Extremity trauma
Download
Report
Transcript Extremity trauma
Extremity trauma
General principles
Dr . Almaghrabi Issam
Damascus Hospital
Definition of fracture
Loss of continuity in the substance of bone
Causes
1.
Causes of trauma
2.
Car accident
Work accident
Sport accident,…
Mechanism of trauma
•
Direct shock
Serious
soft tissue lesions
Indirect shock
Flexion
Torsion
compression
General aspects
A.
According to the type of bone:
Long bones
•
Diaphysis
•
Epiphysis
* extra-articular
* intra-articular: difficult treatment , ↑↑ complications
Short bones
•
Scaphoid , Calcaneus, Talus,…
Present diagnostic , therapeutic and prognosis problems
Long bones
Diaphysis
•
Epiphysis
extra-articular
intra-articular
Short bones
soft tissue lesions
According to the age
B.
Elderly
Young adult
Minor trauma
↑↑ morbidity & mortality
e.g. femoral neck fracture
Violent trauma
The risk is local , preserve function
Infant
Minor trauma
Violent trauma
D
Fracture avec décollement
épiphysaire de type 1
G
Fracture en « motte
de beurre » et « bois vert »
Diagnosis of fractures
History
A.
1.
Trauma itself :
2.
Circumstances of the accident
Mechanism of the injury: direct, indirect
Time of accident
Traumatized patient
Functional signs : pain, immobility…
Age , past history.
Clinical exam (comparative):
B.
Local examination : signs of the fracture
i.
Inspection : deformation, edema, hematoma, ecchymosis
Palpation : tenderness, abnormal mobility.
Regional examination
ii.
Cutaneous : open fractures, contusion….
Vascular: peripheral pulse, color & temperature
Neurological: e.g. humeral fracture (radial n.)
General examination:
iii.
Clinical: associated lesions
Para clinical : ECG, blood analysis, chest X-ray
X-ray examination:
C.
Technique:
The rule of 2:
2 views , 2 joints , 2 limbs , 2 times
Sometimes a special X-rays, e.g. scaphoid.
Results :
Site
Type
Displacement : depending on the distal fragment.
Pitfalls
Elderly patient + unable to weight bear
→ femoral neck fracture
Snuff-box pain + normal X-ray
→ suspected scaphoid fracture
Dashboard lesions → 2 patellae , femoral shaft , silent
hip dislocation
Calcaneus fracture → the other calcaneus + vertebral
column.
Ankle sprain → 5th base metatarsal fracture.
Epilepsy + shoulder pain → think about post. dislocation.
Monteggia – Galeazzi (associated dislocations)
Elderly patient + unable to weight bear
D0
Snuff-box pain + normal X-ray
D 21
Dashboard lesions
Fall from height
Ankle sprain
Epilepsy
Post. dislocation
Galeazzi Fracture
Monteggia Fracture
25
Treatment
Primary aims :
Bony union without deformity
Restoration of function
ER treatment :
Alignment of the fracture
Temporary splintage
Open fractures : sterile bandage , AB , tetanus
Treatment
Simple fractures:
±Reduction + casting :
After care of patient in plaster
swollen fingers – blue – pain → bivalve the cast
Complex fractures : admission
Traction : skin – skeletal
Open reduction & internal fixation
Indications
Failed closed reduction
Fractures cannot be held by closed methods (femoral neck)
Intra-articular fractures
Multiple injuries
Techniques
Plates , screws , K-wires , nails
Interlocking nail , elastic flexible nails
external fixation: open fractures
Casting
Ostéosynthèse du tibia par plaque vissée
Infant
Flexible Titanium Nailing of Tibia
Ostéosynthèse du col fémoral
Bi polar
Evolution
Favorable : consolidation within the expected time .
Complications:
Immediate :
General : choc
Loco-regional : skin , vascular , nerves
Secondary :
General : DVT , bed sores , infections , fat embolism
Loco-regional : secondary displacement , opening ,
necrosis , Volkmann .
Late :
Delayed union , nonunion , malunion , arthritis , AVN
Functional : pain , stiffness , Sudeck .
infection
Volkmann
Non union
Malunion
Sudeck atrophy
Records
Date & time , legible hand writing , employ
only common use contractions.
Full record on the day of the admission
Write results of X-rays (neg., pos.)
Communications
Telephoning description
Anatomy
of the fracture :
Age of patient
Occupation
Type of accident
The rule of 6 A’s
(proximal tibia )
Articular
Extra vs Intra
Alignment
A.P. view
Angulation
Lat. view
Apex
Distal fragment
Apposition
75% , 25%
Fracture clinic
What , When
3 A’s (assessment , action , advice)
When , What
What , When
What :
What we are dealing with (diagnosis)
Recording ↓↓ duplication.
When :
Establish the time that has passed since the patient’s
injury
Initial Medical record and X-rays are available.
3 A’s
Assessment :
Appropriateness (whether this was the best
treatment )
Action :
too tight plaster → split
More senior opinion → ↑↑ Outcome.
Advice :
It is important to Explain to the patient the nature of his injury,
to keep him Informed of his progress
When , What
When:
the date & time of the next appointment .
e.g. ↨ of stitches , ↨ of plaster
What :
The purpose of the patients next visit
Save valuable time by avoiding the patient having to
wait and seen twice.
Questions ????