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Tue Nov 22, 2016 2:31 am
Jyva says...



oh ho ho ho.

1. how long would it take a fifty-year-old to heal from being shot in the shin in the 1800s, assuming they receive appropriate medical attention?

2. several characters get run through with a seax - a blade about 55 cm long, about .5 cm thick. stab areas include the solar plexus, the throat, and the abdomen. how long would it take for a person stabbed in those areas to die, respectively? would any of those scenarios have our person still able to move and attack back?

3. how much damage would an 1800's flintlock pistol do to an unarmoured person, assuming they're shot centre mass?

4. what would a person experience immediately after getting a sabre dug into their side, say, 6 cm? would they be able to think rationally and maintain control of their hands?

5. a character gets shallowly sliced from shoulder to opposite hip. would this impact their spine? would they be able to eventually recover, given that the only medicine available is from 1800s london? if so, how long would that take?

6. how long would it take a fifteen-year-old girl to die from being shot through the heart? would she be able to think and see and hear? for how long?
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Tue Nov 22, 2016 4:12 pm
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StellaThomas says...



1. how long would it take a fifty-year-old to heal from being shot in the shin in the 1800s, assuming they receive appropriate medical attention? "Appropriate medical attention" is a tricky concept in the 1800s, but assuming that he didn't die of infection... it depends on how badly his bone is damaged. It would take at least six weeks - up to twelve - for the bone to heal, and even then I find it unlikely that they'd recover completely, they'd probably always have a limp.

2. several characters get run through with a seax - a blade about 55 cm long, about .5 cm thick. stab areas include the solar plexus, the throat, and the abdomen. how long would it take for a person stabbed in those areas to die, respectively? would any of those scenarios have our person still able to move and attack back?

Solar plexus/upper abdomen - you get run through, they hit your descending aorta, and even if they don't sever your spinal cord, less than a minute.

Throat - even if they don't sever your spinal cord, they cut your airway which fills up with blood and you lose your airway. They may also hit one of your carotids. Either way, seconds/up to a minute

Abdomen - depends if you want them run through in the centre or on the side. The more central = more likely to hit the aorta/vena cava and have them bleed out in less than a minute. It's conceivable that if they got stabbed more laterally (i.e. to one side) that they might have longer. It then comes down to what exact injuries they hypothetically sustained. They could hypothetically fight back, probably not very well, but especially if they're young (young people just have a better chance of compensating blood loss for longer).


3. how much damage would an 1800's flintlock pistol do to an unarmoured person, assuming they're shot centre mass?

I'm not hot on guns or weapons in general, so I can't really give a specific answer to this one, but I would say "lots". You need to decide whether it's through and through which, although there's more blood loss, is generally safer as there's less tearing of the tissues on the inside, or if the bullet is going to bury itself into a vital organ. Then decide which vital organ. Being shot in the lung is probably better, for instance, than being shot in the kidney, and being shot in the stomach is better than being shot in the heart (though you may still bleed out from your stomach).

4. what would a person experience immediately after getting a sabre dug into their side, say, 6 cm? would they be able to think rationally and maintain control of their hands?

Pain. A lot of pain. It depends on whether the blade is withdrawn or not. Withdrawn and there's more bleeding, but there's less pain. With regards to blood loss, as mentioned above, some people - especially younger people - are able to maintain their blood pressure and be functional for a surprisingly long time after they lose a lot of blood. So it's plausible from a bleeding PoV. When it comes to pain, regrettably I can't give you a straight answer, as everyone experiences pain in different ways, but I would say that that gives you leeway to let them be functional for a few minutes before passing out.

5. a character gets shallowly sliced from shoulder to opposite hip. would this impact their spine? would they be able to eventually recover, given that the only medicine available is from 1800s london? if so, how long would that take?

Ha, I have a building beam fall on my MC's back and give her a similar injury (though she also breaks several ribs). As long as it's clean, which would have been plausible with attention in 1800s London, and stitched, it wouldn't affect their spine. Remember that the spine is a bone, it's strong, it's there to protect. So just keep them infection free. I'd say it would heal in about ten days to two weeks.

6. how long would it take a fifteen-year-old girl to die from being shot through the heart? would she be able to think and see and hear? for how long?

