The Treatment of Minor Injuries - Essay Example

Minor Injuries Introduction The treatment of minor injuries is preceded by an in depth evaluation and assessment of the situation at the diagnosis stage. In this case, the patient falls on an icy path within her homestead and injures her left wrist just below the thumb. She has trouble when trying to move her wrist or when picking up objects. However, the patient does not report any immediate swelling around the injured area. From this case, several anatomical, physiological and pathophysiological knowledge and application in nursing practice is evident (Massen et al., 2014, p. 5). The treatment of minor injuries is constituted by sequential medical procedures. Diagnosis precedes the other procedures. Diagnosis seeks to identify the nature of the injury and any other health complication through comprehensive examination of the injured area and other areas. From the diagnosis, inferences can be made on the extent of the patient’s condition and the medic can provide an appropriate treatment procedure. During the treatment, an appropriate referral plan is formulated. The patient may be referred to the imaging departments in the hospital for radiology or x-rays. Imaging enables the application of the correct treatment procedures by providing an in depth view of the severity of the injury. Differential is also relevant in this case. Therefore, studying this case inculcates the techniques used in the diagnosis, treatment and referral of cases of minor injuries with specific reference to wrist pain. Hence, it is vital to apply the anatomical, physiological, and pathophysiological knowledge in the attempt to care for the people suffering from minor injuries. Diagnosis The diagnostic procedure commences with the assessment of the effects that the wrist injury might have on the posture of the patient. The assessment involves the examination of all the aspects of the upper limb to identify any deformities, swelling, bruising or wounds (Cooney, 2010, p. 831). These are the core symptoms or characteristic effects of wrist injury including pain. In the assessment, the regions of the forearm are examined in both pronated and supinated positions. Immediate swelling is absent according to the patient’s report. Upon the assessment of the patient, swelling within the anatomical snuffbox of the left wrist is notable. The findings provide a basis for further examination of the situation to identify other areas of the forearm that are affected (Shen et al., 2015, p. 7). During the diagnosis, the examiner should check or assess the exact region in which the patient feels pain and enquire from the patient if there is pain around the clavicle or generally in the regions of the upper arm. In this case, the patient confirms that there is pain below the thumb and not in the other areas of the arm. The next step in the examination is the palpation of the regions and all bones of the upper limb (Appendix A). The palpation enables the examination of these regions for pain or other disorders that are related to the wrist sprain. The forearm is also palpated to determine if the patient feels pain within the anatomical regions of the forearm (Woitzik, deGraauw & Easter, 2014, p. 403). Preceding the examination of the upper regions of the forearm is the diagnostic assessment of the wrist and the fingers that constitute the primary centre of attention in this case. At the wrist, the examiner palpates the distal radius extending to the carpal bones and leaves the painful area that undergoes examination in the last stages of the diagnostic assessment (Yamamoto, 2008, p. 134). The palpation of the metacarpals of the hand and fingers then follows. Finally, the anatomical snuffbox is also palpated (Pistohl et al., 2013, p. 6). The patient complains of tenderness over the anatomical snuffbox. Therefore, acute pain is detected in this region of the wrist and forms an imperative diagnostic assessment result in relation to sensitivity to pain (Allouch et al., p. 14). The assessment of sensation over both forearms and the medial ulna and radial nerve distribution is mandatory and imperative (Takahashi, Tonogai & Sairyo, 2014, p. 218). The assessesment determines whether or not reduction is notable. Warmth