Pathology and Fractures pictures

Lead Pipe

term for a radiographic appearance given to a simultaneous greenstick fracture of one side of the bone (usually metaphysis) with a buckle fracture of the opposing cortex of the same bone. Caused by bone bending on compression side with failure on tension side of the bone and the fracture can later hinge open. Usually treated with splint versus cast and heals within a few weeks. Common fracture with self-defense injuries from blunt force due to protecting face/head with arms/hands.

Dirty fat

- Definition- Also called fat stranding, it is the change in attenuation of fat around an inflamed structure and is a helpful sign for localizing intra-abdominal pathologies such as acute appendicitis. It is mostly seen on CT images wherever fat can be found, mostly in the abdomen/pelvic area. - Symptoms- Fat stranding is a non-specific sign in itself and is dependent on what pathology is causing it, however it is shown from inflammation of a structure - Cause- it is caused by presence of infectious, inflammatory, malignant, or traumatic conditions - Treatment/prognosis- dependent on the ailment that is causing the inflammation/fat stranding. If the appendix is inflamed, appendicitis is most likely the reason. Treatment for this is often an appendectomy and antibiotics.

Paget's disease

- Definition- a disease where new bone gradually replaces old bone tissue with time leading to fragile and misshapen bones. It mostly affects the pelvis, skull, spine, and legs, but can be seen anywhere. It is diagnosed with x-rays, bone scans, and blood tests. - Symptoms- most patients have no symptoms, but if they do, they usually have pain in the area that is affected. If in the pelvis, Paget's disease can cause hip pain. If in the skull it can cause hearing loss or headaches. If in the spine it can cause pinched/compressed nerves leading to numbness or tingling. If in the legs, it can cause them to become bow legged and lead to osteoarthritis in knees or hip - Cause- cause of Paget's disease is unknown, but it is found to mostly affect people with certain genetic and environmental factors. Factors include being over 50, being male, having ancestry in england, scotland, central europe, and greece, and if you have a family member with paget's disease. - Treatment- if there are no symptoms, treatment may not be required. If the disease is active, treatments may include medications like osteoporosis drugs (bisphosphonates) that are given intravenously or some by mouth; or surgery for rare or more severe cases that have caused more damage. Prognosis-there is no cure, but prognosis is good if detected early enough. If not detected soon enough, it can lead to osteosarcoma which has a low survival rate

Pyuria

- Definition- a urinary condition that involves the increased presence of white blood cells in urine, which causes urine to look cloudy as if it contains pus. It is most common in women, older individuals, and being sexually active. - Symptoms- for UTIs, a patient may have frequent urination, blood in urine, cloudy urine, burning sensation when urinating. Other symptoms for pyuria includes bladder pain, nausea and vomiting, cloudy urine, discharge, fever, and chills - Cause- most commonly from urinary tract infections, but can also be caused from sexually transmitted diseases, viral infections, painful bladder syndrome, pelvic infections, sepsis, pneumonia, kidney stones, fungal infections, foreign bodies in urinary tract, and many more. Also long term use of drugs such as NSAIDS, diuretics, or antibiotics with penicillin can cause pyuria. - Treatment- dependent on its many causes. Mostly will include taking antibiotics or possibly antifungal meds - Prognosis- if left untreated, pyuria can lead to infections that spread throughout the body and cause blood poisoning or organ failure. If treated, the outlook is good once the UTI or other cause clears up.

Cystic bone lesion

- Definition- fluid-filled areas inside growing bone that have not developed into osseous tissue or actual bone. Four types occur and include: nonossifying fibromas, where a central portion of the bone that has failed to form into hard bone but is instead more fibrous; fibrous cortical defects, where a benign bone lesion forms in the outer edge of the bone; unicameral bone cysts, fluid-filled areas that usually occur near epiphyses in larger bones; and aneurysmal bone cysts, fluid- or blood-filled areas of bone that most commonly occur in adolescents. - Symptoms- bone cysts usually cause no pain and are asymptomatic, but if large enough, they can weaken bone and cause pathologic fractures which can lead to pain and swelling, stiffness, or deformity. - Cause- exact causes unknown. Unicameral bone cysts may form if fluid is not properly drained from a bone as it grows and in aneurysmal bone cysts, the cause may be from an issue with bone blood vessels - Treatment- they usually resolve on their own with time, and repeated x-rays are taken to monitor the size of the cyst. If a fracture occurs, the cyst may need to be surgically cleaned and packed with bone graft to promote bone healing Prognosis-daily activities after surgery will vary depending on the size and location of the cyst. Most patients can return to full activity within 3 to 6 months.

Gastric diverticulum

- Definition- outpouchings of the stomach wall that typically form in the fundus, mostly on the posterior wall. They are the least common gastrointestinal diverticula and are usually discovered incidentally during routine diagnostic testing. They are usually found in people between the ages of 50 and 70 years old - Symptoms- most people with gastric diverticulum are asymptomatic, but some may have epigastric pain, discomfort, nausea, vomiting, dyspepsia, early satiety, belching, halitosis, anorexia, and dysphagia. Occasionally, complications, such as ulceration, upper gastrointestinal bleeding, hemorrhage, perforation, and malignant transformation, can develop that may be life-threatening. - Cause- usually caused by a background history of other GI pathology, such as peptic ulcer disease, malignancy, pancreatitis, or gastric outlet obstruction. Or sometimes seen after surgical procedures on the stomach, including Roux-en-Y gastric bypass - Treatment- there is no specific treatment plan for asymptomatic gastric diverticulum and for symptomatic, it is dependent on the size and severity of the diverticulum, but most patients should be treated with PPI therapy (Proton Pump Inhibitors reduce the production of stomach acid), histamine H2 receptor antagonist therapy, or antacid therapy. If surgery is necessary then the diverticulum will be resected. - Prognosis- varies on the outcome of treatment and severity of gastric diverticulum, but prognosis is usually good due to most being asymptomatic

Cavitation

- Definition- the formation of an air-filled space forming within an area of pulmonary consolidation, mass or nodule, as a result of liquefication of the necrotic portion of the lesion and the discharge of this necrotic material via the bronchial tree. - Symptoms- symptoms vary depending on the cause of a cavity, but generally they include a cough, dyspnea, chest pain, hemoptysis, tachycardia, - Cause- A cavity is the result of any of a number of pathological processes including necrosis, cystic dilatation of lung structures, displacement of lung tissue by cystic structures, tuberculosis, cancer, common bacterias, mycobacterium, fungi, and parasites - Treatment- asymptomatic cavities should be monitored and resected if still detectable after 2 years; symptomatic cavities may require oral azole therapy or to oral antibacterial therapy, and/or surgical resection after amphotericin treatment (antifungal injections) if possible. Resections are the surgical removal of tissue. Prognosis- The presence of lung cavities is associated with worse outcomes in lung cancer and tuberculosis; however, if a lung cancer develops cavitation after chemotherapy and radiofrequency ablation, that indicates a good response to treatment

Spinal stenosis

- Definition- the narrowing of one or more spaces within the spine, most often in the cervical or lumbar region. This causes the spinal cord nerves to become compressed, irritated, or pinched, leading to back pain or sciatica. - Symptoms-pain, numbing, tingling, and/or weakness in the neck, back, arms, legs, or feet. In lumbar stenosis, symptoms may worsen when walking or standing; in cervical stenosis someone may have loss of balance or problems with hand function - Cause- It develops slowly over time from osteoarthritis/wear-and-tear; bone spurs can form due to the worn down cartilage from arthritis and compress nerves; bulging or herniated discs can compress nerves; thickened ligaments from arthritis can bulge into the spinal space; fractures, injuries, tumors, and cysts in the spinal cord can all put pressure on spinal nerves and cause spinal stenosis. It could also be congenital if the patient is born with a small spinal canal. - Treatment- dependent on how severe the stenosis is, physicians will recommend self-help remedies such as applying heat or cold, and exercise,over the counter pain relievers, prescription pain meds, physical therapy, steroid injections, a procedure called percutaneous image-guided lumbar decompression (PILD) that is performed in fluoroscopy with contrast media. The PA or Radiologist will use a small needle to remove a portion of the lamina from the spine. Additional surgery such as a laminectomy or spinal fusion for severe cases may be needed Prognosis- there is no cure, but many people can obtain relief for symptoms nonsurgically, or in more severe cases, physical therapy or surgery may be required for pain relief

Mandibular Torus Fracture

- Definition: 'torus' refers to the existence of a convex, bony exophytic excrescence with an even base in the cortical bone layer. The torus core consists of spongy bone, surrounded by a dense cortical component. Within the lower jaw the torus is located on the lingual surface of the mandibular body, in the canine-premolar zone above the mylohyoid line; fracture of the mandibular bone normally occurs in one or two places - Mechanism: fall on a slippery surface, sports injury, or other traumatic accident that results in a fractured mandible - Symptoms: pain at the fracture site and subjective malocclusion (imperfection of how the teeth are positioned); Swallowing, talking, and mouth opening/closing aggravate pain. Patients may complain of difficulty opening the jaw, loosened or fractured teeth, and lower lip numbness - Treatment: depends on severity, location, and number of fractures in the mandible; resting the jaw, prevention of chewing by use of liquid or soft foods, jaw stabilization by being wired shut; surgery for more severe cases that could involve metal plates; because of the inability to open/move the mandible, imaging may require less movement from the patient and more angulation during imaging exams as well as AP or reverse positions - Prognosis: can require up to four to six weeks for your fracture to heal but may need a few months for full recovery. During this time, you'll typically receive prescriptions or advice to take: Anti-inflammatory medications to increase your comfort and aid in your healing. Antibiotics to prevent an infection of the bone. Although full recovery is most likely, patient is more likely to be prone to other mandibular/jaw fractures or dislocations

Bone Islands

- Definition: (enostosis) a noncancerous/benign lesion that is an isolated, tiny, dense piece of compact bone that grows within a cancellous bone most commonly occurring in the femurs, pelvis, and ribs - Causes: Can be congenital or developmental from failure of bone remodeling - Symptoms: usually asymptomatic but can cause occasional bone pain and can sometimes turn into malignant growths - Diagnosis: are often discovered while looking for something else on an x-ray, CT, or MRI but can be determined by the shape, type of bone, and density of tissue - Treatment: no treatment necessary unless they cause pain; observation may be necessary to check for growth or malignancy - Prognosis: very positive with little chance of pain

Biliary Fistula

- Definition: Chronic pipe-like ulcers that occur from an abnormal injury or connection between the biliary tract and gallbladder or gastrointestinal tract - Causes: Most commonly seen as a complication from gallstone diseases treated by methods of cholecystectomy or laparoscopic surgery, common bile duct exploration, operative injury of the bile duct, or a consequence of infection, Bouveret's syndrome (gastric outlet obstruction produced by a gallstone impacted in the distal stomach or proximal duodenum), Mirizzi's syndrome (common hepatic duct obstruction caused by extrinsic compression from an impacted stone in the cystic duct or infundibulum of the gallbladder) - Symptoms include: jaundice, cholangitis and sepsis, bowel occlusion from passage of large gallstones in the alimentary tract caused by Bouveret's syndrome, abnormal hepatic function tests, and aerobilia (gas in the biliary tree) - Diagnosis: With suspected biliary fistulas, they can diagnose by abdominal ultrasound, CT scans, Magnetic resonance cholangiopancreatography, endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) - Treatment: laparoscopic surgery (inserting a tiny video camera and special surgical tools through four small incisions to see inside your abdomen and remove the gallbladder), T-Tube drain or biliary stent (draining tube placed in the common bile duct after common bile duct exploration with supra-duodenal choledochotomy to drain bile), cholecystectomy with a choledocoplasty (gallbladder removal with plastic surgery to the common bile duct), enterotomy (incision into the intestines) with stone extraction - Prognosis: postoperative wellness depends on the preoperative status, high chance of healing with no complication but there has been record of multiple complications such as hemorrhage, anastomosis stricture, or other organ failure

Per trochanteric Fracture

- Definition: Per-trochanteric femoral fractures are a subtype of trochanteric fractures involving the femur occurring between the femoral neck and femoral shaft. They are one of the most common fractures in old patients. They can involve both the greater and lesser trochanter and are a type of extracapsular (outside of the head/neck of the femur) fracture; usually starts laterally anywhere on the greater trochanter and exits the medial cortex either proximal or distal to the lesser trochanter. - Mechanism: majority occur in a low energy mechanism in the older population in actions such as falling from a standing height but can also occur in younger patients often as a result from high energy mechanisms such as motor vehicle collision; either mechanisms can occur in either the younger or older population - Symptoms: immediate hip pain, a lower extremity deformity, and the inability to bear weight; these symptoms will change how the hip/pelvis will be imaged in the radiology department. Rather than use a non-injury routine hip evaluation, we would most likely need to build the hip up and perform a clements nakayama or cross table evaluation as well as most likely looking at the rest of the femur - Treatment: Surgery is often recommended within 48 hours of diagnosis with arthroplasty being the primary option followed by extramedullary fixation, and intramedullary fixation - Prognosis: Depending on the patient's initial wellbeing, the prognosis is generally positive. However, due to different variables while in the hospital such as bed sores, atelectasis, or pneumonia, changes of different health issues could occur.

Toddler's Fracture

- Definition: a common fracture of the tibia in children usually younger than 6 years old, normally in the years of early walking; it is a spiral fracture of the tibia without any injury to the fibula; the fracture is stable where the ends of the bone are lined up and barely out of place that does not need to be aligned; Childhood Accidental Spiral Tibial Fracture or CAST fracture - Mechanism: Common causes are twisting of the leg while tripping or stumbling when walking/running or getting the foot caught in a twist such as when sliding down a slide; rotational force through the tibia with the foot and ankle fixed - Symptoms: pain and swelling in the shin, ankle, and foot; refusal to bear weight on the injured leg or limping - Treatment: determined by x-ray and are referred to immobilization, a splint, or walking boot; use of controlled ankle motion boot with no orthopedic follow up; in imaging, it is necessary to perform an ap, lateral, and an additional oblique view in order to diagnose most missed toddler's fracture - Prognosis: With the use of immobilization or walking boot, children are normally able to bear weight on the affected limb and usually heal in 3 to 4 weeks. The child can resume all usual activities afterward. Toddler's fractures do not affect the child's growth plate, so there is no risk for problems with growth or deformity of the tibia in the future.

Impacted Fracture

- Definition: a fracture in which bone fragments have been driven into each other also known as a buckle fracture; seen often in arm fractures of children - Mechanism: A significant amount of force is necessary to result in an impacted fracture, such as trauma from a car accident, that would cause two fragments of a fractured bone together - Symptoms: intense sharp pain, inability to move the body part, tenderness to the touch, swelling, and bruising; symptoms typically occur immediately after the injury - Treatment: surgery is often needed to separate bone fragments and may need the use of pins, rods, or other surgical hardware to keep the bones separated and immobilized. Physical therapy may be necessary to help regain strength to the area; During imaging, it is best to consider the pain and mobility of the patient. The use of cross table exams may be necessary with the use of supports and immobilizers to achieve imaging - Prognosis: Most fractures heal well within 6-8 weeks but vary from the type of bone; hand and wrist fractures may take 4-6 weeks where larger tibia fractures can take over 20 weeks

Colles' Fracture

- Definition: a type of fracture to the wrist that is also called a distal fracture with dorsal angulation (an upward angle) - Mechanism: usually occur after a fall on an outstretched hand landing on the small bones that make up your hand and wrist, especially the lunate and scaphoid. This contact transfers energy to your radius resulting in a break of the dorsal end of the radius and causes the broken bone to tilt upward. - Appearance: The wrist may have bruising, swelling, decreased range of motion, and could hang at an angle. Because of the decreased range of motion as well as the angle of the fractured wrist, the tube could need to be angled in order to achieve propriate positions. The use of towels or supports may be needed to hold the wrist into position. - Treatment: The doctor will realign and immobilize broken bones and reset them back to their natural positions (if possible) and then use a cast or brace to hold them in place. If they cannot reset them, surgery might be necessary and could involve the use of metal pins, plates, screws, or an internal fixator. - Prognosis: After reset, the prognosis is generally good. It may take up to a year to resume natural activities with the fractured wrist. Physical therapy may be necessary.