I'd say she'd be able to see and hear for maybe a few seconds before eventually losing consciousness and dying. But we don't really have any evidence on this, since the only people who die after being shot in the heart are, well, dead. But there has to be a time lag between cardiac death and brain death, so I'd say you could push for a few seconds there.

Sounds like you're writing quite the steampunk murder mystery here! ;)
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Mon Nov 28, 2016 2:43 pm
BeTheChange says...



My questions are a little weird. Sorry.
1. My fanfiction character is a thirteen year old boy in relatively good health. In the final battle, he exerts himself to the point of being nearly unconscious. How long would he have to be fighting before this happens? Would there be any lasting physical effects from this specifically?
2. He gets burns on his face and limbs. Not too severe, but not mild, either. How long would it take to recover from these? Would he have scars after recovering?
3. Eventually, the monster he's fighting dies, but it manages to throw him, and he hits the wall of a cave. Would he get a concussion, or something more severe? Again, how long would recovery take?
4. Would a prosthetic limb be damaged by fire or the impact of hitting the cave wall?
5. With burns, overexertion, and a head injury, would he live at all? Would there be any lifelong/chronic damage, pain, etc.?
6. For most of the story, he hears voices (due to a magical artifact, but still like a mental illness). When he comes to, would the hospital put him on drugs to stop this, and if so, which ones? Any side effects?
  





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Mon Nov 28, 2016 5:13 pm
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StellaThomas says...



Hey @bookishminecrafter! Honestly not that weird at all :)

1. My fanfiction character is a thirteen year old boy in relatively good health. In the final battle, he exerts himself to the point of being nearly unconscious. How long would he have to be fighting before this happens? Would there be any lasting physical effects from this specifically?

So I thought about this on my way home from work and don't have a straight-up answer for you. A collapse like this might just be a faint (posh word = syncopal episode) from dehydration. It wouldn't be a lasting unconsciousness, but his vision might be going black and he might feel very woozy and need to get himself down on the ground to try recover.

In terms of lasting effects, the only thing I can think of is based on a time when a friend ran a marathon and got rhabdomyolysis at Mile 21. Rhabdo is a condition where your muscles break down very fast and can cause kidney damage. It's not very common but it does happen, if that's something you're interested in - but the kid has enough going on without going into kidney failure too I think.

2. He gets burns on his face and limbs. Not too severe, but not mild, either. How long would it take to recover from these? Would he have scars after recovering?

So "not too severe" but "not too mild" leaves us right in the middle with second degree burns. Second degree burns are painful, red, and blistering. They would take a few weeks to recover completely, and they might scar, especially if the blisters pop.

You can do a mix of second and third degree, but I would be cautious about giving your character third degree burns to the face, because the face is extremely complicated and there's so many structures (like, you know, your airway) that are in danger in severe facial burns. But if you wanted to give him third degree burns on his limbs they're less serious (as long as they're only covering a small percentage of his total body surface area). Third degree are waxy white or charred black in appearance, and they're painless as the nerve roots have been burned through. I discussed this more a couple of pages back - obviously most bad burns have less severe burns around the edges too, so an epicentre of third degree and second/first degree further out. Third degree would scar, and if this is a modern day story he may get skin grafting for them.

3. Eventually, the monster he's fighting dies, but it manages to throw him, and he hits the wall of a cave. Would he get a concussion, or something more severe? Again, how long would recovery take?

If he hits his head, he would almost definitely get a concussion, if not worse. Obviously the worst thing in this situation would be a brain haemorrhage which could kill him in less than an hour. A concussion is more like a brain bruise, and they're quite varied in how they can appear. Some people will have visual disturbance, some will lose memories etc etc.

When it comes to acquired brain injury, 80% of people actually lose their sense of smell - your olfactory nerve is a skinny little nerve running along the jagged base of your skull, so if your head is hit hard enough and your brain moves it can snap that nerve and boom, there goes your sense of smell. Other than that, poor memory and concentration, sometimes personality changes. If he gets a haemorrhage even stroke-like symptoms - like hemiparesis, slurring of speech, etc etc. can occur. If he does have a brain haemorrhage (I don't know if this is modern day but assuming it is) he would need surgery to evacuate the bleed. If no haemorrhage - it honestly just depends on the injury whether his recovery would be weeks, months or years to get back to normal (and a lot of people with ABIs never reach "normal" again).

