General principles of fractures treatment

1. General principles of fractures treatment Klinika Ortopedii i Traumatologii PAM

2. Management of major injuries • Emergency treatment at the scene of the accident and during transport to the hospital • Resuscitation and the evaluation in the accident department • Early treatment of visceral injuries and cardiorespiratory complication • Provisional fixation followed by definitive treatment of musculoskeletal injuries • Long term rehabilitation

3. Individual patient • Obtain access • Establish an airway but protect the cervical spine • Ensure ventilation • Arrest haemorrhage and combat shock • Give analgesia • Splint fractures • Transport

4. Examination • Pulse feeling • Measure capillary return • Observe the respiration • Palpate the head, chest, abdomen, and limbs

5. Second mortality peak • Death from hypoxia or hypovolaemic shock • At risk of further damage to cervical spine, thoracolumbar, brain • The golden rule (effective resuscitation) • Advanced Trauma Life Support Programme

6. Primary survey • A – Airway maintenance • B – Breathing and oxygenation • C – Circulation and control of bleeding • D - Disability • E – Exposure and aviodenance of hypothermia

7. Disability

8. Blood loss

9. Chest injuries • Tension pneumothorax • Sucking chest wounds • Flail chest • Cardiac tamponade • Massive haemothorax

10. Complication of major trauma • Tetanus • ARDS • Fat embolism syndrome • DIC • Crush syndrome • MSOF - prevention

11. How fractures happen • A single traumatic incident • Repetitive stress • Abnormal weakening of the bone

12. Mechanism of injury • Spiral (twisting) • Short oblique • Bending - Triangular ‘butterfly’ fragment • Transverse

14. Principles of treatment • Anatomical reduction • Stable internal fixation • Preservation of blood supply • Early mobilization

15. Implants types • Pin and wire fixation • Screw fixation • Plate and screw fixation • Intramedullary nail fixation • External fixation

16. Primary Secondary Haematoma Inflammation Callus Consolidation Remodelling Fractures healing

17. Fractures healing

18. Open fractures • Classification

19. Open fractures • Wound debridement • Antibiotic prophylaxis • Stabilization of the fracture • Early wound cover

20. Early - visceral injury - vascular injury - nerve injury - compartment syndrome - haemarthrosis - infection - gas gangrene - fracture blisters - plaster and pressure sores Late - delayed union - non-union - avascular necrosis - bed sores - myositis ossificans - tendon lesion - nerve compression - muscle contracture - joint instability - joint stiffness - algodystrophy RSD - osteoarthritis Complications of fractures

21. Compartment syndrome • Pain • Paraesthesia • Pallor • Paralysis • Pulslesness

22. Volkmann’s ischaemia

23. Non-union