Orthopedic Injuries

Dr. Waleed bin Waheed

Lecturer
Uob

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Introduction
Fracture
Dislocation
Microtrauma
Macrotrauma
Fall
RTA
Sports or recreational activites

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Fundamentals of skeletal fracture
Microtrauma
Macrotrauma
Pain
Edema
Ecchymosis

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 Fractures
Signs/symptoms
Pain close to site
Deformity
Shortening
Swelling
Guarding
Tenderness
Crepitus © Chuck Stewart, MD.

Exposed bone

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 Shoulder Girdle
Clavicle fractures: Shoulder injury:
 Pain in shoulder  Swelling
 Swelling  Ecchymosis
 Unwillingness to raise the  Pain
arm Scapular fracture:
 Tilting of the head toward
 Pain that increases with
fracture arm abduction
 Swelling

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Shoulder Girdle
Management
Treat shoulder fractures with a sling or swathe.
Treat suspected scapula fractures with full spinal
stabilization.

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Midshaft Humerus Fractures
Assessment
Signs and symptoms include:
 Significant swelling
 Ecchymosis
 Gross instability of the region
 Crepitus
 Damage to upper arm nerves and blood vessels

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Midshaft Humerus Fractures
Management
To correct angulated fractures, apply longitudinal
traction.
Once the extremity is in place, apply a rigid splint and a
sling.
Use cold packs to reduce pain and swelling.

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Fractures of Forearm
Colle’s fracture most common
Smith fracture
Fracture of radius and
ulna together

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Fracture of elbow
Cause by:
Blunt trauma
Fall on outstretch hand
Brachial artery and median nerve complications
Volkman ischemic contractures
Radial palsy

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Cont....
Fracture of neck of humerus
Fracture of shaft
Fracture of distal head of humerus
Fracture of tuberosities
Supracondylar fracture
Fracture of epicondyles
Dislocation of elbow

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 Elbow
Distal humerus
 Supracondylar fractures
typically occur as a result
of falling onto an
outstretched hand.
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Proximal radius and ulna
 Radial head fractures occur
as a result of falling onto
an outstretched hand or
from a direct blow.
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 Elbow
Signs of a distal humerus Signs of a radial head
fracture: fracture:
 Pain in the elbow  Pain associated with
 Significant swelling supination or pronation
 Ecchymosis  Ecchymosis

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Elbow
Treatment of injuries is the same:
Repeatedly assess for compartment syndrome.
Conduct a neurovascular exam before splinting.
 If there is a distal pulse, splint.
 If there is no distal pulse, consult medical facility.

Transport the patient gently.

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 Wrist and Hand
Scaphoid
 Injuries result from falling
onto an outstretched hand.
Boxer’s fracture
 Occurs after punching a
hard object
Metacarpal shaft
 Fractures result from a
crush injury or direct
trauma.
Mallet finger
 Occurs when a finger is
jammed into an object

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 Wrist and Hand
Signs of scaphoid
fracture include:
Pain
Tenderness in the
anatomic snuffbox
Signs of a boxer’s
fracture include:
Pain over ulnar aspect
of the hand
Swelling

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 Wrist and Hand
Signs of metacarpal Signs of mallet finger
fractures include: include:
 Abnormal rotation of  Inability to extend distal
fingers phalanx
 Swelling of palm  Flexed position is
 Pain maintained.
 Tenderness

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 Wrist and Hand
Management
Secure extremity to an
armboard or rigid
splint.
Elevate the extremity.

Courtesy of AAOS

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 Fracture of pelvis
Pelvic fractures include:
Extreme pain
Tenderness throughout the injured area
Hematuria indicating internal hemorrhage
Destot sign:
Indicated by formation of a hematoma above the
inguinal region.
Roux sign
Indicates bilateral distance discrepancies between the
greater trochanter and anterior superior iliac spines,
signifying an acetabular fracture

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Pelvis
Open pelvic fractures
Injury to the major vascular structures can cause life-
threatening hemorrhage.
May result from penetrating or blunt trauma
Causes massive hemorrhage

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 Pelvis
Signs of a stable injury
include:
 Pain in the pelvis
 Difficulty bearing weight
Signs of profound injury
include:
 Shock
 Gross instability
 Diffuse pain
 Possible bruising or
lacerations
 Possible hematuria

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 Pelvis
Signs of a vertical shear Signs of an open fracture
include: include:
 Significant shortening of  Blood in the vaginal or
limb. rectal regions.
 Possible massive
hemorrhaging into the
pelvis.

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Pelvis
Assess mental status and ABCs.
Assess the pelvis for bleeding, lacerations, bruising,
and instability.
A search for entry and exit wounds should not delay
transport.

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 Pelvis
Treatment should The goal of management
include: is to:
 Monitoring ABCs  Reduce bleeding.
 Spinal stabilization  Decrease instability.
 IV access  May include pelvic binder

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 Pelvis
To apply a pelvic
binder:
Place binder over the
trochanters and below
the ribs.
Connect sides.
Apply pressure from
either side. EMS facility courtesy of St. Charles County Ambulance District, Missouri, ©
Ray Kemp/911 Imaging
Perform definitive
tightening.

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Complications
Intrapelvic compartment syndrome.
Digestive and reproductive systems dysfunctions.
Internal infections subsequent to disruption of
urinary and bowel structures.

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Femur
Femoral neck fracture
Femoral shaft fracture
Supracondylar fracture
Condylar fracture
AVN

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Immobilized femur in a traction
splint

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Tibia and fibula
Fractures of condyles of knee
Fracture of shaft of tibia and fibula
Dislocation of tibio-femoral joint
Dislocation from ankle joint
Fracture of shaft of tibia or fibula alone

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Ankle and foot
Rupture of lateral ligament of foot (sprain)
Fracture of calcaneum
March fracture

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 Management

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 Principles of Splinting
Splint joints and fractures above & below
injuries
Cover open fractures
Document pulses, sensation, motor
function before & after splinting
Stabilize the limb with gentle in-line
traction to a position of normal alignment
Immobilize dislocations in a position of
comfort with:
-Ice, cold compresses.
-Elevation.

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 Splinting
Indications:
Techniques
Include fractures, dislocations, and sprains
Stabilization of an extremity fracture with a splint
will preserve proper bone alignment and alleviate
discomfort.
Splinting immobilizes injured extremities and
prevents further injury, decreases pain and bleeding,
and allows healing to begin.
Contraindications:
There are no absolute contraindications,
When neurovascular compromise is present,
First attempting immediate reduction.

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 Equipments
The materials needed for basic extremity splint
placement include:
A stockinette,
Cotton padding,
Plaster or fiberglass rolls or sheets,
Elastic bandages with clips or adhesive tape, heavy-
duty scissors
A bucket of water

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Technique

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