Tibial Plateau Fractures

Tibial plateau fractures are fracturs that occurs at the top of the tibia, and involves the cartilage surface of the knee joint. These type of fractures can be non-displaced (meaning relatively aligned) or displaced (meaning not in alignment). A non-displaced fracture can often be taken care of non-surgically, but require restricted activities. When a displaced fracture occurs, normally surgery is the option that must be taken to ensure adequate healing.

Recovery from a tibial plateau fracture can take several months. Because the cartilage is involved, the patient must take every precaution to keep the affected extremity from weight until healing is documented. Each injury will require its' own healing time and appropriate restrictions. Healing varys per patient and injury.

Scaphoid Fractures

Scaphoid fractures are one of the more common fractures in the wrist. They most often occur when you brace yourself from a fall or through a sports injury. Once a clinical exam occurs, most physicians will order a routine radiograph of the wrist. Scaphoid fractures most often do not cause much swelling and bruising so at times treatment may be delayed for some patients. Many times, the fracture will be visible on the xray. If, however, the exam is negative but their is continued suspician a CT of the wrist will be performed. This exam is readily available and is quick and less costly than an MRI. CT provides excellent boney detail. Scaphoid fractures respond well to treatment and will heal nicely. However, if one does not get treated the fracture can heal unevenly and cause long term pain and also arthritis. Above are some images of scaphoid fractures.

Labral Tear of the Shoulder

The labrum is a thin piece of cartilage in the shoulder that is rigid and fibrous. The labrum has two functions. The first is to keep the "ball" or head of the humerus in place and the other main job for the labrum is to keep structures and tissues around the shoulder together.

Labral tears usually involve trauma to the shoulder of some sort, either by dislocation or fractures. The labrum usually will not heal in the right location on its' own.

Imaging of the shoulder for labral tears includes either a CT or MRI arthrogram. This test requires a radiologist to inject contrast media into the bursa prior to either the CT or MRI. Both tests are fairly accurate but can miss small tears. This is why surgery is often required for this condition. If MRI/CT demonstrates a tear then it will always be present during surgery. However, if the tear is not complete or "frayed", sometimes surgery isn't necessary.

Recovery is good post op, however it can take up to 6 weeks for the labrum to recover.

Cervical Cancer

Many women pass symptoms of cervical cancer off as PMS. Often by the time symptoms accumulate the cancer is far progressed. Symptoms of cervical cancer include: unusual heavy discharge, pelvic pain that is not related to the menstrual cycle, dysuria, bleeding between cycles or after intercourse or a pelvic exam.

Increased risk factors include having multiple sexual partners or a partner with multiple sexual partners, having many children, being on birth control pills for extended time - however studies have shown that a woman's risk is dramatically reduced after ceasing taking them and a lack of pap smears

Once an abnormal pap smear result is received a biopsy will be performed to give a more definitive diagnosis. Once cervical cancer is found, CT and MRI's are often done to ensure the cancer has not spread, causing metastatic disease. A PET scan could be performed to stage the cancer and help plan the best radiation or chemotherapy to fight the cancer after surgery.

Cervical cancer is one of the most preventable types of cancers. With regular pap smears cervical cancer can be prevented in most cases. Survival rates have gone up tremendously since more and more women get an annual pap smear.

Pancreatitis

Acute pancreatitis is an inflammation of the pancreas. The pancreas is an organ that secretes insulin and glucagon and also aids in digestion.

Symptoms most often include left upper quadrant abdominal pain, fever, nausea and vomiting. This disease is often is a result of gallbladder dysfunction or alcoholism.

Treatment for pancreatitis usually includes IV pain medication due to the severe abdominal pain. It also requires IV fluids and withholding food to attempt to keep the pancreas inactive. This allows time for the inflamed pancreas to resolve. If medication does not work, then the next steps include removing gallstones or to place a stent in the pancreas and to drain fluid from around the pancreas. This is done oftentimes in Radiology under fluoro during a procedure called ERCP or endoscopic retrograde cholangiopancreatography.

This disease is treatable and nearly all recover. However, there is a small percentage that can develop chronic pancreatitis as well.

Empyema

Empyema is a collection of pus in between the space of the lung and chest wall. It is an infection that spreads from the lungs and leads to a build up of fluid in the pleural space. Symptoms of this condition include chest pain, cough, dyspnea, fever, and sometimes weight loss.
Empyema has several possible causes but is most often is an associated complication of pneumonia.

There are three phases of empyema. The acute phase that fills the lung cavity with thin purulent fluid, second stage in which the fluid thickens, and then a third stage in which the lung is covered with a thick fibrous material. The third phase can only be cured with a thoracotomy to remove that thick fluid and scrape the lining of the lung of the fibrous material. In the earlier phases antibiotics or drainages can help clear the infection.

When this infection complicates pneumonia it raises the risk of death and permanent damage to lung tissue significantly. But, with long term antibiotic therapy and drainages the patient most often recovers.

Kyphoplasty for compression fractures of thoracic spine

When particular patients are assessed after a spinal fracture and meet certain guidelines, their physician may recommend a procedure called kyphoplasty. These patients usually have a pathologic fracture or a fracture due to osteoporosis. Osteoporosis weakens the bone and makes the simplest fall or cough a major problem.

The goal of this procedure is to help relieve pain from the spine due to fracture and to stabilize the spine as well. The other goal is to return loss of height to the vertebral body.

The exam is usually done in a Special Procedures lab or an OR setting. The physician will insert a balloon into the vertebrae and inject a special filler that is a hard cement like material that expands. This assists with the bone height loss due to the compression fracture. After the procedure is over many patients immediately feel relief. To document the placement a CT scan is done post procedure. I've attached some images of a pre kyphoplasty patient with a t12 compression fracture and then the same patient's post exam.