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In a high energy injury to the midfoot, such as a fall from a height or a motor vehicle accident, the diagnosis of a Lisfranc injury should, in theory at least, pose less of a challenge. There will be deformity of the midfoot and X-ray abnormalities should be obvious. Further, the nature of the injury will create heightened clinical suspicion and there may even be disruption of the overlying skin and compromise of the blood supply. Typical X-ray findings would include a gap between the base of the first and second toes. The diagnosis becomes more challenging in the case of low energy incidents, such as might occur with a twisting injury on the racquetball court, or when an American Football lineman is forced back upon a foot that is already in a fully plantar flexed position. Then, there may only be complaint of inability to bear weight and some mild swelling of the forefoot or midfoot. Bruising of the arch has been described as diagnostic in these circumstances but may well be absent. Typically, conventional radiography of the foot is utilized with standard non-weight bearing views, supplemented by weight bearing views which may demonstrate widening of the interval between the first and second toes, if the initial views fail to show abnormality. Unfortunately, radiographs in such circumstances have a sensitivity of 50% when non-weight bearing and 85% when weight bearing, meaning that they will appear normal in 15% of cases where a Lisfranc injury actually exists. In the case of apparently normal x-rays, if clinical suspicion remains, advanced imaging such as magnetic resonance imaging (MRI) or X-ray computed tomography (CT) is a logical next step.
Lisfranc injury, also known as Lisfranc fracture, is an injury of the foot in which one or more of the metatarsal bones are displaced from the tarsus. The injury is named after Jacques Lisfranc de St. Martin (2 April 179013 May 1847), a French surgeon and gynecologist who described an amputation of the foot through the tarsometatarsal articulation, in 1815, after the War of the Sixth Coalition.
The onset is not dramatic. When the boot or shoes are taken off, there is a cramp-like pain in the affected forefoot, and moderate local edema appears on the dorsal aspect. On moving each toe in turn, that of the involved metatarsal causes pain, and when the bone is palpated from the dorsal surface, a point of tenderness is found directly over the lesion. Radiography at this stage is negative, but the condition is diagnosed correctly by military surgeons without the aid of x-rays. In civil life, it is seldom diagnosed correctly for a week or two, when, because of lack of immobilization, there is an excessive deposit of callus (which may be palpable) around the fracture.
Symptoms reported by sufferers include: pain and aching to the neck and back, referred pain to the shoulders, sensory disturbance (such as pins and needles) to the arms and legs, and headaches. Symptoms can appear directly after the injury, but often are not felt until days afterwards. Whiplash is usually confined to the spine. The most common areas of the spine affected by whiplash are the neck and middle of the spine. "Neck" pain is very common between the shoulder and the neck. The "missing link" of whiplash may be towards or inside the shoulder and this would explain why neck therapy alone frequently does not give lasting relief.
Cognitive symptoms following whiplash trauma, such as being easily distracted or irritated, seems to be common and possibly linked to a poorer prognosis.
March fracture, also known as fatigue fracture or stress fracture of metatarsal bone, is the fracture of the distal third of one of the metatarsals occurring because of recurrent stress. It is more common in soldiers, but also occurs in hikers, organists, and even those, like hospital doctors, whose duties entail much standing. March fractures most commonly occur in the second and third metatarsal bones of the foot. It is a common cause of foot pain, especially when people suddenly increase their activities.
A Chance fracture is a flexion injury of the spine, first described by G. Q. Chance in 1948. It consists of a tension-failure injury to the anterior column of the vertebral body and a transverse fracture through the posterior elements of the vertebra and the posterior portion of the vertebral body. It is caused by violent forward flexion, causing distraction injury to the posterior elements.
The most common site at which Chance fractures occur is the thoracolumbar junction (T12-L2) and midlumbar region in pediatric population. This fracture initially became known as a "seat belt injury" due to its association with the sudden forward flexion that occurs when one is involved in a head-on automobile collision while being restrained by a lap belt. With the advent of both lap and shoulder belts in the 1980s, Chance fractures have become less common especially now that lap-belt-only seat belts have been almost entirely phased out.
Up to 50% of Chance fractures have associated intraabdominal injuries. Injuries associated with Chance fractures include contusions and/or lacerations of the pancreas, duodenum, and mesentery.
The injury can be difficult to diagnose initially as the attention is focused on the injury to the radial head, leading to the distal radio-ulnar injury being overlooked. The examination finding of tenderness of the distal radio-ulnar joint suggests an Essex-Lopresti injury in patients who have sustained high energy forearm trauma. Plain radiography shows the radial head fracture, with dorsal subluxation of the ulna often seen on lateral view of the pronated wrist.
