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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