The document provides classifications for various orthopaedic fractures and injuries. It includes classifications such as the Frykman classification for distal radial fractures, Salter-Harris classification for epiphyseal plate fractures, Neer classification for proximal humeral fractures, and Garden classification for femoral neck fractures. It also covers classifications for injuries to other bones and joints, such as the pelvis, tibia, calcaneus, and spine. The classifications are used to describe and guide treatment for different fracture patterns.
This document describes the surgical procedure for repairing a Type 2 radial head fracture. It involves making a skin incision over the radial head, exposing the fracture, reducing the fracture anatomically with tools like elevators and k-wires, and fixing it with a Herbert screw placed under the articular surface. Range of motion is checked after fixation to ensure stability before closing.
Cervical spine fractures, especially those involving C1 and C2, were discussed. Key points included that 10% of cervical fractures involve C1, with 56% being isolated fractures and 44% combined fractures. 20% involve C2. Types of C1 fractures described were Type 1 stable fractures at the posterior arch-lateral mass junction, Type 2 burst fractures, and Type 3 lateral mass fractures. Types of C2 fractures included odontoid fractures classified using Anderson and D'Alonzo's system, Hangman's fractures classified using Levine or Francis systems, and other miscellaneous fractures. Management depended on fracture type but often involved external immobilization though surgery may be indicated for unstable fractures or those with displacement,
The seminar discussed ankle injuries, focusing on anatomy, classification systems, and common injuries. The ankle is supported by strong ligaments and tendons and permits dorsiflexion and plantar flexion. Common injuries include ligament sprains and fractures of the medial and lateral malleoli. Injury patterns are classified using systems like Lauge-Hansen which consider the mechanism of force and resulting bone and soft tissue injuries. Proper treatment aims to restore normal ankle alignment and joint surfaces.
The cervical spine anatomy is specialized to support the cranium while allowing a large range of motion. C1 (atlas) has no vertebral body and unique articular pillars. C2 (axis) has a dens that is embryologically derived from C1's body. The ligaments of the cervical spine, including the tectorial membrane and transverse ligament, allow for wide range of motion while maintaining stability. Common cervical spine injuries include flexion teardrop fractures from hyperflexion, wedge fractures from compression, hangman's fractures from hyperextension, and Jefferson fractures from axial loading. Odontoid fractures also occur from hyperextension or hyperflexion forces on the neck. Radiographic evaluation of
C2 fractures can range from asymptomatic to paralysis and are often caused by motor vehicle accidents or falls. Higher level cervical spine injuries carry greater risks. C2 fractures include odontoid fractures, lateral mass fractures, extension teardrop fractures, and traumatic spondylolisthesis (hangman's fracture). Diagnosis involves imaging like X-rays and CT/MRI to classify the fracture. Treatment depends on fracture type and severity but may include immobilization, traction, internal fixation, or fusion surgery. Complications can include malunion, nonunion, or pseudarthrosis if not properly treated.
An 92 year old male presented to the emergency department after a mechanical fall at a nursing home with neck pain. Imaging showed a type II odontoid fracture. He was placed in a rigid cervical collar and referred to spine surgery for further management which may include halo vest immobilization or surgical fixation.
This document reports on a case of non-union of an odontoid fracture in a 24-year-old male patient. The patient initially presented with neck pain after a fall and was found to have a type II odontoid fracture with minimal displacement. He was treated conservatively with a cervical collar. After 4 months, he developed neurological deficits. Surgery was performed to achieve posterior C1-C2 fusion with instrumentation. The document then reviews literature finding that non-union of odontoid fractures is multifactorial but not due to compromised blood supply, and is more common when there is less bone density, trabeculae, and surface area at the fracture site.
This document discusses various types of elbow fractures that can occur in children, including medial epicondyle apophysis fractures, pulled elbow syndrome, lateral condylar fractures, capitellar fractures, and medial condylar fractures. It provides details on the mechanisms of injury, classification systems, stages of displacement, and treatment approaches for each type of fracture. Key facts covered include that lateral condylar fractures can cross the physis or extend into the trochlear cartilage, and medial condylar fractures have both an intra-articular and extra-articular component. Classification systems such as those proposed by Milch and Weiss are described.
This document describes the surgical procedure for repairing a Type 2 radial head fracture. It involves making a skin incision over the radial head, exposing the fracture, reducing the fracture anatomically with tools like elevators and k-wires, and fixing it with a Herbert screw placed under the articular surface. Range of motion is checked after fixation to ensure stability before closing.
Cervical spine fractures, especially those involving C1 and C2, were discussed. Key points included that 10% of cervical fractures involve C1, with 56% being isolated fractures and 44% combined fractures. 20% involve C2. Types of C1 fractures described were Type 1 stable fractures at the posterior arch-lateral mass junction, Type 2 burst fractures, and Type 3 lateral mass fractures. Types of C2 fractures included odontoid fractures classified using Anderson and D'Alonzo's system, Hangman's fractures classified using Levine or Francis systems, and other miscellaneous fractures. Management depended on fracture type but often involved external immobilization though surgery may be indicated for unstable fractures or those with displacement,
The seminar discussed ankle injuries, focusing on anatomy, classification systems, and common injuries. The ankle is supported by strong ligaments and tendons and permits dorsiflexion and plantar flexion. Common injuries include ligament sprains and fractures of the medial and lateral malleoli. Injury patterns are classified using systems like Lauge-Hansen which consider the mechanism of force and resulting bone and soft tissue injuries. Proper treatment aims to restore normal ankle alignment and joint surfaces.
The cervical spine anatomy is specialized to support the cranium while allowing a large range of motion. C1 (atlas) has no vertebral body and unique articular pillars. C2 (axis) has a dens that is embryologically derived from C1's body. The ligaments of the cervical spine, including the tectorial membrane and transverse ligament, allow for wide range of motion while maintaining stability. Common cervical spine injuries include flexion teardrop fractures from hyperflexion, wedge fractures from compression, hangman's fractures from hyperextension, and Jefferson fractures from axial loading. Odontoid fractures also occur from hyperextension or hyperflexion forces on the neck. Radiographic evaluation of
C2 fractures can range from asymptomatic to paralysis and are often caused by motor vehicle accidents or falls. Higher level cervical spine injuries carry greater risks. C2 fractures include odontoid fractures, lateral mass fractures, extension teardrop fractures, and traumatic spondylolisthesis (hangman's fracture). Diagnosis involves imaging like X-rays and CT/MRI to classify the fracture. Treatment depends on fracture type and severity but may include immobilization, traction, internal fixation, or fusion surgery. Complications can include malunion, nonunion, or pseudarthrosis if not properly treated.
An 92 year old male presented to the emergency department after a mechanical fall at a nursing home with neck pain. Imaging showed a type II odontoid fracture. He was placed in a rigid cervical collar and referred to spine surgery for further management which may include halo vest immobilization or surgical fixation.
This document reports on a case of non-union of an odontoid fracture in a 24-year-old male patient. The patient initially presented with neck pain after a fall and was found to have a type II odontoid fracture with minimal displacement. He was treated conservatively with a cervical collar. After 4 months, he developed neurological deficits. Surgery was performed to achieve posterior C1-C2 fusion with instrumentation. The document then reviews literature finding that non-union of odontoid fractures is multifactorial but not due to compromised blood supply, and is more common when there is less bone density, trabeculae, and surface area at the fracture site.
This document discusses various types of elbow fractures that can occur in children, including medial epicondyle apophysis fractures, pulled elbow syndrome, lateral condylar fractures, capitellar fractures, and medial condylar fractures. It provides details on the mechanisms of injury, classification systems, stages of displacement, and treatment approaches for each type of fracture. Key facts covered include that lateral condylar fractures can cross the physis or extend into the trochlear cartilage, and medial condylar fractures have both an intra-articular and extra-articular component. Classification systems such as those proposed by Milch and Weiss are described.
Traditional classification were given 100 years back when RTA , assaults, sports injuries, industrial accidents were minimal.
Over the past 100 years RTA (high speed & Low speed) assaults, sports injuries (high contact/ low contact), industrial accidents have increased.
Fracture patterns which are not matching the traditional injuries pattern.
Can speed up diagnosis and treatment planning
Cohorting / clubbing of complication to Specific Fractures.
It facilitate communication between peers and assist documentation and research.
It also have prognostic value for patients and assist Surgeons in planning their management.
It serves as a basis for treatment and for evaluation of the results.
Different fractures/ Areas of fracture has different treatment plan / approaches.
Undisplaced fracture : conservative/ surgical
Displaced Fractures: Surgical/ conservative with traction
This document discusses various orthopedic injuries seen on radiographs. It begins with a discussion of clavicle fractures, describing the different types based on the location and displacement of bone fragments. It then covers shoulder dislocations, elbow fractures including radial head and olecranon fractures, and forearm injuries such as Monteggia and Galeazzi fractures. Wrist fractures involving bones such as the scaphoid and lunate are also summarized. The document concludes with discussions of hand, finger, hip, femur, knee and lower leg fractures seen on radiographs.