4. Would a prosthetic limb be damaged by fire or the impact of hitting the cave wall?

It depends what the prosthetic is made of! I would say that if it's plastic the fire would probably melt it (I think most prostheses these days are a mixture of plastic and metal, maybe fibreglass too, sorry I'm not an expert - my orthopaedics job doesn't come until the end of the year ;) ), but it would need to be hit with quite some force to break against the wall - the same way you need to hit a flesh leg/arm with quite some force.

5. With burns, overexertion, and a head injury, would he live at all? Would there be any lifelong/chronic damage, pain, etc.?

All of these things are on a sliding scale, it depends on how severe you want them all to be. Like if he had severe third degree burns, rhabdomyolysis and a brain haemorrhage, I would not expect him to survive. But if his burns were more mild, he was just tired, and he has an ABI but not a haemorrhage, he'd live. There's lots of complications that follow - both burns and brain injuries can cause stress ulcers in the stomach (Curling's ulcer for burns and Cushing's ulcer for head injury), and if he was dehydrated to start with (hence the exhaustion), the burns won't help, which brings us back to the kidney situation (kidneys don't like being dehydrated).

The good thing though is that he's thirteen, and kids are amazingly resilient. They do better with burns than adults do, and at thirteen his brain would still have some plasticity so that he could recover from the brain injury.

If you want him to have lasting effects, the effects of the ABI can be, as I say, multiple and varied, I would do a bit of research yourself of what it's like to live with an acquired brain injury. Chronic pain would most likely come from being hit against the wall - but chronic pain from injuries is much more a thing that happens to adults than happens to children (because adult bodies don't recover as well).

6. For most of the story, he hears voices (due to a magical artifact, but still like a mental illness). When he comes to, would the hospital put him on drugs to stop this, and if so, which ones? Any side effects?

So, the hospital will only put him on drugs for it if he tells them about it, crucially. The second consideration is this: most psychiatrists will only look to stop distress, not necessarily symptoms. The most common cause of "hearing voices"/auditory hallucinations is obviously schizophrenia. The problem is that schizophrenia generally doesn't just leave if at hearing voices - it makes people hear really distressing things, the voices are really intrusive and people absolutely can't stand them.

When this is the case, we use anti-psychotics. Now, you've probably heard a lot about anti-psychotics, especially the likes of haloperidol which is old-school and still used in dire situations but not the norm. The point of an anti-psychotic isn't necessarily to put a stop to the hallucinations, but to stop them being distressing/intrusive/frightening. I've talked to a good few people with schizophrenia whose voices are still there, but the medication gives them the opportunity to ignore the voices and get on with their lives and the voices don't bother them anymore - so therefore we don't need to give them any more medications to try blot the voices out completely.

The second generation/"atypical" antipsychotics don't have the same effects as the typical/1st gen ones, but they do have their own side effects, which include weight gain and (it sounds stupid) hyper salivation, causing excessive drooling at night (told you it sounds stupid, but patients hate it, it soaks their pillow through and it's horrible to wake up to). In adults it can lower sex drive and cause breast growth in men - I'm not sure about children but they might have effects on puberty. Most of these drugs haven't been tested and aren't licensed for kids (most psychosis doesn't appear until late teens/early twenties), and honestly if he's happy-out they might try avoid medications altogether.

The first gen antipsychotics cause a family of side-effects called "extra-pyramidal side effects", mainly effects on movement, in particular Parkinsonism. But as I say, we try to avoid them these days.
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Mon Nov 28, 2016 5:21 pm
ChieTheWriter says...



@StellaThomas I'm back with another question. It's the same story btw.

So I changed a few things and the back injury had to to with some mystical power so that made things less confusing. But here's another question. Remember I was talking about those burns? They were deep, deep enough to hit muscle. How long would it take for my character to regain/rebuild muscle mass? I'd think it would take a while because not only were the muscles damaged by the saber, they weren't used while she was in bed for a decent amount of time. How long would it take for her to rebuild that strength?
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Mon Nov 28, 2016 9:40 pm
StellaThomas says...



Hey @ChieRynn!

