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Mrc Sorthopaedicsandtraumalecture
Mrc Sorthopaedicsandtraumalecture
Mrc Sorthopaedicsandtraumalecture
Mrc Sorthopaedicsandtraumalecture
Mrc Sorthopaedicsandtraumalecture
Mrc Sorthopaedicsandtraumalecture
Mrc Sorthopaedicsandtraumalecture
Mrc Sorthopaedicsandtraumalecture
Mrc Sorthopaedicsandtraumalecture
Mrc Sorthopaedicsandtraumalecture
Mrc Sorthopaedicsandtraumalecture
Mrc Sorthopaedicsandtraumalecture
Mrc Sorthopaedicsandtraumalecture
Mrc Sorthopaedicsandtraumalecture
Mrc Sorthopaedicsandtraumalecture
Mrc Sorthopaedicsandtraumalecture
Mrc Sorthopaedicsandtraumalecture
Mrc Sorthopaedicsandtraumalecture
Mrc Sorthopaedicsandtraumalecture
Mrc Sorthopaedicsandtraumalecture
Mrc Sorthopaedicsandtraumalecture
Mrc Sorthopaedicsandtraumalecture
Mrc Sorthopaedicsandtraumalecture
Mrc Sorthopaedicsandtraumalecture
Mrc Sorthopaedicsandtraumalecture
Mrc Sorthopaedicsandtraumalecture
Mrc Sorthopaedicsandtraumalecture
Mrc Sorthopaedicsandtraumalecture
Mrc Sorthopaedicsandtraumalecture
Mrc Sorthopaedicsandtraumalecture
Mrc Sorthopaedicsandtraumalecture
Mrc Sorthopaedicsandtraumalecture
Mrc Sorthopaedicsandtraumalecture
Mrc Sorthopaedicsandtraumalecture
Mrc Sorthopaedicsandtraumalecture
Mrc Sorthopaedicsandtraumalecture
Mrc Sorthopaedicsandtraumalecture
Mrc Sorthopaedicsandtraumalecture
Mrc Sorthopaedicsandtraumalecture
Mrc Sorthopaedicsandtraumalecture
Mrc Sorthopaedicsandtraumalecture
Mrc Sorthopaedicsandtraumalecture
Mrc Sorthopaedicsandtraumalecture
Mrc Sorthopaedicsandtraumalecture
Mrc Sorthopaedicsandtraumalecture
Mrc Sorthopaedicsandtraumalecture
Mrc Sorthopaedicsandtraumalecture
Mrc Sorthopaedicsandtraumalecture
Mrc Sorthopaedicsandtraumalecture
Mrc Sorthopaedicsandtraumalecture
Mrc Sorthopaedicsandtraumalecture
Mrc Sorthopaedicsandtraumalecture
Mrc Sorthopaedicsandtraumalecture
Mrc Sorthopaedicsandtraumalecture
Mrc Sorthopaedicsandtraumalecture
Mrc Sorthopaedicsandtraumalecture
Mrc Sorthopaedicsandtraumalecture
Mrc Sorthopaedicsandtraumalecture
Mrc Sorthopaedicsandtraumalecture
Mrc Sorthopaedicsandtraumalecture
Mrc Sorthopaedicsandtraumalecture
Mrc Sorthopaedicsandtraumalecture
Mrc Sorthopaedicsandtraumalecture
Mrc Sorthopaedicsandtraumalecture
Mrc Sorthopaedicsandtraumalecture
Mrc Sorthopaedicsandtraumalecture
Mrc Sorthopaedicsandtraumalecture
Mrc Sorthopaedicsandtraumalecture
Mrc Sorthopaedicsandtraumalecture
Mrc Sorthopaedicsandtraumalecture
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Mrc Sorthopaedicsandtraumalecture

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  • 1. Trauma & Orthopaedic Surgery for the Intercollegiate MRCS Edward Gardner SpR Trauma and Orthopaedics 1
  • 2. What is the structure of bone? 2
  • 3. Microscopy • Cortical bone – also “compact” and “lamellar” bone • Cancellous bone – spongy bone, woven bone. 3
  • 4. Bone Cells • Osteoblasts make bone • Osteoclasts multinucleated giant cells, resorb bone • Osteocytes are osteoblasts in bone 4
  • 5. Blood supply • Blood vessels- nutrient artery • Endosteal • Periosteal • Venous drainage 5
  • 6. 6
  • 7. How do fractures heal? 7
  • 8. Healing cascade: indirect healing • Inflammation 0 – 5 days – Haematoma – Necrotic material – Phagocytosis • Repair: 5 – 42 days – Granulation tissue – Acid environment – Periosteum – osteogenic cells – Cortical osteoclasis • Remodelling – years 8
  • 9. How do you treat a fracture? 9
  • 10. TREATING A FRACTURE • Reduce • Hold • Rehabilitate 10
  • 11. TREATING A FRACTURE • Reduce – Open – Closed 11
  • 12. TREATING THE FRACTURE • Hold • Operative / Non Operative • Internal / External • Intra / Extra medullary 12
  • 13. TREATING THE FRACTURE • Rehabilitate • Physio 13
  • 14. FACTORS AFFECTING FRACTURE HEALING • Injury Factors – Energy – Associated injuries • Bone factors – Reduction, fixation – Blood Supply (scaphoid, talus, femoral and humeral head) – Infection • Patient factors – Smoking – Diabetes 14
  • 15. ATLS A - Airway and cervical spine immobilisation B - Breathing C - Circulation D - Disability E - Exposure 15
  • 16. Pelvis Fracture and Ex-Fix 16
  • 17. Soft Tissue Injuries Open I Clean, <1cm Simple # II Clean, >1cm Simple # III Extensive High energy # 17 Gustilo & Anderson, 1976
  • 18. Soft Tissue Injuries Open I Clean, <1cm Simple # II Clean, >1cm Simple # III Extensive High energy # 18 Gustilo & Anderson, 1976
