1. Orthopaedic Emergencies
17th May 2012
Dr Liling Patterson
Surgical HMO

2. Orthopaedic Emergencies
Open (Compound) Fractures
Compartment Syndrome
Dislocation
Septic Arthritis

3. Compound Fractures Wound infection Osteomyelitis Gas gangrene Tetanus
Non-union

4. Wound Classification Gustilo-Anderson Classification:
Type I – clean wound, < 1cm, no skin crushing
Type II – wound > 1 cm, moderate soft tissue injury
Type III – extensive soft tissue injury

5. Management “Six Hour Golden Rule” Fluid resuscitation
Control haemorrhage
Analgesia
Irrigation
Dressing, splint
Antibiotics, tetanus prophylaxis
Surgical debridement & fixation
“Six Hour Golden Rule”

6. Compartment Syndrome Limb threatening
Increased pressure in tight fascial compartment
Muscle necrosis at > 30mm Hg
Ischemic injury at 4 hrs
Irreversible injury 4-8 hrs
Signs: disproportionate pain, 5 P’s
Pain
Pallor
Paraesthesiae
Paralysis
Pulseless

7. Causes of Compartment Sx
Fractures ~75%
Crush injury
Burns
Extravasation
Tourniquets, constrictive dressings/plasters
Snake bites

8. Management
Early recognition!
Urgent fasciotomies

9. Dislocations When bones at a joint become displaced or misaligned
Neurovascular compromise
Main principle of Mx – reduce it!

10. Knee Dislocation Popliteal artery (20-30%) Peroneal nerve (up to 25%)
PCL/ACL

11. Septic Arthritis Infection within joint space Usually bacterial
Staph aureus
Streptococcus
Neisseria gonorrhoeae
Signs: fever, NWB, raised WCC/CRP
Prosthetic joints – delayed presentation

12. Management Diagnosis by aspiration -> Gram stain, culture iv Abx
Analgesia
Washout