Transcript basic management of fractures , sprains and strains

Basic Management
of
Fractures, Sprains and Strains
Phillip de Lange
Walk-a-Mile Centre for Advanced
Orthopaedics
June 2016
Sprains
• Ankle Sprains
• Knee sprains and soft tissue injuries
• Shoulder sprains
Ankle Ligament injuries
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Lateral Ligament injuries
General treatment conservative
Initial immobilization <10 days
Review < 2 weeks
– Referral if abnormal xray
• Active physiotherapy
• Weightbearing acc to pain
Ankle Ligament injuries
• Syndesmosis injuries
• Tender just superior to ankle
• External rotation test
• Surgical treatment
Knee sprains and soft
tissue injuries
• Mechanism of injury
– Direct trauma
– Twisting injury
• Swelling/Effusion
– Immediate
– Delayed
• Locking or clicking
• Instability
Knee sprains and soft
tissue injuries
• Initial management
– Xray : Any immediate swelling/effusion
– Robert Jones Bandage
– RICE Principles
– Review in 1/52 unless danger signs
– Beware of knee dislocations and vascular injuries
Knee sprains and soft
tissue injuries
• Common injuries
– Patella dislocation
• Patellar apprehension
• Need patellar strapping and physiotherapy
– Meniscus tears
• Initial conservative management
• Joint line tenderness
• Locking symptoms require referral
– Collateral ligament injuries
• Can generally be treated conservatively
– Cruciate ligament injury
• Referral ASAP
Shoulder injuries
• Mechanism
– Direct trauma
– FOOSH
– Heavy object lifting
• Examination essentials
– Muscle girdle/C-spine
– Rotator cuff attachment
– Biceps tendon area
– Subscapularis
– AC Joint
Shoulder injuries
• Rotator cuff injuries
– Complete tears
– Incomplete tears
• Danger signs
– Ability to lift arm…
– Biceps deformity
– AC Joint deformity
• Long term – Shoulder impingement
Hand and Fingertip injuries
• Most common occupational injury
• Fingertips
– Nailbed lacerations
– Tuft fractures
Hand and Fingertip injuries
• Hand Fractures
– Distal phalanx
• Conservative
– Middle and proximal phalanx
• Depending on displacement
– Metacarpal
• More prone to surgical management
Immobilization leads to stiffness and prolonged return to
function
Hand and Fingertip injuries
• Hand lacerations
– Structure dense area
– High risk for vital structure injury
– Low tolerance for surgical exploration
Open fractures
• Basic principles
– Early IV Antibiotics/Tetanus
– Sterile dressings
– Splintage
– Elevation
• Any breakage in skin in same region
• Small wound – Tip of iceberg
Open fractures
• Antibiotic choice
– Cefazolin 2g STAT, 1g 8hrly
– Add Gentamycin and Flagyl in
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Agricultural injuries
Severe contamination
Foot injuries
Animal bites
– Human bites
• Augmentin 1,2g 8hrly IVI
Fractures
• Upper Limb
– Clavicle
– Proximal humerus
– Humerus
– Elbow
– Forearm
– Distal Radius
– Wrist fracture/dislocations
Clavicle fractures
• Indications for surgery
– Shortening 2 cm
– Translation >100%
– Z fragment
– Open injury
– Threatening of the skin
Clavicle fractures
Clavicle fractures
Proximal Humerus
Treatment by displacement
and patient age
Conservative treatment often
better in elderly
Splint in Barford Jones sling.
No use for POP Slab
Humerus
Humeral shaft
Radial nerve injury
Splint: Modified shoulder splint
Humerus
Distal Humerus
Supracondylar/intracondylar
High risk of ulnar nerve injury
Splint in high above elbow slab
Elbow
Olecranon Fractures
Elbow
Olecranon Fractures
Forearm fractures
Generally treated operatively in the adult patient
Forearm fractures
Forearm fractures
Distal Radius
Distal Radius
Wrist injuries
Wrist injuries
Wrist injuries
Wrist injuries
Reduction should be attempted
in emergency department.
Examine carefully for Median nerve
symptoms.
Scaphoid fractures
If visible of pain xray – Displaced
Should be fixated
Tender like fracture but not visible
Volar slab/Scaphoid slab
Repeat x-ray 7 to 10 days
? CT – Scan in high demand wrist
Fractures
• Lower Limb and Pelvis
– Pelvis/Acetabulum fractures
– Femur neck fractures
– Femur fractures
– Tibial Plateau fractures
– Tibia Fractures
– Ankle Fractures
– Ankle Ligament injuries
Pelvis/Acetabulum
fractures
• Lateral Compression fracture
– Risk of hollow viscus injury
– Traction if hip displaced
Pelvis/Acetabulum
fractures
• Open book fractures
– Bleeding
– Close book/ Pelvic binder
Pelvis/Acetabulum
fractures
Femur neck fractures
• Young patient
– Emergency
– Risk for AVN
Femur neck fractures
• Old patient >65
– Undisplaced/Valgus
• Emergency
– Displaced
• Hip replacement surgery
– No traction
– Emergency management
• Fluids
• Oxygen
Femur fractures
Tibial plateau fractures
• Beware – Vascular injuries
Tibial fractures
• Often massive soft tissue injury
• Simple fractures
– Compartment syndrome
Ankle fractures
Ankle fractures
• Not all ankle fracture the same
• ORIF for all ankle fractures
except undisplaced lateral
maleolus fracture with no
medial tenderness
Ankle fractures
• Emergent reduction in casualty
• Talus in line under tibia
• Placed in slab/ankle in neutral
to stabilize reduction
• Surgery – Early before swelling
or elevate numerous days
Pilon fractures
The End