ORTHOPAEDIC EMERGENCY นพ.พรพงศ์ อิสริยะพฤทธ์ิ

กลุม่งานศลัยศาสตร์ออร์โธปิดิกส์ รพ.นครพิงค์

EMERGENT ORTHOPAEDIC CONDITION

• Life threatening

• Major pelvic ring injuries

• Crush injury syndrome

• Vascular injuries

• Limb threatening

Trauma

• Open fracture

• Compartment syndrome

• Joint dislocation

Non-trauma

• Osteomyelitis, septic arthritis

• Acute disc herniation

INITIAL ASSESSMENT AND MANAGEMENT

• Primary survey

• Resuscitation

• Adjuncts to primary survey and resuscitation

• Secondary survey

• Adjuncts to secondary survey

• Definitive care

• Transfer

PRINCIPLE OF FRACTURE MANAGEMENT (5R)

Recognition

Reduction

Retention

Rehabilitation

Refer

PRINCIPLE OF FRACTURE MANAGEMENT (5R)

Recognition

Reduction

Retention

Rehabilitation

Refer

X-RAY

• Adequacy

• Center of film

• Orthogonal view

• One joint above and below

• Bilateral sides (Children)

PRINCIPLE OF FRACTURE MANAGEMENT (5R)

Recognition

Reduction

Retention

Rehabilitation

Refer

FRACTURE/JOINT DISLOCATION REDUCTION

Purpose

• Pain control

• Bleeding control

• Improve distal blood circulation

• Prevent soft tissue damage

FRACTURE/JOINT DISLOCATION REDUCTION

• Closed reduction

*Check neurovascular status before/after reduction

• Open reduction

PRINCIPLE OF FRACTURE MANAGEMENT (5R)

Recognition

Reduction

Retention

Rehabilitation

Refer

PRINCIPLE OF IMMOBILIZATION

• Check distal neurovascular status

• Wound coverage

• Pad bony prominence

• Apply adequate splint; 1 joint above and 1 joint below

• Reassess distal neurovascular status

TYPES OF IMMOBILIZATION

• Splinting; wooden, commercial

• Slab

• Cast

• Traction

• Strap

• Brace or support

• External fixation

• Open reduction and internal fixation

CERVICAL SPINE INJURY

CLAVICULAR FRACTURE

FRACTURE AROUND SHOULDER

HUMERAL SHAFT FRACTURE

FRACTURE AROUND ELBOW AND FOREARM

DISTAL RADIUS FRACTURE

PELVIC FRACTURE

PELVIC FRACTURE

FRACTURE AROUND HIP

FEMORAL SHAFT FRACTURE

FRACTURE AROUND KNEE AND LEG

SPINAL INJURY

OPEN FRACTURE

• Primary and secondary survey

• Immobilization and sterile dressing

• IV antibiotics

• Tetanus prophylaxis

• Debridement and irrigation

• Stabilization

• Redebridement

• Delay wound closure

• Rehabilitation

OPEN FRACTURE

PELVIC FRACTURE

• Hemorrhage control

• Pelvic sheet wrap/binder

• External Fixation

• Packing (open)

• Fluid resuscitation

Apply binder

No binder

SPINE AND SPINAL CORD INJURY

• Associated injury

• Neurological examination is important !!

Management

• Immobilization

• Fluid challenge ,vasopressors

• Medications

• High-dose methylprednisolone

• Transfer

• Intubation ,stabilization

COMPARTMENT SYNDROME

• Release all constriction

• Reassess for next 30 min

• Fasciotomy

THANK YOU