Hierarchy of management that covers different levels of management
PRESENTATION........... ............. pptx
1. D R M O H A M M A D Y O U S A F
ORTHOPAEDIC TRAUMA
2. TRAUMA
• COULD BE DEFINED AS CELLULAR DISRUPTION
THAT RESULTS FROM THE EXCHANGE WITH
ENVIRONMENTAL ENERGY THAT IS BEYOND
BODY’S RESEILIENCE.
• OR
• IT MEANS INJURY FROM ONE OR MORE SYSTEMS,
THAT RESULTS IN EXCESSIVE BLEEDING AND MAY
AFFECT THE NORMAL BODY FUNCTIONS.
.
3. ORTHOPAEDIC TRAUMA
• FRACTURE: IT MEANS BREAK IN THE STRUCTURAL
CONTINUITY OF BONE
• SUBLUXATION: IT MEANS PARTIAL LOSS OF
CONGRUITY BETWEEN ARTICULAR SURFACES
• DISLOCATION: IT MEANS TOTAL LOSS OF
CONGRUITY BETWEEN ARTICULAR SURFACES.
4. TRAUMA AND BASIC MANAGEMENT
• THE GOLDEN HOUR: IT IS THE FIRST HOUR FROM
THE TIME OF TRAUMA
• IT IS THE MOST CRITICAL FOR LIFE AND THE LIMB
VIABILITY FOLLOWING FEMUR FRACTURE.
• RAPID TRANSPORT OF SEVERLY INJURED PATIENT
TO A TRAUMA CENTER FOR DEFINITIVE CARE.
7. PRIMARY SURVEY
• RAPID ASSESSMENTS OF ABC’s AND ADDRESSINF
LIFE THREATENING PROBLEMS
• -establish airway and ventilation, control hemorrhage
• PLACE LARGE BORE IV’S AND BEGIN FLUID
REPLACEMENTS
• TRAUMA X-RAYS
• -chest, pelvis, and lateral C-spine
8. SECONDARY SURVEY
• Assess entire patient for other non life threatening
injuries
• Orthopaedic Assessment of Skeleton
• -splint fractures
• -reduce dislocation
• Evaluate distal pulses and peripheral nerve function.
• Obtain Xray and CT of affected area when patient is
stable
9. TRAUMA ASSESSMENT
• Take history i.e to know mechanism of injury
• Note swelling, lacerations
• Perform physical examination
• Check for Crepitus: the grating feeling when two bones rub
against each other.
• Abnormal motion: the tibia bends in the middle
• Check pulses, sensory exam and motor testing if possible
10. ASSESS FOR THE INJURIES THAT COMMUNICATE
WITH THE FRACTURE
-CLOSED FRACTURE: Skin intact over fracture
-OPEN FRACTURE: LACERATION COMMUNICATING
WITH FRACTURE (OFTEN REFERRED AS COMPOUND
FRACTURE)
11. URGENT SKELETAL ISSUES
• IRRIGATION AND DEBRIDEMENT OF OPEN
FRACTURES
• REDUCTION OF DISLOCATIONS
• SPLINITING OF FRACTURES
• COMPARTMENT SYNDROME
20. DIAGNOSING BONE INJURY
• HISTORY
• MECHANISM
• EXAMINATION
• GENERAL-ABCDE
• LOCAL (SWELLING,TENDERNESS, ABNORMAL PORTION)
• DISTAL (CIRCULATION AND SENSORY OR MOTOR
DEFICIT)
INVESTIGATION-IMAGING
• 2 VIEWS (AP/LATERAL)
• 2 JOINTS (ABOVE AND BELOW INJURY)
• 2 SIDES (FOR COMPARISON)
• 2 TIMES (BEFORE AND AFTER TREATMENT)
21. FRACTURE MANAGEMENT
• GOALS
• RESTORE PATIENT TO OPTIMAL FUNCTIONAL
STATE
• PREVENT FRACTURE AND SOFT TISSUE
COMMPLICATIONS
• GET FRACTURE TO HEAL IN SATISFACTORY
POSITION TO REGAIN OPTIMAL FUNCTION
• REHABILITATE
22. TREATMENT OF FRACUTURES
• REDUCE
• MAINTAIN REDUCTION (+HOLD UNTIL UNION)
• REHABILITATE- RESTORE FUNCTION
• PREVENT OR TREAT COMPLICATIONS
26. INTERNAL METHOD
• INDICATIONS
• FRACTURE THAT NEED OPERATIVE FIXATION
• INHERENTLY UNSTABLE FRACTURE PRONE TO RE-
DISPLACEMENT (MID-SHAFT FEMORAL FRACTURE)
• PATHOLOGICAL FRACTURE
• POLYTRAUMA (MINIMISE ARDS)
• PATIENT WITH NURSING DIFFICULTIES
(PARAPLEGIC, ELDERLY)
27. INTERNAL METHOD
• WIRES : USE TO TREAT FRACTURES OF SMALL
BONES
• PINS: USED FOR PIECES OF BONES TO SMALL TO
BE FIXED WITH SCREWS
• PLATES
• NAILS OR RODS
• SCREWS
28. COMPLICATION OF FRACTURE
EARLY
-VISERAL,VASCULAR,NERVE INJURY
-HAEMARTHROSIS
-INFECTION
-FAT EMBOLISM
-COMPARTMENT SYNDROME
LATE
-MALUNION
-DELAYED UNION
-NON UNION
-TENDON RUPTURE
-MYOSITIS OSSIFICANS
-OSETEONECROSIS
-COMPLEX REGIONAL PAIN SYNDROME
OSTEOARTHRITIS AND JOINT STIFFNESS
