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Colles fracture

A very common bone fracture that occurs in patients under 65 years of age, Colles fracture injures the wrist bone of the patients. Older patients normally sustain hip fractures. The most common type of broken wrist is one in which the larger forearm gets broken near the wrist. This fracture is noticed when a patient falls with an outstretched hand. The wrist joint of the patient is displaced and it rests behind its usual anatomic position. Accidents like car accident, a bike accident or similar situations can lead to Colles fracture. When the ulna (the other forearm bone) is broken, it is called a distal ulna fracture. The fracture is named after an Irish surgeon and anatomist, Abraham Colles in 1814 who first described it.


The doctor usually describes a wrist fracture by radius. This means that the patient has sustained a fracture in one of the two forearm bones. There may be other types of fractures one can sustain near the wrist, but when the end of the forearm bone is broken it is a wrist fracture or Colles fracture. When pain is associated in the wrist joint after an injury, a wrist fracture is suspected. There are typical symptoms of a wrist fracture such as wrist pain and deformity of the wrist. Normally the fracture is about 1 inch from the end of the bone. When the fracture extends into the joint, it is called an intra-articular fracture. This kind of fracture is more difficult to treat.


A primary care physician reviews the X-rays to determine the proper position of the fracture and assesses the stability of the broken bone structure. The area of the wrist is amenable for cast treatment and most of the Colles fracture patients can be treated using casts. For fractures in which the bones are out of proper position, a doctor can reset the fracture with local anesthesia or under light sedation. This procedure is known as reducing a wrist fracture. Only an orthopedist can determine if surgery is necessary. Various considerations like the abnormality of the wrist angle or the degree of shortening of the forearm bone are kept in mind before going for treatments like casting or surgery. If there is minimal shortening or displacement, casting is sufficient. Operative treatment is necessary if the injury is more significant.One can prevent Colles fracture by maintaining good bone health and by avoiding osteoporosis and falls. Older people should take extra care to keep their balance and prevent falls.

Femur fracture

The word 'femur' is taken from Latin meaning 'thigh'. The femur is the thigh bone and it is the largest and strongest bone in the human body. The femur bone extends from the hip to the knee joint. A femur fracture can be life threatening. Since the inside of the thigh is a place of major blood vessels, broken femur means break in the artery. Femur fracture is also called femoral shaft fracture, femur injury, femur stress fracture, fractured femur, femur trauma and femoral diaphyseal fracture. Femur is a tremendously strong bone. It usually requires a great deal of force to break the femur bone. The most common causes for femur fractures include:


  • Falls from a great height
  • Blows that are strong in force
  • Car accidents and Collisions
  • Severe twists
  • Bones weakened by osteoporosis, tumor or infection leading to a condition called pathologic femur fracture.

Proximal femur fracture: This involves fracture in the uppermost portion of the thighbone adjacent to the hip joint. are further sub divided into different types.

Femoral shaft fracture: The femoral shaft fracture is a severe injury that occurs during high-speed motor vehicle collisions and significant falls. Injuries caused by femoral shaft fractures are usually severe. Treatment of femoral shaft fracture is always with surgery. The common procedure is to insert a metal rod bone, called 'intramedullary rod' down the center of the thigh. The two ends of the bone are connected by the rod. This intramedullary rod usually remains in the bone for the life of the patient but can be removed if it causes pain and other problems.


Supracondylar femur fracture: In this kind of fracture, the injury occurs just above the knee joint. Cartilage surface of the knee joint is usually involved in this fracture. Patients who sustain supracondylar femur fracture are at high risk of developing knee arthritis later. Supracondylar femur fracture is common in patients with severe osteoporosis. Patients who have undergone total knee replacement surgery also run the risk of this fracture. Treatment for supracondylar femur fracture is highly variable. A cast or brace, external fixator, plate, screws or intramedullary rod are used for treatment.


Symptoms of femur fracture include swelling, bruising and severe pain. There may be numbness or paralysis in the leg below the femur fracture. Femur fractures are apparent and visible in many cases. Apart from clinical examination by the orthopaedic, for non-apparent fractures, a bone scan is required. Treatment for fractures of femur depends upon various factors such as the patient's age, type of fracture, location of the break, bone stability in the injured, mechanism of injury, direction of the blow, factors of twisting, existence of internal bleeding and extent of soft tissue damage. Some of the methods of treatment are:


  • Reduction or re-alignment
  • Immobilization whereby the movement is restricted
  • Insertion of an intramedullary fixation
  • A cast
  • External fixation such as a frame on the outside of the leg anchored into the bone using pins.

Potential complications from fracture of femur
  • Pain or arthritis
  • Rotational deformity due to misalignment
  • Infections in open fractures
  • Uneven leg length
  • Injury of blood vessels
  • Nerve damage
  • Compartment syndrome
  • Amputation
  • Failure to heal - 'non-union' is also a possibility

Intra articular sepsis, arthritis and knee stiffness are some of the permanent complications that can occur among persons who have undergone femur fracture and treatment. Sometimes femur fracture is bound to cause permanent disability in injured persons. This is due to the thigh muscle pull and incorrect reunion of fragments when they overlap. Femur fracture patients should be careful not to put weight on the leg as this can delay the healing process.


Andropause

Andropause in men is similar to the menopause in women. Andropause is also referred to as male menopause. It is characterized by reduced production of testosterone and dehydroepiandrosterone. Symptoms experienced by middle-aged men during andropause are - fatigue, memory loss, erectile dysfunction, prostate problems, osteoporosis, weight around the belly and lowered sex drive.


The decreased concentration of the testosterone levels does not follow a gradual time span and hence there is no affirmative evidence of the abrupt drop in the testosterone levels. Some studies describe the drop in testosterone levels by symptoms such as decreased sexual activity, increase in body fat, decrease in the muscularity and also cognitive impairment. However the decrease in testosterone levels may also result in lesser bone mass, lack of energy, lethargy, mood swings and irritability. The decreased bone mass due to the andropause may also result in hip fractures in older men.


Symptoms of Andropause

Decreased libido
Prolonged refractory period
Feeble erections
Lethargy
Irritability
Hot flashes
Lack of enthusiasm
Decrease in muscle strength, mass and endurance
Hair loss
Decreased bone mass

The physiological factors that lead to andropause are poor hypothalamic activity, hormonal deficiencies, hypertension and obesity. Testosterone levels vary from person to person. An average value of serum testosterone levels are taken to facilitate the treatment. The average value of testosterone is greater than 200ng/dl. Any value less than the average are considered as low serum testosterone level. Analog free testosterone method is used for the diagnosis. In order to obtain accurate values of serum testosterone levels, the diagnostic blood tests should be done before 10 am in the morning.


Testosterone replacement therapy

It is employed for andropause which is proven to be the most effective treatment. The objective of this treatment methodology is to improve the libido, erectile function, muscle and bone mass restoration and also improving mental health of the individual. The apparent methods include oral sustained release medications, injections and also through transdermal patches. The advantages of testosterone replacement therapy is that it is gradual, effective and also increases the testosterone levels in a significant manner such high during the morning and gradual decrease during the course of the day.

Disadvantages of testosterone replacement therapy include conditions such as hypertension, pedal edema, liver toxicity, sleep apnea, breast enlargement in older men etc. In addition to these negative effects, inducing testosterone in to the body from external source may hinder the natural spermatogenesis process of the testes.

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Collection of Pages - Last revised Date: August 24, 2019