This document discusses supracondylar fractures of the humerus, which occur most commonly in children ages 5-10 years old. It describes the anatomy of the elbow joint and mechanisms of injury for supracondylar fractures. The Gartland classification system grades the fractures from non-displaced to severely displaced. Treatment depends on the fracture type, with non-displaced fractures treated conservatively and displaced fractures requiring closed or open reduction with pin fixation. Complications can include vascular injury, nerve injury, compartment syndrome, malunion, and elbow stiffness.
An olecranon fracture is a break of the proximal end of the ulna bone where it forms part of the elbow joint. It most often occurs from a fall on an outstretched arm. Diagnosis is made through physical exam finding tenderness and a gap at the fracture site as well as x-rays. Treatment depends on the severity of the break, with minor fractures treated by casting and more severe displaced fractures requiring surgical fixation such as screws, plates or wires to stabilize the bone fragments. Complications can include stiffness, non-healing of the fracture and arthritis if not properly treated.
This document summarizes the case of a 3-year-old Thai boy who was brought to the emergency room after falling from a motorcycle. On physical examination, he was found to have a deformity and limited range of motion of his left elbow. X-rays revealed a Gartland Type III supracondylar fracture of the left humerus. The patient's management included admission, IV fluids, pain control, antibiotics, and being taken to the operating room for closed reduction with pinning and application of a long arm cast.
Dear all,
This ppt contains the cause, types, clinical and radiological features, treatment and complication of supra Condylar fracture of Humerus. I hope this is useful to you.
Thank you
This document provides an overview of Monteggia fracture dislocations, beginning with definitions, history, epidemiology, classification, mechanisms of injury, clinical features, management, complications, and recent updates. Monteggia fractures, first described in 1814, constitute 1-2% of forearm fractures. Bado's 1958 classification divides them into four types based on the direction of radial head dislocation and location of the ulna fracture. Type I is the most common, involving anterior radial head dislocation and ulna fracture. Nonoperative treatment typically involves closed reduction and casting, while surgery is indicated for failed reductions. Complications can include nerve injuries, ossification, and compartment syndrome.
Cervical Spine injuries by rakesh(presented on 11.11.10)Rakesh vallittayil
Cervical spine injuries can result from car accidents, falls, sports injuries, or violent acts. They can range from stable fractures where the spine structure is intact to unstable fractures where the spine cannot properly support and distribute weight. Imaging like x-rays, CT scans, and MRIs are used to diagnose and characterize fractures and other injuries like ligament damage. Treatment depends on the stability and extent of the injury, and may include immobilization with a collar, traction, or fixation surgery. Common cervical spine fractures include Jefferson fractures of C1, odontoid fractures of C2, Hangman's fractures, and bilateral or unilateral facet dislocations.
This document provides information on Monteggia fracture-dislocations, including:
- Classification into 4 main types based on the direction of the ulnar fracture and radial dislocation. Type 1 is the most common.
- Description of injury mechanisms, radiographic evaluation, treatment approaches including closed or open reduction of fractures and dislocations, and casting.
- Complications like neglected fractures and nerve injuries. Variations like Monteggia equivalents and revisions to the classification system are also discussed. Surgical techniques for addressing chronic cases, like annular ligament reconstruction and ulnar osteotomies, are covered.
supracondylar fracrture of humerus in childrenHardik Pawar
Supracondylar fractures of the humerus are the most common elbow fractures in children. They involve the lower end of the humerus just above the elbow joint. Radiographs are used to classify fractures as non-displaced (Type I), displaced with intact posterior cortex (Type II), or completely displaced (Type III). Treatment depends on the type of fracture and presence of displacement. Undisplaced fractures are treated with splinting while displaced fractures may require closed reduction and casting or pinning. Close monitoring of neurovascular status is important due to risk of injury.
paediatric injuries around the elbow
supracondylar elbow injuries
pulled elbow in paediatric age r
radiological signs around elbow in supracondylar fracture humerus
This document discusses zygomaticomaxillary complex fractures, including:
- Anatomy of the zygoma and classification systems for ZMC fractures.
- Clinical examination findings include flattening of the malar prominence and deformities of the orbital margin.
- Radiographic evaluation includes Waters' view and CT scans to determine fracture pattern and displacement.
- Treatment principles involve open reduction with or without fixation depending on fracture stability, with goals of restoring facial contour and function.
A 62-year-old female presented to the emergency department after falling down stairs and landing on her right arm. On examination, she had bruising just below her shoulder joint and was unable to move her arm due to pain. X-rays showed a linear fracture through the proximal humerus. The Neer classification system was used, which divides proximal humerus fractures into 1-4 parts based on displacement of fragments. Based on the classification, treatment options range from sling immobilization for nondisplaced fractures to surgery for displaced multi-part fractures. Prognosis depends on the fracture type and degree of displacement.
This document provides an overview of extremity trauma and injuries. It discusses various fractures and dislocations that can occur in the shoulder, arm, elbow, wrist, hand, pelvis and lower extremity. Key points include classifications of injuries like Garden classification of femoral neck fractures, AO classification of intertrochanteric hip fractures, and Ruedi-Allgower classification of pilon tibia fractures. Common injuries described include acromioclavicular joint separations, shoulder dislocations, radial head and elbow fractures, Colles' fractures of the wrist, and tibial plateau fractures. Imaging findings and anatomy are discussed to aid in diagnosis.
Supra condylar humerus fracture in childrenSubodh Pathak
Upper-extremity fractures account for 65-75% of all fractures in children, with 7-9% involving the elbow. Supracondylar fractures of the distal humerus are the most common elbow injuries in children, typically occurring between ages 5-10 years old. These fractures are classified into Types 1-3 based on displacement. Type 1 fractures are non-displaced, Type 2 have angulation/displacement with an intact posterior cortex, and Type 3 have complete displacement of fragments. Closed reduction and percutaneous pinning is the most common treatment, with pins placed medially and laterally for stability. Open reduction is rarely needed but may be indicated for inadequate closed reduction or vascular injury.
The document provides information on condylar fractures, including:
1. Condylar fractures account for 26-40% of all mandible fractures and can result in pain, dysfunction and deformity if not treated properly.
2. The condyle has a unique anatomy and is an important growth center for the mandible. Fractures can occur in the condylar head, neck or subcondylar region.
3. Various classification systems are described that categorize fractures by location, degree of displacement, and direction of forces involved. Accurate classification is important for determining appropriate treatment.
1. Ankle fractures are commonly caused by twisting injuries and can involve the lateral malleolus, medial malleolus, or both. More severe fractures involve the tibial plafond.
2. Fractures are classified using the Lauge-Hansen or Denis-Weber systems to determine the mechanism and pattern of injury.
3. Treatment depends on the fracture type but often involves operative fixation using plates, screws, or external fixation to restore ankle anatomy and stability.
This document discusses ankle fractures, including their epidemiology, anatomy, classification systems, evaluation, and management. Some key points:
- Ankle fractures most often result from road traffic accidents or falls and twisting injuries. Left untreated, they can cause long-term pain, instability, and arthritis.
- The ankle joint is stabilized by bones, ligaments, tendons, and the fibrous capsule. Common fracture patterns include lateral malleolus, medial malleolus, and syndesmotic injuries.
- Classification systems include Lauge-Hansen (based on mechanism of injury), Weber (based on fibular fracture location), and OTA (describing bony patterns). Evaluation involves clinical
Traditional classification were given 100 years back when RTA , assaults, sports injuries, industrial accidents were minimal.
Over the past 100 years RTA (high speed & Low speed) assaults, sports injuries (high contact/ low contact), industrial accidents have increased.
Fracture patterns which are not matching the traditional injuries pattern.
Can speed up diagnosis and treatment planning
Cohorting / clubbing of complication to Specific Fractures.
It facilitate communication between peers and assist documentation and research.
It also have prognostic value for patients and assist Surgeons in planning their management.
It serves as a basis for treatment and for evaluation of the results.
Different fractures/ Areas of fracture has different treatment plan / approaches.
Undisplaced fracture : conservative/ surgical
Displaced Fractures: Surgical/ conservative with traction
This document discusses various orthopedic injuries seen on radiographs. It begins with a discussion of clavicle fractures, describing the different types based on the location and displacement of bone fragments. It then covers shoulder dislocations, elbow fractures including radial head and olecranon fractures, and forearm injuries such as Monteggia and Galeazzi fractures. Wrist fractures involving bones such as the scaphoid and lunate are also summarized. The document concludes with discussions of hand, finger, hip, femur, knee and lower leg fractures seen on radiographs.
