Extremity%20trauma

1
?.???? ???????
2
Extremity trauma

• General principles

Dr . Almaghrabi Issam Damascus Hospital
3
Definition of fracture

• Loss of continuity in the substance of bone

4
Causes

• Causes of trauma
• Car accident
• Work accident
• Sport accident,
• Mechanism of trauma
• Direct shock
• Serious
• soft tissue lesions
• Indirect shock
• Flexion
• Torsion
• compression

5
General aspects

• According to the type of bone
• Long bones
• Diaphysis
• Epiphysis
• extra-articular
• intra-articular difficult treatment , ??
  complications
• Short bones
• Scaphoid , Calcaneus, Talus,
• Present diagnostic , therapeutic and prognosis
  problems

6
Long bones

• Epiphysis

• Diaphysis

extra-articular
intra-articular
7
Short bones

• soft tissue lesions

8

• According to the age
• Elderly
• Minor trauma
• ?? morbidity mortality
• e.g. femoral neck fracture
• Young adult
• Violent trauma
• The risk is local , preserve function
• Infant

9
Violent trauma
Minor trauma
10
Fracture avec décollement épiphysaire de type 1
11
Fracture en motte de beurre et  bois vert 
12
Diagnosis of fractures

• History
• Trauma itself
• Circumstances of the accident
• Mechanism of the injury direct, indirect
• Time of accident
• Traumatized patient
• Functional signs pain, immobility
• Age , past history.

13

• Clinical exam (comparative)
• Local examination signs of the fracture
• Inspection deformation, edema, hematoma,
  ecchymosis
• Palpation tenderness, abnormal mobility.
• Regional examination
• Cutaneous open fractures, contusion.
• Vascular peripheral pulse, color temperature
• Neurological e.g. humeral fracture (radial n.)
• General examination
• Clinical associated lesions
• Para clinical ECG, blood analysis, chest X-ray

14

• X-ray examination
• Technique
• The rule of 2
• 2 views , 2 joints , 2 limbs , 2 times
• Sometimes a special X-rays, e.g. scaphoid.
• Results
• Site
• Type
• Displacement depending on the distal fragment.

15
Pitfalls

• Elderly patient unable to weight bear
• ? femoral neck fracture
• Snuff-box pain normal X-ray
• ? suspected scaphoid fracture
• Dashboard lesions ? 2 patellae , femoral shaft ,
  silent hip dislocation
• Calcaneus fracture ? the other calcaneus
  vertebral column.
• Ankle sprain ? 5th base metatarsal fracture.
• Epilepsy shoulder pain ? think about post.
  dislocation.
• Monteggia Galeazzi (associated dislocations)

16
Elderly patient unable to weight bear
17
Snuff-box pain normal X-ray
D 0
18
Dashboard lesions
19
Fall from height
20
Ankle sprain
21
(No Transcript)
22
Epilepsy Post. dislocation
23
Galeazzi Fracture
24
Monteggia Fracture
25
(No Transcript)
26
Treatment

• Primary aims
• Bony union without deformity
• Restoration of function
• ER treatment
• Alignment of the fracture
• Temporary splintage
• Open fractures sterile bandage , AB , tetanus

27
Treatment

• Simple fractures
• Reduction casting
• After care of patient in plaster
• swollen fingers blue pain ? bivalve the
  cast
• Complex fractures admission
• Traction skin skeletal
• Open reduction internal fixation
• Indications
• Failed closed reduction
• Fractures cannot be held by closed methods
  (femoral neck)
• Intra-articular fractures
• Multiple injuries
• Techniques
• Plates , screws , K-wires , nails
• Interlocking nail , elastic flexible nails
• external fixation open fractures

28
Casting
29
(No Transcript)
30
(No Transcript)
31
(No Transcript)
32
Ostéosynthèse du tibia par plaque vissée
33
Infant
Flexible Titanium Nailing of Tibia
34
(No Transcript)
35
Ostéosynthèse du col fémoral
36
(No Transcript)
37
(No Transcript)
38
(No Transcript)
39
Evolution

• Favorable consolidation within the expected
  time .
• Complications
• Immediate
• General choc
• Loco-regional skin , vascular , nerves
• Secondary
• General DVT , bed sores , infections , fat
  embolism
• Loco-regional secondary displacement , opening
  , necrosis , Volkmann .
• Late
• Delayed union , nonunion , malunion , arthritis ,
  AVN
• Functional pain , stiffness , Sudeck .
• infection

40
Volkmann
41
Non union
42
Malunion
43
Sudeck atrophy
44
Records

• Date time , legible hand writing , employ only
  common use contractions.
• Full record on the day of the admission
• Write results of X-rays (neg., pos.)

45
Communications

• Telephoning description of the fracture
• Age of patient
• Occupation
• Type of accident
• The rule of 6 As

Articular Extra vs Intra Anatomy (proximal tibia )
Angulation Lat. view Alignment A.P. view
Apposition 75 , 25 Apex Distal fragment
46
Fracture clinic

• What , When
• 3 As (assessment , action , advice)
• When , What

47
What , When

• What
• What we are dealing with (diagnosis)
• Recording ?? duplication.
• When
• Establish the time that has passed since the
  patients injury
• Initial Medical record and X-rays are available.

48
3 As

• Assessment
• Appropriateness (whether this was the best
  treatment )
• Action
• too tight plaster ? split
• More senior opinion ? ?? Outcome.
• Advice
• It is important to Explain to the patient the
  nature of his injury, to keep him Informed of his
  progress

49
When , What

• When
• the date time of the next appointment .
• e.g. ? of stitches , ? of plaster
• What
• The purpose of the patients next visit
• Save valuable time by avoiding the patient having
  to wait and seen twice.

50
Questions ????