Post on 30-May-2018
transcript
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(Medical Student Education Series-Core
Orthopaedics)
(Medical Student Education Series:Core Orthopaedics)
ALL ABOUT FRACTURES
(Fxs).Part One
Open Fx tibia from suicide
The 10-15 minute FractureTalk for all Medical Studentscopyright 2008 eugene [sic]
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there are > 500 differenttypes of Fxs and softtissue injuries; it took me
30 years to know them;here you can learn themin just 10-15 minutes.
(You can learn orthopaedics fromreading books or from:
Youtube or simply building your
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What is aFracture (Fx)?A break in the
bone
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Why treat a
Fx?
To revent mal-
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How to describe aFx.
(stand one meter from the XRbox,
name the patient and the date ofthe XR)Which bone, which end of thebone, fracture
line configuration
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How to treat a Fx?
(save the patient, ABC,and save the limb).
REDUCE the Fx(Externally-traction &manipulate orINTERNALLY- operate) and
HOLD the Fx(Externally-POP, external
REDUCE-MANIPULATE
HOLD
REDUCE-TRACTION
Skier dead fromhead injury
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How does a Fx heal?Haematoma (minutes),granulation tissue (hours),(forget days),immature callus (weeks, =clinicalunion),
mature callus (months, =XR union),
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How can you tell a Fx ishealed?
No pain when loaded in
Healed Fx tibia
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Open and
Open Fxcommunicates
with the skin.Wash-out within
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Open Fx (need to stop
Soft tissues-Debride/clean,close,reconstruct (skin grafts/flap)
Open subtalar Fx/dislocation
The Bone-Debride,reduce, hold,reconstruct(bone graft).ie wash-out,ext fix to bone,close skin 2 to 3 days, maybe skin graft,bone graft at 6 to 8 wks.
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Complications ofFxs.
Nerves-
neuropraxia/axonotmesi
s/neurotmesis
Non unionhumerus
Heel pressurearea
EPL rupture
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and late(Osteo-
OA ankle
OA kneeOA wrist
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Dont forget INFECTION
Never get in closed
management
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Compartment syndrome(EMERGENCY-easilymissed; can become
disaster).
Extreme pain at rest,extreme pain with movement,
ins-and- needles.Release tight POP,
fascioto
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Stress Fx
where XR is normal,
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(Medical Student Education Series-Core
Orthopaedics)
(Medical Student Education Series:Core Orthopaedics)
ALL ABOUT FRACTURES
(Fxs).Part Two
Open Fx tibia from suicide
The 10-15 minute FractureTalk for all Medical Studentscopyright 2008 eugene [sic]
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Which Fxs you shouldust about
always operate on?
Multi-trauma,
athological,nursing difficulties,forearm,displaced into joints,
Pathological Fx
Ankle Fx
Fx femurFx left femur,Fx right tibia
Pelvic Fx
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Which Fxs you just
aboutnever operate on?
Children (with
Pelvic Fx, 8 yo, re models. Fx wrist.8 yo.Closed reduction.
Fx forearm.Closed
reduction. 11 yo.
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Who NOT to operateon?
Patients who haveroblems
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NEVER-
pplyPOPto new
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FOLLOW-UP ALL Fxs.Esp childrens.
Lat condylar Fx in a 8 yo, complicationsmay appear at age 20.20 yrs.
Fx lower femur, 11 yo,growtharrest may appear 12 to 24 mths later.
Physealbridge
ankle 11 yo.Apparent
Growth arrestLower femur apparentat 18 mths post injury
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Difficult to treat Fxs
-Impossible Fx(comminuted, pathological,
unstable)-Impossible facilities( you need the right
knowledge& equipment)
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Childrens Fxs.
Involves growth plateinjuries ,bone may stop growing,
which can later causeshortening andangulation of leg/limbs.
Lat condylar Fx in a 8 yo, complicationsmay appear at age 20.20 yrs.
Fx lower femur, 11 yo,see below:
Physeal bridge.Ankle Fx. 11 yo,.
Growth arrest
at 18 mths.
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Here we
ALL
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Common Fxs:
Shoulder-proximalhumerus,
clavicle.Elbow-lateralcondylar,
supra-condylarColles/wristScaphoid5th metacarpal neck
Supra condylarFx humerus
Colles Fx
Fx 5thmetacarpal
Fx clavicle
Fx proxhumerus
Fx lateralcondyle
Scaphoid Fx
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Hip and femurKnee
Tibiankle
TalusCalcaneusBase 2nd
metatarsalBase 5thmetatarsal
Both legs broken. 8 yo.
Plateau Fx
Upp tibial Fx
ommon so t t ssue
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ommon so t t ssueinjuries:
Skiers thumb-brace/splint
Dislocated shoulder-sling/investigate/follow/often needsurgery
Knee sprain-examine/image/often surgery
Dislocated
Torn meniscus
Sprain
Skiers thumb
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And dont forget:
-Important signs (eg blood at tipof
penis post injury? = Pelvic Fx.)
-In multi trauma,young doctorssometimes forget about footfractures, these later becomethe main concern of the patient(
Blood at tip
penis
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Enjoy treating Fxs; try hard;these are often young and
active patients, you canmake a big difference totheir life.
MVA nearly killed Beforesurgery
Put nail infemur You saved
herBeforesurgery
Before surgery
You saved her