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COMMON FRACTURES PowerPoint Presentation

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Description : Check out this medical presentation on Orthopaedics, which is titled "COMMON FRACTURES", to understand the principles of the initial management of closed and compound fractures and be able to interpret common limb X rays.

Tags : Orthopaedics, COMMON FRACTURES, principles, initial management, closed, compound fractures, limb X rays

Published on : Aug 10, 2021 | Views : 3827 | Downloads : 19

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1 COMMON FRACTURES Chris Maimaris FRCS FCEM
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2 Objectives To understand the principles of the initial management of closed and compound fractures To be able to interpret common limb X rays
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3 Fracture Management Diagnosis History Examination Ix -Xrays, CT Re-examination of pt prn if in doubt Recognised specific injury Ask for advice Treatment Reduction Retention Rehabilitation
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Treatment Fractures/Dislocations Reduction- restore bones +/- joints to normal anatomical position Retention- Maintain reduced position- until bone union or healing of soft tissues Perkin’s formula for pop immobilisation Rehabilitation – restore function: Full range of movements -FROM - and strength 4
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5 Life or Limb Threatening Emergencies Major pelvic fracture Exsanguinations Compartment syndrome Ischaemia, myoglobinuria, renal failure Open fracture Osteomyelitis Limb injury with vascular injury Amputation
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The ‘Ten Commandments of Emergency Radiology’ according to Touquet et al (BMJ 1995): Treat the patient, not the radiograph Take history +examination before ordering Xray Request a radiograph only when necessary Never look at radiograph without seeing patient, and never treat patient without seeing radiograph Look at every radiograph, the whole radiograph, - remember the ABCS: alignment/ adequacy, bones, cartilage (joints) and soft tissues. 6
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The ‘Ten Commandments of Emergency Radiology’ according to Touquet et al (BMJ 1995): Re-examine the patient when there is an incongruity between the radiograph and the expected findings Remember the rule of twos — two views, two joints (above and below the injury), two sides (for comparison), two occasions (may need a follow up x-ray) and two radiographs (compare to a normal radiograph) Take radiographs before and after procedures If a radiograph does not look quite right ask and listen: there is probably something wrong. Ensure you are protected by fail safe mechanisms — establish a quality control system 7
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8 Fracture Complications Early Local damage Soft Tissues Nerves Vessels Infection Early general Bleeding Fat embolism Infection-Tetanus, gangrene Late Local Mal-union -Non-union Avascular necrosis Osteomyelitis CRPS-complex regional pain s
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9 Wrist X Ray
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10 Colles Fracture 10% of A & E # Low energy - elderly patient Fracture of distal radius within 2.5 cm of wrist. There is # ulnar styloid and characteristic displacement.
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11 Colle’s # Reduction Retention Rehab Healing #s Bier’s/Haematoma block/ Sedation MUA reduce # and or dislocation Re-Xray to check POP Back slab position HAS and # clinic F/U UL Child 3/52 Adult 6/52 LL Child 6/52 Adult 6-12/52
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12
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13 Describe this fracture Open/ Compound Transverse mid shaft right tibia and fibular Mid-shaft left tibia and fibular medial displacement no bony apposition
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14 TIBIA SHAFT RESUSCITATION ANALGESIA BOX SPLINT OPEN OR CLOSED SOFT TISSUES PULSE X - RAY
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Management of Compound fractures/dislocations Analgesia Photograph Avoid further contamination cover Washout, Debridement etc Antibiotics/Tetanus prophylaxis Reduction /Immobilisation Theatre within 6 hours 15
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Clavicle Commonest site of fracture Easily diagnosed clinically One x ray view enough
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In anterior dislocation diagnosis is usually clear on AP as humeral head moves medially and inferiorly
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Anterior dislocation of the glenohumeral joint Clinically usually obvious X ray is to confirm and rule out accompanying fracture
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Humeral head is anterior to the Y of the scapula/acromion/coracoid
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Humeral head is anterior to the Y of the scapula/acromion/coracoid
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25 UPPER ARM HEAD / NECK MINIMAL DISPLACED NECK OF HUMERUS OR TUBEROSITY # COLLAR AND CUFF SHAFT SHAFT CHECK RADIAL NERVE AND ARTERIAL SUPPLY U SLAB PLASTER SUPRACONDYLAR ?NEUROVASCULAR STATUS
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27 Elbow X Ray
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28 ? Dislocated radial head Elbow X Ray Radiocapitellar line
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29 ? Supracondylar # Elbow X Ray Anterior humeral line
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30 Elbow X Ray Fat pad signs ? Fracture Adult ? radial head Child ? supracondylar
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Elbow dislocation
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Elbow Dislocation Check for coronoid process # radial head # epicondylar # in children ulnar/medial nerve damage brachial artery damage
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Elbow dislocations X rays are normal in ‘pulled elbow’ Elbow dislocation is usually obvious on x ray check carefully for avulsions on post reduction film - especially medial epicondyle
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Pulled Elbow Age: 1-4- Reduce: pronation/ flexion manoeuvre Supination / Flexion
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Elbow epiphyses in children ‘critol’ Capitellum - appears first Radial head Internal Epicondyle (medial) Trochea Olecranon Lat epicondyle It is the order they appear in that is important, not the age at which they appear
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36 FOREARM FRACTURES SHAFT # ALWAYS EXAMINE & X RAY JOINTS ABOVE AND BELOW # SITE
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43 Trauma Scaphoid 80-90% of carpal # Often difficult to see Need four views Follow up1-2 week if normal, Re-Xray
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Adult Hip X rays usually following fall onto hip Look for # in subcapital region trochanteric area acetabulum pubic rami
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Shenton’s line is disrupted by this # femoral neck
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Right pubic ramus fracture
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SUFE – line drawn up femoral neck equally bisects the epiphysis on the left but not the right
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More clearly seen on this frog view
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Perthes’ disease – note flattened, ragged appearance of epiphysis on right
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50 FEMUR NECK ANALGESIA FAST TRACK TO WARD SHAFT O2 / IV NaCl ANALGESIA FEMORAL NERVE BLOCK TRACTION SPLINT NECK SHAFT
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51 FIBULA DIRECT BLOW ISOLATED # TWISTING LOOK FOR # MEDIAL MALLEOLUS
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52 Ankle Anatomy Movements Mech. Of injury Examination Ottawa ankle rules
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53 Ottawa Ankle Rules Clinical Assessment to decide upon need for X-Ray. Large Trials Bony Tenderness at the sites A-D. Inability to weight bear in A&E and at initial injury. Also palpate the fibular neck.
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54 Ankle Fractures
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55 ANKLE EMERGENCY REDUCTION IF POOR CIRCULATION OR PRESSURE ON SKIN UNSTABLE BI /TRI MALLEOLAR # PLUS LIGAMENT RUPTURE ORIF DISPLACED MEDIAL MALLEOLUS DISPLACED OR LATERAL ABOVE JOINT LINE
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56 What about the x-ray?
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57 Fracture Dislocation
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58
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59 Maissonerve Fracture
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60 CALCANEAL FRACTURE DIRECT BLOW FROM FALL FROM HEIGHT CALCANEAL VIEWS ELEVATE ADMISSION
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61 FRACTURE 5th METATARSAL DIFFERENTIAL DIAGNOSIS OF SPRAINED ANKLE LOCAL TENDERNESS FOOT X RAY TRANSVERSE JONES # POP MINOR AVULSION TREAT AS SPRAIN