1/5. Stigmata: part I. shame, guilt, and anger.The aesthetic surgeon may occasionally be consulted by a patient who wishes to discuss what can be done for the scars of self-inflicted wounds on the forearms. These scars are popularly referred to as "hesitation marks" or "suicide gestures." Unlike patients suffering from factitial ulcers or Munchhausen syndrome, these patients will admit to the physician that the scars are the result of self-inflicted wounds. These scars often consist of multiple, parallel, white lines extending up and down the forearms (usually volar surface), with more on the nondominant side. Although the pattern of these scars is apparently what drives these patients to the aesthetic surgeon for relief (because even lay people identify these scars as self-inflicted suicide marks), the authors propose a new and deeper motivation for surgery. Recent experiences with three of these patients resulted in an epiphany that prompted this report. Once the symbolic meaning of these scars was broached, a torrent of thoughts and theories followed. This article will recount these three cases and present a central thesis for this type of self-inflicted injury. A proposal for the proper surgical treatment of this condition will be offered. Uniquely, two of the patients will relate their own stories and propose guidelines and warnings for the aesthetic surgeon.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/5. Ultrasound guided reduction of pediatric forearm fractures in the ED.Reducing badly displaced or angulated pediatric forearm fractures in the emergency department can be difficult. Multiple attempts at reduction may be required, with repeated trips to the radiology department, before an adequate reduction is achieved. We have recently found that bedside ultrasound by emergency physicians is very helpful in guiding the reduction of difficult forearm fractures, allowing the physician to assess the adequacy of the reduction at the patient's bedside. In this report, we describe the technique we have developed for ultrasound-guided fracture reduction and present three case histories showing the usefulness of this technique.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
3/5. An adjustable splint for forearm supination.The adjustable supination splint is used in select cases in which traditional mobilization therapy is not productive in supination gains. The success of the splint varies depending on many factors, including the type and severity of the injury; the timing of the intervention; the patient's age; and the patient's tolerance of and compliance with the treatment program. The therapist must consult with the physician and have his or her approval before initiating the treatment regimen. Splint use is contraindicated in patients with unstable fractures or with injuries that require surgical intervention before splinting. Therapists should watch for edema, pain, and neurological changes. Depending on the severity of these symptoms, the splint may need to be discontinued or the wearing time and tension adjusted. In our experience at Union Memorial Hospital and in our weighing of the above considerations, we have found favorable results in the use of the adjustable supination splint, with gains in range of motion and function in select patients.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/5. Torsional fractures and the third dimension of fracture management.Torsional strength is the weakest structural property of bone. Fractures produced by common indirect mechanisms are likely to have significant rotational components that bear on their management. The characteristics of torsional fracture lines in bone specimens are completely predictable and reproducible. The physician who is aware of these biomechanical consistencies can use them for fracture reduction and can anticipate and treat fracture deformities accentuated by torsional loading.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/5. hypnosis for pediatric fracture reduction.hypnosis can diminish pain and anxiety for many emergency patients during examinations and procedures. While hypnosis has been used for millennia and was demonstrated to be of use in clinical medicine more than a century ago, modern physicians have been reluctant to adopt this technique in clinical practice. This article describes four children with angulated forearm fractures who had no possible access to other forms of analgesia during reduction, and in whom hypnosis was used successfully. A simple method for hypnotic induction is described.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |