Question

Shelly is a healthy 12 year-old that is heavily involved in competitive gymnastics. At a recent meet she fell and broke her right arm. Upon X-ray it revealed a compound radial-ulnar fracture which was treated with an open reduction procedure. However, she had to remain in the hospital for 10 days due to an infection in the area of the skin breakage. Currently she is undergoing physical therapy to help regain full movement and muscle tone.

Please respond to each of the following in your reply:

1. Her break required a type of surgery called open reduction. What is meant by reduction? What is involved with open reduction?
2. What is meant by fixation (immobilization)? Explain the difference between Internal and External fixation.
3. During physical therapy Shelly is also having difficulty with her elbow. Her MRI shows a 3^rd degree sprain. Differentiate between levels of severity, and between a strain and a sprain.
4. Over the next few years Shelly continues to have pain in her elbow. It is determined she has post-traumatic arthritis. How might this be treated?

Answer 1

1. REDUCTION

Reduction is a type of a surgical procedure to repair a fracture or dislocation to the correct alignment.

OPEN REDUCTION

Open reduction means the doctor makes an incision to reach the bones and move them back into their normal position. Internal fixation is done in open reduction. Internal fixation means metal screws, plates, sutures, or rods are placed on the bone to keep it in place while it heals.

2. FIXATION

Fixation is a method used to fix the fractured bone by using metal plates, screws, rods or pins .

EXTERNAL FIXATION

External fixation is a process for fracture fixation by which pins or wires are inserted into bone percutaneously and held together via an external scaffold.

INTERNAL FIXATION

Internal fixation means metal screws, plates, sutures, or rods are placed on the bone to keep it in place while it heals.

3. STRAIN AND SPRAIN

Based on severity strain and sprain can be classified into following

Grade 1 (mild) : Tissue is stretched

• slight swelling
• mild loss of range of motion and strength (0-25%)
• no decrease in stability

Grade 2 (moderate) : Involves stretching and some tearing of tissue

• moderate swelling
• usually includes some bruising
• moderate loss of range of motion and strength (25-75%)
• some decrease in stability

Grade 3 (severe) : complete tearing of tissue

• significant swelling and bruising
• near complete loss of range of motion and strength (75-100%)
• marked decrease in stability

TREATMENT OF POST TRAUMATIC ARTHRITIS

Generally post traumatic arthritis is treated by following methods

• weight loss
• strengthening of the muscles surrounding the joint
• low impact exercise
• NSAIDs
• cortisone injections