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General principles of fractures treatment Klinika Ortopedii i Traumatologii PAM Management of major injuries Emergency treatment at the scene of the accident and during transport to the hospital Resuscitation and the evaluation in the accident department Early treatment of visceral injuries and cardiorespiratory complication Provisional fixation followed by definitive treatment of musculoskeletal injuries Long term rehabilitation Individual patient Obtain access Establish an airway but protect the cervical spine Ensure ventilation Arrest haemorrhage and combat shock Give analgesia Splint fractures Transport Examination Pulse feeling Measure capillary return Observe the respiration Palpate the head, chest, abdomen, and limbs Second mortality peak Death from hypoxia or hypovolaemic shock At risk of further damage to cervical spine, thoracolumbar, brain The golden rule (effective resuscitation) Advanced Trauma Life Support Programme Primary survey A – Airway maintenance B – Breathing and oxygenation C – Circulation and control of bleeding D - Disability E – Exposure and aviodenance of hypothermia Disability Blood loss Chest injuries Tension pneumothorax Sucking chest wounds Flail chest Cardiac tamponade Massive haemothorax Complication of major trauma Tetanus ARDS Fat embolism syndrome DIC Crush syndrome MSOF - prevention How fractures happen A single traumatic incident Repetitive stress Abnormal weakening of the bone Mechanism of injury Spiral (twisting) Short oblique Bending - Triangular ‘butterfly’ fragment Transverse Principles of treatment Anatomical reduction Stable internal fixation Preservation of blood supply Early mobilization Implants types Pin and wire fixation Screw fixation Plate and screw fixation Intramedullary nail fixation External fixation Fractures healing Primary Secondary Haematoma Inflammation Callus Consolidation Remodelling Fractures healing Open fractures Classification Open fractures Wound debridement Antibiotic prophylaxis Stabilization of the fracture Early wound cover Complications of fractures Late Early - visceral injury - vascular injury - nerve injury - compartment syndrome - haemarthrosis - infection - gas gangrene - fracture blisters - plaster and pressure sores - delayed union - non-union - avascular necrosis - bed sores - myositis ossificans - tendon lesion - nerve compression - muscle contracture - joint instability - joint stiffness - algodystrophy RSD - osteoarthritis Compartment syndrome Pain Paraesthesia Pallor Paralysis Pulslesness Volkmann’s ischaemia Non-union
