Category Archives: blog

Treating Common Knee Injuries with PRP Therapy

By  david@ogrelogic.com  published  December 27, 2018

Meniscus tears are the most common knee injuries. These injuries can affect either the medial or lateral meniscus. Tears may occur because of a sudden, twisting motion resulting in –

  • pain
  • swelling
  • ‘catching’ or ‘locking’ sensation

If the physical examination by the orthopedic surgeon shows a torn meniscus, an MRI can be advised for confirmation.

Initially, meniscus tears are treated conservatively with rest, ice and NSAIDs (Non-Steroidal Anti-Inflammatory Drugs), such as ibuprofen, naproxen. It may be complemented with physical therapy for muscle strength and improved range of motion. Arthroscopic surgery may be recommended for severe cases.

However, now a highly effective, non-surgical intervention is available – PRP therapy. PRP or Platelet Rich Plasma therapy uses concentrated platelets from your own blood. With the help of ultrasound guidance, the injection is administered into the tear, allowing the tear to heal naturally. The injection is given under local anesthesia in an outpatient setting.

Other common knee injuries are –

  • ACL or Anterior Cruciate Ligament tear

This tear occurs as the result of a sudden stopping, sudden change in direction or hyperextension. This could be accompanied with a ‘popping’ sensation followed by deep pain, swelling, and instability.

  • PCL or Posterior Cruciate Ligament tear

The PCL can become inured due to a force to the anterior shin bone when the knee is flexed.

Both ACL and PCL tear can be treated with PRP therapy, stimulating the body’s natural healing mechanism.

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Wrist Splint for Fracture

By  aenriquez  published  December 18, 2018

The wrist is subject to fractures due to falling with outstretched or flexed hand. This can happen in a car, bike, skiing accident or with certain other sports activities. There are two bones in the forearm including the radius and ulna. The radius is on the thumb side. A fracture of the radius near the wrist is called a distal radius fracture.

 

Splinting is one choice for immobilizing the fracture and is commonly used for wrist fractures, reduced joint dislocations, sprains, soft tissue injury, and post-laceration repairs. Splints are mainly to immobilize and protect the injured wrist, aid in healing and decrease pain. Splints are primarily used for extremity injuries. Good anatomical fracture alignment is important.

 

There are a variety of splints used to treat fractures of the wrist and forearm. The splint used depends on the location of the fracture. These splints include:

  • Volar short arm splint
  • Dorsal short arm splint
  • Single sugar-tong
  • Long arm posterior
  • Double sugar-tong
  • Long arm

For immediate treatment, a splint may be applied to reduce pain and provide some comfort

There are two types of distal radius fractures called a Colles or Smith fracture. Determining the break depends on the angle at which the break occurs.

  • Colles fracture: results from a direct impact on the palm of the hand; a bump in the wrist results from the distal radius shifting toward the back of the hand.
  • Smith fracture is less common and can result from impact to the back of the wrist; a bump in the palm side of the wrist results when the distal radius shifts toward the back of the hand.

 

Wrist fracture symptoms include:

  • immediate pain when area is touched
  • bruising and swelling
  • deformity

 

Treatment for a distal radius fracture is dependent on several factors. For immediate treatment, a splint may be applied to reduce pain and provide some comfort. If the fracture is displaced it is put back into correct alignment under local anesthetic before application of the splint.  Additional factors influencing treatment are:

  • whether bones have shifted (displaced)
  • if there are multiple fractures presentation
  • involvement of the joint
  • ulnar fracture with injury to median nerve
  • whether it is the dominant hand
  • occupation and activity level

 

Once the fracture is in good position, a splint or cast is applied. The splint (or cast) will remain in place for approximately 6 weeks. A removable splint will be worn after that to allow physical therapy to regain proper wrist function and strength. X-rays may be taken at 3 weeks and 6 weeks to assess healing of fractures that were reduced or unstable.

 

It is still important to be aware of potential complications that require additional monitoring. Complications from immobilization include:

  • joint stiffness
  • muscle atrophy
  • complex regional pain syndrome

 

The fractured extremity should be immediately evaluated if:

  • pain worsens or does not improve after medications
  • cast or splint becomes damaged, breaks, or gets wet
  • hands/fingers feel numb or cold
  • hands/fingers turn blue or white
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Femur Fracture Complications

By  aenriquez  published  December 14, 2018

The femur is the biggest and generally the strongest bone in the human body. Fractures take a long time to heal. Normal activities of daily living are impacted as it is the main bone used for walking and standing.  Depending on the type of fracture and potential complications the impact will last a lifetime.

