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HANDBOOK OF FRACTURES 3RD EDITION PDF

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Publisher's Note: Products downloadd from Third Party sellers are not guaranteed by the publisher for quality, authenticity, or access to any online entitlements. Handbook of fractures / Kenneth A. Egol, Kenneth J. Koval, Joseph D. Zuckerman 4th ed. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins Health. (PDF) Oxford Handbook of Pediatrics, 2nd dancindonna.info Safety topics Book for daily toolbox talk. Though many of these topics are not new, it will definitely.


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Handbook of Fractures, 3rd Edition. Read more Arthroscopic Management of Distal Radius Fractures Lecture Notes: Orthopaedics and Fractures 4th ed. HANDBOOK OF FRACTURES Third Edition EDITORS John A. Elstrom, M.D. Clinical &sistant Professor University of IUinois Chicago, Illinois Department of. [dancindonna.infoman] Handbook of Fractures (3rd Ed.) - Ebook download as PDF File . pdf), Text File .txt) or read book online.

Koval, Kenneth J. Author Kenneth J. Koval M. Joseph D. Zuckerman M. Kenneth J. Koval To my wonderful wife Janet, and to my outstanding sons Scott and Matthew for teaching me important lessons about life and family.

Segmental fracture Bone loss Compartment syndrome Crush mechanism Extensive degloving of subcutaneous fat and skin Requires flap coverage any size defect From Bucholz RW. Grade III: Grade IV: Large laceration w ith heavy bacterial contamination. Factors that modify open fracture classification regardless of initial skin defect Contamination A. Perform a careful clinical and radiographic evaluation as outlined earlier. Court-Brow n C. Exposure to soil Exposure to w ater pools.

Heckman JD. Grade 0: Grade I: Grade II: Injury from indirect forces w ith negligible soft tissue damage Closed fracture caused by low to moderate energy mechanisms.

Initiate parenteral antibiosis see later. The current dose of toxoid is 0. Farm injuries: First-generation cephalosporin Add an aminoglycoside Add penicillin and an aminoglycoside Tetanus prophylaxis should also be given in the emergency room see later.

Only obvious foreign bodies that are easily accessible should be removed. Grade I. Perform provisional reduction of fracture and place a splint. In certain centers. Antibiotic Coverage for Open Fractures Table 3. The patient should undergo formal w ound exploration. Both shots are administered intramuscularly. Wound hemorrhage should be addressed w ith direct pressure rather than limb tourniquets or blind clamping.

Assess skin and soft tissue damage. From Bucholz RW.

Of 3rd handbook edition pdf fractures

If a surgical delay is anticipated. Operative intervention: Important Do not irrigate. Intravenous antibiotic therapy for open fracturesa Type I Cefazolin. Bone fragments should not be removed in the emergency room. A traumatic skin flap w ith a base-to-length ratio of 1: More recently.

Factors of muscle viability Color Normally beefy red. Pulsatile lavage irrigation. Meticulous hemostasis should be maintained. One should close the surgically extended part of the w ound only. The w ound. The w ound should be extended proximally and distally to examine the zone of injury.

The clinical utility of intraoperative cultures has been highly debated and remains controversial. Serial debridement s should be performed every 24 to 48 hours as necessary until there is no evidence of necrotic soft tissue or bone. The fracture surfaces should be exposed.

Fasciotomy should be considered. Meticulous debridement should be performed. Table 3. Extension into adjacent joints mandates exploration. Osseous fragments devoid of soft tissue may be discarded. Soft Tissue Coverage and Bone Grafting Wound coverage is performed once there is no further evidence of necrosis. Severe contamination: Wood may become blood soaked and difficult to differentiate from muscle. See individual chapters for specific fracture management Table 3.

