Orthopaedics

CHAPTER 17 Orthopaedics




Fractures








Relation to surrounding structures




Principles of fracture treatment



First aid


Follow Advanced Trauma Life Support (ATLS) principles (→ Ch. 4). Ensure clear airway. Ensure adequate breathing. Stop bleeding. Splintage to prevent further damage by movement of fragments. If open fracture, cover with Betadine-soaked gauze, administer prophylactic antibiotics and check tetanus status.




The fracture itself







Reduction







Methods of stabilizing a fracture









Complications of fractures




Early (during the period of initial treatment)




General





Pneumonia





Late (after the period of initial treatment)












Spinal trauma





Management of spinal injuries




Initial management at the receiving hospital











Fractures and dislocations of the spine




Cervical spine fractures and dislocations


Injuries most often occur because of RTAs or sport. A fall on the head with the neck forcibly bent, e.g. flexion and rotation. Subluxation or dislocation occurs with disruption of disc. Forced extension, e.g. a fall on the face or forehead, may occur resulting in cervical spine injury. If a cervical spine injury is suspected the first move should be to safeguard the cord by controlling neck movements. Do not allow the head to flex forward, and do not hyperextend the neck. Keep in a neutral position.







Thoracic spine


Flexion injuries result in crush or wedge fractures, which are usually stable. Such fractures may occur with minimal trauma if the vertebral body is weakened, e.g. osteoporosis or secondary deposits. Fracture-dislocations tend to occur at the thoracolumbar junction and are caused by flexion and rotation injuries, e.g. a fall from a height on to the shoulders or a heavy load falling on the flexed back. If the disc and posterior ligaments are disrupted the injury is unstable. Paraplegia is common in fracture-dislocations.








Spinal cord injury




Management and complications of cord injury













Pelvic fractures












Injuries to the lower limb



Hip and thigh




Fractures of the proximal femur






Fractures of the femoral shaft










Fractures and dislocations around the knee









Jun 14, 2017 | Posted by in GENERAL SURGERY | Comments Off on Orthopaedics

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