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The Tile classification system is based on the integrity of the posterior sacroiliac complex. In type A injuries, the sacroiliac complex is intact. The pelvic ring has a stable fracture that can be managed nonoperatively. Type B injuries are caused by either external or internal rotational forces resulting in partial disruption of the posterior sacroiliac complex.
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Tendon injury can occur in people treated both nonoperatively and operatively, most commonly to the extensor pollicis longus tendon. This can be due to the tendon coming in contact with protruding bone or with hardware placed following surgical procedures. Complex regional pain syndrome is also associated with distal radius fractures, and can present with pain, swelling, changes in color and temperature, and/or joint contracture. The cause for this condition is unknown.
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Bones are evaluated with plain film x-ray or computed tomography if deformity (misshapen), bruising, or joint laxity (looser or more flexible than usual) are observed. Neurologic evaluation involves testing of the major nerve functions of the axillary, radial, and median nerves in the upper extremity as well as the femoral, sciatic, deep peroneal, and tibial nerves in the lower extremity. Surgical treatment may be necessary depending on the extent of injury and involved structures, but many are managed nonoperatively.
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Myelography is inadequate to completely evaluate the patient for recurrent disc disease, and CT or MRI scanning is necessary. Measurement of tissue density can be helpful. Even though the complications of laminectomy for disc herniation can be significant, a recent series of studies involving thousands of patients published under auspices of Dartmouth Medical School concluded at four-year follow-up that those who underwent surgery for a lumbar disc herniation achieved greater improvement than nonoperatively treated patients in all primary and secondary outcomes except work status.
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Literature regarding long-term follow-up after surgical repair of type III injuries is scarce, and those treated nonoperatively generally do quite well. Many studies have come to the conclusion that non-surgical treatment is as good as or better than surgical treatment, or that anything attained because of surgery is quite limited. It appears that after a while, the body "remodels" the joint, either expanding the distal clavicle or causing it to atrophy. There may also be the potential that surgical repair may be less painful in the long run.
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The main goal is to stop any sources of bleeding before moving onto any definitive find and repair any injuries that are found. Due to the time sensitive nature, this procedure also emphasizes expedience in terms of gaining access and controlling the bleeding, thus favoring a long midline incision. Intra-abdominal injuries are also frequently successfully treated nonoperatively as there is little benefit shown if there is no known active bleeding or potential for infection. The use of CT scanning allows care providers to use less surgery because they can identify injuries that can be managed conservatively and rule out other injuries that would need surgery.
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Acute rupture of the distal biceps tendon can be treated nonoperatively with acceptable results, but because the injury can lead to 30% loss of elbow flexion strength and 30-50% loss of forearm supination strength, surgical repair is generally recommended. Complete distal biceps tears are commonly treated with re-attachment of the biceps tendon to its native insertion on the tuberosity of the radius using bone tunnels, suture buttons, or suture anchors. Proximal ruptures of the long head of the biceps tendon can be surgically addressed by two different techniques. Biceps tenodesis includes release of the long head of the biceps tendon off of its insertion on the glenoid and re-attachment by screw or suture anchor fixation to the humerus.
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