Are you changing the location of her injuries or are you going to stick with her back? I can only imagine that with a laser sword like you're describing, the muscle fibres affected would be dead and she'd have to build completely new ones. Luckily the muscles of your back are thick and strong so she'd still have enough fibre to work with (the same with the leg muscles - e.g. glutes/hamstrings/quads if you're looking to change the location to the legs). I would say that it would take at least six weeks of intense physiotherapy to get her back on track, and even then she wouldn't be running marathons or anything for quite a while, any athletic training she'd have to start from scratch again.
"Stella. You were in my dream the other night. And everyone called you Princess." -Lauren2010
  





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Mon Nov 28, 2016 9:46 pm
ChieTheWriter says...



Thanks! And yes the injuries are still on her back.

But thanks! You helped a lot, Doc.
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Mon Nov 28, 2016 11:04 pm
Megrim says...



What do people experience during a petit mal seizure? (Or grand mal, for that matter)
  





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Tue Nov 29, 2016 7:53 pm
StellaThomas says...



Hey @Megrim! Excellent question :)

The first thing regarding your question is that we tend not to use 'petit mal' and 'grand mal' so much anymore in terms of classifying seizures. Classifying is an absolute pain, and if I try to do it I'll tie myself in knots and still be wrong - but essentially it boils down to:

- simple seizures - where the patient retains consciousness/awareness
- complex seizures - where the patient loses consciousness/awareness

So despite the name, a petit mal- also known as an "absence seizure" is in fact a complex seizure - where the patient loses consciousness.

A 'grand mal' is also a complex seizure - a generalised tonic-clonic seizure to be exact. A tonic-clonic seizure is specific itself: there is a "tonic" phase where the patient's body goes completely rigid for a moment- and then the "clonic" phase, where there is rhythmic jerking of all four limbs - NB - not of the trunk/torso/pelvis, just the limbs.

So most people lose consciousness during these seizures. Seizures can be split into:

-pre-ictal phase - before they start seizing. People may or may not experience an 'aura' - an aura is a recognised phenomenon and is thought to be a small partial seizure before the complex seizure begins. You still with me? Most commonly people will smell something unusual - it's funny, some people with epilepsy will know when they smell oranges, or gas, or something all of a sudden, that they're about to have a seizure. But also visual disturbance, loss of control of a limb, hearing a funny noise, etc etc.

-ictal phase - this is the seizure itself. Now, generalised seizures can be varied as we've discussed.

Absence/Petit Mal - a person will lose consciousness for a few seconds to a few minutes. They're really interesting to hear witnesses talking about. The person stares blankly ahead and won't respond to being called, won't blink when a hand is waved in front of their eyes, may fall from their chair or drop what they're holding. Afterwards they'll have no recollection what happened.

Tonic-Clonic/Grand Mal - fall to the ground, rhythmic jerking of all four limbs. Won't respond. Can go on a worrying amount of time - when it doesn't stop we call it status epilepticus.

There are key things that make you know it was an epileptic seizure (as opposed to non-epileptic, which are complex and psychological in origin but a whole different story): the person loses continence and will most of the time urinate and occasionally defaecate during the seizure. There's also 'lateral tongue biting' where they bite and injure the side of their tongue because they're not aware. And the last key thing about a seizure is the

-post-ictal phase: Everybody is groggy after a seizure, no matter what type of seizure it was. This generally lasts at least twenty/thirty minutes but could last over 24 hours. The person is groggy, has a decreased level of consciousness, basically feels like crap -- and doesn't remember what happened to them. A lot of people will also lose the memory of the post-ictal phase itself. The presence of a post-ictal phase is important in identifying petit mal/absence seizures as what they are, rather than just faints or falls from other reasons. If you faint, you're back to yourself in a couple of minutes. But not if you seize.

None of this probably answers the question that you wanted answered about what someone experiences because the truth is: I don't know! The person isn't conscious but that doesn't necessarily mean they are experiencing nothing, but you can't ask them during and they forget afterwards! I would recommend hunting in the blogosphere to see if anyone has ever described it :)

Sorry, hope it was of some help anyway!
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Tue Nov 29, 2016 9:33 pm
MissElaney says...



Hey Stella,

I am writing a modern-day crime fic and I have a character, Viktor, who was roughed up in a turf war and he's broken a bone, among other injuries that put him in need of a hospital (not sold on anything, just seriously roughed up by being jumped). He's well-aware it's broken, but the fear of going to the hospital convinces him to stay away from the hospital because, well, he got it broken in a gang turf war. So he calls his friend Daniel instead, because Daniel was/is a combat medic.