Teratoma

- Definition: a type of germ cell tumor that can contain different types of tissue such as bone, muscle, teeth, and hair that can be classified as benign or malignant; can occur anywhere in the body but most commonly occur in the ovaries, testes, or the coccyx - Causes: Teratomas form in germ cells (undifferentiated) meaning that they can turn into any type of cell. A teratoma develops when there are disruptions during your cells' differentiation process and travel to various places in the body - Symptoms: slow onset of symptoms with variation depending on the location of the tumor; general symptoms of pain, bleeding, swelling, elevated levels of BhCG (beta human chorionic gonadotropin - chemical created by trophoblast tissue, tissue typically found in early embryos), elevated levels of tumor marker AFP, and either visible or non-visible masses - Diagnosis: a lump may or may not be present, but various tests should be performed such as x-ray, ultrasound, bone scans, MRI, and CT to locate and contain the tumor; blood tests to check hormone levels for tumor presence and biopsy of the teratoma to check if it is cancerous - Treatment: surgical removal is recommended for cancerous and noncancerous teratomas because of the potential to grow or rupture leading to further complications. If cancerous, surgical removal could be recommended along with chemotherapy or radiation therapy. IF detected during fetal stage, the teratoma should be monitored closely with rare occurrence of fetal surgery - Prognosis: most teratomas (cancerous and non-cancerous) have excellent survival rates especially with early diagnosis and treatment

Diaphragmatic Hernia

- Definition: aka a hiatal hernia - a protrusion of abdominal organs or contents (such as the intestines, stomach, and liver) through an abnormal opening of the diaphragm (the hiatus of the diaphragm) into the thoracic cavity - Causes: can be congenital occurring during abnormal development of the diaphragm during fetal growth or acquired as a result of blunt or penetrating injury o Baby - begins as a birth defect during fetal development where there is a hole in the diaphragm where organs in the abdomen (such as intestines, stomach, and liver) can move through the hole in the diaphragm and upwards into a baby's chest. o Adult - results from weakened muscle tissue allows your stomach to bulge up through your diaphragm; Injury to the area, Changes in your diaphragm as you age. A rise in pressure in your belly, as from pregnancy, obesity, coughing, lifting something heavy, or straining on the toilet - Symptoms: difficulty breathing, tachypnea or tachycardia, cyanosis, diminished or absent breath sounds, bowel sounds in the chest area, and problems with oxygen levels - Diagnosis: fetal ultrasounds showing abdominal organs in the chest or irregular movements/sounds as well as chest x-rays - Treatment: reparation of the diaphragmatic hernia requires surgery to repair the opening and place the organs into proper position; Nissen fundoplication is a surgical procedure used to treat gastroesophageal reflux disease, or GERD, and hiatal hernia. It tightens and reinforces the sphincter at the top of the stomach to prevent stomach acid from rising into the esophagus - Prognosis: depends on the development of the lungs of the baby as well as any other congenital defects; the outlook is good for infants with no other health problems and decently developed lung tissue but will often have ongoing breathing, feeding, and growth challenges

Lover's Fracture

- Definition: also known as Don Juan fracture or Casanova fracture is a type of calcaneal fracture. They are fractures of the calcaneal body and may be intra- or extra-articular (in or outside of the joint). - Mechanism: generally traumatic fractures occurring from motor vehicle accidents, muscular stress, or falls from a height; categorized based on whether the fracture is displaced (greater than 2mm displacement), open (with soft tissue or bony structure exposed), closed (with skin and soft tissue intact), or comminuted (3 or more pieces) - Symptoms: Pain over the heel, inability to walk, or a hematoma that extends to the sole of the foot are all signs of a calcaneal fracture - Treatment: Treatment for calcaneal fractures varies based on the type of fracture and are diagnosed by standard radiographs and CT scans; for non-displaced fracture nonsurgical treatment may be sufficient. Displaced or comminuted fractures typically require surgical treatment consisting of some type of fixation with metal plates or screws. In closed fractures surgical treatment is often postponed until swelling has subsided. In open (exposed soft tissue or bone) or avulsion fractures (when a tendon pulls off a piece of bone), more urgent treatment is required. - Prognosis: Patient may not be able to apply pressure for calcaneus views in imaging; extreme angulation may need to be used of the x-ray tube or extreme build up of the foot; Minor calcaneal fractures usually heal within a few months with no long-term limitations. More severe fractures may take years to heal, and never return to the previous condition. Long-term complications may include pain, limb length discrepancies, and changes in gait

Pulmonary Edema

- Definition: an abnormal build up of fluid in the lungs that collects in the air sacs making it difficult to breathe - Causes: often caused by congestive heart failure (when the heart does not pump blood efficiently) but can also be caused by pneumonia, medications, chest trauma, or contact with certain toxins - Symptoms: difficulty breathing or extreme shortness of breath, cough with frothy sputum, rapid/irregular heartbeat, cold and clammy skin, wheezing, swelling in the limbs, or a feeling of suffocation or drowning - Diagnosis: diagnosed by use of symptoms along with tests such as chest x-rays, Chest CT scans, pulse oximetry, arterial blood gas, electrocardiograms, echocardiograms, coronary angiogram, or ultrasounds of the lungs - Treatment: deliverance of oxygen to the patient along with medications such as diuretics, blood pressure medicine, inotropes or morphine; the cause should be identified and treated quickly - Prognosis: depends on the cause of the edema; has the ability to get better quickly or slowly and may require long time use of oxygen or a breathing machine; mortality increase without treating the condition

Portal Hypertension

- Definition: an increase in blood pressure of the portal venous system/portal vein as a result of blocked blood flow through the liver leading to large and swollen veins within the esophagus, stomach, rectum, or umbilical area that can rupture or bleed resulting in life threatening complications - Causes: most commonly caused from scar tissue blocking the flow of blood through the liver as a result from cirrhosis but can also be caused by blood clots in the portal vein, blockages of veins carrying blood from the liver to the heart, schistosomiasis (parasitic infection) and focal nodular hyperplasia (a disease found in those with HIV) - Symptoms: GI bleeding, vomiting of blood, black/tarry stools, ascites (fluid in the abdomen), encephalopathy, and a reduced level of platelets, blood cells that form blood clots, or white blood cells, enlarged liver/spleen, enlarged veins, weight loss, kidney malfunction, or internal hemorrhoids - Diagnosis: usually diagnosed by the presence of ascites or dilated veins/varices during a physical exam of the abdomen and anus in combination with lab tests, x-rays, and endoscopic exams - Treatment: effects of portal hypertension can be managed through diet, medications, endoscopic therapy, surgery, or radiology. Once the bleeding episode has been stabilized, treatment options are prescribed based on the severity of the symptoms and on how well your liver is functioning. Medications such as beta blockers, propranolol, or lactulose can be prescribed to reduce pressure and assist with mental changes. Surgical procedures such as Transjugular intrahepatic portosystemic shunt (TIPS - placed in the liver), Distal splenorenal shunt (DSRS - connects splenic vein to left kidney), or liver transplant may be necessary. - Prognosis: can be fatal if bleeding occurs without treatment; portal hypertension can be managed although the cirrhosis cannot be cured; after treatment (such as surgery or implantation), patients need regular monitoring of the liver and healthy lifestyle change in order to have a good prognosis

Parenchymal Atelectasis

- Definition: when larger units of lung parenchyma (functional tissue) cause a collapsed lung - Causes: caused by blockage of the air passages of bronchioles/bronchus, pressure on the outside of the lung, and general anesthesia which changes the exchange of lung gases and function of aveoli - Symptoms: shortness of breath, increased heart rate, coughing, chest pain, or blue tinted skin and lips - Diagnosis: can be seen in an x-ray or verified in CT; oximetry, ultrasound, and bronchoscopies can be used to determine the type/severity of the atelectasis (Bronchoscopy - a procedure to look directly at the airways in the lungs using a thin, lighted tube (bronchoscope). The bronchoscope is put in the nose or mouth. It is moved down the throat and windpipe (trachea), and into the airways. A healthcare provider can then see the voice box (larynx), trachea, large airways to the lungs (bronchi), and smaller branches of the bronchi (bronchioles) - Treatment: can go away on its own if mild, may require medication or surgery such as bronchoscopy to remove blockages, tumor removal, or breathing treatments Prognosis: small areas of atelectasis are usually not life threatening but large areas could be life threatening especially to babies/children or those with disease or illness; once blockage has been removed, the collapsed lung usually re-inflates but could leave scarring or damage; chances of pneumonia during atelectasis increase

Bend Fracture

- Defintion: A curving of a long bone where it is bent but not completely broken; sometimes referred to as a "greenstick" fracture, the bone will bend and crack on one side instead of breaking into two separate pieces; most commonly seen in children because they have softer and more flexible bones - Mechanism of Injury: most commonly occurs when reaching out to catch yourself when you fall; the force to a long bone will bend the bone but not fully break which may result in one or multiple cracks to one side - The site of injury will have pain and possible bruising, swelling, and slight deformity but also may not have a large change in appearance; on an x-ray, the bone will appear bowed or curved; imaging may or may not need to be altered to align with anatomy depending on the bend - Treatment: in most cases, the area is immobilized by a cast or splint for 4-6 weeks with a prescription of medication such as Tylenol or ibuprofen; more severe injuries require surgery with slender rods or metal plates to break and realign the bone which could take up to a year to heal - Prognosis: Most commonly have a full recovery from these fractures within a couple of months to a year

Incomplete

- Fractures where the bone does not completely break, it cracks without breaking all the way through. Types of incomplete fractures include hairline, greenstick, buckle, or torus fractures. Most common in long bones such as radius, ulna, humerus, tibia, and fibula. - Mechanism: if hairline, they're often caused by overuse or repetitive actions when microscopic damage is done to the bone over time; greenstick fractures and buckle fractures can be caused by mostly falls, sports, or motor vehicle accidents - Area of fracture: area will have pain, swelling, bruising, and tenderness - Imaging creativity: these patients are usually able to move pretty normally. Routine views for x-rays should be attainable. If patient experiences pain when moving, a possible x-table lateral may be needed and images done on stretcher. - Treatment: for hairline, try to reduce weight on the area by using crutches or protective wear until healed; greenstick or buckle fractures may require an immobilizer for 4-6 weeks. During the healing time, new bone will grow around the edges of the bones to reconnect them Prognosis:depending on the type of incomplete fracture, healing can take up to a couple months, but patients usually fully recover

Comminuted

- Fractures where the bone is broken in at least two places and often in long bones like the femur, tibia, fibula, humerus, or radius and ulna - Mechanism: caused by traumatic events such as a car accident or a fall from a high place such as a ladder or roof - Area of fracture: pain, swelling, bruising, and possibility of seeing bone through the skin - Imaging creativity: patient is in immense pain and cannot move these extremities. X-rays will probably be done in the patient's stretcher and x-table laterals will be needed - Treatment: pain medicine may be given and surgery will be required to repair the broken bones. This is done by placing rods, plates, screws, pins and/or wires in the bone to stabilize it and reduce the fracture and known as open reduction internal fixation. Some surgeons may recommend external fixation prior to internal. This is where screws will be put on either side of the fracture inside your body then connected to a brace or bracket around the bone outside your body. Bone grafting may also be necessary. After surgery, a brace, cast, or splint must be worn to immobilize the bone. - Prognosis: will be able to move after a few weeks, but can take up to a year to heal. Physical therapy will be needed to regain strength and range of motion.

Pineal Gland

- Location: deep in the brain in the epithalamus where the two halves of the brain join; it is a cone shaped structure situated between the superior colliculi, pulvinar, and the splenicum; it sits in a groove just above the thalamus - Hormone Secretion: best known for the secretion of melatonin that regulates the body's circadian clock and is used to research biological time; melatonin also can inhibit the secretion of luteinizing hormone from the anterior pituitary gland

Dupuytren's

- Term loosely applied to a variety of bimalleolar ankle fractures. The injury is caused by a combined abduction external rotation from an eversion force. Also known as Pott's fracture or Pott's syndrome I. Also characterized by a disruption of the tibiofibular ligament - Mechanism: occurs most often from sports tackling injuries; recieving a blow to the outside of the ankle causing it to roll inwards (sole of foot faces laterally). This damages the ligaments on the inside of the ankle and fractures the fibula at the point of contact. - Area of fracture: swelling, bruising, pain around the ankle; possible obvious deformity - Imaging creativity: depending on severity of fracture, may need to do x-table lateral and done in stretcher. If not too severe then an AP, oblique, and lateral view will diagnose this fracture - Treatment: displaced fractures will require surgical fixation. Post-operatively, protective boot, brace, or a plaster cast, and/or crutches are used for a number of weeks. Nondisplaced fractures may just require use of a plaster cast and crutches, then a boot to follow. Prognosis:in most severe cases, patients will make full recovery with appropriate management and can return to activities and sports in a number of weeks to months.

Transcervical

- These are fractures of the proximal femur in the midportion of the femoral neck. These fractures are most common in elderly adults with poor bone density. About 90 percent occur in people over 50. - Mechanism: most often from trauma such as falls or vehicle collisions. Can be caused by low bone mineral density, such as osteopenia or osteoporosis, or by other conditions like cerebral palsy or muscular dystrophy in children - Area of fracture: pain in groin, injured leg may appear shorter than uninjured leg, or the injured leg may be externally rotated with the foot and knee turned outward - Imaging creativity: these patients will be unable to move themselves, so the images may need to be taken in their stretcher. An AP pelvis/hip and lateral will be needed. X-table lateral hip will be needed due to the fracture. AP and lateral femur may also be ordered. - Treatment: depends on the location of the break and the quality of the patient's blood supply due to the fracture causing blood vessels to tear and cut off supply to the femoral head. Will most often include pain meds, emergency surgery which may include internal fixation, partial hip replacement, or total hip replacement. Prognosis:physical therapy will be required after surgery to regain strength and ability to walk, which can take up to 3 months. Complications can include delayed union, nonunion, refracture, osteonecrosis, and avascular necrosis. Mortality rate is 25-30% at one year with the first 6 months post-op having the highest risk.

Thyroid vs parathyroid

- They are both endocrine glands that produce hormones for the body and even though they are located in the same area, they are not related. - The thyroid is a butterfly-shaped gland that lies in front of the trachea, just below the larynx. The thyroid gland uses iodine from food to make two thyroid hormones that regulate the way the body uses energy. About 95 percent of the active thyroid hormone is thyroxine, and most of the remaining 5 percent is triiodothyronine. - The parathyroid glands are four tiny glands located on the posterior side of the thyroid gland. The parathyroid glands produce parathyroid hormone that helps control the amount of calcium in the blood. CT, MRI, PET, and ultrasound can all show the function of the thyroid or parathyroid to detect any nodules or determine functional issues

Monteggia's

- a dislocation of the proximal radioulnar joint along with a forearm fracture, most commonly a fracture of the ulna, as well as a radial head dislocation. These injuries are relatively uncommon, accounting for fewer than 5% of all forearm fractures. - Mechanism: usually occurs from falling onto an outstretched hand with forced pronation. Also caused by direct blows to the forearm. - Area of fracture: severe pain, swelling, bruising, possible obvious deformity - Imaging creativity: x-rays of forearm from elbow to wrist (AP and lateral); patients may be unable to move much so these images will need to be taken in their stretcher and with great care. X-table images may be needed. - Treatment: dependent on fracture severity; nonoperative treatments include closed reduction. Operative treatments include ORIF of ulnar fracture and indirect reduction of radial head dislocation - Prognosis: recovery is around 6-12 weeks. In children, a mild hyper-extension deformity may be present after healing

Rolando

- a three-part or comminuted intra-articular fracture-dislocation of the base of the thumb (proximal first metacarpal). It can be thought of as a comminuted Bennett fracture and the fracture is typically T or Y shaped - Mechanism: usually caused by an axial blow to a partially flexed metacarpal like in a fist fight or boxing - Area of fracture: pain, swelling, bruising, limited or no mobility of thumb, possible deformity - Imaging creativity: x-rays of a thumb needed to diagnose. Usually consists of true AP, lateral and oblique projections - Treatment: either closed or open reduction; most commonly ORIF due to the complexity of this fracture. Percutaneous k-wire fixation is also commonly done. - Prognosis: recovery after surgery is about 4-6 weeks in a cast then physical therapy to help regain mobility and function. Some people may develop osteoarthritis or stiffness as a long term issue.

Bennett's

- the most common fracture involving the base of the thumb. Refers to an intraarticular fracture that separates the palmar ulnar aspect of the first metacarpal base from the remaining first metacarpal. - Mechanism: most often happens from a direct hit to a bent thumb. Examples include boxing, martial arts, fist fights, or contact sports - Area of fracture: misalignment, pain, bruising, and swelling localized to the base of the thumb and/or back of the hand - Imaging creativity: diagnosed with a simple AP, oblique, and lateral x-ray of the hand - Treatment: if displaced, surgery needed for reduction of the fracture; closed reductions are done without surgery where the doctor moves the bones into place from outside the skin; open reductions are done with surgery where the surgeon will make an incision to move the bones back into place and will place pins to hold the bones. Pain medicine will be given as needed. After the reduction, a cast of some sort will be given and the patient will be told to apply ice and perform stretching/strengthening exercises. - Prognosis: outlook varies on severity of fracture but most patients have a good recovery if they keep up with exercises, ice, elevation, etc. possible complications could be continued pain, weakness, stiffness, or arthritis.

Pseudocysts

1. "Pseudo" means false. A pseudocyst appears like a true cyst but is made from different kinds of tissue than that of a true cyst. A true cyst is more likely to be cancerous. A pancreatic pseudocyst is a collection of tissue and fluids that form on the pancreas. A pseudocyst is often non-life threatening unless the cyst itself has ruptured. a. Symptoms: Pancreatitis, nausea, vomiting, pain in the upper abdomen, difficulty eating and digesting food. A ruptured cyst may present vomiting blood, fainting, weak and rapid heartbeat, severe abdominal pain, and decreased consciousness. b. Causes: Pancreatic pseudocysts most often occur after pancreatitis (inflammation of the pancreas). The pseudocyst forms when the ducts within the pancreas become blocked. Pseudocysts usually form as the result of a had blow to the abdomen as well. c. Treatment: Pseudocysts often heal on their own, however, they are regularly monitored for growth or shrinking of the cyst. If the pseudocyst compresses other organs a doctor may provide surgery in which to drain the cyst by way of creating a small incision while the patient is under general anesthesia. If there is concern for the cyst being cancerous then the doctor will remove the cyst. d. Prognosis: Those affected by pseudocysts typically live a normal lifespan. However, if the pseudocyst becomes cancerous complications will arise which will reduce lifespan and normal activities of daily living.

