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