This document discusses supracondylar fractures of the humerus, which occur most commonly in children ages 5-10 years old. It describes the anatomy of the elbow joint and mechanisms of injury for supracondylar fractures. The Gartland classification system grades the fractures from non-displaced to severely displaced. Treatment depends on the fracture type, with non-displaced fractures treated conservatively and displaced fractures requiring closed or open reduction with pin fixation. Complications can include vascular injury, nerve injury, compartment syndrome, malunion, and elbow stiffness.
An olecranon fracture is a break of the proximal end of the ulna bone where it forms part of the elbow joint. It most often occurs from a fall on an outstretched arm. Diagnosis is made through physical exam finding tenderness and a gap at the fracture site as well as x-rays. Treatment depends on the severity of the break, with minor fractures treated by casting and more severe displaced fractures requiring surgical fixation such as screws, plates or wires to stabilize the bone fragments. Complications can include stiffness, non-healing of the fracture and arthritis if not properly treated.
This document summarizes the case of a 3-year-old Thai boy who was brought to the emergency room after falling from a motorcycle. On physical examination, he was found to have a deformity and limited range of motion of his left elbow. X-rays revealed a Gartland Type III supracondylar fracture of the left humerus. The patient's management included admission, IV fluids, pain control, antibiotics, and being taken to the operating room for closed reduction with pinning and application of a long arm cast.
Dear all,
This ppt contains the cause, types, clinical and radiological features, treatment and complication of supra Condylar fracture of Humerus. I hope this is useful to you.
Thank you
This document provides an overview of Monteggia fracture dislocations, beginning with definitions, history, epidemiology, classification, mechanisms of injury, clinical features, management, complications, and recent updates. Monteggia fractures, first described in 1814, constitute 1-2% of forearm fractures. Bado's 1958 classification divides them into four types based on the direction of radial head dislocation and location of the ulna fracture. Type I is the most common, involving anterior radial head dislocation and ulna fracture. Nonoperative treatment typically involves closed reduction and casting, while surgery is indicated for failed reductions. Complications can include nerve injuries, ossification, and compartment syndrome.
Cervical Spine injuries by rakesh(presented on 11.11.10)Rakesh vallittayil
Cervical spine injuries can result from car accidents, falls, sports injuries, or violent acts. They can range from stable fractures where the spine structure is intact to unstable fractures where the spine cannot properly support and distribute weight. Imaging like x-rays, CT scans, and MRIs are used to diagnose and characterize fractures and other injuries like ligament damage. Treatment depends on the stability and extent of the injury, and may include immobilization with a collar, traction, or fixation surgery. Common cervical spine fractures include Jefferson fractures of C1, odontoid fractures of C2, Hangman's fractures, and bilateral or unilateral facet dislocations.
This document provides information on Monteggia fracture-dislocations, including:
- Classification into 4 main types based on the direction of the ulnar fracture and radial dislocation. Type 1 is the most common.
- Description of injury mechanisms, radiographic evaluation, treatment approaches including closed or open reduction of fractures and dislocations, and casting.
- Complications like neglected fractures and nerve injuries. Variations like Monteggia equivalents and revisions to the classification system are also discussed. Surgical techniques for addressing chronic cases, like annular ligament reconstruction and ulnar osteotomies, are covered.
supracondylar fracrture of humerus in childrenHardik Pawar
Supracondylar fractures of the humerus are the most common elbow fractures in children. They involve the lower end of the humerus just above the elbow joint. Radiographs are used to classify fractures as non-displaced (Type I), displaced with intact posterior cortex (Type II), or completely displaced (Type III). Treatment depends on the type of fracture and presence of displacement. Undisplaced fractures are treated with splinting while displaced fractures may require closed reduction and casting or pinning. Close monitoring of neurovascular status is important due to risk of injury.
paediatric injuries around the elbow
supracondylar elbow injuries
pulled elbow in paediatric age r
radiological signs around elbow in supracondylar fracture humerus
This document discusses zygomaticomaxillary complex fractures, including:
- Anatomy of the zygoma and classification systems for ZMC fractures.
- Clinical examination findings include flattening of the malar prominence and deformities of the orbital margin.
- Radiographic evaluation includes Waters' view and CT scans to determine fracture pattern and displacement.
- Treatment principles involve open reduction with or without fixation depending on fracture stability, with goals of restoring facial contour and function.
A 62-year-old female presented to the emergency department after falling down stairs and landing on her right arm. On examination, she had bruising just below her shoulder joint and was unable to move her arm due to pain. X-rays showed a linear fracture through the proximal humerus. The Neer classification system was used, which divides proximal humerus fractures into 1-4 parts based on displacement of fragments. Based on the classification, treatment options range from sling immobilization for nondisplaced fractures to surgery for displaced multi-part fractures. Prognosis depends on the fracture type and degree of displacement.
This document provides an overview of extremity trauma and injuries. It discusses various fractures and dislocations that can occur in the shoulder, arm, elbow, wrist, hand, pelvis and lower extremity. Key points include classifications of injuries like Garden classification of femoral neck fractures, AO classification of intertrochanteric hip fractures, and Ruedi-Allgower classification of pilon tibia fractures. Common injuries described include acromioclavicular joint separations, shoulder dislocations, radial head and elbow fractures, Colles' fractures of the wrist, and tibial plateau fractures. Imaging findings and anatomy are discussed to aid in diagnosis.
Supra condylar humerus fracture in childrenSubodh Pathak
Upper-extremity fractures account for 65-75% of all fractures in children, with 7-9% involving the elbow. Supracondylar fractures of the distal humerus are the most common elbow injuries in children, typically occurring between ages 5-10 years old. These fractures are classified into Types 1-3 based on displacement. Type 1 fractures are non-displaced, Type 2 have angulation/displacement with an intact posterior cortex, and Type 3 have complete displacement of fragments. Closed reduction and percutaneous pinning is the most common treatment, with pins placed medially and laterally for stability. Open reduction is rarely needed but may be indicated for inadequate closed reduction or vascular injury.
The document provides information on condylar fractures, including:
1. Condylar fractures account for 26-40% of all mandible fractures and can result in pain, dysfunction and deformity if not treated properly.
2. The condyle has a unique anatomy and is an important growth center for the mandible. Fractures can occur in the condylar head, neck or subcondylar region.
3. Various classification systems are described that categorize fractures by location, degree of displacement, and direction of forces involved. Accurate classification is important for determining appropriate treatment.
1. Ankle fractures are commonly caused by twisting injuries and can involve the lateral malleolus, medial malleolus, or both. More severe fractures involve the tibial plafond.
2. Fractures are classified using the Lauge-Hansen or Denis-Weber systems to determine the mechanism and pattern of injury.
3. Treatment depends on the fracture type but often involves operative fixation using plates, screws, or external fixation to restore ankle anatomy and stability.
This document discusses ankle fractures, including their epidemiology, anatomy, classification systems, evaluation, and management. Some key points:
- Ankle fractures most often result from road traffic accidents or falls and twisting injuries. Left untreated, they can cause long-term pain, instability, and arthritis.
- The ankle joint is stabilized by bones, ligaments, tendons, and the fibrous capsule. Common fracture patterns include lateral malleolus, medial malleolus, and syndesmotic injuries.
- Classification systems include Lauge-Hansen (based on mechanism of injury), Weber (based on fibular fracture location), and OTA (describing bony patterns). Evaluation involves clinical
This document discusses various types of fractures of the distal humerus. It begins by describing distal humerus fractures in general, including common mechanisms of injury and clinical features. It then discusses specific fracture types - supracondylar, intercondylar, condylar, trochlear, and capitellar - providing details on classification systems, treatment options, and potential complications for each. Measurement techniques for radiographic evaluation and several classification systems used for distal humerus fractures are also summarized.
1) There are several classifications for spine fractures based on the location and type of injury. Injuries to the cervical spine are divided into supra-axial injuries involving the occiput-C1-C2 complex and sub-axial injuries involving C3-C7.
2) Thoracolumbar spine fractures are classified based on the failure mode and stability. Compression fractures can be treated non-operatively if stable, but unstable fractures may require surgery.
3) Initial management of spine fractures involves immobilization, assessment for neurological deficits and imaging to evaluate fracture type and guide treatment, which could be non-operative or operative depending on stability.
This document provides an overview of fractures, including their definition, classification, clinical features, healing process, investigations, and management principles. It defines a fracture as a partial or complete break in bone continuity with soft tissue involvement. Fractures are classified based on their clinical presentation (open vs closed), anatomical location, radiological appearance, and involvement of specific bones/regions. Key points covered include the stages of bone healing, factors influencing healing, indications for various treatment approaches like closed reduction, internal/external fixation, and complications of skeletal traction.
The document discusses various classifications of fractures including the Neer classification of proximal humeral fractures, the Garden's classification of hip fractures, Evan's classification of intertrochanteric fractures, and the Weber classification of ankle fractures. The Neer classification categorizes humeral fractures based on the number of fracture parts and degree of displacement. Garden's classification divides femoral neck fractures into 4 stages based on displacement. Evan's classification organizes intertrochanteric fractures. The Weber classification sorts ankle fractures into types A, B, and C depending on the fracture level and stability.