Lis franc

1. : a tarsometatarsal fracture dislocation characterized by traumatic disruption between the articulation of the medial cuneiform and the base of the second metatarsal. Caused by motor vehicle accidents, falls from heights, athletic injuries, and force on the hyper-plantarflexed forefoot. Treatment is an open reduction internal fixation surgery to attach the medial cuneiform and the base of the second metatarsal during which the top of the foot is opened and screws are placed to bring the tarsal and metatarsal back together, or arthrodesis to fuse the medial cuneiform to the base of the second metatarsal. AP x-rays of the foot will be done to see placement of screws or the fusion site.

Exostosis

1. A benign growth of new bone on top of existing bone. It can occur in many parts of the body. A common type of exostosis includes bone spurs, which are bony growths also known as "osteophytes." Exostosis can be painless or can cause severe pain. There are many types of exostoses and can occur in the ear canal, ankle, jaw, sinuses, and long bones of the leg. a. Symptoms: Many of those with exostosis do not experience symptoms. The bone growths themselves do not cause pain but can put pressure on nearby nerves limiting movement or cause friction by rubbing against other bones or tissues. Those who do have symptoms exhibit pain, stiffness, limited movement, bumps (in the hands and feet), swelling, weakness, numbness, one extremity may be longer than the other. b. Causes: There are many factors that can cause exostosis including genetic mutations, heredity, injuries, trauma, disc and joint degeneration, aging, nutrition arthritis, osteoarthritis, poor posture, and spinal stenosis. c. Treatment: Apply ice and take nonsteroidal anti-inflammatory drugs, use of shoe inserts for bone spurs in the feet, weight loss to put less stress on the joints, and rest. One may be prescribed physical therapy, prescription pain and anti-inflammatory medication, cortisone injections, and surgical removal. d. Prognosis: Those with exostosis will have a normal lifespan and typically do not have a severe change in their activities of daily living.

Intracapsular Fracture

1. A bone fracture located within the joint capsule such as the hip joint. a. Mechanism of injury: Fall from high heights due to age and/or high energy trauma such as a motor vehicle accident. b. Appearance of injury: Bruised and swollen. c. Special imaging considerations: Patient mobility and range of motion to the affected hip will be severely diminished and may require immobilization of the part of interest for routine projections. A cross-table hip lateral must be obtained. The patient must not be inclined over 90-degrees while in the bed or stretcher. d. Treatment: Internal fixation and open reduction (insertion of metal plates, screws, and pins). Arthroplasty is another treatment option in which the entire joint will be replaced with a prosthesis. The patient will be prescribed pain and anti-inflammatory medication. It is common for physical therapy and occupational therapy to be prescribed. e. Prognosis: It may take up to an entire year for a full recovery.

Bullae

1. A bulla is a fluid-filled sac or lesions that appears when fluid is trapped under a thin layer of one's skin. It is a type of blister. Bullae is the plural word for bulla. The blister must be larger than 0.5 centimeters in diameter for it to be classified as a bulla. Pulmonary bullae are a common cause of pneumothorax. a. Symptoms: The affected skin will be slightly raised and is typically filled with clear fluid. If a bulla is infected the liquid will be milky or cloudy in appearance. If the bulla is a result of trauma the blister may contain blood. b. Causes: Bullae are common and can be caused by various medical and environmental factors. The most common cause is due to friction, or persistent rubbing of the skin on another surface. Contact dermatitis or inflammation of the skin due to an allergic reaction also causes bullae to appear. Viruses such as chickenpox and shingles may also cause bullae to appear. Other causes include various skin disorders (e.g., impetigo), thermal or chemical burns, frostbite, trauma to one's skin, and allergic reaction to medication and other outside stimulus. c. Treatment: Usually, the individual will need to keep the bullae cleaned and protected by use of gauze. If the bullae become infected a medical doctor may drain the bullae using a sterile instrument before applying a dry bandage to the area. Alternative treatments such as over the counter pain medication may be ingested and a compression wrap applied to the area to reduce further friction. d. Prognosis: Bullae typically heal on their own and disappear within a week.

Adhesive Capsulitis

1. A condition characterized by stiffness and pain in the shoulder joint. Also known as "frozen shoulder." a. Symptoms: Occur slowly and in three distinct stages, each of which may last several months. (1) The freezing stage: Any movement of the shoulder causes pain and range of motion becomes limited. (2) The frozen stage: Pain may begin to subside; however, the shoulder becomes stiffer, and use of the shoulder is more difficult. (3) Thawing stage: Range of motion in the shoulder begins to improve. b. Causes: The bones, ligaments, and tendons within the shoulder joint are encased in a capsule of connective tissue. Frozen shoulder occurs when the capsule thickens and tightens around the shoulder joint, making movement restrictive. The exact cause is unknown currently; however, risk factors do exist. Risk factors include individuals over the age of forty. Women are more likely to develop frozen shoulder. Immobility or reduced mobility due to rotator cuff injury, broken arm, stroke, or recovery may increase the chance of developing frozen shoulder. Those with diabetes, hyperthyroidism, hypothyroidism, cardiovascular disease, tuberculosis, and Parkinson's disease have a higher chance to develop frozen shoulder. c. Treatment: Over the counter and prescribed pain relievers and anti-inflammatory drugs. Physical therapy, such as range-of-motion exercises. If frozen shoulder does not get better within 12 to 18 months one may receive steroid injections (corticosteroids). Joint distention, injection of sterile water into the joint capsule to stretch the tissue to increase mobility. Shoulder manipulation, in which the patient is under anesthesia while a doctor performs different maneuvers of the shoulder to help loosen the tightened tissue. Surgery to remove scare tissue and adhesions from inside of the shoulder joint, although surgery is rare for this condition. d. Prognosis: Adhesive capsulitis can last 12 to 18 months, with 3 distinct phases. The first phase can last 2-9 months, the second phase 4-12 months and the last phase, the thawing phase, from 6-9 months.

Complicated Fracture

1. A fracture of bone associated with significant injury to other structures such as arteries, nerves, or muscles. a. Mechanism of injury: High energy impacts such as car accidents. b. Appearance of injury: Bruising, swelling, bleeding and blood if the fracture is open. c. Special imaging considerations: Patient mobility and range of motion to the affected part will be severely diminished and may require immobilization of the part of interest for routine projections. Cross-table lateral projections must be rendered. d. Treatment: Immobilization of the affected body part by way of a cast or splint. Surgical insertion of metal rods, plates, screws, and pins. Pain and anti-inflammatory medications may be prescribed. Physical and occupational therapy may be prescribed. e. Prognosis: It may take up to as long as a year for a full recovery.

Trimalleolar Fracture

1. A fracture of the ankle in which the medial, lateral, and posterior malleoli are affected. a. Mechanism of injury: Results from injuries such as a fall, motor vehicle accident, or sports injury in which the ankle has been twisted or rotated. b. Appearance of injury: Bruising, deformity, and swelling of the affected ankle. c. Special imaging considerations: The patient will not be able to bear weight on the affected ankle. Due to trauma to the ankle, cross-table laterals will need to be obtained. d. Treatment: Nonsurgical treatment includes anti-inflammatory and pain medication. An ice pack to reduce swelling to the ankle and rest. Surgical procedure to stabilize the ankle and improve the healing time include options such as realigning the bones, inserting pins or screws, inserting a plate and screws, and/or wiring the bones together. A bone graft may be utilized to reduce the chance of developing arthritis. Post the patient will be put in a cast, splint, or brace. e. Prognosis: It takes about 6 weeks for a bone to heal after a fracture. Post surger the doctor will remove the cast at 6 weeks. 3 to 4 months the patient may return to normal activities of daily living. At 4-6 months the patient may return to sporting activities. It is uncommon for the fracture(s) to take up to as long as 2 years to reach a full recovery.

Smith's Fracture

1. A fracture of the distal radius. Also known as a "Goyrand" or "Reverse Colles fracture. A Smith's Fracture is associated with palmar angulation of the distal fragment, which means the fractured piece of bone is displaced toward the direction of the palm. Typically, the fracture does not extend into the wrist joint. The fracture is usually transverse in nature, meaning the fracture occurs at a right angle to the bone. a. Mechanism of injury: Falling on the wrists while the wrists are flexed or a direct blow to the back of the wrist. b. Appearance of injury: Bruising and swelling to the wrist. The wrist may hang in an odd or bent matter. c. Special imaging considerations: Patient mobility and range of motion to the affected wrist will be severely diminished and may require immobilization of the part of interest for routine projections. d. Treatment: Surgery for the broken bone is called a reduction. Without surgery it is called closed reduction. Closed reduction is preferred and if possible, the doctor will place the affected extremity in a cast or splint. Depending on the severity of the fracture, closed reduction may not be possible and will need to be surgically repaired through an incision and insertion of metal pins, plates, and screws before being put in a cast. Physical therapy, occupational therapy, anti-inflammatory, and pain reliever may be prescribed. e. Prognosis: Recovery takes about a year. Pain and stiffness may persist two years after the injury.

Blowout Fracture

1. A fracture of the floor or inner wall of the orbit or eye socket. a. Mechanism of injury: A direct blow or impact to the orbit by an object that is too large to enter the orbital cavity, such as a fist or a baseball. The force of the impact travels through the bone and is transferred to one or more of the walls of the obrit. b. Appearance of injury: Black and blue bruising around the eye(s). swelling of the forehead, cheek, and skin under the eye. Blood in the white part of the eye. Flattened cheek. Bulging or sunken eyeballs. c. Special imaging considerations: Patients with injury to the eye must not be radiographed in the prone position due to the increased pressure on the eye the prone position would cause. d. Treatment: Most orbital fractures do not need to be treated surgically. If the fracture is small usually an ice pack will reduce swelling. Anti-inflammatory and pain medications may be taken as well as decongestants. When the fracture has caused the eye from moving properly or has caused double vision, surgery will be prescribed by the ophthalmologist and performed by an oculoplastic surgeon for repair. e. Prognosis: Three to four weeks post injury the formation of new mature bone starts. This formation can take several years depending on the size and site of fracture. If there is no complication resulting post-surgery or treatment the patient will experience normal activities of daily living.

Epicondylar Fracture

1. A fracture to the epicondyle(s) of the long bones. a. Mechanism of injury: A direct blow or caused by pure avulsion. Pure avulsion occurs when a muscle or ligament has pulled the bone fragment away from the bone. b. Appearance of injury: Bruised and swollen. The extremity may be dislocated. c. Special imaging considerations: Patient mobility and range of motion to the affected humerus and/or elbow will be severely diminished and may require immobilization of the part of interest for routine projections. Cross-table lateral projections must be obtained. d. Treatment: Traditionally the epicondylar fracture is treated by means of closed reduction. Meaning the affected part will be placed in a cast and removed after 6 weeks without surgical intervention. Surgery or reduction will occur when the displaced bone fragment is incarcerated within a joint space. The doctor will make a small incision and insert metal plates, pins, and screws before casting. Anti-inflammatory drugs and pain reliever are often prescribed. e. Prognosis: It may take up to as long as a year for a full recovery.

Hip

1. A hip fracture is a break in the upper portion of the femur (thighbone).Causes: Most hip fractures occur in elderly patients whose bones have become weakened by osteoporosis. When a hip fracture occurs in a younger patient, it is typically the result of a high-energy event, such as a fall from a ladder or vehicle collision.Treatment: Surgery depends on where, how severe and if its displaced. The patient may get screws to hold the bone together while it heals. The patient may also need total hip replacement where the femur and socket is replaced with artificial parts. The patient may have a partial hip replacement where the surgeon might remove the head and neck and install a metal replacement.

Osteogenesis Imperfecta (OI)

1. A rare bone disease that affects the unborn child, children, and adults in which they will have fragile bones that break easily, often without cause. Also known as "brittle bone disease." There are 19 different types of osteogenesis imperfecta. The first four types are the most common and include: Type I, the most common and mildest form of bone fracture(s) and muscle weakness but no bone deformity exists. Type II, infants born with this type cannot breathe and die very young. Multiple broken bones occur before the baby is born. Type III, the baby will have multiple broken bones at birth which often lead to severe physical disability. Type IV, the bones break easily and usually affects a child before puberty. Type IV patients may have mild to moderate bone deformity. a. Symptoms: Most individuals with this pathology will experience many a broken bone over the course of their lifetime. Those who have a more severe form may have hundreds of broken bones even before birth. Other symptoms include bone deformity, pain, bruising, difficulty breathing, hearing loss, loose joints or muscle weakness, curved spine, small stature, triangular face shape, weak and brittle discolored teeth, and blue sclerae (bluish color of the whites of the eyes). b. Causes: Osteogenesis imperfecta occurs because of a gene mutation (change). This mutation may be sporadic, or a baby may inherit the gene from one or both parents. Babies born with this pathology have a problem with making connective tissue due to a lack of type I collagen. Collagen is mostly found in bones, ligaments, and teeth. Collagen helps keep bones strong. As a result of the gene mutation, the body may not make enough collagen, and bones may weaken. c. Treatment: The goal of treatment is to increase bone strength and help those affected live more independently. Occupational therapy, for fine motor skill improvement. Physical therapy to increase strength, range of motion, and flexibility. Assistive devices such as canes or walkers can improve mobility. Oral and dental care. Pain medication and medication to slow bone loss may be prescribed by their doctor. For treatment of broken bones an orthopedic specialist will stabilize the broken bone using braces, splints, or casts. Surgery is common to correct curved or misshapen bones. Rodding surgery is a common treatment for children with OI. d. Prognosis: Life expectancy for those affected by OI vary greatly depending on what type they are classified. Type I generally have a typical lifespan. Babies with Type II typically die soon after birth. Children with Type III often live until the age of 10. Those with Type IV live into adulthood but may have a shortened lifespan.

Barium Embolism

1. A very rare occurrence in which barium sulfate, a contrast medium, enters the into the blood stream and creates an obstruction within the blood vessel. Also known as "barium intravasation." Intravasation is the occurrence of a cell or foreign substance moving through the wall of a blood or lymph vessel. a. Symptoms: Sudden deterioration of patient condition during or within minutes after start of a contrast study. Other symptoms include fainting, abdominal and/or chest pain. Hypovolemic shock, cardiac arrest, and death. If the barium embolism has entered the pulmonary circulation the patient will exhibit shortness of breath, chest pain, cough, tachycardia, dizziness, excessive sweating, fever, clammy and/or discolored skin (cyanosis). b. Causes: Barium embolism occurs when barium sulfate enters the bloodstream while the barium is administered during a contrast study, such as a barium enema. The contrast may have entered the bloodstream by way of perforation or fistula of the large intestine. c. Treatment: Immediate cessation of the contrast study. The patient is placed in an upright position to reduce the potential for the barium embolism to enter pulmonary circulation. Intensive monitoring and an increase in fluid intake. Surgery may be required to remove the embolus. Prognosis: Those who receive treatment immediately live a normal lifespan. However, if the barium embolism has entered pulmonary circulation and treatment is delayed there is an increased chance of death.

Histoplasmosis

1. An infection caused by a fungus called histoplasma. · Symptoms: usually none but if so it would be Fever, cough, fatigue, chills, headache, chest pains, body aches. · Reason of development: Caused by breathing in the microscopic fungal spores in the air, this fungus comes from bird or bat droppings. · Treatment: For some people it will go away on its own but for people with weak immune systems they may need an antifungal medication. · Prognosis: should go away between 2 weeks and several months, most people recover fully.

Encephalitis

1. Inflammation of the brain. There are two main types of encephalitis: primary and secondary encephalitis. Primary encephalitis occurs when a virus or other agent infects the brain. The infection may be concentrated or widespread. Secondary encephalitis results from a faulty immune system reaction to an infection elsewhere in the body. The immune system mistakenly attacks the healthy cells of the brain. Secondary encephalitis is also known as "post-infection encephalitis" and often occurs 2 to 3 weeks after the initial infection. a. Symptoms: Most people with viral encephalitis have mild flu-like symptoms such as headache, stiff neck, fever, aches in muscles or joints, and fatigue or weakness. More severe symptoms include confusion, agitation or hallucinations, seizures, loss of sensation or ability to move certain areas of the face or body, muscle weakness, problems with speech or hearing, and loss of consciousness. Infants and young children often have bulging of the fontanel's of their skull, nausea and vomiting, body stiffness, poor feeding, and irritability. b. Causes: There are several causes including viral infection, autoimmune inflammation, bacterial infection, insect bites, and more. Sometimes there is no known cause. c. Treatment: Bed rest, increased fluid intake, and anti-inflammatory drugs for those with a mild form. Antiviral drugs may be prescribed for those with viral encephalitis. Those with autoimmune encephalitis are prescribed with immunosuppressant drugs such as steroids. Follow-up therapy may be needed such as physical therapy, occupational therapy, speech therapy, and psychotherapy. d. Prognosis: Those with a mild form of encephalitis usually make a full recovery but this process is slow and 10% of these cases resulted in death. Survivors of severe cases of encephalitis can be left with permanent problems such as fatigue, irritability, impaired concentration, seizures, hearing loss, memory loss and blindness. The recovery process may take months to even years.

