Ortho conf
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A 68-year-old Thai male was in a motorcycle accident and suffered injuries including an open fracture of the right tibia and fibula and a closed fracture of the right distal femur. At the emergency room, he received pain control, antibiotics, tetanus vaccination, and external fixation of the tibial fracture. He was then admitted to the trauma surgery ward to monitor for vascular injury before being transferred to orthopedics. He will require further treatment including definitive fixation of the fractures and management of open fractures according to Gustilo-Anderson classification. Complications of "floating knee" injuries which involve both femur and tibia fractures can include ligament injuries, neurovascular problems, and infection.
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Ortho..
- The patient is a 38-year-old Thai man who was in a motorcycle accident after drinking alcohol. He complains of left knee pain for 3 hours.
- Radiographs show a fracture of the left tibial plateau and left fibula. Physical examination reveals tenderness over the left knee with limited range of motion due to pain.
- The diagnoses are a fracture of the left tibial plateau, a fracture of the left fibula, and a mild head injury. The patient is placed in a long leg splint and advised to remain non-weightbearing on the left leg. Close monitoring is needed for compartment syndrome or neurological changes.
Acinjury chitphisut-chennisata
- The patient is a 38-year-old Thai man who was in a motorcycle accident while intoxicated. He hit a footpath and was thrown from the motorcycle, landing on his right shoulder on the road without a helmet.
- On examination, he had pain and limited movement in his right shoulder. Imaging showed a grade V injury of the right acromioclavicular joint with disruption of the acromioclavicular and coracoclavicular ligaments.
- He underwent open reduction and internal fixation surgery with tightrope fixation of the right acromioclavicular joint.
.Ortho.
An 81-year-old Thai woman presented to the hospital with left hip pain after falling three days prior. Imaging revealed a Garden type 3 fracture of the left femoral neck. She was diagnosed with a displaced left femoral neck fracture. Her treatment plan included pain control, skin traction of the left leg, and a left bipolar hemiarthroplasty surgery. Femoral neck fractures typically result from low-energy falls in older patients and require prompt surgical management to reduce complications.
Case conference extern ortho ed1
This case conference discusses a 48-year-old Thai man who presented to the hospital after falling and injuring his right hip. On examination, he had tenderness and swelling of the right hip and thigh with limited range of motion due to pain. X-rays revealed a closed fracture of the right femoral neck. The attending physician provided a provisional diagnosis and treatment plan involving admission, skin traction, pain medication, and monitoring. The discussion then reviewed femoral neck fractures, including risk factors, mechanisms of injury, imaging, classifications, complications, and treatment options such as internal fixation, hemiarthroplasty, or total hip arthroplasty.
Ortho con supra copy
The document summarizes an orthopedic case of a child who fell from a table and injured his left arm. On physical examination, the child's left elbow was swollen and deformed with limited range of motion due to pain. X-rays revealed a complete transverse fracture at the supracondylar region of the left humerus with total posterior-medial displacement, classified as a Gartland Type III injury. The child underwent closed reduction and percutaneous pinning of the fractured elbow. Post-operatively, the child will need elevation, pain control, range of motion exercises, and pin removal after 3-4 weeks once the fracture has healed. Complications of this type of injury can include nerve damage,
Extern conference may
- An 11-year-old Thai girl presented with left elbow pain and swelling after being knocked over by a dog at home. She had limited range of motion of her left elbow due to pain.
- X-rays showed a closed fracture of the left supracondylar humerus, classified as a Gartland type II.
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Ortho
This document summarizes a case of a 9 year old female who presented with right leg pain for 2 hours after a bicycle accident. On examination, she had deformity, swelling and tenderness of the right ankle with limited range of motion due to pain. X-rays showed close transverse fractures of the right distal tibia and fibula with minimal displacement. The diagnosis was close fractures of both bones of the right leg. Management included pain control, possible closed reduction, application of a long leg posterior splint, and monitoring for compartment syndrome. The document then reviews general knowledge of tibia and fibula fractures including mechanisms of injury, signs and symptoms, radiological findings, and treatment options such as cast immobilization or surgery.
Ext.conference..
1. An 82-year-old Thai man presented to the emergency room with right knee pain for 3 hours after tripping and falling on his right knee.
2. Examination found marked swelling and tenderness of the right knee with a palpable patella defect and joint effusion. X-rays showed a closed comminuted fracture of the right patella.
3. The patient was diagnosed with a closed comminuted fracture of the right patella. His treatment plan included immobilization with a cylindrical slab and observation for compartment syndrome, with plans for open reduction and internal fixation using a tension band construct.
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Ortho..