The foreign material itself usually incites an inflammatory response. Periarticular fractures A. Tibia C. Definitive Distal radius Elbow dislocation Selected other sites B. Humerus D. Fracture Stabilization In open fractures w ith extensive soft tissue injury. Femur B. Diaphyseal fractures A. In combination w ith screw fixation for severe soft tissue injury Internal fixation 1. Gunshot injuries are discussed separately. Cloth and leather are usually found betw een tissue planes and may be remote from the site of injury.

Relative indications for type of skeletal fixation in open fractures External fixation 1. Proximal ulnar radius E. Foreign Bodies Foreign bodies. Distraction osteogenesis 4. The expected postsalvage function does not justify limb salvage. The patient presents w ith an injury severity score ISS.

High energy close-range shotgun. Some advocate bone grafting at the time of coverage. Even after revascularization the limb remains so severely damaged that function w ill be less satisfactory than that afforded by a prosthesis. Limb ischemia 1. Low energy stab. The limb is nonviable: Pulse reduced or absent but perfusion normal 1b 2. Immediate or early amputation may be indicated if: The timing of bone grafting after free flap coverage is controversial.

Very high energy above plus gross contamination. The severity of the injury w ould demand multiple operative procedures and prolonged reconstruction time that is incompatible w ith the personal. Bone grafting can be performed w hen the w ound is clean. Hypotensive transiently 1 3. It may be avoided by a high index of suspicion w ith serial neurovascular examinations accompanied by compartment pressure monitoring.

Persistent hypotension 2 D. Gross contamination at the time of injury is causative. Open fractures may result in cellulitis or osteomyelitis. Age Years 1. Compartment syndrome: This devastating complication results in severe loss of function.

The permanent cavity is small. The direct passage of the missile through the target tissue becomes the permanent cavity. Chote shot pattern 2. Shotgun w ounding potential is dependent on: The energy of the missile on exiting the tissue exit energy.

This may lead to regions of destruction apparently distant to the immediate path of the missile w ith resultant soft tissue compromise. This includes all handguns. This can draw adjacent material. The temporary cavity cone of cavitation is the result of a stretch-type injury from the dissipation of imparted kinetic energy i. It is large.

Gases are compressible. Load size of the individual pellet 3.

Edition handbook 3rd pdf fractures of

The energy delivered by a missile to a target is dependent on: This includes all military rifles and most hunting rifles. The degree of injury created by the missile is generally dependent on the specific gravity of the traversed tissue: A missile projectile achieves a high kinetic energy because of its relatively high velocity.

The behavior of the missile w hile traversing the target: The impact area is relatively small. The energy of the missile on impact striking energy. Administration of antibiotics first-generation cephalosporin. Attention must also be paid to possible injuries sustained after the missile impact. CourtBrow n C. Temporary cavitization causes a transient lateral displacement of tissue. The two areas of tissue injury: The shock wave.

Indications for operative debridement: Missile fragments can often be found distant to the site of missile entry or exit.

Irrigation and debridement of the entrance and exit skin edges. Careful neurovascular examination must be undertaken to rule out the possibility of disruption to vascular or neural elements.. The permanent cavity is caused by localized areas of cell necrosis proportional to the size of the projectile as it travels through. Specific attention must be paid to retained missile fragments. Figure 4. Steps in treatment include: Follow ing initial trauma survey and management see Chapter 2.

In addition. This is secondary to skin flora. Meticulous debridement and copious irrigation w ill minimize the possibility of w ound infection.

Compartment syndrome Gastrointestinal contamination 4. Temporary cavitation may produce traction or avulsion injuries to structures remote from the immediate path of the missile. High-Velocity and Shotgun Wounds These should be treated as high-energy injuries w ith significant soft tissue damage. These may result in injuries ranging from neuropraxia and thrombosis to frank disruption of neural and vascular structures.

These require debridement of the intraabdominal and extraabdominal missile paths. Neurovascular disruption: The incidence of damage to neurovascular structures is much higher in high-velocity injuries military w eapons. Lead poisoning: Synovial or cerebrospinal fluid is caustic to lead components of bullet missiles.