There are several types of fractures. Each has its own characteristics. Each fracture is dependent on the force that breaks the femur.

Elderly people are subject to femoral breaks from falling due to weak bones

These types of fractures include:

  • stable fracture – pieces of bone line up
  • displaced fracture – bone is out of alignment
  • closed fracture – the skin remains intact
  • open fracture – bone punctures the skin

 

Fractures are classified by:

  • location – distal, medial, proximal
  • pattern – bone breaks in different directions (crosswise, lengthwise, in the middle)
  • skin and muscle damage

 

The most common femoral shaft fractures include:

  • transverse – straight horizontal break across the shaft
  • oblique – angled line across the shaft
  • spiral – spirals the bone shaft caused by a twisting force
  • open – bone or fragments stick through the skin; also known as a compound fracture; there is damage to tissues, tendons, and ligaments. High risk of complications.
  • comminuted – bone breaks into three or more pieces

 

Common symptoms noted with a femoral break include:

  • immediate severe pain
  • cannot bear weight
  • injured leg appears to be shorter and/or looks crooked

 

A femoral fracture is normally found in severe accidents such as an automobile accident. Elderly people are subject to femoral breaks from falling due to weak bones. Hip fractures are also common with the elderly.

 

Common complications from femur fractures are related to the following:

  • the bone must be set properly – there’s a chance injured leg may become shorter and can cause chronic hip and knee pain; poor alignment can be painful
  • peripheral injury – muscles, ligaments, and tissues can be damaged
  • surgical – infection or blood clots, common surgical risks
  • Compartment syndrome

 

 

On a special note: Compartment syndrome is caused when increased pressure inside a closed space, that compromises circulation and function of surrounding tissues. Temporary or permanent damage to muscles and nerves may result in temporary or permanent damage.

Compartment syndrome may be:

  • Acute – most often caused by trauma, generally more minor. Prompt diagnosis and urgent treatment are required.
  • Chronic – usually caused by exercise. Symptoms begin with recurrent pain and disability. These symptoms may subside when the cause (usually running) is stopped and returns when activity is resumed.

The bones have many blood vessels that help promote healing. With time, the body will regenerate and further promote healing. Practice caution to prevent a re-fracture.

A diet that contains bone-boosting foods like calcium and vitamin D helps with healing, as well as, using protective gear that can help prevent future fracture.

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What does your Knee Pain indicate?

By  david@ogrelogic.com  published  November 16, 2018

The Knee Joint

The knee is the largest bone joint in the body that allows you to run, walk, stand, sit, bend your legs, pivot, swivel and more. The knee joint consists of bones, cartilage, muscles, ligaments, and tendons, all working together. Three bones – the tibia (shinbone), the femur (thighbone) and the patella (kneecap) come together at the knee joint.

Knee Pain

Knee injuries are complicated because they can be the result of damage or injury to any of the several parts that make up the knee. It is also important to understand that the knee functions between two very mobile joints – the hip and the foot. Injury to the hip or foot can also affect the mobility of the knee.

With age, the strain on our knees increases and pain and discomfort become common complaints. However, the pain may also result from injury or an underlying condition, apart from aging. An experienced orthopedic doctor or surgeon can make an accurate diagnosis of the cause of knee pain and treat it.

Depending on its location, different problems can be responsible for knee pain.

  • Front of the knee – related to kneecap injury or damage
  • Inside or medial side of knee – related to medial meniscus tears, MCL injuries, and arthritis
  • Outside or lateral side of knee – often caused by lateral meniscus tears, LCL injuries, IT band tendonitis, and arthritis
  • Back of knee – due to the collection of fluid, also referred to as a Baker’s Cyst
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Nursing Management of Fracture

By  aenriquez  published  November 14, 2018

Fracture stabilization is the use of a variety of processes to enhance the healing of bone fractures. There are several methods including surgical, non-surgical, minimally invasive (vertebroplasty, fusion, kyphoplasty). Fracture stabilization gives pain relief and prevents further damage to soft tissue and bone.

 

There are closed and open fractures. With open fracture surrounding tissues and bone are visible. Fractures may include one or more bones and can be a clean break or shattered into numerous pieces. Breaks are a traumatic injury to the bone, tissues, and individual.

 

There are five classifications of fractures. These include:

  • Greenstick – found in children, incomplete fracture where the bone is bent
  • Transverse
  • Oblique – pattern of curves and slopes
  • Comminuted – bone breaks into pieces
  • Impacted/Buckle Fracture – bone ends are driven into each other

Early stabilization leads to better outcomes, such as less complications, shorter hospitalization, and lower cost

In addition, a pathological fracture is due to bone weakness, stress, and hairline fracture.

