management

• Fractures are breaks or disruptions in the continuity of bone caused by trauma or disease
• Types of fractures

  • Complete
  • Incomplete
  • Impacted
  • Comminuted
• Clinical signs of fractures include pain, swelling, deformity, loss of function
• Fracture examination

  1. Inspection

  2. Palpation

  3. Assessment of range of motion
• Imaging plays a key role in diagnosis and fracture characterization
• Potential complications of fractures

  • Vascular or nerve injury
  • Visceral injury
  • Infection
  • Malunion
• Proper diagnosis and management can help prevent long-term disability from fractures
• Closed reduction

  Immobilization and traction
• Surgical management

  Open reduction and internal fixation
• The goals of fracture treatment are to restore length, axis, and function by anatomical realignment of fragments
• There are two main treatment approaches - conservative management and surgical management
• Damage control orthopedics focuses on rapidly stabilizing fractures to control bleeding and prevent further tissue injury, while delaying more definitive fixation
• Amputations can be indicated by poor circulation, injury, infection, and tumors
• Types of amputations

  • Closed amputations
  • Open amputations
• Principles of amputation

  • Using anesthesia
  • Using a tourniquet
  • Fashioning adequate skin flaps
  • Sectioning muscles and blood vessels
  • Protecting cut nerve endings
• Complications of amputations can include hematoma, infection, necrosis, contractures and phantom limb
• Compartment syndrome occurs when increased pressure within a closed muscle compartment reduces blood flow, potentially causing tissue death
• Early fasciotomy, in which fascia is cut to release pressure, can prevent complications of compartment syndrome if performed within 6-8 hours of onset
• External fixators are a classical method for treating open fractures, especially of the tibia
• Femoral shaft fractures are typically caused by high-energy trauma and present with thigh pain and swelling
• Management of femoral shaft fractures involves resuscitation, splinting, and either non-operative treatment with traction or operative treatment with intramedullary nailing or plating
• Hip dislocations are most commonly posterior or anterior, depending on the direction the femoral head is displaced from the acetabulum
• Treatment of hip dislocations involves closed or open reduction, sometimes along with fixation of any fractures
• Complications of hip dislocations can include myositis ossificans or avascular necrosis leading to osteoarthritis
• Fractures are classified based on type, communication with the external environment, and anatomic location
• Fracture treatment

  1. Emergency care like splinting

  2. Definitive care like closed or open reduction and immobilization with casting or internal fixation

  3. Rehabilitation
• Complications of fractures can be systemic like shock or local like injury to surrounding tissues or joints
• Proper management of fractures aims to restore function and alignment of the injured bone
• Amputation


  A surgical procedure that removes a limb or extremity
• The etymology of the word "amputation" traces back to Latin
• Amputation process

  1. Development of amputation techniques throughout history

  2. Types of amputations

  3. Common causes

  4. Potential complications

  5. Principles and process of both closed and open amputations
• Skin graft


  A surgical procedure that involves removing a piece of skin from one area of the body and transplanting it to another area
• Skin flap


  A surgical procedure that involves transferring skin and underlying tissue from one area of the body to another while maintaining the blood supply of the transferred tissue
• Skin has two layers, the epidermis and dermis
• Types of skin grafts

  • Partial thickness grafts
  • Full thickness grafts
• Skin flaps differ from skin grafts in that they maintain the blood supply of the transferred tissue
• Types of skin flaps

  • Local flaps
  • Distant flaps
• The techniques, indications, and advantages/disadvantages of various skin grafts and flaps are outlined
• In Australia from 1997-2005, the rate of burn-related deaths was 0.5 per 100,000 people and hospitalization rates for fire, burn, and scald injuries was 31.9 per 100,000 per year
• During 2001-02, burns and scalds accounted for over 6,000 hospitalizations costing $132 million