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BarbaraKE
01-09-2009, 07:31 PM
The setting is 1730 rural Poland and the character is an 8-year-old boy. He will get either very primitive medical treatment or none at all (this part is variable). And I need the injury to be caused either by a bad fall or a crushing-type injury (i.e. hit with something heavy).

I need the injury to be something he would recover from yet would leave him with (at a minimum) a permanent limp. It would be good if it causes pain even when 'healed'.

I'm thinking hip dislocation that was not properly reduced (i.e. the head of the femur never properly put back in the pelvic socket). Would this work?

Thanks in advance!!

(Rep points will be given. :) )

cbenoi1
01-09-2009, 08:25 PM
Something like Dr House, I guess.

http://en.wikipedia.org/wiki/Gregory_House


A large portion of the show's plot centers on House's use of Vicodin to manage pain stemming from an infarction in his quadriceps muscle some years earlier, an injury that forces him to walk with a cane

-cb

Rabe
01-09-2009, 09:45 PM
Something like Dr House, I guess.

http://en.wikipedia.org/wiki/Gregory_House



-cb

Except that without proper diagnosis and treatment, the infarction would have either killed him or killed the leg completely.

As it was, it wasn't entirely successful.

For the most part, most any injury to the bones would give the original poster the desired effects. Remember, they didn't have the medical knowledge and skillsets we have today. Heck, even about fifty years ago a broken bone could leave someone with a permanent limp.

Rabe...

Teleute
01-09-2009, 10:35 PM
I think that dislocated joints would manage to relocate itself eventually.

Here's what I can think of off the top of my head:

Knee - Torn ACL, a lot of guys get this falling while playing football or baseball in high school, it requires surgery (sometimes several over a lifetime), and gives them lifetime problems and intermittent pain.

Hip - Bone spurs. I don't know how these are caused, I *think* they develop from breaks or dislocations. It's really difficult to injure a hip at that age though. Every hip problem I have ever witnessed is congenital, has slow onset, or is caused by osteoporosis.

That's all I can really think of, but if you just google orthopedics or sports injuries I bet you can find a lot more.

Calixus
01-09-2009, 11:05 PM
Hey BarbaraKE!

I have seen many crush injuries and most require some form of surgery to repair. If not, the leg is worthless, will not heal properly and would not hold the person's weight. If this was done as a child that young, odds are it would effect the growth plate at the end of the bone in a joint. It could be either the distal end of the femur if at the knee, or the proximal end (the ball) if at the hip. Injury to the growth plate will prevent the bone from lengthing during normal growth, causing the leg in this case to be shorter than the other. With years of hobbling on a shortened leg, the person would have chronic pain with not only the injury, but constant pain in their back, the other hip and/or knee and if a support such as a crutch or cane is constantly used, possibly in the shoulder/elbow from pivoting their weight on that joint with walking.

There is also the fact that Poland is an area that has very cold, snowy (wet) winters and if an adult in your story, may well have severe arthritis even at an early age. If your character was very poor as a child, you can factor in poor nutrition that would prevent proper healing from lack of cacium, phosphorous, magnesium, etc. needed to heal bones.

I hope this will help you some. You might be able to an archival search with medical journals such as JAMA (Journal of American Medical Association) if this is not enough to get you started.

Calixus

BarbaraKE
01-09-2009, 11:45 PM
Thanks everyone so far!!

The main problem I had trying to google this is that everything I find deals with treatments in the present day, not what would happen if it weren't treated.

I don't need to go into specifics about the exact injury but I want it to be realistic. Is it conceivable that an 8-year-old child could suffer a bad fall and end up with a permanent impairment like this (limp/pain) for the rest of his life.

Maybe he can dislocate his hip and chip the acetabulum (hip socket) somehow. They (primitive medical help) manages to reduce the dislocation but the femur doesn't fit properly anymore, causing limp/pain. Possibly the growth plate at the head of the femur is injured, so the femur doesn't grow properly.

Is this possible?

Calixus
01-10-2009, 12:11 AM
Yes it is very possible, especially with an injury to the growth plate. Most dislocations will eventually pop back in, it is the damage to the ligaments that is the problem. They get stretched and/or torn and allow a permanent weakness to the joint that will allow it to more easily dislocate again with less stress to the joint. The chip fracture could be a possiblility with a fracture to the hip joint, although in a child that might be more problematic. Children's bones are more flexible until the growth plate hardens, to adapt to rapid growth. Children are more likely to have what are known as greenstem fractures. This is a fracture that is similar to what happens when a green plant stem is twisted, with multiple areas of spliting lengthwise and breakage along the twisted area. I would have to talk to some doctor friends to find out if the child's mid shaft would be more likely to fracture in this way before the hip dislocated. It might work if the child's foot was fouled in say a rope that pulled his leg out of socket first then twisted it, snapping the bone? Not really sure how to set this injury up for you. But with the lack of any medical intervention that would happen with a poor child in a poor country, permanent disability would be most likely.

As for causing pain from the injury, if he did a complete fracture across the face of the growth plate, it would heal roughly, not be smooth as is normal, and would cause a constant grind in the joint. This would not only cause a chronic pain problem, but might slowly grind away the head or the socket of the hip and create further problems as an adult.

As for the fall, it would more likely cause an impaction fracture of the joint, where the ball is jammed into the socket and snap the neck of the femur, just below the ball or shatter the femur shaft. It would cause similar problems with improper care but there would be more disability of the limb. Does this help any?
Hope so.

Puma
01-10-2009, 01:05 AM
Personal experience: when I was about six, my Dad and brothers built me a cabin from old barn beams. They just set the beams one on top of the other so there was lots of open space in the walls and the beams protruded out at the ends. One of my favorite pasttimes was to climb up onto the roof of the cabin and jump off - over and over again. Then I got more daring and jumped off the highest beam at the peak and that became my new thrill. You know what's coming - from the time I was about 12 on, I've limped, just a bit. Now, I have constant knee, hip, and back pain and the only reasonable explanation is from damage from all my "flights" through the air. There was never any visible damage (other than banged up knees a couple times) so no medical treatment back then. Puma

Teleute
01-10-2009, 02:30 AM
Maybe he can dislocate his hip and chip the acetabulum (hip socket) somehow. They (primitive medical help) manages to reduce the dislocation but the femur doesn't fit properly anymore, causing limp/pain....

Is this possible?

Well, I have moderate hip dysplasia, which is congenital (so I've had it for my whole life), so my hip socket is too small. I didn't know it until my hip started hurting in my early twenties when I gained 20 pounds or so very quickly, and it only bothered me for about 6 months.

But it never made me limp, even on really bad days. My sister and roommate both have hip problems, too, and the pain is the worst while sitting, not standing or walking. The range of motion that's most affected is the one with a 45 degree - 90 degree angle between the leg and head, not at 180 degrees or thereabouts. If that makes sense. It never bothered me to walk or even run.