Bone fractures

A broken bone or bone fracture occurs when a force exerted against a bone is stronger than it can structurally withstand.

Bones are a form of connective tissue, reinforced with calcium and bone cells. Bones have a softer centre, called marrow, where blood cells are made. The main functions of the skeleton include support, movement and protection of vulnerable internal organs.

Symptoms
The symptoms of a bone fracture depend on the particular bone and the severity of the injury, but may include:

• Pain
• Swelling
• Bruising
• Deformity
• Inability to use the limb.

Different types of fracture
The different types of bone fracture include:

• Greenstick fracture – the bone sustains a small, slender crack. This type of fracture is more common in children, due to the comparative flexibility of their bones.
• Comminuted fracture – the bone is shattered into small pieces. This type of complicated fracture tends to heal at a slower rate.
• Simple fracture – or ‘closed’ fracture. The broken bone hasn’t pierced the skin.
• Compound fracture – or ‘open’ fracture. The broken bone juts through the skin, or a wound leads to the fracture site. The risk of infection is higher with this type of fracture.
• Pathological fracture – bones weakened by various diseases (such as osteoporosis or cancer) tend to break with very little force.
• Avulsion fracture – muscles are anchored to bone with tendons, a type of connective tissue. Powerful muscle contractions can wrench the tendon free and pull out pieces of bone. This type of fracture is more common in the knee and shoulder joints.
• Compression fracture – occurs when two bones are forced against each other. The bones of the spine, called vertebrae, are prone to this type of fracture. Elderly people, particularly those with osteoporosis, are at increased risk.

Back pain - schoolbags

Around 70 per cent of Australian schoolchildren may be damaging their spines by carrying schoolbags. For example, a heavy bag that’s slung over one shoulder can, over the 12 years of schooling, cause chronic back problems that linger into adulthood. Risks include muscle strain, distortion of the natural ‘S’ curve of the spine and rounding of the shoulders. Parents can reduce the risk in many ways, such as buying the child an appropriately sized backpack and making sure the load isn’t too heavy.

Schoolbag risk factors
Risk factors for spinal damage include:

• A schoolbag that weighs more than 10 per cent of the child’s weight
• Holding the bag in one hand by its straps
• Carrying the bag over one shoulder
• An incorrectly packed backpack
• An incorrectly fitted backpack.

Australian study into backpacks
A recent study published in the Australian Spine journal investigated the link between backpacks and back pain in schoolchildren. Selected statistics include:

• The weight of the average backpack is heavier, proportionally, than the legal load-bearing limit for adults.
• 79.1 per cent of children say their backpacks feel heavy.
• 65.7 per cent report feeling fatigued by the weight of their backpack.
• 46.1 per cent report back pain caused by their backpack.

Ways to reduce the risk
Risk reduction strategies include:

• Buy the right kind of backpack.
• Make sure it is packed correctly.
• Show your child correct lifting and carrying techniques.

Buy the right kind of backpack
Your child should have a backpack, rather than a traditional schoolbag with handles. Suggestions include:

• Look for a backpack endorsed by an Australian professional organisation, such as the Australian Physiotherapy Association or the Chiropractors’ Association of Australia.
• Don’t try to save money by buying the biggest backpack you can find – make sure the backpack is appropriate to your child’s size.
• Choose a backpack with a moulded frame and/or adjustable hip strap, so that the weight of the filled backpack will rest on your child’s pelvis instead of their shoulders and spine.
• The shoulder straps should be adjustable, and the rear of the backpack padded for comfort.
• To help with packing, the backpack should have a few separate compartments.
• Canvas backpacks are lighter than leather varieties.
• Consider buying a backpack with built-in wheels.
• Children are fashion conscious and vulnerable to peer pressure, so make sure you take your child with you when buying their backpack. If the style you choose is ‘uncool’, your child may compensate by carrying the backpack in a ‘cool’ way, such as over one shoulder.

Common causes of back pain

Most people with back pain do not have any significant damage to their spine. The pain comes from the muscles, ligaments and joints. Some common causes of back pain include:

• Arthritis – osteoarthritis and ankylosing spondylitis are two forms of arthritis linked to back pain.
• Muscle and ligament strains – weak muscles and ligaments are unprepared for sudden or heavy loads and are easily injured. Lifting a heavy load the wrong way, an unusual bout of exercise or even bad posture over a period of time can hurt soft tissue.
• Osteoporosis – fracture of the vertebrae due to osteoporosis. Osteoporosis is a disease characterised by thinning of the bones. The vertebrae can become so porous and brittle that they break easily. Pain is due to the fracture.
• Sciatica – the nerve that runs from the lower back into the leg is compressed by a bulging intervertebral disc, causing pain.
• Stress – one of the side effects of stress is increased muscle tension. This can lead to fatigue, stiffness and localised pain. Constantly tight muscles can create imbalances in a person’s posture that may cause misalignment of the spine.

