children in general are at greater risk because of their high activity levels. Children that have risk-prone behaviors are at even greater risk.
The indication to surgically stabilize a cervical fracture can be estimated from the "Subaxial Injury Classification" (SLIC). In this system, a score of 3 or less indicates that conservative management is appropriate, a score of 5 or more indicates that surgery is needed, and a score of 4 is equivocal. The score is the sum from 3 different categories: morphology, discs and ligaments, and neurology:
Once diagnosed and located, surgery is the most common treatment for a malunion. The surgery consists for the surgeon re-breaking the bone and realigning it to the anatomically correct position. There are different types and levels of extremity where it is possible that the bone will trimmed to allow full orientation at the fractured spot. Most often, either screws, plates or pins are used secure the new alignment. It is possible that a bone graft could be used to help with healing.
After surgery make sure not to smoke or use any nicotine products as that affects the healing process by limiting blood flow. Also, don’t use any NSAIDS (non steroidal anti-inflammatory drug) as that will also affect the blood flow and the healing to the area of fracture. Do not put weight on the area where the fracture and surgery occurred until informed by your doctor and that could lead to other and future problems. After surgery and the surgical stitches are removed you will be put into a cast to complete the healing process. During follow ups an X-ray or a CT scan may be used to verify that the fracture is healing properly and is now in the anatomical correct position.
X-ray is seldom helpful, but a CT scan and an MRI study may help in diagnosis.
Bone scans are positive early on. Dual energy X-ray absorptiometry is also helpful to rule out comorbid osteoporosis.
Bone stability after a fracture occurs between 3 and 4 weeks. Some experts suggest not wearing glasses or blowing the nose during this time as it can affect the bone alignment. Full bone fusion occurs between 4 and 8 weeks. General activity is fine after 1–2 weeks, but contact sports are not advisable for at least 2–3 months, depending on the extent of injury. It is recommended that when participating in sports a face guard should be worn for at least 6 weeks post-injury.
Conventional radiography is usually the initial assessment tool when a calcaneal fracture is suspected. Recommended x-ray views are (a) axial, (b) anteroposterior, (c) oblique and (d) views with dorsiflexion and internal rotation of the foot. However, conventional radiography is limited for visualization of calcaneal anatomy, especially at the subtalar joint. A CT scan is currently the imaging study of choice for evaluating calcaneal injury and has substituted conventional radiography in the classification of calcaneal fractures. Axial and coronal views are obtained for proper visualization of the calcaneus, subtalar, calcaneocuboid and talonavicular joints.
Diagnosis is based on symptom and confirmed with X-rays. In children an MRI may be required.
An X-ray film will show a marked gap between the pubic bones, normally there is a 4–5 mm gap but in pregnancy, hormonal influences cause relaxation of the connecting ligaments and the bones separate up to 9 mm. To demonstrate instability of the joint the patient is required to stand in the "flamingo" position, (standing with weight on one leg and the other bent). A vertical displacement of more than 1 cm is an indicator of symphysis pubis instability. A displacement of more than 2 cm usually indicates involvement of the sacroiliac joints.
A Cochrane review of low-intensity pulsed ultrasound to speed healing in newly broken bones found insufficient evidence to justify routine use. Other reviews have found tentative evidence of benefit. It may be an alternative to surgery for established nonunions.
Vitamin D supplements combined with additional calcium marginally reduces the risk of hip fractures and other types of fracture in older adults; however, vitamin D supplementation alone did not reduce the risk of fractures.
Severe pain will usually be present at the point of injury. Pressure on a nerve may also cause pain from the neck down the shoulders and/or arms. Bruising and swelling may be present at the back of the neck. A neurological exam will be performed to assess for spinal cord injury. X-rays will be ordered to determine the severity and location of the fracture. CT (computed tomography) scans may be ordered to assess for gross abnormalities not visible by regular X-ray. MRI (magnetic resonance imaging) tests may be ordered to provide high resolution images of soft tissue and determine whether there has been damage to the spinal cord, although such damage is usually obvious in the conscious patient because of the immediate functional consequences of numbness and paralysis in much of the body.
It is also common for imaging (either a plain film X-ray or CT scan) to be completed when assessing a cervical injury. This is the most common way to diagnose the location and severity of the fracture. To decrease the use C-spine scans yielding negative findings for fracture, thus unnecessarily exposing people to radiation and increase time in the hospital and cost of the visit, multiple clinical decision support rules have been developed to help clinicians weigh the option to scan a patient with a neck injury. Among these are the Canadian C-spine rule and the NEXUS criteria for C-Spine imaging, which both help make these decisions from easily obtained information. Both rules are widely used in emergency departments and by paramedics.
Diagnosis by a doctor’s examination is the most common, often confirmed by x-rays. X-ray is used to display the fracture and the angulations of the fracture. A CT scan may be done in very rare cases to provide a more detailed picture.
X-rays usually do not show evidence of new stress fractures, but can be used 3 weeks after onset of pain when the bone begins to remodel. A CT scan, MRI, or 3-phase bone scan may be more effective for early diagnosis.
MRI appears to be the most accurate test.