Showing posts with label fractures. Show all posts
Showing posts with label fractures. Show all posts

Saturday, September 10, 2011

SAFETY AT THE PLAYGROUND


Due to its location in a residential area, the hospital sees a fair amount of injuries involving children. The numbers seen in the emergency room usually correspond to the school holidays, where we see an increase in the number of children being brought in due to some kind of injury, usually due to a fall while playing.  I suppose the holidays are the time children are given more freedom to play outdoor, free from the pressures of homework and tuition.
The neighbourhood playground is a natural spot for children to congregate, interact and play; at the same time it helps to build their physical skills, co-ordination and strength. It is also a wonderful place for families to get some fresh air and exercise.  It may look like a safe place, but hidden dangers do lurk. The hospital had a “Smart Parent Safe Kids” campaign earlier this year where I gave a talk on prevention of playground injuries.  Why playground injuries? Well, apart from the home, accidents occur more frequently on the playground than any other places. 
In the US, more than 200,000 playground-related injuries occur annually. Similarly in Malaysia, a recent study has shown that 17% of childhood fractures occur in the parks, second only to the home (35%). Now scrapes and bruises are a normal part of growing up, but injuries that are brought to the hospital are usually of a more severe kind. We see sprains, fractures, dislocations, and rarely, amputated fingertips.



Children can injure themselves at the playground in a variety of ways.  As I have explained above, the majority of the injuries result from a fall from playground equipment. They might slip, lose their grip while climbing, or lose balance while playing on the “monkey bars”. Another way is by improper usage of equipment.
The onus is on parents and caregivers to create a safe environment for children to play. One should firstly choose a safe playground based on the location and surrounding hazards. Watch out for open drains, exposed electrical wires and busy roads among other things.
Close supervision by a responsible adult may be the most important factor in preventing playground injuries.  For young children, adults should be with them the whole time they are playing on play equipment. The word is “Active supervision” – one should not be distracted by other activities such as reading a book, talking on the phone or texting.  Although I do agree that  sometimes  adult supervision might be a problem in urban areas as both parents may be working, delegating this responsibility to the grandparents, housemaids or elder children might not be as effective.  Educating the child on the correct usage of play equipment not only decreases the chance of injuries but also goes a long way in preserving the lifespan of the play equipment.




All these might sound frightening, so should you stop sending your children to the playground? My thoughts are that the benefits of fresh air and exercise far outweigh the danger, and so long as mummy and daddy keep an eye and play an actively supervise, time spent at the playground need not end up a tearful experience.

-The BomohTulang 



Tuesday, November 16, 2010

Forearm - Single bone fracture

As I explained in the previous post, we had to operate on the patient with a forearm fracture.

Basically what she had was a fracture of the distal 1/3 of the radius with a concomitant dislocation of the distal radio-ulnar joint (the so-called "Galleazi Fracture" - medical students, take note :) )





Can we treat this non-surgically? I mean people have been treating fractures of the forearm with splints and POP for years right? Well with the advent of modern orthopedic management, that line of treatment has been largely abandoned.
We know that with this fracture, a treatment regimen consisting of closed reduction and cast immobilization has a high rate of unsatisfactory results. Patients will have problems with malunion, pain at the distal radio-ulnar joint, and worse still pronation and supination of the forearm will be severely compromised.
Therefore open reduction of the radial shaft fracture and internal fixation with dynamic compression plate is the treatment of choice in adults. Rigid anatomical fixation of the radial shaft fracture generally reduces the distal radioulnar joint dislocation.

Ladies and Gentlemen, I now present to you the post op x rays:




Tadaa! As you can see, the fractured bone has been aligned in place and the distal radio-ulnar joint is reduced.



Patient went back to work at 6 weeks.. as a GP (!)


- the BomohTulang -