More persistent back pain may be associated with arthritis of the facet joints and degeneration of the discs. However, people with this condition may not experience any pain.

Lifestyle factors contribute to back pain

Most cases of back pain are exacerbated by lifestyle factors, including:

• Lack of exercise
• Being overweight or obese
• Leading a sedentary life
• Poor posture
• Stress
• Bad work practices.

Preventing back pain

In most cases, back pain can be prevented by making a few lifestyle changes. Some suggestions include:

• Exercise regularly – this is important to improve posture and increase muscle support of the spine. Try walking instead of using the car. Work towards doing 30 minutes of gentle exercise each day. This can be broken into shorter periods for equal benefit.
• Lift and carry safely – if you are picking up a heavy load: squat down, hold the object as close to your body as practical and lift by using your legs, keeping your back straight. Get some help from another person or use equipment (such as a trolley) if the load is too heavy to manage comfortably on your own.
• Maintain a healthy body weight – being overweight or obese puts extra strain on your back.
• Be aware of your posture – consider your posture, particularly in seated positions such as when driving or sitting at a desk for long periods of time. Don’t slump, keep your back upright and use support where necessary (such as a lumbar support cushion or footstool).
• Take regular breaks – when driving, standing or sitting for long periods of time, take a break at least every hour. This will help change the position of your joints and loosen your muscles. Include a short walk and a few stretches as part of your break.
• Relax and manage your pain – learn some relaxation techniques to reduce stress levels and related muscle tension. Try massage, heat or cold packs and gentle exercise. Seek advice from a physiotherapist.
• Change your mattress – surfaces that are too soft or too hard can aggravate a sore back. Avoid sleeping on your stomach.

Bairnsdale ulcer

The Bairns dale ulcer is a skin disease caused by the bacterium Mycobacterium ulcerans. The toxins made by the bacteria destroy skin cells, small blood vessels (capillaries) and subcutaneous fat, which leads to ulceration and skin loss. These bacteria are found naturally in the environment, but the mode of infection to humans is unknown. Native and domestic animals can also be at risk.

The Bairns dale ulcer is not thought to be contagious. It gets its name from the local area in which an outbreak among farmers was documented in 1948. Since this type of ulcer is found in other parts of Australia and around the world, it has many names including Daintree ulcer and Buruli ulcer. Its medical name is Mycobacterium ulcerans (MU) infection. MU is a rare infection, although the number of cases in Victoria varies widely from year to year.

Symptoms
The progression of symptoms can include:

• A spot that looks like a mosquito bite forms on the skin.
• The spot grows bigger over days or weeks.
• The spot may form a crusty, non-healing scab.
• The scab then disintegrates into an ulcer.
• The ulcer continues to enlarge.
• Unlike other ulcers, this ulcer is usually painless and there is generally no fever or other signs of infection.
• The limbs are more commonly affected.
• The infection may sometimes present as localised pain and swelling with fever but no ulceration.

The effect of toxins
Myobacterium ulcerans is related to the same family of bacteria responsible for leprosy and tuberculosis but, unlike them, is not contagious. The toxins made by the bacteria destroy the skin and the fat layer beneath it, and block the small blood vessels that service the infected areas.

These toxins are also thought to have a dampening effect on the person’s immune system, which means the body has less chance of fighting the infection. In severe cases, the infection can destroy bone and cause lifelong deformity and disability. In developing countries, common complications for people who are unable to get adequate medical care can include amputation and the loss of affected organs, such as the eyes.

Locations of recent outbreaks
Myobacterium ulcerans infection has been reported in at least 32 countries around the world. Affected areas include rural West Africa, Central Africa, New Guinea, Latin America and tropical regions of Asia.

In Australia, MU most commonly occurs in localised coastal areas of Victoria, where cases have been reported from East Gippsland, the Mornington Peninsula area, Western Port and Phillip Island, and the Bellarine Peninsula. Most recently there has been a large outbreak associated with the small township of Point Lonsdale. It also occurs less commonly in the Daintree region of Far North Queensland.