This document discusses the history and treatment of distal radius fractures. Some key points:
- Distal radius fractures are common injuries that were first recognized in the late 18th century, with descriptions of injury patterns evolving over the 19th century.
- Treatment has progressed from casting to external fixation to various internal fixation methods like dorsal, volar, and combined plating approaches.
- Factors like fracture pattern, displacement, comminution, and articular involvement help determine appropriate treatment, whether closed reduction or open reduction with internal fixation.
- The goal of treatment is to restore normal anatomy, allow early motion, and avoid complications like malunion.
This document discusses various classification systems for intertrochanteric fractures. It describes Evans' classification, Jensen's modification of Evans' classification, Kyle's classification, the AO classification, Boyd & Griffin classification, Tronzo classification, Ramadiers classification, Decoulx & Lavardes classification, Briot's classification, Ender classification, and Kulkarni's modified Jensen-Evans classification. The classifications are based on factors like stability, anatomical pattern, number of fragments, and whether the fracture extends into the subtrochanteric region. The clinical importance of each classification is providing guidance on fracture management and predicting outcomes.
1) Subtrochanteric Fracture
Subtrochanteric typically defined as area from lesser trochanter to 5cm distal fractures with an associated intertrochanteric component may be called peritrochanteric fracture.
*Unique Aspect
Blood loss is greater than with femoral neck or trochanteric fractures – covered with anastomosing branches of the medial and lateral circumflex femoral arteries branch of profunda femoris trunk.
2) Femoral Shaft Fracture
Femoral shaft fracture is defined as a fracture of the diaphysis occurring between 5 cm distal to the lesser trochanter and 5 cm proximal to the adductor tubercle
The femoral shaft is padded with large muscles.
- reduction can be difficult as muscle contraction displaces the fracture
- healing potential is improved by having this well-vascularized
*Age
-usually a fracture of young adults and results from a high energy injury
-elderly patients should be considered ‘pathological’ until proved otherwise
-children under 4 years the suspected possibility of physical abuse
*FRACTURES ASSOCIATED WITH VASCULAR INJURY
Warning signs of an associated vascular injury are
(1) excessive bleeding or haematoma formation; and
(2) paraesthesia, pallor or pulselessness in the leg and foot.
~Warm ischemia in 2-3H
~If > 6H – salvage not possible
*‘FLOATING KNEE’
Ipsilateral fractures of the femur and tibia may leave the knee joint ‘floating’
3) Distal Femoral Fracture
Defined as fractures from articular surface to 5cm above metaphyseal flare
*clinical feature
The knee is swollen because of a haemarthrosis – this can be severe enough to cause blistering later
Movement is too painful to be attempted
The tibial pulses should always be checked to ensure the popliteal artery was not injured in the fracture.
Reference: Apley's System of Orthopaedic and Fracture (9th edition)
This document summarizes common lower limb fractures, including fractures of the femur (hip), tibia, fibula, patella, ankle, calcaneus, and metatarsals. It describes the location and classification of these fractures, along with examples of X-ray images demonstrating various fracture patterns such as femoral neck, tibial plateau, lateral malleolus, and Jones fractures of the 5th metatarsal. Classification systems are outlined for femoral neck, ankle, and calcaneal fractures based on their location and degree of displacement.
This document discusses various fractures and dislocations that can occur around the elbow joint. It begins with relevant elbow anatomy and then describes several types of fractures in detail, including supracondylar fractures, lateral condyle fractures, radial head fractures, and distal humerus fractures. It also discusses coronoid process fractures, radial head dislocations, Essex-Lopresti injuries (radial head fracture with distal radioulnar joint dislocation), and olecranon fractures. For each type of injury, it provides information on classification systems, mechanisms of injury, clinical features, imaging findings, and treatment approaches.
This document describes various fractures of the lower limbs, including: femur (femoral neck, shaft, distal end), tibia and fibula, patella, ankle (Weber classification), calcaneus (Sanders classification), and metatarsals. Key details are provided on classifications of femoral neck fractures (Garden, Pauwels), tibial plateau fractures, and calcaneal fractures. Common fracture patterns such as supracondylar femoral fractures and lateral malleolar fractures are also outlined.
Compartment syndrome most commonly occurs in the anterior compartment of the leg. The anterior compartment contains the muscles that lift the toes and extend the foot. It has relatively inelastic fascial boundaries that can easily become tense and compressed when swelling occurs within the compartment due to trauma, such as a fracture. The small and tight space makes the anterior leg muscles particularly vulnerable to pressure buildup and the decreased blood flow that can develop into compartment syndrome.
This document discusses distal radius fractures, which make up 20% of orthopaedic admissions. It describes the anatomy of the distal radius and classifications of fractures. Common types include Colles, Smith, Barton, and die punch fractures. Treatment depends on factors like patient age and fracture stability/displacement, and may involve closed or open reduction with pinning or plating to restore normal anatomy. Nonoperative treatment uses casting for stable fractures, while unstable fractures often require surgical fixation.
1) The document discusses different types of femoral fractures including femoral head, neck, intertrochanteric, subtrochanteric, shaft, and distal fractures.
2) Subtrochanteric fractures are defined as occurring within 5cm below the lesser trochanter. Fielding classification categorizes subtrochanteric fractures based on their location relative to the lesser trochanter.
3) Treatment options depend on the type and stability of the fracture, and may include traction, plating, intramedullary nailing, or hip screws.
Thoracic and lumbar fractures account for 30-50% of all spinal injuries. The majority occur between T11-L1 (thoracolumbar junction). They account for 50% of all spinal fractures, with an incidence of 4-5 per 100,000 people aged 18-35 years and occurring more in males. Neurological injuries occur in 25% of cases. Operative treatment is indicated for vertebral height loss over 40%, canal compromise over 40%, or kyphosis over 25 degrees. The goals of treatment are maximizing neurological recovery, maintaining spinal alignment, obtaining a healed and stable spine, and preventing deformity.
Distal radius fractures can be extra-articular or intra-articular. They are commonly classified based on location, configuration, displacement, involvement of the ulna, and stability. Treatment depends on factors like age, fracture pattern, and degree of displacement. Options include closed reduction with casting or surgical fixation to restore anatomy and allow early mobility. Complications can include malunion, arthritis, and nerve injuries if not properly treated.
Neck of femur fractures most commonly occur in elderly patients due to osteoporosis and are often caused by falls. The Garden classification system is used to categorize neck of femur fractures based on the degree of displacement. Treatment depends on factors like the patient's age, bone quality, and fracture displacement - undisplaced fractures may be treated with internal fixation while displaced fractures in elderly patients are typically treated with hemiarthroplasty or total hip replacement.
Cervical Spine Fractures and injuries classificationDr Gandhi Kota
1) The document classifies and describes various types of cervical spine fractures and injuries, including occipital condyle fractures, atlanto-occipital dislocations, atlas fractures, axis fractures, subaxial fractures and dislocations.
2) It discusses classifications for different fracture types from various authors, including the Anderson and Mantesano classification for occipital condyle fractures, the Traynalis classification for atlanto-occipital dislocations, and the Levine classification for atlas fractures.
3) It also covers classifications for fractures of the odontoid process, Hangman's fractures, subaxial fractures and dislocations including the Allen-Ferguson classification.
Immersive Learning That Works: Research Grounding and Paths ForwardLeonel Morgado
We will metaverse into the essence of immersive learning, into its three dimensions and conceptual models. This approach encompasses elements from teaching methodologies to social involvement, through organizational concerns and technologies. Challenging the perception of learning as knowledge transfer, we introduce a 'Uses, Practices & Strategies' model operationalized by the 'Immersive Learning Brain' and ‘Immersion Cube’ frameworks. This approach offers a comprehensive guide through the intricacies of immersive educational experiences and spotlighting research frontiers, along the immersion dimensions of system, narrative, and agency. Our discourse extends to stakeholders beyond the academic sphere, addressing the interests of technologists, instructional designers, and policymakers. We span various contexts, from formal education to organizational transformation to the new horizon of an AI-pervasive society. This keynote aims to unite the iLRN community in a collaborative journey towards a future where immersive learning research and practice coalesce, paving the way for innovative educational research and practice landscapes.
When I was asked to give a companion lecture in support of ‘The Philosophy of Science’ (https://shorturl.at/4pUXz) I decided not to walk through the detail of the many methodologies in order of use. Instead, I chose to employ a long standing, and ongoing, scientific development as an exemplar. And so, I chose the ever evolving story of Thermodynamics as a scientific investigation at its best.