Daniel, the medic, wants him to go to the hospital bar none, but he can't convince him, for multiple reasons (like "I can't go, they'lll know where I am and I'll be vulnerable"). He's not going to DIE if he doesn't go, but he still should go. So because it is clear that the hospital is not an option, Daniel treats Viktor to the best of his ability. I imagine this amounts to disinfecting wounds, setting the broken bone manually, and fashioning some kind of improvised splint/cast until he can do a second shot at it with better materials.

I know as a layperson, I'm not supposed to even remotely try to set someone's broken bone. I'm just supposed to immobilize the person so it doesn't get worse, and call for help. So, I'm having trouble writing the specific scene where Daniel is split between treating Viktor and convincing him to get proper treatment with the right equipment.

What would a trained professional do first, given that they have nothing on hand but stuff they could buy from the nearest general pharmacy on the block? Because I'm sure you can only leave someone in pain for so long before the fact that you know how to fix it overrides the fact that you can't get an X-ray and make the perfect cast?

Thank you!
  





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Wed Nov 30, 2016 1:00 am
Megrim says...



Cool! Good to know. Some new info in there ^^ The perception thing is something we miss out on in our training, and sometimes I end up baffled like... I know what this disease DOES, but who knows what's going on in their brains while it's happening. I very much like giving my characters neuro diseases so it crops up a lot xD
  





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Wed Nov 30, 2016 6:14 pm
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StellaThomas says...



Yeah @Megrim I figured you would know a lot of that already, sorry xD But I also like to keep the thread as a point of reference for other members in case they have similar questions. I think when it comes to writing it, you can basically write whatever the heck you want, because no one can tell you you're wrong. It's like writing heaven or hell, there is literally no way to disprove you ;)

@MissElaney - this is an exciting question!

The first thing that I would say is that I don't know if you're planning to write it as an open fracture (where the bone pokes through the skin) but if you are, I'd avoid that. It's just that those are very hard to treat without operating - it's not just infection, but the bone cuts off blood supply to muscles and the muscles break down and somebody has to come in and cut out all the dead muscle before it spreads death onto the surrounding tissue. It's a hot mess. It's cool - under the right conditions - but if not - it's a hot mess. I would stick with a closed fracture, and by all means give him loads of cuts and bruises elsewhere, but don't let the bone come through the skin!

When it comes to setting the bone, it depends what fracture he has sustained. Whenever we get a fracture we want to know the following things:

-is it a full or partial fracture? (if it's partial it won't need setting at all so let's assume it's full)
-is it displaced or non-displaced? (that means do the two ends of the bone meet up - we're going to assume no for MAXIMUM CHARACTER ANGUISH right?)
-is it rotated? (this is largely for legs, you basically try and see if their foot is pointing the right way at the end of the bed, or is it pointing inwards or outwards?)
-is it impacted? (is the distal/bottom part of the broken bone being pushed up against the top part - this happens because when you break a bone your muscles go into spasm and pull the two broken parts back together, but they can pull them back in the wrong position).

Usually we use Xray for this, but in your story Daniel is going to have to do a lot of guesswork. In legs, it's easy to see if a foot is rotated or if one leg is shorter than the other (because of the muscle spasm), and in the forearms you can generally tell based on the deformity of the wrist. When it comes to the humerus I'm not sure.

OKAY. That was a segue. Sorry.

So the first thing that Daniel will do is assess the rest of Viktor, make sure he's nothing life threatening going on. He'll disinfect any wounds. Then he'll assess the broken bone. Pain relief is absolutely 100% crucial, because what happens next isn't pleasant.

In the local drug store, he'll probably only be able to pick up over-the-counter meds. Something like co-codamol (codeine and paracetamol/acetominophen) is the strongest you can get there - it likely won't really touch the pain of a broken bone, but if you don't have opiates there's not much you can do.

So the next thing is reduction of the fracture - that is, putting it back into place. This can be tricky and generally only done by experienced people, but let's assume Daniel knows what he's doing. It also requires a surprising amount of physical strength, especially for legs. (This is why so few women become orthopaedic surgeons). In fact for legs, if something is impacted, we use continuous traction using like a pulley to pull the leg back into place, (for instance he could somehow tie something to the foot and tie that to e.g. a door handle or a light fixture and gently exert more and more pressure) rather than letting a member of staff put their back out doing it. But for a wrist etc he'd be able to manage. Basically he'll want to pull the broken limb *down* and move it forward/back depending on what way it's displaced, and let it pop back into place.