- The patient is a 38-year-old Thai man who was in a motorcycle accident after drinking alcohol. He complains of left knee pain for 3 hours.
- Radiographs show a fracture of the left tibial plateau and left fibula. Physical examination reveals tenderness over the left knee with limited range of motion due to pain.
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Acinjury chitphisut-chennisata
- The patient is a 38-year-old Thai man who was in a motorcycle accident while intoxicated. He hit a footpath and was thrown from the motorcycle, landing on his right shoulder on the road without a helmet.
- On examination, he had pain and limited movement in his right shoulder. Imaging showed a grade V injury of the right acromioclavicular joint with disruption of the acromioclavicular and coracoclavicular ligaments.
- He underwent open reduction and internal fixation surgery with tightrope fixation of the right acromioclavicular joint.
.Ortho.
An 81-year-old Thai woman presented to the hospital with left hip pain after falling three days prior. Imaging revealed a Garden type 3 fracture of the left femoral neck. She was diagnosed with a displaced left femoral neck fracture. Her treatment plan included pain control, skin traction of the left leg, and a left bipolar hemiarthroplasty surgery. Femoral neck fractures typically result from low-energy falls in older patients and require prompt surgical management to reduce complications.
Case conference extern ortho ed1
This case conference discusses a 48-year-old Thai man who presented to the hospital after falling and injuring his right hip. On examination, he had tenderness and swelling of the right hip and thigh with limited range of motion due to pain. X-rays revealed a closed fracture of the right femoral neck. The attending physician provided a provisional diagnosis and treatment plan involving admission, skin traction, pain medication, and monitoring. The discussion then reviewed femoral neck fractures, including risk factors, mechanisms of injury, imaging, classifications, complications, and treatment options such as internal fixation, hemiarthroplasty, or total hip arthroplasty.
Ortho con supra copy
The document summarizes an orthopedic case of a child who fell from a table and injured his left arm. On physical examination, the child's left elbow was swollen and deformed with limited range of motion due to pain. X-rays revealed a complete transverse fracture at the supracondylar region of the left humerus with total posterior-medial displacement, classified as a Gartland Type III injury. The child underwent closed reduction and percutaneous pinning of the fractured elbow. Post-operatively, the child will need elevation, pain control, range of motion exercises, and pin removal after 3-4 weeks once the fracture has healed. Complications of this type of injury can include nerve damage,
Extern conference may
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Ortho
This document summarizes a case of a 9 year old female who presented with right leg pain for 2 hours after a bicycle accident. On examination, she had deformity, swelling and tenderness of the right ankle with limited range of motion due to pain. X-rays showed close transverse fractures of the right distal tibia and fibula with minimal displacement. The diagnosis was close fractures of both bones of the right leg. Management included pain control, possible closed reduction, application of a long leg posterior splint, and monitoring for compartment syndrome. The document then reviews general knowledge of tibia and fibula fractures including mechanisms of injury, signs and symptoms, radiological findings, and treatment options such as cast immobilization or surgery.
Ext.conference..
1. An 82-year-old Thai man presented to the emergency room with right knee pain for 3 hours after tripping and falling on his right knee.
2. Examination found marked swelling and tenderness of the right knee with a palpable patella defect and joint effusion. X-rays showed a closed comminuted fracture of the right patella.
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Scaphoid fx
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Extern conference ortho
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bbfx_orthomhr
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Extern case
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Orthofaipun
This document summarizes the case of a 49-year-old Thai female patient who presented with left hip pain for 5 hours after falling from her motorcycle. Examination revealed tenderness and limited range of motion of the left hip with shortening and external rotation of the left leg. X-rays showed a displaced Garden IV femoral neck fracture. The document then reviews femoral neck fracture epidemiology, anatomy, signs and symptoms, investigations, classification systems, management options including fixation versus arthroplasty depending on patient age and fracture characteristics, and potential complications.
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2) X-rays showed a fracture of the right femur. She was given pain medication and placed in skeletal traction awaiting surgery.
3) Surgical fixation with a plate and screws was planned to treat the femoral shaft fracture.
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Morning conference Orthopedic - Fracture of Tibial Plateau
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Teddy bear
This document provides an overview of the multi-specialty approach to trauma management. It outlines the Advanced Trauma Life Support (ATLS) algorithm which focuses on assessing and stabilizing the ABCDEs (Airway, Breathing, Circulation, Disability, Exposure). The primary survey involves rapid assessment and resuscitation of life-threatening injuries. This is followed by a secondary survey with a full head-to-toe examination. Key priorities include controlling hemorrhage, treating shock, identifying injuries requiring emergent intervention (e.g. tension pneumothorax), and preventing hypothermia.