Occult Fracture

1. Occult means hidden. An occult fracture is one that does not appear well on an X-ray. A possible occult fracture is a suspected fracture that needs to be confirmed with other imaging examinations such as CT, MRI, or nuclear medicine studies. a. Mechanism of injury: Fall or other type of impact injury. b. Appearance of injury: Bruising and swelling around the site of injury. c. Special imaging considerations: There may be clinical signs of a fracture without one being seen on the radiograph. The patient may need assistance in positioning their affected anatomy for the radiological examination. The patient may return in a cast for radiological examination 10-14 days after examination. d. Treatment: The patient may need to be put into a cast to heal naturally, called closed reduction. If surgery is required, the bone(s) will be reduced through an incision. Metal plates, screws, and pins will be inserted before being put into a cast, splint, or brace. After six to eight weeks the cast will be removed. e. Prognosis: Full recovery can take up to a year depending on the site of injury.

Mediastinoscopy

1. a procedure that uses a mediastinoscope to examine the area between the lungs (mediastinum) a. Symptoms/reasons to have a mediastinoscopy procedure: i. Cancer in lungs to remove lymph nodes ii. Cancer in other structures of the mediastinum iii. Infection iv. Tumor of the thymus b. Risks of having this procedure: i. Bleeding, infection, paralysis of laryngeal nerve, pneumothorax, hole in esophagus, trachea, or heart blood vessels c. After procedure: will be held in recovery room, chest x-ray will be taken to look for a possible pneumothorax, once home pain medication can be taken according to physician, and resume normal but not strenuous activities until a few days after procedure and according to physician instructions

Jefferson/Burst Fracture

1. a bone fracture of the front and back arches of the C1 vertebra (atlas) Cause: caused by an axial load on the back of the head or hyperextension of the neck, causing a posterior break, and may be accompanied by a break in other parts of the cervical spine. (Diving into shallow water, children falling at the playground off of the playground Treatment is typically an emergency surgery that includes the reduction of the dislocated hip under anesthesia. In most cases, it also includes the fixation or removal of the fractured fragment of the femoral head. As a rule, the earlier the reduction, the better the outcome. equipment, impact against the roof of a vehicles and falls) Treatment: if the transverse ligament is a thick band that helps stabilize the C1 in the neck. Surgery: may be necessary if the ligament is badly torn. Patient may also be put into traction called a halo to keep the head from moving. C1 breaks generally need surgery though, which would be the fusion or fixation of C1, C2 and C3. Vertebral fusion is the adjoining adjacent vertebrae through bone tissue while vertebral fixation is when two or more vertebrae are joined through a specific immobilization device. Recovery: if surgery is needed, recovery will likely take about 12 weeks. This is regardless of the type of surgery. If the fracture is minor for you, you may be able to get by wearing a neck brace for 6 to 8 weeks. Halo ring/traction (external fixator) Halo rings are predominately used for injuries to the upper part of the spine (neck). Halo rings provide rigid immobilization of the neck and head and can be used as a stand-alone treatment or following surgery. They are used with traction or fitted to a vest.

Multiple Myeloma

1. a cancer that forms in the white blood cell called a plasma cell. · Symptoms: bone pain, nausea, constipation, loss of appetite, mental fog, fatigue, frequent infections, weight loss, numbness in legs, excessive thirst. · Reason of development: it's not clear what causes it but, it is caused by abnormal plasma cell in your bones that multiply rapidly. Cancer can be caused by mutations in DNA. · Treatment: There are different treatments available for the patient's condition, some include - target therapy, which targets weaknesses in the cancer cells and kills them. - immunotherapy, which uses your immune system to fight the cancer cells. - induction therapy, which reduces the number of plasma cells in the bone marrow. - consolidation therapy, short course of chemo to help keep multiple myeloma in remission. - maintenance therapy, which is treatment given to patients after high-dose chemotherapy with autologous stem cell transplant. - medications such as chemo, steroids, bone modifying drugs. · Prognosis: there overall 5-year survival rate is 55%.

Ping-pong

1. a depression skull fracture usually in newborns and infants because of the resilient nature of their bones; no fracture line is usually visible a. Mechanism of injury: birth related trauma, falls, or direct blunt trauma to the skull (such as the head hitting a wall or an object forcefully hitting the skull) b. How area will look: the skull will look indented at the site of injury similar to an indention made with the finger on a ping pong ball; no visible fracture will be seen on a radiograph; instead there will be an indention in the skull seen c. Imaging creativity needed? Since these fractures happen to very young newborns and infants, a tech and/or parent may need to be shielded and help hold the child still; depending on the views and projections needed, the tube may need to be angled and adjusted to match the anatomy of interest d. Method used to repair injury: can spontaneously repair within 6 months on its own; negative pressure and vacuum assisted elevation to reset the depression fracture in the skull; sometimes surgical elevation of the fracture and dura and cranioplasty (surgical repair to reshape the deformed skull) may be necessary if the vacuum or negative pressure methods do not work e. Prognosis: once the fracture is healed, there usually are no future issues with the fractured area; the fracture typically takes 6 months to fully heal

Direct

1. a direct fracture is a fracture of the bone that is caused from a direct attack, or trauma to that area. Signs include loss of the power of movement, pain with tenderness at the site of fracture, swelling and bruising, and crepitus or grating heard when the ends of the bone rub together.Causes: A Direct hit to the bone causing a fracture at the site of the trauma.Treatment: immediate splinting, casting, and possible surgery if necessary and the surgery would depend on where the fracture is located.

Boxer's Fracture

1. a fracture of the neck of the fifth metacarpal (a bone in the "pinky finger") It is referred to as a boxer's fracture because, most commonly, it occurs when people punch something.Cause: The most common cause of a boxer's fracture is the force applied to the fifth metacarpal bone when the fist punches something while the hand is in a clenched position. Less commonly, this fracture may also occur from getting the hand crushed.Treatment: splints and casting; surgery for severe cases Surgery: surgical repair of a boxer's fracture is usually done through an open reduction internal fixation. In this type of procedure, an incision is made in the skin overlay in the fracture, and rods, pins, or screws are implanted in the bones to keep them in place. The wound is closed, and a splint is placed. Recovery: this fracture in the hands often caused by hitting something with a closed fist, that's where the name boxer's fracture comes from. It is commonly seen in teenagers. The pressure will typically heal within 3 to 4 weeks from the date of injury

Sarcoidosis

1. a multisystem disorder of unknown etiology characterized by the formation of inflammatory non-caseating granulomas within affected tissues. This most commonly affects the lungs and lymph nodes. 90% of patients with this also have pulmonary involvement. Chest x-rays are used to "stage" sarcoidosis. Sarcoidosis occurs in 3 phases; first is inflammation, second is when granulomas form and the third is fibrosis of tissues and organs. If the scarring is extensive it can lead to deathTreatment involves use of corticosteroids to help reduce inflammation of the affected tissues and reduce granuloma development and prevent lung fibrosis.

Ascariasis

1. a parasite that lives in the intestines. Worms · Symptoms: usually none but if any, abdominal pain, intestinal blockage, impaired growth, and cough if the worms migrate in the body. · Reason of development: caused by ingesting worms · Treatment: anthelmintic medications to remove the worms. Anthelmintic medications are antiparasitic drugs used to expel parasitic worms from the body by either killing or stunning them without hurting the host. · Prognosis: This parasite doesn't usually cause complications

Pneumomediastinum

1. air in the mediastinum (space between the lungs and the heart) a. Symptoms: chest pain, difficulty breathing, throat pain, difficulty swallowing, change in voice b. Develop due to another cause? (environmental or condition) i. Blunt force trauma ii. Substance abuse iii. Excessive vomiting, surgery, excess coughing, using a ventilator, tearing of the windpipe or esophagus, COPD or chronic obstructive pulmonary disease, giving birth, strenuous weight lifting, asthma, lung cancer, SARS (Severe Acute Respiratory Syndrome), complications from a thoracotomy, complications from an endoscopy c. Treatment: typically will heal on its own in 1-2 days; bed rest for at least two days (possibly staying in the hospital for closer observation); may be put on oxygen to aid in healing; pain management with analgesic drugs d. Prognosis: will heal in 1 to 2 days; may take up to two weeks to heal and can lead to a collapsed lung or respiratory distress (although this is rare)

Wagstaffe's Fracture

1. an avulsion fracture of the medial aspect of the distal Fibula due to avulsion of the Anterior Tibiofibular Ligament (ATFL) attachment, also causing the Tibia and Fibula to separate. It affects the distal tibiofibular joint, the Fibula, and the Tibia. Cause: are falls, sports injuries, and traffic accidents. If the ATFL is torn, it causes the fibula to separate from the tibia. Most commonly due to the foot being supine and then externally rotated. Treatment- Surgery; specifically Open reduction internal fixation (ORIF) is usually the only option to restore the distal tibiofibular joint with the use of a screw and/or thread. Surgery: surgery may be recommended, but treatment usually starts with a splint or cast. If possible, your Health care provider can realign your broken bones without surgery. Recovery: this type of fracture usually takes about 3 to 12 weeks to heal completely.

Aneurysms and types of: abdominal aortic, thoracic aortic, and cerebral

1. an excessive localized enlargement of an artery caused by a weakening of the artery wall. Aneurysms of the aorta carry a higher risk of thrombi, which can turn into emboli. The bulge of the aneurysm can take on two distinct shapes: fusiform - the aneurysms bulges on all sides of the artery, secular - the aneurysm bulges on only one side, mycotic - this time is exclusive to cerebral aneurysms and it is caused by an infection. Symptoms: Aneurysms often have no symptoms until they rupture. Treatment: Surgical clipping is a procedure to close off an aneurysm. Prognosis: Ruptured brain aneurysms are fatal in about 50% of cases. Of those who survive, about 66% suffer some permanent neurological deficit. Approximately 15% of people with a ruptured aneurysm die before reaching the hospital. Most of the deaths are due to rapid and massive brain injury from the initial bleeding.

Grave's Disease

1. an immune system disorder resulting in the overproduction of thyroid hormones. Hyperthyroidism. · Symptoms: weight loss, rapid or irregular heartbeat, nervousness, irritability, trouble sleeping, fatigue, shaky hands, muscle weakness, frequent bowel movements, enlarged thyroid called a goiter. Can also cause your skin to become reddish, thick, and rough. Can also cause eye problems such as bulging eyes. · Reason of development: a malfunction in the body's immune system, possible caused by genetics. · Treatment: radioiodine therapy · Prognosis: It's a lifelong condition but you can take medications to help lessen symptoms.

Avulsion

1. an injury to the bone in a location where a tendon or ligament attaches to the bone. When an avulsion fracture occurs, the tendon or ligament pulls off a piece of the bone. Avulsion fractures can occur anywhere in the body, but they are more common in the ankle, hip, finger, and foot. They are more common in children than adults, but often affect adults who play sports. It can be caused by direct force such as a hard tackle in football, or indirect force such as an aggressive pivot in soccer or basketball. Treatment of an avulsion fracture typically includes resting and icing the affected area, 3-4 months in a knee-high boot to allow tendons to repair, followed by controlled exercises that help restore range of motion, improve muscle strength, and promote bone healing. Most avulsion fractures heal very well without surgical intervention.

Clay Shoveler's

1. avulsion type spinous process fracture in the lower cervical or upper thoracic spine a. Mechanism of injury: lifting weights rapidly with arms extended such as shoveling snow, using a pickax, and pulling out roots; the force of the trapezius and rhomboid muscles pulling on the spine at the base of the neck breaks the spinous process; also from those who would shovel red clay and throw the shovel and clay over the shoulder. The handle of the shovel would hit the spinous process causing it to fracture. b. How area will look: area may appear slightly swollen; best seen on a lateral x-ray; will see a spinous process of a lower cervical or upper thoracic vertebra broken; on the AP image it will look like there is another spinous process between the vertebra of interest and the inferior vertebra c. Imaging creativity needed? If the patient is in a C-collar and on spinal precautions, it will be treated like a Trauma C-spine (shooting the lateral cross-table and the AP's with the IR underneath the backboard; cannot move the head or neck so it may be necessary to match the tube to the MML line on the tip shot (if needed) d. Method used to repair injury: restricted physical activity (rest) and wearing a soft c-collar for 4-6 weeks (this is a stable fracture and typically will heal on its own) i. If pain persist, surgery may be necessary to excise or remove the bony fragment e. Prognosis: return to normal activities three to four months after injury

Osteosarcoma

1. cancer that begins in the cells that develop and form the bones a. Symptoms: bone pain, a warm mass or lump near area affected, swelling and redness at site, pain when lifting affected limb, limited movement, unexplained fever, broken bone b. Develop due to another cause? (environmental or condition) i. Rapid bone growth (growth spurts as a child) ii. Exposure to radiation iii. Genetic factors iv. Bone infarction c. Treatment: i. surgery- entire limb amputation or "limb salvage" surgery by removing the tumor and tissues around the tumor ii. chemotherapy- before and after surgery iii. radiation therapy iv. cryosurgery- an extremely cold liquid or instrument (cryoprobe) used to freeze and destroy abnormal tissue d. Prognosis: localized- 70 to 75% survival rate; spread around the body- 30% survival rate

Bipartite Patella

1. congenital anomaly that occurs when the patella forms from two bones and the bones fail to fuse during childhood, leaving them with 2 separate bones. · Symptoms: pain over the supralateral patella, pain with deep squats, percussing of the patella over the bipartite portion can reproduce a patient's symptoms. · Reason of development: The reason is not completely known but research suggests it could be a multifactorial genetic issue. · Treatment: avoiding activities that cause irritation, such as squatting, lunges, and contact activities. Surgery of an arthroscopic excision of the bipartite patella may be done if symptoms are bad. · Prognosis: the prognosis after having the surgery is good and the patient can start early range of motion, weightbearing, and slow progression of activities.

Fissured Fracture

1. crack the extends from the surface but not through a long bone. it is considered a closed fracture occurs in the femur, tibia/fibula, forearm. Causes: a break in continuity of bone; may be caused by trauma, twisting due to muscle spasm or indirect loss of leverage, or by disease that results in osteopenia. Treatment: crutches to keep weight off if injured foot or leg, or casting Surgery: surgical treatment should be undertaken in those patients who complain of acute pain at the site of a fissure fracture and who risk completing the fracture. Fissured fractures involving the femoral neck should be fixed even win hey symptomatic because of the risk of nonunion if they become complete. Treatment is typically an emergency surgery that includes the reduction of the dislocated hip under anesthesia. In most cases, it also includes the fixation or removal of the fractured fragment of the femoral head. As a rule, the earlier the reduction, the better the outcome. Recovery: most fissure fractures take around a year or longer to heal properly.

Compression Fracture

1. fracture that occurs due to a bone being crushed; most commonly the vertebrae of the thoracic and lumbar spine, and it can affect more than one vertebra. On X-ray, the bone will appear crushed. Symptoms: include severe acute back pain that is alleviated by lying on your back and worsened with standing, sensitivity to touch, issues with the nerve that comes from the vertebra (e.g., pain in the hands or legs, difficulty walking, issues with bowel and bladder control) though this is more uncommon, pain when twisting or bending, loss of height, limited movement, and kyphosis. Postmenopausal women are the most susceptible to a compression fracture, but older men are also vulnerable. X-ray, CT, and MRI can help with diagnosis. Cause: Osteoporosis is the most common cause, traumatic spinal injuries (e.g., car accidents, sports injuries) and cancer are also potential causes. If it is caused by a cancerous tumor, the vertebra can be the original site of oncogenesis, but more commonly it is due to metastasis. Treatment: Osteoporosis treatment, Calcium and Vitamin D supplements, pain medicine, total bed rest for a period time followed by limited activity, back braces, physical therapy are the first initial treatments; effect for mild fractures. Surgery: In more severe cases, surgery is the only option, which includes Vertebroplasty and Kyphoplasty if osteoporosis is the cause. Vertebroplasty involves the doctor injecting cement into the fracture, which supports and strengthens the vertebra, and provides pain relief. Kyphoplasty is similar, but before injecting cement, small balloons make the vertebra taller. They are then removed, and the cement is placed in. If a traumatic injury is the cause, the patient may need Fusion surgery, where the bone is repaired, and vertebrae are joined together. Spinal fusion is surgery to permanently connect two or more vertebrae in your spine, eliminating motion between them. Spinal fusion involves techniques designed to mimic the normal healing process of broken bones. During spinal fusion, your surgeon places bone, or a bonelike material within the space between two spinal vertebrae. Metal plates, screws and rods may be used to hold the vertebrae together, so they can heal into one solid unit. Recovery: compression fractures usually heal on their own in about three months. If that happens, your doctor may suggest you try some things at home that can make you feel better, such as pain medicine, rest, physical therapy, or a back brace.

LeFort

1. fractures of the midface that involve separation of all or a portion of the midface from the skull base; the pterygoid plates must also be fractured a. Mechanism of injury: high speed deceleration crashes in which the face hits something stationary (such as the dashboard of a car or pavement) is the most common; also getting hit in the face with a baseball bat or a tire iron b. How area will look: the face may appear bruised, swollen, and/or bloody depending on the severity of the injury; may see fracture between the upper teeth and the maxilla, around the connection of the maxilla and nasal bones to the frontal bone, or at the connection of the frontal bone to the rest of the facial bones; sometimes a severe le fort fracture can cause a traumatic brain injury c. Imaging creativity needed? This patient would most likely be in a lot of pain and have very limited movement, so imaging may be difficult especially when having to align OML for a AP image of facial bones; may have to adjust the tube according to OML; AP and cross-table lateral images are likely to be done d. Method used to repair injury: prompt stabilization of fracture followed by surgery of internal fixation with plates and screws in place according to fracture location; plates are positioned parallel to the nasomaxillary and zygomaticomaxillary buttresses; neurosurgical intervention to repair any damage to the brain specific to the injury and needs e. Prognosis: plates and screws removed within 6-12 months; very low mortality rates for these fractures however the recovery is very dependent on how severe the fracture is

Glomerulonephritis

1. inflammation and damage to the filtering part of the kidney. · Symptoms: fatigues, high blood pressure, swelling of face, hands, feet, and belly, blood and protein in the urine, decreased urine output. · Reason of development: · Treatment: can't be cured but treatments include blood pressure medicines, corticosteroids, diuretics, diet changes, dialysis, kidney transplant. · Prognosis: generally good, 95% of individuals are asymptomatic after 5 years.

