the fractures diagnosed after radiographs were:
LEFT - distal radius, open at ulnar syloid.severly comminuted distal
humerus (trans and intercondylar, intra-articular) with posterior
dislocation of elbow.
RIGHT - distal radius, comminuted open midshaft radius/ulna (Gustillo IIIb
I believe)
Plus - smashed left acetabulum with some medial displacement of fragments
into the pelvis, posterior left hip dislocation, symphysis disruption -
widened and vertically displaced. Undoubtably some posterior disruption as
well.
>Ah, a subtle philosophical distinction, I suppose, but valid nonetheless!
I figure the bracing must mean the upper limb fractures which Vic has
described, but I didn't think you'd see a Monteggia from "bracing". Surely
bracing would produce a similar pattern to a fall on the outstretched hand?
And judging from the other injuries, I suspect that this vehicle was truly
"compressed", so the Monteggia was probably as a result of a direct blow on
the dash or steering wheel, rather than a bracing injury. Still not sure
about dash roll though!
>
>Adrian
>
>> from: Paul Bailey <[log in to unmask]>
>> date: Thu, 01 May 2003 08:58:41
>> to: [log in to unmask]
>> subject: Re: Ideas please....
>>
>> Adrian,
>> an MVC is a Motor Vehicle Crash. The simple fact of the matter is that
most
>> of them aren't 'accidents' in the true sense of the word. ie they're
not
>> unforseen, involuntary or lacking in intention, but mostly due to bad
>> driving - ie excessive speed, ethanol, not obeying road rules -
>> intentionally.......
>>
>> Hope this helps.
>>
>> Paul
>>
>> ----- Original Message -----
>> From: "Adrian Fogarty" <[log in to unmask]>
>> To: <[log in to unmask]>
>> Sent: Thursday, May 01, 2003 3:50 PM
>> Subject: Fw: Ideas please....
>>
>>
>> > Before this thread runs out, could you translate some things for me,
Vic,
>> > and for all those other obligate anaerobes (hospital dwellers) on the
>> list?
>> >
>> > 1 What's a dash roll?
>> >
>> > 2 What are bracing fractures (I've never heard of this term in
hospital
>> > before)?
>> >
>> > 3 What's an MVC (sounds like a chain of stores that sells music and
>> > videos in this part of the world, but I presume it's a variant of MVA
>> which
>> > is north American for RTA)?
>> >
>> > Adrian
>> >
>> > > > -----Original Message-----
>> > > > From: [log in to unmask]
>> > > > [mailto:[log in to unmask]] On Behalf Of Vic Calland
>> > > > Sent: 30 April 2003 10:54
>> > > > To: [log in to unmask]
>> > > > Subject: Ideas please....
>> > > >
>> > > > Attended a MVC last night. Driver doing a 100mph plus put his car
>> under
>> > > > the end of an HGV only doing 50mph. Dragged 200-300 yards down the
>> road
>> > > > as the driver of the lorry regained control and came to a halt.
>> > > >
>> > > > Driver was late twenties, physically fit but on the heavier end of
>> > > > normal weight range. Trapped upright until the fire crew did a
dash
>> > > > roll. Had 8cm transverse laceration of forehead with bit of skull
in
>> > > > wound but amazingly had GCS of 12-13. Had bilateral bracing
fractures;
>> > > > left elbow was a posterior dislocation, radius & ulna a comminuted
>> > > > compound fracture as crunchy as a bag of crisps; his right was a
more
>> > > > classical Monteggia apart from the fact it was compound and the
bone
>> was
>> > > > protruding. He also has a fractured pelvis with a dislocation of
the
>> > > > left hip.
>> > > >
>> > > > He had breath sounds bilaterally so we didn't realise he had a
>> ruptured
>> > > > left hemidiaphragm until the CXR came back. At the time he wasn't
too
>> > > > shut down, so we splinted the arms, gave him 50mg Ketamine im and
free
>> > > > flow Entonox for the extrication (long board to the rear). We were
>> only
>> > > > 5 minutes from the hospital so we ran with him rather than
established
>> > > > an i.v. on scene. There they ended up with a right femoral vein
access
>> > > > with a "security guard" watching it.
>> > > >
>> > > > I'd be interested to know if anyone has clever ideas for dealing
with
>> > > > this kind of situation because his pain relief was not ideal by
any
>> > > > means.
>> > > >
>> > > > Vic Calland
>> > > >
>> > >
>> >
>
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>
>
Dr.Marten C. Howes MRCP(UK) FFAEM
Specialist Registrar
Accident and Emergency Medicine
Royal Preston Hospital
Preston
PR2 9HT
Lancashire, UK
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