and circulation are also some of the characteristics that are assessed in this stage. Assessing sensation enables the examiner to determine the effects that the injury has on the nerves and the subsequent effect on detection of stimuli such as pain (Appendix A). Blood circulation and warmth may remain affected by the injury making it vital for an examiner to assess this in the process of determining the extent of the effects that result from wrist injuries (Thapa, Iyer & Gross, 2013, p. 106). In the next stage of the assessment, an examiner is expected to check or examine movements at the elbow, wrist and the hand. The examination begins with the assessment of the movements at the elbow in terms of flexion, extension, supination and pronation. The extension, flexion and ulnar and radial deviations around the wrist are also examined (Abe & Tominaga, 2011, p. 179). The same movements are then assessed passively to assess if there are significant differences in the pattern of pain. The examiner should a certain that the movements of the elbow are normal (Appendix A). In this case, the movements at the elbow are normal. Such an examination reflects the effects of the wrist strain on the elbow. The wrist movement should also be assessed to identify any signs of reduction (Elsaftawy et al., 2014, p. 5). The diagnostic assessment of the thumb, hand and finger movements is done based on abduction, palmer abduction and opposition at the metacarpal of the thumb. In addition, the assessing the flexion and extension of the thumb and the fingers is fundamental (Decostre et al., p. 39). The patient should respond appropriately for these aspects to be assessed successfully. A series of special tests constitute the final part of the assessment. In the first special test, an examiner stresses the collateral ligaments of the thumb, which are normal in this particular case. Second, the axial compression of the thumb is tested and the patient feels some pain during the compressions (Bethel, 2009, p. 25). An X-ray examination for the assessment of the severity of the sprain is necessary for the identification of fractures or torn ligaments. If the procedure of applying the X-ray is wrong, the wrist might appear normal yet the symptoms are severe. In such a case, additional tests are necessary. For instance, magnetic resonance imaging (MRI) or a computed tomography scan (CT) would be appropriate. Errors and ignorance in the assessment process might lead to a wrong diagnosis (Wong, Catto-Smith & Zacharin, 2014, p. 146). Consequently, the patient would not get the appropriate or relevant treatment. For instance, a wrong diagnosis might categorise a Grade II wrist sprain as being Grade I and treatment will not be comprehensive and inclusive of all the anatomical disorders. Therefore, the wrist sprain may become more severe and persistent (Rodriguez-Martin, Pretell-Mazzini & Vidal-Bujanda, 2010, p. 43). In case radiography is used in the diagnostic process, the lateral and posterior views are essential for the evaluation of the bone structures. The aspects of the bones that are checked during the evaluation include alignment, the symmetry of the joints and their width and the conditions of the soft tissues. Imaging methodologies only apply when the initial diagnostic procedures are not able to provide the relevant medical information sufficiently. Other imaging modalities that could be used apart from CT and MRI include the technetium bone scan and ultrasonography. The patient had a minor wrist sprain and an X-ray can be used to sufficiently generate the relevant diagnostic information (Hunter, 2010, p. 21). During a radiographic examination of the wrist injury, the alignment of the bones, in this case the carpals at the wrist, is assessed by the lateral view. If a misalignment is detected, it indicates a ligament injury or tear which causes carpal instability and chronic pain. A scaphoid view is necessary when an examiner suspects that a scaphoid structure exists (Mulligan & Amblum, 2014, p. 18). Carpal tunnel and supinated oblique views are necessary the hook of the hamate is suspected to have a fracture. Therefore, imaging especially x-rays and radiography inculcates the knowledge that is related to the different views that are