Mallet Finger

1. injury to the tendon that straightens the finger or thumb; aka "drop finger" a. Mechanism of injury: usually occurs in sports such as baseball, basketball, or football when you try to catch a hard ball and it hits the extended finger tip b. How area will look: unable to straighten the finger, the fingertip droops, bruised, redness, and swollen; in an x-ray the phalange of the affected finger will not be straightened, and a small piece of bone may be detached if the affected tendon pulls the attached area of bone away from the phalange c. Imaging creativity needed? The affected finger will not be able to be straightened all the way; if allowable, a small piece of cloth may be used to straighten the finger; if it cannot be straightened, then tell the patient to straighten the rest of the finger as much as possible and take the image as is d. Method used to repair injury: finger will be put in a splint for 6 weeks; should be iced daily; follow up x-rays at the 6 week mark; repair to the tendon may also be needed e. Prognosis: after the 6 weeks in the splint, the finger and tendon should be healed completely and normal activities can resume; if a piece of a bone fractured when the injury occurred, there is a possibility of arthritis of that area in the future

Orbital Blow-Out

1. is a fracture that occurs in the orbit and is usually a result of trauma or direct blow to the back of the head. When doing a CT scan the key sign for this type of fracture is a tear drop look to the orbital floor. Cause: increased pressure in the orbit which causes it to give way at its weakest point which is the orbital floor. Blowout fractures result from trauma to the orbital bone. When an object hits the back of the head with such a great enough force, the bones buckle and break. Any large object with a force of speed can cause a blowout fracture. Immediately after an orbital floor fracture, the affected eye may have impaired motility, resulting in double vision. The eye may be proptotic or enophthalmic, depending on the amount of edema (causing proptosis) and the size of the fracture (larger fractures leading to enophthalmos). Treatment: Apply ice to the eye to decrease swelling, decongestants to aid in the drainage of blood and fluid accumulating in the sinuses, avoidance of nose blowing to prevent pressure from propelling the sinus contents into the orbit, oral steroids in some cases to decrease swelling and scarring, sometimes oral antibiotics. Surgery: If surgery is need then, small, and thin flexible endoscopes are inserted through the nasal sinus and repairs can be made to the orbital bones without leaving any visible external scars. Also, small incisions can be made under the eyelashes or to the inside of the eyelid to gain access to the orbital walls. To repair the orbital wall, either grafting with autologous bone such as iliac bone or implantation of biomaterials such as titanium, mesh nets and porous polyethylene are often used. Recovery: orbital flow strength is regained within 24 days after repair. Doctors will let patients resume normal activities approximately three weeks after uncomplicated orbital floor fracture repair. But for the entire orbital fracture to heal it takes anywhere from 8 to 13 weeks.

Temporal bone fracture

1. is a sequel of a blunt head injury. Can cause potential damage to hearing and facial nerves as well as intracranial injuries. Typically recognized by bleeding from the external auditory canal. Temporal bone fracture cause injury to the middle and inner ear and can possibly rupture the eardrum. Treatment is based on managing the facial nerve injury, hearing loss, vestibular dysfunction and CSF leakage. Treatment of the fracture is only needed if it causes severe problems. Treatment for hearing loss with damage to the ossicles can be repaired surgically. For vertigo, benzodiazepine can be given for relief. A patient with a CSF leak needs to be hospitalized to insert a drain to prevent infection. Facial paralysis can occur as well and can by treated by conservative management such as with a corticosteroid.

Tracheoesophageal fistula

1. is an abnormal opening between the trachea in the esophagus. Symptoms: may include Frothy, white bubbles in the mouth, coughing or choking when feeding, vomiting, blue color the skin also known as cyanosis, especially when the baby is feeding, difficulty breathing, and a very for abdomen. Causes include iatrogenic injury, Blunt chest or neck trauma, prolonged mechanical ventilation via endotracheal or tracheostomy tube, and excessive tube cuff pressure pressure in patients ventilated for lung disease. Treatment: with interventional treatment with bronchoscopy ( allows physicians to look at lung and airway) and endoscopy. The festival is divided, closing the connection between the esophagus and trachea. Prognosis: The survival rate in prognosis in a healthy infant who undergo surgical repair for this disease may be 100%. In groups of infants who have comorbidities or who are not fit enough for early repair, the survival rate is 80 to 95%.

Gas gangrene

1. mostly caused by bacteria called Clostridium Perfringens. Bacteria gather in an injury or surgical wound that has no blood supply. The bacterial infection produces toxins that release gas and cause tissue death. Symptoms: changes in skin color ranging from pale gray to blue, purple, black, bronze or red, swelling, blisters, sudden and severe pain followed by numbness, a foul-smelling discharge leaking from sore, thin shiny skin or skin without hair, skin that feels cool or cold to the touch. Septic shock can occur if the germs that caused the gangrene spread throughout the body. Risk factors include diabetes, blood vessel disease, severe injury or surgery, smoking, obesity, immunosuppression, injections, and complications of COVID-19. Treatments for gas gangrene may include antibiotics, oxygen therapy(hyperbaric chambers), and surgery to restore blood blow and remove dead tissue. Amputation is often times needed. The earlier gangrene is identified and treated, the better the chances for recovery are.

Cleft palate

1. opening in the roof of the mouth that occurs when the roof of the mouth does not fuse during development a. Symptoms: split in the roof of the mouth and/or lip on one or both sides of the mouth, difficulty feeding, difficulty swallowing, food or drink coming out of the nose, nasal speaking voice, chronic ear infections b. Develop due to another cause? (environmental or condition) i. Family history of cleft palate ii. smoking, drinking, or taking certain medications during pregnancy iii. pregnant mother having diabetes or being obese c. Treatment: surgery to repair and close the opening in the cleft lip and palate; therapy to help with proper eating and speech; braces to align the permanent teeth; there are studies and research being done to see if this condition can be fixed in utero in the future, however there is no information on if this is currently being practiced and performed d. Prognosis: long term prognosis is good; minor issues with teeth alignment and speech are usually fixed with treatment, and the condition cannot reoccur in the future once it is fixed

Meckel's Diverticula

1. small out-pouching of the intestinal wall near the ileocecal junction a. Symptoms: GI bleeding (seen in stool), abdominal pain and cramping, tenderness near navel, bowel obstruction, diverticulitis b. Develop due to another cause? (environmental or condition) i. Occurs in fetus before birth in early pregnancy; when the vitelline duct is not fully absorbed into the fetus by the 7th week, this diverticula forms c. Treatment: if there are no issues, then no treatment is usually needed; surgery may be needed if bleeding occurs and continues to remove the diverticulum d. Prognosis: great long-term recovery; full recovery after treatment

Hypoplastic Vertebra

1. small underdeveloped vertebral bodies; also known as a "butterfly vertebra" a. Symptoms: dizziness due to the compression of the vertebra compressing a vertebral artery causing a lack of blood flow to the brain or inner ear, low back pain, neurological impairment b. Develop due to another cause? (environmental or condition) i. Underdevelopment of the vertebral bodies during growth and development c. Treatment: stent placement to treat positional occlusion; surgery on the vertebrae specific to the patient's anatomy and needs d. Prognosis: minimal issues in the future after treatment and monitoring of pain; will live a relatively normal life

Spiral Fracture

1. spiral fracture happens when a long bone is torn in half by a twisting force or impact. Most spiral fractures involve the long bones of the legs, such as the femur, tibia, and fibula. The injury can also involve the long bones of the arms, including the humerus, ulna, and radius. Spiral fractures are usually serious injuries and carry the risk of complications. When long bones are broken on an angle, they often separate into two parts that do not align and have rough, uneven edges. This fracture can make it difficult to put the bone back together. Spiral fractures are sometimes called torsion or twisting fractures Causes: of spiral fractures include:Sports Injuries: Skiing or snowboarding injuries, when the leg is twisted by being stuck in a ski or snowboarding boot while the rest of the leg continues to move.· Soccer injuries, especially when two players run into one another and become entangled or twisted.· American football injuries, especially when one player runs into another, one player is held or restrained by another, or a player twists to get free.· Wrestling injuries to the legs or arms caused by twists.· Motor vehicle and motorcycle accidents.· Bicycle accidents, typically those involving a motor vehicle as well.Child abuse: if a child's arm or leg has been jerked aggressively.Falling: down the stairs or a slope with fixed obstacles, such as rocks or trees that can twist an arm or leg away from the rest of the body. Physical violence: when a person's arm or leg has been twisted forcibly. Treatment for a spiral fracture depends on the severity of the breakage and damage to the surrounding tissues and blood vessels. Immediately after the injury takes place, it is important to make sure no weight is put on the fracture. If possible, it should be splinted to prevent further damage. The affected limb should be elevated to heart level and iced to reduce blood flow and limit inflammation. Ice should be applied for no longer than 10 minutes at a time. Acetaminophen is the only over-the-counter medication recommended during initial treatment for a fracture. Anti-inflammatory medications weaken the blood's ability to clot and may make internal bleeding worse. Calling 911 or an emergency hotline to request an ambulance may be the best way to get to a hospital without further injury. Surgery: Less severe cases, where the bone is not fully separated, may be operated on using local anesthesia. If the two ends of the bone are separated, then an open reduction surgery will be necessary. The surgeons will examine the entire area, looking for stray pieces of bone, broken blood vessels, and tissue damage before realigning or reducing the broken parts of the bone. If necessary, the bone is then reinforced using pins, screws, or rods to ensure the bone stays aligned while healing. If the surgery involves reinforcement, it is called open reduction with internal fixation surgery. If the bone is not separated, a doctor may perform closed reduction surgery. Surgeons will guide the bone into proper alignment from the outside, manipulating the bone through the skin. Recovery: bones grow very slow, so many spiral fractures take about 4 to 6 months to heal. That's why it is imperative to get prompt treatment to help with the proper healing of bones in spiral fractures.

Thrombophlebitis

1. the condition in which a blood clot in a vein causes inflammation in pain. Symptoms: may include redness, swelling, pain, or warmth of the affected area. Thrombophlebitis usually occurs in surface layer veins located in the area with poor blood flow. In rare cases, the clock could indicate risk for more serious conditions call deep venous thrombosis. Causes of this condition include trauma, surgery or prolong in activity. DVT increases the risk of serious health problems. Treatment: It is usually treated with blood thinning medications call coumadin Prognosis: for this condition usually settles in goes within 2 to 6 weeks.

Shingles

1. viral infection caused by the chicken pox virus (varicella-zoster) and causes a painful and itchy rash a. Symptoms: pain, burning, numbness, tingling, sensitivity to touch, red rash that appears on either sides of the body around the waist or on the neck and face, blisters, itching, fever, headache, sensitivity to light, fatigue b. Develop due to another cause? (environmental or condition) i. Varicella-zoster virus (chickenpox) that lies dormant in the body then reappears usually in those usually over 60 years old as shingles c. Treatment: there is no cure; antiviral drugs such as Zovarix or Valtrex to speed up healing process, lidocaine cream to ease pain, corticosteroid injection, or a Capsaicin topical patch; getting this vaccination as a child can prevent contracting the varicella-zoster virus and preventing the development of shingles a. Prognosis: usually last between two and six weeks; most people only get it once in their life however it is possible for it to occur more than once

Lumbarization

1. where the first sacral segment is, at least partially, mobile instead of being part of the fused mass of the sacrum. It constitutes an 'extra' lumbar vertebra, often referred to as L6.Symptoms: Pain during movement, lower back pain along with buttock pain, limited ipsilateral flexion (same side of body), reduced mobility, muscle spasms, decreased coordination and flexibility, sciatic or radicular pain patters, chronic back pain in adolescents. Treatment: Patients start by relieving pain killers and anti-inflammatory medications. If they do not help, then patients will receive nerve block injections. Surgery is also an option and can fuse the separated vertebrae.Prognosis: Because it is a congenital condition, it can be diagnosed early and can be treated before it is too late.

Appendicoliths

5. is a calcified deposit within the appendix. They are present in a large number of children with acute appendicitis and may be an incidental finding on an abdominal radiograph or CT. Incidence may be increased among patients with a retrocecal appendix. Overall they are seen in 10% of patients, with 90% subsequently going on to develop appendicitis Symptoms: may cause intermittent abdominal pain. It may mimic stone disease of the genitourinary tract. Sometimes it can be difficult to differentiate acute appendicitis from urolithiasis. Both of these pathologies may cause leukocytosis and hematuria. Treatment: For patients with acute appendicitis, the treatment is appendectomy. However, for patients who have a ruptured appendix with an inflammatory mass or abscess, one approach is nonoperative management with intravenous antibiotics. Prognosis: Without surgery or antibiotics (as might occur in a person in a remote location without access to modern medical care), more than 50% of people with appendicitis die. For a ruptured appendix, the prognosis is more serious. Decades ago, a rupture was often fatal.

Celiac Disease

6. Celiac disease is a chronic digestive and immune disorder that damages the small intestine. The disease is triggered by eating foods containing gluten. The disease can cause long-lasting digestive problems and keep your body from getting all the nutrients it needs. Symptoms: include nausea, diarrhea, bloating, Weight loss, fatigue, constipation Prognosis: After adequate treatment and regular medical follow-up, the prognosis is excellent. People who are not treated or who do not respond to treatment may suffer some complications of the disease or even die earlier than what is generally considered normal. Treatment: Currently, the only available treatment for a patient with celiac disease is a strict gluten-free diet. A lifelong diet completely free of gluten can be very costly and challenging.

Lyme's Disease

6. Lyme disease is a bacterial infection you get from the bite of an infected tick. At first, Lyme disease usually causes symptoms such as a rash, fever, headache, and fatigue. But if it is not treated early, the infection can spread to your joints, heart, and nervous system. Symptoms: include fever, headache, fatigue, and a characteristic skin rash called erythema migrans. If left untreated, infection can spread to joints, the heart, and the nervous system. Lyme disease is diagnosed based on symptoms, physical findings (e.g., rash), and the possibility of exposure to infected ticks. Prognosis: Most of the people who get Lyme disease and are treated early will be fine. Even after proper treatment, some patients (estimated at 5% to 15%) may experience lingering fatigue, achiness or headaches. This does not signify ongoing infection and will not respond to additional antibiotics. The risk of Lyme disease follows a general geographic pattern, with concentrations in the Northeast, mid-Atlantic, and upper Midwest. Treatment: Antibiotics. Oral antibiotics. These are the standard treatment for early-stage Lyme disease. These usually include doxycycline for adults and children older than 8, or amoxicillin or cefuroxime for adults, younger children, and pregnant or breast-feeding women. VLA15 is the only Lyme disease vaccine candidate currently in clinical development.

Pericarditis

6. inflammation of the pericardium, a sac-like structure with two thin layers of tissue that surround the heart to hold it in place and help it work. A small amount of fluid keeps the layers separate so there's less friction between them as the heart beats. If a patient has Perry carditis they will experience sharp chest pain. The chest pain occurs when the irritated layers of the pericardium rub against each other. Symptoms: Chest pain is the most common symptom of pericarditis. It usually feels sharp or stabbing. However, some people have dull, achy or pressure-like chest pain. Pericarditis pain usually occurs behind the breastbone or on the left side of the chest. Other signs and symptoms of pericarditis may include: Cough, Fatigue or general feeling of weakness or being sick, Leg swelling, low-grade fever, pounding or racing heartbeat (heart palpitations) ,Shortness of breath when lying down ,Swelling of the belly (abdomen). Treatment: May include medication for pain and inflammation, such as ibuprofen and aspirin. Depending on the cause of your pericarditis, you may need an antibiotic or antifungal medication. Patients may be given colchicine, vancomycin and ceftriaxone. Pericardiocentesis: in this procedure, a doctor uses a stair needle or a small two also known as a catheter to remove and drain the excess fluid from the pericardial cavity. You receive a numbing medication in most times is lidocaine before the procedure. The doctor uses ultrasound and echocardiogram images to guide the needle and tube to the correct location in the body. This will drain and stay in place for several days while the patient is in the hospital. Pericardiectomy: this type of surgery removes the entire pericardium. It may be done if the sac surrounding the heart has become permanently rigid due to constrictive pericarditis. Prognosis: Patients with acute idiopathic or viral pericarditis have a good long-term prognosis. Cardiac tamponade rarely occurs in patients with acute idiopathic pericarditis and is more common in patients with a specific underlying etiology such as malignancy, tuberculosis, or purulent pericarditis.

Mitral Valve Regurgitation

A backflow of blood caused by failure of the heart's mitral valve to close tightly. Mitral valve regurgitation is a condition in which the heart's mitral valve doesn't close tightly, which allows blood to flow backward in the heart.

