General principles of fractures treatment

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General principles of fractures treatment

• Klinika Ortopedii i Traumatologii PAM

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Management of major injuries

• Emergency treatment at the scene of the accident
  and during transport to the hospital
• Resuscitation and the evaluation in the accident
  department
• Early treatment of visceral injuries and
  cardiorespiratory complication
• Provisional fixation followed by definitive
  treatment of musculoskeletal injuries
• Long term rehabilitation

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Individual patient

• Obtain access
• Establish an airway but protect the cervical
  spine
• Ensure ventilation
• Arrest haemorrhage and combat shock
• Give analgesia
• Splint fractures
• Transport

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Examination

• Pulse feeling
• Measure capillary return
• Observe the respiration
• Palpate the head, chest, abdomen, and limbs

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Second mortality peak

• Death from hypoxia or hypovolaemic shock
• At risk of further damage to cervical spine,
  thoracolumbar, brain
• The golden rule (effective resuscitation)
• Advanced Trauma Life Support Programme

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Primary survey

• A Airway maintenance
• B Breathing and oxygenation
• C Circulation and control of bleeding
• D - Disability
• E Exposure and aviodenance of hypothermia

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Disability
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Blood loss
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Chest injuries

• Tension pneumothorax
• Sucking chest wounds
• Flail chest
• Cardiac tamponade
• Massive haemothorax

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Complication of major trauma

• Tetanus
• ARDS
• Fat embolism syndrome
• DIC
• Crush syndrome
• MSOF - prevention

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How fractures happen

• A single traumatic incident
• Repetitive stress
• Abnormal weakening of the bone

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Mechanism of injury

• Spiral (twisting)
• Short oblique
• Bending - Triangular butterfly fragment
• Transverse

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Principles of treatment

• Anatomical reduction
• Stable internal fixation
• Preservation of blood supply
• Early mobilization

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Implants types

• Pin and wire fixation
• Screw fixation
• Plate and screw fixation
• Intramedullary nail fixation
• External fixation

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Fractures healing

• Haematoma
• Inflammation
• Callus
• Consolidation
• Remodelling

• Primary
• Secondary

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Fractures healing
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Open fractures

• Classification

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Open fractures

• Wound debridement
• Antibiotic prophylaxis
• Stabilization of the fracture
• Early wound cover

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Complications of fractures

• Late - delayed union
• - non-union
• - avascular necrosis
• - bed sores
• - myositis ossificans
• - tendon lesion
• - nerve compression
• - muscle contracture
• - joint instability
• - joint stiffness
• - algodystrophy RSD
• - osteoarthritis

• Early - visceral injury
• - vascular injury
• - nerve injury
• - compartment syndrome
• - haemarthrosis
• - infection
• - gas gangrene
• - fracture blisters
• - plaster and pressure sores

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Compartment syndrome

• Pain
• Paraesthesia
• Pallor
• Paralysis
• Pulslesness

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Volkmanns ischaemia
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Non-union