necessary for effective image diagnosis to be possible (Rodriguez-Martin, Pretell-Mazzini & Vidal-Bujanda, 2010, p. 43). The results of the diagnostic assessment provide a basis for the application of specific treatment procedures. The treatment of wrist injuries ranges from minor hand therapies for the mild cases to orthopaedic surgeries in case of complete destruction of the ligaments. The suitable mode of treatment is determined with regard to the extent of the wrist sprain (Cheng, 2008, p. 5). The mild or grade I level is characterised by the stretching or microscopic tearing of the ligaments and can be treated through simple exercises of the thumb, fingers and wrist. Second is the Grade II or the moderate level in which the damage of is severe and the ligaments that are present in the wrist region may be torn partially and treatment is through hand therapy (Bonham & Greaves, 2011, p. 355). The final stage is Grade III or severe sprains in which the wrist ligaments are entirely torn and they cannot attach the bones as they normally do. The reliability of the diagnostic assessment and results is dependent on the extent of the patient examination process. Superficial evaluations are less reliable compared to comprehensive assessments. The severity of wrist sprains can be determined by applying all the relevant diagnostic procedures including palpations, X-rays, MRI or CT scans. Failure to apply these methods would result to a misled diagnosis and the treatment may not alleviate the wrist sprain permanently (Malviya & Gerrand, 2012, p. 790). Therefore, a wrong diagnosis only postpones the effects of minor injury and the persistence of the pain may be felt again in future (Limburg, Maxwell & Mautner, 2014, p. 225). The injury might also become more severe because of the continuous damage of the ligaments. The diagnosis should also consider the fact that this patient is asthmatic according to her medical history. The treatment procedure should not compromise her asthmatic nature. Differential Diagnosis for Wrist Sprains or Injuries Differential diagnosis involves the creation of a distinction between conditions that have common symptoms. The differential diagnosis of wrist injuries takes various parts and aspects of wrist sprains into consideration. The first aspects are the effect of the wrist injury on the ligaments. Ligament tear or dissociation is an essential factor in such a case. A ligament tear may be evident through radial and ulnar deviation that is coupled with excessive extension (Tornese et al., 2014, p. 38). Ulnar wrist pains are a result of ligament dissociations (Gelberman, 2009, p. 724). Another aspect of the differential diagnosis is the examination of wrist fractures. In this situation, the patient is assessed to establish if she has fractures or bruises on her wrist (Ricchetti et al., 974, 2013). Some fractures may be on the metacarpals and would require radiology or x-ray imaging (Bunker et al, 2012, p. 326). When examining the fractures, the concentration should be on the scaphoid and lunate bones because they are more likely to have fractures (Charalambous, 2010, p. 28). Tendon injury is another constituent of the differential diagnosis. The characteristics of tendon injury are pain at the radial part and the dorsum of the distal radius (Gliedt & Daniels, 2014, p. 54). Finally, nerve injury should be assessed. In this specific case, the patient feels pain on the snuffbox of the wrist and some areas are painless. Examining the nerves in and around the painful area aids in the identification of nerve injury and a subsequent conclusion on the pain sensation by the patient is made (Agarwal et al ., 2014, p. 97). Treatment of Wrist Sprains In case a minor injury persists, there are two primary procedures that patients can use to get over the pain and eventually recover from the disorder (Mahajan & Mittal, 2013, p. 556). However, if the pain is not severe, the patient is advised to look after it by avoiding HARM and concentrate on PRICE methodology of minor injury treatment. PRICE is an acronym that stands for protection, rest, and the ice beside compression and elevation. In protection, the injured person protects the part exhibiting the pain from contracting further injury (Du Mortier & Docquier, 