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Principles of orthopaedic care
- 1. Principles of Orthopaedic Care Gordon H. Stock, MD Orthopaedic Surgeon, Central Utah Clinic
- 3. Objectives • Describe differences in Orthopaedic injuries – Fractures, dislocations, subluxations • Describe fractures using current medical definitions • Understand physiology of Orthopaedic injuries • Understand proper Orthopaedic assessment • Understand proper treatment of Orthopaedic injuries • Identify injuries most likely to cause hemodynamic instability • Identify simple orthopaedic injuries from radiographic images
- 4. Objectives • Understand the burden of Orthopaedic injuries on Society • Briefly review fracture classifications & definitions • Review Tscherne and Gustilo grading system for open injuries • Review Salter-Harris Classification • Review treatment modalities for Orthopaedic injuries • Review critical injuries that can be seen during transport of orthopaedic injuries
- 5. EMS Considerations • Isolated orthopaedic injuries are rarely fatal • However, Multiple injuries & associated blood loss can be life threatening • Knowledge of orthopaedic injures and proper care of these injuries will allow greater patient comfort and minimize long term disability
- 6. 75yo F Tripped Over a Chair
- 7. After Total Hip Replacement
- 8. Burden to Society • Orthopaedic Injuries • Pediatric • Elderly Falls – Of those that fall 20-30% moderate to severe injuries • Hip fractures • Head trauma • Vertebrae, hip, wrist, ankle, pelvis, proximal humerus – 3-5% of falls result in fracture – Total cost for falls >65 years of age • 1994 $20.2 billion • 2020 $32.4 billion (estimated)
- 10. Function of Bones • Structure & Movement • Bone marrow: produce RBC • Protection
- 11. Definitions • Fracture – Any break in bone (complete or incomplete) • Dislocation – Complete dissociation of a bone from it’s normal position in a joint – Associated with fracture and soft tissue injury • Subluxation – Partial or incomplete dislocation – Typically soft tissue injury
- 12. Definitions • Open (Compound) • Closed (Simple) • Complete • Incomplete • Displaced • Non-displaced • Greenstick • Comminuted • Segmental • Butterfly • Spiral • Oblique • Transverse • Hairline • Occult • Epiphyseal • Fatigue (Stress Fracture) • Impacted
- 15. 47 yo M, 4-Wheeler Rollover
- 19. Post Reduction
- 20. Problems associated with Epiphyseal (Growth Plate) Fractures
- 21. Tscherne Method for grading Closed Fractures
- 22. Gustilo Classification for Open Fractures
- 23. Assessment of Skeletal System • Airway • Breathing • Circulation • Skeletal Assessment – Observation – Palpation – Functional testing
- 24. Assessment of Skeletal System • Acute deformity – Fracture or dislocation until proven otherwise – To reduce or Not to reduce? • Laceration over deformity – Open fracture until proven otherwise • Hemodynamic Instability – Intra-abdominal – Intrathoracic – Fractures
- 26. Assessment of the Skeletal System • History • Physical Exam • X-ray • CT scan • MRI
- 27. Treatment • Splint • Casting • Reduction/Realignment – Where – When – Whom • External Fixation • Internal Fixation • Amputation
- 28. Treatment
- 30. Critical Orthopaedic Fractures • Pelvic Fractures – Massive blood loss potential (>2000ml) – Treatment: Sheet wrap, SAM splint
- 31. Critical Orthopaedic Fractures • Femur Fractures – Longest bone in body – Not easily fractured – Often associated with other injuries – Blood loss potential (1500ml per femur) – Treatment: Splinting
- 32. Critical Orthopaedic Fractures • Hip Fractures – Intracapsular Femoral Neck • Subcapital • Transcervical • Basicervical – Extracapsular • Intertrochanteric • Trochanteric • Subtrochanteric • Treatment – Internal fixation – Hip Replacement • Total • Partial – Early Ambulation
- 33. Critical Orthopaedic Fractures • Vertebral Fractures – Potentially Catastrophic • Permanent disability • Death – Expensive Societal burden • Individual spinal injury can reach >$1 million lifetime – Recognition is critical • Cervical Spine • Thoracic Spine • Lumbar Spine
- 34. Critical Orthopaedic Fractures • Humerus Fractures – Blood loss (750ml per humerus) – Splinting – Treatment • Rib Fractures – Rib cage protects thoracic cavity – Pulmonary compromise: pneumothorax – 1st rib fracture: 30% risk of aortic injury
- 35. Critical Orthopaedic Fractures • Femur Fractures – Longest bone in body – Not easily fractured – Often associated with other injuries – Blood loss potential (1500ml per femur) – Treatment: Splinting
- 36. Critical Orthopaedic Injuries • Amputation – Eye catching – Life over limb – ABC’s – Treatment • Stop further bleeding • Rinse amputated part with saline • Bandage moist gauze • Place in plastic bag • Place in container with ice
- 37. Critical Orthopaedic Injuries • Pulseless extremity – Reduce/realign extremity – Local protocols vary – Discuss with ED physician • Compartment Syndrome – 6 P’s – Pain, pallor, paralysis, pulselessness, pressure, paresthesia – Catastrophic if left untreated – Treatment: facsiotomy
- 38. Orthopaedic Pharmacology • NSAIDs • Opiates • Antibiotics • Muscle relaxants • Anticoagulants
- 39. 76 yo tripped at home, Temazepam
- 41. Questions
- 42. References • Principles of Orthopaedic Care. Chapter 19, Critical Care Paramedic. Brosius JR, Bledson BE
- 43. THANK YOU!