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Orthopaedic Trauma Pat Fleming Consultant Orthopaedic Surgeon

Orthopaedic Trauma Pat Fleming Consultant Orthopaedic Surgeon

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  • Orthopaedic TraumaPat FlemingConsultant Orthopaedic Surgeon

  • Orthopaedic TraumaFracturesSoft tissue injuries

    Musculo-skeletal injury

  • Final ExamsRecognition of orthopaedic injuryDescription of orthopaedic injuryAppropriate terminologyPrinciples of management of orthopaedic injuries- Emergency treatment- Definitive treatment

  • TraumaBluntPenetrating

    E = mv2

    High-velocity vs Low-velocity

  • Blunt trauma

  • Penetrating trauma

  • Penetrating trauma

  • Blunt AND penetrating

  • Multiple Trauma

  • ATLSAdvanced Trauma Life Support

    A-B-C-D-E

  • A-B-C-D-EABCDEAirway and cervical spine BreathingCirculationDeformityEnvironment

  • Isolated TraumaMost commonIsolated injury to spine / extremitiesUsually not life-threateningLimb-threateningDisabling

  • Isolated fractures

  • FracturesAn abnormal discontinuity in the skeleton

    A breakA hairline crack

  • Trauma - HistoryHistory of the Injury - Mechanism of injuryHigh velocity or low velocity?Closed or open?Penetrating or blunt?Duration since injury

  • Velocity of Injury

  • Past Medical HistoryHistory of previous injuriesIllnesses that may affect the prognosisIllnesses that may affect surgeryIllnesses that may delay discharge

  • Examination of fracturesTenderness, crepitus, deformityAssociated soft-tissue injuriesNeurovascular damage

    X-ray

  • Description of a FractureWhich bone?

  • Which part of the bone ?Description of a Fracture

  • Joint surfaceMetaphysisDiaphysisPhysis (Growth plate)Epiphysis

  • Description of a FractureOpen or Closed?

  • Description of a FractureFracture pattern?

  • Description of a FractureDeformity?

    DisplacementShortening

  • Description of a FractureDeformity?

    Angulation

  • Description of a FractureDeformity?

    Rotation

  • Plain X-rays2 joints2 planes2 views

  • Emergency managementTake a historyExamine / consider other injuries

    AnalgesiaSplint the fracture

  • Thomas splint

  • Fracture position

    Fracture stabilityDefinitive Fracture Treatment

  • Fracture reduction

  • Fracture reduction

  • Fracture reduction

  • StabilisationPlaster cast

    Internal fixation

    External fixation

  • Internal fixationPlates and screws

    K-wires (Kirschner)

    Intra-medullary nails

  • External fixation

  • Fracture UnionClinically united-Non tenderNo movement

    Radiological union -Callus

  • Fracture callus

  • Fracture callus

  • Complications of ImmobilisationStiffnessMuscle wastingWeaknessOsteoporosis

    Bed-sores, chest infections, UTIs, ileus, boredom

  • Rehabilitation

  • Rehabilitation

  • Stages in Fracture ManagementInitial assessment & first aidX-ray assessmentFracture reductionStabilisation -Cast immobilisationInternal fixationExternal fixationRehabilitation

  • Specific fracturesHip fracturesWrist fracturesAnkle fractures

  • Specific soft-tissue injuriesLigament injuries at the kneeAchilles tendon injuriesRotator cuff injuriesShoulder instabilityFinger dislocations

  • Fractures in ChildrenNAIGrowth platesGreenstick fracturesRapid unionRemodelling

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