  • 19. Soft Tissue Injuries Open I Clean, <1cm Simple # II Clean, >1cm Simple # III Extensive High energy # 19 Gustilo & Anderson, 1976
  • 20. Soft Tissue Injuries Open IIIa Soft tissue cover IIIb Soft tissue loss periosteal strip IIIc Vascular injury -repair 20 Gustilo, Mendoza & Williams, 1984
  • 21. Soft Tissue Injuries Open IIIa Soft tissue cover IIIb No soft tissue cover IIIc Vascular injury -repair 21 Gustilo, Mendoza & Williams, 1984
  • 22. Soft Tissue Injuries Open IIIa Soft tissue cover IIIb Soft tissue loss periosteal strip IIIc Vascular injury -repair 22 Gustilo, Mendoza & Williams, 1984
  • 23. Diagnosis • Clinical assessment – History - Co-morbidities – Exposure/systematic examination • “First-aid” reduction • Splintage and analgesia • Radiographs – Two planes including joints above and below area of injury 23
  • 24. Describe the Fracture • Anatomical site • Configuration Displacement – angulation – translation – shortening • Articular involvement/epiphyseal injuries – fracture involving joint – dislocation – ligamentous avulsion • Soft tissue injury 24
  • 25. 25
  • 26. 26
  • 27. 27
  • 28. What are the complications of fractures? 28
  • 29. Complications of Fractures Early Late General Other injuries Chest infection PE UTI FES/ARDS Bed sores Bone Infection Non-union Malunion AVN Soft-tissues Plaster sores/WI Tendon rupture N/V injury Nerve compression Compartment syn. Volkmann contracture 29
  • 30. What is the definition of compartment syndrome? 30
  • 31. Compartment Syndrome Increased Pressure in a closed tissue compartment resulting in local ischaemia 31
  • 32. Pain & spasm Tissue Compartment Muscle swelling pressure Ischaemia Ischaemia Venous Arteriolar Nerve stasis stasis Paraesthesia 32
  • 33. Fasciotomy 33
  • 34. 34
  • 35. How do you classify hip fractures? 35
  • 36. Fracture types • Intracapsular Femoral neck • Extracapsular Intertrochanteric • Subtrochanteric Below lesser troch 36
  • 37. Gardens Classification INTRACAPSULAR FRACTURES Undisplaced Displaced 37
  • 38. 38
  • 39. 39
  • 40. 40
  • 41. Shoulder Dislocations 41
  • 42. What is carpal tunnel syndrome? 42
  • 43. Carpal Tunnel Syndrome The entrapment of the median nerve at the fibro osseous tunnel of the carpus 43
  • 44. CTS signs • wasting of thener eminence • numbness • weakness • Tinel sign • Phalen sign 44
  • 45. CTS Treatment • non operative – Splint – Steroid injection? • surgical decompression – open 45
  • 46. What is trigger finger? 46
  • 47. Trigger Finger Stenosing tenovaginosis of the flexor tendon sheath (A1 pulley) 47
  • 48. What is Dupuytren’s Disease 48
  • 49. Dupuytren’s Contracture nodular hypertrophy and contracture of the palmar fascia 49
  • 50. What is the pathology of rheumatoid arthritis? 50
  • 51. Rheumatoid Arthritis Synovitis  chronic infltrates, synovial hypertrophy, effusion Destruction  proteolytic enzymes, pannus Deformity  articular destruction, capsular stretching, tendon rupture 51
  • 52. Rheumatoid Arthritis early joint changes 52
  • 53. Rheumatoid Arthritis Late Symptoms joint destruction  pain  deformity  instability  53
  • 54. Rheumatoid Arthritis advanced joint changes 54
  • 55. 55
  • 56. 56
  • 57. What is osteoarthritis? 57
  • 58. Osteoarthritis A chronic joint disorder in which there is progressive softening and disintegration of articular cartilage accompanied by new growth of cartilage and bone at the joint margins (osteophytes) and capsular fibrosis 58
  • 59. Osteoarthritis classification Primary or idiopathic  Secondary - infection  - dysplasia - Perthes’ - SUFE - trauma - AVN 59
  • 60. 60
  • 61. Osteoarthritis X-ray changes 61
  • 62. What is the treatment of osteoarthritis? 62
  • 63. Non-surgical treatment analgesia  altered activity  walking aids  physiotherapy  63
  • 64. 64
  • 65. 65
  • 66. Joint Replacement Hip Complications dislocation - 1%  loosening >90% 10y survival  DVT / PE  infection - 1%  Death  66
  • 67. Joint Replacement Knee complications limited ROM  patellar instability 3-5%  loosening > 90% 10y survival  DVT / PE  infection - 2%  67
  • 68. What are the common bone tumours? 68
  • 69. Metastatic bone tumours • Breast • Brostate • Bung • Bhyroid • Bidney • Multiple Myeloma 69
  • 70. Hot topics • # NOF • OA • CTS • Principles of # management • ATLS • Open # 70

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