0rtho and Trauma introduction traumatilogy

Trauma

1. ORTHOPAEDIC AND TRAUMATOLOGY
Greek words:-
Ortho–straight & Paedics-child
The art of correcting and preventing
deformities in children.
Traumatology-deals with fracture and its
treatment

2. ANATOMY OF BONE
BONE
Lamellar Woven
Cortical Cancellous Pathologic Immature
(femoral shaft) (distal femoral metaphysis) (osteogenic sarcoma) (embronic
skeleton, fracture
callus)

3. ANATOMY OF BONE
Bone Cells:-
1) Osteoblast –form bone
2) Osteocytes –maintain bone
3) Osteoclasts –resorb bone
4) Osteoprogenitorcells –become osteoblasts
5) Linningcells –narrow flattened cells that form
envelop around
bone
Types of Bones:-
Long bones –femur
Short bones –phalanx
Flat bones –skull, scapula
Irregular bones –pelvic
Sesamoid bones -patella

4. ANATOMY OF BONE
Composition of Bones:-
1)Organic components–40% of dry weight of bone
a) collagen
b) proteoglycans
c) matrix proteins
d) growth factors and cytokines
2)Inorganic (mineral) components–60% of the dry
weight of
bone
a) calcium hydroxyapatite
b) osteocalciumphosphate

5. ANATOMY OF BONE
General Structure of Bones:-
* Epiphysis
* Growth plate (Physis)
* Metaphysis
* Diaphysis
Bone Circulation:-
1) Nutrient artery system
2) Metaphyseal-epiphyseal system
3) Periosteal system

6. Function of Bone:-
* Support to the body
* Protect vital’sorgan
* Movement
* Haemopoiesis
* Mineral storage

7. JOINTS
Joints exists where two or more skeletal components-
whether bone or cartilage come together to meet.
CLASSIFICATION OF JOINTS:-
A. Synarthosis or fibrous joint-
a) Syndesmosis:
characterized by a dense fibrous membrane that binds the
articular bone surfaces very closely and tightly to each other.
e.g distal tibiofibular joint
b) Sutures:
the adjoining bone margins are united into rigid, jagged
interlocking processes. e.g sagittal suture of the skull
c) Gomphosis:
conical peg or projection that fits into a socket. e.g. teeth

8. B. Amphorthosis or cartilaginous joints:
are slightly movable joints with either hyaline or fibro cartilage
in between.
a) Symphysis-
fibro cartilage is interposed in between and usually
found in the midline of the body. e.g pubic
symphysis
b) Synchondroses-
hyaline cartilage is posed in between. e.g
articulation between rib and sternum
C. Diarthosis or synovial joints:
have between the bones, a synovial or joint cavity

9. 1) Uniaxial:
permit movement in one plane and one axis.
a) Hinge joint-
movement take place around a horizontal axis. e.g
elbow joint
b) Pivot joints-
movement take place around a vertical axis which
permits rotation. e.gatlantoaxial joint.
2) Biaxial joints:
movement occurs in two planes and two axis that are at right
angle to each other.
a) Saddle joint-
articular surface is concave in one direction and
convex in the other while the articular surface of
opposing bone is exactly the opposite. e.g
carpometacarpal joint at the base of the thumb
b) Condyloid joint-
an oval condyle fits into an elliptic socket or cavity. e.g
radiocarpal joints.

10. 2) Multiaxial joints-
are two or more axial of rotation and movement take
place in three or more planes.
a) Ball and socket joint-
a ball-shaped head of one fits into a concave
socket of another bone. e.g shoulder, hip joint
b) Gliding joints-
are numerous and gliding movements occur
in all planes. e.g joint between the carpal and
tarsal bones and all the joints between the
articular processes of the vertebrae

11. GENERAL PRINCIPLES OF FRACTURES AND
DISLOCATION
Fracture:-
A fracture is a break in the structural
continuity of bone.
Fracture results from:-
1) single traumatic incident (e.g R.T.A)
2) repetitive stress
3) trivial / abnormal weaking of the bone
( e.g pathological fractures)

