All About Fractures

(Medical Student Education Series:Core Orthopaedics)

ALL ABOUT FRACTURES (Medical Student Education Series-Core

(Fxs). Orthopaedics) Part One ALL FRACTURES

Open Fx tibia from suicide

The 10-15 minute Fracture

Talk for all Medical Students copyright 2008 eugene [sic]

there are > 500 different types of Fxs and soft tissue injuries; it took me 30 years to know them; here you can learn them in just 10-15 minutes. (You can learn orthopaedics from reading books or from: Youtube or simply building your

What is a Fracture (Fx)? A break in the bone

Why treat a Fx? To prevent mal-

How to describe a Fx.

(stand one meter from the XR box, name the patient and the date of the XR) Which bone, which end of the bone, fracture line configuration

How to treat a Fx? Skier dead from head injury

(save the patient, ABC, and save the limb).

REDUCE the Fx (Externally-traction & manipulate or INTERNALLY- operate) and HOLD the Fx (Externally-POP, external fixateur or

REDUCE-TRACTION

REDUCE-MANIPULATE

HOLD

How does a Fx heal? Haematoma (minutes), granulation tissue (hours), (forget days), immature callus (weeks, =clinical union), mature callus (months, =XR union), re modeling (years).

How can you tell a Fx is healed? Healed Fx tibia

No pain when loaded in two planes

Open and closed Fx. Open Fx communicates with the skin. Wash-out within 6 to 8 hrs.

Open Fx (need to stop infection)

Soft tissues-Debride/clean,close, reconstruct (skin grafts/flap) Open subtalar Fx/dislocation

The Bone-Debride,reduce, hold, reconstruct(bone graft). ie wash-out,ext fix to bone, close skin 2 to 3 days, maybe skin graft, bone graft at 6 to 8 wks.

Complications of Fxs. Early (general and

Nervesneuropraxia/axonotmesi s/neurotmesis

Heel pressure area

EPL rupture

Non union humerus

and late(Osteoarthritis) OA ankle OA knee

OA wrist

Don’t forget INFECTION Never get in closed management

Compartment syndrome (EMERGENCY-easily missed; can become disaster). Extreme pain at rest, extreme pain with movement, pins-and- needles. fascioto Release tight POP my., NO delays.

Stress Fx where XR is normal, pain,

(Medical Student Education Series:Core Orthopaedics)

ALL ABOUT FRACTURES (Medical Student Education Series-Core

(Fxs). Orthopaedics) Part Two ALL FRACTURES

Open Fx tibia from suicide

The 10-15 minute Fracture

Talk for all Medical Students copyright 2008 eugene [sic]

Which Fxs you should just about always operate on? Multi-trauma, Pathological Fx Pelvic Fx pathological, nursing difficulties, Ankle Fx forearm, displaced into joints, femur. Fx femur Fx left femur, Fx right tibia

Which Fxs you just about never operate on? Pelvic Fx, 8 yo, re models.

Fx wrist. 8 yo. Closed reduction.

Fx forearm. Closed

reduction. 11 yo.

Children (with exceptions),

Who NOT to operate on? Patients who have problems following your post-

NEVER Apply full

POP to new FxFx.

FOLLOW-UP ALL Fxs. Esp children’s. Growth Fx arrest lower femur, 11 yo,growth Lower femur arrestapparent may appear 12 to 24 mths later. at 18 mths post injury Physealbridge ankle 11 yo. Lat condylar Fx in a 8 yo, complications Apparent may appear at age 20.20 yrs. at 12 mths

Difficult to treat Fxs -Impossible Fx (comminuted, pathological, unstable) -Impossible facilities ( you need the right knowledge & equipment) -Impossible patient

Children’s Fxs. Involves growth plate injuries , bone may stop growing, which can later cause shortening and angulation of leg/limbs. Lat condylar Fx in a 8 yo, complications may appear at age 20.20 yrs.

Fx lower femur, 11 yo, see below:

Physeal bridge. Ankle Fx. 11 yo,.

Growth arrest at 18 mths.

ALL Fxs. Here we

Common Fxs: Fx prox

Fx clavicle

humerus

Shoulder-proximal humerus, clavicle. Elbow-lateral condylar, supra-condylar Scaphoid Fx Colles/wrist Scaphoid 5th metacarpal neck PIP jnt

Supra condylar Fx humerus

Fx lateral condyle

Fx 5th metacarpal

Colles Fx

Hip and femur Knee Tibia Ankle Talus Calcaneus Base 2nd metatarsal Base 5th metatarsal Toes

Plateau Fx

Upp tibial Fx

Both legs broken. 8 yo.

Common soft tissue injuries: Skiers thumb-brace/splint Dislocated shoulder-sling/ investigate/follow/often need surgery Knee sprainexamine/image/often surgery

Skier’s thumb

Dislocated

Torn meniscus

Sprain

And don’t forget: Blood at tip penis

-Important signs (eg blood at tip of penis post injury? = Pelvic Fx.)

-In multi trauma,young doctors sometimes forget about foot fractures, these later become the main concern of the patient( and their lawyer).

Enjoy treating Fxs; try hard; these are often young and active patients, you can make a big difference to their life.

MVA nearly killed

Before surgery

Before Before surgery surgery

Put nail in femur

You savedher You saved her