Medial branch block vs epidural steroid injection

External fixation of the tibia is the MOST appropriate initial treatment. Some surgeons prefer to defer the fibular fixation until definitive ORIF of the pilon but the common theme is that pilon fractures are treated with external fixation and staged ORIF. If bone grafting of the tibia is necessary it would be performed during the staged ORIF of the tibia.

Sirkin et al reports Level 4 evidence of a staged protocol of immediate (within twenty-four hours) open reduction and internal fixation of the fibula, using a one-third tubular or -mm DC plate and application of an external fixator spanning the ankle joint. They followed both open and closed pilon fractures that were treated with external fixation until the soft tissue swelling resolved and then underwent ORIF. There was less than an 11% rate of major wound complication or infection in both groups. Their conclusions suggested the historically high rates of wound complication and infection associated with ORIF of pilon fractures are likely due to attempts at immediate fixation through swollen, compromised soft tissues.

The Procedure
The patient is placed in the prone (laying face down) position with two pillows under the chest and a small pillow under the forehead. The skin on the back of the neck or upper back is sterilely prepared. Using fluoroscopic (x-ray) guidance, the appropriate levels for medial branch blockade are viewed. The skin is anesthetized. A thin needle is then advanced under x-ray guidance to the appropriate region for the block. A small volume of contrast solution is injected to prove that the medication will stay in the appropriate area. Then, a small volume of long-lasting anesthetic is injected. The patient is cared for in the recovery area for 30 minutes.

The risk associated with wisdom tooth surgery is commonly accepted to be 2% temporary and % permanent. However, this risk assessment is not concrete as the same source [ citation needed ] is cited for lingual nerve paresthesia. It is well documented that inferior alveolar nerve injury is more common than lingual nerve injury [ citation needed ] . The percentage of injury varies significantly in different studies. Furthermore, many factors affect the incidence of nerve injury. For example, the incidence of nerve injury in teens removing third molars is much lower than the incidence in patients 25 and older. [5] This risk increases 10 fold if the tooth is close to the inferior dental canal containing the inferior alveolar nerve (as judged on a dental radiograph). [6] These high risk wisdom teeth can be further assessed using cone beam CT imaging to assess and plan surgery to minimise nerve injury by careful extraction or undertaking a coronectomy procedure in healthy patients with healthy teeth [7]

Sometimes, a patient notices that the thumb−index finger pincer grip is weak. Two of the key muscles involved in this movement are the adductor pollicis (adducting the thumb) and the first dorsal interosseous muscle (adducting the index finger). In addition to the weak pincer grip, the median-innervated flexor pollicis longus partially compensates for the weakened adductor pollicis, and the thumb flexes at the distal joint. This flexion usually goes unnoticed by the patient, but when it is demonstrated by the examiner, it constitutes the Froment sign.

Medial branch block vs epidural steroid injection

medial branch block vs epidural steroid injection

Sometimes, a patient notices that the thumb−index finger pincer grip is weak. Two of the key muscles involved in this movement are the adductor pollicis (adducting the thumb) and the first dorsal interosseous muscle (adducting the index finger). In addition to the weak pincer grip, the median-innervated flexor pollicis longus partially compensates for the weakened adductor pollicis, and the thumb flexes at the distal joint. This flexion usually goes unnoticed by the patient, but when it is demonstrated by the examiner, it constitutes the Froment sign.

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