In orthopedic medicine, fractures are classified in various ways. Historically they are named after the physician who first described the fracture conditions, however, there are more systematic classifications in place currently.
The Essex-Lopresti fracture is a fracture of the radial head with concomitant dislocation of the distal radio-ulnar joint and disruption of the interosseous membrane. The injury is named after Peter Essex-Lopresti who described it in 1951.
The Hume fracture is an injury of the elbow comprising a fracture of the olecranon with an associated anterior dislocation of the radial head which occurs in children. It was originally described as an undisplaced olecranon fracture, but more recently includes displaced fractures and can be considered a variant of the Monteggia fracture.
The injury was described in 1957 by A.C. Hume of the orthopaedic surgery department of St. Bartholomew's Hospital, Rochester.
A sprain is a type of acute injury which results from the stretching or tearing of a ligament. Depending on the severity of the sprain, the movement on the joint can be compromised since ligaments aid in the stability and support of joints. Sprains are commonly seen in vulnerable areas such as the wrists, knees, and ankles. They can occur from movements such as falling on an outstretched hand, or a twisting of the ankle or foot.
The severity of a sprain can also be classified:
Grade 1: Only some of the fibers in the ligament are torn, and the injured site is moderately painful and swollen. Function in the joint will be unaffected for the most part.
Grade 2: Many of the ligament fibers are torn, and pain and swelling is moderate. The functionality of the joint is compromised.
Grade 3: The soft tissue is completely torn, and functionality and strength on the joint is completely compromised. In most cases, surgery is needed to repair the damage.
Ice and elevation may help reduce pain and swelling, and allow the injury to begin to recover.
Severe sprains accompanied by significant pain and swelling may need to be immobilized.
Whiplash is a non-medical term describing a range of injuries to the neck caused by or related to a sudden distortion of the neck associated with extension, although the exact injury mechanisms remain unknown. The term "whiplash" is a colloquialism. "Cervical acceleration–deceleration" (CAD) describes the mechanism of the injury, while the term "whiplash associated disorders" (WAD) describes the injury sequelae and symptoms.
Whiplash is commonly associated with motor vehicle accidents, usually when the vehicle has been hit in the rear; however, the injury can be sustained in many other ways, including headbanging, bungee jumping and falls. It is one of the most frequently claimed injuries on vehicle insurance policies. In the United Kingdom, 430,000 people made an insurance claim for whiplash in 2007, accounting for 14% of every driver's premium.
Before the invention of the car, whiplash injuries were called "railway spine" as they were noted mostly in connection with train collisions. The first case of severe neck pain arising from a train collision was documented around 1919. The number of whiplash injuries has since risen sharply due to rear-end motor vehicle collisions. Given the wide variety of symptoms associated with whiplash injuries, the Quebec Task Force on Whiplash-Associated Disorders coined the phrase 'Whiplash-Associated Disorders'.
Fractures of the acetabulum occur when the head of the femur is driven into the pelvis. This injury is caused by a blow to either the side or front of the knee and often occurs as a dashboard injury accompanied by a fracture of the femur.
The acetabulum is a cavity situated on the outer surface of the hip bone, also called the coxal bone or innominate bone. It is made up of three bones, the ilium, ischium, and pubis. Together, the acetabulum and head of the femur form the hip joint.
Fractures of the acetabulum in young individuals usually result from a high energy injury like vehicular accident or feet first fall. In older individuals or those with osteoporosis, a trivial fall may result in acetabular fracture.
In 1964, French surgeons Robertt Judet, Jean Judet, and Emile Letournel first described the mechanism, classification, and treatment of acetabular fracture. They classified these fractures into elementary (simple two part) and associated (complex three or more part) fractures.
A bone fracture (sometimes abbreviated FRX or Fx, F, or #) is a medical condition in which there is a damage in the continuity of the bone. A bone fracture may be the result of high force impact or stress, or a minimal trauma injury as a result of certain medical conditions that weaken the bones, such as osteoporosis, bone cancer, or osteogenesis imperfecta, where the fracture is then properly termed a pathologic fracture.
Ideal x-ray visualization of an elementary fracture will depend on the fracture type:
- Posterior wall fracture: Iliac oblique and obturator oblique views
- Posterior column fracture: Iliac oblique and obturator oblique views
- Anterior wall fracture: Iliac oblique view
- Anterior column fracture: Obturator oblique view
In all cases, CT scan can assist in identifying impacted bone pieces, which may be found within the joint, and MRI may be done to identify the extent of potential injury to the sciatic nerve.
