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ortho 03 principle of closed reduction in fracture and dislocation
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    ortho 03 principle of closed reduction in fracture and dislocation ortho 03 principle of closed reduction in fracture and dislocation Presentation Transcript

    • Principle of closed reduction in fracture and dislocation Department of Orthopaedic Surgery Faculty of Medicine Siriraj Hospital Mahidol University
    • Principle of closed reduction
      • Recognition the pathologies
        • Associated injury
        • Deforming forces
      • Adequate anesthesia
      • Good team
      • Good technique
      • Acceptable reduction
      • Retention
    • Recognizing the pathology
      • Type of fracture/dislocation
      • Deformities (including the deforming forces)
    • Signs and symptoms of fracture/dislocation
      • Pain
      • Swelling
      • Tenderness
      • Deformities
      • Limit ROM
      • Stepping
      • Crepitus
    • Typical fractures
    • Stress-strain curve
    • Mode of failure
      • Tension
    • Mode of failure
      • Compression
    • Mode of failure
      • Shear
    • Mode of failure
      • Bending
        • Tension
        • Compression
    • Mode of failure
      • Torsion
        • Tension
        • Compression
        • Shear
    • Mode of failure
      • Crush
        • Tension
        • Compression
        • Shear
    • Know the classification
    • Anesthesia
      • Local
        • Hematoma block
      • Regional block
      • General
        • General anesthesia
        • Sedation using morphine, benzodiazepine
    • Regional/sedation
    • Reduction technique with or without assistances
    • Principle of reduction
      • Traction based technique
      • Increase deformities
      • Reverse mechanisms
      • Forces using:
        • Constance
        • Shaking for muscle relaxation
    • Sequences of fracture reduction
      • Traction
      • Increase deformity
      • Reverse deformity
      • 3 point bending
    • Ligamentotaxis
      • Tension applied across a fracture site
      • Realign the fracture fragments by the surrounding intact soft tissue
      • Soft tissue hinge eg. Periostium
      • Perform early after injury
    • Shoulder dislocation
      • Siriraj reduction technique
      • Usually no need the anesthesia
      • Supine position
      • Gentle longitudinal traction and external rotation
      • Gradual abduction
      • Usually reduce around 120 deg of abduction
    • Traction based
    • Hip dislocation (Allis method)
    • Acceptable reduction?
      • Mainly focus on fracture not dislocation
      • Joint must be congruent and concentric
    • Acceptable reduction?
      • Functional concern
      • Mechanics
      • Shortening
      • Apposition
      • Sagital, coronal plane malalignment
      • Axial malalignment is not accepted (rotation)
    • Acceptable reduction?
      • More acceptable in:
      • Young age eg. Bayonette
      • # Far from the joint
      • Compensation
      • Less acceptable in:
      • # Near the joint
      • Intraarticular involvement
    • Immobilization alone (no reduction needed)
      • Non displaced fracture
      • Isolated fibular fracture
      • Acceptable alignment
        • Pediatric # shaft of femur
        • Bayonett apposition
    • High failure rate of reduction in:
      • Avulsion fracture
      • Unstable fracture
        • Displaced fracture both bone of forearm
        • But realign the fracture
        • Except # BB in children
      • Fracture that won’t heal
        • Fracture neck of femur in elderly
    • Common fracture in upper extremities
      • Distal end of radius
      • Boxer’s (neck of 5 th MCB)
      • Humerus
        • Neck of humerus
        • Shaft
        • Supracondyle
      • Clavicle
    •  
    •  
    • Common fractures in lower extremities
      • Common Fracture in Adult
      • Femoral shaft
      • Tibia and fibular
      • Ankle
    •  
    • Common fractures in lower extremities
      • Common Fracture in Elderly
      • Femoral neck
      • Intertrochanteric
    •  
    • Fracture of the spine
      • C-spine
        • Odontoid
        • Compression
        • Burst
        • Fracture dislocation
      • Thoracolumbar
        • Compression
        • Burst
        • Fracture dislocation
    •  
    •  
    • Commonly missed conditions
      • Scaphoid fracture
      • Perilunate dislocation
      • Forearm fracture with radioulnar joint dislocation
      • Pediatric fracture around the elbow
        • Supracondyle
        • Lateral condyle
        • Medial condyle
      • Nerve injury eg. Axillary nerve
      • Occult fracture
      • Obese patients
      • Uncommon injuries eg. Posterior shoulder dislocation
      • Impact fracture neck of femur
    • Occult fracture
      • Not visible in an x-ray within 1-2 day of injury
      • Become visible
        • Within 3-4weeks
        • At the time that healing
    • Obese
    • Posterior shoulder dislocation
    • Management problems?
      • Fracture dislocation
      • Complex dislocation eg. MCP joint
      • Fracture of necessity eg. Monteggia’s, Galeazzi’s
    • Fracture dislocation
    • Complex dislocation
    • Monteggia fracture
    • Fracture healing
      • Clinical union
      • Timing
      • No false movement
      • No local tenderness of #site
        • Axial loading
        • Bending
        • Rotation
      • Radiographic union
      • Crossing trabeculae
      • Absent fracture line