That's the hard part, and it will hurt. like. heck. But after that, instant relief - the pain won't go entirely, he'll still have a broken bone, but it won't be nearly as bad.

Regarding a cast, it's not actually that important to have a perfect cast, it just needs to keep the bone in place. In the emergency setting we often just use a back slab - a half cast that you just bandage the limb to to immobilise it and keep it in place so that it heals the right way. Regarding what he can use, I don't know, something sturdy xD They use doors as back boards with people with spinal injuries and stuff like that.

Hope that helps - if you have a specific fracture in mind let me know, I might be able to give some more specific information!
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Wed Nov 30, 2016 9:48 pm
MissElaney says...



Thank you very much! Forgive my ignorance, but since people used to liquor you up in the 1800s and he's got you know, drugstore painkillers to work with -- just how irresponsible would it be for Daniel to liquor him up for the Biggun?

Since Daniel's currently working as a tow truck driver when he's called to do this (hur durr) I'm already amusing myself with designs for a doorjack-wrench-ziptie-tiedown splint abomination.

I am hesitant about making it a leg bone because I was reading that most lower leg fractures are open fractures thanks to how thin the skin is there at the shin, and as for the upper leg, femurs are so strong compared to other bones that breaking them takes some capital E Effort. Since he's getting jumped by multiple people, I see any of these scenarios causing a broken bone:

1. Screwing up his wrist by trying to block a blow, which would cause it to break like uh, not impacted but displaced because something is striking it hard from the side
2. Screwing up his wrist by falling and then it getting impacted (I assume?) because he's falling onto his wrist and the force would be shoving it in in the first place, I imagine.
3. Getting tackled while he's running could cause an entirety of horrible, horrible things to happen to his lower leg bone. Earlier up in this thread you were talking about a spiral fracture happening if someone is knocked down while their foot is planted. But then the situation you described that would occur seems to me that spiral fracture = inevitable compartment syndrome? I don't want to end up lopping a leg off. Maybe. D: Yet. I'm a horrible person, though. But probably not.

What do you think on those options?
  





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Thu Dec 01, 2016 5:03 pm
StellaThomas says...



Well @MissElaney you've certainly done your homework!

Regarding getting someone drunk, I mean, obviously never mix alcohol and painkillers but in this case... go for it. Or alternatively if they have benzos/sleeping tablets lying around the house, they might help the situation a little bit!

You are right about lower leg/tib-fib fractures being open, in particular tibia fractures and as for broken fibulas, meh, they're not really very exciting are they? When it comes to femurs, they are tough. We classify a pathological fracture as breaking a bone following a fall from your own height, but a non-pathological one would be like falling from a fire escape or something to break his femur. But they really require surgical fixating these days so I'm kind of leaning towards a wrist/forearm injury as well.

The most common type of wrist injury is FOOH (Fall Onto Outstretched Hand... orthopods. Not the most creative bunch of people) which causes a Colles Fracture/dinner fork fracture. I've had the pleasure of seeing one of these manually reduced in the emergency department (the guy was completely dosed up on morphine). A lot of these have associated clavicle/collarbone injuries which, like rib injuries, you just have to endure. So whether he was running and fell or he got thrown against a wall and used his hand reflexively to stop himself... and obviously you can break it other ways too. No 2 seems the most plausible to me but No1 works too.

Regarding spiral fractures and compartment syndrome - no, definitely not! And there's no saying that compartment syndrome will lead to amputation either - if you get compartment syndrome (your leg becomes pale, painful, pulseless, paralysed, paraesthetic and perishingly cold and you get pain on passive movement), what they do is:
-rip off your cast and backslab and bandages
-grab a scalpel
-cut down through all four compartments of your leg, through the skin, subcut fat and fascia

So you have four long, deep gashes in your leg. It's kind of intense, but you hopefully won't lose the leg if they get it done on time.

(You thought medicine had advanced further than that, hadn't you? xD)

But yeah, spiral fractures are an option. They just might be harder for Daniel to knock back into place than a good old transverse fracture.
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MissElaney says...



Thanks for your help!
  








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