2014, p.3). The patient achieves this with a support or wearing of clothes that support or enclose the hand. Rest suggests that the patient should stop the work that caused the injury. The person should rest the injured muscle or joint and avoid the activity for 48 to 72 hours. Consequently, the patient is supposed to apply a dump towel having ice to the place injured for about 15-20 minutes and every 2-3 hours per day. The patient should not allow the ice to touch directly the skin since it may cause a cold burn, and he or she must not leave the ice on the injury while asleep (Khan et al., 2015, p. 104). During compression, a bandage or compressor is tied around the injured area to stop any swelling and movements that could cause further damage. The patient can use simple classic bandages or elastic tubular bandages accessed from the pharmacies. The bandage should be wrapped snuggly around the damaged body part, but it should not restrict the flow of blood. Further, it is important to take off the bandage when goes to bed (Van der Kallen et al., 2014, p.195). During the elevation, the patients should keep the injured part supported and raised to reduce swelling. The HARM technique involves taking care of the injured part by reducing the heat that reaches the area, achieved through avoiding heat from the heat packs, hot baths, and saunas (Adani, 2008, p. 63). In addition, alcohol consumption is not good since it may increase swelling and bleeding of the injured area slowing the healing process. Further, running is prohibited since it may result in more harm to the already injured body part (Shen et al., 2015, p.2). Finally, the patients need to avoid massage as it may increase swelling and bleeding from the injured part. Referral plan for the wrist pain and Injury General Practitioners (GPs) are partly responsible for the referral of patients. After the diagnosis of the patient, she is referred to the relevant departments within the hospital setting in which she can obtain specialized care. The patient has a minor wrist injury and GPs can refer her to the radiology department after the superficial examination is complete (Limburg, Maxwell & Mautner, 2014, p. 223). The extension of medical services by GPs enhances the provision of treatment and medication making the process efficient and facilitates the discharge process. GPs give specific direction to patients and refer them directly to their radiographic examinations. GP services also offer the patient the choice and ease of accessing the relevant service efficiently. The GP services speed up the referral process by increasing the referral units that deal with minor injuries. The patient referral plan should concentrate on increasing the units of care to increase the rate at which patients receive treatment (Desteli et al., 2015, p. 38). Minor injuries departments offer specialized services that entail investigation and the provision of special support for an acute general hospital. The staffs that work in the departments include nurses and GPs (Wong, Catto-Smith & Zacharin, 2014, p.141). Nurses have the access to radiological and other imaging services and can easily refer patients to the medical imaging departments. An adequate and feasible referral plan should be composed of GPs that are responsible and analyse the patients’ diagnostic history before making referrals. If the referral plan is inadequate, patients may opt to avoid consulting GPs and try to find the relevant departments on their own. However, self-referral is less effective as compared to the provision of directions to patients by GPs or other healthcare practitioners (Malviya & Gerrand, 2012, p.789). Therefore, GPs should ensure that they refer patients to relevant care units with regard to their health needs. The existence of an efficient patient referral protocol builds the patients’ confidence in the referral personnel and the GPs. The referral plan should contain provisions that stipulate that the GPs and other relevant workers have the responsibility of referring patients with urgent injuries during the working and out-of-office hours (Jacobs et al., 2015, p. 2). Such protocols will increase the number of patients that are able to receive the urgent medical care services and reduces