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The Essential
ORTHOPEDIC TRAUMA
Biomechanics of Fractures
Pelvis
Vm VM
M
m
E ( Energy Kinetic ) = MV 2
Definition
Emergency :
A situation that involves a potential disabling or life
threatening condition.
Trauma :
A physical wound or injury to living tissue caused by an
extrinsic agent
Fracture : discontinuity of cortex or cartilage
Dislocation : discontinuity of joint
luxation subluxation
Multitrauma : emergency, life threatening more than one
organ requiring immediate treatment intervention
PRIMARY SURVEY
The ABCDE of muskuloskletal
trauma care identify life
threatening condition.
A. Airway maintenance w/
cervical spine protection
B. Breathing and ventilation
C. Circulation w/ hemorrhage
control, pelvic stability
D. Disability : neurological
status
E. Exposure : completely
undress but prevent
hypothermia life threatening
conditions are identified and
simultaneous management
is instituted
Pelvic Stability
Anteroposterior
Compression
Lateral
compression
Vertical Shear
SECONDARY SURVEY
Done after the patient stable
Head to toe !
DIAGNOSTIC IMAGING
FRACTURES
Deformity Angulation
- Rotation
- DIscrepancy
Position
Edema
Appearance of the
distal part
Pale
Darken
FEEL
Crepitation
Sensory
MOVE
Active
Passive
Power
False
movement
MEASUREMENT
MEASUREMENT-
discrepancy
True
length,Anatomical
length
Appearance length
CLINICAL DIAGNOSIS
Patognomonis sign/definite sign of
fracture: deformity,false movement,
Prevention of infection
Soft tissue healing and bone
union
Restoration of anatomy
Functional recovery
DO NOT DO HARM
BONE HEALING
Healing of fractures
* Haematoma formation
* Initially, there is bleeding from the broken bone ends, and the
surrounding soft tissues. This forms a clot or haematoma, which
provides a scaffold for new fiber and bone building cells to move in,
leading to stage two.
Healing of fractures
* Cell proliferation
* The early cells are fibroblasts, arising from the periosteum (a
membrane around the bone). These convert the blood clot to
fibrous material in about 10 days, making the fracture sticky.
The fibroblasts are then replaced by bone building cells called
osteoblasts.
Healing of fractures
* Callus formation
* The osteoblasts start to produce the first bone around the fracture.
At this stage, this begins to appear on an X-ray looking like cotton
wool, and is known as callus. The callus may be felt around the
bone, and the patient will usually notice that the bone is beginning
to feel stronger and less painful.
Healing of fractures
* Consolidation
* Over the next few weeks the callus will harden and consolidate and
the bone will regain its full strength.
Healing of fractures
* Remodeling
* The last stage of the process is the remodeling, when the excess
lump of new bone is removed. This is a slow process, carried out
by cells called osteoclasts. In children, the remodeling is good
enough to remove all trace of the fracture but adults are not so
lucky, so there is often evidence of the fracture in the bone for
many years.
SOFT TISSUE HEALING
Cardinal Signs of Inflammation
Substrate Phase
Begins almost right away, lasts approx. 2-4 days
Goal
Protect,
Localize,
Decrease injurious agents,
Prepare for healing and repair
Critical to the healing processes - If this phase does not
accomplish what it is supposed to or if it does not
subside, normal healing cannot take place.
Lasts until damaged tissue has been removed & new
capillary network has been formed
Phase II: Proliferation/Fibroblastic
Phase
Repair/Regeneration or Fibroblastic phase