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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

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  • 1. Principle of closed reduction in fracture and dislocation Department of Orthopaedic Surgery Faculty of Medicine Siriraj Hospital Mahidol University
  • 2. Principle of closed reduction
    • Recognition the pathologies
      • Associated injury
      • Deforming forces
    • Adequate anesthesia
    • Good team
    • Good technique
    • Acceptable reduction
    • Retention
  • 3. Recognizing the pathology
    • Type of fracture/dislocation
    • Deformities (including the deforming forces)
  • 4. Signs and symptoms of fracture/dislocation
    • Pain
    • Swelling
    • Tenderness
    • Deformities
    • Limit ROM
    • Stepping
    • Crepitus
  • 5. Typical fractures
  • 6. Stress-strain curve
  • 7. Mode of failure
    • Tension
  • 8. Mode of failure
    • Compression
  • 9. Mode of failure
    • Shear
  • 10. Mode of failure
    • Bending
      • Tension
      • Compression
  • 11. Mode of failure
    • Torsion
      • Tension
      • Compression
      • Shear
  • 12. Mode of failure
    • Crush
      • Tension
      • Compression
      • Shear
  • 13. Know the classification
  • 14. Anesthesia
    • Local
      • Hematoma block
    • Regional block
    • General
      • General anesthesia
      • Sedation using morphine, benzodiazepine
  • 15. Regional/sedation
  • 16. Reduction technique with or without assistances
  • 17. Principle of reduction
    • Traction based technique
    • Increase deformities
    • Reverse mechanisms
    • Forces using:
      • Constance
      • Shaking for muscle relaxation
  • 18. Sequences of fracture reduction
    • Traction
    • Increase deformity
    • Reverse deformity
    • 3 point bending
  • 19. 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
  • 20. 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
  • 21. Traction based
  • 22. Hip dislocation (Allis method)
  • 23. Acceptable reduction?
    • Mainly focus on fracture not dislocation
    • Joint must be congruent and concentric
  • 24. Acceptable reduction?
    • Functional concern
    • Mechanics
    • Shortening
    • Apposition
    • Sagital, coronal plane malalignment
    • Axial malalignment is not accepted (rotation)
  • 25. Acceptable reduction?
    • More acceptable in:
    • Young age eg. Bayonette
    • # Far from the joint
    • Compensation
    • Less acceptable in:
    • # Near the joint
    • Intraarticular involvement
  • 26. Immobilization alone (no reduction needed)
    • Non displaced fracture
    • Isolated fibular fracture
    • Acceptable alignment
      • Pediatric # shaft of femur
      • Bayonett apposition
  • 27. 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
  • 28. Common fracture in upper extremities
    • Distal end of radius
    • Boxer’s (neck of 5 th MCB)
    • Humerus
      • Neck of humerus
      • Shaft
      • Supracondyle
    • Clavicle
  • 29.  
  • 30.  
  • 31. Common fractures in lower extremities
    • Common Fracture in Adult
    • Femoral shaft
    • Tibia and fibular
    • Ankle
  • 32.  
  • 33. Common fractures in lower extremities
    • Common Fracture in Elderly
    • Femoral neck
    • Intertrochanteric
  • 34.  
  • 35. Fracture of the spine
    • C-spine
      • Odontoid
      • Compression
      • Burst
      • Fracture dislocation
    • Thoracolumbar
      • Compression
      • Burst
      • Fracture dislocation
  • 36.  
  • 37.  
  • 38. 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
  • 39. Occult fracture
    • Not visible in an x-ray within 1-2 day of injury
    • Become visible
      • Within 3-4weeks
      • At the time that healing
  • 40. Obese
  • 41. Posterior shoulder dislocation
  • 42. Management problems?
    • Fracture dislocation
    • Complex dislocation eg. MCP joint
    • Fracture of necessity eg. Monteggia’s, Galeazzi’s
  • 43. Fracture dislocation
  • 44. Complex dislocation
  • 45. Monteggia fracture
  • 46. Fracture healing
    • Clinical union
    • Timing
    • No false movement
    • No local tenderness of #site
      • Axial loading
      • Bending
      • Rotation
    • Radiographic union
    • Crossing trabeculae
    • Absent fracture line