Orthopaedic Trauma
Pat FlemingConsultant 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
• A• B• C• D• E
Airway and cervical spine BreathingCirculationDeformityEnvironment
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?
• Which part of the bone ?
Description of a Fracture
Joint surface
Metaphysis
Diaphysis
Physis (Growth plate)
Epiphysis
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 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 tenderNo
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 fixationExternal 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