Gp lecture foot_ankle_sept_2010
This document provides an overview of a foot and ankle session. It discusses topics like imaging the foot and ankle, common injuries like lateral ankle sprains and their treatment, and case studies involving various foot and ankle conditions like plantar fasciitis, pes planus, and Achilles tendinopathy. Clinical tests and management strategies are described for different injuries and conditions.
Traumatic brachial plexus injury
This document presents a case report of a 53-year-old female who sustained a traumatic brachial plexus injury after falling down a flight of stairs. On examination, she had sensory and motor deficits in her right upper limb consistent with an infraclavicular brachial plexus palsy. She underwent conservative therapy including physiotherapy and splinting. Over an 18-month period, her function gradually improved but she was left with some residual weakness. The document discusses the anatomy of the brachial plexus, mechanisms of injury, clinical examination findings, and prognosis factors for peripheral nerve injuries.
Open fracture
- A 16-year-old Thai man presented to the emergency room with a laceration wound on his left foot after falling off his motorcycle. On examination, he had a 6x2 cm laceration wound on his left midfoot with tendon tearing and smaller wounds on his toes. X-rays showed an open fracture of the tarsal bone.
- In the emergency room, the wounds were irrigated and dressed. IV antibiotics and tetanus prophylaxis were started. In the operating room, the wounds underwent aggressive debridement and irrigation. The fractures were stabilized with internal fixation. Staged debridements were planned every 24-48 hours as needed.
- Open fractures require prompt antibiotic treatment
Spinal haematoma
Built upon my own experience,by the time I was depressed thinking that I am the culprit who caused the problem.
fracture shaft of humerus
This document summarizes the case of a 13-year-old Thai boy who was in a motorcycle accident and suffered blunt injuries. He presented with hypovolemic shock, deformities of both humerus bones, and a suspected cervical spine injury. Initial management included IV fluids, immobilization, and monitoring. Diagnosis was blunt abdominal injury with hypovolemic shock, fractures of both humerus, and suspected cervical spine injury. He was referred for further care.
Rolando Fracture
A 36-year-old Thai woman fell from her motorcycle and injured her right wrist. Radiographs showed a comminuted intra-articular fracture of the base of the first metacarpal bone, known as a Rolando fracture. The fracture was treated with application of a thumb spica cast initially, followed by open reduction internal fixation using a miniplate to surgically repair the fracture fragments. Rolando fractures involve comminution of the base of the first metacarpal and typically result in worse prognosis and higher risk of post-traumatic osteoarthritis compared to other thumb metacarpal fractures like Bennett fractures.
Case conference: cherrin pomsoong PCM38
This document summarizes a case conference about a 56-year-old Thai female patient who presented to the emergency room with right arm pain after a water tank fell on her arm. On examination, she had deformity and swelling of the right arm with tenderness over the mid humerus and limited range of motion. X-rays showed a fracture of the distal one-third of the right humerus shaft. She was given pain medication, her arm was reduced and placed in a U-slab cast. She was diagnosed with a distal right humerus shaft fracture and advised to follow up in one week.
Kanathit Pakdeevongse Extern Interesting Case
This case involves a 35-year-old Thai male who experienced a motorcycle accident 11 hours prior to arriving at the hospital. He sustained an open fracture of the right distal fibula and a closed fracture of the right medial malleolus. In the emergency room, his wounds were irrigated and dressed, and antibiotics and splinting were provided. In the operating room, he underwent debridement, irrigation, fracture stabilization, and wound closure. As this was a Gustilo Type IIIA open fracture, antibiotic treatment included clindamycin and an aminoglycoside for several days. Operative management with open reduction internal fixation was indicated given the displaced fractures and open nature of the injury.
Kanathit Pakdeevongse Extern Interesting Case
Extern Presentation in Orthopedics course
at Maharaja Nakhorn Rajasima Hospital
Present about Open Fracture of Ankle
Gustilo III
Lauge-Hansen SAII
Orthopedic pelvic fracture
A 30-year-old Thai man was brought to the emergency room 15 minutes after a motor vehicle accident. He was unresponsive with a blood pressure of 80/50 mmHg and pulse of 120/min. A pelvic compression test was positive and his right leg was 3 cm shorter. Initial management included resuscitation with Ringer's lactate and oxygen, monitoring of vital signs, and pain control. Imaging found a fracture of the right pubic rami and left sacrum. The pelvic fracture was classified as Type B or C, indicating rotational and vertical instability. Management included immobilization with a pelvic binder and potential open reduction and internal fixation surgery.
Extern orthopedics-conference
1) The patient is a 60-year-old Thai male who presented to the hospital with left hip pain after being hit by a motorcycle 14 hours prior.