Fracture stabilization. Fracture treatment: Generally treat this injury as a closed fracture. These are generally tolerated w ell by the patient and do not w arrant a specific indication for surgery or a hunt for fragments at the time of surgery unless they are causing symptoms pain.

Delayed w ound closure w ith possible skin grafts or flaps for extensive soft tissue loss. Extensive and often multiple operative debridements.

Handbook of Fractures - PDF Free Download

Intraarticular or subarachnoid retention of missiles or missile fragments is thus an indication for exploration and removal. Gunshot w ounds that pass through the abdomen and exit through the soft tissues w ith bow el contamination deserve special attention. Local recurrence is higher. Patients w ith fractures and underlying suspicious lesions or history should be referred for biopsy. They may occur later in patients w ith radiation osteonecrosis Ew ing sarcoma.

Pathologic fracture complicates but does not mitigate against limb salvage. Causes include neoplasm. Most are asymptomatic before fracture. Antecedent nocturnal symptoms are rare. Fractures more common in benign tumors versus malignant tumors..

Most common in children: Humerus Femur Unicameral bone cyst. Alw ays obtain a biopsy of solitary destructive bone lesions even in patients w ith a history of primary carcinoma. Survival is not compromised. Suspect a primary tumor in younger patients w ith aggressive-appearing lesions: Poorly defined margins w ide zone of transition Matrix production Periosteal reaction Patients usually have antecedent pain before fracture..

Ew ing sarcoma. Suspicion of pathologic fracture should be raised in patients presenting w ith fracture involving: Normal activity or minimal trauma. Physical examination: In addition to the standard physical examination performed for the specific fracture encountered. UPEP to rule out possible myeloma hour urine hydroxyproline to rule out Paget disease Specific tests: It is difficult to measure size accurately.

Patients w ith a know n primary malignant disease or metabolic disease. Table 5. As w ith all fractures. Risk factors such as smoking or environmental exposure to carcinogens. A history of multiple fractures. Paget disease: Search for primary source in patient with suspected metastatic bone lesion 1. Physical examination. Pathologic fracture is the most common orthopaedic complication. Metastatic disease: Bone scan: This is the most sensitive indicator of skeletal disease.

It gives information on the presence of multiple lesions. Osteomalacia and hyperparathyroidism may be present. Hematopoietic disorders: Review of systems. Chest radiograph: To rule out primary lung tumor or metastases in all cases.

Total-body technetiumm bone scan 6. Abdominal ultrasound 7. Systemic Osteoporosis: This is the most common cause of pathologic fractures in the elderly population. Other useful tests in evaluating a patient w ith suspected pathologic fracture of unknow n origin include the follow ing Table 5. Localized This accounts for the majority of pathologic fractures and includes: Primary malignancy of bone. Contrary to popular belief. Healing and callus formation are normal.

Internal fixation w ill eventually fail if the bone does not unite. Healing time is slow er than in normal bone. Loss of fixation is the most common complication in the treatment of pathologic fractures. Local Disease Nonossifying fibroma. Mechanical support for w eakened or fractured bone to permit the patient to perform daily activities. Operative Treatment Goals of surgical intervention are: Prevention of disuse osteopenia.

Decreased length and cost of hospitalization. Pain relief. Internal fixation. Most common locations include the spine. Correctable disorders include osteomalacia.

Paget disease. Noncorrectable disorders include osteogenesis imperfecta. Adjuvant Therapy: Radiation Therapy and Chemotherapy Role in treatment of pathologic fractures: Palliate symptoms. Facilitation of nursing care. Diminish lesion size. Mental obtundation or decreased level of consciousness that precludes the need for local measures to relieve pain. They delay soft tissue healing and should not be administered until 10 to 21 days postoperatively.

