Orthopedic

1. Trauma may affect:
 Bone -------- Fracture
 Joint --------- Dislocation
 Soft tissue
(Muscles & ligaments)

2. What is a fracture?
Interruption of bone continuity

4. 1) Direct trauma

5. 2) Indirect Trauma

6. 3) Muscle violence
Patella
Olecranon

7. Types of fractures

8. Transverse

10. Spiral

11. Fissure fracture>>blunt trauma

13. Segmental
(Double level)

14. Green stick fracture

15. Compression fracture
of vertebral body

16. x
A fracture with an overlying
wound communicating it to
the exterior

17. Pathological
fracture:
Fracture on top
of a disease e.g.
-Tumour
-Infection

18. Complaints
1) Pain

19. 2) Swelling

20. 3) Deformity

21. 4) Inability to
use the fractured
part
But
Can move his
fingers or
toes”mcq’

22. Examination
Localized
tenderness

23. Diagnosis
X ray in 2 planes : AP & Lateral

24. TREATMENT

25. 1) First aid treatment
2) Definitive treatment
‫أولية‬ ‫اسعافات‬
‫النهائى‬ ‫العالج‬

26. First aid treatment
1) Assess general condition:
A- Airway
B- Breathing
C- Circulation

27. 2) Splintage :
Splint =
- To alleviate pain
- To prevent further soft tissue damage
‫جبـــيرة‬

28. Sling
Pouch arm sling
Improvised
Sling
For upper limb

30. Thomas splint
For lower limb

32. 3) Analgesics to prevent neurogenic
shock
 To alleviate pain
 Parentral

33. Definitive treatment
1) Reduction
2) Immobilization (fixation)
3) Rehabilitation

34. 1) Reduction
To restore apposition of bone fragments

35. Reduction
A) Closed
B) Open

36. Closed reduction

37. Open Reduction

38. 2) Immobilization
1) Plaster cast:
Below elbow Above elbow

39. Below knee Above knee Hip spica

40. 2) Internal fixation
Screws

41. K wires

42. Plates & Screws

43. Plates & Screws

44. Special plate
(Dynamic Hip Screw)
(DHS)
½ is plate
½ is screw

45. Intra-medullary nails

46. 3) External fixator

47. External fixator for
Fracture lower end radius

48. Ilizarov
Fixator>> An Ilizarov
external
fixator (Ilizarov frame
) is a ring-like brace (see
figure 1
). The frame is applied to
the outside of the limb and
connected through the
unbroken part of the bone
inside the limb
. This is done by using a

49. Indications for external fixator
mcq:

50. 1) Open fractures

51. 2) Severely
comminuted
fractures

52. 4) Traction: (rarely used for treatment nowadays)

53. b) Skeletal traction

54. Treatment of open fractures

55. 1- Stop bleeding:
by
- Dressing
- Bandage
- Raising the limb

56. DO NOT TIE ABOVE THE WOUND

57. 2- Medications:
- Anti-biotics
- Anti-tetanic serum
- Anti-gas gangrene>>clostridium
perfringes

58. 3- Debridement:
- Removal of foreign bodies & necrotic tissue
- It can be repeated
- Only in the operative theater (Never in ER)

59. 4) Irrigation :
with copious amount of normal saline

60. 6) Fixation:
Temporary fixation with external fixator

61.  I: Puncture
(< 1 cm ,from within)
 II: 1 – 10 cm

62. III: > 10 cm
A: Possible coverage
- Delayed primary
- Secondary
B: Needs ST coverage
- Split thickness graft
- Flap
C: Vascular injury

63. Complications

64. 1) Vascular injury
Ischemia:
1-Pain>>cry of
nerve
2-Pallor/Cyanosis
3-Pulselessness
4-Parathesia
5-Paralysis
6-Oedema
7-Coldness

65. Ischemia
If not treated :
* Gangrene
>>compartmental syndrome>>treated by
fasciotomy * Volkmann ischemic
contracture

66. 2) Nerve injury
Sciatic nerve
Median nerve

67. 3) Malunion
Union in a bad or unaccepted position
Callus

68. Malunion
Treatment:
Correction by osteotomy & internal fixation

69. 4) Non union
Fracture did not unite after
the expected period for union

70. Non union
Treatment:
- Excision of sclerotic (dead) bone ends
- Reduction
- Internal fixation
- Bone graft
- Plaster cast

71. 5) Delayed union
Fracture takes longer time
than expected to unite
Treatment:
-Continue plaster cast
-Internal fixation & graft

72. 6) Myositis ossificans >>mcq
Traumatic ossification and new boney formation in
muscle around the joint.
Predisposing factors :
* Massage
* Repeated vigorous manipulation

73. 7) Sudeck`s bone atrophy
Complex Regional Pain Syndrome (CRPS)
The hand or foot becomes
swollen, painful with shiny skin,
sweating & osteoprotic
bone sympathetic nervous
system. The latter is the the
network of nerves that controls
many bodily functions – and in
the skin it is responsible for
opening and closing blood
vessels, and controlling sweat
gland due to inactivity during

74. 8) Avascular necrosis
Part of bone becomes dead (necrotic) due
to interruption of its blood supply

75. Avascular necrosis of femoral head
Treatment : Replacement arthroplasty
(Total Hip Replacement THR)

76. 3) Rehabilitation
To regain the pre-fracture condition
1- Active Exercises
2- Physiotherapy
3- Walk while in plaster before removal

78. Shoulder joint
Normal Dislocated

79. Elbow joint

80. Knee joint
Subluxation
Dislocation

81. Clinical presentation
1) Pain
1) Pain
2) Deformity
2) Deformity
3) Swelling
3) Swelling
4) Loss of function :
4) Loss of function :
* Inability to bear weight
* Inability to bear weight
* Inability to flex or extend the knee
* Inability to flex or extend the knee

82. Treatment
Reduction
Immobilization
Rehabilitation

83. Soft tissue injuries

84. Terminology
Sprain : Tear of ligaments
Strain : Tear of muscles
Ecchymosis (Bruises) :
Subcutaneous bleeding

85. Knee
ligaments>>
MRI

87. Twisting injury

88. Ankle ligaments
Lateral ligament

90. Plaster cast Ankle brace Elastic bandage