PRESENTATION11.pptx

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!

PRESENTATION11.pptx

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