A brief introduction to orthopaedic trauma

1. D R M O H A M M A D Y O U S A F
ORTHOPAEDIC TRAUMA

2. TRAUMA
• COULD BE DEFINED AS CELLULAR DISRUPTION
THAT RESULTS FROM THE EXCHANGE WITH
ENVIRONMENTAL ENERGY THAT IS BEYOND
BODY’S RESEILIENCE.
• OR
• IT MEANS INJURY FROM ONE OR MORE SYSTEMS,
THAT RESULTS IN EXCESSIVE BLEEDING AND MAY
AFFECT THE NORMAL BODY FUNCTIONS.
.

3. ORTHOPAEDIC TRAUMA
• FRACTURE: IT MEANS BREAK IN THE STRUCTURAL
CONTINUITY OF BONE
• SUBLUXATION: IT MEANS PARTIAL LOSS OF
CONGRUITY BETWEEN ARTICULAR SURFACES
• DISLOCATION: IT MEANS TOTAL LOSS OF
CONGRUITY BETWEEN ARTICULAR SURFACES.

4. HISTORY AND EXAMINATION
• HISTORY
• MECHANISM OF INJURY
• PATIENT DISCRIPTION OF SYMPTOMS
• SYMPTOMS
• EXAMINATION
• GENERAL-ABCDE
• LOCAL (SWELLING,TENDERNESS, ABNORMAL PORTION)
• DISTAL (CIRCULATION AND SENSORY OR MOTOR DEFICIT)
• INJURIES OCCUR IN PATTERN OF DISLOCATED KNEE
RESULTS IN VASCULAR INJURY which should be identified and
recorded -( Check for dorsalis pedis)
• NERVE INJUSRY SHOULD BE IDENTIFIED AND RECORDED

5. CONTINUED
• INVESTIGATION-IMAGING
• X-RAY IS GOLD STANDARD
• 2 VIEWS (AP/LATERAL)
• 2 JOINTS (ABOVE AND BELOW INJURY)
• 2 SIDES (FOR COMPARISON)
• 2 TIMES (BEFORE AND AFTER TREATMENT)

6. PRIMARY SURVEY
• RAPID ASSESSMENT OF ABC’s AND ADDRESSING
LIFE THREATENING PROBLEMS.
• Establish airway ventilation and control hemorrhage.
• PLACE LARGE BORE IV’s AND BEGIN FLUID
REPLACEMENTS
• TRAUMA X-RAYS
• -chest, pelvis and lateral C-spine

7. SECONDARY SURVEY
• Assess entire patient for other non life threatening
injuries
• Orthopaedic Assessment of Skeleton
• -splint fractures
• -reduce dislocation
• Evaluate distal pulses and peripheral nerve function.
• Obtain Xray and CT of affected area when patient is
stable

8. ASSESS FOR THE INJURIES THAT COMMUNICATE
WITH THE FRACTURE
-CLOSED FRACTURE: Skin intact over fracture
-OPEN FRACTURE: LACERATION COMMUNICATING
WITH FRACTURE (OFTEN REFERRED AS COMPOUND
FRACTURE)

9. FRACTURES
• BASICS
• BIOMECHANICS
• BENDING
• AXIAL LOADING
• -tension
• -compression
• TORSION

10. FRACTURE TYPES

11. THE BONY INJURY
A GOOD DESCRIPTION (8 POINTS)
1. NAME OF THE INJURED BONE
2. GIVE THE REGION OF THE BONE
3. IS THE FRACTURE SIMPLE OR
MULTIFRAGMENTARY
4. DESCRIBE THE DIRECTION OF THE FRACTURE
LINE : TRANSVERSE, OBLIQUE OR SPIRAL
5. ARE THE FRAGMENTS DISPLACED OR
UNDISPLACED
6. IF DISPLACED, DESCRIBE ALINGMENT, LENGTH
AND ROTATION.

12. CONTINUED
7. NOTE ANY EVIDENCE OF PRE-EXISTING
PATHOLOGY
8. ANY ASSOCIATED JOINT DISLOCATION
IN ADULTS THE FRACTURE IS USUALLY COMPLETE
WHILE IN CHILDREN IT MAY BE INCOMPLETE i.e
Torus and Greenstick.

