Download Orthopaedic Emergencies

17th May 2012
Dr Liling Patterson
Surgical HMO
Orthopaedic Emergencies
 Open (Compound) Fractures
 Compartment Syndrome
 Dislocation
 Septic Arthritis
Compound Fractures
 Wound infection
 Osteomyelitis
 Gas gangrene
 Tetanus
 Non-union
Wound Classification
Gustilo-Anderson Classification:
 Type I – clean wound, < 1cm, no skin crushing
 Type II – wound > 1 cm, moderate soft tissue injury
 Type III – extensive soft tissue injury
Management
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Fluid resuscitation
Control haemorrhage
Analgesia
Irrigation
Dressing, splint
Antibiotics, tetanus prophylaxis
Surgical debridement & fixation
“Six Hour Golden Rule”
Compartment Syndrome
 Limb threatening
 Increased pressure in tight fascial compartment
 Muscle necrosis at > 30mm Hg
 Ischemic injury at 4 hrs
 Irreversible injury 4-8 hrs
 Signs: disproportionate pain, 5 P’s
o
o
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Pain
Pallor
Paraesthesiae
Paralysis
Pulseless
Causes of Compartment Sx
 Fractures ~75%
 Crush injury
 Burns
 Extravasation
 Tourniquets, constrictive dressings/plasters
 Snake bites
Management
 Early recognition!
 Urgent fasciotomies
Dislocations
 When bones at a joint become displaced or misaligned
 Neurovascular compromise
 Main principle of Mx – reduce it!
Knee Dislocation
 Popliteal artery (20-30%)
 Peroneal nerve (up to 25%)
 PCL/ACL
Septic Arthritis
 Infection within joint space
 Usually bacterial
o Staph aureus
o Streptococcus
o Neisseria gonorrhoeae
 Signs: fever, NWB, raised WCC/CRP
 Prosthetic joints – delayed presentation
Management
 Diagnosis by aspiration -> Gram stain, culture
 iv Abx
 Analgesia
 Washout