Download Free Medical COMMON FRACTURES PowerPoint Presentation

COMMON FRACTURES PowerPoint Presentation

DOWNLOAD MEDICAL POWERPOINT PRESENTATION

About This Presentation

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 : 3213 | Downloads : 19

Shareable Url :

Embed Code :

Comment

Transcript

Slide 1-

1 COMMON FRACTURES Chris Maimaris FRCS FCEM
Slide 2-

2 Objectives To understand the principles of the initial management of closed and compound fractures To be able to interpret common limb X rays
Slide 3-

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
Slide 4-

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
Slide 5-

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
Slide 6-

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
Slide 7-

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
Slide 8-

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
Slide 9-

9 Wrist X Ray
Slide 10-

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.
Slide 11-

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
Slide 12-

12
Slide 13-

13 Describe this fracture Open/ Compound Transverse mid shaft right tibia and fibular Mid-shaft left tibia and fibular medial displacement no bony apposition
Slide 14-

14 TIBIA SHAFT RESUSCITATION ANALGESIA BOX SPLINT OPEN OR CLOSED SOFT TISSUES PULSE X - RAY
Slide 15-

Management of Compound fractures/dislocations Analgesia Photograph Avoid further contamination cover Washout, Debridement etc Antibiotics/Tetanus prophylaxis Reduction /Immobilisation Theatre within 6 hours 15
Slide 16-

16
Slide 17-

Clavicle Commonest site of fracture Easily diagnosed clinically One x ray view enough
Slide 18-

ppt slide no 18 content not found
Slide 19-

In anterior dislocation diagnosis is usually clear on AP as humeral head moves medially and inferiorly
Slide 20-

ppt slide no 20 content not found
Slide 21-

ppt slide no 21 content not found
Slide 22-

Anterior dislocation of the glenohumeral joint Clinically usually obvious X ray is to confirm and rule out accompanying fracture
Slide 23-

Humeral head is anterior to the Y of the scapula/acromion/coracoid
Slide 24-

Humeral head is anterior to the Y of the scapula/acromion/coracoid
Slide 25-

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
Slide 26-

ppt slide no 26 content not found
Slide 27-

27 Elbow X Ray
Slide 28-

28 ? Dislocated radial head Elbow X Ray Radiocapitellar line
Slide 29-

29 ? Supracondylar # Elbow X Ray Anterior humeral line
Slide 30-

30 Elbow X Ray Fat pad signs ? Fracture Adult ? radial head Child ? supracondylar
Slide 31-

Elbow dislocation
Slide 32-

Elbow Dislocation Check for coronoid process # radial head # epicondylar # in children ulnar/medial nerve damage brachial artery damage
Slide 33-

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
Slide 34-

Pulled Elbow Age: 1-4- Reduce: pronation/ flexion manoeuvre Supination / Flexion
Slide 35-

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
Slide 36-

36 FOREARM FRACTURES SHAFT # ALWAYS EXAMINE & X RAY JOINTS ABOVE AND BELOW # SITE
Slide 37-

37
Slide 38-

38
Slide 39-

39
Slide 40-

40
Slide 41-

41
Slide 42-

42
Slide 43-

43 Trauma Scaphoid 80-90% of carpal # Often difficult to see Need four views Follow up1-2 week if normal, Re-Xray
Slide 44-

Adult Hip X rays usually following fall onto hip Look for # in subcapital region trochanteric area acetabulum pubic rami
Slide 45-

Shenton’s line is disrupted by this # femoral neck
Slide 46-

Right pubic ramus fracture
Slide 47-

SUFE – line drawn up femoral neck equally bisects the epiphysis on the left but not the right
Slide 48-

More clearly seen on this frog view
Slide 49-

Perthes’ disease – note flattened, ragged appearance of epiphysis on right
Slide 50-

50 FEMUR NECK ANALGESIA FAST TRACK TO WARD SHAFT O2 / IV NaCl ANALGESIA FEMORAL NERVE BLOCK TRACTION SPLINT NECK SHAFT
Slide 51-

51 FIBULA DIRECT BLOW ISOLATED # TWISTING LOOK FOR # MEDIAL MALLEOLUS
Slide 52-

52 Ankle Anatomy Movements Mech. Of injury Examination Ottawa ankle rules
Slide 53-

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.
Slide 54-

54 Ankle Fractures
Slide 55-

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
Slide 56-

56 What about the x-ray?
Slide 57-

57 Fracture Dislocation
Slide 58-

58
Slide 59-

59 Maissonerve Fracture
Slide 60-

60 CALCANEAL FRACTURE DIRECT BLOW FROM FALL FROM HEIGHT CALCANEAL VIEWS ELEVATE ADMISSION
Slide 61-

61 FRACTURE 5th METATARSAL DIFFERENTIAL DIAGNOSIS OF SPRAINED ANKLE LOCAL TENDERNESS FOOT X RAY TRANSVERSE JONES # POP MINOR AVULSION TREAT AS SPRAIN