A strain is a type of acute injury that occurs to the muscle or tendon. Similar to sprains, it can vary in severity, from a stretching of the muscle or tendon to a complete tear of the tendon from the muscle. Some of the most common places that strains occur are in the foot, back of the leg (hamstring), or back.
The term jammed finger refers to finger joint pain and swelling from an impact injury. It's the most common injury in sports. This injury tends to be very painful, and immediate treatment will usually help heal the joint faster. Most jammed fingers heal relatively quickly, if no fracture occurs. If there is a fracture, however, the healing process will take longer; anywhere from one or two weeks to several months, and the methods of healing will become more in depth. Toes can become jammed as well, but not as often as fingers.
Symptoms of gamekeeper's thumb are instability of the MCP joint of the thumb, accompanied by pain and weakness of the pinch grasp. The severity of the symptoms are related to the extent of the initial tear of the UCL (in the case of Skier's thumb), or how long the injury has been allowed to progress (in the case of gamekeeper's thumb).
Characteristic signs include pain, swelling, and ecchymosis around the thenar eminence, and especially over the MCP joint of the thumb. Physical examination demonstrates instability of the MCP joint of the thumb.
The patient will often manifest a weakened ability to grasp objects or perform such tasks as tying shoes and tearing a piece of paper. Other complaints include intense pain experienced upon catching the thumb on an object, such as when reaching into a pants pocket.
Vertebral fractures of the thoracic vertebrae, lumbar vertebrae or sacrum are usually associated with major trauma and can cause spinal cord injury that results in a neurological deficit.
In medicine the Holdsworth fracture is an unstable fracture dislocation of the thoraco lumbar junction of the spine. The injury comprises a fracture through a vertebral body, rupture of the posterior spinal ligaments and fractures of the facet joints.
The injury was described by Frank Wild Holdsworth in 1963. He described the mechanism of this injury as a flexion-rotation injury, and said that the unstable fracture dislocation should be treated by fusion of the two affected vertebrae.
A spinal fracture, also called a vertebral fracture or a broken back, is a fracture affecting the vertebrae of the spinal column. Most types of spinal fracture confer a significant risk of spinal cord injury. After the immediate trauma, there is a risk of spinal cord injury (or worsening of an already injured spine) if the fracture is "unstable", that is, likely to change alignment without internal or external fixation.
A strain can occur as a result of improper body mechanics with any activity (e.g., contact sports, lifting heavy objects, overstretching) that can induce mechanical trauma or injury. Generally, the muscle or tendon overstretches and is placed under more physical stress than it can exert. Strains commonly result in a partial or complete tear of a tendon or muscle, or they can be severe in the form of a complete tendon rupture. The most common body location for strains to occur is in the foot, leg, or back.
- Acute strains are more closely associated with recent mechanical trauma or injury.
- Chronic strains typically result from repetitive movement of the muscles and tendons over a long period of time.
Degrees of Injury (as classified by the American College of Sports Medicine)
• First degree (mildest) – little tissue tearing; mild tenderness; pain with full range of motion.
• Second degree – torn muscle or tendon tissues; painful, limited motion; possibly some swelling or depression at the spot of the injury.
• Third degree (most severe) – limited or no movement; pain will be severe at first, but may be painless after the initial injury
In medicine, a stinger, also called a "burner" or "nerve pinch injury", is a neurological injury suffered by athletes, mostly in high-contact sports such as ice hockey, rugby, American football, and wrestling. The spine injury is characterized by a shooting or stinging pain that travels down one arm, followed by numbness and weakness. Many athletes in contact sports have suffered stingers, but they are often unreported to medical professionals.
Anyone who experiences significant trauma to his or her head or neck needs immediate medical evaluation for the possibility of a spinal injury. In fact, it's safest to assume that trauma victims have a spinal injury until proven otherwise because:
- The time between injury and treatment can be critical in determining the extent of complications and the amount of recovery
- A serious spinal injury is not always immediately obvious. If it is not recognized, more severe injury may occur
- Numbness or paralysis may develop immediately or come on gradually as bleeding or swelling occurs in or around the spinal cord
An unhappy triad (or terrible triad, "horrible triangle", O'Donoghue's triad or a "blown knee") is an injury to the anterior cruciate ligament, medial collateral ligament, and medial meniscus. Analysis during the 1990s indicated that this 'classic' O'Donoghue triad is actually an unusual clinical entity among athletes with knee injuries. Some authors mistakenly believe that in this type of injury, acute tears of the medial meniscus always present with a concomitant lateral meniscus injury. However, the 1990 analysis showed that lateral meniscus tears are more common than medial meniscus tears in conjunction with sprains of the ACL.