This infection may spread into the fascial Custom mouth guards are made by a dentist after a spaces of the head and neck possibly causing airway complete dental examination and proper questioning generic 150 mg lithium overnight delivery. The infection may spread to the periorbital An impression is taken of the athlete’s mouth allow- area with complications such as loss of vision purchase lithium 300 mg, cav- ing the dentist to make a stone cast of the mouth. A ernous sinus thrombosis, and central nervous system single layer thermoplastic mouth guard material is (CNS) involvement. A vacuum custom mouth guard be placed on antibiotics and incision and drainage can be made in the office. CHAPTER 31 INFECTIOUS DISEASE AND THE ATHLETE 173 Increased evidence has shown that a multilayer guard or laboratory pressure laminated may be preferred to REFERENCES a single layer. These can either be made by the dentist in office if proper materials are available or need to be Cohen S. Louis, MO, When properly worn helmets and facemasks will Mosby, 2002, p 605. Am Fam sports: acrobatics, basketball, boxing, field hockey, Phys 67:3, 2003. Kenny DJ Barrett EJ: Recent developments in dental traumato- football, gymnastics, handball, ice hockey, lacrosse, logy. J Public Health Dent 58:289, squash, surfing, volleyball, water polo, weightlifting, 1998. Lee JL, Vann WF, Sigurdsson A: Management of avulsed perma- Injury rates in football rates have gone from 50% to nent incisors: A decision analysis based on hanging concepts. Phys Sportsmed Compliance can be a problem with mouth guard use— 28:1, 2000. DENTAL MAINTENANCE Trope M: Clinical management of the avulsed tooth: Present strategies and future directions. An initial compre- hensive dental examination should be performed, including chief complaint, health history, intraoral and extraoral examination, and radiographs where appli- cable; then the dentist will recommend a recall sched- 31 INFECTIOUS DISEASE ule as needed dictated by the evaluation. AND THE ATHLETE Oral jewelry has become a recent fad with the youth of this country. Dental professionals are advised to John P Metz, MD give these patients information about the problems that can occur with the jewelry.
Occasionally buy 150 mg lithium amex, in 5% of injuries buy 150 mg lithium otc, a fracture of the outer third of the clavicle may be seen and any displacement at this site is sug- gestive of coracoclavicular ligamentous damage. The coracoclavicular and acromioclavicular ligaments hold the clavicle in position and damage to these ligaments can result in clavicular subluxation or dislocation2 (Box 7. Salter-Harris type Features Diagram I Separation of the metaphysis and epiphysis which is seen radiographically as misalignment or widening of the physis Accounts for 6–8% of injuries and is most commonly seen in children under 5 years of age II Separation of physis (with or without misalignment) plus a metaphyseal fracture Commonest fracture pattern and accounts for 70% of injuries Most frequently seen in distal radius injuries and in children over 8 years of age III An intra-articular fracture through the epiphysis which results in a separated epiphyseal fragment Accounts for 7% of injuries and is commonly seen in the distal femoral and tibial epiphyses IV An intra-articular fracture through the epiphysis, physeal plate and metaphysis Accounts for approximately 12% of injuries and is most frequently seen in the lateral condyle of the humerus V Compression of the physis which has serious prognostic consequences This is the most serious physeal injury and accounts for 0. It is most commonly seen in the distal tibia and femur but can be difﬁcult to identify, particularly after fusion across the physis has begun in adolescence 134 Paediatric Radiography Fig. Type 1: Spraining of the acromioclavicular ligaments with no movement of the clavicle. Type 2:T earing of the acromioclavicular ligaments with coracoclavicular ligaments remaining intact. Minimal malalignment may be seen with displacement of the acromioclavicular joint of up to half the thickness of the clavicle. Type 3:T earing of both the acromioclavicular and the coracoclavicular ligaments with possible associated avulsion of the coracoid process. The acromioclavicular joint is widened and the clav- icle is seen above the level of the acromion process. The scapula The scapula is rarely fractured owing to its thick covering of muscles and there- fore signiﬁcant force is necessary to cause injury (e. The secondary ossiﬁcation centres on the lateral aspect of the acromion can cause confusion and it is important to remember that they do not appear until between the ages of 15 and 18 years and can be fragmented in appearance. The glenohumeral joint Dislocation at the glenohumeral joint is rare in children as the proximal humeral growth plate forms a natural line of weakness and will transmit any force to gen- erate a Salter-Harris type injury. However, if a true dislocation does occur, it is likely to be in an anterior direction (97% of cases) following a fall on an out- stretched hand. Humeral shaft fractures will commonly occur following direct trauma and may have an asso- ciated open wound whereas transverse, oblique and spiral fractures are gener- ated by indirect forces. Up to 25% of humeral shaft fractures will have an associated elbow, shoulder or clavicular injury and, therefore, it is essential that the whole of the humerus is imaged including the elbow and shoulder joints.
Type III is additionally characterized Treatment of the underlying disorder by muscle hypotonia with gait abnormalities order lithium 300 mg with mastercard, strabismus A breakthrough was made some years ago in the treat- and psychomotor retardation buy cheap lithium 300 mg online. These are soon followed ment of Gaucher disease, following the production of the by anemia, bleeding tendency and repeated infections. The The following skeletal changes are observed: Infiltration missing enzyme can now be substituted with Ceredase of the bone marrow, bone necroses, »bone crises«,. The treatment is very expensive, but is capable of pathological fractures, osteolysis and osteomyelitis. The metaphysis and diaphysis of the affected bone are widened and the corti- Orthopaedic treatment cal bone becomes thinner (⊡ Fig. The orthopaedic treatment depends on the nature of the These changes often remain asymptomatic for a fairly complication. The storage of Gaucher cells can ultimately lead logical fractures and osteomyelitis. The fracture manage- to impairment of the blood supply and thus to necrosis. Long periods of immobilization tial confusion with Legg-Calvé-Perthes disease, although are frequently required. The osteomyelitis is treated by the necrosis can also occur in the head of the humerus or local clearance and the administration of antibiotics. This is characterized by intense ing kyphosing at the thoracolumbar junction (⊡ Fig. The frequently occurring femoral head necrosis can warmth, redness and occasionally fever as well. During result in premature osteoarthritis of the hip and the need the crisis, an increased uptake is apparent on the techne- for a total hip replacement. AP x-ray of the pelvis in a 7-year old girl with Gaucher disease and an intertrochanteric fracture of the right femur 699 4 4.