Adequate patient management requires multidisciplinary care by oncologists. Cement augmentation. Goals of surgery in treating patients w ith pathologic fractures are: Nails versus plates versus arthroplasty. Arthroplasty for periarticular fractures. Aggressive rehabilitation. If the acetabulum is not involved. Pathologic fracture treatment includes: Restoration of function. Pathologic femoral shaft fractures may be managed w ith intramedullary nailing.

Metastases of Unknown Origin: These treatments are used to decrease the size of the lesion. Prevent advancement of lesion. Pathologic fracture survival Seventy-five percent of patients w ith a pathologic fracture w ill be alive after 1 year. Pathologic fractures of the femoral neck generally do not unite regardless of the degree of displacement. Interlocked nails to stabilize the entire bone.

Contraindications to surgical management of pathologic fractures are: General condition of the patient inadequate to tolerate anesthesia and the surgical procedure.

Radiation and chemotherapy are useful adjunctive therapies in the treatment of pathologic fractures.

Persistent pain follow ing irradiation. Prophylactic fixation of impending pathologic fractures is not recommended on a routine basis. Advantages of prophylactic fixation compared to fixation after fracture occurs are as follow s: Decreased morbidity Shorter hospital stay Easier rehabilitation Pain relief Faster and less complicated surgery Decreased surgical blood loss Table 5.

Pathologic avulsion of the lesser trochanter. Quantitative computed tomography is a sensitive study to assess the degree of bone destruction. Indications for prophylactic fixation Harrington are: Operative stabilization of pathologic fractures of the humerus may be performed to alleviate pain. Consider bone grafting the defect. They occur more frequently w ith noncemented components.

Revision surgery. There is a 0. Place cortical w indow s in an anterolateral location on the femur in line w ith the neutral bending axis. Risk Factors Osteopenia: Osteoporosis or bone loss secondary to osteolysis. Stress risers secondary to cortical defects.

Choose the correct starting point for reaming and broaching. Loose components: Inadequate implant site preparation: Large implant w ith inadequate reaming or broaching may be responsible.

Type III: Pericapsular pathology: A scarred capsule w ith inadequate release may result in intraoperative fracture.

McRae's Orthopaedic Trauma and Emergency Fracture Management

Type II: Explosion type w ith comminution around the stem. Type IV: Level I: Level II: Level III: Type I: Type V: Type VI: Proximal femur distally to the low er extent of the lesser trochanter 10 cm of the femur distal to level I Covers remainder of femur distal to level II Fracture proximal to the intertrochanteric line that usually occurs during dislocation of the hip Vertical or spiral split that does not extend past the low er extent of the lesser trochanter Vertical or spiral split that extends past the low er extent of the lesser trochanter but not beyond level II.

Classification scheme proposed by Johansson. Modified from Petty W. Revision plus ORIF. American Academy of Orthopaedic Surgeons. Age and medical condition of the patient. Accurate reduction and secure fixation. Treatment Principles Treatment depends on Location of the fracture. Figure 6. Instructional Course Lectures W B Saunders. Options include: Nonoperative treatment: Modified from Duncan CP. Jackson D. Masri BA. A loose stem should be revised. Stability of the prosthesis. Fractures of the femur after hip replacement.

American Academy of Orthopaedic Surgeons classification of fractures associated with hip arthroplasty. Vancouver classification scheme for periprosthetic fractures about total hip arthroplasties. Total Joint Replacement.

Type B: Type C: Fracture in the trochanteric region Greater trochanter region Lesser trochanteric region Around or just distal to the stem Stable prosthesis Unstable prosthesis Unstable prosthesis plus inadequate bone stock Well below the stem Figure 6. Bone stock. ORIF is used to maintain abductor function w ith w ide displacement. Composite allograft. Cemented prosthesis.

Adequacy of stress riser augmentation. Do not make any new stress riser. Revision of acetabular component is indicated w ith severe polyethylene w ear. The severity of the bone defect. Fluted long-stem prosthesis. Choice of implant includes: Uncemented prosthesis: Extensive coated long-stem curved prosthesis. Proximal femoral replacement.