2) Physical examination revealed localized tenderness and limited range of motion of the left hip. X-rays showed a closed fracture of the left intertrochanteric region.
3) Intertrochanteric fractures occur between the greater and lesser trochanters. Surgical treatment with an intramedullary hip screw is usually recommended for unstable patterns to stabilize the fracture.
Spinal fracture
This document provides an overview of spinal cord injuries through presenting a case study of a 50-year old male patient admitted with a C5-C6 spinal cord compression from a motor vehicle accident. It discusses the objectives, significance, patient history, assessment findings, diagnostic tests, surgical and pharmacological management, nursing care plan, teaching, and research related to spinal cord injuries. Key points include defining a spinal cord injury as any non-disease related trauma to the spinal cord, describing varying symptoms depending on the level of injury, discussing surgical procedures like laminectomy to treat compressions, and outlining nursing priorities like positioning, respiratory assessments, and family education.
Extern.con.anklefx.chaipat
- 17-year-old Thai female presented to the hospital with right ankle pain and swelling after twisting her ankle 3 hours prior while playing football.
- Physical examination revealed swelling and tenderness of the right ankle which was held in plantarflexion. X-rays showed a bimalleolar fracture of the right ankle.
- Bimalleolar fractures involve fractures of both the medial and lateral malleoli. Non-displaced fractures are typically treated conservatively with immobilization while displaced or unstable fractures require open reduction and internal fixation surgery followed by non-weightbearing and rehabilitation.
Teleconferences 22.2.18
A 36-year-old Thai man presented to the hospital after a motorcycle accident where he collided with a dog and fell off his bike 3 hours prior. He complains of left shoulder and chest pain. Imaging shows a closed fracture of the mid-shaft left clavicle with a left scapula neck fracture. The patient is admitted and managed conservatively with sling immobilization.
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Nearly amputation extern conference
This document describes the case of a 13-year-old Thai boy who was in a motorcycle accident, resulting in a near amputation of his left index finger. Upon initial examination, he was conscious and coherent with a laceration on his left eyebrow and active bleeding from his injured left index finger. X-rays showed no fractures. He was referred to another hospital, where he underwent surgery to close the stump of his amputated left index finger. The document then provides definitions, classifications, and management guidelines for traumatic finger amputations.
Ortho con
1) A 14-year-old boy was in a motorcycle accident where his left hip hit the ground, causing left hip pain and deformity.
2) Examination and x-rays revealed a posterior dislocation of the left hip.
3) The patient was taken to the operating room for closed reduction of the hip dislocation under general anesthesia with skeletal traction.
Conference der
- A 50-year-old Thai man presented to the emergency department with right wrist pain and swelling for 6 hours after a motorcycle accident.
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- He underwent hematoma block and closed reduction with placement in a short arm splint. Post-procedure x-rays confirmed acceptable reduction of the fracture based on measurements of volar tilt, radial shortening, and radial angle.
Septic arthritis
A 61-year-old Thai woman presented with left knee pain and fever for 2 days. She had a known diabetic ulcer on her left foot. On examination, she had swelling and tenderness around her left ankle with redness and warmth. Joint fluid analysis found white blood cells of 54,000/ml with 92% polymorphonuclear cells and gram-positive cocci. She was diagnosed with septic arthritis of the left knee and taken to the operating room for arthrotomy and antibiotics.
Posteriorhipdislocation
This document summarizes the case of a 41-year-old man who was in a car accident where he hit a tree with his console but did not hit his head. He reported right hip pain after the accident and could not walk or move his right leg. On examination, he had marked tenderness over his right hip with limited and painful range of motion. He was taken to the OR for closed reduction of a posterior hip dislocation under general anesthesia. Potential complications of posterior hip dislocations include osteonecrosis, osteoarthritis, and sciatic nerve injury.
