1. Pat Fleming Consultant Orthopaedic Surgeon
Orthopaedic Trauma
Pat Fleming
Consultant Orthopaedic Surgeon

2. Orthopaedic Trauma Fractures Soft tissue injuries
Musculo-skeletal injury

3. Final Exams Recognition of orthopaedic injury
Description of orthopaedic injury
Appropriate terminology
Principles of management of orthopaedic injuries
- Emergency treatment
- Definitive treatment

4. Trauma
Blunt
Penetrating
E = mv2
High-velocity vs Low-velocity

5. Blunt trauma

6. Penetrating trauma

7. Penetrating trauma

8. Blunt AND penetrating

11. Multiple Trauma

12. ATLS
Advanced Trauma Life Support
A-B-C-D-E

13. A-B-C-D-E Airway and cervical spine A Breathing B Circulation C
Deformity
Environment

15. Isolated Trauma Most common Isolated injury to spine / extremities
Usually not life-threatening
Limb-threatening
Disabling

16. Isolated fractures

17. Fractures “An abnormal discontinuity in the skeleton” “A break”
“A hairline crack”

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

19. Velocity of Injury

20. Past Medical History History of previous injuries
Illnesses that may affect the prognosis
Illnesses that may affect surgery
Illnesses that may delay discharge

21. Examination of fractures
Tenderness, crepitus, deformity
Associated soft-tissue injuries
Neurovascular damage
X-ray

22. Description of a Fracture
Which bone?

23. Description of a Fracture
Which part of the bone ?

24. Joint surface
Physis (Growth plate)
Epiphysis
Metaphysis
Diaphysis

25. Description of a Fracture
Open or Closed?

27. Description of a Fracture
Fracture pattern?

28. Description of a Fracture
Deformity?
Displacement
Shortening

30. Description of a Fracture
Deformity?
Angulation

31. Description of a Fracture
Deformity?
Rotation

33. Plain X-rays
2 joints
2 planes
2 views

34. Emergency management Take a history Examine / consider other injuries
Analgesia
Splint the fracture

37. Thomas’ splint

38. Fracture position Fracture stability
Definitive Fracture Treatment
Fracture position Fracture stability

39. Fracture reduction

40. Fracture reduction

41. Fracture reduction

42. Stabilisation
Plaster cast
Internal fixation
External fixation

43. Internal fixation Plates and screws K-wires (Kirschner)
Intra-medullary nails

46. External fixation

47. Fracture Union Clinically united - Non tender No movement
Radiological union - Callus

48. Fracture callus

49. Fracture callus

50. Complications of Immobilisation
Stiffness
Muscle wasting
Weakness
Osteoporosis
Bed-sores, chest infections, UTI’s, ileus, boredom

51. Rehabilitation

52. Rehabilitation

53. Stages in Fracture Management
Initial assessment & first aid
X-ray assessment
Fracture reduction
Stabilisation - Cast immobilisation
Internal fixation
External fixation
Rehabilitation

54. Specific fractures
Hip fractures
Wrist fractures
Ankle fractures

55. Specific soft-tissue injuries
Ligament injuries at the knee
Achilles’ tendon injuries
Rotator cuff injuries
Shoulder instability
Finger dislocations

56. Fractures in Children NAI Growth plates Greenstick fractures
Rapid union
Remodelling