Professional Documents
Culture Documents
Management
Widiyatmiko
Introduction
Orthopaedics is
concerned with
bones, joints,
muscles, tendons and
nerves the skeletal
system and all that
makes it move
Introduction
Scope : Subdivision :
Congenital & Traumatology
developmental
abnormalities Orthopaedi :
Infection & inflammation 1. Adult Reconstruction
Arthritis & rheumatic 2. Oncology
disorders
Orthopaedic
Metabolic & endocrine
disorders 3. Pediatric Orthopaedic
Tumours 4. Spine
Sensory disturbance & 5. Hand & Microsurgery
muscle weakness
Injury & mechanical 6. Sports Injury
derangement
In Emergency Room
Assess all trauma patient for possibility of orthopaedic case!
If the patient need operation prepare as soon as possible!
1. Informed consent
2. Tell to fast at least 6 hours prior to op
3. Make IV line
4. Tetanus prophilactic
5. Antibiotic & analgetic
6. Blood check (SYSMEX for < 40 y.o, complete for > 40 y.o and < 14
y.o)
7. Urine check
8. Cross match & blood reservation in blood bank
9. EKG ( for > 40 y.o)
10. Chest X-Ray, with expertise for < 14 y.o
11. Complete the medical record ! (under resident supervision)
12. IPD or paediatric consultation ( for > 40 or < 14, sometimes no
need)
13. Anesthesiology consultation
General Principles of Fracture
Treatment
1. First, Do No Harm
2. Base Treatment on Accurate Diagnosis
and Prognosis
3. Select Treatment with Specific Aims
4. Cooperate with the Laws of Nature
5. Make Treatment Realistic and Practical
6. Select Treatment for You as an
Individual
Aphorism of Fracture
Management
1. Think before you start. Are you
treating the patient? Or merely the x
ray?
2. Think before you reduce. Have you
worked out how to do it? And how to
hold your reduction?
3. Think before you hold. Is your splint
necessary? Is it harmful?
4. Think before you operate. Are you
good enough? Are your facilities good
enough?
What is fracture ?
Fracture is a break or disruption in
the continuity of a bone.
Fracture divide in 2 types :
Closed fracture
Open fracture
Fracture Description
First We LOOK
Then We FEEL
Then We MOVE
Neurological examination
Diagnostic imaging
Blood Test
Synovial fluid analysis
Bone biopsy
Arthroscopy
Electro diagnosis
Adult and Children Fracture
Children Fracture
1. Fracture more common .
2. Stronger and more active periosteum .
3. More rapid fracture healing .
4. Special problems of diagnosis .
5. Spontaneous correction of certain residual
deformities .
6. Differences in complications .
7. Different emphasis on methods of treatment
8. Torn ligament and dislocation less common .
9. Less tolerance of major blood loss
Adult Fracture
1. Fracture less common but more serious .
2. Weaker and less active periosteum .
3. Less rapid fracture healing .
4. Fewer problem of diagnosis .
5. No spontaneous correction of residual
fracture deformities .
6. Differences in complication .
7. Differences emphasis on methods of
treatment.
8. Torn ligament and dislocations are more
common .
9. Better tolerance of major blood loss .
CLOSED FRACTURE
The fracture is not exposed to
the external environment.
Prevention of infection
Restoration of function
Steps in management
Hemorrhage control
Pain relief
Prevent further soft tissue injury
Apply splint early, but avoid delay in
resuscitation.
Be careful in dislocation
Primary Survey & Resuscitation
Adjuncts : X-Rays
Look
Feel
Listen
For What?
For What?
Look Feel
Deformity Crepitus
Pain Skin flaps
Tenderness Neurologic
Wound(s) deficit
Pulses
Listen
Doppler signals
Bruit
Life- Threatening
Injuries
Vascular injuries
Compartment syndrome
Neurologic injury
What are my early
concerns?
Vascular compromise
Open fractures
Limb Threatening
Musculoskeletal Trauma
Open Fractures
Management
Muscle necrosis : 6 h
Warm & Cold
Ischemic
Reimplatantation &
Revascularization
Proper amputee
management!
Limb Threatening
Musculoskeletal Trauma
Compartement Syndrome
Fractures of the arm or leg
ischemia
Infarcted muscles fibrous tissue
(Volkmanns ischemic contracture)
Limb Threatening
Musculoskeletal Trauma
Compartement Syndrome
Clinical features
Elbow, forearm bones, 1/3
prox. of tibiae, multiple
fractures of the foot or hand,
crush injuries &
circumferential burns
Five Ps
The presence of a pulse does
not exclude the diagnosis
Be careful in unconscious
patient !
Limb Threatening
Musculoskeletal Trauma
Compartement Syndrome
Treatment
Decompression
Open fasciotomi
Limb Threatening
Musculoskeletal Trauma
Dislocations
Displacement of bone from normal joint
Occult injuries
Occult blood loss
Compartment syndrome
Case 1 : Male, 40 y.o
ICD 9-CM 79.63, 93.44
Summary
Orthopaedic consult
Early immobilization