3 - LL TRAUMATO Flashcards
Description of traumatology
TRAUMATOLOGY
- Injuries sustained through trauma
- Typically, physical injuries: fall, accident, violence, traumatic events
- Treatments range from surgical intervention to non-surgical therapies
- Injuries: fractures, soft tissue injuries, wounds, dislocation, burns `treatment often involves multiple medical specialties: orthopedics, plastic surgeons, neurology, geriatric care,
pediatrics, psychiatrics
Importance of LL injuries in clinical practice
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Classification of LL injuries based on MoI
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Classification of LL injuries based on anatomical locations
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Specific injuries & management: pelvis fracture
- stable vs unstable
- young-burgess classification
- surgical intervention
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Surgical interventions in pelvis fractures
- Metalware
- External fixator
- InFix (Internal Subcutaneous Internal Pelvic Fixator)
- Extensive ORIF (Open Reduction & Internal Fixation)
- Inserted using guide wires & radiographic landmarks
Specific injuries & management: proximal femoral fracture
- intracapsular vs extracapsular
- management
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Management
Surgical management depends on location, type of fracture, patients age, health & function
- Intramedullary Nailing (IMN)
- Plate & screws (ORIF)
- Hemiarthroplasty
- Total hip arthroplasty (THA, THR)
- Dynamic Hip Screw
- External fixation: open fracture & significant STi
Specific injuries & management: tibial plateau fracture
- Schatzker classification
- description
Sequential treatment management
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- Nondisplaced closed injuries heal readily with protected eight bearing
- Complex fracture patterns extending into diaphysis => soft tissue or neurovascular injuries
that can threaten limb - Goals: stable knee, restore joint surface, preserve functional ROM
- Split depression fracture associated with lateral meniscus & MCL injuries (type 2 & 3)
- 18% of patient with type 6 had compartment syndrome
Sequential treatment management
a. PA X-ray view
b. Lateral Xray view
c. Ex-fix in situ
d. PA Xray view with ex-fix in situ
e. PA Xray view with ORIF: plates & screws
f. Lateral Xray view of ORI: plates & screws
Specific injuries & management: pilon fracture
Pilon fractures
- Surgical intervention required for unstable fracture, unable to perform until swelling / blisters managed
- Ex-fix often used primarily: helps restore bone alignment, limb length & provides stability
- Extensive STI need ex-fit surgery until injuries settle
- Internal fixation using screws & metal plates: ORIF
Specific injuries & management: lisfranc injuries & fracture
Lisfranc (midfoot) injuries & fractures
- Lisfranc midfoot joint complex very little movement
- Critical in stabilizing arch for push off during gait cycle
- Transfers forces generated by calf muscles to forefoot
- If injury occurs but left untreated instability of arch can cause it to collapse
- Low energy trauma seen in football players when one player lands on back of another
player’s foot whilst foot is plantarflexed & in push off position
- High energy trauma: RTA’s, fall from height
- Surgery recommended with displaced fractures or malalignment of bones to restore stability
to midfoot
- ORIF: screws & plates may need removing later date
o multiple screws
o combination of plates & screws
o plates that span joints
- Midfoot fusion: cartilage from bones removed & metal plates, screws or staples used to
compress bones together
Specific injuries & management: dislocations
Dislocations
- Posterior (90%) > Anterior
- Anterior iliofemoral ligament stronger than posterior ischio-femoral ligaments
- Displaced femoral head interrupt blood supply => avascular necrosis
- Branches from external iliac artery from ring around neck of femur
- Medial femoral circumflex artery flows posterior direction, often disrupted with posterior
displacement
- Lateral femoral circumflex artery flows anterior direction, often disrupted with anterior
displacement
- Management: traction techniques
Acute complications:
- types
Compartment syndrome
Vascular injury & ischemia
Nerve injuries
Compartment syndrome:
- description
- key areas
- key symptoms
- management
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Vascular injury & ischemia:
- types
- description
- needed
- key symptoms
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Nerve injuries:
- description
- key symptoms
- functional issues
- management
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Chronic complications
CHRONIC COMPLICATIONS
- Nonunion or malunion
- Osteomyelitis: bone infection => cause of healing complications, bone death, hardware
failure, sepsis & amputation
- Infection often in soft tissue envelope not restored. Plastic surgeons often work alongside orthopedic surgeons
- Post traumatic arthritis: occurs years after initial injury & significantly impacts mobility & QoL
- Fractures intra-articular or where joint surface is injured
Rehabilitation & recovery:
- principles of rehab
- gradual return to normal activities, long rehab journeys
Principles of rehabilitation
- Promote healing
- Restore function
- Reduce pain
- Improve QoL
Gradual return to normal activities, long rehabilitation journeys
1. Pain Mx
2. Early mobilization, circulation ex’s, PROM ex’s
3. Protection of injured area: braces, splinting, casting, activity modifications, avoid high risk
activities
4. Gradual weight bearing & strengthening always led by orthopedic consultant
5. Restore ROM: passive, active-assisted, active
6. Functional training
7. Progressive load & activity progression
MDT, psychological support, monitoring & evaluation of pain, function, ROM & strength