the likelihood of an increase in the severity of minor injuries. GPs and other emergency healthcare service providers should be readily available and easily accessible to patients to avoid inconveniences during the referral process (Khan et al., 2015, p. 102). The availability of GPs at the patients’ disposal reduces the amount of time they spend in seeking treatments for minor injuries (Oliveira, Barlow & Bayer, 2015, p. 2). Therefore, the referral plan should encourage more of the referrals provided by GPs than self-referrals. Conclusion The treatment of minor injuries with specific regard to wrist injury is a procedural process that includes diagnosis, treatment and referral of the pertinent patients. The case discussed above involves a patient with a minor wrist injury. From the anatomical and physiological diagnosis of the patient, the upper regions of the forearm do not show any effects (Anandkumar, 2013, p. 435). The pain is chronic around the anatomical snuffbox below the thumb. Palpation of the various regions of the arm is a primary methodology used for the diagnostic assessment. The patient is able to indicate the painful regions from the palpations. Further diagnostic procedures are also essential in ensuring that the diagnosis is comprehensive. Such procedures include imaging techniques such as X-rays, MRI and CT. The treatment of the wrist pain is dependent on the extent of the sprain. It the severity is low, the patient is advised to nurse the wrist using ice to numb the injured area, minor physical exercises to stretch the thumb and protecting it from mechanical stress. Bandaging the injured area reinforces the alignment of the disorientation of the wrist as a result of the injury (Yildirim & Nas, K 2010, p. 195). Minor injury patient referrals may be self-based or through healthcare personnel and GPs. An efficient referral plan is comprised of agile and competent GPs that can comprehensively cater for the patient needs. The radiology or imaging department is an essential referral unit for patients with wrist injuries (Davis & Higgins, 2014, p. 176). An increase in the number of referral units enhances efficiency by reducing the time that the patients use when seeking treatment (Finley, 2013, p. 84). Therefore, the treatment of minor injuries such as wrist sprains must incorporate an elaborate diagnostic assessment, procedural treatment and an appropriate referral plan. Bibliography Abe, Y, & Tominaga, Y 2011, Ulnar-Sided Wrist Pain Due to Isolated Disk Tear of Triangular Fibrocartilage Complex Within The Distal Radioulnar Joint:: Two Case Reports, Hand Surgery, 16, 2, pp. 177-180, Academic Search Premier, EBSCOhost, viewed 20 July 2015. Adani, R, Tarallo, L, Amorico, M, Tata, C, & Atzei, A 2008, The Treatment of Distal Radius Articular Fractures through Lcp System, Hand Surgery, 13, 2, pp. 61-72, Academic Search Premier, EBSCOhost, viewed 20 July 2015. Agarwal, P, Gupta, S, Yadav, P, & Sharma, D 2014, Cadaveric study of anatomical variations of the median nerve and persistent median artery at wrist, Indian Journal of Plastic Surgery, 47, 1, pp. 95-101, Academic Search Premier, EBSCOhost, viewed 20 July 2015. Allouch, S, Younès, R, Boudaoud, S, & Khalil, M., 2014, Physiological And Biomechanical Anandkumar, S 2013, Kinesio tape management for superficial radial nerve entrapment: A case report, Physiotherapy Theory & Practice, 29, 3, pp. 232-241, Academic Search Premier, EBSCOhost, viewed 20 July 2015. Approach For Human Finger Movement: Modeling, Simulation And Experimental Ben-Jacob, E., 2013, Grasp Detection from Human ECoG during Natural Reach-to-Grasp Bethel, J 2009, Scaphoid fracture: diagnosis and management, Emergency Nurse, 17, 4, pp. 24-29, Academic Search Premier, EBSCOhost, viewed 20 July 2015. Bonham, C, & Greaves, I 2011, Brachial plexus injuries, Trauma, 13, 4, pp. 353-363, Academic Search Premier, EBSCOhost, viewed 20 July 2015. Bunker, D, Pappas, G, Moradi, P, & Dowd, M 2012, Radiographic Signs Of Static Carpal Instability With Distal End Radius Fractures: Is Current Treatment Adequate?, Hand Surgery, 17, 3, pp. 325-330, Academic Search Premier, EBSCOhost, viewed 20 July 2015. Charalambous, C, Mills, S, & Hayton, M 2010, Gradual Distraction Using an External Fixator Followed