Gastroparesis

A condition that affects the stomach muscles and prevents proper stomach emptying. A. Symptoms: vomiting, nausea, abdominal bloating and pain, the feeling of fullness after eating a small amount, acid reflux, lack of appetite, weight loss and malnutrition, etc. B. Fewer than 200,000 US cases per year for this condition. C. Treatment: changes to your diet by eating smaller foods more frequently, chewing food more thoroughly, avoiding fibrous fruits and vegetables, avoiding carbonated drinks, and try to avoid lying down for at least two hours after consuming a meal. Surgical treatment is also available for those who cannot tolerate any foods or liquids. D. Prognosis: managing proper treatment by consuming the appropriate foods can lead to a relatively normal life

Overriding Fracture

A displaced fracture where the bone fragments overlap. Impacted- A complete, displaced fracture where one fragment is driven into ("impacting") a second piece because of trauma. This occurs with long bone fractures because the muscles are pulling so tight that when the bone breaks it is pulled together and overlaps. If the femur is broken the patient will be in significant pain due to the muscles in spasms due to the overriding fracture of the bone. The solution to relieve the pain is a traction splint which will stretch the muscles back out and allow the fracture to resume normal position. A. Appearance: Deformity to area of fracture as well as bruising. B. Image Creativity: The overriding bones could also be twisted and therefore possible throw off the normal position of the anatomy of the bone. C. Treatment: Is treated with closed reduction with the patient under conscious sedation if patient's vitals are stable. Patients sometimes will require general anesthesia followed by open reduction internal fixation (ORIF) to hold the fracture in correct alignment. D. Prognosis: Fractures if easily reduced and are stable will heal normally within 6-8 weeks of being in a cast. Post-surgical prognosis may include increased healing time as well as physical rehab once out of cast.

Flexion-Teardrop fracture

A flexion teardrop fracture occurs when flexion of the spine, along with vertical axial compression of the spine, causes a fracture of the anteroinferior aspect of the vertebral body. This fragment is displaced anteriorly and resembles a teardrop. Occurs trauma involving head impacts such as motor vehicle accidents and diving in shallow water and fall from high heights. A. Appearance: resembles a teardrop B. Imaging Creativity: Flexion teardrop fractures most commonly occur at mid/lower cervical spine, specifically at C4, C5, or C6. C. Treatment: are variable and depends on the degree of injury. Due to the associated injury of both osseous and ligamentous structures, this fracture is usually unstable with almost all patients requiring decompression which is removing of pressure on joint space and internal fixation, which means securing the bone in correct place by using metal plates and screws. D. Prognosis: The long-term prognosis of this injury mostly depends on the degree of neurological injury. Although milder cord injuries may be asymptomatic or have few neurological sequelae, injury with posterior column translocation is associated with paralysis and quadriplegia.

Arteriovenous Malformation

Abnormal tangle of blood vessels where the arterial blood bypasses capillaries and reaches the veins. Usually occurs in the brain or spinal cord. Condition is congenital. While not considered hereditary, a family history increases the risk of occurrence. Symptoms: Headache, seizure, loss of neurological function, muscle weakness, loss of consciousness, trouble walking, abdominal pain, back pain, chest pain, children can experience hydrocephalus, seizures, and congestive heart failure Treatment: Anti-seizure and pain medicines are used to treat symptoms. Embolization is the direct clogging of vessels to prevent blood flow to area. During embolization a small incision is made and a catheter is guided by fluoroscopy, contrast is used to locate the target site, and a medication is injected into the target site to create an embolus blocking complete blood flow to the area. Craniotomy can be performed to close off and remove vessels. During a craniotomy, an incision is made in the scalp, a burr hole is drilled in the skull, a skull flap is then removed to expose the dura, the dura is opened, the defect is corrected, the dura is sutured closed, and the skull flap is replaced using screws. Prognosis: Pathology is treatable, can last years, and can be lifelong for the individual

Chauffeurs

Also known as Hutchinson's fracture is an oblique fracture of the radial styloid process. Originally named due to trauma sustained when starting a car with a crank. This type of fracture is sustained when blunt force is received to the back of the wrist. Angle of central ray may be needed for oblique view due to patient toleration of movement. Open reduction internal fixation is often needed to reduce movement of fracture in wrist and allow healing. Cast is often applied post-surgery. Recovery is expected 6 weeks post-op.

Buckle/Torus Fracture

Also known as buckle fractures, are incomplete fractures of the shaft of a long bone that is characterized by bulging of the cortex. They result from trabecular compression due to an axial loading force along the long axis of the bone. Usually in children 10 and under due to the bones being more flexible. A. Appearance: The fracture looks like a bump on a bone. B. Imaging Creativity: A diagnostic radiograph can be taken to identify a buckle fracture by taking both an AP and a lateral projection. It may appear as a small bulge or protuberance in the radius or ulna but may also appear to have a slight angulation in the affected bone. C. Treatment: There is no established treatment for buckle fractures, but methods vary from soft bandages to removable splints to stricter immobilization such as casting for 2-4 weeks, with regular follow ups until fracture heals D. Prognosis: Buckle fractures (impacted fractures) heal very quickly, especially compared to other types of broken bones. Usually, kids only need to wear a splint for 2 to 3 weeks. If their symptoms like pain and tenderness go away, there's usually no additional treatment or follow up needed.

Curbstone fracture

An avulsion fracture of the posterior margin of the tibia, typically due to striking the dorsal surface of thefoot on an unyielding surface, such as a curb. A. Appearance: Swollen and bruised on medial portion of ankle. B. Imaging Creativity: normal 3 view will show the fracture clearly. C. Treatment: Nonoperative treatment · Nondisplaced, stable fracture patterns with an intact syndesmosis · Displaced fractures for which stable anatomic reduction of the ankle mortise is achieved. · An unstable or multiple trauma patient in whom operative treatment is contraindicated because of the condition of the patient or the limb. · -Operative Treatment·Open reduction and internal fixation (ORIF) are indicated for failure to achieve or maintain closed reduction with amenable soft tissues · Unstable fractures that may result in talar displacement or widening of the ankle mortise. · Fractures that require abnormal foot positioning to maintain reductions (e.g., extreme plantar flexion) · ORIF should be performed once the patient's general medical condition, swelling about the ankle, and soft tissue status allow. D. Prognosis: Patients with stable fracture patterns can be placed in a short leg cast or a removable boot or stirrup and allowed to bear weight is tolerated. For those patients that had ORIF surgery they will be placed in cast or boot for 6 weeks with no weight bearing allowed and physical therapy afterwards for 2 - 3 months.

Foramen of Luschka

An opening in each lateral extremity of the lateral recess of the fourth ventricle of the human brain, which also has a single median aperture. The two lateral apertures provide a conduit for cerebrospinal fluid to flow from the brain's ventricular system into the subarachnoid space; specifically into the cerebellopontine angle. The structure is also called the lateral aperture of the fourth ventricle or the foramen of Luschka after anatomist Hubert von Luschka.

Kaposi sarcoma

Cancer that causes lesions to grow in the skin, lymph nodes, internal organs, and mucous membranes lining the mouth, nose, and throat. A. Symptoms: Purple, red, or brown skin blotches are a common sign. Tumors also may develop in other areas of the body. B. It often affects people with immune deficiencies, such as HIV or AIDS. C. Treatment may include radiation or chemotherapy. Rarely, surgery may be needed. D. Unlike early in the AIDS epidemic, Kaposi is very treatable. Very few people die from the disease because it usually responds to one treatment or another. Data from the National Cancer Institute indicates that the five-year relative survival is about 72 percent.

Rectocele

Condition when the tissue wall which separates the rectum from the vagina is weakened and leads to the vaginal wall to bulge. Symptoms: Feeling of rectal fullness even after bowel movement, bulge in the vagina, pain and difficulty having bowel movements, dyspareunia frequent pain in pelvis or during sexual intercourse, constipation Treatment: Surgical repair to remove excessive tissue Prognosis: Generally occurs after fifty, once repaired, patients are instructed to eat high fiber diets to decrease complications in the future

Double Fracture

Definition: two or more fractures occurring in the same bone - Mechanism: caused by a trauma of high impact such as contact made in sports, falls, or traumatic accidents - Appearance: Could be an open or closed fracture with deformity, bruising, and swelling; special considerations for positioning including use of objects to build up the limb or holding into place - Treatment: the severity will determine if surgery is necessary to perform a closed reduction surgery which would realign the bones with nails, screws, and metal plates placed to immobilize the bone. A cast would need to be worn for 6-8 weeks for healing with the addition of physical therapy leading to a generally good prognosis; weakness of the area could still occur

Cystic Fibrosis

Genetic disorder, in which the lungs and the digestive system get clogged with mucus. Symptoms: Persistent cough with phlegm, postnasal drip, salty tasting skin, wheezing/shortness of breath, sinusitis, male infertility, repeated lung infections, foul-smelling/bulky greasy stools, poor growth and low body weight despite a good appetite, blockage in the intestinal especially in newborns, diarrhea/constipation Treatment: Antibiotics are used to keep lungs free of bacteria, Anti-inflammatories are used to prevent inflammation of airway, Medications to thin mucus to prevent build up in the lungs and airway, bronchodilators used to relax muscles around lungs, bronchoscopy and lavage are used to clear lungs and airway of build-up, lung transplant may be needed, therapies include breathing exercises, chest therapy to loosen mucus, and oxygen therapy. Vests, called high-frequency chest wall oscillation (HFCWO) vests, are used to shake and brake-up the mucus to help expel from the bronchioles. Prognosis: Present at birth, no cure, lifelong for the individual. Individuals generally live into their 40s.

Greenstick

Incomplete fracture where bone is bent, most often occurring in children. Like a partial fracture as the break does not go completely through the long axis of the bone. Often occurs in the arm when bracing from fall. Deformity can be noted. May have to do a cross table to obtain lateral dependent on patient's range of motion. The bone may need to be straightened manually (at which time pain medication and sedation is usually given), cast applied, and the cast will remain for four to eight weeks. Radiographs will be obtained a few weeks after cast is applied to ensure proper healing.

Scabies

Intensely itchy rash caused by a mite known as Sarcoptes scabiei. Symptoms: Presents with itchy red papules, itching is worse at night, rashes on palms and soles, wrists and axilla, umbilicus and in between web spaces, itchy lumps or nodules in the armpits and groin are highly suggestive of scabies, linear or curved skin burrows in which mites might live are observed Treatment: Topical ointment to kill the scabies mites and their eggs. Oral medication if the patient's immune system is altered. Prognosis: Usually lasts days to weeks

Pyelonephritis

Inflammation of the kidney due to a bacterial infection. The inflammation of the kidney is due to a specific type of urinary tract infection (UTI). The UTI usually begins in the urethra or bladder and ureteral reflux causes the urine to travel back to the kidneys. A. Symptoms: Fever, frequent urination, and pain in the back, side, or groin are symptoms. B. Kidney infections are caused by bacteria or viruses C. Treatments: includes antibiotics and often requires hospitalization D. Prognosis: Most people who are diagnosed and treated promptly with antibiotics feel completely better after about 2 weeks. People who are older or have underlying conditions may take longer to recover.

Gonarthrosis

Knee arthrosis; disease of the knee joint caused by wear of the cartilage between the thigh and the lower leg. It is often confused with arthritis. In most cases gonarthrosis is age related wear of the cartilage in the knee joint. Causes of gonarthrosis include obesity, misaligned legs, knee injuries, permanent stress in one's daily routine, and high impact sports. Symptoms usually manifest as pain and restricted movement of the knee joint. Treatment could involve prevention of removing the cartilage from the knee joint by exercise and physiotherapy. Surgery is another way of slowing the progression of gonarthrosis and counteracting its symptoms. Surgical treatments, such as implanting an artificial knee joint or correcting bones in deformed legs are serious and should only be considered if conservative therapy has been unsuccessful.

Sarcoma

Rare type of cancer that grows in connective tissue like bones, nerves, muscles, tendons, cartilage and blood vessels of the arms and legs. No known cause, risk increases with family history, Padget's disease, genetic disorders and exposure to radiation. Symptoms: Abdominal pain, lump, bone pain, trouble breathing, trouble walking, swelling, fatigue, and weight loss Treatment: Chemotherapy, amputation, radiation therapy Prognosis: Depends on factors, like stage of cancer, overall health, and location of cancer.

Sprain

Sprains and fractures can have a lot of the same symptoms, which can make it difficult for you to determine which one you've sustained in an injury. However, the difference is simple — a fracture is a break in your bone, while a sprain is a soft tissue injury. 3 types of sprains: Grade 1 (Mild). The ligament fibers stretched slightly or there is a very small tear. Your ankle will have minor swelling and tenderness to the touch. Grade 2 (Moderate). The ligament is torn, but it isn't a complete tear. Your ankle has swelling over the injury, and it hurts to move. Grade 3 (Severe). The ligament is torn completely. Your ankle has significant swelling, the injury is painful, and walking is difficult. A. Appearance: Swelling, Bruising B. Image Creativity: Pain, especially when putting weight on your ankle, tenderness to the touch, difficulty walking. These factors will require you to manipulate the patient into the best possible position image for the anatomy with as little touch as possible to prevent further pain. C. Treatment: Rest and protect the injured area for a day or two after the injury. Then try stretching and gentle exercise to help increase blood flow to the affected area, thus promoting healing. Ice: Apply ice or a cold pack to reduce or prevent swelling. Apply for 10 minutes, then remove for 10 minutes. Prognosis: The recovery time for a sprained ankle varies depending on the severity of your injury. It may take anywhere from two weeks to heal a minor sprain and anywhere from six to 12 weeks to heal a severe sprain

Depressed

When the bone folds inward on itself due to high impact (blunt force) to the surface of the bone. Occurs in the frontoparietal region of the skull, maxilla due to the maxillary sinus, and the zygoma due to the zygomatic arch. Due to the nature of injury, most patients will have other injuries and will have spinal precautions. Due to other injuries and precautions the patient will likely remain still and prone on table or gurney and we will move equipment to match patient position. These fractures are associated with higher rates of infection, seizures, neurological deficits, and death. Surgical repair is required for dural breach (also known as dural tear, is a break in the dura layer and exposes brain tissue to environmental elements), depression greater than 5mm, intracranial hemorrhage, frontal sinus involvement, wound contamination, cosmetic deformity, and pneumocephalus (presence of air or gas in the cranial cavity). Since these fractures are often associated with traumatic brain injury, the prognosis and recovery are hard to generalize as patient condition can vary greatly between cases.

Hemangioma

a benign tumor that develops from blood vessels Causes: skin development when there's an abnormal proliferation of blood vessels in one area of the body. Hemangiomas of the skin are often visible red, raised birthmarks that generally fade out on their own, but they can also form in the internal organs. An internal hemangioma is a type of noncancerous tumor that forms from the abnormal growth of excess blood vessels. They occasionally develop on the brain and the liver and rarely cause symptoms, and people may not know they have an internal hemangioma unil they have a scan for an unrelated condition. Symptoms: depending on the location and size they don't normally cause symptoms during or after their formation. they can be disfigured and have different red discolorationTreatment: can be removed with surgery or by using laser treatment both procedures are safe and effective. in many cases laser treatment is preferable because it does not typically leave scar. Internal are normally diagnosed with MRI or CT after injection of contras to highlight the tumor. During the procedure the blood supply to the tumor is defined through angiogram, the dye is injected into blood vessel, they slow down/eliminate the flow of blood to the tumor. This procedure is known as embolization.Prognosis: unless severe or on an organ hemangioma is more of a cosmetic concern than a medical one. The risk of surgery is blood loss, and the hemangiomas might come back after surgery depending upon the type and location of the tumor.

Closed

a fracture where the bone breaks but does not pierce the skin.Other names/types: greenstick, transverse, spiral, oblique, compression, comminuted, and segmental. Closed fractures most often occur as a result of an injury such as a fall, motor vehicle collision, or sports injury. However, they can also occur because of overuse. Treatment: most treated with a cast immobilization or internal fixation

Subluxation

a partial dislocation within the body. This dislocation typically occurs in a joint. There are two main causes of subluxation: impact from accident, and they can also occur spontaneously. Symptoms include pain near the impacted joint, swelling, reduced mobility, feelings of instability around a joint, balance issues, numbness or tingling, stiffness, and altered gait or range of motion. Pain is sometimes the only symptom. Treatment must be customized to fit the location and the intensity of the injury. Targeted chiropractic adjustments can be especially effective for subluxations. An adjustment is a manual technique that applies varying degrees of pressure and positioning to realign the impacted joint. Most subluxations that are caused by impact will not reoccur. It is possible that subluxations could present again if joint weakness is a problem.

Zenker's Diverticula

a pouch or pocket that can form at the beginning of your digestive tract. It forms above the cricopharyngeal (CP) muscle, which is where your esophagus and pharynx come together. This can happen if the muscle doesn't work the way it should (by not opening or relaxing easily). The wall of the pharynx, above your esophagus, can then form a little pocket or pouch. The cause is unknown. It is believed that too much pressure on the esophagus can lead to this pathology. Symptoms: Weight loss, difficulty swallowing/dysphagia, halitosis due to food being stuck in the pouch, persistent cough, regurgitation of undigested food hoarse voice or a change in voice, aspiration that can lead to pneumonia, gurgling noises, feeling like something is stuck in your throat Treatment: For mild cases (pouches ¼ of an inch in diameter or less) should only have to alter diet by eating less spicy foods and can take medications for reflux. For more severe cases, surgery may be required. Diverticulectomy is used to remove the pouch, cricopharyngeal myotomy is used to remove esophageal muscle for ease of swallowing, and diverticulopexy with cricopharyngeal myotomy is used to connect the pouch to the esophageal wall Prognosis: usually occurs in age 60 and older, with treatment symptoms subside

Fracture dislocation

a severe injury in which both fracture and dislocation take place simultaneously. Frequently, a loose piece of bone remains jammed between the ends of the dislocated bones and may have to be removed surgically before the dislocation can be reduced. A. Appearance: Noticeable deformity, joint appearing out of place, swelling or discoloration around area, inability to move joint. B. Image creativity: Because the patient may not be able to move the joint due to the impingement of the joint the patients x-ray image must be taken by having the patient move areas of their body other than the injured anatomy as well as creating angle of the central ray to get the best picture possible. X-table laterals will also help with getting the best image possible. C. Treatment: Surgery is often required to remove the fractured bone or internally fixate it, to reduce the dislocation in proper placement. D. Prognosis: This depends entirely on the anatomy involved and the severity of the fracture.

