Orthopaedic Trauma

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Orthopaedic Trauma

• Pat Fleming
• Consultant Orthopaedic Surgeon

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Orthopaedic Trauma

• Fractures
• Soft tissue injuries
• Musculo-skeletal injury

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Final Exams

• Recognition of orthopaedic injury
• Description of orthopaedic injury
• Appropriate terminology
• Principles of management of orthopaedic injuries
• - Emergency treatment
• - Definitive treatment

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Trauma

• Blunt
• Penetrating
• E mv2
• High-velocity vs Low-velocity

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Blunt trauma
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Penetrating trauma
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Penetrating trauma
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Blunt AND penetrating
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Multiple Trauma
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ATLS

• Advanced Trauma Life Support
• A-B-C-D-E

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A-B-C-D-E
Airway and cervical spine Breathing Circulation D
eformity Environment

• A
• B
• C
• D
• E

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Isolated Trauma

• Most common
• Isolated injury to spine / extremities
• Usually not life-threatening
• Limb-threatening
• Disabling

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Isolated fractures
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Fractures

• An abnormal discontinuity in the skeleton
• A break
• A hairline crack

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Trauma - History

• History of the Injury
• - Mechanism of injury
• High velocity or low velocity?
• Closed or open?
• Penetrating or blunt?
• Duration since injury

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Velocity of Injury
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Past Medical History

• History of previous injuries
• Illnesses that may affect the prognosis
• Illnesses that may affect surgery
• Illnesses that may delay discharge

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Examination of fractures

• Tenderness, crepitus, deformity
• Associated soft-tissue injuries
• Neurovascular damage
• X-ray

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Description of a Fracture

• Which bone?

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Description of a Fracture

• Which part of the bone ?

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Joint surface
Physis (Growth plate)
Epiphysis
Metaphysis
Diaphysis
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Description of a Fracture

• Open or Closed?

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Description of a Fracture

• Fracture pattern?

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Description of a Fracture

• Deformity?
• Displacement
• Shortening

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Description of a Fracture

• Deformity?
• Angulation

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Description of a Fracture

• Deformity?
• Rotation

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Plain X-rays

• 2 joints
• 2 planes
• 2 views

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Emergency management

• Take a history
• Examine / consider other injuries
• Analgesia
• Splint the fracture

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Thomas splint
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Fracture positionFracture stability

• Definitive Fracture Treatment

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Fracture reduction
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Fracture reduction
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Fracture reduction
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Stabilisation

• Plaster cast
• Internal fixation
• External fixation

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Internal fixation

• Plates and screws
• K-wires (Kirschner)
• Intra-medullary nails

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External fixation
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Fracture Union

• Clinically united - Non tender
• No movement
• Radiological union - Callus

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Fracture callus
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Fracture callus
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Complications of Immobilisation

• Stiffness
• Muscle wasting
• Weakness
• Osteoporosis
• Bed-sores, chest infections, UTIs, ileus, boredom

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Rehabilitation
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Rehabilitation
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Stages in Fracture Management

• Initial assessment first aid
• X-ray assessment
• Fracture reduction
• Stabilisation - Cast immobilisation
• Internal fixation
• External fixation
• Rehabilitation

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Specific fractures

• Hip fractures
• Wrist fractures
• Ankle fractures

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Specific soft-tissue injuries

• Ligament injuries at the knee
• Achilles tendon injuries
• Rotator cuff injuries
• Shoulder instability
• Finger dislocations

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Fractures in Children

• NAI
• Growth plates
• Greenstick fractures
• Rapid union
• Remodelling

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