by Open Reduction in the Treatment of Chronic Lunate Dislocation, Hand Surgery, 15, 1, pp. 27-29, Academic Search Premier, EBSCOhost, viewed 20 July 2015. Cheng, H, Hung, L, Ho, P, & Wong, J 2008, An Analysis of Causes and Treatment Outcome of Chronic Wrist Pain after Distal Radial Fractures, Hand Surgery, 13, 1, pp. 1-10, Academic Search Premier, EBSCOhost, viewed 20 July 2015. Cooney, W. P. (2010). The wrist: diagnosis and operative treatment. Philadelphia [Pa.], Wolters Kluwer/Lippincott Williams & Wilkins Health. Davis, N, & Higgins, G., 2014, Periprosthetic fractures around total knee arthroplasty, Decostre, V, Canal, A, Ollivier, G, Ledoux, I, Moraux, A, Doppler, V, Mary Payan, C, & Hogrel, J 2015, Wrist flexion and extension torques measured by highly sensitive dynamometer in healthy subjects from 5 to 80 years, BMC Musculoskeletal Disorders, 16, 1, pp. 37-57, Academic Search Premier, EBSCOhost, viewed 20 July 2015. Desteli, E, İmren, Y, Erdoğan, M, & Aydagün, Ö., 2015, Quality of Life Following Treatment of Trochanteric Fractures with Proximal Femoral Nail versus Cementless Bipolar Hemiarthroplasty in Elderly, Clinical & Investigative Medicine, 38, 2, pp. E63-E72, Academic Search Premier, EBSCOhost, viewed 29 June 2015. Du Mortier, A, & Docquier, P., 2014, Traumatic Fracture in a Patient with Osteopoikilosis, Case Reports In Orthopedics, pp. 1-4, Academic Search Premier, EBSCOhost, viewed 29 June 2015. Elsaftawy, A, Jablecki, J, Jurek, T, Domanasiewicz, A, & Gworys, B 2014, New concept of scapholunate dissociation treatment and novel modification of Brunelli procedure - anatomical study, BMC Musculoskeletal Disorders, 15, 1, pp. 1-16, Academic Search Premier, EBSCOhost, viewed 20 July 2015. Finley, A 2013, the value of understanding patient referral flow, Hfm (Healthcare Financial Management), 67, 8, pp. 84-89, Business Source Complete, EBSCOhost, viewed 20 July 2015. Gelberman, R. H. (2009). The wrist. Philadelphia, Pa, Lippincott Williams & Wilkins. Gliedt, J, & Daniels, C 2014, Chiropractic management of elbow tendinopathy following a sports related trauma, Journal Of The Canadian Chiropractic Association, 58, 1, pp. 52-57, Academic Search Premier, EBSCOhost, viewed 20 July 2015. Hunter, D 2010, Triage nurse X-ray protocols for hand and wrist injuries, Emergency Nurse, 17, 9, pp. 20-24, Academic Search Premier, EBSCOhost, viewed 20 July 2015. Jacobs, J, Jacobs, J, Sonderen, E, Molen, T, & Sanderman, R., 2015, Fracture diagnostics, unnecessary travel and treatment: a comparative study before and after the introduction of teleradiology in a remote general practice, BMC Family Practice, 16, 1, pp. 1-9, Academic Search Premier, EBSCOhost, viewed 29 June 2015. June 2015. Khan, A, Leslie, W, Lentle, B, lies, S, Kaiser, S, Frame, F, Burrell, S, & Cheung, A., 2015, Atypical Femoral Fractures: A Teaching Perspective, Canadian Association Of Radiologists Journal, 66, 2, pp. 102-107, Academic Search Premier, EBSCOhost, viewed 29 June 2015. Limburg, C, Maxwell, C, & Mautner, B., 2014, Prevention and Treatment of Bone Loss in Patients With Nonmetastatic Breast or Prostate Cancer Who Receive Hormonal Ablation Therapy, Clinical Journal Of Oncology Nursing, 18, 2, pp. 223-230, Academic Search Premier, EBSCOhost, viewed 29 June 2015. Limburg, C, Maxwell, C, & Mautner, B., 2014, Prevention and Treatment of Bone Loss in Patients With Nonmetastatic Breast or Prostate Cancer Who Receive Hormonal Ablation Therapy, Clinical Journal Of Oncology Nursing, 18, 2, pp. 223-230, Academic Search Premier, EBSCOhost, viewed 29 June 2015. Mahajan, R, & Mittal, S 2013, Functional outcome of patients undergoing replantation of hand at wrist level-7 year experience, Indian Journal of Plastic Surgery, 46, 3, pp. 555-560, Academic Search Premier, EBSCOhost, viewed 20 July 2015. Malviya, A, & Gerrand, C., 2012, Evidence for orthopaedic surgery in the treatment of metastatic bone disease of the extremities: A review article, Palliative Medicine, 26, 6, pp. 788-796, Academic Search Premier, EBSCOhost, viewed 29 June 2015. Malviya, A, & Gerrand, C., 2012, Evidence for orthopaedic surgery in the treatment of metastatic bone disease of the extremities: A review article, Palliative Medicine, 26, 6, pp. 788-796, Academic Search Premier, EBSCOhost, viewed 