Thoracic Lordosis

a spinal condition that involves the middle/upper back having an excessive inward curvature, giving the body a swayback appearance. Common causes that increase risk factors are spondylolisthesis, kyphosis, osteoporosis, and obesity. Symptoms: C-shaped back, general muscle weakness, reduced flexibility of the back, back pain, tender and sore back, numbness and tingling sensation if the nerves are affected Treatment: Physical therapy to retain mobility, braces, pain medication, spinal fusion surgery to correct curvature Prognosis: Will last the life of the individual, even after surgery the individual will have a corrected curve but limited range of motion

Pott's

avulsion fracture of the medial malleolus with loss of the ankle mortise, also called Pott's Syndrome I and Dupuytren fracture. Most commonly caused by a jump, sports such as football, rugby, basketball, and volleyball, and rolling of the foot. It only affects the medial malleolus of the tibia. Signs and symptoms are severe ankle pain, inability to put weight on the affected foot, and exceptional swelling and bruising.Cause: It is caused by hyper eversion where the ankle is overly everted. This strains the medial ligament, which is attached to the medial malleolus. Due to the strength of the ligament, it tears off the medial malleolus of the tibia. Note: Hyper eversion of the foot is rarer than hyper inversion due to the strength of the medial ligament and relative weakness of the lateral ligament.Treatment: Mild cases may only require an ankle brace, walking boot, and/or crutches. More severe cases may require casting from the knee down and immobilized for 6 weeks. Surgery is recommended when the bones of the ankle have been displaced, followed by using crutches and/or boot. Lengthening the Achilles tendon of the foot can also be a treatment, which is done through dorsiflexing the foot while the leg and knee are straight.

Fracture Blister

blister that forms under the outer most layer of skin where fracture has occurred. The blister is fluid filled and usually painless. These blisters can occur within 6 hours of the injury and up to 3 weeks post injury. The most common site of fracture blisters is the ankle. The edema caused during the inflammatory process of the fracture causes an overload of fluid in the skin surrounding the area of the fracture leading to the blister. Healing time is usually several weeks. It is most important not to pop these blisters as this will add to risk of infection. Most physicians will allow these blisters to heal on their own without intervention. Blisters are allowed to heal first if fracture/injury allows for it. Physicians prefer to fix fractures after blisters have healed and are not present.

Hangman's

break in the C2 vertebra or axis a. Mechanism of injury: head is snapped up and back with great force (hyperextension); falls and car accidents are most common reasons for this fracture b. How area will look: bruising on the skin around area of interest; best seen on a lateral image; on x-ray will see C2 not aligned with inferior vertebra and a fracture on C2 c. Imaging creativity needed? This patient will be in a C-collar and put on spinal precautions; treated like a trauma cervical spine patient i. The lateral will be taken cross-table, the tube will be aligned with the hole in the c-collar for the AP Axial and the tip of the teeth to the mastoid tip for the open mouth; the IR will be placed under the backboard for the APs d. Method used to repair injury: i. External fixation: hard C-collar and a halo vest (a ring attached to the outer skull with pins and connected to a torso brace) to keep the head and neck immobilized or: ii. Internal fixation: surgery to realign the bones and hold them in place with screws, rods, or plates e. Prognosis: 100% healing rate with immobilization alone; 85% chance of a full recovery within a year

Hemoptysis

coughing up of blood- or blood-stained mucus from the larynx, trachea, bronchi, or lungs. The amount of blood being coughed up determines the categorization: 1) <20 ml = Mild hemoptysis, 2) 20-200 ml (~1 cup) = Moderate / Non-Life Threatening hemoptysis, 3) 200-600+ml (~1 pint) = Massive / Life Threatening hemoptysis.Causes- Lung cancer, tuberculosis, bronchitis, pneumonia, bronchiectasis due to cystic fibrosis, congestive heart failure, drug use, foreign objects in airways, parasitic infections, pulmonary embolism, traumatic injury, and COPD.Symptoms- Aside from coughing up blood, patients can exhibit chest pain, weight loss, nocturnal hyperhidrosis (excessive sweating at night), a fever higher than 101*F, and shortness of breath with a normal level of activity.Treatment- Depends on the category. For Mild / Non-Life-Threatening hemoptysis, bronchitis is the most common cause, which can be treated with antibiotics and cough medicine. Smokers are likely to develop it as well. For Life Threatening hemoptysis, the patient can be placed in the ICU, intubated, and placed in a position where the affected lung is lower than the unaffected. Vasoconstrictors, coagulants, tiny balloons/cuffs to put pressure on the area of the bleed, cryotherapy, and embolization are possible options when the doctor has found the source of the bleeding. In the most severe cases, part or all of the affected lung can be surgically removed. Once the patient is no longer in immediate danger, they can be treated with antibiotics for tuberculosis and pneumonia, chemotherapy for lung cancer, and steroids for inflammatory conditions.

Radiculopathy

describes a range of symptoms produced by the pinching of a nerve root in the spinal column. A. Symptoms: vary by location but frequently include pain, weakness, numbness, and tingling B. Radiculopathy is injury or damage to nerve roots in the area where they leave the spine. C. Treatment: medications (nonsteroidal anti-inflammatory drugs, opioids, or muscle relaxers to manage symptoms), weight loss strategies to reduce pressure on the problem area, physical therapy to strength muscles and prevent further damage, steroid injection (to reduce the inflammation and relieve pain) and in some severe cases surgery. surgery is typically used to reduce the pressure on the nerve root by widening the space where the nerve root exits the spine. this may involve removing all or part of ta disk and/or vertebrae this is cold Endoscopic Discectomy. D. Prognosis: the overall prognosis of person with this is favorable. most patient improve over time with focused nonoperative treatment course. if severe and must do surgery this should relieve the pressure causing you the pain. physical therapy is completed along with follow ups for up to 3-4 months

Pathologic

fracture caused by the weakening of bone due to the pathology, most often tumors or osteoporosis. Bone density is weakened and unable to withstand load or mechanical resistance. Fracture is caused by fall, lifting, or even turning the wrong way but is secondary to the pathology. Surgery is not recommended due to brittle bones. Prevention of fracture is best course since healing of fracture in natural state will most often be allowed to occur. Splint, cast, or brace may be used depending on the fracture. In some cases, prosthetics and ORIF can be utilized when the patient has good bone stock. If fracture goes through the bone rebuilding process will fill the area, monitor with imaging, and sometimes need ORIF with casting.

Diastatic

fracture traverses one or more sutures of the skull causing widening of the affected suture; typically occurs in infants and young children a. Mechanism of injury: head comes in contact with a wide area such as a wall; falling b. How area will look: area on head may appear swollen; on x-ray there will be a widening of the affected suture c. Imaging creativity needed? Since these injuries happen to infants and young children, the use of a toddler chair or piggostat may be necessary to keep the child still; the parent and/or another technologist may need to help hold the patient still so they will need to be wearing lead and avoid putting their hands over the site of injury on the child's head to prevent any blocking of the injury on the x-ray. If the patient is too small to be put in the chair or the piggostat, then they may need to be put on the table with a tech and/or parent helping hold the child d. Method used to repair injury: no immediate surgery is needed; the injury is monitored and reexamined 2-3 months later to check for a growing skull fracture i. If surgery is needed they will do a "regional craniotomy and pericranial dural inlay graft, and immediate contour reconstruction with rigidly fixed cranial bone graft to ensure appearance and functional restoration of the growing skull" (NIH, 2021). If the brain is injured, the craniotomy (removal of a cranial bone) will be performed to make repairs to the brain. Then the surgeons will reconstruct the area worked on for proper appearance and function. e. Prognosis: will heal in 3-6 months; if the brain is injured, it may cause seizures up to the age of 10, and physical, cognitive, and/or behavioral issues as a result

Exercise Induced Asthma

happens when airways get smaller during exercise. Asthma triggered by sports or exercising can make it hard for you to breathe. Asthma symptoms appear when the airways constrict (become narrower) during exercise. Symptoms are worse when the air is cold and dry, or when pollution levels and pollen counts are high. People with exercise-induced asthma should warm up before exercising. Inhalers and other medications can prevent an EIB episode and open the airways. A. Symptoms: can range from mild to severe. They can appear a few minutes after you start exercising or after you finish a workout. (Coughing is the only symptom for some people.) Difficulty breathing (shortness of breath). You may feel like it's hard to push air out of your lungs. Tight feeling in the chest. Severe fatigue. B. People who don't have asthma can get EIB too. Around 10% of people without asthma have exercise-induced asthma. C. Treatment: prescription albuterol inhaler D. Prognosis: It can be outgrown in some kids, but in general this is a condition that is controlled rather than treated. Meaning that you can use medication to keep it from being a problem, but it probably isn't going to completely go away

Osteomyelitis

inflammation or swelling that occurs in the bone generally in the legs, arm, or spine. This is usually caused by a open injury or non healing wound due to lake of blood flow for example diabetic patients. It can result from an infection somewhere else in the body that has spread to the bone, or it can start in the bone, often because of an injury. A. Symptoms: Fever, chills, night sweats, swelling, pain in area of infection, fatigue B. Developed due to injury that caused infection. C. Treatment: Surgery to remove infected or dead bone (debridement) and then the patient will receive antibiotics by IV for at least 6 weeks. D. Prognosis: With treatment, the outcome is good even though symptoms may continue to come in go. Amputation may be needed, especially in people with diabetes or poor blood circulation

Jones Fracture

is a fracture of the proximal meta diaphyseal junction of the fifth metatarsal bone that involves the 4th-5th metatarsal articulation. The fracture is believed to occur because of significant adduction force to the forefoot with the ankle in plantar flexion A. Appearance: With this type of fracture, you will have bruising and swelling on your foot, and it may be painful to put weight on the affected foot. B. Image creativity: Fracture will be seen with 3 views of foot shown best on oblique view. C. Treatment: Operative management is indicated in patients that are elite or competitive athletes or in non-operatively managed fractures when delayed union has occurred. Management includes either intramedullary screw fixation or open reduction and internal fixation (ORIF is also the main management option as a salvage procedure when there is non-union following screw fixation). The outcomes are similar with almost 100% union rates. Internal fixation and even bone grafting may be required in cases of non-union, or where the fracture is significantly displaced. D. Prognosis: Jones fractures are prone to non-union (with rates as high as 30-50%) and almost always take longer than two months to heal. Non weight bearing cast for 6-8 weeks followed by physical therapy.

Dextrocardia

is a rare congenital (present at birth) heart defect, in which the heart is in an abnormal position in the chest. Dextrocardia occurs in about 1 in 12,000 pregnancies. Isolated dextrocardia which is the more common form is when the heart in situated more to the right in the thorax than what is considered normal. People with dextrocardia have severely other congenital defects, such as Congestive heart failure, Infertility (in males with Kartagener syndrome), Intestinal blockages, Respiratory failure, Severe or repeated infections, Death. Situs inversus is when the heart is a mirror image of a normal heart, just on the right side. People with this do not tend to have problems from this disorder. Some people with isolated dextrocardia have an increased risk of lung infections, sinus infections, or pneumonia. With isolated dextrocardia, the cilia in your lungs may not function normally. Cilia are very fine hairs that filter the air you breathe. Symptoms: Breathing problems, Cyanosis, failure to grow and gain weight, fatigue, especially when feeding, frequent sinus or lung infections, jaundice, pallor. B. There are 2 main types of dextrocardia: isolated dextrocardia and situs inversus.In isolated dextrocardia, only the heart is on the opposite side of the body, and there are no other abnormalities with the heart or other organs. Isolated dextrocardia is very rare. In dextrocardia with situs inversus totalis, all the vital organs in the chest and abdomen are on the opposite side of the body from their normal location. The organs may work correctly, or there may be complications with breathing and other functions. C. Antibiotics to manage respiratory infections, Medications to keep fluid out of the lungs, Medications to help the heart pump blood more efficiently, Pacemakers for certain heart problems such as arrhythmias, Surgery for congenital heart defects or problems with organs in the chest or abdomen. D. Children with dextrocardia who have no other congenital abnormalities can lead full, healthy lives. However, it is still important to tell your child's health care providers about the condition. Knowing that the heart is on the opposite side of the chest may be important if a child needs medical tests or treatments in the future.

Spina Bifida Occulta

is the lack of fusion of the lamina so no spinous process if formed. Posterior elements are the lamina. · Symptoms: pain in back legs, weakness in legs, numbness in legs, deformed legs, feet, and back, change in bladder or bowel function. People who have skin over the defect may have a hairy patch, fatty lump, hemangioma, dark spot called Mongolian spots, or hypopigmented spot on the area. · Reason of development: the specific cause is not known but research suggests that it could be related to several genetic, nutritional, and environmental factors such as a lack of folic acid, family history of the condition, having a parent that has uncontrolled diabetes, a parent who has obesity, and a reaction of epileptic medicine. Happens during fetal development in the womb. · Treatment: Surgery to close the gap, physical or occupational therapy, using a back brace or walker, taking medicine to treat bladder or bowel problems. · Prognosis: Most people don't even know they have it, and if they do and have symptoms, there is medicine and treatment available to increase quality of life.

Spondylolisthesis

is where one of the bones in your spine, known as a vertebra, slips out of position. It's most common in the lower back, but it can also happen in the mid to upper back or at the top of the spine at the back of your neck. Symptoms: Pain areas: in the legs, thighs, and buttocks that worsens with standing or lower back Also common: hamstring tightness or tenderness. Can be caused by sport injuries Treatment: Spondylolisthesis is treated with the strengthening of supportive abdominal and back muscles through physical therapy. Treatment may include: Rest. Anti-inflammatory medicines, including ibuprofen or naproxen. Surgeons almost always perform spinal fusion for spondylolisthesis. Spinal fusion stabilizes the spine by permanently joining two vertebrae, eliminating movement between them. Typically, bone grafts are placed between vertebrae to help them fuse together. In time, new bone grows over the graft. Prognosis: Most patients respond well to a conservative treatment plan. For those with continued severe symptoms, surgery can help alleviate the leg symptoms by creating more space for the nerve roots. The back pain can be helped through a lumbar fusion.

Polyp versus diverticula

polyps are usually slow growing non-cancerous tumors derived from cells lining the large intestine. Less than 1% of polyps have abnormal cells, some may be cancerous. They look like amass or finger-like projections into the lumen of the large bowel. Some appear to be on stalks. Inflamed diverticula are in the large bowel and are usually caused by infection. Diverticula are the opposite of polyps because they are small pouches that are open to the lumen. They both have similar symptoms: abdominal pain, bloating, constipation, diarrhea, rectal bleeding, nausea, and vomiting. Symptoms of polyps that usually do not occur with diverticula: decreased stool size, black stools, anemia, the telescoping of one segment of the intestine within another (intussusception), usually due to blockage of the intestine, iron deficiency. Symptoms with diverticula that usually do not occur in colon polyps include pain or difficulty urination, persistent fever and/or persistent constipation and inflammation due to infection. Some may become cancerous. Colon polyps do not cause diverticulitis; however, some researchers suggest that people with diverticulitis are at higher risk for developing polyps. Treatment for diverticula: if the case is mild, lots of rest and a liquid diet is utilized. For more severe cases, IV antibiotics are used and possible surgery. Treatment for polyps usually involves removing the polyps during surgery.

Open Book Fracture

result from anteroposterior compression injury to the pelvis and results in a combination of ligament rupture and or fractures to both anterior and posterior arches. Common way to get these fractures is elderly falls or MVA or other high speed trauma. Treatment: stabilize fracture with pelvic binder and/or bed sheet wrapped around greater trochanter. Transcervical fracture: proximal femur fracture which is at the midportion of the femoral neck. Mechanism of fracture: elderly falls and significant trauma (MVA), Treatment: internal fixation with pins and screws

Straddle

severe type of pelvic fracture usually due to trauma; fracture of both the inferior and superior pelvic rami; unstable injury a. Mechanism of injury: trauma to the groin and pelvis area; straddling a hard object, a motorcycle accident, or falling onto a bicycle crossbar b. How area will look: on the radiograph, the superior and inferior pelvic rami will be fractured; groin area will likely be bleeding, swollen, and bruised c. Imaging creativity needed? The patient will not be very mobile at all, however, since this would be a simple pelvis x-ray, the patient will not need to be moved and the equipment will be moved around the patient just like a normal pelvis x-ray d. Method used to repair injury: temporary external anterior fixator attached to the pelvic ring to stabilize the fractures for healing; once the patient's condition has improved, a plate fixation may be used internally attached to the anterior pelvic ring and screws are usually placed in the posterior pelvic ring e. Prognosis: after 1 year, the anatomy will successfully heal back together correctly and function should resume as normal

Stellate

star-shaped fracture of the patella due to blunt force to the knee. Point of impact in the center with fissures radiating from center point, leaves bone in multiple fragments. Patient unable to stand or have any pressure on patella. For patella views patient will need to be prone on the table without changing the position of the knees to prevent further injury during exam. Cast or splint can be utilized for 6-8 weeks if bone fragments are not displaced. For a horizontal fracture, surgery is needed using screws and tension band in a "figure of eight" configuration. Surgery may be required to remove part or all of patella, called patellectomy.