Diagnosis methods
Bairnsdale ulcer is diagnosed using a number of tests including:

• Medical history – to identify a slowly enlarging, painless ulcer
• Physical examination – the ulcer is not tender
• Swabs taken from the ulcer, which are then tested in a laboratory
• Biopsy of the ulcer.

Treatment options
Since the ulcer gets bigger with time, early diagnosis and prompt treatment can keep the amount of skin loss to a minimum. The first line of treatment is generally surgery to cut away the dead skin. A surrounding portion of healthy tissue is also cut out to make sure the infection is completely removed. Depending on the extent of surgery, skin grafts may be needed to close the wound.

Sometimes the ulceration can return after surgery, which means another operation is required. More recently there has been a trend to combine surgery with the use of oral and/or intravenous antibiotics. Heat therapy regularly applied to the graft area can help prevent relapses – it seems that, while the bacteria thrive at skin temperature, they can’t survive above 39 degrees Celsius.

Prevention strategies
The cause of infection in humans is not known. As the bacterium is environmental (requires particular conditions outside the body to exist), it makes sense to protect yourself from potential sources of infection such as soil and insect bites. A recent study on mosquitoes trapped in the Point Lonsdale area has shown them to be contaminated with the same bacteria that causes Bairnsdale ulcer.

It is important to remember that the risk of infection is very low, even in those areas where the ulcer is endemic (constantly present in the community). Suggestions to reduce the risk of infection while working outdoors or gardening include:

• Protect cuts or abrasions with sticking plasters.
• Promptly wash and cover any scratches or cuts you receive while working outdoors.
• Wear gardening gloves, long-sleeved shirts and trousers.
• Avoid insect bites by using suitable insect repellents.
• See your doctor if you have a slow-healing skin lesion.

Types of bipolar disorder

Bipolar disorder is divided into two main subtypes:

• Bipolar I disorder. You've had at least one manic episode, with or without previous episodes of depression.


• Bipolar II disorder. You've had at least one episode of depression and at least one hypomanic episode. A hypomanic episode is similar to a manic episode but much briefer, lasting only a few days, and not as severe. With hypomania, you may have an elevated mood, irritability and some changes in your functioning, but generally you can carry on with your normal daily routine and functioning, and you don't require hospitalization. In bipolar II disorder, the periods of depression are typically much longer than the periods of hypomania.


• Cyclothymia. Cyclothymia is a mild form of bipolar disorder. Cyclothymia includes mood swings but the highs and lows are not as severe as those of full-blown bipolar disorder.
  

Other bipolar disorder symptoms

In addition, some people with bipolar disorder have rapid cycling bipolar disorder. This is the occurrence of four or more mood swings within 12 months. These moods shifts can occur rapidly, sometimes within just hours. In mixed state bipolar disorder, symptoms of both mania and depression occur at the same time.

Severe episodes of either mania or depression may result in psychosis, or a detachment from reality. Symptoms of psychosis may include hearing or seeing things that aren't there (hallucinations) and false but strongly held beliefs (delusions).

Bipolar disorder symptoms

Bipolar disorder symptoms are characterized by an alternating pattern of emotional highs (mania) and lows (depression). The intensity of signs and symptoms can vary from mild to severe. There may even be periods when your life doesn't seem affected at all.

Manic phase of bipolar disorder
Signs and symptoms of the manic phase of bipolar disorder may include:

* Euphoria
* Extreme optimism
* Inflated self-esteem
* Poor judgment
* Rapid speech
* Racing thoughts
* Aggressive behavior
* Agitation
* Increased physical activity
* Risky behavior
* Spending sprees
* Increased drive to perform or achieve goals
* Increased sexual drive
* Decreased need for sleep
* Tendency to be easily distracted
* Inability to concentrate
* Drug abuse

Bipolar disorder

Definition

Since High to low. Mania to depression. From recklessness to listlessness. These are the edges associated with bipolar disorder, a mental illness characterized by mood instability that can be serious and disable. Bipolar disorder is also recognized as manic-depression or manic-depressive illness — manic activities are one extreme of this disorder, and depression is the other.

The deep mood swings of bipolar disorder may last for weeks or months, causing great disturbances in the lives of those affected, and those of family and friends, too. Today, a growing volume of research suggests that bipolar disorder occurs across a spectrum of symptoms, and that many people aren't correctly diagnosed. Left untreated, bipolar disorder generally worsens, and the suicide rate is high among those with bipolar disorder. But with effective treatment, you can live an enjoyable and productive life despite bipolar disorder.