29 June 2015. Massen, F, Baumbach, S, Volkmer, E, Mutschler, W, & Grote, S 2014, Pathologic fracture of the distal radius in a 25-year-old patient with a large unicameral bone cyst, BMC Musculoskeletal Disorders, 15, 1, pp. 2-15, Academic Search Premier, EBSCOhost, viewed 20 July 2015. Movements, Plos ONE, 8, 1, pp. 1-11, Academic Search Premier, EBSCOhost, viewed 29 Mulligan, J, & Amblum, J 2014, Diagnosis and Treatment of Scaphoid Fracture, Emergency Nurse, 22, 3, pp. 18-23, Academic Search Premier, EBSCOhost, viewed 20 July 2015. Oliveira, T, Barlow, J, & Bayer, S 2015, The association between general practitioner participation in joint teleconsultations and rates of referral: a discrete choice experiment, BMC Family Practice, 16, 1, pp. 1-8, Academic Search Premier, EBSCOhost, viewed 20 July 2015. Pistohl, T, Benedikt Schmidt, T, Ball, T, Schulze-Bonhage, A, Aertsen, A, Mehring, C, & Premier, EBSCOhost, viewed 29 June 2015. Ricchetti, P, Nicolosi, D, Kambara, A, & Andrade, A., 2013, A System to Help Physicians With Fracture Detection in Stents,Artificial Organs, 37, 11, pp. 973-977, Academic Search Premier, EBSCOhost, viewed 29 June 2015. Rodriguez-Martin, J, Pretell-Mazzini, J, & Vidal-Bujanda, C 2010, Unusual Pattern Of Essex-Lopresti Injury With Negative Plain Radiographs Of The Wrist:: A Case Report And Literature Review, Hand Surgery, 15, 1, pp. 41-45, Academic Search Premier, EBSCOhost, viewed 20 July 2015. Shen, L, Tang, J, Luo, C, Xie, X, An, Z, & Zhang, C., 2015, Comparison of Operative and Non-Operative Treatment of Acute Undisplaced or Minimally-Displaced Scaphoid Fractures: A Meta-Analysis of Randomized Controlled Trials, Plos ONE, 10, 5, pp. 1-14, Academic Search Premier, EBSCOhost, viewed 29 June 2015. Takahashi, M, Tonogai, I, & Sairyo, K 2014, Treatment of Extra-Articular Distal Radial Malunion with Percutaneous Osteotomy and an Intramedullary Implant, Hand Surgery, 19, 2, pp. 217-222, Academic Search Premier, EBSCOhost, viewed 20 July 2015. Thapa, M, Iyer, R, & Gross, J 2013, Pictorial Essay of Pediatric Upper Extremity Trauma: Normal Variants and Unique Injuries, Canadian Association Of Radiologists Journal, 64, 2, pp. 101-107, Academic Search Premier, EBSCOhost, viewed 20 July 2015. Tornese, D, Curci, D, Nardo, A, Cuccia, A, & Pozzi, G., 2015, Stress Fracture of the Ulna in an Elite Ice Dancer, Journal Of Sports Science & Medicine, 14, 1, pp. 37-40, Academic Search Premier, EBSCOhost, viewed 29 June 2015. Trauma, 16, 3, pp. 174-182, Academic Search Premier, EBSCOhost, viewed 29 June 2015. Validation, Journal Of Mechanics In Medicine & Biology, 14, 3, p. -1, Academic Search Van der Kallen, J, Giles, M, Cooper, K, Gill, K, Parker, V, Tembo, A, Major, G, Ross, L, & Carter, J., 2014, A fracture prevention service reduces further fractures two years after incident minimal trauma fracture, International Journal Of Rheumatic Diseases, 17, 2, pp. 195-203, Academic Search Premier, EBSCOhost, viewed 29 June 2015. Woitzik, E, deGraauw, C, & Easter, B 2014, Ulnar Impaction Syndrome: A case series investigating the appropriate diagnosis, management, and post-operative considerations, Journal of the Canadian Chiropractic Association, 58, 4, pp. 401-412, Academic Search Premier, EBSCOhost, viewed 20 July 2015. Wong, S, Catto-Smith, A, & Zacharin, M., 2014, Pathological fractures in paediatric patients with inflammatory bowel disease, European Journal Of Pediatrics, 173, 2, pp. 141-151, Academic Search Premier, EBSCOhost, viewed 29 June 2015. Wong, S, Catto-Smith, A, & Zacharin, M., 2014, Pathological fractures in paediatric patients with inflammatory bowel disease, European Journal Of Pediatrics, 173, 2, pp. 141-151, Academic Search Premier, EBSCOhost, viewed 29 June 2015. Yamamoto, M, Koh, S, Tatebe, M, Shinohara, T, Shionoya, K, Nakamura, R, & Hirata, H 2008, Arthroscopic Visualisation of the Distal Radioulnar Joint, Hand Surgery, 13, 3, pp. 133-138, Academic Search Premier, EBSCOhost, viewed 20 July 2015. Yildirim, A, & Nas, K 2010, Evaluation of postoperative early mobilization in patients with repaired flexor tendons of the wrist, the spaghetti wrist, Journal Of Back & Musculoskeletal Rehabilitation, 23, 4, pp. 193-200, Academic Search Premier, EBSCOhost, viewed 20 July 2015. Read More