Conducted over a period of >200 years, Thermodynamics R&D, and application, benefitted from the highest levels of professionalism, collaboration, and technical thoroughness. New layers of application, methodology, and practice were made possible by the progressive advance of technology. In turn, this has seen measurement and modelling accuracy continually improved at a micro and macro level.
Perhaps most importantly, Thermodynamics rapidly became a primary tool in the advance of applied science/engineering/technology, spanning micro-tech, to aerospace and cosmology. I can think of no better a story to illustrate the breadth of scientific methodologies and applications at their best.
PPT on Alternate Wetting and Drying presented at the three-day 'Training and Validation Workshop on Modules of Climate Smart Agriculture (CSA) Technologies in South Asia' workshop on April 22, 2024.
The cost of acquiring information by natural selectionCarl Bergstrom
This is a short talk that I gave at the Banff International Research Station workshop on Modeling and Theory in Population Biology. The idea is to try to understand how the burden of natural selection relates to the amount of information that selection puts into the genome.
It's based on the first part of this research paper:
The cost of information acquisition by natural selection
Ryan Seamus McGee, Olivia Kosterlitz, Artem Kaznatcheev, Benjamin Kerr, Carl T. Bergstrom
bioRxiv 2022.07.02.498577; doi: https://doi.org/10.1101/2022.07.02.498577
PPT on Direct Seeded Rice presented at the three-day 'Training and Validation Workshop on Modules of Climate Smart Agriculture (CSA) Technologies in South Asia' workshop on April 22, 2024.
Mending Clothing to Support Sustainable Fashion_CIMaR 2024.pdfSelcen Ozturkcan
Ozturkcan, S., Berndt, A., & Angelakis, A. (2024). Mending clothing to support sustainable fashion. Presented at the 31st Annual Conference by the Consortium for International Marketing Research (CIMaR), 10-13 Jun 2024, University of Gävle, Sweden.
JAMES WEBB STUDY THE MASSIVE BLACK HOLE SEEDSSérgio Sacani
The pathway(s) to seeding the massive black holes (MBHs) that exist at the heart of galaxies in the present and distant Universe remains an unsolved problem. Here we categorise, describe and quantitatively discuss the formation pathways of both light and heavy seeds. We emphasise that the most recent computational models suggest that rather than a bimodal-like mass spectrum between light and heavy seeds with light at one end and heavy at the other that instead a continuum exists. Light seeds being more ubiquitous and the heavier seeds becoming less and less abundant due the rarer environmental conditions required for their formation. We therefore examine the different mechanisms that give rise to different seed mass spectrums. We show how and why the mechanisms that produce the heaviest seeds are also among the rarest events in the Universe and are hence extremely unlikely to be the seeds for the vast majority of the MBH population. We quantify, within the limits of the current large uncertainties in the seeding processes, the expected number densities of the seed mass spectrum. We argue that light seeds must be at least 103 to 105 times more numerous than heavy seeds to explain the MBH population as a whole. Based on our current understanding of the seed population this makes heavy seeds (Mseed > 103 M⊙) a significantly more likely pathway given that heavy seeds have an abundance pattern than is close to and likely in excess of 10−4 compared to light seeds. Finally, we examine the current state-of-the-art in numerical calculations and recent observations and plot a path forward for near-future advances in both domains.
CLASS 12th CHEMISTRY SOLID STATE ppt (Animated)eitps1506
Description:
Dive into the fascinating realm of solid-state physics with our meticulously crafted online PowerPoint presentation. This immersive educational resource offers a comprehensive exploration of the fundamental concepts, theories, and applications within the realm of solid-state physics.
From crystalline structures to semiconductor devices, this presentation delves into the intricate principles governing the behavior of solids, providing clear explanations and illustrative examples to enhance understanding. Whether you're a student delving into the subject for the first time or a seasoned researcher seeking to deepen your knowledge, our presentation offers valuable insights and in-depth analyses to cater to various levels of expertise.
Key topics covered include:
Crystal Structures: Unravel the mysteries of crystalline arrangements and their significance in determining material properties.
Band Theory: Explore the electronic band structure of solids and understand how it influences their conductive properties.
Semiconductor Physics: Delve into the behavior of semiconductors, including doping, carrier transport, and device applications.
Magnetic Properties: Investigate the magnetic behavior of solids, including ferromagnetism, antiferromagnetism, and ferrimagnetism.
Optical Properties: Examine the interaction of light with solids, including absorption, reflection, and transmission phenomena.
With visually engaging slides, informative content, and interactive elements, our online PowerPoint presentation serves as a valuable resource for students, educators, and enthusiasts alike, facilitating a deeper understanding of the captivating world of solid-state physics. Explore the intricacies of solid-state materials and unlock the secrets behind their remarkable properties with our comprehensive presentation.
1. Frykman Classification of Distal
Radial #
Galeazzi Fracture
distal third of radius with
dislocation or subluxation of distal
radio-ulnar joint
Fracture shaft of ulnar, together with
disruption of the proximal radioulnar
joint and dislocation of radiocapitallar
joint
Fracture of base of the first
metacarpal bone
Salter–Harris fracture
= Fracture that involves the epiphyseal plate or growth
plate of a bone
Type I: undisplaced or minimally displaced fractures.
Type II: displaced with posterior cortex intact
Type III: displaced with no cortical intact
Gartland’s classification of supracondylar
fracture of humerus
• Galeazzi fracture - a fracture of the radius
with dislocation of the distal radioulnar joint
• Colles' fracture - a distal fracture of the
radius with dorsal (posterior) displacement of
the wrist and hand
• Smith's fracture - a distal fracture of the
radius with volar (ventral) displacement of the
wrist and hand
• Barton's fracture - an intra-articular
fracture of the distal radius with dislocation of
the radiocarpal joint
• Essex-Lopresti fracture - a fracture of
the radial head with concomitant dislocation
of the distal radio-ulnar joint with disruption of
the interosseous membrane
ORTHOPAEDICS CLASSIFICATION
PART 1 (UPPER LIMB)
HTARW5B/GKS2013/3-
Neer classification of proximal humeral head #
GT GT+SN “CLASSIC”
SN LT+SN (RARE) “VALGUS IMPACTED”
LN (RARE)
Impression # Head split
1-part 2-part 3-part 4-part
Together In Delivering Excellence (T.I.D.E.)
Contributors: Dr. Tham, Goh, Poh, Shaun, Justine, Shanthy, Huda, Miruna, Lin, Phrindha, Syikin, Fong, Phoon, Ling Ying, Siew Ling, Quah
Gustillo Anderson Classification of Open
Fracture
I – open fracture with a wound <1cm and clean
II – open fracture with wound > 1cm with extensive soft tissue
damage and avulsion of flaps
IIIa – open fracture with adequate soft tissue coverage of bone in
spite of extensive soft tissue laceration or flaps or high energy
trauma irrespective of size of wound
IIIb – open fracture with extensive soft tissue loss, periosteal
stripping and exposure of bone
IIIc – open fracture associated with an arterial injury which requires
repairI II IIIa IIIb IIIc
3L 6L 9LIrrigation:
2. Letournel classification acetabular #
Simple Types
Associated Types
Anterior column Anterior wall Posterior column Posterior wall Transverse
T-type Transverse Posterior column Anterior + posterior Both columns
+ posterior wall + posterior wall hemitransverse
Pipkin classification of femoral head fracture
Type I - # below fovea/ligamentum (small)
Type II - # above fovea/ ligamentum (larger)
Type III - type I or II with associated femoral neck # (high risk of AVN)
Type IV - type I or II with associated acetabular #
Garden classification of femoral neck #
Evan classification of intertrochanteric #
Russel Taylor classification of subtrochanteric #
Winquist classification of femoral shaft fracture
I. Tiny cortical fragment
II. Butterfly fragment is
large but there is still
50%of cortical intact
between the main
fragments
III. Butterfly fragment
involves more than
50% of the bone
width
IV. Segmental fractures
Schatzker classification of tibia plateau #
Lateral tibial
plateau # w/o
depression
Lateral tibial
plateau #
with
depression
Focal
depression
with no
associated
split
Medial tibial
plateau #,
with or
without
depression
Bicondy
lar tibial
plateau
#
Tibial
plateau
fracture with
diaphyseal
discontinuity
Sanders classification of calcaneal
fractures
I - # are non-displaced # (displacement < 2 mm).
II - # consist of a single intrarticular # that divides the
calcaneus into 2 pieces.
IIA: # occurs on lateral aspect of calcaneus.
IIB: # occurs on central aspect of calcaneus.
IIC: # occurs on medial aspect of calcaneus.
III # consist of 2 intrarticular fractures that divide the
calcaneus into 3 articular pieces.
IIIAB: 2 # lines are present, 1 lateral and 1 central.
IIIAC: 2 # lines are present, 1 lateral and 1 medial.
IIIBC: 2 # lines are present, 1 central and 1 medial.
IV # consist of # with more than 3 intrarticular
fractures.
