Orthopaedic Emergencies 17th May 2012 Dr Liling Patterson Surgical HMO

Orthopaedic Emergencies Open (Compound) Fractures Compartment Syndrome Dislocation Septic Arthritis

Compound Fractures Wound infection Osteomyelitis Gas gangrene Tetanus Non-union

Wound Classification Gustilo-Anderson Classification: Type I – clean wound, < 1cm, no skin crushing Type II – wound > 1 cm, moderate soft tissue injury Type III – extensive soft tissue injury

Management “Six Hour Golden Rule” Fluid resuscitation Control haemorrhage Analgesia Irrigation Dressing, splint Antibiotics, tetanus prophylaxis Surgical debridement & fixation “Six Hour Golden Rule”

Compartment Syndrome Limb threatening Increased pressure in tight fascial compartment Muscle necrosis at > 30mm Hg Ischemic injury at 4 hrs Irreversible injury 4-8 hrs Signs: disproportionate pain, 5 P’s Pain Pallor Paraesthesiae Paralysis Pulseless

Causes of Compartment Sx Fractures ~75% Crush injury Burns Extravasation Tourniquets, constrictive dressings/plasters Snake bites

Management Early recognition! Urgent fasciotomies

Dislocations When bones at a joint become displaced or misaligned Neurovascular compromise Main principle of Mx – reduce it!

Knee Dislocation Popliteal artery (20-30%) Peroneal nerve (up to 25%) PCL/ACL

Septic Arthritis Infection within joint space Usually bacterial Staph aureus Streptococcus Neisseria gonorrhoeae Signs: fever, NWB, raised WCC/CRP Prosthetic joints – delayed presentation

Management Diagnosis by aspiration -> Gram stain, culture iv Abx Analgesia Washout