End of Day 2
Mummy is doing much better today.
She is awake a little bit longer. She spoke with Bina who is staying with her during the night in the ICU area. She is likely to be moved out of the ICU after one more day.
She drank a glass of milk today.
She will not be operated upon.
Mummy has four fractures:
pelvic area:
Pubic Ramii
Sacrum
upper body fractures:
Proximal Humeral
Scapula
http://www.merck.com/mrkshared/mm_geriatrics/sec2/ch22.jsp
Pubic ramus fractures are usually caused by a fall on level ground. The pubic and ischial rami on one or both sides of the symphysis pubis may be fractured. Normally, the pelvis bears weight mainly on the strong bony arches in the ilium, with the pubic and ischial rami acting as secondary tie arches. When trauma to the pelvis occurs, the rami tend to fracture first, leaving the iliac arches intact. Patients present with groin pain that may prevent them from walking. However, because the rami are not needed for structural support for walking, weight bearing need not be restricted when the pain eases. The clinical appearance mimics that of a proximal femoral fracture. Localized tenderness in the groin and pain during leg movement suggest the diagnosis; x-rays confirm it.
Prognosis and Treatment
Pubic ramus fractures typically heal without causing permanent functional disabilities. Most patients feel considerable pain when standing or sitting and should be admitted to a hospital or skilled nursing care facility for monitoring of Hct and vital signs. Analgesics and nonsteroidal anti-inflammatory drugs help relieve pain. To avoid the complications associated with bed rest, patients should begin to walk, bearing weight fully, as soon as possible. Most can walk short distances with a walker by 1 week and are moderately comfortable in 1 to 2 months.
Proximal humeral fractures are most commonly caused by falling on an outstretched arm. Patients present with shoulder pain and inability to move the arm. ...
Prognosis and treatment depend on the number of fragments and the extent of displacement. Regaining the ability to perform overhead activities (eg, combing hair) may take several months.
If the alignment and position of fragments are satisfactory, the arm may be immobilized in a sling. If they are unsatisfactory, an orthopedist may attempt closed reduction. If closed reduction is unsuccessful, open reduction with internal fixation or insertion of a prosthesis may be indicated. Patients should be told to expect considerable swelling and discoloration, which will spread to the lower arm and hand.
For stable fractures, the patient should be encouraged to use the hand and wrist immediately.
She is awake a little bit longer. She spoke with Bina who is staying with her during the night in the ICU area. She is likely to be moved out of the ICU after one more day.
She drank a glass of milk today.
She will not be operated upon.
Mummy has four fractures:
pelvic area:
Pubic Ramii
Sacrum
upper body fractures:
Proximal Humeral
Scapula
http://www.merck.com/mrkshared/mm_geriatrics/sec2/ch22.jsp
Pubic ramus fractures are usually caused by a fall on level ground. The pubic and ischial rami on one or both sides of the symphysis pubis may be fractured. Normally, the pelvis bears weight mainly on the strong bony arches in the ilium, with the pubic and ischial rami acting as secondary tie arches. When trauma to the pelvis occurs, the rami tend to fracture first, leaving the iliac arches intact. Patients present with groin pain that may prevent them from walking. However, because the rami are not needed for structural support for walking, weight bearing need not be restricted when the pain eases. The clinical appearance mimics that of a proximal femoral fracture. Localized tenderness in the groin and pain during leg movement suggest the diagnosis; x-rays confirm it.
Prognosis and Treatment
Pubic ramus fractures typically heal without causing permanent functional disabilities. Most patients feel considerable pain when standing or sitting and should be admitted to a hospital or skilled nursing care facility for monitoring of Hct and vital signs. Analgesics and nonsteroidal anti-inflammatory drugs help relieve pain. To avoid the complications associated with bed rest, patients should begin to walk, bearing weight fully, as soon as possible. Most can walk short distances with a walker by 1 week and are moderately comfortable in 1 to 2 months.
Proximal humeral fractures are most commonly caused by falling on an outstretched arm. Patients present with shoulder pain and inability to move the arm. ...
Prognosis and treatment depend on the number of fragments and the extent of displacement. Regaining the ability to perform overhead activities (eg, combing hair) may take several months.
If the alignment and position of fragments are satisfactory, the arm may be immobilized in a sling. If they are unsatisfactory, an orthopedist may attempt closed reduction. If closed reduction is unsuccessful, open reduction with internal fixation or insertion of a prosthesis may be indicated. Patients should be told to expect considerable swelling and discoloration, which will spread to the lower arm and hand.
For stable fractures, the patient should be encouraged to use the hand and wrist immediately.
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