ORTHOPAEDICS CLASSIFICATION
PART 2 (PELVIC & LOWER LIMB)
HTARW5B/GKS2013/3b-
Lisfranc classification of tarsometatarsal injury
Homolateral Isolated Divergent
Garden I fracture
incomplete and
minimally
displaced
Garden II fracture
complete and
nondisplaced
Garden III fracture
complete and
partially displaced
Garden IV fracture
complete displaced with
no engagement of the 2
principal fragment
Evan I
Undisplaced 2
parts fracture
Evan 2
Displaced 2
parts fracture
Evan 3 Displaced 3
parts fracture with
posteromedial
comminution
Evan 4 Displaced 3
parts fracture with
large posteromedial
comminuted
fragment
Evan 5 Displaced 4
parts fracture with
comminution
involving both
trochanters
lateral
medial
Type IIA Type IIB Type IIC
Type IIIAB Type IIIAC Type IIIBC Type IV
Together In Delivering Excellence (T.I.D.E.)
Contributors: Dr. Tham, Goh, Poh, Shaun, Justine, Shanthy, Huda, Miruna, Lin, Phrindha, Syikin, Fong, Phoon,
Ling Ying, Siew Ling, Quah
3. Together In Delivering Excellence (T.I.D.E.)
Contributors: Dr. Tham, Goh, Poh, Shaun, Justine, Shanthy, Huda, Miruna, Lin, Phrindha, Syikin, Fong, Phoon, Ling Ying, Siew Ling, Quah
Anterior column:
AAL: Anterior longitudinal ligament
AAF: Anterior annulus fibrosus
Middle column:
PLL: Posterior longitudinal ligament
PAF: Posterior annulus fibrosus
Posterior column:
SSL: Supraspinous ligament
ISL: Interspinous ligament
LF: Ligamentum flavum
PC: Facet capsule
DENIS THREE COLUMN CONCEPT
DENIS CLASSIFICATION OF SPINAL TRAUMA
MAJOR INJURIES MINOR INJURIES
• Transverse process #
• Articular process #
• Par interarticularis #
• Spinous process #
Stable fractures - don't cause spinal deformity or neurologic deficit,
still able to weight bear
Unstable fractures - unable to weight bear, may progress and
causing further neurological and structural damage.
TLICS:Thoracolumbar Injury Classification and Severity Score
Morphology Posterior Ligamentous complex (PLC)
0 No abnormality 0 Intact
1 Compression 2 Suspected / Indeterminate
2 + Burst fracture 3 Injured
3 Rotation/translation
4 Distraction
Neurological status
0 Intact
2 Root injury
2 Complete cord / conus medullaris injury
3 Incomplete cord / conus medullaris injury
3 Cauda equina
Treatment
TLICS <= 3: non-operative
TLICS = 4: consider for operative or non-operative intervention
TLICS >=5: operative
HTARW5B/GKS2013/4-
Criteria of unstable spine injury
• On palpation gap between 2 spinous processes
increased
• Neurological deficit
• Vertebral compression >1/3
• Vertebral displacement >1/3
• Vertebral canal compromisation > 1/3
• Bilateral facet joints dislocation
• According to Denis 3 columns concept: 2 columns
disrupted
Localisation of level of injury
Vertebral spine Spinal Cord Segment
C1-C7 Add 1
T1-T6 Add 2
T7-T9 Add 3
T10 L1,L2
T11 L3,L4
T12 L5,S1
L1 rest of sacrococcygeal
segment
Central cord
lesion
• Upper > lower
limb involved
• Sacral sparing
• Due to
hyperextension/
Spine OA
Anterior cord
lesion
• Motor -
• Sensory -
• Proprioception +
• Due to
hyperextension
with disc or bone
compressing ant
spinal a
Posterior cord
lesion
• Proprioception -
• Motor +
• Sensory +
Cord hemisection
(Brown Sequard
Syndrome)
• Ipsilateral
paralysis with
contralateral loss
of pain sensation
• Due to unilateral
lamina or pedicle
#
Conus
medullaris
• Root pain -
• Sensory saddle shape distribution with
perianal anaesthesia, symmetrical
• Motor changes -
• Sphincter involved +
• Reflexes – knee jerk normal
• Ankle jerk lost
Cauda
equina
syndrome
• Root pain +
• Sensory may invoke any part of lower
limb, asymmetrical
• Motor changes ++ (wasting)
• Sphincter ±
• Reflexes – knee jerk normal/
• Ankle jerk lost/
ORTHOPAEDICS ESSENTIALS
PART 3 THE SPINE
C6
T1
# Type &
column
involvement
Anterior
column
Middle
column
Posterior
column
Compression
#
Compression None
None or
distraction
Burst # Compression Compression
None or
distraction
Seatbelt
None or
compression
Distraction Distraction
Fracture/disl
ocation
Compression
±rotational/
shear
Distraction
±rotational/
shear
Distraction
±rotational/
shear
Lower limb myotomes
and dermatomes
Upper limb myotomes
and dermatomes
Elbow flexion
Wrist extension
Wrist flexion
Finger flexion
Finger Extension
Finger
abduction
Hip flexors
Knee extensors
Ankle
dorsiflexor
great toe
dorsiflexion
Ankle
plantar
flexion
Bulbocavernosus
reflex
involves monitoring anal
sphincter contraction in
response to squeezing
the glans penis or
tugging on an indwelling
Foley catheter
4. Together In Delivering Excellence (T.I.D.E.)
Contributors: Dr. Tham, Goh, Poh, Shaun, Justine, Shanthy, Huda, Miruna, Lin, Phrindha, Syikin, Fong, Phoon, Ling Ying, Siew Ling, Quah
ORTHOPAEDICS ESSENTIALS
PART 4 DRESSINGS
HTARW5B/GKS2013/4-
Name Active Ingredient Indication Contraindication Advantage Disadvantage
1. Opsite semi-permeable-thin, adhesive
transparent polyurethrane film
superficial wounds
as secondary dressing
highly exudative wounds • some moisture evaporation
• reduce pain
• barrier to external contamination
• allows inspection
• exudate may pool
• maybe traumatic to remove
2. Jelonet
Bactigras
PARAFFIN
non-adherent moist (Tulle Gras
dressing)
gauze impregnated with paraffin
or maybe with antiseptics or
antibiotics
burn
wounds healing by secondary
intention
allergy • reduces adhesion to wound
• moist environment aids healing
• does not absorb exudate
• requires secondary dressingg
• allergy
• may delay healing when
impregnated
3. Kaltostat
CALCIUM
ALGINATE
Calcium alginate
natural polysaccharide from
seaweed
moderately/highly exudative wounds
need for hemostasis
dry wound
hard eschar
• forms gel on wound & hence moist
• environment
• reduces pain
• can pack cavities
• absorbent in exudative wounds
• promotes hemostasis
• low allergenic
• may require secondary dressing
• not recommended in anearobic
infections
• gel can be confused with slough
• or pus in wound
4. Duoderm E
HYDROCOLLOID
hydrocolloid dressing-hydrophilic
colloid
bound to polyurethrane film coated
with adhesive mass
burn (small) abrasions
mildly exudating ulcers
donate moisture & absorb exudates
dry wound
infection
full thickness wound
• retains moisture
• painless removal
• facilitate autolytic debridement
• thermal insulation
• worn for 3-5days-fewer dressing
changes
• avoid on high exudate wounds, sinus
tracts
• fragile skin
5. Duoderm
Hydroactive
HYDOGEL
hydogel - water or glycerin-based
80-99% water on a nonadherent,
cross-linked polymer
pressure ulcer stage II-IV,
partial & full thickness wound
dermabrasion, painful wound
dermal ulcer, radiation burn
donor sites
necrotic wounds
heavily draining wound • rehydrate the wound bed
• reduce pain
• used on infected wound with
• topical medication
• promote autolytic debridement
• need 2ndary dressing
• avoid heavily draining wound
• absorptive properties may macerate
• periwound skin
5. Aquacel
HYDROFIBER
SODIUM
CARBOXY-
METHYLCELLUL
OSE
soft, sterile, nonwoven pad or
ribbon with
sodium carboxymethylcellulose
moderate to heavily draining wound
partial & fully thickness wound
pressure ulcer (stage III & IV)
surgical wound, donor site
dehisced wound, cavity wound
wounds with sinus tracts or tunnels
dry eschar
non-exudating wound
3rd degree burn
heavy bleeding
• retains moisture
• absorb & retain exudate & harmful
• components
• do not damage tissues surrounding
• exudating wound when dressing
changes
• removal trauma free
• reduce dead space
• no frequent change
• dressing non-adherent, need
• 2ndary dressing to secure it
6. Aquacel Ag
SILVER
ionic silver for immediate and
controlled
release
infected/highly colonized wound
partial thickness (2nd degree) burn
DFU, leg ulcers
traumatic wound
wounds prone to bleeding
oncology wounds with exudate
stage I pressure ulcers
3rd degree burn
non-exudating wounds
• inhibit pathogen growth, especially
• antibiotic-resistant strains
• effective antimicrobial action up to 7
days
• 2ndary dressing to secure silver
dressing
• allergy
• not to use with topical medication
• silver turns black when oxidizes, may
• stain or discolor periwound tissue
7. Elase
FIBRINOLYSIN
DESOXYRIBONU
CLEASE
fibrinolysin
desoxyribonuclease
enzymatic debridement of necrotic
tissue in wound & liquefaction &
dissolution of exudates of injured
skin
& mucous membrane
allergic to bovine
compound
• allergy
5. Together In Delivering Excellence (T.I.D.E.)
ORTHOPAEDICS ESSENTIALS
PART 5 PLATINGS, NAILS AND SCREWS
HTARW5B/GKS2013/4-
Bohler’s stirrup
U shaped device to hold
a Steinmann pin and
applying traction
Gigli saw
Twisted wire bone saw,
use to cut bone during
amputation
Crutchfield tongs
To apply skull traction in
case of cervical injury
Dynamic Compression Plate
(DCP)
Exerts axial compression over
# site by combining screw hole
geometry while screw insertion.