 

The doctor will diagnose the type of fracture by physical exam, x-ray, and MRI.

With a stable fracture, minimal treatment is required. In a stable fracture, the bone just breaks in one place and is easier to fix.

 

An unstable fracture can result from a car accident, falls, and other high impact situations. They may be accompanied by other serious injuries as well. Surgery is always required to fix the fracture. Symptoms of an unstable fracture include:

 

  • excruciating pain
  • bone showing through the skin
  • swelling and numbness

 

Early stabilization leads to better outcomes, such as fewer complications, shorter hospitalization, and lower cost. However, it may be contraindicated if there are head injuries, internal injuries, and other risk factors.

 

There are a number of options including the following:

  • External fixation -Pins and rods are placed outside the extremity
  • Internal fixation – Fracture is aligned and plates and pins are placed to hold the pieces together
  • Ring fixator or Taylor Spatial Frame – used if there is a deformity to be corrected

 

An unstable fracture is a severe injury. It is normally treated with the bone reduction and the bone may still slip out of place. This makes it difficult for the bone to be realigned. The bone is shattered into fragments, and it may not be possible to put all the broken pieces back in place.

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Arthroscopic Surgery – Going Inside the Body

By  aenriquez  published  October 31, 2018

Arthroscopic surgery uses a tiny camera (arthroscope) to examine, diagnose and repair damaged tissues inside or around joint like the shoulder or knee. A small incision is made into the skin and the arthroscope is inserted into the area being examined. The number of incisions needed is determined by what needs to be done.

Benefits of arthroscopic surgery are smaller incisions and less damage. Some physicians prefer open surgery because the structures are visible to the naked eye. It depends on what needs to be done, the specific condition, and surgeon experience.

 

There are several shoulder conditions that are repaired with arthroscopy. They include:

  • Rotator Cuff tears
  • Shoulder instability – Labral tears
  • Shoulder bursitis
  • Bicep tendonitis
  • Frozen shoulder
  • AC joint arthritis
  • Bone spurs
  • Repair ligaments
  • Remove inflamed tissue or loose cartilage
  • recurrent shoulder dislocation

Less common repairs include nerve release, fracture repair, and cyst removal.

Following surgery, someone should drive you home. Drowsiness may be felt for two or three days following the surgery. Follow post-op guidelines once home.

Guidelines include:

  • wound care- keep the site clean and dry.
  • Pain control – apply ice during the first 24 hours to reduce swelling, take pain medications as prescribed, Do Not drink alcohol
  • return to activity per doctors instructions

Complications of arthroscopy are uncommon but, may include shoulder stiffness and prolonged rehabilitation

Complications of arthroscopy are uncommon but, may include shoulder stiffness and prolonged rehabilitation. There is one rare complication called chondrolysis (damages cartilage) and can lead to frozen shoulder. Other possible complications include:

  • Infection
  • head or neck injury
  • excessive bleeding
  • blood clots
  • damage to blood vessels or nerves.

 

Rehabilitation plays a huge role in regaining use of the of the joint and resuming daily activities. An exercise program should aim at regaining shoulder strength and movement.

With more complicated repair, physical therapy will be ordered so a physical therapist can supervise the exercise program.

Depending on the health condition treated, recovery times vary. A minor repair may only require a sling and a short period of physical therapy. It will take longer to recuperate from a more complicated surgery.  Full recovery could take several months of physical therapy. Healing is a slow process. Surgeons guidelines and a good rehabilitation plan are important for a successful outcome, as well as, personal participation in the healing process.

Due to the fact that shoulder surgery hurts less, patients tend to do more too soon. The area may feel fine but still needs adequate time to completely heal. Too much activity too soon can cause recurrence of the condition or other damage to repaired tissues.

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Shoulder Dislocation Symptoms

By  david@ogrelogic.com  published  October 24, 2018

Shoulder dislocation is a painful injury. It is common among athletes and may result from a fall or other trauma to the joint. Because the shoulder is a highly mobile joint, it is also at risk for easy dislocation.

Shoulder dislocation can be 2 different types –

  • partial dislocation or subluxation – caused when the top of the humerus bone is partly out of the socket.
  • complete dislocation – when the top of humerus comes completely out of the socket.

The shoulder can dislocate downward, backward or forward.

