Loading in 2 Seconds...
Loading in 2 Seconds...
Managing Pediatric Orthopedic Trauma Emergencies When is it not “Just a broken bone”. Stephen A. Mendelson M.D. Director of Orthopedic Trauma Children’s Hospital Of Pittsburgh of UPMC. Pediatric Orthopedic Trauma. Pediatric Orthopedic Trauma. Pediatric Orthopedic Trauma.
Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.
Managing Pediatric Orthopedic Trauma EmergenciesWhen is it not “Just a broken bone” Stephen A. Mendelson M.D. Director of Orthopedic Trauma Children’s Hospital Of Pittsburgh of UPMC
Pediatric Orthopedic Trauma • 20-30% Trauma patients have orthopedic injury. • 55% of Nonaccidental patients have musculoskeletal injury • As many as 1/3 ER visits related to accidents or injuries
Broken Finger Pelvic Facture Orthopedic TraumaSimple to Complex
Factors Predicting Injury Severity and Outcomes • Injury Mechanism • High Impact • MVA • Fall from Height • Motorcycle and ATV • Low Impact • Ground Level Fall • Sports Accident
Factors Predicting Injury Severity and Outcomes • Concurrent Injuries • Head Injury • Visceral Injuries • Burns • Soft Tissue
Factors Predicting Injury Severity and Outcomes • Associated Injuries • Vascular • Neurologic
Factors Predicting Injury Severity and Outcomes Comorbidities Systemic Musculoskeletal
Orthopedic EmergenciesThe Big Seven! • Open Fracture • Compartment syndrome • Vascular Compromise • Deteriorating Neurologic Exam • Acute Dislocation Major Joint • Femoral Neck fracture • Open or Septic Joints
Open Fractures • Any fracture where the bone is exposed to the environment through a soft tissue defect. Graded I,II, III based on severity of soft tissue wound. • Require urgent cleansing and surgical debridement to prevent infection, and promote healing
Compartment syndrome • Soft tissue injury and subsequent swelling that exceeds the capacity of the fascial space or muscle compartment causing increasing pressure in the muscle compartment. Ultimately cutting off circulation and damaging the muscles and nerves
Compartment Syndrome Symptoms and Signs • Pain • Out of proportion to injury • Pain with passive muscle stretch • Paresthesia • Pallor • Cool, mottled, loss of capillary refill • Pulselessness • Paralysis
Compartment SyndromeDiagnosis and Treatment • Physical exam • Most reliable in awake patient • Compartment pressure measurements • FASCIOTOMY!!!
Fractures with associated vascular Compromise • Immediate vascular insufficiency • Reduce (align) fracture • If vascular perfusion not restored explore, repair or consult • Initial pulse lost aster reduction • Vessel caught in fracture site. Explore, repair or consult
Deteriorating Neurologic Exam • Static Neurologic Deficit • Can observe or explore at time of fracture treatment • Deteriorating Neurologic Deficit • Nerve compressed, stretched or entrapped • Reduce fracture and explore nerve before permanent damage
Femoral Neck Fractures • Blood supply to femoral head very tenuous • Prolonged loss of blood to femoral head causes permanent damage … Avascular Necrosis (AVN) • Emergent reduction and stabilization reduces risk of AVN
Shoulder Elbow Hip Knee Ankle Dislocations
Common orthopedic injuries that are not as urgent as the look (Or The surgeon may say they are to get into the OR quicker)
Growth Plate Fracture Salter Harris Classification
Static Neurologic deficit • Nerve Palsey • Complete Spinal Cord Injury
Child Abuse • >50% long bone fractures in nonambulatory children. • 20% Recurrence Rate. • 1-5% Mortality.
Polytrauma • ARDS • Shock • Fat Emboli
Multidisciplinary Approach • Paramedics and Transport • Emergency Room • Trauma Service • Intensives Care Unit • Neurosurgery • Orthopedics
Damage Control OrthopedicsProvisional Stabilization During Resuscitation period
Summery • Orthopedic trauma can very from simple sprains strains and minor fractures to major multisystem polytrauma. • Recognition of orthopedic emergencies and urgencies can help triage and manage the care of all patients in a trauma center setting. • Orthopedic injuries are common, recognizing the common pitfalls is critical to avoiding serious complications. • A team approach is best!!!!!!!!