Orthopaedic Injuries

ORTHOPAEDIC INJURIES

DISLOCATION OF THE HIP

 USUALLY POSTERIOR

 PRESENTS WITH LEG FLEXED, ADDUCTED AND SHORTENED

 FEMORAL HEAD MAYBE PALPABLE IN THE BUTTOCK

TREATMENT

 REDUCTION

 SKIN TRACTION TO ALLOW CAPSULE TO HEAL

 PROTECTED WEIGHT BEARING FRACTURE DISLOCATION OF THE HIP

NORMAL ACETABULUM HAS A STRONG ROOF

 ILIO PUBIC COLUMN (ANTERIOR)  ILIO ISCHIAL COLUMN (POSTERIOR)

ACETABULAR FRACTURES ARE CLASSIFIED IN 4 GROUPS

JUDET FRACTURE GROUPS

1 FRACTURE OF THE POSTERIOR RIM 2 FRACTURE OF THE ILIO ISCHIAL COLUMN 3 TRANSVERSE FRACTURE 4 FRACTURE OF THE ILIO – PUBIC COLUMN

IN EACH CASE THE FEMORAL HEAD TENDS TO DISLOCATE

TREATMENT

 INTERNAL FIXATION - DISPLACED  TRACTION EITHER LONG TERM OR PRIOR TO DEFINITIVE SURGERY FRACTURE OF THE FEMORAL NECK

 SURGERY  SKIN TRACTION TO RELIEVE MUSCLE SPASM MAY BE APPROPRIATE

PERI-PROSTHETIC FRACTURES

 SURGERY  TRACTION –LONG TERM UNTIL CALLUS FORMS  CHECK X-RAYS TO MONITOR PROGRESS  PROTECTED WEIGHT BEARING FRACTURES OF THE FEMORAL SHAFT

 COMMON IN ALL AGE GROUPS  CAN OCCUR AT VARIOUS LEVELS OF THE SHAFT  OFTEN COMPOUND AND ASSOCIATED WITH OTHER INJURIES  BLOOD REPLACEMENT OFTEN NECESSARY

TREATMENT

 AIM IS TO RESTORE LENGTH AND ALIGNMENT, ENCOURAGE EARLY UNION AND REHABILITATION

 FIXED TRACTION – THOMAS SPLINT BEFORE SURGERY

 INTERNAL FIXATION – INTER – MEDULLARY (IM) NAILING (ALLOWS EARLY MOBLISATION USUALLY TOUCH WEIGHT BEARING (TWB) INITIALLY THEN FULL WEIGHT BEARING (FWB)

 EXTERNAL FIXATION FRACTURES OF THE LOWER SHAFT AND SUPRA – CONDYLAR FRACTURES

 MOST COMMON IN THE ELDERLY  MORE DIFFICULT TO MANAGE (THE LOWER THE FRACTURE THE MORE THE FRAGMENT TENDS TO BE PULLED OUT OF ALIGNMENT)

TREATMENT

 FIXED TRACTION – THOMAS SPLINT PRIOR TO DEFINITIVGE SURGERY OR LONG TERM

 INTERNAL FIXATION – NAIL, SCREWS, PLATE (OSTEOPOROTIC BONE IN THE ELDERLY CAN MAKE THIS DIFFICULT)

 PROTECTED WEIGHT BEARING GIRDLESTONE’S ARTHROPLASTY

 EXCISION AT THE HEAD AND NECK OF FEMUR  FIBROUS TISSUE FORMS IN THE GAP BETWEEN THE ACETABULUM AND THE TROCHANTERS

 ALLOWS MOVEMENT  PAIN FREE  RESULTANT SHORTENING

TREATMENT

 TRACTION POST SURGERY SKIN/SKELETAL