Pat Fleming Consultant Orthopaedic Surgeon Orthopaedic Trauma Pat Fleming Consultant Orthopaedic Surgeon
Orthopaedic Trauma Fractures Soft tissue injuries Musculo-skeletal injury
Final Exams Recognition of orthopaedic injury Description of orthopaedic injury Appropriate terminology Principles of management of orthopaedic injuries - Emergency treatment - Definitive treatment
Trauma Blunt Penetrating E = mv2 High-velocity vs Low-velocity
Blunt trauma
Penetrating trauma
Penetrating trauma
Blunt AND penetrating
Multiple Trauma
ATLS Advanced Trauma Life Support A-B-C-D-E
A-B-C-D-E Airway and cervical spine A Breathing B Circulation C Deformity Environment
Isolated Trauma Most common Isolated injury to spine / extremities Usually not life-threatening Limb-threatening Disabling
Isolated fractures
Fractures “An abnormal discontinuity in the skeleton” “A break” “A hairline crack”
Trauma - History History of the Injury - Mechanism of injury High velocity or low velocity? Closed or open? Penetrating or blunt? Duration since injury
Velocity of Injury
Past Medical History History of previous injuries Illnesses that may affect the prognosis Illnesses that may affect surgery Illnesses that may delay discharge
Examination of fractures Tenderness, crepitus, deformity Associated soft-tissue injuries Neurovascular damage X-ray
Description of a Fracture Which bone?
Description of a Fracture Which part of the bone ?
Joint surface Physis (Growth plate) Epiphysis Metaphysis Diaphysis
Description of a Fracture Open or Closed?
Description of a Fracture Fracture pattern?
Description of a Fracture Deformity? Displacement Shortening
Description of a Fracture Deformity? Angulation
Description of a Fracture Deformity? Rotation
Plain X-rays 2 joints 2 planes 2 views
Emergency management Take a history Examine / consider other injuries Analgesia Splint the fracture
Thomas’ splint
Fracture position Fracture stability Definitive Fracture Treatment Fracture position Fracture stability
Fracture reduction
Fracture reduction
Fracture reduction
Stabilisation Plaster cast Internal fixation External fixation
Internal fixation Plates and screws K-wires (Kirschner) Intra-medullary nails
External fixation
Fracture Union Clinically united - Non tender No movement Radiological union - Callus
Fracture callus
Fracture callus
Complications of Immobilisation Stiffness Muscle wasting Weakness Osteoporosis Bed-sores, chest infections, UTI’s, ileus, boredom
Rehabilitation
Rehabilitation
Stages in Fracture Management Initial assessment & first aid X-ray assessment Fracture reduction Stabilisation - Cast immobilisation Internal fixation External fixation Rehabilitation
Specific fractures Hip fractures Wrist fractures Ankle fractures
Specific soft-tissue injuries Ligament injuries at the knee Achilles’ tendon injuries Rotator cuff injuries Shoulder instability Finger dislocations
Fractures in Children NAI Growth plates Greenstick fractures Rapid union Remodelling