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Pat Fleming Consultant Orthopaedic Surgeon

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Presentation on theme: "Pat Fleming Consultant Orthopaedic Surgeon"— Presentation transcript:

1 Pat Fleming Consultant Orthopaedic Surgeon
Orthopaedic Trauma Pat Fleming Consultant Orthopaedic Surgeon

2 Orthopaedic Trauma Fractures Soft tissue injuries
Musculo-skeletal injury

3 Final Exams Recognition of orthopaedic injury
Description of orthopaedic injury Appropriate terminology Principles of management of orthopaedic injuries - Emergency treatment - Definitive treatment

4 Trauma Blunt Penetrating E = mv2 High-velocity vs Low-velocity

5 Blunt trauma

6 Penetrating trauma

7 Penetrating trauma

8 Blunt AND penetrating



11 Multiple Trauma

12 ATLS Advanced Trauma Life Support A-B-C-D-E

13 A-B-C-D-E Airway and cervical spine A Breathing B Circulation C
Deformity Environment


15 Isolated Trauma Most common Isolated injury to spine / extremities
Usually not life-threatening Limb-threatening Disabling

16 Isolated fractures

17 Fractures “An abnormal discontinuity in the skeleton” “A break”
“A hairline crack”

18 Trauma - History History of the Injury - Mechanism of injury
High velocity or low velocity? Closed or open? Penetrating or blunt? Duration since injury

19 Velocity of Injury

20 Past Medical History History of previous injuries
Illnesses that may affect the prognosis Illnesses that may affect surgery Illnesses that may delay discharge

21 Examination of fractures
Tenderness, crepitus, deformity Associated soft-tissue injuries Neurovascular damage X-ray

22 Description of a Fracture
Which bone?

23 Description of a Fracture
Which part of the bone ?

24 Joint surface Physis (Growth plate) Epiphysis Metaphysis Diaphysis

25 Description of a Fracture
Open or Closed?


27 Description of a Fracture
Fracture pattern?

28 Description of a Fracture
Deformity? Displacement Shortening


30 Description of a Fracture
Deformity? Angulation

31 Description of a Fracture
Deformity? Rotation


33 Plain X-rays 2 joints 2 planes 2 views

34 Emergency management Take a history Examine / consider other injuries
Analgesia Splint the fracture



37 Thomas’ splint

38 Fracture position Fracture stability
Definitive Fracture Treatment Fracture position Fracture stability

39 Fracture reduction

40 Fracture reduction

41 Fracture reduction

42 Stabilisation Plaster cast Internal fixation External fixation

43 Internal fixation Plates and screws K-wires (Kirschner)
Intra-medullary nails



46 External fixation

47 Fracture Union Clinically united - Non tender No movement
Radiological union - Callus

48 Fracture callus

49 Fracture callus

50 Complications of Immobilisation
Stiffness Muscle wasting Weakness Osteoporosis Bed-sores, chest infections, UTI’s, ileus, boredom

51 Rehabilitation

52 Rehabilitation

53 Stages in Fracture Management
Initial assessment & first aid X-ray assessment Fracture reduction Stabilisation - Cast immobilisation Internal fixation External fixation Rehabilitation

54 Specific fractures Hip fractures Wrist fractures Ankle fractures

55 Specific soft-tissue injuries
Ligament injuries at the knee Achilles’ tendon injuries Rotator cuff injuries Shoulder instability Finger dislocations

56 Fractures in Children NAI Growth plates Greenstick fractures
Rapid union Remodelling


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