Transcript General principles of fractures treatment

General principles of
fractures treatment
Klinika Ortopedii i Traumatologii
PAM
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
Individual patient
Obtain access
Establish an airway but protect the cervical spine
Ensure ventilation
Arrest haemorrhage and combat shock
Give analgesia
Splint fractures
Transport
Examination
Pulse feeling
Measure capillary return
Observe the respiration
Palpate the head, chest, abdomen, and limbs
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
Primary survey
A – Airway maintenance
B – Breathing and oxygenation
C – Circulation and control of bleeding
D - Disability
E – Exposure and aviodenance of
hypothermia
Disability
Blood loss
Chest injuries
Tension pneumothorax
Sucking chest wounds
Flail chest
Cardiac tamponade
Massive haemothorax
Complication of major trauma
Tetanus
ARDS
Fat embolism syndrome
DIC
Crush syndrome
MSOF - prevention
How fractures happen
A single traumatic incident
Repetitive stress
Abnormal weakening of the bone
Mechanism of injury
Spiral (twisting)
Short oblique
Bending - Triangular ‘butterfly’ fragment
Transverse
Principles of treatment
Anatomical reduction
Stable internal fixation
Preservation of blood supply
Early mobilization
Implants types
Pin and wire fixation
Screw fixation
Plate and screw fixation
Intramedullary nail fixation
External fixation
Fractures healing
Primary
Secondary
Haematoma
Inflammation
Callus
Consolidation
Remodelling
Fractures healing
Open fractures
Classification
Open fractures
Wound debridement
Antibiotic prophylaxis
Stabilization of the fracture
Early wound cover
Complications of fractures
Late
Early - visceral injury
- vascular injury
- nerve injury
- compartment
syndrome
- haemarthrosis
- infection
- gas gangrene
- fracture blisters
- plaster and pressure sores
- delayed union
- non-union
- avascular necrosis
- bed sores
- myositis ossificans
- tendon lesion
- nerve compression
- muscle contracture
- joint instability
- joint stiffness
- algodystrophy RSD
- osteoarthritis
Compartment syndrome
Pain
Paraesthesia
Pallor
Paralysis
Pulslesness
Volkmann’s ischaemia
Non-union