Cushing's disease

the body makes too much cortisol over a long period of time a. Symptoms: i. weight gain ii. fatty tissue deposits in the midsection, face (moonface), between the shoulders (buffalo hump) iii. Stretch marks iv. Thin skin and easy bruising v. Slow healing of cuts and insect bites vi. Acne vii. Hirsutism in women (growth of facial hair in women) b. Develop due to another cause? (environmental or condition) i. High cortisol levels in the body over time; can sometimes be caused by high doses of corticosteroid medications over a long period of time ii. If the body is making too much cortisol, it can be caused by a pituitary adenoma, an ACTH-secreting tumor, or a primary adrenal gland disease c. Treatment: lower corticosteroid doses, surgery to remove the tumor, radiation therapy, medications to lower cortisol production in the body d. Prognosis: if Cushing's is caused by corticosteroid medications or the body making too much cortisol, the disease can go away within one year; if a cancerous tumor on the adrenal glands is causing the disease, there is a 5 year 30% chance of survival

Reverse peristalsis

when wave-like muscle contractions of peristalsis move backward instead of forward. This is what happens when your vomiting reflex is triggered. Reverse peristalsis can move food backward all the way from your small intestine back through your stomach, esophagus, and mouth. It can also occur on a smaller scale during foods normal journey through the digestive tract if that journey encounters an obstruction along the way. Reverse peristalsis might move the food backward briefly for a small distance before reattempting forward motion. Problems with peristalsis are also called motility disorders. Symptoms include constipation, diarrhea, gas, abdominal pain, abdominal distention, bloated stomach, nausea, burping, regurgitation, acid reflux, dysphagia, and nutritional deficiencies. Certain medications may affect peristalsis such as opioids, anticholinergics, calcium channel blockers, and tricyclic antidepressants. Treating peristalsis problems may be as simple as changing your medication or your diet. Mental/emotional factors can play a part, along with hormones and electrolytes, and sorting these out can involve some trial and error. Some medications used to treat motility disorders are: parasympathomimetic drugs, prokinetic agents, and antidiarrheals. You can maintain healthy peristalsis by getting exercise, drinking enough water, eating fiber, and reducing processed foods in your diet.

Complete

· A complete fracture is when the bone breaks all the way through. It will be broken into two or more pieces. · This fracture will cause pain, swelling, deformed appearance, tenderness, bruising, and the limb will be limp and won't be able to move it. · Since the patient won't be able to move it themselves, you must move it very carefully and gently for them, use good support and hold it at both joints closest. Do a cross table lateral to avoid displacing fragments. · This can be fixed by either casting it if displacement is not an issue, or an Open reduction internal fixation using plates, screws, rods. You could also do an open reduction, external fixation which uses a surgical repair to fix the fracture and an external fixation device to hold the bone in place and support it. · Can take up to 3 months to be completely back to normal.

Nutcracker

· A fracture of the cuboid bone in the foot, it is crushed by the calcaneus and 3 or 4 metatarsals. · This fracture causes pain and swelling along the outside of the foot. Walking and bearing weight will be difficult if at all possible. · The patient should be able to all imaging positions, may need to do cross-table lateral. Be gentle when touching or moving the foot. · This fracture can occur from crush injuries and axial load in combination with forced abduction of the forefoot. · Treatment includes options of casting and immobilization, open reduction internal fixation, open reduction external fixation. Non-displaced fractures will probably be treated just a cast, comminuted fractures will be treated surgically. · Healing takes 3-6 weeks.

Indirect

· A fracture that occurs somewhere other than the site of injury. · Can happen when doing things such as running and jumping and turning quick. Can also occur from force, such as hits or falls. For example the if top of fibula and bottom of tibia is fractured and the injury at the bottom of the tibia was the initial injury, the force from the tibia injury caused the fibula injury. · Indirect fractures have the normal characteristics of a fracture so swelling, pain, tenderness, bruising. · Casting may be done for fractures that are not displaced or complicated. Depending on where and what type of fracture, may need to do Open reduction internal fixation using plates and screws. · Can heal in 3-8 weeks depending on fracture. Special imaging considerations include being gentle when touching and moving the limb, supporting at the joints, be prepared to do cross-table images.

Salter Harris

· A fracture through the growth plate of a long bone. · Will be painful with swelling around the end of the long bone. Won't be able to put weight on limb, limited range of motion, bone deformity. · Need to be gentle when moving limb and support at the joints of the long bone. · Can be caused by falls, motor vehicle accidents, sports accidents, rotating or twisting. · Depending on the severity of fracture it can be treated with a closed reduction and cast or with a surgical open reduction where plates and screws are used. · X-rays will be done then 6-12 months to check on healing.

Emboli versus Thrombus

· Symptoms: a thrombus is a blood clot. Symptoms of thrombi include pain in one leg, swelling in the leg or arm, chest pain, numbness, or weakness in one side of the body, sudden change in mental state. A thrombus is stationary. An Embolus is anything that passes through blood vessels until eventually getting to a small vessel that it can't pass through and blocks it causing a block in blood flow. An embolus is continuously moving until it is stopped because it can't get through a small vessel. Symptoms include drooping face, numbness in one arm, slurred speech or inability to talk or understand what's going on. · Reason of development: Thrombi are caused by disease, injury, not moving, a broken bone, certain medicines, obesity, genetic disorders, autoimmune disorders. Emboli are caused by foreign body that shouldn't be in the body, fat, air, cholesterol, amniotic fluid, blood clots are all examples of emboli. · Treatment: Thrombi treatment can be treated by blood-thinning medicines, thin tubes to widen vessels, wire mesh tube to hold a blood vessel open, medicines to dissolve blood clots. Emboli are treated in different ways depending on what type they are, a surgical procedure called an embolectomy to remove an obstruction, medication can be used to dissolve blood clots, hyperbaric chambers can be used to treat air embolisms. · Prognosis: Survival of a embolism depends on the type and severity of it, and also how fast you treat it. It you treat it early most people recover fully. For short term survival of thrombosis is from 95%-97%.

Duverney's

· This is a fracture of the pelvis, specifically the iliac wing, usually caused by a direct blow to the ilium. · The area may appear normal but with some pain and swelling, and bruising. · Special imaging considerations would be that the patient is going to be very uncomfortable, may need to do a cross table lateral hip. · These fractures typically do not need surgery, usually only walking aids are used until pain subsides. Open reduction internal fixation will only be needed if there is deformity, damage to blood vessels, nerves, or organs. · It can take 8-12 weeks for it to heal.

Transverse

· When a bone breaks perpendicularly to its length. · Happens when the bone is hit forcefully perpendicular to its long axis. The area of injury will be painful, have swelling, tenderness, bruising, deformity, limited mobility. · Since it is usually on long bones, remember to move the limb gently and support at joints, the patient may not be able to do all textbook positions so you must work around them. · Depending on the fracture you may only need immobilization for 6-8 weeks. If the fracture is more severe you may need a closed reduction to put the bone back in alignment. For the most severe you will have an internal fixation which is a surgical procedure to correct the alignment and use screws and plates to hold them in place.

Bimalleolar

· when both malleoli are broken. · Can happen due to a fall or trip, usually when your foot and ankle roll inward. Can also be caused by a direct hit to the ankle. · This fracture will have swelling, redness, hematoma formation, and lateral and medial tenderness of the malleoli and proximal head of the fibula. · Won't be able to apply pressure to walk. Special imaging considerations would be that the patient will not be able to move much so you may need to do cross-table lateral. · Treatment includes nonsurgical which will be a below the knee cast for 6 weeks or total contact cast for 3 months for diabetic patients. This will need repeat radiographs to ensure there is no displacement. Surgical treatment includes an open reduction and internal fixation when the fracture is unstable. They will use plates and screws to stabilize the fracture. Prognosis for this fracture depends on the patient's comorbidities, full-weightbearing can occur at 12 to 16 weeks, it can take up to 6 months for complete weightbearing and final functional recovery.

Intrauterine Fracture

❖ "fracture that occurs in utero." A fracture that results from maternal trauma, Osteogenesis imperfecta, or metabolic structural abnormalities. Blunt abdominal trauma late in gestation increases the risk of fetal skull fracture. First the doctor will determine whether or not it is safe to have a vaginal delivery or a cesarean delivery. Treatment depends on how well the fracture repairs in utero. The doctor will weigh the risk vs benefit to determine whether or not surgery is needed to correct long term. Splinting may be used after birth if the fracture is not significantly displaced. If the fracture is displaced or they have a significant deformity, then corrective surgery will be required

Snowboarder's Fracture

❖ A lateral process fracture of the talus occurs most frequently when the foot is dorsiflexed and eversion. The injury is acute and typically occurs when the outside of the talus is jammed heavily against the fibula. This fracture is typically seen in those who snowboard. Many lateral process fractures of the talus are displaced or unstable enough and require surgical fixation. If the displacement is more than 2mm, an open reduction and internal fixation may be performed. This involves an incision on the lateral aspect of the ankle, through which lag screws or wires are used to stabilize the bone fragment to the talus body. If there are any loose bodies found during the surgery, these are also removed. Sometimes the bone will be broken into multiple pieces (comminuted) that are non-viable. In this case, it may be necessary to excise these bone fragments from the ankle.

Tripod Fracture

❖ AKA Zygomaticomaxillary complex (ZMC) fractures, tripod, tetrapod, quadripod, malar or trimalar fractures Seen in the setting of traumatic injury to the face. They comprise fractures of the: zygomatic arch, inferior orbital rim, and anterior and posterior maxillary sinus walls, lateral orbital rim. Treatment generally aimed at realignment of mid face skeleton with restoration of relative symmetry including projection of malar eminence, as well as restoration of unrestricted motion of the globe and mandible. If the patient has bilateral tripod fractures, they will typically have an accompanying brain injury which would not have a good prognosis.

Diabetic Neuropathy

❖ Nerve damage that is caused by diabetes. Depending on which nerves are affected, diabetic neuropathy can cause pain, numbness and tingling in the affected limbs. This is a severe complication from diabetes and approximately 50% of individuals with diabetes can develop this condition. If a patient can control their blood sugar levels then they can easily prevent this from occurring. There is no known cure for diabetic neuropathy, but the goals of treatment are to slow down the progression, relieve pain and manage further complications. This is done by managing blood sugar levels and using pain medications such as NSAIDS for pain relief. The prognosis of this disease will primarily depend on how severe the underlying diabetes is and if it is controlled or not.

Osteophytes

❖ These are bone spurs that develop off of the spine or around the joints in the body typically affected by osteoarthritis. The symptoms associated with osteophytes include stiffness, pain, possible pressure on nearby nerves which can cause numbness and tingling, and then possible tendon tears depending on the location of the osteophyte. Osteophyte symptoms are treated with NSAIDs, ice to reduce swelling, rest, physical therapy if range of motion is affected and then possible surgery if all other treatment options fail to provide any relief. The prognosis following osteophytes is good, but they will not go away on their own without surgical intervention. They can continue to grow, but if surgery is done they typically will not grow back in the same place but you can develop them in other parts of your body.

Fatigue Fracture

❖ This fracture occurs when abnormal stress is applied to a bone. Also called a stress fracture, hairline fracture, fissure fracture, spontaneous fracture, march fracture and insufficiency fracture. This is commonly seen in individuals who participate in repetitive movements, such as runners especially those who run on concrete instead of grass. These fractures are often missed on initial x-rays and can take 7-10 days to possible see on x-rays. More likely to be diagnosed clinically. Treatment for these fractures typically include immobilization such as wearing a walking boot, and rest.

Ankylosing Spondylitis

❖ This is a chronic inflammatory disease associated with human leukocyte antigen B27, first affecting the spine and adjacent structures and commonly progressing to eventual fusion of the involved jones. This typically begins at the SI joints and works it way up. When the patient's spine is fused to the atlanto occipital joint, they are no longer able to lay down and must sleep in an upright position typically in a recliner. We must radiograph these patients in an upright position. Symptoms include pain and inflammation of the involved joints, and in extreme cases a forward flexion of the spine called "poker spine" or "bamboo spine" develops. Treatment includes NSAIDs to reduce pain and inflammation, tumor necrosis factor drugs, physical therapy and occupational therapy. Most individuals with this disease can expect to lead mostly normal and productive lives, but some individuals may develop a severe case of this disease which could eventually lead to them being disabled.

Tetralogy of Fallot

❖ This is a congenital cardiac anomaly that consists of four defects including pulmonary stenosis, ventricular septal defect, malposition of the aorta so that is arises from the septal defect or the right ventricle, and right ventricular hypertrophy. This is typically denoted by a "boot shaped" heart on x-ray. ←The primary symptoms in infants include cyanosis, hypoxia, difficulty in feeding, failure to gain weight and poor development. In older children the symptoms include clubbing of fingers and toes. There is a pansystolic murmur heard but the second heart sound is faint or absent. The treatment consists mainly of supportive measures and palliative surgical procedures, primarily systemic to pulmonary anastomosis to decrease tissue hypoxia and prevent complications until the child is old enough to tolerate total corrective surgery. If a patient does not undergo corrective surgery their prognosis is not good and the patient will potentially die. However if the patient does undergo corrective surgery they can typically go over 20 years without seeing any complications from the disease.

Compound Fracture

❖ This is a fracture in which the broken end or ends of the bone have torn through the skin. It is also called an open fracture. Most are caused by blunt-force trauma such as a gunshot or motor vehicle accident. They can also be caused by a simple fall or playing sports. Most commonly occur in the upper and lower limbs of the body. Requires different kinds of treatment than a closed fracture (not breaking through the skin). Once the skin is broken, bacteria can enter the wound and cause infection. The wound, tissues, and bone fragments must be cleaned out during surgery. The fractured bone will then be stabilized using hardware to allow the wound to heal appropriately.

Bronchiectasis

❖ This is an abnormal condition of the bronchial tree characterized by irreversible dilation and destruction of the bronchial walls. The condition is sometimes congenital but is more often a result of bronchial infection or of obstruction by a tumor or an aspirated foreign body. Symptoms can include a constant cough producing sputum, hemoptysis, chronic sinusitis, clubbing of fingers and persistent moist coarse crackles. Treatment includes frequent postural drainage, expectorants, antibiotics and rarely surgical resection of the affected part of the lungs. For individuals with a mild case of bronchiectasis they have a normal life expectancy, but this disease can be fatal to those with more severe cases.

Osgood Schlatter's Disease

❖ This is inflammation or partial separation of the patellar tendon from the tibial tubercle caused by chronic irritation, usually as a result of overuse of the quadriceps muscle. The symptoms include swelling and tenderness over the tibial tubercle that increases with exercise or any activity that extends the leg. Treatment consists primarily of anti-inflammatory medications, patellar tendon strap, and exercises to stretch the quadriceps. A hip-to-ankle immobilizer may be needed to allow the patient time to rest from overuse. Prognosis following this disease is good and with physical therapy most individuals are able to see full relief of their symptoms.

Pertussis

❖ also known as whooping cough. This is a very contagious upper respiratory infection caused by the bacterium Bordetella pertussis. The symptoms include violent coughing, low-grade fever, runny nose, vomiting and lethargy. After the violent coughing fits, you can hear a "whooping" sound as the patient tries to catch their breath. After someone has been exposed to this infection, it can take 3-5 days before any symptoms appear. Antibiotics are usually used to treat the infection with the most common antibiotic being erythromycin. The prognosis for pertussis in anyone over the age of 3 months is really good with full recovery in approximately 3-4 weeks. However patients can still experience a lingering cough for months.

Bowing Fracture

❖ an incomplete fracture of tubular long bones in pediatric patients that often require no intervention and heal with remodeling. Usually occurs in the forearm but can also be found in the tibia, fibula, and femur. Bowing fractures happen when an angulated longitudinal force is applied and the bone bends. If left untreated significant deformity may occur. This type of fracture will appear curved, and the patient will have limited movement of supination and pronation of the hand.A bowing fracture is usually accompanied by another type of fracture. Treatment is determined due to the severity of the injury. Depending on the child's age and degree of bowing will determine if a reduction (setting the fracture back in place) of the fracture will be needed. If the angulation of the fracture is greater than 20 degrees, the fracture will require a reduction. The reduction can include placing a rod down the fractured bone. For angulation of less than 20 degrees the patient would just need a splint for support.

Barrett's Esophagus

❖ is a disorder of the lower esophagus marked by a benign ulcer-like lesion in columnar epithelium, resulting most often from chronic irritation of the esophagus by gastric reflux of acidic digestive juices. This is a precursor to esophageal cancer. The symptoms include heartburn, difficulty or painful swallowing, constant sore throat, vomiting and blood in stool. The recommended treatment for this disorder is to have an endoscopic resection to remove the damaged tissue and possibly radiofrequency ablation following the resection. Even though this disorder is a precursor to esophageal cancer, only approximately 10% of individuals with Barrett's Esophagus actually develop cancer. The prognosis is good as long as you monitor the condition.