The functional class of the patient. Long-term results depend on: Implant alignment. Options for fixation include: W ires or cables. Proximal femoral reconstruction. Treatment depends on: The age of the patient. Routine bone graft is used w ith ORIF. Cortical onlay allograft. Preservation of the periosteal blood supply.

Nondisplaced fractures may be treated nonoperatively. Classification NEER. The interface remains intact. In the absence of significant osteopenia. The fracture is nondisplaced. Risk Factors Supracondylar fractures after total knee replacement are multifactorial in origin. Preexisting neurologic disease.

Fracture of the patella after total knee arthroplasty may occur. Displaced fractures should be treated by ORIF. The patient has a loose or failing prosthesis in the presence of either a displaced or a nondisplaced fracture.

They generally occur w ithin 10 years after surgery. Notching of the anterior cortex: Biomechanical analysis: There is a high correlation betw een notching and supracondylar fractures in patients w ith rheumatoid arthritis and significant osteopenia. Nondisplaced fractures should be observed and treated w ith crutches and limited w eight bearing.

There is a high incidence of late loosening of the acetabular component. Rorabeck CH. Immediate prosthetic revision is indicated in selected cases. Revision Total Knee Arthroplasty. Periprosthetic fractures. A blade plate. Classification scheme for periprosthetic fracture of the knee.

Fractures around the diaphysis or the tip of a femoral component may be treated w ith cortical strut grafts and cerclage w iring. Modified from Lew is PL. Primary revision w ith a stemmed component may be considered if there is involvement of the boneimplant interface. If bone quality is poor. Long leg casting or cast bracing for 4 to 8 w eeks may be used to treat minimally displaced fractures. Engh GA. ORIF is indicated if the alignment is unacceptable by closed means and if bone stock is adequate for fixational devices.

Bone loss may be addressed w ith autologous grafting. Cases of severe bone loss. Type I fractures involving the tibial plateau typically involve the bone-implant interface. Stuart MJ. Early conversion to a cast brace to preserve knee range of motion is advised.

Occur in the tibial plateau Adjacent to the stem Distal to the prosthesis Involve the tubercle The stability of the implant is then used to classify the fractures further: Subtype A is a w ell-fixed implant. Subtype B is loose. Classification of periprosthetic tibial fractures. Periprosthetic fractures of the tibia associated w ith total knee arthroplasty. Clin Orthop Hansen AD. Subtype C fractures are intraoperative.

Modified from Felix NA. Patella Fractures Epidemiology The postoperative incidence is 0. Risk Factors Large. Fragment excision: This may be undertaken for small fragments that do not compromise implant stability or patellar tracking. This may be necessary in cases of extensive comminution or devascularization w ith osteonecrosis.

The patient may be placed in a knee immobilizer for 4 to 6 w eeks. This is indicated for type II. Surgical considerations include adequate medial arthrotomy. Type IIIA: Type IIIB: Treatment options include: ORIF w ith revision of the prosthetic patella. Classification of periprosthetic shoulder fractures. Excessive reaming of the proximal humerus Overimpaction of the humeral component Excessive torque placed on the humerus during implant insertion Classification University of Texas San Antonio Classification of Periprosthetic Shoulder Fractures Fig.

Others advocate aggressive operative stabilization of all periprosthetic fractures of the shoulder. ORIF may be performed w ith cerclage w iring and possible bone grafting. Nonoperative Treatment Closed treatment involves fracture brace. Fractures occurring proximal to the tip of the humeral prosthesis Fractures occurring in the proximal portion of the humerus w ith distal extension beyond the tip of the humeral prosthesis Fractures occurring entirely distal to the tip of the humeral prosthesis Fractures occurring adjacent to the glenoid prosthesis Treatment Controversial: Some advocate nonoperative treatment w ith surgical intervention indicated for compromise of prosthetic fixation and intraoperative fractures.

