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General principles of fractures treatment

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General principles of fractures treatment Klinika Ortopedii i Traumatologii PAM Management of major injuries Emergency treatment at the scene of the accident and ... – PowerPoint PPT presentation

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Title: General principles of fractures treatment


1
General principles of fractures treatment
  • Klinika Ortopedii i Traumatologii PAM

2
Management of major injuries
  • Emergency treatment at the scene of the accident
    and during transport to the hospital
  • Resuscitation and the evaluation in the accident
    department
  • Early treatment of visceral injuries and
    cardiorespiratory complication
  • Provisional fixation followed by definitive
    treatment of musculoskeletal injuries
  • Long term rehabilitation

3
Individual patient
  • Obtain access
  • Establish an airway but protect the cervical
    spine
  • Ensure ventilation
  • Arrest haemorrhage and combat shock
  • Give analgesia
  • Splint fractures
  • Transport

4
Examination
  • Pulse feeling
  • Measure capillary return
  • Observe the respiration
  • Palpate the head, chest, abdomen, and limbs

5
Second mortality peak
  • Death from hypoxia or hypovolaemic shock
  • At risk of further damage to cervical spine,
    thoracolumbar, brain
  • The golden rule (effective resuscitation)
  • Advanced Trauma Life Support Programme

6
Primary survey
  • A Airway maintenance
  • B Breathing and oxygenation
  • C Circulation and control of bleeding
  • D - Disability
  • E Exposure and aviodenance of hypothermia

7
Disability
8
Blood loss
9
Chest injuries
  • Tension pneumothorax
  • Sucking chest wounds
  • Flail chest
  • Cardiac tamponade
  • Massive haemothorax

10
Complication of major trauma
  • Tetanus
  • ARDS
  • Fat embolism syndrome
  • DIC
  • Crush syndrome
  • MSOF - prevention

11
How fractures happen
  • A single traumatic incident
  • Repetitive stress
  • Abnormal weakening of the bone

12
Mechanism of injury
  • Spiral (twisting)
  • Short oblique
  • Bending - Triangular butterfly fragment
  • Transverse

13
(No Transcript)
14
Principles of treatment
  • Anatomical reduction
  • Stable internal fixation
  • Preservation of blood supply
  • Early mobilization

15
Implants types
  • Pin and wire fixation
  • Screw fixation
  • Plate and screw fixation
  • Intramedullary nail fixation
  • External fixation

16
Fractures healing
  • Haematoma
  • Inflammation
  • Callus
  • Consolidation
  • Remodelling
  • Primary
  • Secondary

17
Fractures healing
18
Open fractures
  • Classification

19
Open fractures
  • Wound debridement
  • Antibiotic prophylaxis
  • Stabilization of the fracture
  • Early wound cover

20
Complications of fractures
  • Late - delayed union
  • - non-union
  • - avascular necrosis
  • - bed sores
  • - myositis ossificans
  • - tendon lesion
  • - nerve compression
  • - muscle contracture
  • - joint instability
  • - joint stiffness
  • - algodystrophy RSD
  • - osteoarthritis
  • Early - visceral injury
  • - vascular injury
  • - nerve injury
  • - compartment syndrome
  • - haemarthrosis
  • - infection
  • - gas gangrene
  • - fracture blisters
  • - plaster and pressure sores

21
Compartment syndrome
  • Pain
  • Paraesthesia
  • Pallor
  • Paralysis
  • Pulslesness

22
Volkmanns ischaemia
23
Non-union
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