12. TYPES OF FRACTURE:-
A.1)Simple or closed fracture:-the fracture is not exposed to
the external environment. The soft tissue injury ranges
from minor to massive.
2) Compound or open fracture:-the fracture is exposed to
the external environment. The amount of soft tissue
destruction is related to the level of energy impaired to
the limb during the traumatic episode.
B.BASED ON THE EXTENT OF FRACTURE LINE: -
1) Incomplete fracture:-involves only one surface or cortex of
the bone.
2) Complete:-involves the entire bone.
a) Displaced
b) Undisplaced

13. C.BASED ON FRACTURE PATTERNS: -
a)Transverse –tension
b) Oblique –compression
c) Spiral –twisting
d) Triangular ‘butterfly fragment’ –bending
e) Comminuted
f) Segmental
*ATYPICAL FRACTURES:-
a) Stress or fatigue fracture
b) Impacted fracture
c) Hairline fracture
d) Greenstick fracture
e) Pathological fracture
f) Torus fracture

14. TYPES OF FRACTURE

15. DISLOCATION:-
Dislocation is defined as a total loss of contact
between the two ends of bones (at least part of supporting
joint capsule and some of its ligament are disrupted)
TYPES OF DISLOCATION:-
A. Congenital–CDH
B. Acquired –
a) Traumatic
b) Pathological
c) Infective
d) Paralytic
e) Inflammatory
SUBLUXATION:-
Subluxation is defined as partial loss of contact
between the two ends of the bones.

16. HIP DISLOCATION

17. APPROACH TO INJURIED PATIENTS
* History
* Age/sex
* Mechanism of Injury
CLINICAL FEATURES
Patient complain- Sign-
. Pain .swelling
. Swelling .tenderness
. Deformity .deformity
. Inability .crepitus
.abnormal mobility
.shortening
.loss of transmitted movements

18. LOOK–FEEL–MOVE
1) examine the most obviously injured part.
2) test for nerve and artery damage.
3) look for associated injuries in the regions.
4) look for associated injuries in distant parts.

19. INVESTIGATION
# X –Ray
# Radioisotope scanning
# CT
# MRI

20. X-RAY

21. MANAGEMENTS OF FRACTURES
A. Conservative B. Operative
1) for undisplaced/impactedOpen reduction and fixation
& incomplete fractures
a) cuff/collar slinga) kirschner wire
b) strapping b) plate and screws
c) plaster slabs c) intramedullary nails
d) continuous traction d) hip implants
e) rest and NSAIDS e) spine implants
f) external fixator (lizarov)
2) for displaced fractures
closed or open reduction

22. SPLINTS
Splints:-
Any material which is used to support a fracture is called a splint.
e. g -Wood Plaster of Paris splint
Book Thomas splint
Newspaper Bohler-Braun splint
Plaster of Paris an ideal splint:-
.cheap .strong and light
.comfortable .quick setting
.easily available .easy to remove
.easy to mould .permeable to radiography
.noninflammable
.permeable to air and hence underlying skin can breath

23. Thomas splint:-
described by HO Thomas in 1876 to assist for
ambulatory treatment of TB knee.
# Uses of Thomas Splint :-
* to immobilize fracture femur anywhere
* easy transportation of an injured patient
* first aid measure
* treatment of joint disease like TB knee
Bohler –Braun splint:-
* shaft / supracondular fracture of femur
* fracture shaft of tibia
* trochanteric fracture of femur
Types of Traction:-
1. skin traction
2. skeletal traction

24. TRACTIONS

25. CLOSE REDUCTION AND PLASTER

26. INDICATION FOR OPERATION:-
# Absolute Indication:-
. Failed closed reduction
. Displaced intra-articular fractures
. Major avulsion fracture
. Type iii and iv epiphyseal injuries
. Non union
. Replantation of extremities
# Relative Indication:-
. Multiple fractures
. Lose of reduction
. Delayed union
. Pathological fractures
. Early mobilization
. Fractures of necessities