Introduction to Fractures and Dislocations. CAPA 2016 Winnipeg, MB
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1 Introduction to Fractures and Dislocations CAPA 2016 Winnipeg, MB
2 CAPA 2016 Dr. Chris Graham Orthopedic surgeon Practice primarily trauma related Assist. Prof. U of M Health Sciences Centre No conflicts to declare
3 CAPA 2016 Objectives: Achieve a basic understanding of fractures/dislocations Basic approach to assessment and management of patient
4 CAPA 2016 Format: You have the basic word document of the principles I will use powerpoint to demonstrate principles Add to document or sit and take it in
5 CAPA 2016 WARNING: This is GRAPHIC This is real
6 Fractures Bone is compromised Aka smashed, cracked, broken etc
7 Why do bones break? High energy Low/repetitive energy
8 Pathologic - Fractures
9 Fractures Classification E - low Bone - humerus Location diaphysis (shaft) Pattern - transverse A fracture is a soft tissue injury with a broken bone in it
10 Clinical Pain Deformity Loss function Crepitus Bruised Bleeding Look at all of it
11 Management Goals: stabilize, diagnose, treat, rehabilitate Restore function
12 Assessment In the field: first aid principles ABC of ATLS Stabilize the pt. Check deformity, tenderness and painful areas, circulation Splint and transport
13 Injury history General history Assessment Examine look, feel, move (patient moves first then you move it) Inspect entire region move other joints
14 Assessment Important items to note: in context of the injury and patient Open or closed injury Circulation Neurologic function- static and evolving problems compartments
15 Assessment Splint very helpful, comfortable, transport Xray orthogonal views 90 degrees - AP + lateral - extra views depend on area involved - ankle - mortise - shoulder axillary lateral - foot - oblique
16 Xrays First line easy, cheap lots of info Limited detail however
17 Imaging After xray if NOT helping, NOT comfortable you might want more to help CT easy bony +/- soft tissues MRI soft tissues +/- bone Bone scan ultrasound
18 Xrays Approach Read the whole film Confirm pt., part, side Rule of 2 s joint above and below, two views, two times before and after intervention
19 Describing fractures What Bone, part of bone Ulna Diaphysis Fracture geometry (oblique) Xrays Displaced? Length Angle look at apex of two longitudinal lines Displacement translation Rotation mostly clinical
20 Xrays Describing: Diaphysis Comminuted 100% displaced
21 Xrays Humerus Proximal shaft Spiral Min short Not angled ~20 % displaced
22 Displacement Xrays
23 Treatment 1. Is a reduction required? How closed, or open? 2. How to stabilize? Plaster/pins/plate/nail? 3. Decisions made considering the fracture and the patient
24 When to operate? Fail to obtain or maintain reduction Displaced intraarticular Open fracture Pathologic With vascular injury Polytrauma
25 Dislocations Loss of congruence of a joint Neurovascular exam pre/post all (knee**) Some need open reduction Reduce sooner is better Risk AVN in hip
26 Dislocation Elbow Traction Align Flex with P-A pressure on olecranon Local/sedation Check arc of stability
27 Dislocation Hip Most anterior Dashboard Check knee (PCL) Acetabulum and head fractures Check stability
28 Dislocation Shoulder Anteroinferior most Axillary nerve Avoid throwing position Older vascular injury, fractures, cuff Young surgery? Local or sedation
29 Special Open not compound Bone communicates with outside Out-in In-out Graded 1-3(a-c) ER clean gross contamination reduce/splint antibiotic and tetanus xrays
30 Special Open OR I&D Stabilize bone Deal with wound coverage Antibiotics Repeat
31 Open Special
32 Open Special
33 Plates
34 Nail
35 Replace
36 Not good
37 Take Home Approach each patient/injury in a stepwise fashion Be systematic Don t get distracted by the obvious clinical or xray
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