Broad – humerus, femur
Narrow – tibia, forearm, pelvis
Low Contact Dynamic
Compression Plates
Designed to limit vascular
compromise by decreasing
plate-to-bone contact
Reconstruction Plates
Have notches alongside the
plate, which enables bending in 3
dimension to contour towards
complex surfaces easily
Buttress Plating
(Fr – to strike/shoke)
The plate serves to push
or buttress the split tibial
plateau fragment against
displacement and
depression.
T and L plates are
designed to be used as
buttress plates
Angle Blade Plates
95°-angled plates are used in the
repair of metaphyseal fractures and
reconstruction of the femur. It provides
very rigid fixation.
Condylar- distal femur,
intertrochanteric/sub-trochanteric #.
Double angled – femoral valgus
repositioning osteotomy
Condylar
blade
plate
Double
angled
blade plate
Dynamic Hip Plate/Screw
Used in intertrochanteric
fracture of femur
Dynamic Condylar Plate/Screw
Used in distal end femur #
(unicondylar/intercondylar)
Malleolar Screws
Are self tapping screws
Hip Prosthesis
Used for replacement of head of femur following
NOF #. Help patients to early mobilise and
eliminate complication such as AVN, non union,
fixation failure
Austin Moore – used in NOF# with calcar
femorale intact, no osteoporosis; prosthesis has
neck, collar and holes, bone cement is not
required during application
Thompson – used in NOF# with no calcar, with
osteoporosis; prosthesis has NO neck, collar and
holes, bone cement is required during application
Bipolar – used in yiounger patients with non union
of femoral neck. It has low incidence of protrusio
acetabuli
**Calcar femorale = thin plate of condensed
cancellous bone oriented vertically within the
medullary canal of the proxinal part of the femur ,
deep to lesser trochanter
Cortical and Cancellous
Screws
Used either itself (as lag
screw) or with plates, they
are non tapping screws,
thread tapping should be
done in the bone with bone
tap
Illizarov External Fixators
For limb lengthening,
arthrodesis, deformity
correction and infected
non-union
6. REDUCTION METHODS
A. Hippocratic method
1.The patient lies supine.
2.The physician's foot is placed in the patient's
axilla against the chest wall while leaning
backward.
3.Slow, steady and gentle longitudinal traction is
applied to the affected arm in 30-40° abduction for
about one minute.
4.The foot acts as a counterforce and as a lever to
push the humeral head laterally while the
physician pulls the head toward the patient's foot
along the surface of the glenoid, effectively
adducting the affected arm.
5.Put patient on arm sling
B. Kocher method
T – Traction in line of humerus
E – External Rotation of humerus
A – Adduction of arm
M – Medial rotation
Complications:
•Shoulder stiffness
•Axillary nerve damage
•Traumatic OA
•Recurrent dislocations
•Unreduced dislocation
Plan: CMR of shoulder joint with Velpeau’s
strapping x 3/52 followed by physiotherapy
Together In Delivering Excellence (T.I.D.E.)
Contributors: Dr. Tham, Goh, Poh, Shaun, Justine, Shanthy, Huda, Miruna, Lin, Phrindha, Fong, Ling Ying, Phoon, Quah
ORTHOPAEDICS ESSENTIALS
PART 6 DISLOCATIONS
HTARW5B/GKS2013/4-
ApproachManage
HOPI
Fall on the out
stretch hand with
rotation
Anterior dislocation (due to
external rotation of ABDucted
arm)
Posterior
dislocation (due to
internal rotation)
Signs
Absent of normal contour of shoulder
Bryan sign – anterior axillary fold looks elongated
Callaway’s sign – axillary girth get increased
Duga’s sign – inability to touch opposite shoulder by
affected hand
Hamilton’s ruler test – a ruler can touch lateral
epicondyle and acromion process at the same time
X-ray
AP view in internal and external rotation
Axillary view
HOPI
Fall on outstretched hand with elbow slightly flexed
TYPES
MOST COMMON
Signs
Short forearm with 3 bony
points relation disturbed (also in
# of epicondyles)
Triceps tendon stands
prominent(bow stringing)
X-ray
AP view – greater superimposed of distal
humerus with proximal ulna
Lateral – coronoid process lies posterior to
condyles
Approach
REDUCTION METHODS
Dislocation reducing the dislocation
by traction and pressure flexing the
elbow fully as a test of reduction
immobilizing the limb in an above-
elbow plaster slab (margin shown
by dotted line) and a sling.
Complications:
•Nerve injury (M>U>R)
•Brachial artery injury
•Myositis ossifican
•Recurrent dislocations
•Osteochondral fracture
•Unreduced dislocation
•Fractures of associated structures
(epicondyles, radius head, coronoid
process, olecranon)
Plan: CMR with above elbow POP x
3/52 followed by physiotherapy Manage
CLASSIFICATION:
•Posterior 70%
•Anterior 10-15%
•Central
HOPI
Usually occurs in an MVA as a result of dash board injury
Signs
Posterior dislocation shows: FLEXION, ADDUCTION,
INTERNAL ROTATION deformity with shortening of limb,
abnormal gluteal bony mass of head of femur
X-ray (AP and Lateral view)
femoral head out of acetabulum
Lesser trochanter less prominent
Broken Shenton’s line
ASIS shifted upward
Associated fractures
Approach
REDUCTION METHODS (POSTERIOR DISLOCATION)
SHOULD BE DONE ASAP TO REDUCE THE CHANCE OF AVN OF HEAD
A. Bigelow method
FLEX
ABDUCT
EXTERNAL ROTATION
EXTENSION
NEUTRAL ROTATION
B. Allis method
1.The patient is supine
2.Affected hip and knee are flexed in 90 degree
3.In neutral rotation of hip, an upward traction is applied along the axis of
femur and the same counter traction is given by holding the pelvis.
C. Stimsons’ gravity method
The patient is laid prone with the lower limb hanging over the other end of the
table
Femoral head is pushed down into the acetabulum and at the same time the
traction is applied downward along the axis of femur
Complications:
•Sciatic nerve injury
•Vascular injury
•Irreducible dislocation
•Recurrent dislocation
•Associated fractures
•AVN (15%)
•Secondary OA
•Myositis ossificans
Early
Late
Manage
Plan: CMR with fixed skin traction on Thomas splint or POP hip
spika x 4-6/52 then partial weight bearing on crutches x 6/52
7. Together In Delivering Excellence (T.I.D.E.)
Contributors: Dr. Tham, Goh, Poh, Shaun, Justine, Shanthy, Huda, Miruna, Lin, Phrindha, Fong, Phoon, Quah
ORTHOPAEDICS ESSENTIALS
PART 7 (a) ANGLES IN ORTHOPAEDICS (b) DIABETIC FOOT
HTARW5B/GKS2013/4-
Calcaneum Fracture
Q angle
Increased in
genu valgum,
external tibia
torsion, lateral
positioned tibial
tuberosity, tight
lateral
retinaculum
Norm:
male= 14 ±3
females= 17 ±3
Baumann’s angle
Norm: 5-15
Excessive = cubitus valgus
Decrease = gunstock deformity
Carrying angle
Supracondylar Fracture Wagner Classification of Diabetic Foot Ulcers:
Grade 0: No ulcer in a high risk foot.
Grade 1: Superficial ulcer involving the full skin thickness but not
underlying tissues.
Grade 2: Deep ulcer, penetrating down to ligaments and muscle, but no
bone involvement or abscess formation.
Grade 3: Deep ulcer with cellulitis or abscess formation, often with
osteomyelitis.
Grade 4: Localized gangrene (forefoot).
Grade 5: Extensive gangrene involving the whole foot.