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Ortho conf
- 1. Extern’s Orthopaedics Inter- hospital Conference PISUT PONGCHAIKUL 29th September 2018
- 2. Case: A 68-yo Thai male with Right leg pain 2 hr PTA: motorcycle crashed with a lorry. No loss of consciousness. Pain at right thigh and right leg with open wound
- 3. Primary survey A: can speak, active neck flexion, not tender along C- spine B: good air-entry, equal breath sounds both lung, Chest compression test - negative C: V/S- stable , Pelvic compression test - negative D: E4V5M6 E: laceration wound 3 cm on the right shin
- 5. X-Ray: Right Femur AP, Lateral AP Lat
- 6. X-Ray: Right leg AP, Lateral AP Lat
- 7. Secondary survey A: no food and drug allergy M: no current medication P: no known underlying disease L: Last meal (Food with alcohol) 12.30 E: motorcycle accident with a lorry
- 8. Physical examination Extremities: - Laceration wound 3 cm on the right shin - Limited ROM of the right leg due to pain - Tender along the right leg - Right dorsalis pedis pulse: 2+ - Right posterior tibial pulse: 2+ - Ankle-brachial index (Rt): 0.75 (SBP Ankle =105; Arm = 140)
- 9. Diagnosis Closed fracture of the right distal Femur Open fracture of the shaft of right Tibia and Fibula Fraser classification type I Gustilo – Anderson type II (Tibia)
- 10. Management at ER Vascular assessment Peripheral pulse and ABI Immobilisation of the injured organ Long leg slab Pain control Tetanus vaccination: TT (x3) and TAT Antibiotic : Cefazolin 1 g IV every 6 hours Set OR for emergency debridement and external fixation
- 11. External fixation On external fixation (Tibial fracture) Awaiting definitive fixation
- 12. Clinical course Admit at Trauma Surgery ward To observe vascular injury Then transferred to Orthopaedics ward Awaiting definitive treatment
- 13. Open fracture Gustilo – Anderson Classification
- 14. Management Type 1st line ATB Alt. ATB I 1st Gen Cephalosporin for 24 hours - Clindamycin (pen allergy) - Fluoroquinolone - Doxycycline and 3rd and 4th gen Ceph II III 1st Gen Cephalosporin + Aminoglycoside (+Penicillin in farm yard) for 24-72 hours Irrigation & Debridement Tetanus booster Stabilisation of the bone Closure: primary vs delayed primary
- 15. Femural fracture with ipsilateral tibial fracture AKA floating knee
- 16. Floating knee Combined fracture: Femur and ipsilateral Tibia High-energy mechanism (M/C: traffic accident and fall from height) Clinical presentation History of high energy trauma Pain and swelling Haemarthrosis Knee instability in anterolateral rotation
- 17. Floating knee Associated injury Polytrauma (due to high energy mechanism) Complications Ligamentous injury Neuro-vascular injury (esp. Popliteal artery) Fat embolism Compartment syndrome
- 18. Classification Blake and McBryde Fraser Vives, et al. EFFORT Open Review, 2016
- 19. Management
- 20. Post-operative care Early joint mobilisation Weight-bearing in Fracture at diaphysis Delayed weight-bearing in intra-articular involvement (type II)
- 21. Complication Union problem: Non-union, malunion, delayed union Infection: Osteomyelitis (in Gustilo-Anderson type II or Fraser type II) Knee stiffness (in delayed rehabilitation)
- 22. THANK YOU
Editor's Notes
- Comminuted fracture Distal femur Posterior and lateral displacement Lateral angulation overridding
- Complete fracture + comminuted and spiral Distal tibia and fibula No displacement Medial and posterior angulation
- Type I wound ≤1 cm, minimal contamination or muscle damage Type II wound 1-10 cm, moderate soft tissue injury Type IIIA wound usually >10 cm, high energy, extensive soft-tissue damage, contaminated adequate tissue for flap coverage farm injuries are automatically at least Gustillo IIIA Type IIIB extensive periosteal stripping, wound requires soft tissue coverage (rotational or free flap) Type IIIC vascular injury requiring vascular repair, regardless of degree of soft tissue injury Most accurate way to grade open fratures is by intra-operative examination
- Principle Infection prevention Soft tissue repair Bone repair Restore function
- vessels (mainly the popliteal and posterior tibial arteries) the nerves (eg, peroneal nerve)
- Blake and McBryde1 ’floating knee’ to describe homolateral fractures of the femur and tibia, where the knee is disconnected from the rest of the limb. Type I (71%) constitutes the true ‘floating knee’ in which neither the femoral nor the tibia fracture extends to the knee, instep or hip. Type II (29%) is a variant in which one or both fractures involve the knee.2 In 1978, Fraser3 classified type II according to knee injury type (Fig. 1). Type II a) (8%) is a tibia plateau fracture associated with a femoral shaft fracture type II b) (12%) is an articular fracture of distal femur associated with a tibial shaft fracture and type II c) (9%) is a fracture of the tibia plateau and articular fracture of the distal femur.2
- If open fracture occurred Mx as open fx first at that site
- Using the criteria of Karlstrom and Olerud, [8, 9, 10] most authors of published series describe excellent-to-good results in as many as 65% of surgically treated patients. After conservative treatment, success rates decrease to 29%. The complication rate is associated with fracture type (open fracture), Fraser type IIc, tibial plateau, and distal tibia. [11, 12]