1972 ผศ.นพ.ธรา ธรรมโรจน ภาควชาออรโธปดกส คณะแพทยศาสตร, มหาวทยาล!ยขอนแก#น
Common Fracture in lower Extremity Common Fracture in Adult(Traumatic Associated Fracture) Fracture of Tibia and Fibular Fracture of The Shaft of The Femur Common Fracture in Elderly(Nontraumatic Associated Fracture) Femoral neck fracture Intertrochanteric fracture
Orthopaedic Conditions 78% incidence of significant orthopaedics injury in the patients with multiple trauma equivalent to head injury twice that of major thoracic injury four times the incidence of abdominal injury
Multiple Injured Patient
Phase in The Care of The Multiple Injured Patient 1.Resuscitation 2.Emergency Procedures 3.Stabilization 4.Delayed Operative Procedure 5.Rehabilitation
Indication for Immediate Surgery Hemorrhage secondary to Laparotomy: liver, spleen, kidney Thoracotomy: Aortic, caval or pulmonary vessel tear Craniotomy: depressive skull fracture, acute subdural hemorrhage Pelvic fracture stabilization Prevention of pulmonary failure femoral shaft fracture pelvic fracture
First Orthopaedics Management
Fracture around the ankle Anatomy Biomechanic
Anatomy
Diagnosis History Physical examinations X-ray
Diagnosis
Diagnosis
Diagnosis
Diagnosis
Diagnosis
Fracture Managements Maleolar Fracture Stable Unstable Casting ORIF
ORIF
Fracture of The Tibia and Fibula The most common long bone fracture Anatomy Two unequal bone Four compartments Between two hinge joints
Open Fracture Management What? When? Where? How? Diagnosis&Classification Golden period Operative room Preoperative Intraoperative Postoperative
Diagnosis History Physical examinations X-ray
X-ray
Classification of Open Fracture Type Wound Level of Soft tissue Bone Contamination I <1cm. Simple II >1cm. Moderate III A >10cm. Comminuted B C Clean Minimal Moderate Moderate High Severe+crushing Skin defect Vascular injury
Preoperative management Splint+Pressure dressing Antibiotic Tetanus prophylaxis Lab.blood request IV
Intraoperative procedures Systematic debridement Immobilization Cast Nail Plate External fixator
Closed Fracture Managements Closed Tibial Fracture Stable Unstable Casting CRIF
Casting Technique
Internal Fixation for Tibial Fracture
Femoral Shaft Fracture Incidence second most common long bone fracture in lower extremity Anatomy Tubular bone Anterolateral bowing
Physical Examination Clinical features Shortening external rotation swelling angulation Splint
X-ray
Classification
Treatment Options Plate External fixator Femoral Shaft Fracture Cast Indications for plating 1.Metaphyseal extension 2.Ipsilateral major arterial injury 3.Nonavalability for closed nailing Nail
Femoral Neck Fracture Incidence and Epidermiology 280,000cases/yr. 63% of osteoporotic fractures(3-5% in adult) increase 2 times/5 yrs. from 30 yrs. 18/1000 at 85
Diagnosis History mechanism of injury underlying disease medications Physical Examinations minimal swelling minimal external rotation minimal shortening pain on motion
X-ray
Classification
Patient and Fracture Evaluation What? Fracture type and Where? When? How? OPD/Operative room Underlying Control medical conditions Conservative/Operative
Treatment Options Femoral neck fracture Nonoperative treatment Operative treatment Internal fixation Hemiarthroplasty
Indication for Hemiarthroplasty Old fracture dislocation Neglected fracture Fail internal fixation Untolerate to second operation Preexisting lesion
Intertrochanteric Fracture Incidence Gender and race dependance M:F=63:34/100000 Anatomy Zone of transition Calcar femorale
Diagnosis History mechanism of injury underlying disease medications Physical examinations swelling external rotation shortening pain on motion large subcutaneous hematoma
Classification
Patient and Fracture Evaluation What? Fracture type and Where? When? How? Operative room Underlying Control medical conditions Conservative/Operative
Treatment Options Intertrochanteric fracture Nonoperative treatment Operative treatment Internal fixation Hemiarthroplasty
Internal Fixation for Intertrochanteric Fracture