**Rays Amputation – Removal of toes with metatarsal from tarsometatarsal joint
Amputations
Cobb’s angle
(Scoliosis)
x
1- Radial height 11mm (10-26)
2- Radial incline = 22
(12-28)
3- DRUJ space 4mm
4- Ulnar
variance ±5mm
5-Volar tilt = 11
(3-16)6- Step <2mm
7- Gap <2mm
Distal end radius fracture
8. Together In Delivering Excellence (T.I.D.E.)
ORTHOPAEDICS ESSENTIALS
PART 8 SPLINTS, CASTS, PLASTERS, FRAMES
HTARW5B/GKS2013/4-
WELL LEG TRACTION
Used in correction of
abduction deformity of hip
Traction is applied to the
normal limb while deformed
hip is stabilised by splint
90-90 TRACTION
Used in subtrochanteric #,
compound # of femur with
posterior wound and shaft
femur of children
GALLOW’S/BRYANT’S
TRACTION
Used in femur shaft # in
children <2 yrs
HAMILTON-RUSSELL
TRACTION
Used in femur shaft # in
adult, trochanteric #
PERKINS TRACTION
Used in femur shaft # in
adult
BUCK’S TRACTION
Apply skin traction in
femur shaft #, NOF #,
acetabulum # after
reduction of hip
dislocation, to correct
minor deformity of hip
and knee
CALCANEAL TRACTION
Used in open # of ankle joint/leg
BÖHLER BRAUN FRAME
Apparatus used for
application of skeletal
traction of lower limb. It may
be used with transcondylar,
tibial or calcaneal pins
UpperlimbandSpine
HEAD HALTER
TRACTION
Used in cervical
spine injury
LowerlimbandPelvis
Miscellaneous
DUNLOP TRACTION
Used in transcondylar or
supracondylar fracture of the
humerus in children
HALO-PELVIS
TRACTION
Used in scoliosis
HAMMOCK TRACTION
Used in pelvis # with
rotational instability e.g.
open book, Malgaigne #
(both pubic rami+
posterior SI
complex/sacrum #), and
bucket handle injury
CRUSH FIELD
TRACTION
Used in cervical
spine injury
THOMAS SPLINT
(with and without sling)
Temporary stabilisation of
femoral shaft fracture
BALKAN FRAME
A frame employed in the treatment of
fractured bones of extremities that
provides overhead weights and
pulleys for suspension, traction, and
continuous extension of the splinted
fracture limb.
PELVIC BINDER
Used acutely in management of
exsanguinating pelvic trauma, by
applying large amount of
compressive force to the pelvic
ring to reduce the volume of the
pelvis
Trapeze
ROBERT JONES DRESSING
A tape stirrup is applied to the foot before
the bandage is started
Cotton roll is wrapped around a forelimb
after the application of the tape stirrup.
Elastic gauze is then applied firmly bind
the cotton to the leg. Elastic tape is then
use to complete the dressing.
POP CAST & SLAB
Active ingredient of Plaster of Paris is
Gypsum CaSO4 2H2O
Slab only covers a part of
circumferential of a limb whereas a
cast covers whole of the limb
circumference.
BROAD ARMSLING AND
FIGURE ‘8’ STRAPPING
Used in undisplaced and displaced
clavicle fracture respectively.
Cast
Slab
SCAPHOID CAST
Applied from below elbow proximal
to knuckle distally and incorporating
proximal phalanx of thumb. The wrist
is held in dorsiflexion (glass holding
positiion)
90-90 HIP SPIKA
Spika at 90 flexion at hip
because in children proximal
fragment flexes to 90 due to
stronger pull by flexor muscle and
illdevelopment of lumbar lordosis
MILWAUKEE BRACE
For dorsal scoliosis
BOSTON BRACE
For lumbar scoliosis
9. Together In Delivering Excellence (T.I.D.E.)
Contributors: Dr. Goh, Poh, Shaun, Justine, Shanthy, Huda, Miruna, Lin, Maya, Fong, Ling Ying, Phoon, Quah
ORTHOPAEDICS ESSENTIALS
PART 9 ORTHOPAEDIC EMERGENCIES
HTARW5B/GKS2013/4-
Definition: An increase in compartment pressure to the
point where tissue perfusion is impaired.
Causes
•Fracture (tibia, radius)
•Circumferential burns
•Tight dressings
•Crush injuries
•Bleeding (minor injury while anticoagulated)
•Reperfusion injury
Early signs
•Tight
•Escalating pain
•Pain with passive stretch of the involved muscle
Late signs -6P
•Pain
•Pallor
•Pulselessness
•Paresthesia
•Paralysis
•Poikilothermia
Initial Management
•Remove all circumferential dressings/casts
•Ensure leg is at level of the heart - the affected part should
not be elevated above the level of the heart because this
maneuver does not improve venous outflow and reduces
arterial inflow
•Remove any traction
Definitive management
Compartment fasciotomy-2 incisions, 15 cm long
Delay>12 hr. often results in irreversible muscle and nerve
damage in that compartment
Complications
If left untreated: rhabdomyolysis and kidney failure
Definition: syndrome caused by presence of fat
globules in the lung parenchyma and peripheral
circulation. Usually subclinical event after long
bone fractures in young adults (tibia/fibula) and hip
fractures in elderly
Syndrome usually appear in 1-2 days after an acute
injury or after IM nailing.
Diagnosis: based on clinical features after
excluding other causes
Gurd's Diagnostic Criteria
(at least 1 major + 4 minor criteria)
Major Criteria
1.Respiratory insufficiency (PO2 < 60mmHg)
2.Neurological – depression/restless
3.Skin - Petechial rash (axillary/subconjuctiva)
Minor Criteria
•Tachycardia
•Fever
•Jaundice
•Retinal changes
•Renal changes
•Laboratory Features
Microglobulinemia (required)
Thrombocytopenia
Elevated ESR
Anemia
Urine for fat globule
Management:
1.Oxygenation.
2.Fluid resuscitation
6 pints NS/3 hours followed by
3 pints of NS/2 hours followed by
1 pint NS over 1 hour x 3
3.Surgical Care - early stabilization of long bone
fractures
Prophylactic placement of IVC filters may help
reduce the volume of fat reaching the heart.
Rapidly progressive inflammatory infection of the fascia, with secondary necrosis of
the subcutaneous tissues. The speed of spread is directly proportional to the thickness
of the subcutaneous layer. Necrotizing fasciitis moves along the fascial plane.
Diagnosis: requires a high degree of suspicion
• H/O antecedent trauma or surgery
• Intense pain over the involved skin and underlying muscle; over the next several
hours to days, the local pain progresses to anaesthesia.
• Fever, malaise, and myalgia
• Edema extending beyond the area of erythema, skin vesicles, and crepitus.
• Comorbid factors, including DM
Types:
I-Polymicrobial
II-Group A Streptococcus
III-Gas gangrene
Complications
• Renal failure
• Septic shock with cardiovascular
collapse
• Scarring with cosmetic deformity
• Limb loss
• Sepsis
• Toxic shock syndrome
Treatment
• Prompt surgical debridement is
continued until tissue necrosis
ceases and the growth of
fresh viable tissue is
observed.
• Antibiotic (broad spectrum
covering both gram positive
and negative)
• Hyperbaric oxygen therapy
(HBOT)
SPINAL SHOCK = temporary loss of spinal cord function and reflex activity
below the level of spinal cord injury, characterised by bradycardia, hypotension (due
to loss of sympathethic tone), and an absent bulbocarvenosus reflex
Spinal shock Neurogenic Shock HypovolemicShock
BP Hypotension Hypotension Hypotension
Pulse Bradycardic Bradycardic Tachycardic
Reflexes Absent Variable Variable
Motor Flaccid paralysis Variable Variable
Time 48-72hrs immediately after injury Following blood loss
Mechanism Peripheral neurons
become temporary
unresponsive to
brain stimuli
Loss of sympathetic
tone and decrease
systemic vascular
resistance
Decreased preload
= decreased cardiac
output
Treatment Immobilisation
Neurological
charting (until return
of bulbocarvenous
reflex)
Early surgical
intervention
Swan-Ganz
monitoring for
careful fluid Mx
Vasopressors
Fluid/blood
resuscitation
Haemostasis
Wells Criteria:
Active cancer (1)
Paresis/paralysis/recent immobilisation of LL (1)
Recent bed ridden x3/7/major surgeryx4/52 (1)
Localised tenderness over deep vein (1)
Entire leg swollen (1)
Calves swelling >3cm compare to asymptomatic limb (10 cm
below tibial tubercle (1)
Pitting oedema (1)
Collateral superficial vein (1)
Alternative diagnosis (-2)
Interpretation:
<0 – low risk (3% probability DVT)
1-2 – moderate risk (17% probability DVT)
≥3 – high risk (75% probability DVT)
Management:
Heparin/LMWH
Compression stocking