13. GUSTILO AND ANDERSON
CLASSIFICATION

14. SALTER-HARRIS CLASSIFICATION

15. THE AO CLASSIFICATION SYSTEM

16. X-RAYS INTERPRETATION
• REGIONAL LOCATION
• -Epiphysis, metaphysis
• -Diaphysis ( rule of 1/3rd)
• -Intra/extra-articular
• FRACTURE/TYPE
• -Transverse, Oblique, Spiral
• CONDITION OF BONE
• Comminution (3 or more parts)
• Segmental (middle fragment)
• Butterfly segment (Due to bending force)

17. X-RAY INTERPRETATION
• DEFORMITY
• -Angulation (Varus/Valgus, Anterior/Posterior)
• -Translocation
• Rotation
• Shortening/Distraction

18. FRACTURE PATTERN
TRANSVERSE
RESULTS FROM TENSILE
FORCE

19. FRACTURE PATTERN
• SPIRAL
• RESULTS FROM TORSIONAL FORCE

20. FRACTURE PATTERN
• BUTTERFLY
• PRODUCE BY PURE BENDING FORCE

21. FRACTURE PATTERN
• COMMINUTED
• MULTIFRAGMENTS
• DUE TO HIGH ENERGY TRANSFER

22. TREATMENT OF FRACUTURES
• REDUCE
• MAINTAIN REDUCTION (+HOLD UNTIL UNION)
• REHABILITATE- RESTORE FUNCTION
• PREVENT OR TREAT COMPLICATIONS

23. MAINTANING REDUCTION
• EXTERNAL METHOD
• -POP, TRACTION, EXTERNAL FIXATION
• INTERNAL METHOD
• -WIRES, PINS, PLATES, NAILS, SCREWS

24. EXTERNAL METHOD
• POP
• RESINS CASTS
• SKIN TRACTION: TEMPORARY MEASURE WHEN OPERATIVE
FIXATION NOT AVAILABLE
• SKELETAL TRACTION
• EXTERNAL FIXATORS
• INDICATIONS
• FRACTURE ASSOCIATED WITH SEVERE SOFT TISSUE INJURY
• FRACTURE ASSOCIATED WITH NEUROVASCULAR DAMAGE
• UNSTABLE PELVIC FRACUTURE
• INFECTED FRACTURE
• COMPLICATION
• PIN TRACK INFECTION
• DELAYED UNION

25. POP

26. SKIN TRACTION

27. EXTERNAL FIXATOR

28. INTERNAL METHOD
• INDICATIONS
• FRACTURE THAT NEED OPERATIVE FIXATION
• INHERENTLY UNSTABLE FRACTURE PRONE TO RE-
DISPLACEMENT (MID-SHAFT FEMORAL FRACTURE)
• PATHOLOGICAL FRACTURE
• POLYTRAUMA (MINIMISE ARDS)
• PATIENT WITH NURSING DIFFICULTIES
(PARAPLEGIC, ELDERLY)

29. INTERNAL METHOD
• WIRES : USE TO TREAT FRACTURES OF SMALL
BONES
• PINS: USED FOR PIECES OF BONES TO SMALL TO
BE FIXED WITH SCREWS
• PLATES
• NAILS OR RODS
• SCREWS

30. K-WIRES

31. PINS

32. PLATES AND RODS

33. SCREWS

34. COMPLICATION OF FRACTURE
EARLY
-VISERAL,VASCULAR,NERVE INJURY
-HAEMARTHROSIS
-INFECTION
-FAT EMBOLISM SYNDROME:
-Serious manifestation of fat embolism occasionally causes
multi dysfunction, occurs within 72hrs post fracture.
-COMPARTMENT SYNDROME
- Is an elevation of intrestitial pressure in a closed osteo-fascial
compartment that results in vascular copromise
- Nomral compartment pressure= 5-15mmofHg
- Intracompartmental pressure rises to 35-40mmmofHg

35. LATE
LATE
-MALUNION
-DELAYED UNION
-NON UNION
-TENDON RUPTURE
-MYOSITIS OSSIFICANS
-OSETEONECROSIS
-COMPLEX REGIONAL PAIN SYNDROME
OSTEOARTHRITIS AND JOINT STIFFNESS

36. • THANKYOU FOR LISTENING!