Symptoms of Shoulder Dislocation

  • pain in and around the shoulder joint
  • swelling around the shoulder
  • shoulder joint stiffness
  • weakness and/or numbness in the shoulder
  • bruising in the shoulder region
  • shoulder instability

Any combination of the above symptoms can mean a dislocated shoulder. It is best to have your shoulder examined by an orthopedic surgeon.

Whether your shoulder dislocation has happened for the first time or it is a repeat injury, it is important to have it diagnose and treated right away. The surgeon will be able to restore the joint into the correct place and provide immediate relief. This process is known as a closed reduction. Afterwards, your doctor may refer you to a physical therapist in order to help the joint become stronger and prevent future re-injury.

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Everything About Kneecap Fracture

By  aenriquez  published  October 19, 2018

The patella is one of three bones that make up the kneecap. It is covered in cartilage on the underside and is important in maintaining the strength of straightening the knee joint. A fracture is a break in the bone. A fracture usually happens when there is a direct fall onto the kneecap.

A fracture like this can also damage the underlying soft tissue and the skin and result in an open fracture. A fracture can also occur when the quadriceps muscles contract but the knee is straight. When the muscle pulls forcefully the patella can fracture.

Sometimes the patella can fracture with a minor injury, but this is often a result of weak bones which can be caused by osteoporosis.

Names of fractures include:

  • eccentric
  • pathological
  • open fracture

 

Patella fractures can be severely painful and make it difficult to walk.

Signs of a patella fracture include:

  • severe pain
  • swelling and bruising on the front of the knee. After a few days, swelling and bruising may extend down the leg.
  • Inability to lift foot; straight leg lift is used in diagnosing this injury.
  • With palpation a break is felt; This may not be possible if there is considerable swelling.

Damage to the knee joint cartilage can result in a higher chance of arthritis in the joint

Treatment includes an exam in the emergency room and an x-ray to determine how bad the break is, as well as, determine the type of break. One critical factor is the ability to do a straight leg raise from a laying position.

This tests the quadriceps muscle and its attachment to the shin bone (tibia). A separation of the quadriceps tendon, patella and/or the patella tendon cause the inability to lift the leg. If the leg can be lifted then non-surgical treatment could be possible in order to set the fracture.

Knee swelling is common and is from the bleeding from the fractured ends of the bone. If there is a large amount of bleeding then an aspiration would be done to remove the blood resulting in pain relief. In addition, a knee immobilizer will decrease the discomfort from the injury.

Minimally displaced fractures or non-separated fractures can usually be treated without surgery. An immobilizer or a straight leg cast may be sufficient treatment.

Surgical intervention is necessary for displaced separated fractures. The process involves:

  • an incision over the front of the knee
  • the fractured ends are realigned
  • pins, screws or wires are used to hold it in place
  • in some cases, a piece can be removed ( a smaller fracture or fragments)

 

A common complication of patella fracture surgery is the metal implants can become painful especially when able to kneel. Often there is a second surgery to remove the hardware. This can be done a year after the first surgery.

An important aspect of surgery is to repair the cartilage to prevent the development of arthritis of the knee joint. Damage to the knee joint cartilage can result in a higher chance of arthritis in the joint.

 

Other possible complications may include:

  • infections
  • failure of the hardware to hold pieces in place
  • the fracture does not heal
  • kneecap pain
  • possibly knee arthritis

 

Rehab will be needed once the kneecap has healed sufficiently as the knee is kept straight initially to allow healing. Being able to move the knee will depend on the strength of the repair but gentle movement may begin within the first few weeks after surgery.

 

FXRX INC has experience in fixing fractures of all types. For consultation – contact the office at 480-449-FXRX (3979)

1215 W. Rio Salado Parkway
Suite 105
Tempe, AZ 85281

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A Variety of Treatment Options for Closed Fracture Healing

By  aenriquez  published  October 2, 2018

Let’s discuss what a closed fracture is and then look at the list of treatment options.  Be open to choosing the best healing protocol for you!

Closed fractures are classified as “simple fractures” that do not puncture the skin.  Although the skin is not penetrated, soft – tissue injury can be acute and alternate treatments will be offered.  In some cases, surgical procedures may be imminent.

Mainly, closed fractures occur from sports injuries, car accidents, accidental falls and a severe hit to the injured area.

You are at greater risk for a closed fracture if you are elderly, have osteoporosis, smoke or consume excessive amounts of alcohol (which makes bones brittle), steroid use, or lengthily resting periods (which make bones stiff – causing increased risk of fractures).

Please note – not all closed fractures require an intervention.  Some can heal on their own, over time.