Options for postoperative immobilization range from sling immobilization for comfort until range-of-motion exercises can be instituted.

Revision to a long-stem prosthesis may be required for cases w ith gross implant loosening. These occur more commonly in the humerus than in the ulna. The splint may then be changed to a fracture brace for 3 to 6 w eeks. Risk Factors Osteoporosis Paucity of bone betw een the medial and lateral columns of the distal humerus Abnormal humeral bow ing in the sagittal plane Size and angulation of the humeral and ulnar medullary canals Excessive reaming to accommodate the prostheses Revision elbow surgery Classification Fig.

Supplemental bone grafting may be used as necessary. Most fractures are preceded by prosthetic loosening and thinning of the cortices. Fracture of the humerus proximal to the humeral component Fracture of the humerus or ulna in any location along the length of the prosthesis Fracture of the ulna distal to the ulnar component Fracture of the implant Treatment Nonoperative Treatment Nondisplaced periprosthetic fractures that do not compromise implant stability may be initially addressed w ith splinting at 90 degrees and early isometric exercises.

Displaced olecranon fractures should be fixed w ith a tension band and cement. Type IV fractures require component revision. Classification of periprosthetic elbow fractures.

If stable fixation of implant components cannot be obtained. Pain and temperature fibers are much more sensitive than pressure fibers.

Symptoms include dizziness. Cardiovascular-depressive effects Weaker contraction and arteriolar dilatation occur. Local effect Block is most effective in smaller. Maximal dose of commonly used local anesthetics Lidocaine: Neurotoxicity In high concentrations. They may also decrease local blood loss. Epinephrine Most w idely used. It may also effect neurons in the thalamus and midbrain. Morphine and codeine are directly from the plant.

Papaver somniferum. The action is both presynaptic and postsynaptic.

Of edition handbook fractures pdf 3rd

CNS effects Analgesia. Mechanism They act centrally. It has a much shorter half-life than most benzodiazepines that are used clinically.

Ketamine Dissociative anesthetic Catatonic. Use w ith caution because it may precipitate seizures. They are metabolized in the liver and excreted in the urine. Effects Sedation. The dose is 0. The GABA receptor is the chloride channel. W hen activated. Single case report in orthopaedic literature. It provides analgesia for closed reductions. Infection Theoretically converting a closed fracture to an open one.

It provides postreduction analgesia. Hematoma Block This replaces the fracture hematoma w ith local anesthetic. Enter the fracture hematoma w ith a large-bore needle. May increase salivation: Technique Sterile preparation of the fracture site is indicated. Bier block if proper equipment and training available. Wait 5 to 7 minutes. Bupivacaine may be added to help w ith postreduction pain. Technique Supinate the forearm. Do not use epinephrine.

Use about 2 mL per nerve 8 mL total. They are useful in fracture-dislocation reduction. The needle is placed betw een the palmaris longus and the flexor carpi radialis.

They provide anesthesia to a certain area of the body. Use tw o injection sites. Length of block depends on the choice of anesthetic. Wrist Block Fig. Bridenbaugh PO. Digital Block Indications include finger fracture.

Local anesthetic is injected around the peripheral nerves. They are also beneficial for postprocedure analgesia. Neural Blockade ed. Technique Fig. Figure 7. The skin w heal is just medial to the brachial artery. Four nerves are involved: Elbow Block Indications include procedures of the hand and w rist. Radial nerve Indications include thumb and dorsum of hand lacerations. Technique Field block is performed on the pronated hand at the level of the snuff box.

Advance the needle until paresthesia is obtained. Median nerve Draw a line betw een the medial and lateral condyles of the humerus. This is superficial to the extensor palmaris longus tendon. Ulnar nerve Indications: If no paresthesia occurs. A dose of 5 to 8 mL is required. Axillary Block Indications These include hand and forearm procedures and some elbow procedures. Deep peroneal Just lateral to the anterior tibial artery and the extensor hallucis longus.

