This document outlines several orthopedic emergencies including compartment syndrome, open fractures, fractures with vascular compromise, cauda equina syndrome, and septic arthritis. It describes the key clinical features, investigations, and treatments for each condition. Compartment syndrome requires urgent fasciotomy to prevent muscle and nerve necrosis. Open fractures are classified and treated with irrigation, debridement, and splinting. Fractures with compromised circulation require prompt realignment and vascular evaluation. Cauda equina syndrome needs MRI and surgical decompression within 48 hours. Septic arthritis is commonly caused by Staph aureus and requires urgent arthrotomy and long-term antibiotics.

1. Orthopedic Emergencies
Dr. Yasser Alwabli
Orthopedic Surgery

2. Contents
 ATLS protocol
 Compartment syndrome
 Fractures and dislocations with vascular
compromise
 Open fracture
 Cauda equina syndrome
 Septic arthritis

3. ATLS protocol
 Primary survey
ABCDE
Adjuncts to primary survey
 Secondary survey
Head-to-toe examination
Adjuncts to secondary survey
 Definitive care

4. Hemorrhagic shock

5. Compartment syndrome

6. Compartment syndrome
Increased interstitial pressure in a fibro-
osseous compartment with little room
for expansion which eventually leads to
muscle and nerve necrosis.

9. Pathophysiology

10. Clinical features
 High index of suspicion
 Pain out of proportion
 Pain with passive stretch
 Tense, swollen area
 5 Ps of CS- late

11. Investigations
 A clinical diagnosis
 In cases of unreliable clinical exam
 Compartment pressure measurements
 Delta P less than 30 mmHg is high

12. Treatment
 Remove tight cast or bandage
 Urgent fasciotomy

13. Complications
 Volkmann's ischemic contracture
 Rhabdomyolysis
 Renal failure

14. Fractures and dislocations with
vascular compromise

15. Fractures and
dislocations
with vascular
compromise
Always check the neurovascular status
with fractures
If diminished pulses, realign the
deformity
Re-check pulses
In knee dislocation even if pulse Ok,
does not rule out vascular injury
Do ABI (Ankle-Brachial Index)
If ABI >0.9, do serial assessments
If ABI <0.9, do CT angiography
Get help from a vascular surgeon
A true emergency

16. Open fractures

17. Open fractures - classification

18. Open fractures
 Follow trauma protocol
 Give ABX early
 Depends on type
 Tetanus as needed
 In ER
 Remove obvious foreign material
 Irrigate with NS
 Cover with sterile dressings
 Reduce and splint
 Prepare for OR

19. Open fractures
 Typical surgery
 Irrigation and debridement
 Ex fix application
 Internal fixation is acceptable

20. Cauda equina syndrome

21. Cauda equina syndrome
 Cauda equina syndrome is defined by a constellation of symptoms that
result from terminal spinal nerve root compression in the lumbosacral
region.

22. Causes
 Spinal stenosis
 Herniated disc
 Fracture
 Tumor

23. Clinical features
 Saddle anesthesia
 Low back pain radiating to legs
 Bilateral sensory loss or pain
 Urinary retention
 Fecal incontinence
 Weakness in lower limbs

24. Investigations
 Urgent MRI

25. Treatment
 Surgical decompression in less than 48 hrs

26. Septic arthritis

27. Septic arthritis
 Risk factors
 Age
 Immune compromise
 IV drug abuse
 Recent intra-articular steroid injection

28. Septic arthritis
 Etiology
 Staph aureus most common

29. Septic arthritis
 Clinical features
 Inability/refusal to bear weight
 Localized joint pain
 Erythema
 Warmth, swelling
 Pain on active and passive ROM
 ± fever

30. Septic arthritis
 Investigations:
 Imaging
 X-Ray
 US
 MRI
 Labs
 WBC
 ESR
 CRP
 Joint aspiration

31. Septic arthritis

32. Septic arthritis
 Cloudy yellow fluid
 WBC >50,000 with >90% neutrophils
 Protein level >4.4 mg/dL
 Glucose level < 60% blood glucose level
 No crystals
 Positive Gram stain results

33. Septic arthritis

34. Septic arthritis
 Treatment is urgent arthrotomy and long course of antibiotics (IV, Oral)