1/4. growth arrest of the distal radius following a metaphyseal fracture: case report and review of the literature.We report a 12-year-old girl who developed growth arrest of the distal radius physis 9 months after sustaining a complete fracture of the distal radial and ulnar metaphysis with no involvement of the physis evident at time of injury. The girl sustained a fracture of the metaphysis of her right distal radius and ulna after a fall. Anterior-posterior, lateral and oblique radiographs at injury, and during subsequent healing show no evidence of the fracture involving the physis. She was treated with closed reduction and casting for 6 weeks and healed uneventfully. She returned 4 month later concerned about distal ulnar prominence. Radiographs revealed a loss of radial tilt and with suspicion of a physeal bar. magnetic resonance imaging confirmed a physeal bar located in the dorsal radial region. A literature search of the medline database was used to obtain prior case reports for review purpose. The patient underwent an epiphysiodesis of the distal radius and ulna along with an opening wedge osteotomy and bone grafting of the distal radius to restore radial height and inclination. She healed without complication and with restoration of the normal relationship of the distal radius and ulna. A review of the literature reveals five reported case of distal radial metaphyseal fractures not invloving the physis leading to growth arrest. By comparison, there are 31 reported cases of distal radius physeal arrest following fractures involving the physis. The physician should be aware that common distal radius metaphyseal fractures may rarely lead to growth arrest.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/4. Acute pain management for patients receiving maintenance methadone or buprenorphine therapy.More patients with opioid addiction are receiving opioid agonist therapy (OAT) with methadone and buprenorphine. As a result, physicians will more frequently encounter patients receiving OAT who develop acutely painful conditions, requiring effective treatment strategies. Undertreatment of acute pain is suboptimal medical treatment, and patients receiving long-term OAT are at particular risk. This paper acknowledges the complex interplay among addictive disease, OAT, and acute pain management and describes 4 common misconceptions resulting in suboptimal treatment of acute pain. Clinical recommendations for providing analgesia for patients with acute pain who are receiving OAT are presented. Although challenging, acute pain in patients receiving this type of therapy can effectively be managed.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/4. osteopetrosis in trauma.A 19-year-old male with a bone disease that predisposes to pathological fractures was involved in an automobile accident. Although the physician must always look for multiple injuries in any trauma patient, this case illustrates that in the patient with bone disease, the probability of multiple fractures is extremely high. The differential diagnosis of dense-bone disease is discussed as are considerations relevant to caring for the trauma patient with bone disease.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/4. Bilateral distal radius and ulnar fractures in adolescent weight lifters.Two cases of bilateral radius and ulnar fractures in adolescent weight lifters are described. The fractures healed without complications. However, the authors stress that these injuries can be prevented if coaches, trainers, and sports medicine physicians are aware of their occurrence and undertake necessary preventative measures. Adequate supervision with spotters at the end of each bar, appropriate foot wear, and, above all, the maximum level of concentration are key factors in preventing these injuries.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |