basic orthopedics management including emergency care and definitive care

1. BASIC FRACTURE MANAGEMENT
Treatment of a fracture can be considered in
three
phases:
 Phase I - Emergency care
 Phase II - Definitive care
 Phase III - Rehabilitation

2. MANAGMENT
FIRSTAIDTREATMENT

3. INITIAL ASSESSMENT
 Primary survey (ABCDE)
 Resuscitation
 Adjuncts to the primary survey
 Secondary survey
 Definitive care

4. Primary survey (ABCDE)
 ● A: Airway maintenance + C-spine
protection
 ● B: Breathing &Ventilation
 ● C: Circulation & Hemorrhage control
 ● D: Disability – Neuro
 ● E: Exposure / Environment control

5. RESUSCITATION
 Jaw thust / Chin lift / Head tilt
 Naso / Oropharyngeal airway
 Combitube, LMA
 Definitive airway (Cuff in trachea)
 – Oro / Naso tracheal intubation
 – Surgical cricothyroidotomy

6. ADJUNCTS TO THE PRIMARY
SURVEY
 EKG monitor
 Foley's catheter
 “Gastric” catheter
 Respiratory rate
 ABG
 Pulse oximetry
 CXR, Pelvis AP, Lateral C-spine
 FAST

7. SECONDARY SURVEY
 Not begin until primary survey is completed
 History (AMPLE)
 ALLERGY
 MEDICATION
 PAST ILLNES/PREGNANCY
 LAST MEAL
 EVENTS
 Head-to-toe evaluation
 GCS
 X-rays

8. Immobilization
 Splinting is the most common procedure
for immobilizing an injury.
 Why DoWe Splint?
 To decrease pain
 Actually treat the injury

9.  Soft materials: Splinting using a towel, in
which the towel is rolled up and wrapped
around the limb, then tied in place
 Towels, blankets, or pillows,
 Rigid materials. A board, metal strip, folded
magazine or newspaper, or other rigid item.

10. Guidelines for Splinting
 Support the injured area.
 Splint injury in the position that you find it.
 Don’t try to realign bones.
 Check for color, warmth, and sensation.
 Immobilize above and below the injury.

13. MANAGMENT
DEFINITIVE FIXATION

14. MEDICAL /SURGICAL
MANAGEMENT OF FRACTURES
 Reduction
Reduction of a fracture (“setting” the bone)
refers to restoration of the fracture
fragments to anatomic alignment and
rotation.

15.  OPEN REDUCTION
It’s a surgical approach, the fracture
fragments are exposed and reduced.
 Eg., by External/Internal fixation devices
(metallic pins, wires, screws, plates, nails, or
rods) may be used to hold the bone fragments
in position until solid bone healing occurs.

16. INTERNAL FIXATION

18. EXTERNAL FIXATION

21. CLOSED REDUCTION
 closed reduction is accomplished by bringing the
bone fragments into apposition (ie, placing the
ends in contact) through manipulation and
manual traction.
 Extremity is held in the desired position while the
physician applies a cast, splint, or other device
 X - rays are obtained to verify that the bone
fragments are correctly aligned.
 Traction (skin or skeletal) may be used to
effect fracture reduction and immobilization

23. TRACTION
Traction is the use of weights, ropes and
pulleys to apply force to tissues
surrounding a broken bone.
 Skin traction-
 Bucks traction used for knee, hip bone fracture
 Weight usually 5-7 pounds attach to skin
 Skeletal traction –
 Needs invasive procedure
 Weight is upto 10 kg attached to bone

25. THANK YOU