Superficial peroneal and saphenous Field block medially and laterally from a deep peroneal site P. Others suggest going on either side of the palpable artery. Ulnar nerve The elbow is flexed. Inject 1 cm proximal to the line that connects the medial epicondyle and the olecranon.

The block must include all five nerves: Inject 3 to 5 mL of lidocaine. Some advocate going through the artery. Tibial Posterior to the posttibial artery. Inject very superficially. Palpate the axillary artery in the distal axilla. Think of the four nerves in four quadrants: Identify the popliteal fossa. Popliteal Block Indications include foot and ankle surgery. This w as developed by August Bier in Bier Block Fig.

Add a field block of the saphenous distal to the medial tibial plateau for a more complete block. Advance in an anterosuperior direction. Technique The patient is prone. Hand and Wrist. Technique Start the IV infusion in the hand. Place double tourniquets around the upper arm. Any time a potentially painful procedure needs to be performed in the outpatient setting For procedures not requiring general anesthesia and that are reasonably short in duration W hen appropriate monitoring equipment is available P.

Inflate the tourniquet. The tourniquet must stay inflated for 25 to 30 minutes. Risks Tourniquet pain Length of block most often limited by the ability to tolerate the tourniquet Systemic toxicity Theoretic risks: Inject lidocaine w ithout epinephrine 1. Exsanguinate the upper extremity. Clinically unstable patient requiring other more urgent procedures Refusal by a competent patient Relative contraindication: A and B: Intravenous regional blockade Bier block.

Remember that these patients have likely already had large doses of opioids for pain control. Titrate dosing to achieve appropriate level of sedation w hile minimizing the risk of adverse outcome.

The patient should at all times be responsive to physical or verbal stimuli therefore should have protective airw ay reflexes intact. Interruption of spinal vascularity resulting in ischemia of neurologic structures. Delayed diagnosis of vertebral injury is frequently associated w ith loss of consciousness secondary to multiple trauma or intoxication w ith alcohol or drugs. Mechanical deformation interrupting axonal flow. Several characteristics of the injury force that determine the extent of neural tissue damage have been identified.

Injury occurs by: For patients w ith a spinal cord injury. The remainder of the canal is filled w ith epidural fat. Injury results in longitudinal traction.

A reflex arc is a simple sensorimotor pathw ay that can function w ithout using either ascending or descending w hite matter. Contusion injuries are potentially reversible. These roots are less likely to be injured because they have more room in the canal and are not tethered to the same degree as the spinal cord.

It contains the sacral and coccygeal myelomeres and lies dorsal to the L1 body and L intervertebral disc. The ratio of male to female patients sustaining vertebral fractures is 4: This sudden. Injury occurs as a result of capillary and axonal collapse secondary to tensile distortion. A spinal cord level that is anatomically and physiologically intact may demonstrate a functional reflex arc at that level despite dysfunction of the spinal cord cephalad to that level. Injury results from decreased size of the spinal canal.

These include the rate of force application. The conus medullaris represents the caudal termination of the spinal cord.

Fractures of the Shoulder Girdle. Hippocrates - On Fractures.

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Children's Orthopaedics and Fractures. Fractures in Children. Fractures in children. Arthroscopic Management of Distal Radius Fractures. Fractures of the Pelvis and Acetabulum. Fractures of the Hand and Wrist. Pediatric Fractures Dislocations and Sequelae. Musculoskeletal Fatigue and Stress Fractures. Children's Orthopaedics and Fractures, 3rd Edition. Lecture Notes: Orthopaedics and Fractures 4th ed.

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Rockwood and Wilkins' Fractures in Children. Internal fixation of femoral neck fractures An Atlas. The initiation, propagation, and arrest of joints and other fractures. Fractures of the Cervical, Thoracic, and Lumbar Spine.