introduction to fractures and dislocations - capa - acam · 2019-02-15 · introduction to...
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Introduction to Fractures and
Dislocations
CAPA 2016
Winnipeg, MB
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CAPA 2016
Dr. Chris Graham
Orthopedic surgeon
Practice primarily trauma related
Assist. Prof. U of M
Health Sciences Centre
No conflicts to declare
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CAPA 2016
Objectives:
Achieve a basic understanding of
fractures/dislocations
Basic approach to assessment and
management of patient
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CAPA 2016
Format:
You have the basic “word” document of the
principles
I will use “powerpoint” to demonstrate
principles
Add to document or sit and take it in
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CAPA 2016
WARNING:
This is GRAPHIC
This is real
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Fractures
Bone is compromised
Aka – smashed, cracked, broken etc
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Why do bones break?
High energy Low/repetitive
energy
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Fractures
Pathologic -
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Fractures
Classification
E - low
Bone - humerus
Location – diaphysis (shaft)
Pattern - transverse
A fracture is a soft tissue injury
with a broken bone in it
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Clinical
Pain
Deformity
Loss function
Crepitus
Bruised
Bleeding
Look at all of it
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Management
Goals: stabilize, diagnose, treat, rehabilitate
Restore function
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Assessment
In the field: first aid principles
ABC of ATLS
Stabilize the pt.
Check deformity, tenderness and painful
areas, circulation
Splint and transport
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Assessment
Injury history
General history
Examine – look, feel, move (patient
moves first then you move it)
Inspect entire region – move other
joints
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Assessment
Important items to note: in context of the
injury and patient
Open or closed injury
Circulation
Neurologic function- static and evolving
problems
compartments
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Assessment
Splint – very helpful, comfortable, transport
Xray – orthogonal views 90 degrees
- AP + lateral
- extra views depend on area involved
- ankle - mortise
- shoulder axillary lateral
- foot - oblique
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Xrays
First line – easy, cheap lots of info
Limited detail however
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Imaging
After xray if NOT helping, NOT comfortable
you might want more to help…
CT – easy bony +/- soft tissues
MRI – soft tissues +/- bone
Bone scan
ultrasound
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Xrays
Approach
Read the whole film
Confirm pt., part, side
Rule of 2’s – joint above and below, two
views, two times – before and after
intervention
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Xrays
Describing fractures What Bone, part of bone
Ulna
Diaphysis
Fracture geometry (oblique)
Displaced?
Length
Angle – look at apex of two
longitudinal lines
Displacement – translation
Rotation – mostly clinical
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Xrays
Describing: Diaphysis
Comminuted
100% displaced
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Xrays
Humerus Proximal shaft
Spiral
Min short
Not angled
~20 % displaced
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Xrays
Displacement
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Treatment
1. Is a reduction required? How – closed, or
open?
2. How to stabilize? Plaster/pins/plate/nail?
3. Decisions made considering the fracture
and the patient
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When to operate?
Fail to obtain or maintain reduction
Displaced intraarticular
Open fracture
Pathologic
With vascular injury
Polytrauma
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Dislocations
Loss of congruence of
a joint
Neurovascular exam
pre/post all (knee**)
Some need open
reduction
Reduce sooner is
better
Risk AVN in hip
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Dislocation
Elbow Traction
Align
Flex with P-A pressure
on olecranon
Local/sedation
Check arc of stability
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Dislocation
Hip
Most anterior
Dashboard
Check knee
(PCL)
Acetabulum and
head fractures
Check stability
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Dislocation
Shoulder Anteroinferior most
Axillary nerve
Avoid throwing position
Older – vascular injury,
fractures, cuff
Young surgery?
Local or sedation
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Special
Open – not compound Bone communicates with outside
Out-in
In-out
Graded 1-3(a-c)
ER – clean gross contamination
reduce/splint
antibiotic and tetanus
xrays
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Special
Open OR – I&D
Stabilize bone
Deal with wound coverage
Antibiotics
Repeat
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Special
Open
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Special
Open
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Plates
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Nail
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Replace
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Not good
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Take Home
Approach each patient/injury in a stepwise
fashion
Be systematic
Don’t get distracted by the obvious – clinical
or xray
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