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Orthopedic Emergencies

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FRACTURE NECK OF FEMUR Not emergent ... B1 2- Rotationally and vertically unstable pelvic injury whether unilateral or bilateral or associated with acetabular ... – PowerPoint PPT presentation

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Title: Orthopedic Emergencies


1
Al-Jahra Hospital
Orthopedic Emergencies Dr Fathy Khallaf
Consultant Orthopedic Surgeon
2
Definition Orthopedic Emergency is a
musculo-skeletal injury or disease that, if
missed could result in significant complications
or impairment which badly affect the activity of
the patient and would leave an adverse residual
effect.
3
  • Orthopedic Emergencies
  •  
  • Open fractures
  • Dislocations
  • Fracture or dislocation associated
  • with vascular injuries
  • Acute compartment syndrome
  • .

4
  •  
  • Exsanguinating Pelvic Trauma
  • Fracture neck of femur
  • Fracture neck of talus
  • Septic arthritis
  • Osteomyelitis

5
  Open fractures An open fracture is one in
which a break in the skin and soft tissue
envelope allows for direct communication of the
fracture site or fracture hematoma with the
exterior.
6
 Gustilo- Anderson Classification of open
fractures Type I Type II Type III A Type III
B Type IIIC
7
  •  
  • Open fractures management
  • Dos
  • Cover the wound with sterile dressing
  • Control bleeding
  • Splint the fracture
  • IV antibiotics
  • Tetanus prophylaxis
  • Anti-Gas gangrene serum

8
  •  
  • DONTs
  • - Replace the protruding bone
  • - Explore the wound in ED
  • - Close the wound in ED
  • - Clamp vessels in ED

9
  •  
  • Open fractures complications
  • - Soft tissue infection
  • - Compartment syndrome
  • - Skin gangrene with skin loss
  • - Delayed union
  • - Non-union
  • - Infected pseudo-arthrosis
  • - Gas gangrene
  • - Tetanus
  • - Amputation

10
  •  
  • Acute compartment syndrome
  • Etiology
  • Fractures
  • Direct blow or contusion
  • Crushing injuries
  • Hematoma
  • Prolonged pressure

11
  •  
  • After vascular reconstruction and
    revascularization in acute ischemia due to major
    arterial injury
  • Burns
  • Snake bites

12
 The most common fracture associated with ACS is
tibial diaphyseal fractures which have been
reported to be 3-11. The second most common
cause is soft tissue injury, but the second most
common fracture to be complicated by ACS is
distal radius fracture.
13
  •  Acute compartment syndrome
  • Pathophysiology
  • An injury or a condition that causes
  • prolonged elevation of interstitial tissue
  • pressure
  • Increased pressure within enclosed
  • fascial compartment leads to impaired
  • tissue perfusion.

14
  •  Prolonged ischemia causes cell damage
  • which leads to increase vessels
  • permeability
  • Plasma leaks in the interstitium causing
  • further increase in compartment
  • pressure
  • Extensive muscles and nerve death if
  • this ischemia prolonged more than 8 h.

15
  •  Acute compartment syndrome
  • Symptoms Signs
  • Severe continuous pain out of
  • proportion of the original injury or
  • fracture disturbing the patient's sleep
  • Pain on passive stretch
  • Pain with active contraction
  • Tense swelling in the involved
  • compartment

16
  • Tight shiny skin
  • Late findings Paraethesia
  • Paralysis
  • Pallor
  • Pulselessness

17
 Investigations Measurements of
intra-compartmental  pressure using the
following methods 1- Needle manometer 2-Wick
catheter 3- Slit catheter 4- Pressure
transducer
18
  •  Threshold for Decompression in ACS
  • Absolute measurement of intra-
  • compartmental
  • Pressure 30 mm Hg
  • Relative measurement of intra-
  • compartmental Pressure to diastolic
  • blood pressure DBP-ICP 30 mm Hg
  • Treatment
  • Emergency fasciotomy

19
 Dislocations Definition dislocation is the
displacement of bones at a joint from their
normal relation and position
20
Dislocation shoulder

21
Dislocation elbow
22
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23
Dislocation hip
24
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25
Dislocation knee
26
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28
  Exsanguinating Pelvic Trauma Tile
classification of pelvic fractures The two pelvic
fractures most commonly associated with
significant hemorrhage are 1- Antero-posterior
external rotation injury B1 2- Rotationally
and vertically unstable pelvic injury
whether unilateral or bilateral or
associated with acetabular fracture CI, C2,
C3
29
Clinical presentation -Hemo-dynamically
unstable and deteriorating -Destot's
sign -Earle's sign -Roux's sign
30
  • X-ray and CT scan APC type BI
  • or VS type C 1, 2, 3
  • -U/S and CT scan abdomen
  • revealed no intra-peritoneal
  • bleeding

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35
  • Management
  • Resuscitation according to ATLS
  • guidelines
  • Reduction and immobilization of pelvic
  • fracture using an external fixator in APC
  • B I or pelvic C-clamp in VS C I,2,3 may
  • be required to stop the bleeding

36
  •   Laparotomy with abdominal or pelvic
  • packing
  • Angiography and??selective
  • embolization may also be required.

37

38

39
FRACTURE NECK OF FEMUR Not emergent but urgent
40

41
FRACTURE NECK OF TALUS Not emergent but urgent

42
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43
Septic arthritis Children and
immuno-compromised adults Staphylococcus aureus
is most common organism Hip and knee are the most
affected joints Presentation fever- pain in the
affected joint or limb- toxicity- swelling and
effusion in superficial joints- complete
restriction of active
44
or passive movements in the affected joint-
exquisite pain and tenderness on palpating or
moving the affected joint- x-ray is negative-
bone scan and MRI can give positive
data-leukocytosis-high ESR and CRP Treatment
start broad spectrum antibiotic emergent joint
arthrotomy incision drainage
45
  • Osteomyelitis
  • Children and immuno-compromised
  • adults
  • Staphylococcus aureus is most common
  • organism
  • lower femoral and upper tibial Metaphysis
  • are the most common sites
  • Presentation fever- toxicity- pain in
  • The affected part of the limb- swelling

46
And tenderness along the affected metaphysis-
sympathetic effusion with painful but mildly
limited range of movements- x -ray is
negative-MRI and bone scan are positive-
leukocytosis- high ESR and CRP Treatment start
broad spectrum antibiotic incision drainage
with bone drilling and guttering.
47
Thank you
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