It is best to know which fracture treatments are available and which ones you prefer before making an informed decision.

When our doctor’s access treatment options, we look at these factors; age, what does our patient prefer and surgeon preferences (if need be).

Orthopedic doctors vary in their responses as to what form(s) will be best for your closed fracture.  Patients can appear to be in shock, so first, we ease their minds with simple reassurance and inspiration.  Next, we elevate the area (if possible) to reduce swelling and throbbing, along with keeping it still to prevent any additional damage.  We are extremely careful not to irritate existing injuries and will need to take X – Rays to ensure the extent of damage.  Doctors take into consideration the severity and recommend accordingly, avoiding surgery (if possible).

Some of the most common forms of treatment options are below:

Disable Movement:  some bone fractures do not require an intervention.  We classify them as “stable” and they can be monitored without immobilization.

Slings or “Walking Boots” might just do the trick in properly healing your simple fracture, where no further treatment is necessary.  When you force the fracture to stay stationary, for an extended period of time, you allow it enough of a grace period to heal.

Casts prevent further damage, hold bones in place and stabilize the alignment of the fracture.

Surgery is the last resort to fixing a closed fracture and would be utilized in extreme cases only unless pain is unbearable at the wound site.

At FXRX Orthopedics and Bracing, we offer medical fracture treatment for the following bones https://www.fxrxinc.com/fracturetreatment.html.

Our patients have many good things to say about our caring staff and state of the art facility.

“When I considered total knee replacement, like most people, I was anxious, but when I met Dr. D, he was very reassuring.  I did not feel rushed during our discussion or when scheduling surgery.  My surgery went very well.  I was up and walking soon.  I am walking my dogs again and feeling stronger in both legs.  I have respect for Dr. D not only as a surgeon but as a kind and caring person.”  Debbie R., Phoenix

Our staff is dedicated to providing the best care for you and your injury.

If you would like to schedule an appointment – you can do so here https://www.fxrxinc.com/fracturetreatment.html

 

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How to Deal with Emotional Issues During Orthopedic Treatment

By  aenriquez  published  September 29, 2018

Feeling a bit under the weather, during times of physical impairment?  Have you ever wondered if these midday blues will ever go away?  You might be asking yourself, what is the problem with me?  This is all normal during times of physical pain and treatment.

You just had surgery or are going to have a surgical procedure and you feel anxious.  You are nervous if the surgery will be successful or if you will ever feel the same again.  Will you be able to bend the same, walk normally, eliminate the pain and recover in a timely manner?  You have a right to ponder these unanswered questions.

Sometimes people don’t need advice or neurofeedback or a psychological evaluation.  What people need is family and friends to support them through difficulties and to listen while you vent.  It is very helpful to have people you care about understand your valid concerns.

When you face physical challenges and you must undergo a surgical procedure, it can bring about an onset of feeling anxious and potential depressive states.

What can I do about my emotional issues pre and post-surgery? 

It is extremely difficult to relax, but this one is a big solution to your bouts of anxiousness.  The old saying of mind over matter is powerful for the results that follow.  Lay down in a serene environment and visualize something happy.  When our thoughts are eased, our emotions remain calm as well.

It is also very beneficial to exercise self-care.  For example, take a hot bath (if you can), listen to soothing music, watch a Netflix series, read a book, meditate, pray, call a trusted friend, and write in a journal.

It is beyond frustrating when you are physically unable to walk, exercise or take a regular shower.  People internalize their aggravation and lack the coping skills to stabilize their moods and anxiety.

Part of the healing process prior to and after surgery is lovingly taking care of your mind, emotions and feelings, so you do not experience nerve-racking, uncontrollable episodes.  What we think about, we bring about.  We must learn to feed our mind positive words of affirmation and not negative ones, or we will become mentally exhausted.

The last resort would be to put a patient on a low dose of anti-depressant medication if they cannot learn to manage their emotions and become too stressed out.  Having a surgical procedure is very stressful as well and learning to deal with the pain it brings.  It is not easy to find the proper social support that is needed during fearful times. Worry takes over our once sound mind and produces negative side effects such as headaches, stomachaches, low sex drive, acne, decreased immune functioning and even suicidal thoughts.

Our biggest recommendation is to ASK for help and allow others to be there for you and let trained experts provide treatment, that will solve your issues.

FXRX employs the best medical staff to alleviate pain, but we are also here to assist in making sure you are mentally tranquil as well.  If you have questions, please email us or request an appointment https://www.fxrxinc.com/blog.html.

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